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Birth Pregnancy

Natural Sacred Birth

Natural childbirth for healthy, low-risk women is the only natural function of the human body that typically occurs in the hospital. “Why is that?”, you may ask. Because our culture has co-opted Birth, babies, and women’s bodies for the benefit of capitalism – Big Pharma, Insurance companies, and Hospitals – the Trifecta of the medical-industrial complex. That is the only reasonable explanation as Women’s bodies have been successfully birthing live babies for literally millennia – else how would we be here? Birth has only been happening inside hospitals for about one hundred years and studies have shown that it’s safer to birth outside the hospital to avoid the unnecessary interventions that lead to worse outcomes. 1,2

Doctors are taught to fear birth

Medical schools have also contributed to the situation by instilling a climate of fear surrounding Birth mostly related to potential litigation. They believe that if the doctor is taught how to control birth, then they have control over being sued. In addition, natural birth is not taught to OBs because their focus is surgery. They are surgeons; the interventions they advocate frequently lead to surgery, and this is where they shine. Obstetricians are surgeons and if you are seeking the care of a surgeon, you are likely to have surgery. Very simple.

Birth cannot be controlled

Interventions in childbirth give the illusion of control over a natural bodily function that cannot be controlled. Women’s bodies will open and release the baby inside when the body and the baby are ready. This is normal, natural childbirth in a nutshell. Even the women doing the opening and releasing have no control over the process. The only control that is possible and productive is the act of surrender to this most basic bodily function. When a woman is able to fully surrender to every aspect – when and how – then when her body and the baby are ready, it will happen. The more surrendered a woman is to the process, the more efficient it is.

Thirty-eight percent cesareans in Palm Beach County

Our community (and there are many like ours) has not embraced this principle. It is very typical for women to be induced at 38 or 39 weeks of pregnancy for a myriad of reasons. We know that when labor is induced before the body and baby are ready, then things can go wrong. The body may not fully dilate no matter how much cervical ripening is chemically encouraged or how much Pitocin is given. Often the baby will not be able to tolerate the cocktail of chemicals involved between the induction drugs and the inevitable epidural. A woman may enter the hospital wanting a natural birth, but very few are able to tolerate the torture of hours of fasting, limited mobility and abnormally strong and consistent contractions, not to mention the flow of strangers into the room, the bright lights, uncomfortable bed, etc. An epidural is the only relief she can get in the hopes of maintaining her dream of vaginal birth. Palm Beach County has an average Cesarean rate of about 38%. That’s more than 1:3 women walking into the hospital expecting a vaginal birth and ending up having surgery to have their baby!This is NOT because Birth is dangerous. This is because our community has a culture of meddling with an otherwise normal, natural process. And that meddling leads to dangerous birth.

ACOG supports VBAC

The national organizations that oversee and regulate birth providers have reasonable recommendations regarding things such as vaginal birth after cesarean and breech birth. But the local OBs tend to disregard these reasonable and evidence-based recommendations. One example of how our local OB community rejects recommendations by ACOG (American College of Obstetricians and Gynecologists, the national organization for obstetricians and gynecologists), is with VBAC (Vaginal Birth After Cesarean) candidates. ACOG recommends that doctors offer vaginal birth to women who have had 1 or 2 previous cesareans. They also don’t recommend inducing labors for VBAC candidates. Yet many OBs in our community still recommend repeat surgery for these women or insist that they birth by 39 weeks. They routinely induce VBAC candidates at 39 or 40 weeks which can lead to the very complication that they fear – a ruptured uterus. Also, there is no solid evidence that a woman with more than 2 cesareans is not a good candidate for a VBAC, but there are very few OBs that are willing to “allow” these women to attempt a vaginal birth.

ACOG supports out of hospital birth

Another example of how our community defies the national recommendations is through a document is known as The Levels of Care document that was endorsed by both ACOG and SMFM (Society of Maternal and Fetal Medicine, the obstetric specialists). In this document, it is recommended that all healthy, low-risk women birth outside the hospital in Birth Centers. If the situation changes, the woman is transferred to a higher level of care – one where the ability to perform a cesarean or other interventions such as Pitocin or epidural is available. There are even higher levels of care such as Intensive Care where caring for someone who is on life support machines is available and not all community hospitals have this option for women during or after childbirth, so she would have to be transferred from the lower level hospital to a higher one. The idea is that we have lots of birth centers, less of the community hospitals and only one or two regional centers to care for the very complicated cases. However, our local OBs do not encourage their healthy, low-risk women to birth outside the hospital. Rather, they look for reasons to elevate a woman’s risk and encourage interventions such as unnecessary inductions.

Birth is sacred

Birth is a sacred event that happens to each of us only once as we enter the world. How it happens is important for the one being born and for the one giving birth. If we are going to see a world that is healed from all of the devastations of poverty, war, climate change, and abuse it has to start with how we care for those giving birth and being born. I have grown up in my Midwifery career hearing the saying that ‘Peace on Earth begins with Birth’. We have to honor the process and respect both mother and baby by not causing pain and trauma but rather supporting, facilitating, and protecting the process. This can happen more easily out of the hospital in a woman’s home or in a birth center. However, I have not given up hope that we can shift the culture of childbirth within the hospital by spreading information and demonstrating a better way. We do this by supporting birth centers and encouraging the growth in the number of birth centers in our community.

Support the ‘birth’ of Gentle Birth Centers

I’m happy to announce the addition of a new birth center in Wellington – opening soon. Gentle Birth Centers will be teaming up with Midwife360 to create an integrated practice of home, birth center, and hospital care for healthy, low-risk candidates. We plan to open this spring and are located within a mile of the nearest hospital. Let’s change birth together!

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Birth

What to Expect From a Home Birth

So you’ve decided to have your baby in the comfort of your own home. What should you expect? As a CNM who has provided home birth services for nearly 6 years, I am going to provide you with an overview of the general expectations that await you in this experience.

We visit your home 

Your provider will come to your home at least once during the prenatal period to assess home readiness for birth. We like to see that our clients have acquired all of the supplies that were recommended, including the kit of supplies that was provided by our practice. Some examples of supplies provided by the practice are sterile gauze, sterile gloves, a peri bottle, chux pads, a fish net (for pooper scooper if having water birth), a waterproof mattress cover, and potentially other items depending on the practice. The items that you are responsible for include a drinking water safe water hose, adapter for the faucet, receiving blankets for the baby and towels of various sizes, snacks for the laboring person and birth team, adult diapers or maxi pads, a waterproof covering for the floor and extra padding for under the pool. We like to see that the intended birth space is clean and clutter-free and in an intimate space where the birthing couple can get privacy if desired. It should be in close proximity to the bed and bathroom.

What happens when you go into labor? 

Once you have decided that you are in labor you will be in contact with your midwife and doula. We like our clients to set up a group text with their partner, doula, midwife and assistant so communication is transparent for all involved. This way the laboring couple are not asked the same questions by different people and everyone knows what’s going on. Typically the doula will arrive first, and if the laboring person desires a cervical check to see where things are at, the midwife or assistant will come to do a labor check. We will assess her contractions, her coping, when she last ate/drank/used the bathroom. We listen to fetal heart tones, take vitals and get an overall feel for what’s going on – including the emotional environment. 

Sometimes we have to reassure the partner more than the laboring person of the normalcy of the situation. If the cervical exam isn’t 4-6cm and the labor doesn’t seem to be progressing quickly, the midwife will leave and the doula may stay to help the couple perform some Spinning Babies circuits. Usually the doula will help to set up the tub when it’s time and let the couple know when it’s time to call the midwife back. At any point, if the couple wants the midwife to come, we will come and assess the situation.

Active Labor 

Once the laboring person is clearly in active labor, the midwife or assistant will stay and perform checks on the baby’s heartbeat and mother’s vitals on a schedule at least every half hour. We listen for a period of time through and after the contraction to get a feel for the response of the baby to the contractions. We are watching for anything outside of the normal range as well as for specific things like maternal bleeding, fever, or lack of coping. We have many tools we can employ – depending on the midwife and her range of experience. 

Our Toolbox 

We use herbs, homeopathic remedies, essential oils, posture changes, and of course, hydrotherapy. We make sure she stays well hydrated, well nourished, and well rested – these three elements are crucial to avoid exhaustion which is a laboring person’s enemy. Sometimes we use alcohol to aid relaxation and sleep if mom becomes exhausted and her labor is stalling out. Once she gets rest she is much more capable of continuing and usually the labor will pick up on its own. We have found that labor has its own waxing and waning rhythms much like each individual contraction and it works much better to flow with it rather than trying to force it to conform to some ideal pattern.

A note on hospital transferring 

If at any point along the way the laboring person changes her mind about being at home, for any reason, we will shift gears and transfer to the hospital setting. Of course we first assess if she is in transition as many people have doubts about their ability to birth in the crucial moments just before the baby makes his final descent. However, if we determine that she is no longer comfortable at home we will get her quickly into the car and to the hospital of her choice. We call ahead to give report and accompany her to the hospital.* Once there, we would stay until her care is fully transferred to her new care provider or until the baby comes if financial arrangements have been made.

Staying home 

Most people are happy to stay home as this has been something they have prepared for physically, emotionally, and spiritually, sometimes for years. Most also birth in the tub if they have rented one and are comfortable in it. 

Whether in the water or on land, baby comes out as slowly and gently as possible with lots of encouragement and coaching from the team. We have found that the slower the expulsion of the head and body, the less trauma to the mother’s vagina, labia, and perineum. Contrary to what we hear from our clients who transfer to us, we are well equipped to sew almost any tear that happens during birth. We carry Lidocaine for numbing and sutures for sewing.

“Self Starters” 

Most babies are what I like to refer to as ‘self starters’. They will spit or cough and utter a birth cry and then they are breathing. Most of them do not cry as their birth has been so gentle they have no reason to cry. We know when to employ helpful measures such as postural drainage, stimulation, rescue breaths, and suctioning and are fully equipped to perform a full on cardiac resuscitation on the newborn if necessary. 

I have seen 1 instance out of 250 home births, and 0 instances out of the over 1600 hospital births that I have assisted in my career of babies needing full on cardiac resuscitation. BIRTH IS A NORMAL, PHYSIOLOGIC FUNCTION OF A WOMAN’S BODY THAT RARELY NEEDS HELP FROM OTHERS. As long as the body is healthy with no underlying medical problems, giving birth outside the hospital is actually safer for the mom and the baby.

Post Birth Procedure 

We keep a close eye on both mom and baby right after birth, assessing vital signs and mom’s bleeding every 15 minutes or more often as needed. We carry 3 different drugs to treat hemorrhage, and one of them, methergine, we have both pill and injectable form. We will not hesitate to call 911 if there is any emergency event that requires hospital intervention. We stay for 3-4 hours after the baby is born, assessing vital signs and the baby’s transition. 

Once the placenta is birthed, we ensure that mom has eaten, showered and urinated. We perform an Eldon card so we know the baby’s blood type and can make recommendations for jaundice prevention or give Rhogam to the mom as needed for Rh negative moms. We make sure the baby is breastfeeding well and the parents are comfortable in their new roles. 

Postpartum Visits 

After the birth we make sure our clients know that they can call us for any problem with mom or baby and that we will be coming back to the house between 24-48 hours after the birth. At that visit, we perform the CCHD**, jaundice, and weight checks. We give the Vitamin K injection if the parents have chosen to have it. We would give the Rhogam shot if Mom is Rh negative and baby is Rh positive. We assess breastfeeding again and refer to the pediatrician if there are any concerns with the baby. We assess moms bleeding and comfort and any issues with depression. We return again to the home at 1 week postpartum to reassess all of the above concerns for the mother. And we will schedule the final postpartum visit at 5-6 weeks in the office to talk about family planning, pap smear schedule and any other concerns that arise.

This article gives an overview of what to expect when planning a home birth. Stay tuned for more educational articles from Midwife360!

*There have been a few instances where we have not accompanied a client to the hospital. These were rare and individual circumstances and not the normal scenarios.

** CCHD = Critical Congenital Cardiac Defect A screening test performed on the baby between 24-72 hours after birth to rule out any critical congenital heart defects.

Categories
Birth

What to Expect from a Hospital Birth

What happens when you choose to have your baby in the hospital? The specific answers to this question depend on whether you are sent there for induction or are arriving in labor. It also depends on your planned mode of birth – vaginal or cesarean. We will talk about planned vaginal birth in this article. 

Know what you’re signing for

If you arrive at the hospital for a planned induction, you will be registered for your stay, then sent to the L&D unit to check in. If they have an available room for you, you will be admitted to that room, given a hospital gown to change into and asked to leave a urine specimen in a cup. A nurse will then come in and hand you a clipboard with a stack of papers to sign. Most of them are consent forms and she has likely perfected a quick synopsis of each form. You aren’t encouraged or discouraged from reading them thoroughly, and she will answer your questions. However, this part of the intake usually goes pretty quickly – if you get my drift. The forms include consent to treat for vaginal or cesarean birth, consent for blood products, consent for Vitamin K, eye ointment, (maybe Hepatitis B vaccine, circumcision for boys, and a new eye exam that includes dilating the baby’s eye and holding it open with a metal cup). Your provider is really the one who should be giving you the risks and benefits of each intervention that you are signing for, but in reality that almost never happens.

Triage and cervical checks

If you are in active labor, unless the baby is imminently coming, you will be processed through the labor triage room where you will be given a gown and asked to leave a urine sample and get hooked up to the monitors to determine your labor pattern. Then one of the nurses (or your provider if available) will do a cervical check to see if you are at least 4 – 6 cm. You will stay depending on your contraction pattern and your cervical dilation. If your contractions are not frequent enough or lasting long enough or too long, and your dilation isn’t at least 6, you may get an ultrasound and then (if everything is good on the ultrasound) sent home. This may happen several times before you are finally admitted in labor. It is not a bad idea to stay home as long as you feel safe before going to the hospital to avoid being sent home multiple times.

When you arrive in labor, whether breathing through your contractions or feeling like pushing, the above- mentioned forms still have to be signed once you are admitted – by you, the ‘patient’. If the baby is coming and you absolutely can’t sign, they will give them to you after.  You get the idea.

So what happens when you’re admitted? 

From here on out, whether induction or active labor, everything is basically the same. After the forms, they will come in with all of the IV equipment to start your IV and draw blood. Everyone gets an IV unless you make prior arrangements with your provider, and most providers prefer you to have the IV. You are also then hooked up to the monitor with a toco that documents the timing of your contractions and an US that displays the baby’s heartbeat. 

Things you need to know

Now you are basically tied down with 2 monitor wires and an IV line which makes it difficult to get out of the bed or even change positions. Unfortunately, this goes against one of the main aspects of efficient labor – that of free movement. Even L&D nurses are getting hip to Spinning Babies – a system of postures and movement that help the baby shift into the best relationship to the mother’s pelvis for a smooth birth.

You will likely have a cervical check once you’re all settled in, and you may or may not be asked for your permission. If you are not already 6 cm or do not achieve 6 cm within a couple of hours, the provider will likely want to start pitocin to speed things up. Again, you may or may not be asked permission for this. 

Induction process 

If you are there to be induced, sometimes they start with a cervical ripening agent. In south Florida, most providers use Cervidil which is a tampon-like insert that stays in the vagina for 12 hours. Some still use Cytotec which is ¼ of a pill that is less predictable than Cervidil and can cause strong contractions that come too frequently. It has been associated with fetal intolerance and uterine rupture. You have a right to decline this. Two hours after the Cervidil is finished and taken out, they will want to start the Pitocin and break your water bag.

Here comes the epidural

Once things get rolling, if you choose to get an epidural, the anesthesiologist or Registered Nurse anesthetist will come in to evaluate you, give you the risks and benefits of the procedure and forms to sign. If you are a good candidate for the procedure, they will ask everyone to leave the room, prep and drape you and place the epidural catheter. Afterwards, they lay you flat in the bed for about 20 minutes and then you will be able to sit up and turn side to side with help, but will no longer be allowed out of the bed.

It is not impossible to do some of the Spinning Babies postures while tied to the bed or with an epidural, but it is much harder and requires a dedicated doula or very motivated nurse to accomplish them.

Once you become fully dilated you may be asked to start pushing, even if you don’t feel ready. Alternatively, if your baby is high and you don’t have a strong urge to push (or have an epidural and can’t feel that urge) you may be allowed to ‘labor down’. This refers to the process of allowing the labor contractions to bring the baby’s head down through the birth canal so that the pushing phase can be much shorter. 

Let’s talk pushing + birth

Pushing in the hospital is typically more like an athletic event with everyone yelling at you to “PUUUUSH” and instructing you to hold your breath while you push for a count of 10. You will likely have your knees up in the air with someone helping you hold your legs back. There is a definite air of adrenaline inspired action and rush to get the baby out at this point. Once the head is born, you will be told to push again to effect birth of the body and the baby may or may not be placed on your belly. Typically the cord is cut shortly thereafter and then the baby is taken to the warmer to be stimulated and dried and “eyes and thighs” (eye ointment and Vitamin K shot) are done. The baby will then be swaddled in a receiving blanket and handed to you. Some L&Ds are supporting skin to skin with the parents and may not wrap the baby up before giving him back to you. 

That is a typical hospital labor and delivery scenario. There may be individual providers that do things slightly differently, but for the most part this is the way we do it in America.

Evidence Based Birth

In general, you are not asked permission for any of the procedures and interventions that are performed in the hospital. The general idea being that you have presented yourself there so you must be ok with whatever they feel is appropriate. The truth is that most of what is done in the hospital is NOT evidence based and you would significantly benefit from educating yourself on the different possible interventions (ask your provider what the typical birth scenario looks like to her). A web resource such as Evidence Based Birth is invaluable for expecting parents whether they’ve had a baby in the hospital or are expecting their first.

Interventions 

Another trend that I’ve witnessed is the trove of interventions that are performed on the newborn – especially if she is a premie. Our hospitals and hospital providers are making A LOT of money off the backs of our most precious and fragile resource – the next generation of human beings, who cannot speak for themselves. Please educate yourselves as parents and protect your little ones from these unnecessary interventions!

*As a nurse midwife who worked in the hospital Labor and Delivery units from 2005 – 2014, both as a Labor and Delivery nurse and as a CNM, I have had a substantial amount of experience seeing thousands of women and families come through to experience the birth of their babies. Since 2008, I have worked in my own home birth practice where we have periodic exposure to the hospital L&Ds with the clients that we transfer in for one reason or another. I have not seen many substantial changes happening for the process of hospital birth, other than perhaps a nod to the delayed cord clamping movement with a reluctant delay of a minute or two or milking of the cord in some cesareans (which is now thought to contribute to brain bleeds and not such a good idea). The only real change that has occurred has been the elimination of the regular newborn nursery, and this seems to have resulted in a greater number of babies being sent to the NICU – negating the potential positive outcome of having less babies experiencing separation from their parents.

Categories
Birth

Top Ways to Prepare for a Positive Birth Experience

The top ways to prepare for a positive labor and birth experience begin long before the actual labor starts. At Midwife360, we talk about our “Recipe for Success” when we are discussing a client’s birth plans. 

The core of our recommendations include self-education through reading books and online resources (see the reading and web organization list at the end of this article) and commitment to a healthy lifestyle through clean eating and regular exercise. We strongly advise eliminating processed foods, dairy, and inorganic foods. Through clean eating and regular exercise, it is likely that there will be an absence of disease processes such as diabetes and high blood pressure which can make a pregnancy cross the line into a truly high-risk status. If the pregnancy can be maintained in the low-risk status range, then recommendations such as induction of labor are more easily declined. 

Our “Recipe for Success”

Our “Recipe for Success” also includes hiring a doula and taking a deep meditation for labor course such as Blissborn or Hypnobabies. Many times the doula will be the one who teaches these courses. Doulas are invaluable as educational resources and typically have a wealth of information regarding comfort measures and labor preparation activities. They will meet with the client usually two times prenatally and will be the first to show up at the labor. They help with labor support if things are not progressing, and will let you know when to call the midwife or leave for the hospital. Meditation or hypnosis is a tool that can be used to cope with the surges of labor. It helps to keep the mind occupied with positive thoughts to allow the body to perform the work of releasing the baby unimpeded.

Positioning of the Baby 

The most common reason that labor doesn’t progress is the positioning of the baby. We recommend becoming familiar with an online resource called “Spinning Babies” that teaches postures that can be used prenatally to help ensure proper positioning of the baby in relation to the mother’s bony pelvis. This will ease the baby’s passage and create a more efficient labor process. Your doula will most likely be familiar with this resource and have the ability to guide you through the postures as well as know when to employ them in labor.

Using a Birth Tub 

The final recommendation in our “Recipe for Success” is to use a birth tub for labor and birth. The benefits of hydrotherapy have been recognized by midwives and laboring women for years. Some people call it a ‘liquid epidural’ as the sense of relief is so great when entering a warm tub of water in active labor. Sitting on a yoga ball or stool in the shower can have some of the same sense of relief, but immersion in water is better and helps lift the belly to remove the heaviness caused by gravity. Also, releasing the baby into the water helps with vaginal and perineal stretching and reduces tearing.

Visiting a Chiropractor and Acupuncturist 

In addition to the “Recipe”, we strongly recommend developing relationships with a chiropractor and acupuncturist who are skilled in caring for pregnant people. Get regular massages and take yoga classes or do yoga at home. All of these adjunctive therapies contribute to a body that is well adjusted and free from muscular and energetic blockages that can inhibit the passage of the baby when it’s time for birth. 

Preparing for a positive labor and birth experience ideally starts before pregnancy. However, with a determined mindset and a willingness to do the work, preparation for a positive experience can easily be accomplished in the 40 weeks of pregnancy. Decide where you want to give birth and hire a care provider that you trust. Check out the resources listed below and prepare to have an amazing, informed, respectful labor and birth experience!

Categories
Birth

An Open Letter to Hollywood Producers and Screenwriters

I am writing this letter to appeal to you to stop portraying birth in the manner that nearly every single movie, sitcom, or miniseries has always seemed to portray birth – that of a screaming, sweaty woman lying on her back with her feet up in stirrups and everyone else in the room standing over her, yelling at her to push. The baby comes out and the cord is immediately cut (even in Call the Midwife – the truest to real-life series which portrays childbirth) – this is not beneficial to the baby, was not likely done back in the 1950s in England, and shouldn’t be done today.

Human birth has been domesticated much the same way we have domesticated animals for our benefit. Human birth (especially for low, risk, healthy women) is the only physiological, normal process of the human body that takes place inside a hospital. It doesn’t belong there. It doesn’t work well with bright lights and loud noises and strangers hovering around. Much like our mammalian counterparts, humans do better to birth in a familiar environment, with dim lighting and no distractions. It is a bodily process that requires no input from the thinking mind.

Ask some of the Hollywood actresses and singers who have chosen to birth at home (or in a birth center) how they feel about this. Every one of them have raved about their experience and found an amazing bond with their baby and an easing into motherhood that doesn’t always happen so easily when babies are born in the hospital. Oftentimes, mothers and fathers are frightened by well-meaning care providers and may be treated disrespectfully or even neglected due to the assembly-line nature of hospital birth.

If birth was portrayed in the media as physiological, natural, and low tech (which it actually is for a low risk, healthy person). Then perhaps more people would have the courage to take responsibility for this bodily process that is more of an intimate experience involving the 2 people who created the baby than of the institutions who seek to profit from it.

After all, having a baby is a lot like pooping – what if we had to go to the hospital and get permission to poop? That would be weird… Clients can easily find well trained medical providers to assist them in the out-of-hospital setting to ensure that any potential complications are handled appropriately. This will have a dual benefit of making birth better for birthing people and unclogging the medical system that exists to help those who truly need it.

Let’s start seeing real birth scenes on TV and in the movies – please.

Categories
Birth Pregnancy

Birth Your Own Way

I saw a Facebook post recently, a fundraiser, for a woman who wrote about her search for a provider who would assist her in having a vaginal birth for her 4th baby after having 3 previous cesareans. For whatever reason (VBAC ban, or just no supportive providers to be found) she moved 3 states over just to give birth with a supportive provider. It seemed from the post that they actually moved their family to that location to be in proximity to this supportive provider. Due to moving during the pregnancy, they did not have the funds to pay for the birth upfront, thus the Facebook fundraiser.

How did we get here?

How is it, in our medically advanced culture, that someone has to actually move to a different state to achieve this kind of support? I know that we don’t have supportive providers in our community here in south Florida that would support a vaginal birth for someone with 3 or more previous cesareans. Though, I know that I would support such a person under the right circumstances. Those circumstances are that the pregnant person has to be in excellent health with a healthy, otherwise low-risk pregnancy. She has to be fully committed to her birth plans, to the point of saying “I am doing this with or without you”. In other words, fully committed to the choice for an out of hospital birth.

While there is no guarantee for the outcome, an otherwise healthy low-risk pregnancy has little added risk for VBAC or other complex physiologic circumstances like twins or breech. With good counseling on risks and benefits and the understanding of the limits of any guarantees, clients should be free to make the decision to birth outside the hospital in these situations. Actually, clients should be free to make the decision to birth vaginally and should be able to access a supportive provider wherever they feel the safest – whether that is in the hospital or outside of it.

I am a provider that supports VBAC, twins, and breech for a vaginal birth.

I have found that my sister midwives are not happy that I do this. They report feeling threatened by my choices to support these births out of the hospital due to the possibility that any bad outcome would reflect negatively on the birth community as a whole. They believe that if I have a bad outcome I am giving home birth a bad name. I believe that I am giving people options they would not otherwise have. There are only about 2% of people that choose to birth out of the hospital. Most of those that choose home birth are die-hard home birthers who would not go to the hospital unless someone’s life was in danger (literally). They understand that there are no guarantees in life (or birth) and they typically have educated themselves on the risks and benefits of out of hospital birth and willingly, gladly, sign the consent waiver for home birth under complex physiological circumstances.

Enter the twins

I recently assisted a couple with twins who wanted very little prenatal surveillance, and home birth with mostly a hands-off approach. She went into labor the day she turned 40 weeks. The first baby came fairly quickly and it was the most serene beautiful water birth! Soon after, we attempted to get FHT (fetal heart tones) for Baby B and were unable to locate them for a few minutes, then when we did finally find them, they were very low – the 60s. Mom was instructed to push to try to encourage baby to come quickly, and within minutes, someone called out, “head’s out!”.

When I reached over to touch, it was obvious that it was not a head, and I tore the sac to find 2 legs unfolding into the water. I instructed Mom to get out of the tub as it was a surprise breech (baby had been head down at the last ultrasound at 28w) and I was concerned because of the low FHT. The baby then came fairly easily, but her placenta was sitting on her head and plopped out right after her – complete placental abruption. This is likely the scariest and most serious complication that can happen at home. Luckily Baby A and mom were doing well, no bleeding noted and Baby A was transitioning beautifully.

We immediately began going through the NRP steps that we learn and practice for just this eventuality. We also called 911 as a baby that requires CPR needs to be closely monitored for 24 hours in case there are further issues with the heart and breathing. The paramedics arrived within 6 minutes and by then she was only requiring breaths with the bag and mask as her heart was beating on its own at the appropriate rate.

It was difficult to watch her go without the ability to witness her recovery, but we had no choice as we still had the first baby and mom to care for. One assistant and the dad accompanied the baby to the hospital, the rest of the team stayed at the house. Ultimately, she made a full recovery. She began breathing on her own before they even arrived at the hospital, and was discharged home the next day due to a lot of questioning by and the determination of her parents. She seems to be completely normal and adjusted to life outside the womb.

This couple had 3 previous birth center births and were only having a home birth because their favorite midwife was unable to support a twin birth at her birth center. They were completely uninterested in a hospital birth. I’m pretty sure they would have chosen to birth at home with or without trained medical assistance. Had there not been someone trained in neonatal resuscitation present, their baby could have died. I wonder how our community would have felt about that?

When I help clients with a breech baby, or twins, or VBA3C or 4,5,6,7C or VBAC twins or breech, or past 42w. They tell me there’s no way they will birth in the hospital or no hospital provider will give them a chance to try for a vaginal birth. I believe it’s better to have a trained provider than for them to try a free birth and have a tragic outcome. If there’s a tragic outcome anyway, they have taken full responsibility for their choices.

Think about the big picture

However, I truly believe that our job as out of hospital birth providers is to monitor and observe the big picture at all times and identify an emergency before it becomes one in order to access the proper medical care. This means that we are alert and focused on one mom and her baby(ies) at all times during the experience. This is why we love to work with doulas. It gives us the luxury to arrive in active labor, which is the ideal time to be sharp and ready as birth becomes more imminent.

While I do not relish the added stress of caring for a more complex physiologic situation. I do believe in women’s bodies and the birth process as an inherently normal, natural process. In situations such as those with previous uterine surgery, twins, breeches, or post dates, it is unlikely that there will be any major complications if the pregnancy is healthy and otherwise low risk.

In every situation, as long as the provider is on her toes, focused and present, a major complication can be handled without turning into a tragedy. This is why I will support these clients. I wish more of my colleagues could do the same. I understand that the CPMs would be risking their licenses to do so, but this is not the case for my CNM and OB counterparts. In their case, the fear of birth and mistrust in women’s bodies limits their understanding of what is possible and safe. I have found that many people are seeking healthier living, especially when they are growing a baby. Many are super open to discussions of the importance of a healthy diet, adequate water consumption, and exercise in pregnancy, which all lead to safer birth for everyone.

Don’t judge anyone for their choices in birth. Not when they choose a repeat cesarean or even primary cesarean, and not when they choose home birth – no matter what their circumstances. Every client has their own reasons to choose what is right for them and their families. And don’t judge the providers that help them when they have a track record of good outcomes. It is better to have a trained provider present and we shouldn’t have to hide or suffer unwarranted criticism for our willingness to help.

Categories
Birth Pregnancy

What’s wrong with the Medical Model of childbirth?

Let me tell you a story…

We recently attempted to assist a client to achieve a successful home vaginal birth after 2 previous cesareans. She was a little more than one week passed her due date, and she had tried to induce her labor with castor oil. The oil didn’t seem to do much, but her water broke and she was having contractions soon after. Her labor progressed quickly, but her baby remained high in her pelvis and it took a lot of maneuvering with Spinning Babies postures (Walcher’s Brim is a great one for this problem) and the baby finally began moving down into the birth canal. 

Things take a complicated turn… 

However, after hours of pushing, seeing the head and thinking that the baby was coming any minute, she began having some bleeding. It was significant enough that the midwives elected to transfer by 911 to the hospital. All of mom’s and baby’s vital signs were good, but unexplained bleeding in a mom with 2 previous cesareans is a potentially life-threatening sign. Our job is to recognize potential emergencies and get to the hospital before the train wrecks. This momma continued to push in the ambulance, and within minutes of getting into the hospital she pushed her baby out! 

Hallelujah!!! The baby came through the door, not the window! 

But wait…The baby was a bit shocked, but instead of allowing him to get his full placental transfusion and administering PPV (Positive Pressure Ventilation)* with a bag and mask to help the baby inflate his lungs, they immediately cut the cord and rushed him over to the warmer to tortuously stimulate him into taking his first breath. I had a hard time watching the video due to the roughness and lack of respect afforded this brand new being. 

How does this impact our society?

For the nurses and midwives on duty, it is just another case, just another hour in their day. However, for that baby, it is his BIRTH. That happens to every one of us just ONCE in this life. We clearly do not appreciate the importance and significance of this event for our species. I am frightened to see the future generations coming up in the world when they have embedded in their primal memories this episode fraught with pain and fear and separation from the source of their sustenance. We are not building generations of people who will have love and trust as their core values. Else wise we must figure out how to overcome a beginning like this. Prolonged skin to skin contact with both parents initially and prolonged on-demand breastfeeding with baby-led weaning will both go a long way to repair the damage.

Hospital L&D should be a place that all women feel comfortable, respected, and supported… The other thing that really bugged me about this experience is that when the midwives showed up (they followed the ambulance), they were greeted by a seasoned L&D nurse who was shaking her head and clearly upset by the situation. She said something to the effect that the client is an RN at their facility, and that she should have known better than to attempt a home birth. Really!?!?! Excuse me, but maybe your facility should do a better job at supporting women with their choices so they wouldn’t see home birth as their only option. 

We at Midwife360 would be happy to encourage our VBAC moms to birth in the hospital. We acknowledge that it is the safest place to be for someone with a complex physiologic pregnancy. We also believe that the way someone is treated during their pregnancy, labor, and birth will have far-reaching consequences for them, their baby, and their entire family. It can mean the difference between having postpartum depression or not. It can mean the difference between successful breastfeeding or not. It can mean the difference between having a vaginal or cesarean birth. On an individual level and ultimately on a societal level, these things matter!

What’s wrong with the NICU?

The next situation evolved because the baby had a ‘lesion’ on his head. It was in such a position that it was likely caused when he was trying to get under her pubic bone and the length of time that he was in the birth canal. Neither parent had a history or tested positive for herpes – which is what the hospital providers were worried about. They started the baby on an antiviral, and on an antibiotic, since mom was GBS positive and had received her antibiotics just shy of the 4 hours recommended by the protocol. The baby was not sick and had no abnormal WBC (white blood cell) nor a positive culture. They insisted on performing a spinal tap for this well-baby because they were sure he had herpes somewhere that was gonna kill him. The mom knew her baby was fine, but every time she said she was taking her baby home, the nurse practitioner would tell her that her baby could die. This baby spent 10 excruciating days in the NICU and received multiple doses of antivirals and antibiotics, with multiple IVs in his little body, and endured a spinal tap – FOR NOTHING! A huge NICU bill later for a normal baby with a skid mark on his head. I believe we can do better in our hospitals. 

What can we do? 

Expose the neonatologists who up-sell services for healthy normal newborns and get evidence-based care into standard practice. We must not stand for this any longer! This family was so relieved and ecstatic for the vaginal birth they knew was possible, only to be traumatized and beaten down by having to advocate and protect their new baby. It doesn’t have to be this way! It’s up to individual parents who have these types of experiences to write letters and submit evaluations of their experience to the hospital and local media. Also, seek out respectful maternity care and demand respectful newborn care as well. We as a society can do better for our pregnant people and newborn babies!

*This is giving the baby breaths with the bag and mask and is the first step in neonatal resuscitation. 5 long slow breaths.

Categories
Birth Pregnancy

Natural Birth After C-Section

Can I have a vaginal birth if I already had a c section?

The short answer is, “YES! YOU CAN!” While the long answer requires a conversation about various risks – risks of a VBAC, or vaginal birth after cesarean, AND risks of repeat surgery. Unfortunately, it is the second set of risks that are routinely left out of the conversation when you speak with a hospital provider (OB or CNM) about it. And, also, unfortunately, these same providers often offer the VBAC and then find a reason at the end of the pregnancy that either induction of labor is ‘necessary’ (not the best plan for a successful VBAC) or a repeat surgery if the pregnancy goes beyond 39 or 40 weeks. 

Where can I have a successful VBAC?

This drives many women to seek an out-of-hospital birth provider for their planned VBAC, even though everyone agrees that the hospital is the best place due to the easy and quick access to emergency services. Since VBAC is prohibited in Birth Centers, this leaves home birth as the only option. And home birth is not for everyone. It is certainly not the best idea for someone whose main reason for choosing it is to avoid the hospital. It is always better to run towards something rather than running away from something. In other words, the choice to have a home birth should be driven by the desire to have your baby in the comfort and safety of your home, not by the fear of the hospital.

Successful home birth requires dedication and preparation

We have seen a situation like this where the client chose to have her baby with us because of her fear of having another c section and her inability to find a hospital provider who would support her decision to birth vaginally. She did not have a doula or take a birth preparation class. (These are 2 of Midwife360’s 3 keys to successful, efficient birthing. The 3rd is using the birth tub.) Consequently, she was unprepared and unsure when her labor did start, and did not request the midwife presence in a timely manner. She birthed on the toilet and her baby actually went into the toilet! They had the midwife on the phone throughout the process and she was able to guide them verbally (the part about the toilet came out later!) and everything turned out well. 

This is an example of how normal the process is for most people – even those who have had previous c sections – and for most babies. Babies are resilient and born to survive and know how to start breathing with little to no help in most cases.

Most predictions by OB providers are wrong

“Your baby is breech, and even if it turns, your pelvis is too small to push. There’s an 80% chance you’ll have to have a c section if you try, and then it would be an emergency surgery, which is more dangerous. So let’s just schedule the c section as this will be safer.”

I’ve heard this same speech from many clients over the years. This particular client told us this story of her first birth – the baby turned out to be 5#5oz. When she got pregnant the second time, they said she would have to have another surgery – it would be safer, they said. “But my mom had a c section and then pushed my brother out right after – he was over 10# – can’t I at least try?” “No”, they said, “it’s not safe”. There was no discussion of the risks of surgery, all focus is on the risks of trying a vaginal birth.

You can do it!

When this woman got pregnant a third time, she knew that she could birth her baby vaginally. She drove an hour away from her home to find a provider that believed in her and would support her. And although she did not take advantage of the 3 keys to success, (she used the birth tub only), she was so determined and dedicated that she was able to adequately prepare herself mentally for the big day. She was able to birth an 8#3oz baby vaginally in the birth tub with her sisters, husband, mother-in-law, and daughters all present and cheering her on! She pushed for over 2 hours, but barely tore and the baby came out quickly with no problems.

Our bodies and our babies are made for birth

When will OB doctors and other birth providers stop telling women what their bodies cannot do? Women are created with the social imperative to create life and deliver it to the outside world. Among many other things, we are very well designed birthing machines! If you didn’t know this already, then you do now!

Be empowered, be informed, stand up for yourself and your baby!

Categories
Birth Pregnancy

High-tech Childbirth is Not Always Better

America excels in high-tech medicine

When it comes to healthcare and medicine, America is the greatest country in the world. If you get into a car crash or have a heart attack, or need a life-saving surgery, then you are very grateful to have that happen in the US of A. However, this statement is not true if you are pregnant and healthy. It is well known that the US scores shamefully low on the two standards used worldwide to evaluate how well a country is doing in the area of childbirth – infant mortality and maternal mortality. And it’s not a mystery as to why this is the case. We know that the standard interventions performed on pregnant women in the hospital on low-risk, healthy moms and babies are not evidence based. Withholding food and fluids by mouth.  Limiting movement and positioning in labor.  Use of continuous fetal monitoring for low risk labors.  Non-medically indicated inductions.  Immediate cord clamping.  Overuse of Pitocin for labor augmentation. All of these standard interventions can lead to perceived and real problems that trigger the cascade of events leading to an operative delivery – forceps, vacuum extraction, or cesarean (and occasionally a cesarean with forceps or vacuum delivery!).

Low-tech better for physiologic childbirth

When it comes to childbirth, high tech is not better than low tech. I have been privileged to attend many out of hospital births and many more in hospital births. Even a ‘normal’ birth in the hospital typically comes with continuous fetal monitoring and epidural. And unless it is the middle of the night and the lights are kept dimmed, the nurses use intermittent monitoring, the cord is left alone for at least 10-15 minutes, and the baby is kept on the mother AT ALL TIMES, no hospital birth worker has truly witnessed natural birth. There are many, many videos of home birth on the internet and it can be seen time and again the beauty and wonder of birth as it is meant to be.

Out-of-hospital birth should be first-line care for all low-risk childbirth

We have such great prenatal care standards, that any significant problem with the mom or the baby will most likely be detected prior to labor so that a baby that may need more high tech assistance can be born in a place where she can receive that assistance in a timely manner. It is so unlikely that a healthy mom and baby will have a major life-threatening problem during the birth process, that out of hospital birth and midwifery have been approved through legislation in most states. And statistics have proven that most transports from an out of hospital setting are done for non-emergent reasons. The American Congress of Obstetricians and Gynecologists have suggested that the out of hospital Birth Center should be the first level of care for healthy pregnant women. They recommend only moving up the chain to a hospital capable of performing a cesarean if there are risk criteria that have been demonstrated.

Low-tech interventions for childbirth

So that means in order to fix the problem, more doctors need to be trained in the low tech hand skills that are truly helpful to laboring women. These include Leopolds maneuvers (feeling the baby from the outside to determine it’s position), which, when performed properly, can assist the provider to be able to tell not only the baby’s position but if there is adequate fluid around the baby. Keeping hands out of the way other than to provide warm compresses during the actual birth. Turning a breech baby to avoid a breech delivery. Even being able to perform a breech delivery – these are skills that are slowly being lost to us because they are not being taught in medical schools. And delayed cord clamping is probably the single most important non-intervention that can be supported at a birth! We have been complacent, and have allowed an intervention – immediate clamping and cutting of the umbilical cord (that typically happens in the course of surgical birth) – to become standard of care for all births without studying the effects. It is part of the OB culture and doctors and CNMs are taught to do it without question. This is what happens when you put surgeons in charge of a physiological event.

Women’s complacency has really been the main cause of our loss of control over our bodies and our labors. It is time for us to stand up and reclaim our bodies, our labors, and our births. Support your local midwife, demand respect and evidence based care. Maintain a healthy lifestyle and prepare yourself for an out of hospital birth – it will transform your life!