Birthing Beautiful Ideas

Attending the NIH Consensus Development Conference on VBAC has been more enthralling than I could have ever hoped, and here’s why: instead of hearing hours upon hours of what I expected today (i.e. exaggerated accounts of the relative risks of VBACs and benefits of repeat cesarean section), I heard this:

Women’s choices matter.

Whether it was Dr. Caroline Signore clearly implying that women should be the ones to determine what is and isn’t an acceptable risk level for VBAC or repeat cesarean section (RCS), or Dr. Kimberly Gregory acknowledging the importance of psychosocial factors and their relevance to a woman’s risk evaluation, or Dr. William Grobman describing a model to help predict individual VBAC success rates so that women can make more well-informed birth decisions, or simply every speakers’ claim that evidence-based policies and practices and informed consent and refusal are central to any discussion of VBAC, women’s rights and autonomy were respected and represented in the discussions today.

But can they be respected and represented in the panel’s consensus statement?

And such a statement actually affect the policies and practices of maternity care providers in the United States?

This all remains to be seen, but I for one am happy now just to bask in the glow of knowing that the charge to the panel–a panel who will very likely have a profound effect on my and others’ birthing futures–was one that recognized my right and responsibility to evaluate the risks and benefits of VBAC and RCS and to autonomously choose the way I bring my child into the world.

(Remember, you can keep up with the live webcast of the conference at http://videocast.nih.gov.)

I have arrived in Bethesda, Maryland for the NIH Consensus Development Conference on VBAC!

My arrival here means so much more to me than just crossing off one of the items on my “things I want to do before I turn 30” list.  (But that does mean a lot.  I’m a lover of to-do lists and an even bigger lover of crossing things off those lists.)

This is the first time that I’ve ever represented my beliefs and my passions on a national level.

Simply by sitting in on the conference, I hope that my presence–and the presence of the other VBACtivists here–represents my beliefs that:

• Unnecessary c-sections (including coerced and/or non-necessary repeat cesareans) put women at unnecessary risk in future pregnancies and births.
• Reducing the primary c-section rate is a crucial component of fighting for VBAC rights.
• VBAC is an absolutely defensible right (and a human right, as The Feminist Breeder so eloquently points out).
• Women deserve accurate and transparent information about their birth choices, especially when it comes to the information they receive from their care providers.
• Women deserve un-exaggerated information about the relative risks and benefits of VBAC and repeat cesarean–they don’t deserve scare tactics.
• All women have a fundamental right to bodily integrity and autonomy when it comes to the birth of their children.
• All women deserve evidence-based maternity care.
• All women deserve respectful maternity care.
• And women’s stories and experiences are exceedingly important when it comes to evaluating practices, guidelines, and policies regarding vaginal birth after cesarean.

And on that note, I have your stories–I have our stories–and I’m taking them with me to the conference.  I will do my damndest to share those stories and their spirit with the other conference attendees, whether during discussion sessions, one-on-one conversations with conference participants, or even during The Feminist Breeder’s VBACtivist luncheon.

The NIH Consensus Development Conference on VBAC is fast approaching.

This is an exceedingly important event not just for birth and VBAC activists but also for all women who currently have, are having, or plan to have children.

For while the NIH Consensus Development Program in general does not intend to issue legal documents, policy statements, or practice guidelines in its consensus statements (or the general findings and recommendations drafted at the end of each conference), these statements often do affect medical policies and practices.

In other words, the statement that comes out of this conference might very well have a profound effect on policies, practices, availability, and attitudes toward VBAC in the future.

This is enormously important, not only for women’s reproductive health but also for women’s rights, bodily integrity, and autonomy.

It’s important for anyone who ever has or ever plans to give birth.

And it’s especially important for those of us who have cesarean scars on our uterus.

This VBACtivist is currently packing her bags and getting ready to head out to Bethesda tomorrow for the conference!  But for those of you who cannot attend yet want to participate in or even just be aware of the conference proceedings as they happen, there are loads of ways that you can do so from work and from home:

Watch the Live and/or Archived Webcasts

You can find the live webcast on the NIH website at: http://videocast.nih.gov.  (If you cannot view the proceedings live, the NIH will post the archived webcasts at http://videocast.nih.gov approximately one week after the conference.)

The NIH does recommend that you sign up for the webcast ahead of time so that they can ensure adequate capacity for all those interested in viewing the proceedings.

If you plan to watch live, the conference dates and times are as follows:

• Monday, March 8 from 8:30 a.m. – 5:00 p.m. EST
• Tuesday, March 9 from 8:30 a.m. – 11:30 a.m. EST
• Wednesday, March 10 from 9:00 a.m. – 11:00 a.m. EST

Follow VBACtivists on Twitter

Some the conference attendees and viewers plan to take to Twitter (perhaps even via “live-tweeting”) in order to post  updates on the conference proceedings.  If you’d like to follow the proceedings on Twitter, you can follow the #NIHVBAC hashtag or the NIH’s own Twitter account, @nihconsensus.

Other VBACtivist “tweeters” include:

@kristen_bbi (me)

@Feminist Breeder

@Preparing4birth

@ICANtweets

@Pushformidwives

@midwifeamy

@BirthBabiesBlog  (Danielle will also be live-blogging the conference!)

(If you’d like your name to be added to this list, please let me know!)

Access the Panel’s Draft Consensus Statement

The conference panel will present their draft consensus statement on Wednesday, March 9.  (They will release their final statement approximately six weeks after the conference.)

You do not need to be present at the conference in order to access this statement as it is released!  (Although if you are in the area, you can go to the Natcher Conference Center on the main NIH campus in Bethesda, Maryland on Wednesday, March 10 at 9:00 a.m. EST in order to see the live presentation.)

You can also watch the statement presentation live via webcast at http://videocast.nih.gov.

And if you can’t watch the live presentation, you can sign up to receive an email when the final statements are available online, or you can even sign up to receive a final copy of the statement in the mail.

You can also look for the panel’s draft statement later that on Wednesday, March 9 on the NIH website at http://consensus.nih.gov.

Participate in the Press Telebriefing

After the panel presents their statement, and after the public has been given the chance to weigh in on the statement, the panel will hold a press telebriefing at 2:00 p.m. EST on Wednesday, March 9.  This telebriefing is available via telephone conference call only, but you do not need to pre-register in order to participate in the telebriefing.

To dial into the telebriefing, please call 1-888-428-7458 (within the US) or 201-604-5177 (international).

If you are a member of the media, you can also register for the press telebriefing in order to receive relevant media materials before the telebriefing.  You can find pre-registration materials and other media resources here: http://consensus.nih.gov/2010/vbacmedia.htm.

While non-media members are not permitted to ask questions during the telebriefing, they can still call in to listen to the draft consensus statement. The NIH recommends that you call five to ten minutes before the telebriefing begins.

Keep Sending Me Your Stories

I’m planning to take your voices to the conference–especially your stories of lies, misinformation, and scare tactics regarding VBAC.  If you haven’t shared your story here yet, please do!

Continue Reading Birthing Beautiful Ideas

I will be blogging every afternoon and/or evening following each day’s events, so stay tuned to see my updates on the conference.  I’m hoping to come back with lots of positive reports!

In anticipation of next week’s NIH Consensus Development Conference on VBAC, and in response to ICAN’s first blog carnival, many birth advocates, birth professionals, mothers, and general supporters of VBAC are taking to their keyboards this week to write in defense of the vitality (and viability) of VBAC.

I, for one, believe that VBAC is a vital option.

I believe this passionately, and I’ve written about it extensively.

But instead of examining and defending why VBAC is a vital option, I’d instead like to address those who deny that VBAC is a vital option–especially those whose decision effectively prevents women from having VBAC as one of their birthing options.

More specifically, I think that care providers who deny women the opportunity to have a VBAC–whether because of medical philosophy, malpractice insurance policies, hospital guidelines, or even personal preference–should be under some sort of real (even regulatory) pressure to limit the number of primary cesareans that they perform.

If they do not want to or are ill-equipped to offer the relatively safe (and, yes, vital) option of VBAC, then they should take painstaking care to limit–and even eliminate–the number of unnecessary scars they put on first-time birthers.

And I think that they need some good old fashioned “motivating” incentives to make these sorts of changes.

And that’s because I’m not sure that the evidence supporting the relative safety of VBAC–and all of the eloquent and persuasive arguments based on that evidence–is enough to convince care providers to change their opinions of and practices regarding VBAC.

As much as medical professionals and others may disagree with me, it seems that the history of VBAC in the United States (and potentially elsewhere) is largely  a history of shifting opinions based primarily on financial and medico-legal concerns and pressures, and secondarily on evidence-based medicine and the rights and autonomy of women.  For like most human beings, it is the tangible incentives that change hearts and minds–not the intangible, philosophical ones.

(Case in point: was it overwhelming evidence or insurance incentives to reduce maternity costs that contributed to the increase in VBACs in the early to mid-90s?  And was it overwhelming evidence or malpractice insurance policies and lots of [induction-related] uterine rupture lawsuits in the late-90s that led to the sharp decrease in VBACs at the end of the 90s and up to today?)

It’s sad.  Disappointing.  Even atrocious in some cases.

And this doesn’t mean that VBACtivists (and birth advocates in general) should give up fighting vehemently in support of a woman’s right to bodily autonomy and integrity when it comes to the birth of her child(ren).  It doesn’t even mean that we should give up writing eloquently phrased, persuasive, and evidence-based arguments in support of VBAC!

But it does mean that VBAC advocates might want to consider (or continue considering) the following questions and concerns when discussing and formulating VBAC policy:

• If a care provider refuses to attend VBACs–or if a hospital refuses to allow VBACs–shouldn’t they be expected to maintain an especially (yet safely) low primary cesarean rate?  (And I mean “expectation” in the most concrete sort of way–with standards, incentives, repercussions, investigations, etc.)  The “problem” or “issue” of VBAC is not as much of a problem or issue if fewer women have scars on their uteri.
• Who can, or should (or even would) create such standards of care? ACOG?  The AMA?  Insurance companies?  Hospitals?  (The issue becomes increasingly complex, however, when one considers the financial benefits that many hospitals reap from higher c-section rates.  This, of course, might give them an implicit incentive not to pressure doctors to decrease the c-section rate.)
• Instead of denying coverage to women with prior cesarean sections, why don’t insurance companies raise premiums for OB/GYNs with inordinately high c-section rates?  C-sections cost thousands more than most vaginal deliveries, and lowering the c-section rate (and, correlatively, increasing the VBAC rate) would thus save a substantial amount of money each year on maternity costs.
• Can consumer groups advocate for these sorts of insurance practices?  Does media attention (on the increasing risks and costs of repeat cesareans, for instance) ever affect the way that insurance companies operate?  (Am I hoping for the impossible here?)
• (This is my bottom-of-the-barrel thought.)  Many care providers cite the fear of a lawsuit as one of their reasons for refusing to attend VBACs.  This is not entirely unreasonable, especially given those law firms devoted to  seeking out uterine rupture cases indiscriminately.  But…has any woman who has 1) been explicitly denied a VBAC (against her wishes) yet 2) lost her uterus (or, devastatingly, her life) as the result of placenta accreta (one of the risks associated with repeat cesareans) ever sued her care provider, partly on the basis of the denied VBAC?  (Put more flippantly–seriously, does it have to come down to a slew of placenta accreta lawsuits before care providers start changing their tune about VBAC?!)

What do you think?

Is the VBAC-supporting evidence enough to change hearts and minds?

Or do we need some of these (and other) incentives to convince care providers in the United States and elsewhere that VBAC is a vital option?

We’re on our way out of winter!  Hurrah!

(Two Three quick thoughts.  1) I realize that “we” have no sense of agency when it comes to the comings and goings of seasons, so we’re not really “on our way” our of winter.  Mother Nature does what she pleases–and “she” probably doesn’t really have any agency either.  But I like to think of myself marching triumphantly out of winter once March rolls around, just so that I can bury the worrisome thought that we in Ohio very well could get–and have gotten in years past–a sixteen-inch snowstorm in the middle of April. 2) I also realize that I may be engaged in some perversely wishful thinking by claiming that “we” Midwesterners are on the way out of winter when it’s only the beginning of March.  March is not a consistently “spring month” here in Ohio, despite what I was taught in elementary school.  BUT there are daffodils poking through the snow!  There are fa-reakin’ BIRDS tweeting outside of my bedroom window in the morning!  I THINK THEY KNOW SOMETHING WE DON’T!  And if they’re just messing with me, then they can join hands with the lopsided snowman in my yard and kiss my vitamin-D deficient ass.  3) I love winter, I really, truly do, but the distinctly-Ohio grey and the ice-snow and the people who don’t know how to drive in said snow really get me down after a few months.  And yes, I would whine like an over-tired three-year-old if I had to withstand an Alaska winter.)

Where was I again?

Oh yeah, we’re on our way out of winter.

And since winter is almost over (right daffodils and birds?), I thought I’d reflect upon the winters I’ve experienced in all of the places I’ve lived and revisit the whines that I’ve whined about those winters.

It sounds like an entralling post, I know.  And perhaps my eyes are gazing so far up my navel now that I’m fooling myself into thinking that spring is on the horizon.  Whatever.

Syracuse, NY

You might think that my five winters in Upstate New York were my top five whiniest winters of all times.

I mean, Syracuse is a regular winner of the Golden Snowball, for godssakes!  (Why yes, cities in Central and Upstate New York do have a contest to see who gets the most snowfall each year.  THEY EVEN AWARD TROPHIES TO THE WINNING CITY!)

But living in a city that averaged well over 100 inches of snow each year really didn’t bother me all that terribly, and here’s why:

1) The good people of Syracuse know how to plow a road.

And 2) the good people of Syracuse know how to drive in the snow.

There’s nothing like a bunch of folks who don’t know how to drive in winter weather to send the whole season down the toilet (see below), and that’s primarily because these people make me want to stay off the road in the winter, thereby forcing me to be housebound from November until March (or October until April if you’re thinking of a Syracuse winter).

But with well-plowed streets and generally good snow-drivers, Syracuse winters were relatively pleasant (as far as snowy and grey winters go).  And the snow was really, really beautiful and tranquil too.  It’s “movie snow,” if you know what I mean.

Dayton and Columbus, OH

I grew up in Dayton, and I currently live in Columbus, and from what I remember, we have gotten snowfall every single year in these parts of the country.

BUT YOU WOULDN’T KNOW THAT GIVEN THE WAY PEOPLE DRIVE IN THE SNOW!

Good freakin’ lord, people!  It’s SNOW!  You know, in OHIO!  Where we GET SNOW!

And I know that Ohio gets a lot of ice, which make the roads impossibly treacherous (and which also makes a two-inch snow and ice-fall in Ohio eons worse than a sixteen-inch snowstorm in Syracuse).  But drivers here seem to act as if a SNOWPOCALYPSE is coming anytime the weatherperson promises a flurry, and then in their panic, they drive like my four-year-old racing his big wheel on an ice rink.

So to the people of Ohio, I implore you to calm down, slow down (or speed up, especially if you’re going 10 mph on the highway and there’s only a handful of flurries in the air), and get used to the fact that OHIO GETS SNOW, FOR CRYIN’ OUT LOUD!

Chicago, IL

I loved living in Chicago.  It is unquestionably my favorite city on the planet.  I miss it the way one misses an old friend.

But the one winter I spent in Chicago was unquestionably the hardest winter I’ve ever endured, and it had nothing to do with snow.  (If I recall correctly, we only got one snowfall that amounted to much of anything that year.)

It had everything to do with that godforsaken cold and wind.

Ohmygod, the wind.

Have you ever walked through the Loop, alongside the river, with the wind whipping at, like 1000 mph while the temperature outside is barely in the single digits?  IT SUUUUUUCCCCKKKKS!  (Or–heh heh–it blows.)

I feel quite confident in saying that although I love Chicago with all of my heart, I would take the 150 inches of Syracuse snow or the bad drivers of Ohio ANY DAY over even one day of the Chicago winter wind.

(And I will take no more days of below-freezing weather and that horrible, depressing midwestern grey, thank you very much.)

As of today, Tim has been working full days for forty days straight.

That’s right, forty.

Four-teeeeeee.

And you know what that means?

I’ve been responsible for full-time, daytime parenting duties for (yep) forty days straight.

Because of circumstances far beyond my control, I have not had one parenting break, not a semblance of the ebb and flow of our usual co-parenting arrangements, not one guarantee of a “day off” in the entirety of those forty days.

(For those who haven’t yet felt the magnitude of my whining, that’s the same number of days that Noah and his wild menagerie spent on that ark of theirs.  And to that I ask, “Where the hell is my dove carrying the olive branch already???”)

Just give me some intravenous vodka now.

It’s not that I don’t love spending time with my kids.

It’s not that I don’t get any time to do meaningful work of my own.

It’s not even that I haven’t devised games and outings and activities and playdates to mitigate the drudgery of forty break-less days of stay-at-home parenting.

It’s just that…I’m used to doing this whole parenting gig as a co-parent, and when my co-parent is MIA, I begin to feel as if I’m drowning a bit.

I perceive each whine more piercingly, each missed or refused nap with excessive dread, each second that Tim’s arrival home is delayed with increasing panic or frustration or even despair.

My toddler crushes a handful of Goldfish crackers in his hands, sprinkles the crumbs on the just-swept floor, and I feel as if he has smooshed my brain like a hunk of Playdoh between his fingers.

And yet I sit here, with a roof over my head, a heater that works reliably in this reliably cold winter, a refrigerator stocked with nutritious food, an income that allows me to purchase nutritious food, a car that I can drive to purchase that food, at-home access to the internet, an education that gives me the privilege-that-should-be-a-right of demanding transparent and evidence-based care from my health care providers, two children who are healthy and (for the most part) delightful, a partner who is respectful and loving and kind, a marriage that I enjoy, a family who loves me unconditionally, friends who support me unbelievably…

…AND A SET OF IN-LAWS WHO ARE GRACIOUSLY WELCOMING MY CHILDREN AND ME INTO THEIR CHICAGOLAND HOME STARTING TOMORROW SO THAT I CAN GET A MUCH-NEEDED WEEK OF PARENTING BREAKS!

(They’re also coming back with us to Ohio the following week so that they can watch the kids while I attend the NIH VBAC Consensus Development Conference in Bethesda, Maryland!)

I know.  I’m exceedingly, undeservedly lucky.

And if I just think about that luck for a moment, just let it seep into my perspective on my life right now, it makes my whining about these forty days seem petty, even childish.

It makes those crushed crackers seem less like an evil toddler’s brain-squish and more like what they really were:

“Oooooh, Mommy, these crackers feel so silly and funny and strange in my little hands!  Look, just look at them!  Look at me play!  Just look at how happy I am, doing something so silly and funny and strange!  And aren’t you so lucky to be so silly and funny and strange with me?!”

Yes, I know.

I’m exceedingly, undeservedly lucky.

K and J, just a couple hours away from welcoming baby Annie.

I had the opportunity–and the honor–to work with this couple while they brought their third baby into the world.  I took this photograph after witnessing this moment of profound and immense love between K and J–all while K was riding out pitocin-contractions on the birth ball!  With their permission, I’ve included it here.

I think we need to see more positive images of labor.  Not just ones where women are screaming furiously at their partners, but ones where the love between a woman and her partner, or her friend, or her mother, or her sister becomes deeper, and more profound, and more immense.

Anyone who has read my VBAC story might remember that my VBAC itself occurred after I switched care providers at nearly 37 weeks into my pregnancy.

Obviously, this is not something that one does “on a whim.”

It’s hard to do anything on a whim when you have an eight-pound person tucked inside your midsection!

And so my decision to seek a new care provider in the last four weeks of my pregnancy was not a “whim” decision but was instead a decision informed by my own careful (yet harried) reflection and research.

And it was a decision I made in reponse to the blatant misinformation about VBAC and repeat cesarean that my original OB/GYN had given me in an attempt to “talk me into” an (unnecessary) repeat cesarean.

So in the the spirit of my request for your stories about the lies, misinformation, and/or miscommunication you’ve experienced when it comes to VBAC, I’m going to share my own story of “Very Bad At Communication” here:

It all started when my obstetrician informed me that he “needed” to do an ultrasound at my 36 week appointment so that he could measure my lower uterine segment.  As he told me, if my lower uterine segment (LUS) was “too thin,” we would need to schedule a repeat cesarean.  If it was not “too thin,” then I could “attempt a trial of labor.”

(For what it’s worth, I’ve found that care providers who use phrases like “attempting a trial of labor” tend not to demonstrate much confidence in vaginal birth after cesarean.)

The warning bells started blaring in my head when he told me that, “You know, just last week, a mom came in here, and we measured her LUS, and it was too thin for a VBAC.  She’s gonna have to do a c-section.”

Why did he share that information with me?

I’m guessing it was his own way of telling me not to get my hopes up (because he was going to shatter them no matter what the ultrasound showed?).

And then I had the ultrasound.

The sonographer determined that my LUS was measuring approximately 3.7 mm thick.

And I, I who had done myVBAC research–I who had scoured PubMed for articles on VBAC, including the then-published articles on using LUS measurements to predict uterine rupture–celebrated for a brief moment, because most studies on this topic recommended anywhere from 1.5 mm – 3.5 mm as a “safe cut off point” for attempting a VBAC.

Even if those studies were flawed in some ways, 3.7 mm still made me safe in their eyes!

Except then my OB/GYN told me that my LUS needed to be 5 mm thick in order to safely attempt a vaginal birth.

The devastation started creeping in.  Those “warning bells” were trying to tell me something after all.  (And they had probably been ringing all throughout my pregnancy, but that’s another issue entirely.)

The sonographer noted the immediate change in my expression and attempted once more to measure my LUS, just to see if there was any one point that was 5 mm thick.

And there wasn’t.

I immediately tried to ask about the other studies I had read, but my OB/GYN interrupted me mid-question and said, “Kristen, I’m sorry, we need to schedule a repeat cesarean.”

I tried again.  “Well, what is the risk of uterine rupture with a LUS measuring less than 5 mm?”

His response?  “The risk of uterine rupture during all VBACs is 2%.”  (By the way, that’s not true.  And it didn’t answer my question.)

I tried again.  “Hmm, that seems pretty high!  And doesn’t pitocin…”

He interrupted me.  “The risk of uterine rupture during all VBACs is 2%.  Period.  And anyway, you never know if you’ll need pitocin!”

(I was trying to ask him about how pitocin affects the risk of uterine rupture.  For what it’s worth, pitocin augmentation and induction have been shown to increase the uterine rupture rate from approximately .4% to .9% and 1.1%, respectively.)

I tried again.  “Well, what are the risks of repeat cesarean as compared to VBAC?  Will having this c-section have any negative effect on my future pregnancies or births?”

His response?  “No, repeat c-sections are no big deal!  You can have as many of them as you want!  And hey!  Now you don’t have to worry about incontinence issues in the future!”

(Note: just six months prior, he had informed me about how he only recommends VBACs to women who want more than two children since third, fourth, etc. cesareans can carry so many extra risks and complications.)

I tried again, people! “But didn’t you say…”

And here’s where he threw down the gauntlet.

Well, first he turned to my husband and chuckled, “I’m really making her angry, aren’t I?”

And then he said, “Look, Kristen, we need to schedule your repeat.  Period.  There’s no more discussion.  Now, let’s see, you’re due on May 27th, I’m going to Italy at the beginning of May…how does May 20th look?”

I was stunned.  (And pisssssed!  Seriously, that patronizing crap he pulled with my husband was totally uncalled for.  And it’s what infuriated Tim the most throughout the entire “conversation.”)

But I was also searing with the hormonal rush that is the last few weeks of pregnancy.  I was on the absolute precipice of tears.  And I held myself together just long enough to mutter, “Well, we’ve got a two-year-old, so we’re gonna have to find a babysitter before we schedule anything.”

And Tim and I left that office so fast that we forgot our jackets in the waiting room.

The rest is history.

With the help of our doula, we found a new care provider.

I went on to have not only a successful VBAC but also my hospital’s first waterbirth.

And I was eternally grateful that I had made the terrifying yet empowering decision to switch to a more supportive care provider at such a late stage in my pregnancy.

(And, to his partial credit, my original OB/GYN even called me at home–and my husband on his personal cell phone–to tell me that he had “gone and done his research” and “discovered” that my LUS measurements were “alright for a trial of labor afterall.”)

But what if I hadn’t done all that research?

What if I had allowed myself to fall prey to my original OB/GYN’s non-evidence-based claims about VBAC and uterine rupture?

Should I have even been expected to have read those relatively obscure studies on LUS measurements anyway?

Thinking about the potential answers to those questions make me realize just how exceedingly important the issue of VBAC-related patient counseling is.

Some of you may know that for my 29th birthday, I created a list of 29 things I want to do before turning 30 next January.

Before this weekend, I had accomplished two of those goals.

But now, I can cross off a third from the list: I made a big heaping batch of chorizo gumbo for Tim’s birthday dinner this week.

(Do I get a medal for that?  How about an Abita?)

This particular recipe is one of my signature meals.  It’s a greatest hit, a crowd-pleaser, and a dish that I could eat over and over and over again if it didn’t take so much time, effort, and money to make it.

And it’s unique deliciousness was actually the product of a new cook’s mistake.

Because when you send a 22-year-old out into world to purchase things like “andouille sausage,” she might just think, “Oh hell, I can’t find the stupid andouille anywhere.  What about this spicy Spanish chorizo here?  It’s sausage!  It’s spicy!  It will do!”

And that spicy Spanish sausage transformed an already tasty recipe for Louisiana Seafood Gumbo into a spectacularly unique and flavorful recipe for Kristen’s Chorizo Gumbo.

Palacio's hot chorizo, celery, onions, green peppers, and garlic

I've never burned the roux. NEVER. (And that's why I couldn't take a picture until after I added the vegetables to the roux.)

Mussels. They deserve to be celebrated more often. Not just because they're delicious. But also because they look like vulvas. (YES I JUST SAID THAT!)

Simmering (homemade) fish stock

GUUUMMMMMBBBOOOO! (Say it like Oprah with me.)

Doulas and midwives often integrate aromatherapy into their work with laboring women.

Some may mix essential oils (such as lavender or peppermint oil) with vegetable oil to make a soothing and/or nausea-alleviating massage oil to rub on the mother’s back, arms, or legs.

Others may place a drop or two of lavender or rose oil into a warm bath so that a mother can relax in an aromatic tub.

Still others may mix essential oils (such as lavender, rose, or jasmine) with water in a spritz bottle and spray the mixture in the birthing room throughout the mother’s labor so that she can feel the potentially calming effects of the scents.

(Notably, it is always best if a birth attendant–whether s/he is a doula, a midwife, an aromatherapist, a massage therapist, or even an aromatherapy-loving friend–asks the mother before labor what her “aromatic likes and dislikes” are.  These likes and dislikes may even change during the course of labor!)

While all of these uses of aromatherapy during labor have the direct purpose of soothing the mother, alleviating her nausea, or even promoting better circulation and breathing, I discovered one additional benefit of aromatherapy (and of lavender oil in particular) at the most recent birth I attended:

It can provide a calming atmosphere for everyone who enters the laboring room–not just the laboring woman.

At this particular birth, the mother’s care providers (an obstetrician and a midwife) were attempting an external cephalic version (or the manual rotation of a breech baby) before the mother underwent either a cesarean section or an induction of labor, depending on the outcome of the version.

Before the version began, I massaged a lavender oil mixture onto the mother’s temples to promote relaxation and reduce any anxiety she may have had.  (We wanted her to be as relaxed as possible in order to give her the best chance of having a successful version!)

Photo by Heron

Everyone who entered the room thereafter–two obstetricians, one midwife, and one nurse–remarked not only about how nice the room smelled but also about how “soothing” it made the entire atmosphere of the room.

And let me tell you, the room where the version was performed was a triage room, with bright lights, an ultrasound machine, a traditional hospital bed, and about one-hundred square feet of space for all seven people standing in it at the time.  Simply looking at the room gave off no indication of “niceness” and calm!

But the mother remained incredibly calm and relaxed, and the version itself (and everyone who assisted with it) ended up being not only a relatively peaceful but also successful procedure!

After we moved into a labor and delivery room, I continued to use aromatherapy throughout the mother’s labor induction by soaking washcloths in a basin of ice water, to which I added a couple of drops of lavender oil.  When the more strenuous work of her labor began, I used these washcloths as cool compresses on her back, shoulders, neck, and forehead.

And while my intention was certainly and solely to provide comfort to the laboring mother with these lavender-scented washcloths, I do believe that the very aroma of the lavender played at least a partial role in providing a calming atmosphere to the entire labor room and the individuals who entered it.

With lights dimmed and the slightest scent of lavender filling the air, every person who entered the room would enter quietly and would use a low, deliberate speech when conversing with the mother, her husband, or me.  Three nurses, one obstetrician, one midwife, (and one husband and doula!) in a busy hospital, with loads of paperwork to complete and monitoring to perform, with other women birthing in adjacent rooms, surrounded by the machines that go “ping!” and IV poles and birth balls–all took note of the tranquility of the labor room, and even treated it as if it were the mother’s labor sanctuary, so to speak.

And yes, this mother was blessed with fabulous nurses who were pitch perfect for the parts of her labor for which they were present.

And yes, she was blessed with one of the few hospital-based care providers I’ve seen who evaluates a woman’s labor not by looking at the monitors or doing the umpteenth vaginal exam but by watching and listening and observing the woman engaging in the work of birth.

And yes, she was blessed with a supportive husband, who became not only an expert in the “double-hip squeeze” but also a literal and figurative “rock” as the mother held her arm around his shoulders as she birthed their baby into the world.

She was blessed with people who were respectful of her wishes for a peaceful birth!

But I also believe that the low lights and lavender helped every one of us in the room with her to take part in that peacefulness.

The scent was a signal to all who entered the room that even though this was a hospital, and even though this woman was attached to an IV pole, and even though her care providers were medically trained to attend birth, this was not a medical event.

This was a birth, in a place of peace and tranquility, in a place where peace and tranquility are so rarely found.

*I cannot stress enough that you should use caution whenever working with essential oils, especially when using or touching them in their concentrated forms.  If you are pregnant or breastfeeding, please consult an aromatherapist, doula, or midwife before using essential oils as some may be harmful to you or your baby.