After taking a birthing class in England, Marijana and Richard had a long list of questions for the staff at the Mrkonjic Grad clinic where they would have their baby: Would her husband be allowed to stay with her? Most husbands in Serbia don’t, they were told, but the staff could make an exception. What kind of pain medication would they provide? None, the doctor answered, unless you need a C-section.  What about epidurals? “If you want it, you have to buy it yourself,” the doctor responded. “Most people get them from Italy. And then you have to find the anesthesiologist to give you the injection.”

Marijana’s water broke that November on her birthday.  She called the clinic to tell them she and Richard were coming so they could turn on the heat in the labor room.

Two years earlier in Oaklyn, New Jersey, twenty-eight-year-old Melissa Farah, a special education teacher at Avon Elementary School, was pregnant for the first time. Melissa and her husband, Dan, were planners.  They had been married for almost two years and had begun trying to start a family on their first wedding anniversary. Melissa felt especially lucky because a close girlfriend, Valerie Scythes, was pregnant, too.  Both women planned to have their babies at the same hospital in Woodbury, New Jersey.

Here’s the question: Which young woman would be better off, the one in a small Balkan country still recovering from a brutal civil war, or the mom in the richest and most powerful country in the world with state-of-the-art medical equipment and know-how?

The answer: Marijana.

According to the most recent reports, the likelihood of a mom like Melissa dying due to pregnancy or childbirth in the United States is more than four times higher than in Bosnia and Herzegovina and seven times higher than in Italy or Ireland; the likelihood of her dying as a result of childbirth is five times greater than in Germany and Spain, and fifteen times greater than in Greece.

The United States also lags behind most industrialized countries when it comes to the health and well-being of infants.  Eight American children per 1,000 live births will not live to age five.

___________________

Excerpt from The Business of Baby: What Doctors Don’t Tell You, What Corporations Try to Sell You, and How to Put Your Pregnancy, Childbirth, and Baby Before Their Bottom Line by Jennifer Margulis, award-winning journalist and senior fellow at the Schuster Institute for Investigative Journalism at Brandeis University.

The Business of Baby investigates prenatal care, ultrasound, the cost of childbirth, circumcision, formula marketing, potty-training and diapers, vaccination, and well-baby care.  The book is available here at Amazon.

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A note from ImprovingBirth.org: In the true story recounted above, Marijana went on to have a healthy baby after a labor that included no fetal monitoring and no pain medication. When her contractions slowed down, her doctor and her midwife had her get up and walk around to get labor moving again. Melissa, who had entered the hospital healthy, underwent a C-section in the state with one of the highest cesarean rates in the country, and passed away the next day due to complications from the surgery.

We share this not to demonize cesarean section, which can save lives, but because it is a real-life illustration that, contrary to popular belief, the United States is not the safest place in the world to give birth.

The post The Business of Baby, by Jennifer Margulis appeared first on Improving Birth.

· · ·

The long-awaited national Listening to Mothers Survey III* was released this past Thursday, pulling back the curtain on what American mothers experience in maternity care. What stood out to us most as advocates for mothers, babies, and better maternity care was the dismaying contrast between the care women thought they received and wanted to receive, and the sub-standard care they were actually subjected to.

An overwhelming majority of women (83%) rated their care as “good” or “excellent.” They called their providers “very trustworthy” or “completely trustworthy” (80%). A closer look, however, reveals some deficits in care and providers whose recommendations deserved a second look.

What the survey found was an overuse of certain medical interventions in circumstances that don’t improve outcomes, but do increase the odds of complications and health risks to moms and babies; an underuse of scientifically proven best birth practices; and a lack of understanding on the part of the mothers who received this care.

Labor Induction

Two-thirds (67%) of all mothers agreed with the statement “if a pregnancy is healthy it is best to wait for labor to begin on its own rather than inducing it or scheduling a cesarean.” But a substantial number of the 40% of women who said that their care providers tried to induce their labors were induced for non-medical reasons. Some non-medically indicated reasons cited were things like convenience, reaching the estimated “due date,” wanting to end the pregnancy, and the care provider suspecting a “big baby.”

Childbirth Connection, Listening To Mothers III, 2013

Movement and Positioning

Research strongly supports mobility during labor. Movement reduces pain, lowers the need for pharmacological pain relief, shortens labor, and helps ensure optimal blood flow to the baby. Yet, in the Listening to Mothers III Survey, three out of five women did not get out of bed after admission to the hospital in labor.  (See articles at EvidenceBasedBirth.com and the Cochrane Review on this topic.)

Meanwhile, fully nine out of ten women gave birth on their backs or in a semi-sitting position—positions that compress the mother’s aorta and may lower oxygen to baby, reduce the ability of the uterus to contract most efficiently, narrow the pelvic opening, and force the mother to work against gravity.

Childbirth Connection, Listening To Mothers III, 2013

It is thought that most women give birth on their backs or semi-sitting because this is more convenient for the care provider. In contrast, upright pushing positions—which were rarely used—have been shown by evidence to lower the risk of forceps of vacuum-assisted delivery by 23%, the use of episiotomy by 21%, and abnormality in fetal heart rate patterns by 54%.

Expectations vs. Outcomes

Why did so many women have routine interventions for non-medical reasons—interventions that didn’t align with what so many of them said they believed: that birth is a “process that shouldn’t be interfered with unless medically necessary”? It seems a lack of understanding of the implications of the interventions PLUS complete trust in and pressure from care providers is a dangerous combination.

The Listening to Mothers III survey revealed that the overwhelming majority of women could not accurately identify the major complications associated with two of the most common interventions: medical labor induction and Cesarean surgery. The researchers said, “We provided mothers with statements concerning possible adverse effects of cesarean section and induction and asked if they agreed or disagreed with those statements. In no case did a majority of mothers cite the “correct” response. Pluralities of mothers were “not sure” for both cesarean questions and one of two induction questions” (emphasis ours).

Most women (two-thirds) thought it was best to wait for labor to begin on its own if the pregnancy was healthy, but almost eight out of ten women (79%) also incorrectly identified “early term” or “pre-term” weeks of pregnancy as “safe” for delivery. The timing these women most identified is associated with increased risks of harm for babies.

Childbirth Connection, Listening To Mothers III, 2013

A concerning number of women reported that they felt pressure from a health professional to accept medical interventions, including labor induction (15%), epidural analgesia (15%), or cesarean section (13%). Three times as many mothers (25%) who did have an induction or cesarean said they were pressured vs. mothers who weren’t pressured (8%).

Last, women didn’t always feel confident communicating with their care providers. Three in ten mothers (30%) said they’d held back on asking a question at least once because their provider seemed rushed. Women also held back from voicing concerns and asking questions because they “wanted maternity care that differed from what their care provider wanted” (22%) and because their care provider might think they were “being difficult” (23%).

    Non-Evidence-Based Recommendations

Childbirth Connection, Listening To Mothers III, 2013

Shared decision-making is considered a healthcare ideal.  But how can women engage in shared decision-making when they are being steered in the wrong direction?

When women in the Listening to Mothers III Survey were asked about three decision-making processes, the majority of women in two situations were steered in the wrong (non-evidence-based) direction by their care providers’ recommendations.  In the third situation (Vaginal Birth After Cesarean or VBAC vs. Elective Repeat Cesarean Section or ERCS), they were steered overwhelmingly towards ERCS, even though this is a very preference-sensitive decision and does not have one right or wrong path.

Two provider recommendations are particularly concerning: induction for big baby and induction for reaching the estimated due date. These are cases in which women are being influenced to take on significant increased risks with a major medical intervention for no potential benefit to them or their babies.

“We want women to trust their providers, but we also need providers to be trustworthy.” – Leah Binder, president of the Leapfrog Group, which focuses on incentivizing the health care industry
to concentrate on better care through private purchasing

The Listening to Mothers III survey found that, overall, American women are making uninformed decisions about their care or deferring to the recommendation of their care providers, with a result of high rates of interventions. These findings indicate a significant lack of fully informed consent.  We, as women in the U.S. maternity care system, have been agreeing to treatments that carry increased risks of complications, injury and death without fully understanding these risks.

How Can We Do Better?

Childbirth Connection, Listening To Mothers III, 2013

Shared decision-making can’t exist without great communication: honest and complete disclosure of concerns, risks, and potential benefits, and a discussion of all alternatives—all of which is framed within non-judgmental and non-coercive conversations.

There is shared responsibility here.  Both women and providers can improve maternal health care by better educating themselves about the current best medical evidence around birth practices, and by communicating more fully.  And both women AND their care providers must understand that the rights of informed consent and refusal allow the person receiving care to make the final decisions about recommended treatments, procedures, and medications.  Ideally, care decisions are reached by consensus—if there is hesitation on either side, there is probably an opportunity for more communication.

The good news is that this is all so very “doable.”  We have excellent research on best birth practices.  We have the technology to intervene when needed and save lives.  We have models that demonstrate how maternal and infant health outcomes can be improved while actually lowering costs.

In the U.S., we have the resources and the opportunity to do so much better for our moms and babies.  It’s time for all of us to play our parts and turn that “opportunity” into “reality.”

* The Listening to Mothers Survey III surveyed 2,400 mothers giving birth from July 2011 through June 2012.  The survey was produced by Childbirth Connection, conducted by Harris Interactive®, and funded by the W.K. Kellogg Foundation.  The full report is here.

The post Listening to Mothers III Survey Reveals Need for Improvements in Information, Communication in U.S. Maternal Health Care appeared first on Improving Birth.

This is not a post about natural birth.  Just keep reading.

When I was preparing to give birth, I saw it as a once-in-a-lifetime event and something I wanted, more than anything, to do “right.”  By doing it “right,” I meant that I wanted the safest and most positive outcome possible; to me, it was perfectly obvious that safety and a good experience were inextricably linked.  And, as the person playing the most active role in the event, I felt it was my responsibility to shape those things.

It was a little alarming to me that so many of my friends and acquaintances who had given birth did not particularly want to talk about it, and didn’t necessarily think it was a good idea that I learned as much as I could about it before doing it.

Before and after giving birth, I got the sense from some people that in seeking a “positive” experience, I was being high-maintenance and was somehow less concerned with my baby’s well-being than someone who didn’t ask questions or want to actively participate.  I rolled my eyes at the speculation and barreled right through it, but, on reflection, it struck me as odd.  How could it be “selfish” to do what I could to facilitate a less traumatic birth?  Didn’t less traumatic mean “safer”?  My body—a body I’d come to know and like for the last 30-some years—was being subjected to a major, life-altering process.  Why did it suddenly have such reduced value?  Why was I suddenly not supposed to have any say over what happened to it?

And . . . why did people assume that my baby’s safety must be lower on my priority list, because I wanted his birth to be a positive experience? 

That’s a doozy of an assumption.

Prior to giving birth, my primary motivations for attempting a normal, unmedicated, physiologic birth were so that my baby wouldn’t be born with drugs in his system; so that we could benefit from the dance of hormones science hasn’t come close to replicating; and so we could avoid the dreaded “cascade of interventions” that ends in 1 in 3 American babies being born by surgery.  All of these things meant healthier bodies, better bonding, and a higher chance of successful breastfeeding.  That was selfish?

When I first began researching birth and options, I went in completely biased against unmedicated birth (why would anyone choose pain?), but what I found didn’t support my bias.  I found, to my complete surprise, that it was possible to give birth with dignity and humanity, and that, on the whole, those births seemed to be the least medically risky.  Over and over again, I saw that the births where women were supported in the process rather than managed like children–where mom was treated by her skilled, attentive providers as the most important person in the room–the smoother the birth and the safer the baby.  Bingo.

Choices in birth are very personal.  I do not believe that every woman should, must, or can have a physiologic birth.  That fact does not change a word that I write here.

It was only after I gave birth that I grasped the real value of what I instinctively wanted.  I’m not sure I knew it then, but my tendency toward a physiologic birth was me protecting myself and my baby.  But the bigger picture is that if birth were merely a day or two out of our lives, I wouldn’t have gone on to devote my time to this cause.  Birth carries a much bigger impact than a one-time mere medical event.

Birth is valuable because it is the beginning of the mother-baby relationship.

Once you have been a mother, you will never not be a mother again.  The minute you go into labor, you are on a rollercoaster that doesn’t stop.

The way you meet your baby can very much set the tone for the postpartum period.  It is a tough time.  You’re unsure of yourself, on no sleep, hoping you don’t accidentally harm or starve this helpless, completely dependent little thing. The stress of a baby crying for no discernable reason is indescribable.  I don’t recall ever feeling so frustrated in my life.  We all laugh about those moments of irrationality, when you have to place your baby in her crib and walk away in order to keep your sanity.

I have seen first-hand how the birth experience impacts this time.  I came off my baby’s birth strengthened and confident—in complete awe of what my body had done.  And it was still the most difficult time I’ve ever had.  I’ve seen what happens when women come off a traumatic birth, too, and I’ve seen the lack of spirit and the helplessness they sometimes exhibit.  I’ve talked to the women who spent hours crying in the basement or listless in bed, unable to get it together, or just dragging through the day with no joy.  Even the women who rally and carry on are carrying wounds they must wrestle with at some point or another.

When I say “traumatic birth,” I’m not talking about medical complications. I’m talking largely about healthy women with realistic expectations who were treated disrespectfully or without compassion at that most vulnerable time: women who weren’t treated like the most important person in the room, as they gave birth to the most important thing in the world.

Feelings of desperation, low spirits, and worse plague a new mother and affect how she nurtures her baby.  We’ve only begun to explore the connection between birth experiences and incidences of postpartum depression or post-traumatic stress disorder in new moms.  Coming off birth strengthened and supported is invaluable to mom and baby.

Something we forget is that you are already a mother during birth.  Birth and postpartum are your relationship with your baby as a new mom.  The quality of that time is something you will remember all your life.  Saying that what happens with you and your baby during and after birth doesn’t matter is the same as saying it doesn’t matter whether you bond with your toddler or that it doesn’t matter whether your teenager hates you.  Birth is part of your life as a mother.  This is your life.

Birth is valuable because women matter.

It’s a dangerous assumption I alluded to above: that only a woman who doesn’t care about her baby would care about her body and her birth.  It’s damaging and wrong to communicate to women that we must make a choice between ourselves and our babies, because we can’t both matter.

Acting as if a baby’s safety is compromised by treating his mother well in birth is ludicrous, and I’d like to call for an end to that.  If I could go back in time, I’d ask those people who questioned me to please explain how I was the most important factor in pregnancy and the least important in birth.  How my value as a person deserving of positive experiences plummeted so dramatically when I crossed the threshold from pregnant woman to woman in labor.  And how on earth treating my body well in pregnancy was intuitive, but treating my body well in birth was not.

I’d say to those people, “Explain to me again how it’s selfish to take my responsibility as a mother seriously?”

Simply by virtue of being human beings, women matter.  We deserve respect, compassion, and kindness in birth, because we are human beings.  But let’s not forget that greatest of responsibilities given to us as mothers: we are guardians of our babies.  In pregnancy and birth, what happens to us happens to our babies.  And because the ways in which our children come into the world are some of our first acts as mothers, our babies deserve for us to be treated as if we matter.

I encourage you to embrace that truth, and act as if you mean it.

Want to support ImprovingBirth.org’s mission?  Like us on Facebook, participate in our history-making 2013 Rally to Improve Birth, and donate to the cause.

 _________________________

Cristen Pascucci is Vice President of ImprovingBirth.org.
She is a political and communications strategist, and writes professionally.
Contact her here to inquire about those services.

Also by Cristen:

A Healthy Baby Isn’t All That Matters
“A healthy baby is all that matters” is simply not true—especially when, all too often, “healthy” means “surviving birth,” for both moms and babies.

Respect in Birth: Get Over Yourselves
As birthing women, the conflicting messages we quite often receive are: You make decisions about your body—except when we do.  You are in charge of your birth—until you’re not.

Take Back Your Birth
Take back your birth.  It truly is yours, and you don’t need anyone’s permission.

I Don’t Care How You Give Birth
Birth doesn’t always go according to plan, which is why it’s not enough to create a “birth plan” and call it a day.  Sure, most of the time it is safe, but that doesn’t mean it’s predictable.

One Year Ago Today
I knew a medical induction in a first-time mom doubles her chances of a c-section.  Something wasn’t right, but I wasn’t sure what.

“My mom matters.”

The post Selfish Women and Their Silly Birth Experiences appeared first on Improving Birth.

I’m supposed to say I’ve recovered and that the cesarean didn’t matter.  But that’s just not true. Twelve years have passed and though the tears, like my scar, have faded, I lost part of myself on that operating table.

Roanna Rosewood is the author of the new Cut, Stapled, & Mended

I told people that it didn’t matter. I smiled at visitors and said “at least the baby and I are fine.” I even ordered a big dessert tray for the hospital staff for delivering my baby, for changing his diaper and bathing him, for doing all of the things that a mother is supposed to do but I could not. But at night, when the house was quiet, and my son’s soft lips released their seal on my breast, the tears would come. Flashes of being tied down and cut open haunted my dreams. No matter how hard I tried, I couldn’t snap out of it.

Desperate, I sought help from an array of alternative healers. I tried acupuncture, chiropractic work, rapid eye movement, herbalists, traditional therapy and hypnotherapy, homeopathy, and cranial sacral. I even visited a psychic. But eventually I realized that expecting others to fix me was no different than letting others take my baby from my body. As only a mother can deliver her own baby, (doctors are limited to catching, cutting or pulling them out) only I could reclaim what had been lost on that operating table.

Fear became my enemy. As I started to challenge it, I saw that what I had thought was my comfort zone was really just a gilded cage. Every time I self-consciously sat still when my feet longed to dance, or kept silent when I had something meaningful to say, I perpetrated what the cesarean had done to me.

I started to see that the cesarean wasn’t a random event. True, doctors could have prevented it by supporting me through labor and birth. But wasn’t the outcome of medical care alone. It was also a reflection of who I was: someone who sought comfort over glory and security over challenges, someone whom I didn’t like very much.

As painful as this awakening was, it offered hope. Because I was responsible for who I had become, I had the power to change who I would be. Every time the little voice in my head said to sit still and be quiet. I did the opposite. I risked making myself look foolish. I spoke my truth. I danced (gasp) in public! This conquering of self was so rewarding that, before I knew it, I was riding a mechanical bull, parasailing off mountaintops, walking on hot coals, and traveling to remote corners of the world.

No longer a victim, I relish the sacred ground that only survivors can walk upon. Though I will always mourn the part of me that died on the operating table, I love what was born even more. Yes, I love myself now.

Roanna Rosewood (www.RoannaRosewood.com) is an award-winning speaker, the producer and co-host of BirthPlan Radio, a coach who loves to help women claim their power, and the author of Cut, Stapled, & Mended: When One Woman Reclaimed Her Body and Gave Birth on Her Own Terms After Cesarean–which hit #1 in FOUR categories on Amazon the same day of its launch (April 30, 2013)!

The post Cesarean Awareness Month: Cut, Stapled & Mended appeared first on Improving Birth.

A powerful video story, written by Chelsea Shure of ICAN in Los Angeles, and put to video by ImprovingBirth.org’s Dawn Thompson.

The post Cesarean Awareness Month: The 18-Month Cry appeared first on Improving Birth.

Every April (Cesarean Awareness Month), it is hard not to notice the advocates working diligently at raising awareness surrounding the overuse of cesarean surgery in the U.S.  There are blogs, articles, radio pieces, films, round tables, and Facebook campaigns plugging the risks and benefits of cesarean, preventing the first cesarean, family-centered cesarean, and the possibility of VBAC (vaginal birth after cesarean).  It can be difficult and sometimes “triggering” for those of us who have experienced traumatic cesarean, or traumatic circumstances leading to cesarean, to consume all this information, even as we feel called to participate in raising awareness.

Why?  Because for some of us our births are too fresh.  Some of us who have experienced traumatic births still feel angry and hurt, and are reminded of what could have been done better.  Others are reminded of how much work there is left to do in our own healing and in advocating for women.  How do we come to the place where we are healed not only outwardly, but also inwardly?  How do we come to the place where our scars are no longer a burden to bear?

When I became pregnant for the first time, I didn’t doubt my body’s ability to create, grow, and birth a baby.  I’d supported my sister through the natural, unmedicated birth of her son; I’d witnessed the incredible power of the female body and felt it pulsing through the room as he emerged into this world.  It simply never occurred to me that I would give birth any other way than “naturally”: unmedicated and vaginally.  I stayed active and healthy; wrote a birth plan that included natural pain relief techniques and shared it with the OB practice I was seeing; attended hospital birth classes; read pregnancy magazines and popular pregnancy books; and asked my sister to support me and my husband through our big day.

After an ultrasound on the day I turned 38 weeks, it was recommended that my labor be induced because of my baby’s large size.  I was told it was my best hope at achieving a vaginal birth with no pain medication, and so I agreed.  I wasn’t told that induction can fail; I wasn’t told that it doubled my chances of surgery.  Before the induction could happen, however, another doctor decided it would be too risky, as my baby would be over ten pounds.

I was told that vaginal birth might even end in my or my baby’s death.  It was heartbreaking, but I, my husband, and my sister felt that surgery that same day was the only option.  It was still hard to understand how a healthy pregnancy was ending in surgery before I’d even gone into labor, but the cesarean was presented as being the safest course.

I tearfully signed the papers and we were in surgery within the next few hours.  I had never been hospitalized before; I was nervous, frightened, and alone.  I was crying hard, and the anesthesiologist who had been laughing and poking fun at some of my questions about the spinal procedure said, “Why are you crying?  It’s your baby’s birthday!”  I could not answer him.

My daughter was delivered from me at 8 pounds 13 ounces with “We Built This City” playing on the radio in the background.  I was never spoken to directly by the doctors during surgery and was groggy from the medications when my husband was finally allowed to come in the room to see us.  As she left the OR, my doctor glanced down at me and said, “Congratulations.”  I never saw her again.  My daughter and I spent five days in the hospital healing from a surgery that, somehow, felt very wrong.

Those first days with my daughter were both tremendously special, and some of the darkest days of my life.  I cried continuously.  We both suffered complications from surgery and early birth that I hadn’t been aware were risks when I consented to the procedure. Because I wasn’t encouraged to get out of the bed and walk, and I could not bring myself to do it, I suffered shortness of breath and a heavy chest, which required that I be tested further to rule out a pulmonary embolism.  My daughter had to be suctioned several different times during our stay for fluid in her lungs and also given an enema to help her pass meconium.  She was so sleepy from the medications of birth and her other difficulties that breastfeeding was difficult.  I became painfully engorged.  We begged to see a lactation consultant, but one never came.

The weeks that followed were tough, too, as I continued to experience minor physical complications from surgery.  My outer incision, which had been glued and taped, came open and became infected after I bent to pick up a blanket I’d dropped on the floor.  At that point, I couldn’t even care for my baby alone.  The weight of what I had just experienced was almost too heavy to bear.  No one but my sister and husband understood why I was so sad—perhaps because they, too, had been there for the misinformation and scare tactics and dismissive treatment.

I began searching for answers as to how this surgery had happened when I thought I’d planned so carefully, and what I learned in the following years changed the course of my life forever.  I discovered a whole world of information that at the time wasn’t readily offered to a young, naive first-time mother.  I found that the resources I could have utilized to help me achieve the unmedicated, vaginal birth I’d wanted were in my city, but I wouldn’t have known to look for them.  I hadn’t known doulas or independent childbirth education existed, or that midwives still attended births in homes.  I hadn’t understood why when I had looked for an in-hospital midwife, I could not find one.

At the same time I was learning all of this, I continued on my path of healing from what was ultimately a loss.  I had a beautiful daughter and we had bonded well, and I was beyond proud to be her mother, but I felt we had been robbed of her healthiest birth.

Eventually, we decided to have another baby.  By that time, I had plugged into the mothering community in my city, and was able to carefully plan a vaginal birth after cesarean (VBAC) attended by a midwife and supported by a doula.  This birth would be at home.  I was too afraid to go into another hospital.  At that point in my life, I had trouble even going for a normal doctor’s visit after what I’d experienced with my first baby’s birth.

My second daughter was ultimately delivered via cesarean, as well, after complications in a long labor coupled with a few other factors led to necessary surgery for us.  This surgery—at a different hospital than before—was nothing like my first cesarean.  I was treated with compassion by the doctor and staff; I felt like a real part of the process in this birth; and the decision I made to give my daughter the safest birth possible, by surgery, was based on sound medical evidence.  This birth was relatively peaceful, and I knew what to ask for in our aftercare and newborn care so that my daughter and I were never separated.  As good as it was compared with my first birth, it pained my heart that it wasn’t the vaginal birth I knew was possible.  I decided then that I was finished having children and my focus would be on mothering them.

What I know now is that I hadn’t done the inner work that it took to heal emotionally from my first cesarean experience.  I had not been prepared as I should have been to VBAC.  There were so many things that I still could not face.  What had happened in my first birth was not because I was uneducated or did not seek out the best care for me and my baby, or did not do everything possible for her safety.  But it was nothing short of a violation, and I needed to heal from that reality.

First and foremost, I needed to value myself as a woman and mother.  If I had no self-worth, how could I expect that the experience of birth would offer me any more value than I already had for myself?  What my second birth taught me is that when one values herself even just a little bit, her confidence prompts others to treat her with respect.  I needed to take that sense of self-worth further, and rise up out of victimhood and into empowerment.

Another thing I had not done to prepare for birth either time was learn to love my body.  So often, we mothers sacrifice ourselves and our self-care—and so we should, but we must value ourselves, too.  I did not see my body for the amazing thing that it was or the beautiful work that it was doing.  I saw the work of birth as a toughing it out: a show of strength.  While it is very much a show of strength, it is so much more.  In pregnancy and birth, our bodies are at work and performing at the top of their capabilities.  My body will do the work differently than my mother’s, my friends’, my colleagues’, or the woman down the street.  As familiar as birth is to our bodies and our gender, “normal” birth isn’t what we’ve come to expect, if we believe it looks like it what we see in movies and on television.  Our pregnant bodies are ornate vessels laid out with intricate design, shaped in amazing ways, and ready, when we acknowledge them, to serve us.

As I learned to truly respect what my body had done for me, I looked at my births less as me failing or being failed, and more as a means for me to grow into the mother and person I am today. I came to understand that being a victim and trying to save others from being victims doesn’t help improve the climate of birth in our country or the world.

It means taking responsibility into our own hands.  Responsibility doesn’t mean blaming yourself for past choices, or being a martyr, or wallowing in guilt.  It means taking responsibility for how this event – whether it was a traumatic cesarean, an unplanned necessary cesarean, or any other form of trauma in childbirth – will imprint your life.  We can sit in disappointment, blame ourselves or others, or we can empower ourselves through what can be gleaned from the experience.

It was during my third “surprise” pregnancy that I learned the bulk of these things.  Preparing for that birth was a much deeper experience for me.  I learned my body like I had never known it before.  I released emotions from way back when.  I fed my body.  I nurtured my spirit.  I enjoyed my children and my husband.  I moved in beautiful ways.  I had my first maternity photos taken.  I celebrated.  I prepared and thought about what was appropriate for whatever way my birth needed to come to fruition. I accepted and planned for all possibilities.

What I learned in this journey was healing holistically.  You can’t assume fear is addressed if you have toughened up.  You can’t believe in your body’s ability to see your baby into the world in the safest, truest possible way—whether it’s vaginal or cesarean birth—or in your body’s ability to feed and nurture your babies, if you look at your body in disgust every day and do not care for yourself properly.  You can’t intuitively know what is right for you if you have fallen out of the practice of listening to the still small voice that every one of us has.

I chose to give birth at home for my third baby, because I knew that a mom-directed birth would be healthiest and safest for us.  I’d come to realize during my preparation that if I was to VBAC successfully, I would need to be able to move, eat, breath, shower, rest, monitor, and listen as my body told me was necessary.  The only way to do that was at home with a carefully selected and very supportive birthing team.  Homebirth is not the right or best option for all women planning a VBAC or vaginal birth after multiple cesareans (VBAMC).  A safe, supportive environment might be in the hospital, at a birthing center, or at home.  It’s a deeply personal and individual decision.

In the weeks before my birth, I surrounded myself with positive people, stories, and activities.  The birth itself was exactly how it should have been for me. Like the period at the end of a sentence.  A most glorious few days of a non-event, and completely normal.  The birth of my third daughter was the perfect summation of all of my efforts for the last seven years.

It is one thing to heal physically from a birth trauma, but we must be willing to go deeper, to ask the tough questions, and to seek our inner balance.  As we are all beautiful in our own unique ways, so will be the ways in which our babies come into the world, and so will be the way we heal and allow that experience to make our lives richer.  For me, reaching that balance was the most normal feeling in the world.

Kelli Haywood is the mother of three daughters, a birth advocate and the founder of Birth True. Haywood lives in Kentucky, where she teaches workshops and offers private coaching for preparing VBAC mothers.

The post My Cesarean Healing: From Trauma to Self-Appreciation appeared first on Improving Birth.

Get over it? Just like that? Of course the ultimate goal is a healthy baby, and of course you are going to agree to the cesarean for the well-being of your child. But that doesn’t mean it’s going to be easy to let go of the experience you’ve been envisioning for nine months, and it doesn’t mean you don’t have the right to grieve that loss.

It can be extremely empowering to take back the birth experience – to decide where and in what position you will labor, to tell the delivery staff, “I will not lie on that bed and push my baby out, thank you very much,” and to place your baby on your bare chest immediately after he or she is born to nurse and begin your new life together. But once a cesarean enters the picture, the ability to maintain any power over your birth experience flies out the window…or does it?

Immediate skin-to-skin for Kelsey and her son Finn while still on the operating table as surgery finishes up. “He was silent, just stared at me, and then rooted around to nurse,” says mom. So precious!

My partner Sean and I had been planning a natural childbirth. We established our prenatal care with a midwifery practice, we took a six-week natural childbirth class, we attended a labor workshop, we read Ina May Gaskin’s Guide to Childbirth, we watched videos of water births, we hired a doula, we had a birth plan – we were set. Our due date came and went, but that’s pretty standard for first babies, so no one was worried. I had had a relatively easy pregnancy, the baby was healthy, I was healthy, so all seemed fine.

At 41 weeks I went in for a routine ultrasound just to make sure my fluid levels still looked good. I sat in the chair, the tech gooped up my belly with gel, and she placed the ultrasound probe on my skin.

“Oh, so I see we have a breech baby.”

“Huh? We don’t have a breech baby!”

“Yes, you do – see? This is the head right here.”

WHAT????!!!

I had just been to see my midwife the week before, and she didn’t think there was anything abnormal about the baby’s position. I immediately started to cry and asked, “What does this mean? Will I have to have a c-section?  Isn’t there some sort of turning procedure that can be done?” The ultrasound tech told me the obstetrician would come and talk to me and that, yes, if the baby wasn’t too big, they might be able to try the External Cephalic Version (ECV) turning procedure, but they could also just go ahead and schedule a cesarean for me since I was already at 41 weeks.

“I really don’t want a cesarean,” I told her. “We really want to have a natural childbirth. I’d really like to try to turn this baby.”

One happy mommy: Donita and Alejandra bonding after birth

Our baby was estimated to be 7 pounds 14 ounces (we later learned he was about a pound larger than this). Since they thought he was fewer than 8.5 pounds, the obstetrician said he could make an attempt at ECV.  He told me to go ahead and schedule the procedure for the next day. If the ECV attempt didn’t work, he told me, he would go ahead and deliver our baby via cesarean that same day.

I felt like I had been hit by a truck. It was just too much to process all at once – to find out that our baby was breech, to schedule an appointment for this weird medical procedure, and to swallow the idea that if the ECV didn’t work, I was going to have my baby surgically removed the next day. It seemed that not only were all of our plans flying out the window, but so was all of our power.

I scheduled the appointment and then went to see my midwife. I felt some relief when she told me that, as long as the baby was not showing signs of distress, I absolutely did not have to have a cesarean the next day if the ECV didn’t work. I was only one week past my due date; I had until the following Monday (two weeks past my due date) to try to get this baby to turn. I was so grateful to have that extra window. I felt like we got back a little bit of that power we had lost.

We went to the hospital the next morning at 6:30 am, and after waiting 3.5 hours, the ECV was performed. It was excruciatingly painful, and, unfortunately, it didn’t work. They monitored the baby for two hours after the procedure was attempted, and we were cleared to go home. We were very disappointed the procedure didn’t work, but we were grateful to have a little extra time to try some other turning techniques.

With careful planning and support of their care team, this family had a gentle, joyful, family-centered cesarean at Baystate Franklin Medical in Greenfield, Massachusetts.  Mama waited until labor began to go into surgery; after birth, she got her wet baby skin-to-skin on her chest, and the obstetrician even
milked the baby’s cord to send her home with the placenta!
Credit: Marissa Potter at www.BellyfullBirth.com

And try we did. Over the course of the next four days, I had two “Turn-Baby-Turn” Massages; four visits to the chiropractor for the Webster Technique adjustment (video here); lots of forward-leaning inversions; and a crazy set-up that involved an ironing board propped on an incline against the couch, me lying on the ironing board with my head at the floor and feet up at the top of the board, a bag of frozen blueberries at the top of my belly, a heating pad at the bottom of my belly, and a flashlight shining and music playing between my legs.

On Friday, we went in for another ultrasound and learned that, despite all of our efforts, our baby was still breech.  Reluctantly, we scheduled the cesarean for Monday morning.

At this point, I reached out to other women I knew who had planned a natural birth but ended up needing to deliver via cesarean.  I asked for their advice – what did they do (or what did they wish had been done) to make their birth experience more in line with what they had hoped for?

I am so glad I asked. I learned that, even with a cesarean, it is possible to retain some control over the birth experience. One friend in particular, who had to have an emergency cesarean after planning a natural homebirth (twice), really helped us identify certain requests that we could make, requests that gave us a taste of those aspects of the natural birth that were most important to us. She also sent me this article, which is about strategies to make cesareans more woman-centered.

On Saturday morning (two days before the cesarean was scheduled), my water broke and I went into labor. We went to the hospital, and, thanks to the bagel I had eaten a half hour before, I had to wait for six hours for the cesarean.

From the U.K.: baby went right to mom’s chest and had delayed cord clamping, as well.

I felt like it was such a blessing to get to experience natural labor for those six hours! Laboring is good for the baby, and it was good for me emotionally. While they were preparing me for surgery, I met with the obstetrician and the anesthesiologist and made a few requests for my cesarean.  They agreed to all of my requests, and I had a much more fulfilling birth experience because of those few little things. Here’s what I asked for:

1. I asked them to drop the surgical curtain down a little bit and to and hold our baby up after they pulled him out so I could see him immediately after he was born. I couldn’t see the actual surgery (thankfully!), but I was able to see our son in the first seconds of his life.
2. I requested that they put our baby on my chest in the operating room while they were sewing me back up. They did have to wrap him up in blankets before they could put him on my chest because they keep the operating room so cold (to prevent bacterial growth), but at least I was able to see him and touch him and kiss him before they took him to be weighed and measured.
3. I asked, in addition to my partner, to have my midwife in the operating room with me (which I was glad to learn was standard operating procedure). I gave my midwife a camera and asked her to take pictures of the cesarean. This was wonderful – the pictures were amazing, and having the documentation of our baby’s first moments outside of the womb helped me to connect to the birth experience and begin to feel like our experience was a real birth.
4. I requested that my partner be able to stay with our baby through all of the post-birth measurements and procedures.
5. I requested that I be allowed to breastfeed our baby as soon as possible. He was brought to me in the recovery room within an hour of his birth.
6. I requested that my doula be permitted to sit with me in the recovery room so that I had someone to keep me company while I waited for my partner and our baby to return from the nursery.

While my partner and I weren’t able to have the birth experience we had been envisioning, our son’s birth was still special. I think the reason it didn’t end up being a traumatic experience for us was because we were able to retain some power over the process. In many cases, there is the opportunity to make requests of the surgical team, but we often don’t realize we are “allowed” to ask.

ASK.

Our thanks to Shannon Bell in Lexington, Kentucky, for contributing this story!

The post A Family-Centered Cesarean: Taking Back Control of My Son’s Birth appeared first on Improving Birth.

Birth is like nothing you’ve ever experienced.  Husbands, mothers, and best friends are wonderful and helpful, but they do not have the benefit of hundreds or thousands of hours of assisting at births.  Certainly, if you are attempting an unmedicated birth, you will want some serious support, but I believe any birth in a hospital setting can benefit tremendously from someone who knows the ropes and is there for you only.  (Click here for a fact sheet to share with your healthcare provider about how the presence of a doula benefits the whole care team.  In the case of Cesarean surgery, see EvidenceBasedBirth.com’s “A doula facilitates skin-to-skin in the operating room.”)

A good doula knows what you need before you do.

A doula in action

I can think of a hundred examples of why my doula, Julie, was so essential to my wonderful birth experience, but here’s just one: when I was several hours into labor, I’d figured out that rocking in my rocking chair seemed to alleviate the pain of contractions.  My sister-in-law/birthing partner Rebekah and I both were thrilled that I was getting along so well.  But you know what my doula said when she walked in on this scene?  She said, “It hurts less because you’re stalling labor.  Do you want to prolong this, or get it over with?”  Of course, she was right, and as soon as I got out of the chair and into the forward position she suggested, labor picked right back up, escalating until we left for the hospital two hours later.  Had she not said something, I would have happily sat there all day, wasting more and more energy and time and thinking I had this labor thing whipped.

What else did she do?  Julie knew how to massage me when I literally couldn’t speak; when I puked, she cleaned up my face and tied my hair in a bun that lasted all day; she knew the nurses at the hospital so that my birth plan was prioritized during delivery; she told me where I was during the phases of labor (which I wanted to know, but was unable to articulate); she guided my hands down to hold Henry as he was being born.  And I will be forever grateful to her for making sure that – just in case – photos were taken of the birth, something I’d forgotten to plan for.

Most important, she was one of the main reasons I got through a natural birth.  She was able to guide me right through the process with confidence, and I trusted her to do so.  I will say this: I would not have had an unmedicated, natural birth without Julie’s guidance.  No question.  Does that tell you how important she was?

I don’t mean to discount other support.  Rebekah and Julie made a great team.  While Julie was assisting me during vomiting spells, Rebekah knew where to find a bucket and towels.  When we needed contact information for someone, Rebekah knew where to find my computer and what the password was.  She registered me at the hospital while Julie talked me through contractions.  And, because she is family, she was a completely different kind of emotional support.  Both ladies were necessary in their own capacities.

If I haven’t convinced you yet, consider this.  What’s the worst that could happen if you get a doula and she’s not that helpful?  You’re out a few hundred dollars – barely a dent in the grand scheme of baby-related medical bills.

What’s the worst that could happen if you DON’T get a doula and you need one?  It’s realistic to say that you could have a significantly less satisfying, possibly more traumatic, birth.  Evidence shows lower rates of medical interventions when doulas are present, and the calming effect of a doula impacts safety in a very real way.  Labor is influenced by your mental and emotional state.  It’s critical to your physical health to support those things.

Simply put: friends and family have a different function from trained, professional labor and birt­h support.  For the best experience you can have, and the happiest, healthiest outcome, consider having a doula at your baby’s birth.  I don’t think you’ll regret it.

A doula is trained to provide mothers with emotional support, information, and assistance during labor and birth.  She may also assist during postpartum care with breastfeeding or newborn care.  She is not a medical professional, and will not act in a medical capacity.

Remember, like any other profession, there are good, bad, and great doulas out there.  Look at certifications, but, in my view, experience and skill are as important, if not more.  Do your research, get recommendations, interview several, and pick someone who is a good fit for you.

For more on “The Evidence for Doulas,” see this excellent article at EvidenceBasedBirth.com.

The post Doulas: A Birth Essential appeared first on Improving Birth.

For me, it took an ultimatum by one care provider (a midwife!) for an unwanted, unnecessary induction to learn how important that is.  Leaving that provider at 41 weeks, 6 days pregnant was a daunting prospect, but one that allowed me to discover a new way of thinking about my responsibility as a mother and my care provider’s responsibility to me.  We hire our providers for their knowledge, expert skill and advice, and the benefit of their experience–not to make decisions for us, without our participation or consent.

“I remember my very first visit to the obstetrician.  I was young and naïve and alone, and a nurse laughed at me because I didn’t know I was supposed to get dressed after the doctor left the room.  I’d never been before, no one told me what to do, and I was almost in tears when I left. That woman had looked right at me and laughed. My teenage pride was hurt.

“It was more than 13 years later that I had an emergency appointment with the midwife who would take everything I’d internalized about birth, my body, and my responsibility as a woman—and turn it on its head.  She did it by allowing me dignity, respecting me, and, most of all, by showing me compassion…”

Read the rest of the article here, at Midwife International’s blog.

Please understand: this was my experience with one midwife.  I am not saying that all midwives are this way, nor am I saying that you can’t get excellent, respectful care from someone who is not a midwife (although the midwifery model of care, by definition, tends to lend itself more towards woman-centered practice).  It’s the theme that’s important: respectful, individualized care rooted in science, not routines.

Melissa, Cristen, and Henry
Photo credit: Mark Mahan, http://markmahan.com/

The post “A Midwife Changed My Life” appeared first on Improving Birth.

“Early Deliveries Without Medical Indication: Just Say No“

“Vaginal Delivery Recommended Over Maternal Request Cesarean“

We spoke with Dr. Nikolas Capetanakis, an Ob/Gyn in Encinitas, California about these statements.  What do they mean?  How do they impact our care as pregnant women?

Dr. Capetanakis told us that “this information is not ground-breaking; however, it is a good reminder about the parameters in which we should practice.”  For one, induction or surgery for “suspected big baby” (macrosomia) is not medically indicated.  This is one myth we hear about all the time, even though ACOG has been talking about the “imprecise” nature of diagnosing macrosomia for at least ten years.  Bottom line: induction for big babies is NOT medically indicated.

Elective inductions prior to 39 weeks gestation is, again, not recommended.  Studies have shown that babies do better when they are able to remain in utero until 39 weeks.  In the article above, ACOG says, “Early-term infants have higher rates of respiratory distress, respiratory failure, pneumonia, and admission to neonatal intensive care units compared with infants born at 39 to 40 weeks gestation. Infants born at 37 to 38 weeks also have a higher mortality rate than those born later.” The March of Dimes’ “39 Week Initiative” has covered the subject intensely and created a protocol for all hospitals to follow.

In this new age of information, Dr. Capetanakis wanted to mention that women should not feel tied to a provider they are not comfortable with.  It is never too late to transfer to a physician who is more in line with your philosophy and willing to communicate openly and honestly about what is and what is not evidence based medicine.

Consulting on this article: Nikolas G. Capetanakis, D.O., FACOG is a board certified obstetrician and gynecologist with a private practice in Encinitas, California.  He completed his residency at Loma Linda University Medical Center and specializes in VBAC and unmedicated deliveries, minimally invasive surgery, and fertility treatments.

The post ACOG Takes a Stand on Elective Cesareans and Induction for “Big Baby” appeared first on Improving Birth.