Birthing Beautiful Ideas

Once upon a time, there was a little boy who asked his mommy to draw him a picture of a cow.

His mommy, who loved her little boy dearly, was more than happy to pick up a crayon and a fresh sheet of construction paper and draw for him her very best bovine creation.

Upon receiving his mother’s heartfelt gift, the little boy held the drawing at arm’s length, examined it, and stated, “Well, it sorta looks like a cow.” 

He was only two.

And, as you may have guessed, he was (and is) my son, M.

And I was (and am) the artistically-challenged mother in the story.

It should come as little-to-no-surprise, then, that after testing out my priming and painting skills in our new kitchen, I realized that it would be a very good idea if Tim and I could hire someone to paint the house.

You know, just so that no one would say ever anything like, “Well, it sorta looks like you didn’t fingerpaint the place!” 

(You may be wondering how anyone could make priming and painting look that bad, but HELLO, did you not read the above anecdote?!  A two-year-old can even spot my poor skills from a mile away.  Or at least an arm’s length away.)

So, with some hefty generosity coming our way, Tim and were able to hire James.  Or “Super-James,” as I call him.

(Super) James is a local independent contractor who is not only painting our house but has also installed new bathtubs and has agreed to install new lighting in the kitchen.  He’s spectacular and amazing and extremely kind and efficient and totally reasonable, so if you’re looking for a spectacular, amazing, etc. contractor in the Central Ohio region, please send me an email and I can send you James’s contact information.

In any case, while the house is far from completely finished, I thought that I would share a few before-and-after teaser shots.  With the love and hard work not only of Tim and me but also of my parents, my uncle, my brother-in-law, my sister, and yes, the spectacular, amazing, etc. James, our house has come a long way since we bought it–i.e. back on closing day when we found a dog turd in the dining room, the unmistakable black streaks of ghosting on the walls, unidentifiable orange grease-goo on the kitchen ceilings, blood stains underneath the carpet, and ORANGE-FLAVORED KY JELLY LEFT IN THE DRAWER OF THE ONE PIECE OF FURNITURE REMAINING IN THE HOUSE oh-my-lord-there’s-nothing-so-gross-as-finding-a-disgusting-and-filthy-stranger’s-KY-jelly.

(Now you may be wondering, “Why in the HELL did you purchase this house?!”  But just wait and see.  Oh just wait and see.)

Dining Room - BEFORE

Please note: nasty carpet (which is GONE and shall be replaced in just one week) and the black-stained walls (which are cleaned and partially painted and now look like this:)

Dining Room - AFTER

Sweet mother of cleanliness!  And you can take that quite literally–my mom and I both scrubbed the ceilings and walls for hours.

Kitchen - BEFORE

This is what the kitchen looked like when the previous owners lived there.  (I won’t even show you the close-up photos I took of the aforementioned unidentifiable orange goo on the ceiling and walls.)

This is what the kitchen looks like with a deep cleaning, some work on the cabinets, and a fresh coat of paint from, you guessed it, Super-James.

Kitchen - AFTER

So the moral of the story?

Next time one of my kids asks me to draw a picture, I’ll say, “Are you sure you don’t want me to hire someone like, say, Super-James to do that?  I mean, I can clean up your crap (literally) like it’s nobody’s business, and, oh yeah, I can install a toilet, little dudes, but I’m not so sure you want me drawing.  Or painting.  Or doing anything that requires an iota of artistic skill.”

I’m proud to say that I’m teaching my kids their manners.

You know, the basic ones, like ”please and thank you,” “you’re welcome,” “excuse me” (which I will address momentarily), etc.

And my reasons for doing this have little to do with caring about what’s “proper.”  I, for one, am pretty much a slug when it comes to all things proper, and I am ten shades of horrible when it comes to etiquette.

Nor do I care at all about teaching my kids to be deferential toward adults.  Of course, I want my kids to listen to an adult when s/he has their health, safety, and general well-being in mind (*ahem* like ME, darling children).  But I certainly don’t want to instill in my children the idea that they are somehow lesser persons or are less deserving of respect than adults are.

In fact, the reason that I do care about teaching my kids to say their “please and thank yous” and so on is that I want to instill in them a respect for all people–adults and other children alike.  And my hope is that this respect and gratitude and kindness and whatnot will translate into some pretty awesome grown-up versions of my kids some day.

Now, before you go thinking, “Oh JAYSUS, is this lady trying to nominate herself for parent-of-the-year or something?!” please think again.

As I was on the phone with my sister yesterday, our children interrupted us a couple of times in the manners-infused way they’ve been taught.

With a polite, “Excuse me” to introduce their interruption.

On my end, these interruptions were mainly filled with the sorts of questions that are only meant to communicate, “Mommy!  You’ve been on the phone for fifteen seconds already!!!  Get off the phone!  It’s time to talk about apple juice, poop, and dragons again!!!” 

You know, questions like, “Um…EXCUSE ME…um…Mommy…um…um…is it sunny out today?” while the kid is standing right next to an open window through which sunlight is pouring and shining upon said child’s little angelic head.

Or, “EXCUSE ME, Mommy, you’re a PEANUT-BUTTER HEAD!!!!  Ahahahahahahahaha!!!”

Nonetheless, I heaved a little motherly sigh to my sister and said, “Well, at least we’ve taught them to say ‘excuse me,’ right?  At least they have good manners.”

And she said, “Yeah, but I think that the ‘excuse me’s’ even get old and annoying after a while, don’t you think?  It’s just not like those other manners words.”

And I paused for a moment.  And then I said, ever so quietly, “Yes.  They are kind of like tiny little needles piercing your eardrums.  Especially when you’re trying to get something done.  Can’t we just find some sort of manner that represents the whole, ‘Please sit down and stay silent for a few moments so that Mom can drink her coffee and get her gab on with her sister’?  Or at least a, ’Hey!  This little box pressed against my ear does not mean that you have to stop playing with your toys and tug at my shirt until I’ve stopped to hear you call me a peanut-butter head!’?”

But instead, I stopped to endure the indignity of patient peanut-butter heads all over the globe.  And I confirmed that, yes, it was sunny outside.  (And I also inserted a few, “Why don’t you work on this puzzle here for a few minutes while Mommy talks to your aunt!  Please!  Thank you!  YOU’RE WELCOME!  EXCUSE ME!  POLITENESS EXPLOSION!”)

Because I’m afraid that if I act like a jackass to them, they might internalize some of that jackassery and not grow up to be awesome grown-up versions of themselves some day.

And I please, pretty please, would not like that.

Thank you very much.

I will be neither the first nor the last person to draw comparisons between birth and marathons.

And I will certainly not be the first nor last blogger to address this analogy.

Rixa Freeze at Stand and Deliver, for instance, offers a beautiful and inspiring metaphorical story documenting the physical, mental, and emotional preparation that the story’s character “Ann” undertakes before running a marathon.  It’s the sort of a preparation that leaves her proclaiming, ”I can do it. I am strong. I am ready” as she stretches before the race. 

Just the sorts of affirmations that any birthing woman should be able to say to herself before welcoming her child into the world.

And then the blogger at Raising My Boychick gives a compelling account of both the misogynistic implications of comparing birth to athletics and the potentially empowering implications this comparison could have if the needs and autonomy of birthing women were respected just as much as the needs and autonomy of certain athletes.

Just the sort of respect that birthing women deserve.

But despite the fact that both bloggers (and many others) have pursued the birth/marathon analogy with remarkable depth, critique, and insight, I would like to add my perspective–a doula’s perspective–to the multitude of analyses and musings on this issue.

Because after witnessing my husband complete his first marathon last week, and after watching hundreds of other people sometimes triumphantly, other times agonizingly, and always inspirationally cross the finish line, my “doula’s attention” was drawn immediately to birth–and not necessarily toward how the physical, mental, and emotional work of a marathon is comparable to labor (although I’m sure in many ways it is) but instead toward what good labor support can offer to birthing women.

In the hours after the race, Tim told me how at all the major mile markers–the half-marathon mark, the 18 mile mark, the 26 mile mark (before the last .2 miles) and so on–there were volunteers whose primary job was to cheer on the runners.  And this was even in addition to the loved ones and general public who were there to see their friends and family run.

They’d remind the runners of how far they’d already come.  They’d remind the runners of how far (or how little) they had to go.  They’d share feelings of pride and excitement and awe with, for the most part, complete strangers running past them.  People they neither knew nor would likely see again.

Of course, I’m sure some runners may have “tuned” out the cheers, either with iPods or with their own internalized focus and awareness–that is, the internal tools they used to accomplish their goal.  (Must like hypnobirthing, I might add!)

But I’m also pretty sure their encouragement carried some runners right through those last strenuous miles.

Tim experienced this particularly in those last few tenths of a mile, where the volunteers were strategically placed to exclaim, “The finish line is just right past that hill up there!  Just run over that hill, and you’ll be there!  You can do it!  We’re so proud of you!  Just keep going!”

It’s what I’ve said to a woman in the throes of transition.  Or at least it’s remarkably close to what I’ve said.  (Without the shouting, of course!)

The pride and awe and encouragement is what doulas and other labor support people all over the world offer to women as they give birth.

And as my eyes welled with tears–as I felt the deepest awe and respect not only for my husband and the runners there that day but also for every woman who has welcomed a child into the world, no matter how she has done it–I said:

“Every woman deserves that sort of support during labor.  I want every birthing woman to experience the sort of encouragement and awe and celebration that you and the other runners received today.”

Really.

We deserve it.

You deserve it.

Whether it’s from a partner or a midwife or a nurse or a friend or family member or, yes, a doula, all birthing woman deserve the encouragement and awe and excitement and celebration that I witnessed at that marathon.

As I was checking my Twitter updates a couple days ago, I noticed that one of my friends–a unbelievably talented feminist philosoper living in NYC–tweeted about how she had recently scored tickets to an invite-only Blondie show at the Brooklyn Museum.

Of course I was immediately struck by an all-consuming (though good-natured) envy, so I tweeted back expressing said good-natured envy (as “Hanging on the Telephone” began playing in the soundtrack of my mind). 

And my friend responded with a comment about how the invitation encouraged attendees to wear “rock n roll attire.”  (I’m not exactly sure what that means, given the many permutations of “rock n roll” attire.  Although I’m guessing they didn’t mean an Elvis jumpsuit.  THOUGH THAT WOULD BE AWESOME, DEAR FRIEND-IN-NYC!!!)

In any case, I tweeted back, ”HA! I used to have some badass silver tights that I wore back when I was in a band.”

And then I basked in a few mental images of me as a pseudo-rocker chick from years past.  (It was nothing special.  But it did leave me with some good “cool cred” for when my future teenagers accuse me of being “uncool” some day.)

And then I looked down at what I was wearing.

Sweatpants and a ratty t-shirt.  And slippers.  With a big freakin’ hole in the left toe.  At 3 in the afternoon.

The veritable uniform of the frazzled stay-at-home parent.

Now, I feel the need to highlight a few caveats to that statement, and one is that I know that not all frazzled stay-at-home parents live in their sweats.  Some of you parents (like my younger sister) have impeccable senses of style and whatnot and can make what would appear to be a bulky brown paper sack on me look like couture on you.  And I hate love you for that.

What’s more, I have nothing against parents (or non-parents, for that matter) who choose sweatpants, ratty t-shirts, and slippers as their outfit of choice.  And that’s primarily because these outfits are the garment equivalent of the world’s largest chocolate, peanut-butter, whipped cream, cherry-on-top ice cream sundae. 

But to me, what was especially disheartening about my attire at the time of the aforementioned twitter-conversation was not only the fact that I was so un-rock-n-roll at the time but also the fact that I was only wearing those sweatpants because of an unfortunate potty-training incident that had left a giant urine stain on the jeans I had been wearing earlier in the day.

Which then left me thinking the following:

I’ve been peed upon, I’ve caught pretzely throw-up in my bare hand, I’ve stepped in half-chewed pasta, I’ve awoken to the pre-dawn cackles of a teething toddler, and I’ve had one or two very short people watch me poop for the past few days.

My outfit just seemed to exacerbate the indignity of those events, especially when juxtaposed with the thought of donning some “rock n roll attire” and heading out to a rock show.

And so I thought, “Where have you taken my dignity, dear children?!  Why can’t I just look down and see that I’m wearing some colorful, flattering get-up straight out of the Anthropologie catalogue?  (Not exactly a catalogue of rock n roll attire, but definitely one that’s chock full of clothes-I’d-love-to-afford-and-wear.)

But then I took a closer look at the shirt I was wearing.  It was, in fact, a shirt I wore to rock concerts all the time when I was in high school.  Including one very fantastic Sonic Youth show I saw in the mid-90’s.   Which was, incidentally, just a couple years after Kim Gordon had given birth to her and Thurston Moore’s daughter, Coco.   When she was the parent of a toddler.

And even though I was only 16 (and childless) at the time, I remember thinking as I passed her on the street before the show (in addition to thinking, “OH MY GOD, it’s KIM GORDON!!!), “Wow, she is one rockin’ mama.  I hope I can rock that much when I’m a mom some day.”

And I don’t.  I never will.  I mean, who out there rocks as hard as Kim Gordon?

photo by Anders Jensen-Urstad

But instead of basking in my former pseudo-rock-chick days or drowning in the indignity of the aforementioned parenting events, my memory of my sorta-one-degree-of-separation from Kim Gordon reminded me that I can always get my RAWK on on the inside.

Even when I’m frumpy on the outside.

(Oh yeah, and I also just won a digital download of one of Rockabye Baby!’s Lullaby Renditions from The Feminist Shopper–a GREAT giveaway and review site–so that will add an extra dollop of rock to my day.  As I sit here typing.  In my sweatpants.  And ratty sweater.  And, this time, penguin socks with holes in the toes.)

Oftentimes when I see anything birth-related covered by the national news, I end up feeling very underwhelmed (to say the least).  One-sided coverage (mostly from ACOG’s perspective), exaggerated risks and benefits of various procedures or processes, and even a blatant lack of research on a given topic all seem to pervade the segments on pregnancy and birth that I’ve seen in recent years.

But the past week has been a relatively good week for transparent and seemingly fair (though, admittedly, not always cheery) coverage of a few birth-related issues.  And in my opinion, each of the following news pieces is worth checking out–not just for the decent news coverage but also for the helpful information.

From CNN

Senior medical correspondent and “Empowered Patient” columnist Elizabeth Cohen examines the relative risks and benefits of VBAC and cesarean section within the context of two current news stories: 1) the fact that some insurance companies have denied women health care coverage after considering their previous c-sections to be “preexisting conditions” and 2)  the story of Joy Szabo, a mother in Arizona who must travel 300 miles to the nearest “VBAC-supportive” hospital just to have her second VBAC (and who was threatened with a court-ordered cesarean by her local hospital if she attempted to have a VBAC there). 

All in all, I am impressed with Cohen’s discussion.  Could she have done a better job of reporting the risk of uterine rupture?  Sure.  (For what it’s wort, the rate of uterine rupture during a VBAC is less than 1% for most women: .4% if labor begins on its own, .9-1.1% if labor is augmented or induced with pitocin, creating a rate of approximately .7% for all VBAC attempts, induced or not.)

But Cohen does a superb job of addressing issues that are often overlooked in the coverage of cesarean sections and VBAC.  For one, she is careful to place the risk of uterine rupture alongside the risks of cesarean section.  This simple exercise in good reporting helps to dispel the illusion that VBACs are a “risky” option when compared with “easy” and “risk-free” cesareans.

In addition, Cohen points out that patient-chosen, non-necessary elective cesareans make up a very small percentage of the cesarean sections performed in the United States.  This is especially noteworthy in light of the fact that some medical professionals (though certainly not all) have often pointed to “too posh to push” cesareans as one of the primary reasons for the nation’s rising cesarean rate.  But their “mother-blaming” (in addition to being inherently misogynistic) simply doesn’t pan out when one considers the relative infrequency with which patient-chosen, non-necessary elective cesareans occur.

You can watch the following video to see more about what Cohen has to say about VBAC, c-section, the related issues:

From MSNBC

The very title of this article left me smiling: “Hospitals to crack down on induced labors.”

An even better title, however, would have been “Hospitals to crack down on UNNECESSARY and EARLY induced labors.”  Because as the article reports (and as studies have demonstrated), these inductions–especially those performed before 39 weeks–can lead not only to iatrogenic (or doctor-caused) prematurity but also increase a baby’s risk of NICU admission and increase first-time mothers’ risk of cesarean section.

So don’t worry–if you and/or your baby’s health requires an induction, hospital regulators and administrators are not going to deny you an induction.  But they may restrict your care provider’s ability to schedule convenience inductions–and that’s all with your and your baby’s health in mind.

From the BBC

And finally, this week the BBC news published an overview of maternal mortality across the world.  In their examination of the United States, they found that:

The US spends more money on mothers’ health than any other nation in the world, yet women in America are more likely to die during childbirth than they are in most other developed countries, according to the OECD and WHO.

The article points to the lack of health insurance and coverage, poverty, the staggering c-section rate, and obesity as potential contributing factors to this sad and disheartening state of affairs.  What’s more, it sheds brief light on the fact that African-American women are “three to four times more likely to die during childbirth than white American women,” even when one compares the outcomes of wealthy black women to wealthy white women.  (Notably, many people have speculated that the stress of racism has a significant effect on the disparity of maternal outcomes between black and white women in the United States.)

But what this article also illuminates is the fact that we must demand better maternity care for women in the United States (and in all countries, for that matter).  We need better prenatal care (which should include not offhand castigations about “gaining so much weight” but respectful and helpful nutritional counseling from the first trimester and beyond).  We need better labor and delivery care (with more emphasis on evidence-based maternity care and not on unnecessarily intervention-heavy birth).  We need health care coverage for all pregnant women (period).

At least that’s what the BBC article illuminated for me!

(For more on issues of maternal mortality in the United States, please see Ina May Gaskin’s Safe Motherhood Quilt Project.)

…and lazy!

I still have a few posts brewing in my head–one about marathons and childbirth support here, one about my transition to cloth diapers there, and a few others about breastfeeding, child-rearing, and my OMG!!OMG!!OMG!!IthinkI’minlove!!! reaction to seeing “Mr. Schuester” sing and dance on Glee the other night.

But I’d much rather devote my 100th post to this here blog itself.  (Not that it will keep me from thinking about Mr. Schuester and his wicked moves all day long, oh-no-it-won’t.)

So…out of 100 posts (some of them awesome, some of them abysmal, some of them popular, some of them seemingly tucked away into obscurity):

The most popular by far has been my VBAC Scare Tactics Series.  The popularity of the series is due largely to the recent shout-outs from Nursing Birth and the Unnecesarean.  Many thanks to both of them for their generous support!

The post with the most comments from others has been My Very Own VBAC Waterbirth.  It’s the story of my second son’s birth.  It’s also the experience that solidified my entry into the world of birth advocacy.

My favorite “Tim story” is actually not the pooper-in-the-woods post, nor is it the post about the time my dad had to puncture Tim’s toenail with a hot needle.  No, my favorite “Tim story” is about the time he bludgeoned a bat with a…well, just go read it for yourself.

Of course, I also have my favorite kid posts.  Like the one about the time when M (our three-year-old) went all Jack McCoy on us in order to avoid being disciplined in a restaurant.  Or about the time when A (our now-17-month-old) flipped his lid over an apple core and a poop-filled diaper.  Or the one where the day from hell turned into a nostalgia-fest.

(Any more “most ___” or “favorite ___” would be overkill for just 100 posts, right?)

So yay.

100 posts.

After months and months of a persistent cough, my son, M, has finally been diagnosed with bronchial asthma.  And while I’m sad that he has to deal with this condition for the next few years (or at least I hope for only a few more years), I’m also happy that he at least has options for treating his cough.

What’s more, I’m also thrilled with the way his new pediatrician handled his treatment options.  In fact, my interaction with her had me day-dreaming about what her approach to informed consent would look like if it were mapped onto the ways that OB/GYNs (and even midwifes) tend to approach the option between VBAC and repeat cesarean.

But before I recount my day-dream, I should give you a picture of what my interaction with M’s pediatrician looked like:

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Dr. S: Based on what you’re telling me, it sounds like your son probably has bronchial asthma, or what some people call “cough asthma.”  *Explains a bit about what it is.*

Me: What sorts of treatments do you recommend?

Dr. S: There are generally two options: Singulair, a medication traditionally used to treat the symptoms of asthma, or Boswellia, an herbal medication that I have also recommended to many of my patients.  From my experience, both seem to treat bronchial asthma equally well.  That being said, there have been many parents who have told me that they have preferred Boswellia since it doesn’t seem to have the same sorts of negative side effects that Singulair does.

Me: What are some of those negative side effects?

Dr. S: Mainly, some parents report that their children experience significant mood changes while taking Singulair.  And this is one of the side effects associated with the drug.

Me: Oh, okay.

Dr. S: *Explains the dosage and administration of each drug, the risks/benefits of each drug, also addresses where we could safely purchase Boswellia.*  Do you have an idea about which treatment you would like to use?

Me: My gut reaction tells me Boswellia, but would it be alright if I went home and researched it first?

Dr. S: Of course!  I actually encourage that.  Why don’t you call me in a couple of days when you make your decision, and then we can talk about how we will proceed from there.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

And then I started dreaming of what a prenatal appointment would look like if a doctor or midwife were to take the same empowering, informed-consent-supporting attitude that my son’s pediatrician took to his asthma treatment.

Dr. OB/GYN: Congratulations on your pregnancy!  Since you had a cesarean for your last birth, have you thought about what you would like for this birth?

Pregnant mama: Do you mean VBAC or a repeat cesarean?

Dr. OB/GYN: Yes!  Both are relatively safe options, although each one carries particular risks and benefits.

Pregnant mama: Can you tell me a little more about that?

Dr. OB/GYN: Of course.  The main risk associated with VBAC is that the uterine scar will begin to separate during labor.  This risk of “uterine rupture” is very small–only .7% for all VBACs, and only .4% if your labor begins on its own. 

Pregnant mama: Uterine rupture sounds very serious.  What about repeat cesarean?

Dr. OB/GYN: You’re right, uterine rupture is serious, but it is only “catastrophic” in approximately .05% of all VBACs.  So the risk itself is very, very small.  We may monitor you a bit more carefully in the hospital, but we can also take steps to make sure that you can still be upright and mobile during your labor.  And repeat cesareans, although relatively safe, also have serious risks.  For instance, each subsequent cesarean increases your risk of serious placental complications, such as placenta previa and accreta.  In addition, a recent study has shown that babies born after VBAC have lower NICU admission rates and fewer respiratory problems than babies born via elective repeat cesarean.

Now, this isn’t meant to scare you!  But it’s always good to know that there are risks associated with both options.

Pregnant mama: Do I have to decide right now?

Dr. OB/GYN: Of course not!  I encourage you to take the next few weeks to do some research on VBAC and repeat cesarean, and then we can discuss your plans during your next appointment.  (Editorial note: In a super-ideal world, the OB/GYN would also give the mom a couple of pamphlets on cesarean section and VBAC from ICAN.  A girl can dream, can’t she?)

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

But I know from experience that these sorts of prenatal appoinments often look a little bit more like this.

Dr. OB/GYN: Congratulations on your pregnancy!  So, when are we going to schedule your repeat cesarean?

Pregnant mama: Well, what about VBAC?

Dr. OB/GYN: VBAC?!?!?!  Why would you ever want to do a thing like that?!?!?!  I.  DON’T.  DO.  VBACs.

“At the end of the day, it doesn’t matter how the baby came out.  All that matters is that you have a healthy baby.”

It’s that dreaded “healthy baby line.”  The one I’ve written about before.  The one that others have addressed with admirable sensitivity and eloquence.

And I’ve been thinking about that line in a relatively new light lately.

My general position on the “healthy baby line” hasn’t changed.  I still think these sorts of statements are hurtful and demeaning and insensitive to women’s experiences.  To be fair, I also don’t think that people generally intend for these statements to be taken as such.

But in addition to the aforementioned response that I’ve given to the “healthy baby line”–a response that focuses on the emotional aspects of birth and new motherhood–I’d also like to add this point: Healthy babies do matter.  And that’s why I (and others) care so much about how they come out.

This is because unnecessary birth interventions that interfere with how babies “come out” can pose additional risks to moms and their babies.

This is not to say major birth interventions such as induction of labor or cesarean section are so risky that they should never be used.  To the contrary, when these interventions are necessary and/or medically indicated–for example, when a woman has a cesarean section for placenta previa, or when a woman’s labor is induced because of preeclampsia–they are wonderful and even life-saving uses of the medical technology that is currently available.

But when these interventions are used in the absence of necessity or medical indication, some parents may decide–and have the right to decide–that the possible benefits of these interventions might outweigh their risks.

Notably, some of these risks are relatively small.  Some of them may even be risks that moms and/or their partners examine and pore over and say to themselves, “You know, I think that the convenience of having an elective induction still outweighs the risks that it presents, and I am willing to take on those extra risks.”

And in these sorts of cases, they’ve made an informed decision.  And informed decisions–informed consent–are something that I not only respect but also champion as a fundamental right for all medical patients.

But before a parent can make an informed decision about unnecessary induction and/or cesarean section, they should know the following:

According to Childbirth Connection’s systematic review of the comparative risks of cesarean section and vaginal birth, cesarean section poses the following extra risks* to both mothers and babies:

• Physical problems in mothers: Compared with vaginal birth, cesarean section increases a woman’s risk for a number of physical problems. These range from less common but potentially life-threatening problems, including hemorrhage (severe bleeding), blood clots, and bowel obstruction, to much more common concerns such as longer-lasting and more severe pain and infection. Even after recovery from surgery, scarring and adhesion tissue increase risk for ongoing pelvic pain and for twisted bowel.
• Hospitalization of mothers: If a woman has a cesarean, she is more likely to stay in the hospital longer and is at greater risk of being re-hospitalized.
• Emotional well-being of mothers: A woman who has a cesarean section may be at greater risk for poorer overall mental health and some emotional problems. She is also more likely to rate her birth experience poorer than a woman who has had a vaginal birth.
• Early contact with, feelings toward babies: A woman who has a cesarean usually has less early contact with her baby and is more likely to have initial negative feelings about her baby.
• Breastfeeding: Recovery from surgery poses challenges for getting breastfeeding under way, and a baby who was born by cesarean is less likely to be breastfed and get the benefits of breastfeeding.
• Health of babies: Babies born by cesarean are more likely to:
  • be cut during the surgery (usually minor)
  • have breathing difficulties around the time of birth
  • experience asthma in childhood and in adulthood.
• Future reproductive problems for mothers: A cesarean section in this pregnancy puts a woman at risk for future reproductive problems in comparison with a woman who has a vaginal birth. These problems may involve serious complications and medical emergencies. The likelihood of experiencing some of these conditions goes up sharply as the number of previous cesareans increases. These problems include:
  • ectopic pregnancy: pregnancies that develop outside her uterus or within the scar
  • reduced fertility, due to either less ability to become pregnant again or less desire to do so
  • placenta previa: the placenta attaches near or over the opening to her cervix
  • placenta accreta: the placenta grows through the lining of the uterus and into or through the muscle of the uterus
  • placental abruption: the placenta detaches from the uterus before the baby is born
  • rupture of the uterus: the uterine scar gives way during pregnancy or labor.
• Concerns about babies in future pregnancies: A cesarean section in this pregnancy can affect the babies of future pregnancies. Studies have found that they are more likely to:
  • be born too early (preterm)
  • weigh less than they should (low birthweight)
  • have a physical abnormality or injury to their brain or spinal cord
  • die before or shortly after the birth

And in addition to the general risks of induced labor (such as an increased risk of NICU admission, forceps and vacuum-assisted delivery, and abnormal fetal heart rate), the use of synthetic oxytocin (or pitocin) itself carries a number of risks of which parents should be aware.  As reported in the RxList Drug Guide, pitocin can lead to the following adverse reactions in a mother:

Anaphylactic reaction
Postpartum hemorrhage
Cardiac arrhythmia
Fatal afibrinogenemia
Hypertensive episodes
Nausea
Vomiting
Premature ventricular contractions
Pelvic hematoma
Subarachnoid hemorrhage
Hypertensive episodes
Rupture of the uterus

Excessive dosage or hypersensitivity to the drug may result in uterine hypertonicity, spasm, tetanic contraction, or rupture of the uterus.

And according the same RxList Drug Guide, the pitocin can lead to the following adverse reactions in the fetus or neonate:

Bradycardia
Premature ventricular contractions and other arrhythmias
Permanent CNS or brain damage
Fetal death
Neonatal seizures have been reported with the use of Pitocin (all due to induced uterine motility)

and:

Low Apgar scores at five minutes
Neonatal jaundice
Neonatal retinal hemorrhage (all due to use of synthetic oxytocin in the mother)

It should go without saying that none of these lists are meant to frighten anyone about labor induction or cesarean section.  To reiterate, these invertentions can be wonderful, life-saving uses of medical technology.  What’s more, there are ways to make the experience of these interventions more mother-, baby-, and family-friendly.

Nonetheless, the risks that these interventions pose to mother and baby demonstrate just why it does matter how a baby “comes out.”

And that’s because how a baby comes out can have a significant affect on how healthy that baby is.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

*Worth noting is that the Childbirth Connection’s systematic review of cesarean section and vaginal birth did find the following increased risks of vaginal birth (as comparedwith c-section): an increased incidence of perineal pain and incontinence for mothers, and increased risk (though still low risk) of nerve injury in babies.

Tim–my amazingly dedicated and disciplined husband–finished his first marathon yesterday.

Yes, the pooper-in-the-woods, the loser-of-the-toenail.   The man whose wife has had the audacity to mention his running-related nipple-chafing on her blog.

He ran 26.2 miles along with 4,000 other dedicated and disciplined athletes yesterday.

 And I couldn’t be prouder of him.

Some day I’ll write about how emotional it was for me simply to observe the runners.  And (surprise, surprise) about how the doula-in-me drew a multitude of comparisons between marathon training and running and childbirth preparation and labor.  And even about how Tim may have inspired me to train for next year’s local marathon.

But that will all have to wait for another day.

Because for right now, I’d like to use this space just to marvel at Tim’s incredible accomplishment.

Honey, I think I even see you in a new light now.

After ten years of friendship, five years of marriage, and four years of parenthood, you can still do something that makes me feel totally, utterly, and completely in awe of you.  And I think that makes me a pretty lucky gal.

Lamaze International’s research blog, Science and Sensibility, has announced a call for submissions for its second Healthy Birth Blog Carnival.  Whereas their first blog carnival showcased bloggers and other guest posters writing about letting labor begin on its own, this second carnival will feature posts on walking, moving, and changing positions during labor.

According to the Lamaze Healthy Birth Practice paper on this subject, research shows that:

…when compared with policies restricting movement, policies that encourage women to walk, move around, or change position in labor may result in the following outcomes:

• less severe pain,
• less need for pain medications such as epidurals and narcotics,
• shorter labors,
• less continuous monitoring, and
• fewer cesarean surgeries (Lawrence et al., 2009; Simkin & Bolding, 2004; Simkin & O’Hara, 2002).

In fact, no woman who participated in any of the research studies said that she was more comfortable on her back than in other positions (Simkin & Bolding, 2004). No study has ever shown that walking in labor is harmful in healthy women with normal labors (Storton, 2007).

So it is easy to see why walking, moving, and changing positions is a healthy birth practice!

For this post, I’d like to document and describe the ways that I walked, moved, and changed positions throughout my labor.  And this is because I think that it is important for women to have access to images of real women who are really laboring and who are really able to walk and move and change positions throughout their child’s birth.

Worth noting is that for most of my labor, I just followed my body’s signals and natural instincts when changing positions.  Sometimes, I also changed positions based on what my doula suggested. 

And for the entire time, I found my labor to be an intensely powerful, empowering, and healthy experience.

A few “stats” about my labor before I begin:

• Even though this was my second child, I was a “first-time laborer” since my first child was born via a pre-labor cesarean section.
• My labor began with my membranes rupturing.
• My contractions began approximately 1 1/2 hours after my membranes ruptured.
• My entire labor lasted a little over 14 hours (or 15 hours if one were to count the irregular, painless contractions I was having in the hour before my water broke).
• I labored at home for approximately 8 1/2 hours before leaving for the hospital.
• My cervix was 1-2 cm dilated and nearly 100% effaced by the time I was checked at the hospital.
• Three hours later, my cervix was dilated 4 cm.
• Just over one hour later, I was fully dilated.
• I actively pushed for about 35 minutes before delivering my healthy 8 lb. 3 oz. baby.
• And I moved and grooved all throughout my labor.

This is what it looked like.

Here I am in early labor, kneeling over the armrest of the couch.  Obviously, the contractions weren’t terribly intense at this point since I could still talk on the phone.  (I do believe, however, that I ended up throwing the phone onto the end table about ten seconds into my next contraction!)  Nonetheless, even though the contractions weren’t very intense, I still found that this position helped to relieve the discomfort that they caused.

What else does kneeling help to do?

It can help to relieve backache, it can encourage the rotation of the baby, it can help a mom to move and/or rock through her contractions, and it also provides a mom’s labor support team with access to her lower back for counter pressure.  One can also kneel over a birth ball or over the back of a raised hospital bed.

Here I am laboring on my side.  I was still in the early phase of my labor, so I wanted to relax as much as possible before the really hard work began.  I used one of my hypnobirthing deepening exercises to help me do just that.

How does side-lying help a mom during labor?

It helps to promote rest and relaxation in early labor, it can help to improve fetal oxygenation (especially when a mom is on her left side), it can help to slow down a precipitous second stage, and it can help to encourage fetal rotation.  It is also a good “alternative position” (instead of lying flat on one’s back) for a mom using epidural analgesia.

Here I am standing to stop for a contraction after walking around the house for a while.

Standing and/or walking throughout labor gives a woman the advantage of gravity to help the baby descend, it encourages the rotation and descent of the baby, it can help to bring on more productive contractions, and it also helps the baby to be well-aligned with the mother’s pelvis.  What’s more, it is yet another position that gives a mom’s labor support team access to her back for counter pressure and/or other touch-based comfort measures, if she desires them.

One of the other great standing movements is to slow dance with one’s partner, doula, or other labor support person.  (I slow-danced with my husband, Tim, right after this picture was taken!)  Besides providing emotional closeness(especially if one is dancing with one’s partner), dancing can offer a mother all of the benefits of walking or standing while allowing her to take some of her weight off of her feet.

Remember how I mentioned the “really hard work” that was on my horizon?

It had definitely begun by the time this picture was taken.

And laboring on my hands and knees felt like the most comfortable and most natural position for me to be in at this point.

Being on one’s hands and knees during labor can help to relieve backache (which I was definitely experiencing here), can encourage the rotation of the baby, and can also allow access for back massage and/or counterpressure.  Doing pelvic rocking while on one’s hands and knees is also an especially good exercise for encouraging the rotation of a baby in the occiput posterior position.

Here I am standing and leaning against the stairs.

As with most upright positions, this position gives moms the advantage of gravity, it can encourage more productive contractions, it can help with fetal rotation, and it can be more restful than standing alone (and putting all of one’s weight on one’s feet).

Since the stairs are pictured here, I should mention that I also made quite a few trips up these stairs during my labor.  Climbing stairs can also enhance rotation of the baby and pelvic mobility, and it may help to “speed” up one’s labor even more than walking does.

Worth noting is that most of those trips up the stairs were taking me to our bathroom, where I spent a good deal of time laboring on the toilet.  (For obvious reasons, I have no photos of this!)  Laboring on the toilet gives a mom the assistance of gravity while still allowing her to “rest,” and it may help her to relax her perineum.  (It is usually not recommended for moms who have trouble with hemorrhoids, however.)

Here I am sitting and swaying on my birth ball.  This proved to be tremendously helpful during the time that I labored at home.

In addition to offering a mom the advantage of gravity, swaying on a birth ball can help to enhance pelvic mobility.  It is also much more comfortable than merely sitting on a chair!

As you can see here, using this particular position with the birth ball also allowed me to gain the advantages of leaning, to receive some emotional support from Tim, and to get the back-relieving benefits of counterpressure from my amazing doula, Chris.  So this was really the “mother” of all laboring positions!  (Sometimes I can’t help myself when it comes to silly birth-puns…)

Here I am at the hospital, lying on my side just as I did at home during early labor.

I was strapped to the wires and transducers needed for the electronic fetal monitor (and didn’t have access to the telemetry unit yet), so my range of mobility was significantly limited.  And even though I needed to rest and “re-group” after a night of laboring and after discovering that I was “only” 1-2 centimeters dilated, the very fact that my range of motion was limited seemed to make coping with my contractions more difficult.

In fact, the time that I spent in the hospital bed, strapped to the monitors, was the only time that I ever considered asking for pain medication during my entire 14-hour labor.

But then I got in the water.

Oh, the water!  Take a moment to review the look on my face in the above picture and then the look on my face as in the picture to the right.  These pictures were taken within about three hours of each other.  And in the one to the right, I am a little less than two hours away from holding my baby in my arms.

Hydrotherapy during labor (which also includes laboring in the shower) can be very relaxing and can help to reduce the intensity of the pain of contractions.  Notably, women are generally advised to avoid getting into a tub or jacuzzi until they are at least 4 cm dilated since getting in the tub “too early” can contribute to irregular and/or less frequent contractions.

In addition, although these items are not visible in the above photograph, moms laboring in the water should also have access to a cold drink (my choice was Gatorade) and cool washcloths so as to help regulate their body temperature.

(Although a bigger tub–or an actual birthing tub–would have been preferable to the hospital’s small bathtub, I was still able to float in between contractions and to move my body during contractions.  In other words, I was still able to move and change positions while in the tub!)

I began pushing while lying on my side.  Although I did not find this to be the most comfortable and advantageous pushing position for me, pushing on one’s side does have some specific benefits.  In particular, this position encourages good fetal oxygenation, it is helpful for moms with elevated blood pressure or who are using epidural analgesia, and it allows the mother to rest in between contractions.

I eventually moved to my hands and knees while pushing and then rested in a sitting position in between contractions.

As one of the many optimal birthing positions, pushing on hands and knees can help to improve fetal heart tones, it can assist with fetal rotation (especially for a baby in the occiput posterior position), it is an excellent position for a woman expecting a large baby, and it can help a mom to avoid a laceration or an episiotomy.

And it was certainly a position that helped this first-time-pusher to deliver her 8 lb. 3 oz. baby after only 35 minutes of active pushing!