Birthing Beautiful Ideas

So I’ve updated my “about” section to include such ever-pressing information as “who I am,” “why I don’t reveal my kids’ names,” and “what I want to be when I grow up.”  (It’s all you ever wanted to know and more, I know.)

I’ve also included some shameless capitalist information on there, including info on sending me stuff to review and purchasing ad space on this blog.  (It’s all you need to know to give me heaploads of money to promote your ethical, eco-conscious, WHO-Code compliant, spectacular product, I know.)

It should be stated that both tasks–sharing personal info about myself in an FAQ-format and conjuring up my inner capitalist–make me feel pretty ridiculous.

But I’m a pretty ridiculous person too.

So check it out–especially if you are in the market for ridiculousness.

Dear Taffy Brodesser-Akner,

Last night, I read the piece you wrote in the LA Times about “weighing the risks and rewards of vaginal birth after cesarean.”

I’ll admit–at first, I was a little perplexed by what you wrote.

Actually, there were times when I was even angry.  And then sympathetic.  And then perplexed all over again.

You see, I’m not sure that I’m all that comfortable with the roles that fear and pessimism played in your article.

It’s not that I would have wanted you to hide your fear and pessimism over your choice to attempt a VBAC.  These feelings are yours.  You own them.  You should not be expected to ignore them.

In fact, I think we do a disservice to any birthing woman when we tell her to obscure any negative feelings she has about birth, sweep them all under the rug, and just hope that they don’t pop up in the middle of labor.

But Taffy, you presented your fears and pessimism in a way that made it all too easy for those feelings to be exacerbated in or even transferred to other women considering VBAC.  You presented them in a way that may have even misinformed women about their birth options.  And that doesn’t seem to be offering any benefits to other birthing women either.

It all began with the tag line:

She knew the statistics about vaginal birth after a c-section, that only about 60% to 80% who try for a VBAC actually have one.  But she also knew that when the time came, she’d just have to decide for herself.

Now, I know that you probably weren’t responsible for writing this tag line.  Nonetheless, I still think that it accurately captures some of what you describe in your “first person” account of your decision to attempt a VBAC.

But does it accurately capture VBAC itself?

Considering that 67.7% of all women who try for a vaginal birth in the United States will actually have one–and this statistic includes women who do not have prior cesarean scars–is it truly fair to claim that only 60% to 80% of women who try for a VBAC actually have one?

In other words, the overall chance of having a vaginal birth after cesarean is very similar to the overall chance of having a vaginal birth after any labor.  This should leave less room for pessimism about VBAC–not more!

Of course, my sympathetic side knows that the fear and pessimism isn’t just about these numbers.  In fact, before my VBAC, I felt and faced those fears–not just the fear of uterine rupture, but the fear of feeling like a failure if I had a repeat cesarean, or of just ending up with a repeat cesarean period.

And we are not alone in experiencing these fears.

But I knew too that signing up for an elective repeat cesarean would give me a 100% chance of “ending up” with a c-section.  And I knew deep inside that ending up with a repeat cesarean would not make me a failure.  And I knew that based on my research, my values, and my preferences, I wanted a VBAC.

So I opted for the 20% – 40% chance of a repeat cesarean (rather than the 100% chance).

Speaking of chances, you seemed to characterize the desire to VBAC as simply the desire to have a chance to have a trial of labor after cesarean (or TOLAC).  You said that those of us who want or have wanted a VBAC simply wanted to “give it a shot.”

Taffy, for many of us, it is so much more than giving labor a shot.

Some of us want to give the benefits of labor a shot.

Some of us don’t want to give the risks of elective repeat cesarean a shot.

Most (if not all) of us want to give informed consent a shot.

Just like women who choose (and are not coerced into) an elective repeat cesarean–we want to give our decisions, our weighing of the risks and benefits of VBAC and repeat cesarean, a shot.

And in weighing those risks and benefits, it is impossible not to consider the risk of uterine rupture during a VBAC.  This is the extra risk that a cesarean scar gives us, and this risk is present regardless of whether we opt for a VBAC or an elective repeat cesarean.

And yes, the risk is greater for those of us who opt for a VBAC.  It’s an approximately .7% risk for women with one prior low-transverse scar–not 1%, as you stated.  And of those uterine ruptures, approximately 6% lead to a fetal or neonatal death.  This means that approximately .04% of all VBACs will result in a uterine rupture-related infant death.  Correlatively, this means 99.96% of all VBACs will not end in a uterine rupture-related infant death.

And to the physician who told you that the risk of uterine rupture is “100% when it’s happening to you,” please know that this person was essentially comparing apples to orange spaceships.  To reiterate, the statistical risk of a uterine rupture is approximately .7% for all women seeking VBAC with one low-transverse scar.  If a woman experiences a uterine rupture during a VBAC, her experience represents that statistic.  She is not a statistic.  Her baby is not a statistic.  Her personal experience is not a statistic.  And this is why she may feel emotionally like the statistic is 100% for her.

But mathematically, statistically, and realistically, this is not the case.

In my mind, this means that women seeking a VBAC should have a healthy fear–or at least an awareness–of uterine rupture and its signs and symptoms.  But the exceedingly low absolute risk itself shouldn’t convey an overall sense of pessimism about VBAC.

Similarly, the risks of c-section shouldn’t convey an overall sense of pessimism about this birth option.  But this doesn’t mean that we should gloss over or pooh-pooh these risks, as you seemed to in your article.

Repeat cesareans–especially third and fourth cesareans–also carry risks, and even serious and life-threatening risks.  The risk of placenta accreta–a complication that can lead to severe blood loss, hysterectomy, or even maternal death–increases from .31% in a second c-section to .57% in a third c-section to 2.13% in a fourth c-section.  Similarly, the rates of hysterectomy and blood transfusion increase with each subsequent cesarean section.

But through all of this risk/benefit analysis and weighing, I do see what you want.

I do understand what is driving a lot of your fear.

For you state that you just want someone to tell you “which option will give [you], with the least amount of intervention, the reasonable guarantee of a healthy child and a healthy [you].”

Oh Taffy, how I wish that every woman and child could have that guarantee!

And there’s nothing like being a parent to make you want to eliminate any and all risk from being born–from living.

But we can’t eliminate these risks.  None of us can.  Not even those of us without cesarean scars.  Not those of us who are first-time moms or seventh-time moms.  Not those of us who opt for vaginal births or cesarean sections.  Not those of us who birth in the hospital or in a birth center or at home.

It’s scary.  It’s daunting.  It can even be debilitating for some of us at times.

Taffy, what I don’t want for you is to obscure your fears.  Acknowledge them, accept them, and own them.

But I also want you to give birth with confidence.

I want you to start seeking information that will increase your confidence in your birth.  And you don’t have to continue looking up statistical data to do this.

There are books (like Birthing from Within: An Extra-Ordinary Guide to Childbirth Preparation).  There are blogs.  There are websites.  There are advocacy organizations.

There are women–other mothers who have had VBACs, other mothers who have had repeat cesareans–who can provide mother-to-mother support to you on your journey.

But please–so that other women can go forth on their birthing journeys with confidence too–try not to allow your fear to infect other women.  Please do not present the “facts” about VBAC with fear and pessimism.

We all deserve a bit better than that. 

You do too.

With warm wishes for a safe, happy, and healthy birth,

Kristen

Remember way back in mid-March when I returned from the NIH Consensus Development Conference on VBAC with a heapload of inspiration and energy to transform maternity care and access to VBAC in the United States?

I haven’t written much about my goals since then, but this doesn’t mean that the momentum I carried home from the NIH has fizzled out in the passing weeks.

Quite the contrary, in fact.

It’s just that I’ve been doing a lot of “behind the scenes” work.  (It should come as no surprise that my goals will take some hefty organizational efforts!)

And as it stands right now, it looks like the first of my goals to materialize will be the “NIH VBAC Statement Primer”–a proverbial “how-to” guide to help consumers use the  statement to their advantage.

To explain, the consensus statement has all sorts of amazing potential to transform thoughts on and access to VBAC in the United States.  (Simply describing VBAC as a “reasonable option” is amazing enough!)

What’s more, birthing women can and should be a part of this transformation!  But we also need to know how to use the NIH statement to fight for this much-needed change.

My hope is that the primer will offer just this sort of knowledge and empowerment to all women who even just consider VBAC as one of their birthing options.

Much to my excitement, lots of other birth advocates, organizations, and bloggers (including Amy Romano, with whom I’ve partnered up for this project) share my enthusiasm over these possibilities!

In fact, just last week, Mother’s Advocate even published on their blog a guest post from me about the NIH VBAC Primer!  (Head on over there to read more about my inspiration for the primer, and about our general time frame for this project.)

Until we get this thing written and published–and this may take a while, especially considering that the NIH panel has not yet released their final statement on VBAC–here is a very rough sketch of what we would like to be included in this primer.  Please let me know in the comments section if you have any questions, concerns, or other issues you’d like to see addressed in the primer.  Again, we want this to be something that women can really, truly  use to advocate for themselves and their births!

The NIH VBAC Statement Primer: An Outline

General

• An explanation of the purpose and scope of the primer, and of the NIH Consensus Statement on VBAC
• A definition of the terms used in the statement

Statistics and Research

• An outline of the risks and benefits of TOL (trial of labor), VBAC, and ERCD (as limited to the ARHQ report, the statement, and perhaps the research presented at the conference)
• A examination of VBAC success rates and prediction models
• A brief outline putting all obstetric emergencies (not just uterine rupture) into perspective

Analysis

• Ideal candidacy – How is this term defined in the statement?  What does this mean for women who are OR aren’t “ideal” candidates?
• The “immediately available” standard – What is the history of this standard?  What were the NIH panel’s recommendations regarding this standard?
• Inconclusive research – What “critical gaps” did the panel find in the research on VBAC?  What is the significance of this “inconclusiveness” for women seeking a VBAC?
• Legal rights and protections – What legal rights and protections do all pregnant women have?  How does the right to informed consent and refusal apply specifically to women who want a VBAC?  How do these rights and protections function in the context of the NIH Consensus Statement on VBAC?

Action

• Advice on “follow-up” local media pitches (e.g. regarding VBAC bans, changing policies and practices, etc.)
• Advice on how to pressure hospitals and care providers to publicize their TOL policies, their VBAC rates, and (for hospitals) their plans for responding to all obstetric emergencies-not just uterine rupture (per the NIH panel’s recommendations)

Advice on using the information in the primer

• Tips on discussing birth options with one’s care provider (or multiple care providers, if one is trying to find a “best fit”)
• Tips on seeking out support and educational organizations

Women’s work. 

It’s a contentious term, and it’s a term whose meaning is (and maybe always has been) in flux.

Historically, “women’s work” has referred to any work that occurred in the domestic sphere: the cooking, the cleaning, the child-rearing, and the general homesteading.

And historically, this work has been entirely undervalued, both by individual societies and cultures and by many of the historians that document those societies and cultures.

But now, “we” are supposed to see things differently.

Now “we” have feminist theories and theorists that can illuminate the historical significance of “women’s work” and critique the social structures that have limited women to the domestic sphere.

Now “we” have an understanding that domestic work need not be gendered work and isn’t just (and shouldn’t just be) the sole responsibility of women.

No “we” know (theoretically) that “women’s work”–that domestic work–has value and that it deserves a revered place in our historical, literary, and philosophical canons.

(Case in point?  This carb-lover wants to personally thank those domestic-types who figured out how to make BREAD all those millenia ago.  Seriously, how did they figure out how all that flour and all that kneading and all that waiting-to-rise and all of that baking would make something so spectacularly delicious?!  THEY DESERVE A TREASURED PLACE IN THE HALL OF SCIENTIFIC BREAKTHROUGHS JUST AS MUCH AS ALL OF THOSE STONE-WEAPONRY FASHIONERS AND ASTRONOMERS AND WHEEL-INVENTORS!!!)

Anyway.

When it all comes down to it, I can talk the talk and wax philosophical all day long about valuing “women’s work/domestic work,” but I still have a hard time at the end of the day when it comes to valuing my own domestic work.

And I don’t think I’m the only stay-at-home-parent who has this “problem.”

You see, because of the way our lives, our finances, and our careers are situated at this juncture in our relationship, Tim and I have found ourselves in the most traditional of traditional gender roles when it comes to work and the home: Tim works outside of the home, and I stay home with the kids while he’s at work.

There are more nuances to our work/home circumstances, of course.  For instance, Tim is responsible for a number of domestic chores, including washing the dishes, changing the cat litter, and organizing our bills.  And I do engage in some work that allows me to “transcend” the sphere of domesticity, including dissertation-writing, doula-ing, and even writing this here blog.

I realize too, in many ways, that our situation is not one to bemoan but rather one for which I should be (and am) grateful.  The fact that I have at least a semblance of choice about whether to stay home with the kids or work outside of the home is a luxury that I do not allow to go unnoticed.

But this doesn’t mean that there aren’t days where, as my toes dig deep into the bedcovers, I think to myself, “Hmph.  What the hell did I do today??!!”

It doesn’t mean there aren’t moments where I get all lost in my head and consider Tim’s out-of-home work as “the meaningful work” in our family and my in-the-home work as the relatively “meaningless, unimportant drudgery-masked-as-work” in our household.

And really, folks?  It’s easy to go there when you live in a society that pays a lot of lip service to work that occurs in the home but doesn’t really value that work in any robust sort of way.

But before I could sink too far into some sort of existential crisis straight out of The Second Sex, one of my friends shared with me her strategy for escaping from the mentality that leads us “workers from home” to think that we fill up our days with endless nothings.

Every night for a month, she made a list of everything she accomplished during the day.  Did she wash some dishes?  It went on the list.  Did she change a heap of diapers?  It went on the list.  Did she finish a book from her dissertation research?  It went on the list.

And each night, she had tangible evidence of her work.

Her important, meaningful, valuable work.

What would your list look like at the end of the day?

Would it document all that you accomplished in your home?

Would it show all of the tasks that you juggled in the home and outside the home at work?

Would it give your partner some evidence of just how much work it takes to keep up your “homestead” the way that you do?

No matter what it would do, I don’t think you have to be a self-identifying feminist to appreciate how much it means to actually see on paper all of the things we do each day in our “domestic spheres.”

Here’s my list, for those who are interested:

Today I…

• did a load of laundry
• rinsed some dishes from last night and loaded them in the dishwasher
• fed the kids a snack (bananas and baked sweet potatoes, which I had to bake and mix with brown sugar)
• swept the floor
• took the kids to the library for story hour
• checked out two books from the library
• put both kids down for a nap
• deep-cleaned the kitchen counter
• set up a lunch-date with a dean from a local university
• started organizing the contents of our local ICAN chapter’s book and video library
• completed my application for my DONA International birth doula certification
• fed the kids another snack
• changed many diapers
• refilled many sippy cups
• ran a toddler across the house a few times so he could go to the potty
• drove M to Tim’s work so that Tim could take him to his first dentist appointment
• took A to a local nursery to check out their selection of phlox
• got the car washed
• cooked dinner (whole-wheat crepes with ham, shiitake mushrooms, and gruyere with a side of garlic spinach)
• washed 75% of the dishes
• scrubbed random gunk off the kitchen floor (random gunk increases exponentially with each additional child in the house)
• brushed the cats
• ran the dishwasher
• wrote this blog post

Not one of my work-iest days, but not one of my laziest days either.

And seeing this list here, in all of its glory?  Knowing that each of these tasks is something that I, and others, should value as work that helps to keep this here ship of a family running?

It makes me think that the glass of red wine I just poured for myself is surely deserved.

Today I am excited to share with my readers a birth story from one of my doula clients!

It’s a special story–one that I often recount to other pregnant women, doulas, and birth advocates.

(Before going on, I should note that all of the births that I have attended are special and near and dear to my heart, and every single woman whose birth I have attended has demonstrated the most humbling and awe-inspiring strength.  Birthing women are amazing.  Birth is amazing.  Period.)

But the birth described below was also special because of its unique circumstances.  Just consider everything that Jessica (the mother in the story) had faced or was facing on the day she went into labor:

• Her husband had been deployed to Iraq for months and would not be returning to the United States for another few months after the birth of their son.
• She had a fifteen-month-old daughter at home, who had been born, with Jessica’s husband present, in another state in an out-of-hospital birth center.
• There were no out-of-hospital birth centers in the state where Jessica resided at the time of her second child’s birth.  The only comparable option was an in-hospital birth center.
• Because Jessica’s baby was measuring “large for gestational age” (the estimate was between nine and ten pounds) in the last couple weeks of her pregnancy, the primary OB/GYN in her practice risked her out of the in-hospital birth center.  According to him, this was because “the beds in the in-hospital birth center”–which was immediately adjacent to the regular labor and delivery unit–”were not equipped with stirrups to handle shoulder dystocia.”
• Because Jessica’s baby was measuring “large for gestational age,” this same OB/GYN tried to talk her into an elective cesarean delivery.  She declined, but not after having to fight for the right to deliver her child vaginally.
• The OB/GYNs and midwives in her practice strongly encouraged her to undergo an induction, again citing her baby’s size as a cause for concern.  Jessica–now over one week past her estimated due date, and tired of fighting off their scare tactics–agreed to an induction by amniotomy.  She was committed to not having pain medication, and didn’t want to have to fight through the extra-intensity of a pitocin induction.

Jessica and I talked at length about her OB/GYN’s recommendations.  We talked about some of the research about “suspected fetal macrosomia” (or suspected “big baby”) and different modes of delivery.  We talked about  the fact that she had already delivered a “big” (9 lb.) baby vaginally.  We talked about her blood sugars were normal when she was tested for gestational diabetes.  We talked about how remaining upright and mobile during labor and delivery would give her the advantage of gravity and allow for greater pelvic mobility to assist with the rotation and descent of her baby.  I even remember reading aloud sections from The Thinking Woman’s Guide to a Better Birth!

We also talked about her wishes and her feelings about this birth.

And it was quite clear that she wanted to avoid an unnecessary cesarean section.  She also wanted to avoid an induction, but she was willing to undergo one if it meant ultimately warding off her care providers’ pressure to have a c-section.

But then her body had plans of its own.

This is Jessica’s birth story, in her own words.

Evan’s Birth Story

April 14, 2009

I woke up at 7 a.m. when Irelyn started fussing and noticed by back was achy and I was having some mild contractions.  Since I had been having prodromal labor  for a few weeks now, I ignored the contractions because I didn’t want to allow myself to think that I could be in labor; I had been disappointed too many times lately.  So, Irelyn and I snuggled and watched tv together on the couch.  It was about 7:30 a.m. when I stood up to go to the bathroom and noticed some wetness in my underwear.  I thought for a second that maybe my water broke but really didn’t know what to think since it was such a small amount.  So I went to  the bathroom and when I stood up from sitting on the toilet, I got a bigger gush so I knew then that my water really did break.  I was so excited tat today was going to be the day, but also shocked and nervous because it seemed like this day would never come!  I called my doula to give her the heads up and told her I was going to go about my normal morning routine and would call her when my contractions picked up and thought I needed her.  I also called my mom and said the same thing.

I proceeded to put Irelyn in her high chair and give her breakfast when I got another big gush of water.  Almost immediately the contractions got so much more intense and closer together.  I went and sat on the toilet and the sitting gave me so much relief that I didn’t feel like I could get up.  I called my mom and doula and told them to come over now because it seemed like things were really going fast.  Meanwhile, Irelyn was such a good girl strapped in her high chair with mommy unable to get up from the toilet.  I think she knew something was going on and decided not to throw a fit or fuss despite having already eaten all of her breakfast.  I could see her from the bathroom so I just worked through contractions and talked to her until finally my mom showed up.  By this time was was about 8:30 a.m.

I jumped in the shower while my mom got all of Irelyn’s stuff together so my stepdad could take her.  I just stood there and worked through some more contractions while the hot water pounded on my back, it felt so good!  But things were definitely progressing fast.  There were a few times my body just went into a squatting position and I was terrified that I was going to end up having this baby in the shower!  So I told my mom to get the car ready because as soon as I could get myself out of the shower we were going to head to the hospital; there was no time to relax and labor at home as planned.  Meanwhile I could hear Irelyn running around the house and I couldn’t believe everything was happening so fast that I wouldn’t even be able to say goodbye to her, so I yelled for my mom to bring her into me and my mom stuck Irelyn’s head in the shower so I could give her a kiss goodbye.  It definitely wasn’t the goodbye I had planned on or wanted to have, but I really didn’t have time to get overly upset about it since the contractions were taking over completely.  My doula showed up when I was getting out of the shower and her and my mom walked me out to the car.  My contractions were right on top of each other at this point and really painful.  It took me about ten tries to climb into my mom’s car; I just didn’t want to be trapped in that car, I needed to be moving around for relief.  But I knew I had to get in if I wanted to have this baby so I sat on my knees with my chest up against the back seat and hugging the head rest.  The hospital is only five minutes away and my mom flew there but it still seemed like eternity.

My doula told her to go to the ER entrance because I was already feeling the urge to push.  So we pulled up to the ER and they brought out a wheelchair, took one look at me and ran and got a stretcher.  The nurses whisked me up to L&D on the fifth floor, where they already had a room ready for me since my mom called on the way to let them know we were coming.  They moved me from the stretcher to the bed and the doctor checked me and said I was only 6 cm!    NO WAY!  I freaked out because the urge to push was definitely there, how could I only be 6 cm?  I had to lay on the bed for ten minutes while they drew my blood and hooked up a fetal monitor.  That ten minutes was the most excruciating time of my whole labor because laying down compounded my pain so much.  I looked at my mom and doula in the eyes and begged for some pain relief.  I didn’t necessarily want an epidural but I needed something, I seriously couldn’t  take the pain any more knowing that I was only 6 cm.  I felt like I had so much longer to go.  My doula and mom, having met with me several times before the birth and knowing I wanted to go natural, encouraged me to keep going without the medication and just go give more minutes, then just ten more minutes.  Again, I looked them in the eye, crying, and insisted that I needed something and tha tI would be okay with no having a natural birth.  At that moment my contraction died down and the nurses were done getting readings off their monitors and I was able to sit up at the end of the bed.  Sitting up took so much pressure  off my back and the pain immediately lessened.  My contractions were still one on top of the other and my doula helped by guiding my breathing.  She kept saying to breathe on top of my contractions, and I guess that can be up for individual interpretation but I just visualized slowly blowing out my contractions like slowly blowing out a big fire.  I got  through three contractions this way and then really felt the urge to go to the bathroom.  This was about 10:15 a.m.

I squatted on the toilet to use the restroom and as soon as I did that my body took over and just started pushing.  The nurse told me not to push and I told her she needed to check me because this urge was undeniable.  I couldn’t not push.  She checked me and immediately said to get back to the bed, that it was time to have this baby!  The doctor checked me and said I was 10 cm and that I could pull my legs back and push on my next contraction.  I was in a sitting up position so I pulled my legs back with the help of my mom and doula and also two nurses who pushed my feet back.  While I was getting ready to push, my doctor took a huge bottle of oil and poured it on my perineum and started massaging it pretty rigorously; he knew I was expecting a big baby and he didn’t want me to tear.  On the next contraction I pushed I pushed and immediately felt the ring of fire.  I was screaming during the next push and the doctor and nurses told me not to scream and to put that energy towards my pushing.  At this point his head was halfway out.  I gave one more long hard push, making no noise, and out came his head;  another push and out came the rest of him!  He was born at 10:32 a.m., three hours after my water broke and one hour after arriving at the hospital at 6 cm!  They immediately put him on my chest and all I could think was thank God it’s over; it was the biggest relief of my life!  The placenta was delivered fairly quickly after and the doctor announced that I had no tears!

After some mommy and baby bonding time, they did all of his measurements.  First came his weight.  The scale read 11 lbs. 9.8 oz. and the nurse didn’t believe it so she unplugged the scale and recalibrated it!  She then put Evan back on the scale and couldn’t believe it when it gave her the same reading.  And I have to admit, I was pretty surprised myself!  Then came his length.  The baby measuring tape goes up to 24 inches, and that’s exactly what he measured!   I can’t believe I had two feet of baby inside of me!  His head measured 14.5 inches.

The doctor that delivered Evan was the only doctor that I had yet to meet at my practice but he was so nice and I will be forever thankful for how he stretched my perineum so I wouldn’t tear.  In fact, there was a resident watching the birth and when Evan’s head started to crown, he got a pair of scissors and handed them to the doctor (for an episiotomy) and he told him that he wouldn’t be using those.

Ironically, the doctors did a shift change about ten minutes after Evan was born.  The doctor that I met with the previous week that thought that I should have a c-section and the one who denied me being able to birth at the birth center was now the one on the floor.  Thank God he was born right when he was or that doctor would have been the one delivering him!  I guess everything happens for a reason.  He did come in because he wanted to see what such a big baby looked like and my doula made it a point to tell him how proud she was of me giving birth naturally to such a big baby and how no shoulders got stuck and I had no tears.  It was kind of an in-your-face type conversation, and I loved every minute of it!

My doula thinks that scheduling my water to be broken and knowing that there was an end in sight was probably just what I needed to relax enough about the birth to go into labor on my own.  And the nurses think that my urge to push at 6 cm was probably the true urge to push given how big Evan is.  His head was that low in my pelvis but I still needed to dilate more to get the rest of his body through.

As for my recovery, I am doing absolutely wonderful!  I have no post-partum care and nothing that is holding me back from doing anything.  Between delivering Evan and losing all the amniotic fluid that I did when my water broke and throughout labor, I have already lost 30 lbs and guess you can’t beat the birth-an-11-pound-baby-weightloss-program!!

She avoided an “unnecesarean”!  She birthed an 11 lb. 10 oz. baby vaginally–and with an intact perineum!  And she did it all with the pressure to have an elective cesarean section, an induction, and even an episiotomy standing in her way!  She is a warrior!

Here are a few of my additional thoughts on this very special birth:

• One of the reasons I asked Jessica’s mom to drive to the ER entrance was that the distance from the parking garage to the labor and delivery unit was rather sizable.  It would have been a long walk.  And what might that have meant for the woman was holding her baby only one hour after arriving at the hospital at “only” 6 cm dilated?  Probably a baby born in the hospital hallway!
• During the nurse’s initial monitoring, all of the residents and other medical professionals in the room kept whispering about how she was “only” 6 cm dilated–as if that were somehow disappointing!  And every time that someone uttered the word ‘six,’ Jessica seemed to lose her focus.  (It didn’t help that she had limited mobility during that period of fetal monitoring and blood draws and hospital questions!)  I wish that these people had known that Jessica’s “birth behavior”–and the sensations she was describing–was more indicative of “how far along” she was in her labor than her cervical dilation.  She was, in fact, holding her baby less than one hour after being told that she was “only” 6 cm dilated!
• Despite Jessica’s requests for pain medication, I kept encouraging her to forego them–not because I was irrationally committed to her going without drugs, and not just because she had expressed the desire to avoid pain medications during our prenatal visits.  I encouraged her to try for five and then ten more minutes without drugs because I had the exceedingly strong feeling that “her six centimeters” was not “every woman’s six centimeters.”  In other words, she was not laboring like a woman in a long, drawn out active labor–she was laboring like a woman in transition, and one very close to pushing her baby out!  What’s more, I knew that once the nurse finished her monitoring, and once Jessica had more freedom of movement, she would be able to cope better with her contractions.
• 11 lbs. 10 oz.  24 inches.  With an intact perineum. Need I say more?!
• I love that the obstetrician catching Jessica’s baby shooed away those episiotomy scissors.
• And I also loved bragging about Jessica’s amazing accomplishment with the other obstetrician.  How could a snark-loving doula like myself not enjoy that?

So yes, a lovely birth indeed.  One just as lovely as all of the births I’ve attended, but one in which the mother overcame more obstacles and hurdles than any other birth I’ve attended.

And I am so proud of Jessica for that.

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

In closing, it would be great if you could send a heartfelt congratulations Jessica’s way in the comments section.  Her son, Evan, just celebrated his first birthday this week, and she is expecting her third child later this Fall!  She is one hard-working, amazing birthing woman!

Dear Miles,

Every day, you do something that makes me proud of you.

You dress yourself, and I swell with pride over your independence.  You write your name, and I marvel at the fact that your small hands were once so teeny tiny that they could barely have gripped a crayon.  You smile, you giggle, you play, you befriend, and I am simply proud to be the woman you call “Mommy.”

I try to make myself proud too.

In fact, for my birthday this year, I created a list of 29 things I want to do before I turn 30.  One of those goals was to teach you how to read.

I thought we’d make each other proud–me, carefully showing you how the letters came together to make words and the words came together to make sentences, and you, finding your way slowly through those letters, words, and sentences.

But then you did something that astounded me.

Something that continues to make me joyfully, exceedingly proud.

You started reading.  Fluidly.  Fluently.  Seemingly all on your own.

You are four years old, and you are reading.

I’m not exactly sure how much or what sort of credit I can take for this accomplishment.

Did I really teach you how to read?

Yes, I started reading to you even in those first few weeks of your infancy.  Yes, you’ve seen me (and your father) reading books, magazines, and newspapers galore.  And yes, I’ve helped you sound out and identify the occasional word or two (or twenty) over the past few months.  I’ve even stood by with a mixture of bemusement, wonder, and exasperation as you insisted upon memorizing the entirety of Neil Gaiman’s The Wolves in the Walls!

But now I know that you aren’t simply mock-reading.  You’re not just listing off a few words and sentences that you’ve memorized in your favorite books.

You.  Are.  Reading.

And you’re reading everything.

You read books.  You read your favorite books, those ones with the worn and cracked spines.  You read new books, ones you’ve never seen before.  You read street signs, cereal boxes, and DVD cases.  You read the silly words on your t-shirts and the silly color names on your crayons and you make me so, so proud with every word you utter.

And my pride is matched only by my excitement for you.

Miles, do you know what this world of words has in store for you?

You are going to find words that will keep you up all night.  Words that will find you under your covers with a flashlight so that you can just finish that one last chapter in the book you can’t put down.

You are going to find words that will break your heart–ones whose melancholy isn’t because of the sad story they tell but because of sheer poetic beauty that they contain.

You are going to find words that make you laugh, and words that make you cry.

You are going to find words that teach you something, and words that make you want to ask more questions.

Your mind, your imagination, your heart, and your soul are going to be blown away by all of these words, my sweet boy.

And me?  I’m just proud to be the woman who can continue to stand back and watch you discover these words.  All on your own.

Love,

Mom

Okay, okay, I don’t exactly have a social media empire.  It’s more like a social media pillow fortress.  Kind of like this one:

my impenetrable empire (and one of the cute kids who occupies it)

But I have taken Birthing Beautiful Ideas on over to Facebook and created (gasp!) a Facebook fan page.

See, look:

expanding my domain (bwa ha ha ha ha)

Yep.  A Facebook fan page.

As I’ve started telling folks (in an only half-joking gesture), this page will give me yet another venue to spread my own special feminist agenda and all of the birthy, breastfeedy, mothery propaganda that goes along with it.

I’ve also promised people there will be lots of links, photos, and even beer on the page.  So far, I’ve posted one link (to the above-pictured, absolutely splendid blog post from First the Egg).  There aren’t really any photos yet, but I promise to add some in the near future.  And as far as beer goes, as soon as I figure out how to dispense beer on my Facebook fan page, I think it’s safe to say that I will have a social media empire on my hands.

So until that glorious day arrives, go on over to Facebook and declare yourself “a fan.”  That is, of course, if you are a fan.  And if Facebook is your sorta thing.

Otherwise, just keep on reading.  Or moving on.  Or flaming my posts over on internet message boards.  Whatever.

Just know that the “empire” *dramatic pause* has expanded.

*You can also join the other arm of my empire by following me on Twitter.  There’s even more snarky and birthy fun to be had over there.

Before having children, spontaneity was something that Tim and I innocently, unknowingly squandered.

There were times when we would step out on a Sunday morning to enjoy, even savor cups of coffee.  Sometimes even while enjoying, even savoring a book or newspaper.  Like this.

There were times when we stop to get a bottle of wine on our way home from work and then spend the night getting tipsy and taking  silly pictures of ourselves.  Like this.

There were evenings where we could walk around the corner to our favorite restaurant without having to worry about coordinating childcare or a diaper bag or just enough snacks to hold our hungry child over until the meal arrived.

There were afternoons where we could have sex without worrying about waking up a baby or (worry of all worries) looking up to find a small child staring at us in confusion.

There were rock shows and neighborhood bars and mindless wanderings.

There were whims and fancies and last-minutes and unplanneds.

And then there were three.

And spontaneity seemed to happen to us.

Not whims or fancies or last-minutes.  (We were new–blissfully new–parents, and venturing outside of the home took at least one hour’s worth of planning and preparation.)

But there were unplanneds.

An unplanned wake-up call at 3 a.m.  And then another at 4 a.m.  And at 5:30.

An unplanned tooth arriving, just as we had gotten into a good sleeping rhythm.

An unplanned illness, an unplanned boo-boo, an unplanned diaper explosion.

An unplanned and profound joy as we witnessed first smiles, first hugs, first wonders at the world.

And then we planned.

And then there were four.

And spontaneity continued to find us–we did not usually find it.

Spontaneous labor, spontaneous feeding cues, spontaneous needs and wants and loves.

But still relatively (no, exceedingly) few whims and fancies and last-minutes.

Until yesterday.

Tim arrived home from work early, unexpectedly.

We had just enough time to dream up a trip to the science museum, to scramble to assemble our membership passes and shoes and snacks, to whisk the kids (and their peanut-butter sandwich halves) into their car seats, and to race off to COSI with just one hour before closing time.

We had just enough time to find spontaneity for ourselves for a change.

And like those long lost days of whims and fancies and last-minutes and Sunday morning savorings and evening wanderings, this newfound spontaneity was just as lovely, just as rejuvenating, and just as fun(ny).

M and Mommy watching a 3D documentary on whales and dolphins, while A and Daddy spent the hour splashing in the water table at the ocean exhibit.

Lamaze International’s fifth Healthy Birth Practice Paper is all about pushing: pushing in an upright position, pushing according to your body’s urges, pushing in a way that both maximizes a woman’s comfort and safety and encourages the rotation and descent of her baby.

It’s all about pushing in ways that research shows are healthy for moms and babies!

Nevertheless, despite the evidence supporting the “spontaneous pushing” (or physiologic pushing) that Lamaze and other birth advocates and researchers recommend, it’s not often that we actually see women pushing spontaneously.

As I’ve reflected upon my VBAC, however, I’ve realized that I did follow the healthy pushing practices set out by Lamaze International.  And this was not because I was a “better” pusher or a “better” birther than anyone else. And it wasn’t just because I knew that spontaneous pushing was healthy.

It was also because I had a support team who knew that spontaneous/physiologic pushing was healthy.

We knew that pushing in upright positions helps to facilitate a baby’s rotation and descent into the birth canal.

We knew that I needed to find the pushing position that worked best for me.

We knew that I needed time to rest in between pushes and in between contractions.

We knew that following my urge to push would decrease my likelihood of perineal and pelvic floor damage.

We knew that pushing in a calm and unrushed environment–and not pushing to a count of ten–would help to maximize my own and my baby’s oxygenation.

And they knew when to step back and allow me to do my work, and they knew when to step in and encourage me to change positions, to stay hydrated, or even to trust the process of birth itself.

This is what it looked–and sounded–like.

(It should be noted that I am publishing these videos with some hesitation–not because I am embarrassed about publicly displaying my “birthing behavior” but because I am offering what was perhaps the most vulnerable moment of my adult life up for public consumption.  Exposing that vulnerability is a bit daunting.  Nonetheless, I love these videos, and I love thinking about what they could help to share with other women and birth professionals.

And one more thing: these videos are not still images from my labor.  They are actual videos of the birth.  I grunt, I groan, I vocalize, and sometimes I even shriek. Birth is hard work.  But I want everyone to know–and especially those women who haven’t yet given birth–that these guttural, strange sounds were not scary to me.  Birthing was intense, and even painful, yes.  But the sounds were what helped me to cope with that intensity, with that pain.  So don’t be frightened when you hear me moaning like a beast!  I was just being a warrior!)

Transitioning from “grunty contractions” to feeling the overwhelming urge to push.

(This one includes the famous “10 cm picture!”)

Puuuushing.

(Adjust your volume accordingly.)

Birthing my baby.

(Again, adjust your volume accordingly.)

All apologies for the poor lighting in these videos.  I was willing to sacrifice a well-lit video for a dimly-lit place to birth, though!