A Letter to My Former OB

I have a great story. It's about a couple who educated themselves and broke free of their OB at over 39 weeks.  It was the difference between a vaginal birth and a c-section.  She was planning to give birth at the hospital where we did our rally last year - the worst in the area, as far as I'm concerned.  I wish I could tell you our rally made all these great changes in our community, but all it did was cause more animosity and bitterness - on both sides.  

I was so proud of this woman, not only for hiring a new care provider so late in her pregnancy, but also for writing this letter afterwards:

*This letter is shared with permission by the author.

As you may already be aware, I discontinued my prenatal care with your practice at 39 weeks on September 16, 2010. I am writing this letter to give brief explanation as to why, in the hopes that a better understanding of the situation will positively affect the care of current and future patients.

Until September 16th, I had been a patient with Dr. Udell for 10 years, I trusted her and respected her opinion. So when I found out that I was pregnant on January 10, 2010, it only made sense for me to continue my care with her. However, I was deeply interested in keeping my prenatal care as natural as possible. I am of the belief that my body was designed to create, carry, and deliver a baby with limited outsider involvement. This is not to say that I am completely against medical advancements and screenings, but I do not subscribe to inductions and cesarean sections when one or both lives are not potentially in jeopardy.  I do not agree that there is a sound medical reason for the cesarean rate in America being well over 30%. Being that I had done significant research on pregnancy and birth, I was well aware of possible complications that could happen and the implications carried with each of them. This being said, I made my wishes very clear to Dr. Udell early on in my pregnancy. Dr. Udell was agreeable and said she would do whatever I wanted as long as I kept in mind she was going to do whatever it took to keep both mother and baby safe.

When my husband and I took the tour of the hospital on June 13, 2010, we were unsettled by the policies surrounding labor and delivery at Medical Center of Arlington. The fact that the hospital did not seem to have any “pro-baby” policies, but instead had very rigid policies that were very counter intuitive made us very nervous about our impending delivery. The requirements for continuous fetal monitoring, and baby being taken from the room for 3 – 4 hours following birth, are the two that stand out in my mind at this time. However, the most unsettling issue was the statement, “Most of our births are scheduled inductions or cesareans.” The fact that Monica, our nurse tour guide, gave Dr. Udell a glowing review, was about the only saving grace for the entire tour. 

I felt secure in the fact that Dr. Udell was going to do exactly what she said. It wasn’t until my 30 week ultrasound on July 15, 2010, when my suspicions were confirmed that my son was going to be large, that my confidence began to waver.  I explained to Dr. Udell that both my sister and I had above average birth weights and my husband at the higher end of the average as well. She seemed to accept this response at the time, however getting a baby that was too big seemed to remain a recurring theme for the rest of my visits. It was not until my 37 week appointment, August 30, 2010, that I started to truly doubt Dr. Udell’s word.  I remember the comment that planted the seeds of doubt specifically, “I find that it’s best when somebody goes into labor naturally at 38 weeks, otherwise you run the risk of baby that can be too big.” At the time, I wrote it off and prepared for my 38 week exam.

At my 38 week exam, I expected a vaginal exam that was similar to the two I had already had on April 12, 2010 and August 24, 2010.  Instead, what I got was a very painful experience that resulted in spotting. I fully understand that vaginal exams are painful and can often result in spotting, the statement that Dr. Udell made, “You’re thinning, but not dilated. I tried to push through, but couldn’t,” was what worried me the most.  In hindsight, I should have asked her what she meant immediately. However, I was too shaken up by the whole experience to think about it at the time. When I called and spoke to Amy, her initial response was something along the lines of, “Dr. Udell was just trying to get things started.” Then when I mentioned that I did not want anything like that it became the standard of care.  Several times during the phone call I felt as though I was being made to feel like I wouldn’t know the difference because I was a first time mother. This, combined with my 39 week visit, where I was called out in the waiting room by Dr. Udell, told that she was feeling for the baby’s head, reassured that she woulddo whatever I wanted,  then told me whether I liked it or not to expect the next visit to be rough.  After that visit, I was very confused.  I got the answer that I ultimately wanted – I will do whatever you want- but it was followed by another comment that conflicted with the last.

In the end, the combination of the poor policies at Medical Center of Arlington and thecontradicting statements I got late in my prenatal care with Dr. Udell led me to believe thatthe likelihood that my birth would turn into a Cesarean section very quickly and easily. After my 39 week visit on September 13, 2010, an opportunity presented itself to switch to the Certified Nurse Midwives at Harris Methodist Fort Worth.  After several days of conversations with my husband and the midwives office, I made the decision that their philosophy of limited medical interventions, limited vaginal exams, intermittent monitoring,  clear fluids, and the option of hydrotherapy during labor were exactly what I was wanting. That combined with the fact that Harris Methodist Hospital was a “pro-baby” hospital, and had a wide array of policies that supported the birth that I wanted, including the fact that all testing immediately following birth are performed in room with the parents present.

I am happy to report, that on September 27, 2010 at 0130, I spontaneously went into labor, during which I was allowed to and instructed to freely walk the halls after my water broke,  I was able to have clear liquids, and use the tub for pain management. After being allowed to labor down for an hour and pushing for almost 3.5 hours, at 1552 on September 28, 2010 I vaginally delivered a 10lb 3.9oz baby boy.  While he was posterior until the last hour of second stage labor; we did not experience shoulder dystocia despite his above average birth weight.

While the prenatal care I received at your office was great, medically, I believe that it was the lack of confidence in the natural process and in my intuition in my body’s abilities that finally ended my care with your practice. I do continue to believe that if I had stayed with your practice this delivery would have definitely turned into a c-section and I would be fighting for my VBAC on the next one.

Thank you ,

Tiffany C.

If you were dissatisfied - or satisfied! - with your care provider, I encourage you also to write a note explaining why. Take it a step further and take a few minutes to fill out The Birth Survey.  In my humble opinion, this is how change takes place.  

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"Have it Your Way" - Choosing an Appropriate Care Provider for Your Birth by Rachel Zimmer, CNM

Rachel Zimmer, DNP, CNM

If you want a hamburger, do not go to a vegan restaurant.  If you do choose to go to a vegan restaurant, arguing with the chef about making you a hamburger will do no good. Therefore, do not be surprised if you choose to stay at the vegan restaurant if you do not get a hamburger. You just set yourself up to be disappointed. Sounds silly right? 

If you are an expectant mom who wants an un-medicated birth, or a birth without interventions, this is exactly what you are doing by staying with your current provider (assuming your current provider is not supportive of your birth preferences).  Let me tell you how it goes. Mom says to her OB: I would really like to have freedom of movement during my labor and deliver in a position other than my back.  OB says: “OK, we’ll see how it goes. We want to have a safe delivery.”   So what is the reality here? The reality is mom has done some reading and knows that changing positions during labor and birth can help promote a good position for baby as well as decrease her discomfort…  This OB does not care one way or another what mom does during labor and believes she will be just like 90 percent of the moms in the practice and end up with an epidural and on her back anyways.  Want to hear a response from a provider supportive of your low intervention birth plan? How about: “That sounds like a great plan, intermittent monitoring is part of my routine practice. Let’s talk about ways to help keep this pregnancy low-risk so that you can avoid an induction and meet your birth goals.” So moms I am here to tell you, if you don’t get the answer that you are looking for……FIND ANOTHER PROVIDER!  So why do women stay? These are some answers I hear…

“I’ve seen my OB since my very first pap smear…” ie loyalty. I guarantee that this means nothing to your provider. They will still check out at the end of the day and let one of their partners catch your baby.  I am not saying there is anything wrong with that, no one can work 24/7. The point is, so what? Your provider does not remember any of the pap smears that they have done for you and will not miss doing them in the future. That is assuming they will even notice you are gone, which they probably will not. Most OBs see 150-200 women every week and you are not special to them.

“I need to deliver my baby at such and such hospital because it is closest to my house….or because they have a special postpartum suite that I want to have”. Most first time moms are in labor an average of 18-24 hours. Unless you are planning to deliver in El Paso, you will have time to get there.   Your baby will benefit from the decisions you make surrounding your birth and none of this has anything to do with the size of your postpartum room, color of the walls, or if they serve you lobster after your birth.

“My OB delivered my last baby…..or all the babies in my whole family”… This is great, you know what to expect! If you were happy with your previous birth experience then by all means stay right where you are! If you are looking for something different, go elsewhere! Your OB has not changed their practices recently.

“It will be fine, I have a doula this time who will make sure my birth plan is followed”… I LOVE doulas and I think all 1st time moms, if not all moms should have one! BUT most OBs don’t understand the role of the doula and don’t like them let alone respect them. Nor will they pay any attention to them as they advocate for your birth plan.  It’s like arguing with the vegan chef to make you a burger… pointless. And, why do you want to fight to get what you want???? Birth should be a time where your birth team is supporting you and working with you, not against you. Doulas are truly amazing BUT your birth experience will be a million times better if you also have an OB or midwife who is ALSO on board with your plan!

“My family is not supportive of me seeing a midwife”… No one said you have to switch to a midwife. There are some great OBs out there who will support your plans for birth. It is absolutely true that midwives are generally less interventional than OBs and more supportive of practices that promote un-medicated birth. But, there is something different for everyone! Ask about interviews, many midwives will offer “meet and greet” visits or interviews that are free and are an opportunity for you and your partner to meet them, see that they’re not crazy witch doctors, and find out if they are right for you. If not, keep moving on!

As OB providers, we attend anywhere from 50-300 births per year…sometimes more! You as an expectant mom, will experience childbirth once, twice, or sometimes more in your whole lifetime. This is YOUR experience. Don’t let any of the above reasons stop you! Choose people to be part of your birth team that want to help support your goals. C’mon moms! YOUR BIRTH MATTERS! Your OB provider MIGHT remember if the baby they put onto your chest (hopefully) was a boy or a girl. You will remember your birth experience for the rest of your life…

Rachel grew up in the Dallas area and is a graduate of The University of Texas at Arlington majoring in nursing. Rachel has a special interest in music, sports, and Spanish. Rachel attended Baylor University Louise Herrington School of Nursing beginning 2008 and graduated in 2011 with her Doctor of Nursing Practice (DNP) degree in Nurse-Midwifery. Baylor University was the first school in the United States to offer the DNP/Nurse-Midwifery program. She then received certification through the American Midwifery Certification Board (AMCB) and is an active member of the American College of Nurse-Midwives (ACNM). During her graduate studies she performed clinical rotations at Parkland Health and Hospital System in Dallas and completed her residency here at MacArthur OB/GYN and Baylor Medical Center at Irving. The focus of her graduate project was utilizing social media to provide childbirth education to women.

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The Pinch Hitting Husband - Hospital to Homebirth

For some men, the thought of a homebirth is frightening and a little weird.  I know that it was for me.

I didn't want a homebirth. I thought my wife and baby would be safer in a hospital. What if something were to happen?  I've always believed in Murphy's law -- anything that can go wrong will go wrong. (It happened to my Texas Rangers last year in the World Series!)

Besides, everyone goes to a hospital to have a baby, right? You have to be some kind of a new-age nut or hippie-wannabe to birth a baby at home.  Not to mention the mess.  I faint at the sight of blood. Does having a baby at home mean that I'm going to have to mop up after the placenta?

So how did Donna convince me that homebirth was the right choice for us?

We were all set to have our third baby in a hospital in Albuquerque. We had a good group of midwives, and everything was going as planned. Until Donna asked them about videotaping the birth. (We used videotapes in our camcorders back in those days.) The hospital had a no-videotaping policy. This pushed Donna over the edge. She called me at work in tears, yadda, yadda, yadda, we decided to have a homebirth.

My first concern of course was Murphy's law. How could I ever face my in-laws if something were to happen to Donna or the baby?

Our first homebirth midwife was an EMT and had worked as a park ranger at a national park. Her gear bag was reassuring.  It was a cornucopia of medical devices, oxygen, needles, vials, chuck pads, etc. She appeared capable of taking care of any emergency. At the time that was very reassuring.

And that surprised/reassured me why? Because I was ignorant that's why! I had a preconceived notion that a medical doctor was more qualified to deliver a baby. What did I expect a midwife to be?  Some daffy old fruitcake chanting and burning incense -- hoping that the baby makes it out OK somehow?

The truth is that most doctors are great at handling medical issues and not so great at delivering babies naturally. That's what they are trained for, right? As with any profession, you do what you are trained to do.  Natural birth is right in the wheelhouse of the homebirth midwife -- that's what they train and prepare for.

Looking back, having a baby at home was the best experience possible. We didn't have to worry about the drive to the hospital. We didn't have to deal with any cranky hospital personnel poking and prodding all hours of the day and night. We didn't have to deal with hospital regulations, the nursery, and the list goes on. And I never had to deal with any bloody mess whatsoever!

Our fourth and last baby, Darcy was born in our bed. I'll never forget lying down before Donna's labor started.  I could feel Darcy moving around. Donna's labor started shortly after.  The midwife made it to our house right as it was time to push. It was a beautiful birth. After everyone was gone, it was just me, Donna, and Darcy -- this time on the outside. I'll never forget looking at little new born Darcy, eyes wide open, snuggled up next to her momma nursing.

So, my fellow fathers and fathers-to-be, if you have the option to have a homebirth, make like Nike and just do it! You will never regret it. Plus it's a really fun conversation starter at office parties and so forth.

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The Birth Nazi

I am continuously amazed at the way people twist my words all around.  I have a friend that said that to me the other day.  She said the comments I get on my blog are consistently 50/50 -- some supportive, some thinking I'm void of any compassion whatsoever and have totally lost my marbles.

Most of you don't know me in real life, but suffice it to say, I am very much the same sitting here at the computer as I am in person.  I will tell you what I think, and I'm OK with you telling me what you think, as long as it is kept respectful.  That's why I do not delete comments from my blog, even the ones that more or less call me a Birth Nazi.  You have the right to your opinion, just as I have the right to mine.

Before I go any further, I want to address my use of the word "Nazi" in this post.  I am using this word because I have heard myself referred to in this manner.  The "Soup Nazi" episode of Seinfeld has been laughed about for years, but when used in this manner, it's not funny.  At least I don't think it's funny.  I, personally, am quite offended by the use of the word, especially in reference to myself.  

Let's address a very interesting topic that I read several blog posts and Facebook statuses about this week:  Is it OK, even good, to expect a good birth experience?  According to most of them, no!  At least this is my interpretation:  You shouldn't get your hopes up because you might be let down.

A very fast recap of my birth experiences:  I have had 4 different births.  My first was an epidural birth where I narrowly escaped a c-section.  My second was my most emotional where I definitely experienced that "birth high." My third sucked and was my hardest (no one's fault but my own), and my fourth was the "easiest" but emotionally hard knowing it was my last and my son would never have a brother.  The only birth I cried tears of joy was my second.  The others, I was just mostly glad they were over.  Does that mean they were bad births because I didn't weep with joy?  Of course not.  They were all just different.  I learned very different things from each experience.  I hope those things I learned, I am able to pass on to my students.  Sometimes it's a case of "Do as I say, not as I did!"

There is this idea that Donna Ryan is an unforgiving natural childbirth educator.  If you have an epidural, I will make you feel awful about it.  And a c-section, forget it!  You might-as-well crawl into a hole!

OK, this is what Donna Ryan teaches.  Pay attention, Donna-haters!  I believe that there are some really awful OBs out there that are happiest when they are performing surgery.  They know nothing about natural childbirth and frankly, don't want to know.  They will scare you into an induction or make you beg for an epidural ("haha, let's keep her pit turned high and strap her to a monitor!"), or they will give you an episiotomy so long you will wish you had a c-section.  (Yes, I've heard a nurse say she heard an OB say this.) Are all OBs like this?  Of course not.  They do exist.  I think that the majority of them have not attended natural, intervention-free births enough to know what that looks like, sounds like, or how to help and encourage a couple on this journey.  Most of them will find a way to put you on their turf, where they are comfortable -- in a bed, strapped to a monitor, legs in stirrups, epidural, pitocin, etc.  See past blog post.

There are other resources in your community.  You may have to dig around to find them, but they likely exist.  Resources that support and encourage natural normal birth.  In Fort Worth, Texas there are so many resources available to families -- amazing midwives, in and out of the hospital.  With choices available, you need to use them.  These are the people who will help you have the birth you want -- or in some cases avoid the birth you don't want!  They encourage you to do the opposite of the (bad) OBs;  things like walking, intermittent monitoring, light food and drink throughout labor, choice of pushing positions, and just plain ole encouragement!  What a difference between a nurse (or midwife) saying, "You got this!  You sound wonderful.  Keep making those low, slow sounds," and "Oh, honey, if you think this is hard now, just wait till you're an 8!  Are you sure you don't want an epidural?"  Well, when you put it that way, of course I want an epidural!

I expect my couples to make the appropriate changes if necessary.  Don't ignore the red flags!  Nearly everyone that sits through my class does change their care provider and/or hospital if they see those red flags.  If you ignore them -- now, this does sound harsh, but it's true -- you have no one to blame but yourself for a "bad" birth if you do not make the necessary changes during the pregnancy.  It's not much fun to be left wondering if that c-section really was necessary. 

Your labor should be a wonderful, yet challenging, time in your life.  Your birth team is critical.  I've said that a million times here over the last three years.  Birth is probably the hardest thing you will ever do.  I never paint a rosy picture.  We don't get to pick the way your birth is going to play out, but you will have a very good idea of what normal birth looks like.  We go through lots of variations of normal too.

This is what I teach about an epidural:  You know what normal birth looks like.  You know what to do, what not to do, you have prepared in every way possible (birth team, relaxation, exercise, nutrition, hired a doula), and you know when you are out of the "normal" range, which can mean a lot of different things.  You have the education to know when you are on the path to a c-section.  Many an epidural has saved a mom from a c-section.  We all hope that an epidural is not a part of the birth equation, but sometimes it is, and sometimes it's even a good thing, a necessary intervention that saves a mom from a c-section.

I have never -- not even once -- told a mom that she failed when she had that epidural.  Or a c-section.  I would never do that.  In many instances, I've put myself in their shoes, and have no doubt that I would have made the exact same decision.  Now, I can't say that a mom won't beat herself up over it, but it's not because I made her feel bad. 

Here's the reality:  When people sit through my class and do all the "right" things and their birth does not go as they had hoped (epidural, transfer, c-section), rarely do I have someone seem to dwell on it and have a hard time getting over it.  Most people know that there are things in birth that are not within our control, but you do your part, roll with the punches, understand why those things became necessary in your birth, and move on!  Learn from them.  Don't become a victim of your birth!  I am seeing this all the time.  It's exhausting.  Your birth does not define who you are as a person.  How you deal with things that happen in your life is more important than the actual things that happen. 

There are some midwives that have told me that the reason they refer to my classes is not necessarily because they love The Bradley Method®, but because my couples seem to bounce back easier when things go differently from their original plans.  My couples also know that they can trust them to help them on this road and if they say they need intervention or medication, it's OK to trust them.  Attitude is everything.

I simply want to see women believe in themselves enough to give birth their all.  Sometimes, that may not mean an unmedicated birth.  It might even mean a c-section in the end.  But if you do your part -- not just become a victim of a very broken maternity system -- you will have a good birth!  Does that make me a Birth Nazi?  Then so be it.

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Why the Closest Hospital May NOT be the Best Place to Have Your Baby

When I was pregnant with my first baby, I was asked a number of times during the pregnancy where I was planning to have my baby.  I thought this was about the dumbest question ever (next to "Are you having the drugs?").  Obviously, I was having my baby at the closest hospital.  I'd seen enough TV shows and movies to know that I would have to get there really fast, so it just made sense to pick the closest one.  It wasn't until I was pregnant with my second baby that I discovered the significance of choosing a hospital wisely -- that maybe distance was not the top priority after all.

When people email me or call me about classes, one of my first questions is "Where are you currently planning to having your baby?"  The word "currently" throws them off, but I want them to know upfront that it's not set in stone.  More than 50% of people that take my class do switch their care provider and/or birth place. 

It seems that most people choose their hospital because that is where their OB delivers.  They've been with him/her for years and just loves him!  They honestly believe that their OB will support their decision to have a natural birth.  This post is not about your OB however, but the hospital.

Fact:  You are more likely to have a c-section in a busy hospital than elsewhere.  Define busy?  Well, the hospital I had Daymon averages 30 babies a day.  I'd call that pretty darn busy.  There's a hospital in the Ft. Worth area that touted more than 5000 babies a year on a billboard.  It is normal to think, Oh good, they do this a lot, so they must be really good at it.  Practice make perfect, right?  If you do the math, that average is almost 14 babies a day.  Doesn't sound so bad after the average of 30 a day I just threw out!  This particular hospital's c-section rate is 35-40% -- straight from the horse's mouth.

But does practice make perfect?  Why would a busy hospital have a higher c-section rate?  Let's face it -- it's like the Olive Garden (I worked there for  4 years and love the OG, so this is not a slam on them!) and you cannot sit at a table all night.  We need your table.  The lobby is filling up and your server needs to make money.  We cannot allow you to take up this table any longer!

And so it is with labor.  They simply will not allow you to occupy a room longer than a day.  At 24 hours, or very close to it, your time is up.  The OB can make up a million reasons why you need a c-section (fetal distress, baby too big, water broken for 24 hours, failure to progress, maternal exhaustion, the list goes on and on), but ultimately, your time is up.  You failed to progress on our time frame.

If you've seen Born In The USA, a PBS documentary, you've witnessed the scene where the residents are sitting around a conference room discussing a particular labor where the woman had a c-section because her time limit was up on pushing (my words, not theirs).  Part of that dialogue includes an OB explaining that it goes against their very nature to not do anything in the hospitals.  She explained that in the hospital, nurses and doctors are constantly monitoring and assessing, monitoring and assessing. They will not just sit around and wait on your labor.  You expect a baby out of this, and darn it, we will be the ones to do that for you!

So, we have imposed time limits.  Next, we simply have hospital policies.  Things such as:  continuous electronic fetal monitoring (EFM), routine vaginal exams (usually every 2-4 hours), no walking after water breaks (which you're not doing anyway if you have EFM), and a routine IV.  I talk about all of these things at length in class, so I don't want to spoil all the fun here.  Suffice to say, none of these things are good for your labor.  You are more likely to have a c-section when these policies are in place.  These are red flags!  Run!  The local hospitals that have these policies have 60% c-section rates.  Ultimately, your baby is left to figure labor and birth out on his own.  You will not be moving around, changing positions, rotating hips, or using gravity to assist the baby on his way down and out.  Labor is harder for mom and baby under these conditions.

Another red flag along the lines of policies are no VBACs (Vaginal Birth After Cesarean).  Over 800 US hospitals banned VBACs in the last decade.  ACOGs recent statement said that women should be given a "trial of labor" -- don't get me started! -- but I haven't seen any change as of yet.  A hospital who does VBACs is hopefully following evidence-based maternity care in other areas as well (allowing women to eat and drink in labor, intermittent fetal monitoring, hep-lock instead of IV, and no routine vaginal exams).

Honestly, I believe you are more likely to find this type of care with a midwife than an OB.  The vast majority of OBs simply are not trained in normality.  They are trained in the management of labor and birth.  And make no mistake -- they will manage your birth.  If your hospital does not even have midwives, this is also another red flag.  Midwives bring a different attitude and philosophy of birth to a hospital.  As long as the staff is open and willing to listen to the evidence, midwives can make a huge impact.  If the doctors won't listen to the midwives and let them be midwives, again, run. 

Birth is very political.  I was speaking with a CNM the other day about this topic.  She's only been out of school for about a year.  She said they didn't talk about how political things are in birth while she was in school and she's been shocked by it since working in the field.  It's like I always say, as long as the baby is still inside, you have options. I've had a handful of women change their plans in the middle of labor!  Don't let your birth be a political battlefield.  Fighting with the staff is not an option.  This also is not good for mom or baby and is not how anyone should remember their labor.

No matter how scary you think it may be, changing care providers or hospitals (or even switching to a home birth!) can be the difference between a c-section and a vaginal birth.  If you have an outcome you are not happy with, you will always wonder what would have happened if you had switched to a better birth place.  Like Tim sings, "There's no such thing as what might have been, That's a waste of time, drive you outta' your mind."  (Had to sneak him in there!)

You might have to drive a titch further, but in the long run, you'll only give birth to this baby one time.  Regret is a yucky thing, especially when you had the red flags laid out before you and you chose to tie your blindfold on and hope for the best.  Don't be a victim of bad hospital policies!

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Is This C-Section Rate For Real?

This week I went to the American Girl store in Dallas with my middle daughter (9) and a friend of hers.  We had a great time and went to lunch afterwards.  While we were waiting for a table, Abby's friend was telling about how she was born in the same hospital as a friend of hers, they have the same pediatrician, and born the same year.  I leaned over and told her that Abby was born at home in a big pool of water in our living room.  She was in total shock!  She said, "Did a doctor come to your house to get her out of your stomach?!"  (Abby seemed equally shocked by her reaction, which I must admit, made this mama proud.)

This is what girls growing up in America believe is normal -- babies being cut out of their mothers. 

I am certain that we are all aware that the rate of women having c-sections in the United States is about 1 in 3.  In North Texas, where I live, it's about 50%.  I have a friend that is a labor and delivery nurse at an area hospital and another that works postpartum at the same hospital.  They have both said there are days/nights that they do not tend to or witness a single woman that has a vaginal birth.  They are at a hospital that has a 60% c-section rate, but they have both told me they believe the rate is even higher.

I have another friend that works as a lactation consultant at another area hospital.  This is a portion of an email I received from her this weekend:

Out of 12 patients on the floor, 6 were c-sections.  Today's breakdown looked like this:

1 induction for "post dates" - mom was 40 weeks.  Ended in C/S

1 induction for "large for gestational age" at 39 weeks - baby weighed 7lb 9oz and ended up on antibiotics because mom ran a fever during labor.  Baby will spend an extra 2 nights in the hospital without mom for antibiotic therapy

1 induction at 39 weeks for "suspected ployhydramnios" - mom managed to deliver vaginally but baby is feeding poorly

1 induction for "post dates" at 40+6 - resulted in maternal fever, Failure to Progress, C/S and baby on antibiotics

1 "Term Induction" (whatever that means!) at 39+2

3 repeat C/S (1 at 36+ wk, 1 at 38wks and 1 at 39wks)

4 spontaneous labors, one of which ended in C/S for "Failure to descend"

Also this week, at the same hospital, a woman was told that she would have to have her birth plan approved by the legal department.   It was 11:30 p.m. and they would not be available to do so until the morning.  Her doula reminded her that she had options.  Yadda, yadda, yadda, she drove across town and birthed with the UNT Midwives in Ft. Worth -- no pain medication, cord wrapped around baby's neck 3 times, and water broken for almost 48 hours.   This couple would certainly have had a c-section had they stayed at their original birth place.   If that story doesn't inspire you to hire a doula, I don't know what will!

One of my couples had their baby at 37 weeks right before Christmas.  She had started bleeding pretty heavily, but it would stop when she laid down.  They suspected a placental abruption, but the midwife (yes, one of the UNT Midwives) and back-up OB couldn't see anything on the ultrasound.  She had lost quite a bit of blood, but they decided to wait it out.  Her contractions were sporadic -- short and not very strong -- and this went on for over 6 hours.  Baby was fine.  The midwife finally decided to break her water and things progressed from there.  She was catheterized so that she would not get up and start the bleeding again.   Her baby was born, posterior and wrapped in his cord, about 12 hours after the midwife broke her water.  No epidural.  As it turns out, she had had an abruption, but she had a large blood clot on the placenta that had stopped the bleeding.   Had it broken free, she would have had an emergency c-section.    I believe she would have had a c-section had she walked into the majority of the DFW hospitals bleeding like that.  Baby is nursing well and everyone is doing great.

So, yes, the c-section rate is crazy.  But we don't have to leave it to chance.  Do not ignore red flags.  If they are popping up at your hospital tour or monthly/weekly appointments, do not put a blindfold on and keep walking, hoping things will work out in your favor.  Tear it off and RUN!  There are care providers who will support you -- not just go along with you -- in your decision to have a normal vaginal birth.

Let's face it though, if I was an OB, I would be all over the c-section thing.  No waiting around, twice as much money, I'm the hero saving the day, and dang it, no one ever sues an OB for performing a c-section!

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The OB at 38 weeks

I am not out to make anyone a bad guy here.  OK, maybe a little.  I have worked as a Natural Childbirth Educator for long enough to make some generalities and feel pretty comfortable with saying them.  I am fully aware that there are exceptions to what I am about to say, but they are so few and far between.  I hope what I am about to say will be listened to and not just heard.

There are two types of maternity care:  the Medical Model and the Midwifery Model.  Briefly, the Medical Model perceives pregnancy, labor, and birth as a disaster waiting to happen;  something a woman needs to be rescued from.  Medicine improves upon the "natural" process.  Labor is all about the cervix and birth canal, always looking for something to go wrong.

The Midwifery Model of Care, on the other hand, trusts a woman's body to grow her baby, start labor at the appropriate time, and labor without time constraints.  A midwife takes into consideration, not just the cervix and birth canal, but the entire woman and her environment.  Birth is as much mental as it is physical.  Medical doctors almost always ignore this fact, usually because the hormones are not working properly when a woman has an epidural.  They just don't see natural normal birth often enough to know what to do -- or more appropriately, what not to do! 

So when couples come to take my Bradley class, I worry about those that have an OB.  And rightfully so.  Most of them will see the light and switch to a midwife, but sometimes the couple is fed so many lines by their OB and hospital nurses, they don't switch, believing their doctor is different. 

From the L&D nurses:

"We have birth balls, showers, tubs, squat bars, dim lights -- everything you want for your natural birth."  (In labor, these things are nowhere to be found.  Only one room has a tub that works, no one can find the squat bar, lights are bright so the doctor can see -- it's all about him, right?  The atmosphere is not what was promised.)


Some of my favorite lines from OBs are:

"As long as everything is going fine, you can do whatever you want."


"As long as your water isn't broken, you can walk around as much as you want."


"We can do intermittent monitoring as long as baby is handling labor okay."

"We don't need to talk about induction unless you are more than a week past your due date."  (No one thinks they will be 'overdue' when they are pregnant.  No one.  They believe this won't apply to them.)


Don't these sound great?  I've got a great OB, right?  Did you hear the clause in each statement?  Remember, an OB is trained to look for things to go wrong.  Statements like these pacify the pregnant woman at monthly/weekly appointments because it seems like she is hearing what she wants to hear.  The problem is, an OB can make up all kinds of reasons to keep you on a monitor in labor, or restrict food and water, or induce labor for a million different reasons.  Seeing this as often as I do, a local doula called this the "Bait and Switch."

Something happens at 38 weeks with an OB, where all-of-a-sudden pregnancy becomes very dangerous.  The placenta starts to deteriorate, amniotic fluid levels rapidly drop, blood pressure is through the roof, and vaginal exams must be done to ensure that your body knows what to do.  Oh yeah, and your baby is getting much too big to fit through your pelvis.  We either need to look at inducing right away or just scheduling a c-section to save you from having to go through the trials of labor.  You'll probably just end up with surgery anyway.

I wish I was making this stuff up.  I'm not.  I see it all the time.  If you stay with an OB who makes "reassuring" statements with a clause and you ignore these red flags, and then you have a c-section, you will always wonder if you really "needed" surgery.  If you change care, even at 39 weeks, to a midwife who trusts birth and encourages you along the way, and then end up with surgery, then you probably did need it. 

I recently had a mom who changed care from an OB at 39.3 weeks to a group of CNMs.  Her baby was over 10 pounds and she pushed for nearly 4 hours.  She had back labor most of her labor and did have an epidural.  Had she stayed with the OB, I am 100% certain she would have had surgery.  Her previous hospital has a 60% c-section rate and they would never have allowed her to push that long.  Sure, she did not have an unmedicated birth, but the switch saved her from surgery.  A good move.

Be on the lookout for these statements from your OB.  The end of pregnancy is so exciting.  You are about to meet your baby for the first time!  A good care provider will reassure you that your baby and body know just when the time is right for labor to begin.  Your care provider should fill you with reassurance, not fear.  And that, really, is the difference between a good care provider and a bad one.

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Want an Unmedicated Birth -- Or Even Just a Vaginal Birth? Hire a Midwife and a Doula

I have recently had a bad run -- lots of cesareans and epidural births.  I've thought about them a lot over the last several days and weeks, and there are some significant numbers that I want to share.

Up to now, my stats have been about 79% of people that take my class give birth without medication.  14% have a cesarean, and about 7% have an epidural, the majority of the time to avoid a c-section.

These last few months have been the worst statistics I've had in over seven years of teaching.  It's hard for me to put this out there, but I've gone back about 4 months to include a couple of classes and several DVD couples.  There are some interesting things to note, and I hope this improves future outcomes.

In the last 4 months, I've had 23 couples give birth.
10 had unmedicated vaginal births.
5 had epidurals (but still had a vaginal birth).
8 had c-sections. 

Let's break this down, starting with the 10 unmedicated vaginal births.  (This is what everyone was shooting for.)
6 hired midwives (mix of CNMs and CPMs).
4 hired an OB.
6 hired a doula.

Of the 5 epidural births:
3 had a midwife.
2 had an OB.    
Only one of these women hired a doula.  
It should be noted that a few of these women started with OBs and switched to midwives.   Length of labor and/or pushing would have certainly resulted in c-sections had they stayed with their original OBs and hospitals.
 

Of the 8 c-sections:
2 had a midwife.
6 had an OB.
Only 2 of these women hired a doula, and only one had her doula present.
Obviously, these c-sections happened for a variety of reasons, some valid, some not-so-much.  Can't ignore that 80% were with OBs.  Honestly question if they would have happened with a midwife.

Summary:  If you want an unmedicated birth, your birth team is crucial.  All the education in the world won't matter if you have a doctor who is determined that you or your baby "need" a c-section.  As for a doula, the statistics speak for themselves.  A woman who has the support of another woman in labor will almost always have a better outcome, or at least feel better about doing all that she could do to prevent having an epidural or a c-section. 

If you are birthing in a hospital, you need to hire a midwife instead of an OB and you need a doula by your side.  End of story.

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Why I Recommend the UNT Midwives

I am doing something quite different for this post. Instead of picking a topic, I've chosen a group of local midwives to write about. I am continuously sending natural birthing couples their way and I decided to make a post out of it. If you do not live in the Ft. Worth area, I suggest you use this standard in finding a similar type group in your area. I have nothing to gain by promoting this group, by the way. Simply giving information on a group of midwives who are working hard to provide Mother-Friendly care.

If you read my blog regularly, you know how I feel about homebirth. About 25% of the couples that take my class do give birth outside of the hospital. But that leaves 75% in the hospital. That is alright. I understand, having had 2 hospital births before my two homebirths, why couples want to birth in the hospital. The hospitals, however, are not all created equal.

Let me tell you, in a nutshell, why I am singling the UNT Midwives out for this post. They are all CNMs, or Certified Nurse Midwives, and there are five in the group. To be perfectly honest, some are more medically minded than others, as in any group.

There are three reasons I choose this group over the other CNM groups in the area:

1) They are doing water birth at the hospital. Even if you do not think that you want to have a water birth, the fact that you have this option is huge. It's all about options, really. They are not telling you, like the majority of the other hospitals, that they want you chained to a monitor in the bed. Water birth, or at least laboring in water (often called "a midwife's epidural") is a lovely option for moms and babies, and it's wonderful that it has become an option in a hospital setting.

2) They give you the full 14 days "over" your "due date" before they start talking induction. I have decided in my seven years of teaching that the majority of women truly believe that this won't happen to them. "Going 'overdue' and long labors are things that happen to other women, not to me." OK, it's not said outloud or sometimes even consciously, but it's real. So many women are not prepared for this possibility at the end of pregnancy. So much can happen in those extra days that the UNT midwives are willing to give you. A lot of other groups and/or hospitals have a 7-10 day rule. Me no likey.

3) They are VBAC friendly and so is the doctor that backs them. Again, huge. Even if you have never had a c-section and are not having a VBAC, this philosophy, mindset, and belief is important to all pregnant women. No one wants to have a doctor who has a no-VBAC policy. He or she is preoccupied with legal issues and does not believe in the inherent safety of birth. They have a what-if mindset. A woman with a doctor like that will have a c-section. Also, their back-up doctors believe in their midwives. There are other local CNMs that are not "allowed" by their back-up doctors to do VBACs. Huge. This might seem like a big who-cares, but it's not. It speaks volumes about what is going on in their hospitals.

Ultimately, you do not have to fight to have a natural birth. As long as you do not have drugs, you will have intermittent monitoring, allowing you the freedom to walk or be in the water. You will be encouraged to eat and drink. You will have very limited vaginal exams. Other hospitals require an IV, continuous fetal monitoring, no walking if your water has broken, and vaginal exams every two hours. These "policies" contribute to the high c-section rates.

I should mention that not every experience at Harris has been great. I have had a handful of couples birth there where I was disappointed in how things were handled. Overall, however, these instances have been few and far between. I also believe that they are working extra hard to lower their rates of intervention, including c-sections. Bottom line: if you are birthing in a hospital in the Ft. Worth area, I am most comfortable with how the UNT Midwives do things.

I had a couple give birth with the UNT midwives this past weekend and I would just briefly like to share why they did not have a c-section. I believe that just about any other hospital in the area, she'd be recovering from surgery this week.

This mom had been having some strong contractions about 7-8 minutes apart for about 4 days. She had had a difficult time sleeping and was exhausted by the time she showed up at the hospital Saturday morning. She had some Demerol to help her sleep and by late afternoon without a whole lot of dilation, she had an epidural. Eventually, she had pitocin to pick things up, but the baby didn't like that so much. Instead of doing a c-section -- as just about any care provider around would have done, calling it fetal distress and fearing a lawsuit -- the midwife turned off the pitocin and told this mom to go back to sleep. They'd try again later.

Eventually, the epidural wore off, after the mom had gotten in some good sleep, and she was able to squat her baby out! Her midwife believed in her ability to do have a vaginal birth. Except for exhaustion, mom was fine and baby was fine. She recognized what was working for them and what wasn't.

I also must add, when her doula showed up at the hospital, all the lights were on, monitors beeping loudly, and family all standing around watching this laboring woman. Her wise doula created an atmosphere of quietness, dim lighting, head massage, snuggle time with the hubby, and things moved along quickly afterwards. She probably should have been there sooner!

"I like my doctor" is not a reason to stay at your hospital. He or she will very likely not be at your birth. The nurses run the show at the hospital. You want nurses who are used to working with midwives and have a respect and belief in the natural process of birth. If all they ever see is inductions, epidurals, and c-sections, this is what they are comfortable with. Get the heck out of Dodge and run over to the UNT Midwives.

Now, if you decide to birth outside of the hospital, you have lots more options available to you. That's another story for another day!

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OBs Ban Doulas, Birth Plans, and The Bradley Method

In case you have a hard time reading it, it says: "Because the Physicians at Aspen's Women's Center care about the quality of their patients deliveries and are very concerned about the welfare and health of your unborn child, we will not participate in: a "Birth Contract", a Doulah Assisted, or Bradley Method delivery. For those patients who are interested in such methods, please notify the nurse so we may arrange transfer of your care."

You may have had the privilege of seeing this sign before now. I just saw it yesterday for the first time. Ironically, these OBs, Dr. Judd and Dr. Gordon, had both been recommended to me when I was pregnant with our first baby in Provo. The doctor I had, Dr. Brian Wolsey, I am certain, held the same opinion as these two doctors. In fact, when David saw the sign he even asked if that was hanging in Dr. Wolsey's office!

Well, as crazy as it seems, at least they are honest about the clients they want walking through their door. So often, I see doctors who feel this way, but are NOT honest. They tell women that, yes, they will do whatever they want, but have no intention of doing so.

Remember, birth is safe. These doctors are determined to save their clients, or "patients", from the "dangers" of a birth contract (plan), doula (they even spelled it wrong!), or the crazy Bradley teachers like myself!

If you have a doctor who ignores the evidence and/or your wishes, he is looking out for himself, not for you or your baby, despite making comments like this. This sign makes the reader feel as if these 3 things are unsafe and they are only looking out for your baby. Just the opposite! He or she wants to run the show. Waiting for your baby and body on your schedule is an inconvenience. They want you to have an epidural.

So, consumer beware. If you suspect, or know, that you have a doctor that holds these views, it's never too late to switch. You will only give birth to this baby one time. There are no second chances. Take control of your birth! Do not relinquish it to an ego-maniac doctor that tells you that you can't educate yourself, have a female companion to help you through labor, or have specific desires for this special day.

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Birth of a Family

I wanted to share this email from a DVD student that gave birth last weekend. I have wanted to put it up here all week, but it's been Spring Break and we were dog sitting THREE dogs. Darcy also had her 4th birthday party. So it's been a little crazy around here!

I enjoyed this birth story for a number of reasons. This couple, before switching to a midwifery group in a hospital, was with an OBGYN at a hospital with a 60% C-section rate. It took a lot of courage to change their birth attendant and birth place towards the end of pregnancy, but they are so thankful they did. FYI -- I left the names of the midwife, nurse, and hospital out of this story on purpose – you'll understand why as you read the story.

“We headed to the hospital around 11 am yesterday. Got there and they did an initial check. I was at 5 and a -1 station. The nurse we had was great. She brought in a birth ball for us, encouraged me to eat whatever I needed and drink as needed. I got in the bathtub/jacuzzi just to help me relax around 2. Transition set in probably around 2:40, and I started pushing around 3:00. We found out later that the policy at (the hospital) is not to let people have a tub birth, but at that point I wasn't getting up, and my midwife practice was awesome. They let me labor exactly how I needed to. We had never even considered giving birth in the tub, but it felt so great to be in the water that I didn't want to get out. Donna--I'm a pretty reserved person. I'm very polite--you know, the whole pooping thing. I made noises during pushing that I didn't know I was capable of. My throat is still sore today from my grunting. I didn't scream, but I was definitely loudly yelling. My midwife, told me at one point, "I know you feel like you're out of control, but you're completely in control. You sound great." It was very encouraging. The pushing was just like you described it, feeling like you have to poop, then the burning when the head is coming out. When he finally made his appearance at 4:41, he had the cord wrapped around his neck four times. I didn't even think to panic because the midwife and the nurse didn't at all. They just unwrapped it and immediately put him on my chest skin to skin. He pinked up right away. He's seven pounds even and 19 3/4 inches long. I did tear slightly, but it was in two places on my labia. My midwife said it wasn't bad at all. All in all labor was just shy of 12 hours. Much quicker than I expected.

So, my thoughts after this are that I'm so glad we went through Bradley. As soon as the birth was over I was able to get up, move around, hold my baby and walk the room with him, hug my family, and eat! It was so worth it to be able to move--and I don't feel like recovery is as big of a deal. Also, every time they checked the heart beat during labor it was nice and strong, around 150. The nurse and my midwife both told me later that if we had been on constant monitoring then they would have probably picked up distress with the cord being around his neck so many times, which could have ended up with a c-section of course. It's awesome that we knew what we wanted and were able to make that happen. Thank you SO MUCH for helping us with this! Also, I honestly believe if we had a doctor and the cord was wrapped around his neck, then they would have gone into emergency mode and I would have been separated from my baby. That might not be true, maybe I'm now skeptical of doctors, but I am SO GLAD we were with the midwives.

Kyle wanted me to tell you that he's sorry he couldn't get back in touch with you yesterday. His phone died, and I didn't have your number stored in my phone. Oops! He also wanted me to tell you thank you so much for all of your help--not just yesterday, but with the classes. We both are still on a high from the whole experience.”

First of all, hats off to the midwife and nurse for trusting this mother, her desires, and most importantly, her needs. They encouraged her to listen to her body and follow her instincts. They were even willing to "break the rules" in order for this woman to do that. They trusted birth. I also loved that they encouraged her to eat and drink in labor. They wanted her up and moving, not strapped to a fetal monitor, which, as mentioned, could have potentially led her to a C-section.

Anyone who has sat through my class knows I spend a lot of time talking about poop -- poop stories, as we call them. We have some good laughs about it, but it is a very serious issue for many women. So serious, in fact, that I've seen a C-section happen because she was so afraid of pushing out something other than just her baby. So, I loved her comments about being reserved and "polite" -- followed up with being shocked by the sounds she made as she pushed her baby out. I encourage women to sound out their contractions, which makes people uncomfortable when they are not exposed to natural birth and its associated sounds. Ina May Gaskin talked about this in "Orgasmic Birth."

Another item I wanted to address was the cord being around the neck four times. She must have had a long cord to do that! One in three babies will have the umbilical cord wrapped around their neck, so it is very common. The midwife will just slip it over the baby's head. I have heard this time and again as a reason for a C-section. Or I've heard comments like, "It's a good thing the doctor did a C-section because the cord was wrapped around the baby's neck," like the c-section saved the baby. It is very common to have the cord wrapped once or twice around the neck -- not so common to have it wrapped FOUR times! So glad they had a midwife to calmly handle the situation without all the unnecessary drama.

I had the opportunity to talk with her husband a couple of days after the birth and he was on a total birth high. This is something I see with couples who work together to give birth without medication or interventions: it brings them closer together and the men have a deeper admiration for their wives. The husband who sits back and lets the doctors take care of everything does not feel this same sense of accomplishment as the man who actively helps his wife give birth. This particular husband and new father simply gushed over what his wife had done. He said that it was "awesome" to see his "Southern Belle" do something so amazing. He pointed out how cool it was to see her give birth, and then after the placenta was born, she got up and walked to the bed with blood running down her leg. I think he thought she was amazingly tough, and yet so feminine! He said the next baby will be born at home! This is an experience that will be imprinted on his heart forever.

Congratulations Jessica and Kyle. Thank you for allowing me to be a small part of this experience in your lives.

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If I Were an Insurance Company, I Would NEVER Pay For an Elective C-section

If I were an insurance company, I would not allow women to choose to have a C-section for no medical reason.  It would cost me twice as much money as a vaginal birth.  I would, however, be happy to pay for out-of-hospital births, as it costs me a fraction of the money a hospital birth does.

Oh wait, the only people I actually listen to, as an insurance company, is doctors and hospitals, who have a financial interests in these policies.  This is not about evidence-based care.  It's about putting the doctor on a pedestal and ignoring the midwife.  The doctors are thrilled to allow a woman to selfishly choose to have a C-section because it fits nicely into the doctor's schedule, and, oh yeah, cha-ching, it's twice as much money!  The doctors have done a great job of convincing me, the insurance company, how dangerous, reckless, and incompetent a midwife, especially a CPM or LM, is -- the smear campaign rages on against midwives.  

How can I, as an insurance company, in good judgement, take the advice of people who stand to gain financially by their recommendations?  The majority of doctors are trained to believe that birth is dangerous and needs to be managed.  The only place this can be done is in the hospital. They are convincing the insurance companies that homebirth is unsafe and women who choose to do this are placing their babies lives at risk.  (But let's go ahead and make abortion legal and accepted.)  Birth is safe for mothers and babies, as most midwives know and believe, because they see it and live it, day in and day out.

I have had a number of students who have wanted to have their baby at home or at a free-standing birthing center, only to be told that, no, they may only give birth in the hospital.  They have a choice of several doctors but only one or two midwives.  But if I am an insurance company, and I am in this for money, why am I ignoring a viable option -- homebirth?  Why, from a financial standpoint, am I covering a woman to have surgery to remove her baby because she is too scared to go through labor and give birth vaginally?  (I am not even going to address the moral and physical reasons why this woman is an idiot.)  I am paying thousands of dollars for a procedure that in 100% unnecessary.  The irony is so thick, it makes me sick.  And women who want to spend a fraction of what they would be allowed to spend if in the hospital are denied that option?  Unbelievable.  

When will the insurance companies begin to listen to midwives and to informed consumers who want to birth their babies at home?  We have to speak up to be heard.  Insist on options from your insurance companies.  They have to provide you with options.  I actually had my first homebirth reimbursed by our insurance company because they failed to give me all the information when I insisted that I needed options.  They could not make me give birth at that one hospital.  There was another hospital they were contracted with, but I was not given that information until the baby was 5 weeks old.  After 3 appeals, I had a hearing where we all sat around a big conference table listening to the recording of the phone conversation where I was told that I had no options.  Needless to say, we were fully reimbursed for our entire homebirth. But we didn't know that would happen at  the time we hired our midwife and we still made the choice to pay, out-of-pocket $2500, instead of our $100 co-pay at the hospital.  

I am not a fan of going into debt, but I do believe that sometimes we have to take our healthcare into our own hands and not leave it to the insurance to make all our choices for us. Fight for your right to birth your baby where you see fit.  Maybe, just maybe, we'll be heard. It's more important now than ever, as the AMA is on a campaign to make it impossible for homebirth midwives to practice.   If a woman wants a homebirth, she would have to illegally hire a midwife to attend her birth.  This is wrong.  Women deserve this choice in childbirth. They can legally kill their babies through abortion and choose to have them surgically removed from their bodies, but they can't lovingly and fearlessly birth their babies in their own homes and beds with midwives who believe in the natural process of birth.  

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The "Big" Baby

Contrary to everything you may have been told, a big baby is a good thing!  Women have become afraid of giving birth to a big baby because their doctors, and even some midwives, have instilled fear into these mothers.  When a woman hears the phrase "birth trauma," do you think she's excited to start labor and give birth?  Of course not.  A woman's body is less likely to start labor when she is fearful.

How does your doctor know the size of you baby?  Ultrasound?  While ultrasound can be a useful device in estimating a number of things, when it comes to the size of the baby, it can be off by more than 2 pounds, either way!  So if you have a doctor telling you that you are carrying a 10-pound baby and a C-section is the way to go, you likely are NOT really having a baby that big.  Do not allow a doctor to conveniently (for him/her) cut you open because he/she is afraid of your "big" baby. They do not trust your body to give birth if they are recommending a C-section.  I have a lot of confidence in a woman's body being able to give to birth to the baby that her body allowed her to grow.

And what if you are carrying a 10-pound baby?  Congratulations!  My dad was 10 pounds, born at home.  So was his brother.  My grandma, who I lovingly call a "hillbilly," lived on the land. She ate the food she grew.  She knew where her food came from.  And she grew healthy, big babies.  

Most women are afraid to birth a big baby because they are afraid they will tear at the time of birth.  You are actually more likely to tear with a smaller baby than a bigger one.  How can this be?  A small baby tends to come through the birth canal faster and the skin, or perineum, doesn't have as much time to stretch.  A bigger baby allows the skin more time to stretch over the baby's head.  I've seen women be fearful of a bigger baby, because, surely if they tore with a 6-pound baby, an 8-pound baby would be dreadful.  Just the opposite is true.  

I have a lot more to say on the subject of tearing, episiotomies, etc., but I'll reserve that information for those lucky enough to take my class!  Wink, wink. 

I would also like to point out a very important statistic:  The #3 reason for a C-section in America is for CPD, or cephalopelvic disproportion, but only 1/2500 women actually has this very rare condition.  This is when a doctor says that your baby is too big to fit through your pelvis.  The only way for a doctor to truly diagnose this condition is when a woman is in labor and has spent a considerable amount of time pushing or has had an X-ray.  No one is going to do an X-ray on a pregnant woman, let alone in labor!  

We all know the tiniest women who have birthed 9 and 10-pound babies.  You cannot tell by looking at woman's hips whether or not her baby will fit through them.  During labor, there are hormones released to help soften the cartilidge within the pelvis.  It shifts with the baby, allowing more room for him or her to pass through.  The baby's head will also mold to fit through. Understanding the process of birth instills confidence in this natural process of the baby passing through the pelvis.  

True CPD was more common in the 19th century when a lot of women had suffered from rickets, causing the pelvis to be misshapen. Very rarely does a mismatch occur with the baby's size and the mother's pelvis, but there is no way for a doctor to prove it, so it is used as a diagnosis very often, even in pregnancy when a woman has never even experienced labor!  Give me a break!

Let's talk about that "birth trauma" we hear so much about.  Specifically, shoulder dystocia, is seen more often with bigger babies, but certainly not as common as the doctors make it sound. This is when the head is born, but the shoulders are "stuck."  Honestly, the baby doesn't have to be huge for this to happen -- just to have really wide shoulders.   A doctor will usually deal with this by giving the mom an episiotomy and then by breaking the baby's collarbone.  Ina Mae Gaskin, who I consider to be the nation's leading midwife, has a different approach, called The Gaskin Manuever:  have the mom get on all fours and lift a leg.  This will release the baby's shoulders. I have done this with one of our births.  It's amazing.  

Briefly, let's contemplate what is believed to be a "big baby."  What do you believe to be a big baby?  If 7 1/2 pounds is average, does that mean anything over that is "big."  I don't believe so. I do not consider a baby in the 8 pound range to be "big" -- just healthy.  We want this!  I, personally, think that once a baby is over 9 pounds, they are "bigger."  I love asking moms that have "big" babies if they tore, and I am constantly amazed by the amount of moms that say no, or very little.  

I had a mom in my class a few years ago that gave birth to a 12-pound baby with a 1st degree tear.   She gave birth in a hospital with a midwife.  Her family and friends couldn't believe that no one knew the baby was going to be so big.  They insisted that if she'd had a doctor instead of a midwife, they would have known.  I made the point that if she'd had a doctor who was expecting a 12-pound baby, she would have had a scheduled C-section and not the wonderful birth experience that she did.  

 

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Types of Midwives

I am finally getting back to answering questions. The one I want to talk about today is the difference between a CNM (Certified Nurse-Midwife) and a CPM (Certified Professional Midwife).

There are a lot of different types of midwives out there. It can become very complicated. I am not going to go very in depth, as the laws are different depending on where you live.

Some states do not allow for homebirth, but most do. Some are very good states to work in if you are a midwife, and others make it hard to practice. If ACOG, the American College of Obstetricians and Gynecologists, gets their way, things will become worse for a midwife to practice anywhere. I would encourage all people -- men and women -- no matter where you are, to be an advocate for midwifery care. Check out www.thebigpushformidwives.org for more information on midwifery care in the U.S.

First of all, I am asked quite often what the difference is between a doula and a midwife. Simply, a doula provides labor support to both the woman and her husband. She is a knowledgeable woman, trained in physical and emotional support before, during, and after the birth. I highly recommend seeking out a doula for your birth. You are less likely to have interventions or a c-section with a doula by your side. Ask your local Birth Boot Camp instructor for recommendations. Some instructors will work as doulas, as well as educators.

A Certified Nurse-Midwife, or CNM, usually works in a hospital, but not always. They have attended nursing school and then specialized in midwifery usually for another year. I have seen a wide range of CNMs over the years when it comes to their attitudes towards birth. Some are very comfortable with interventions and medications. I don't like this. Some view birth as a normal process that works better without intervening. Unfortunately, when you work in the hospital, I believe that your view of birth becomes warped. 95% of women have medication in labor, and this requires a number of interventions as a result. One leads to another. Whether the CNM wants this or not, this is what she is usually surrounded by in the hospital.

I read a book by a Licensed Midwife, or LM, a couple of years ago. She practiced homebirth for more than 10 years. There came a time in her life, however, where she needed to have a more regular schedule. She decided to work in a hospital solely because of the hours. It is interesting to hear her experience there and how it affected her views and feelings towards birth. She found she started to fear the process of birth and use intervention more because this was the attitude she was surrounded by. She would have to step back, attend a handful of homebirths just to be around normal birth again, and then return to her shifts at the hospital.

A CNM, or group of CNMs, in a hospital will practice under a group of doctors. There are certain procedures that a midwife is not allowed to do, such as a vacuum extraction of a baby or a c-section. If there is truly a complication, the doctor will "deliver" the baby. Often, you will not know which midwife will attend your birth. It is good to rotate through so you can meet all of them during your pregnancy. Some groups encourage this and others frown upon it. Remember, attitudes vary and it's good to know which midwives support natural birth and less intervention. Another thing to remember is that this type of midwife has other patients when you are in labor. She will be in and out to see you, similar to a doctor.

There are Licensed Midwives and Certified Professional Midwives, depending on the state you live in. Requirements vary. These are often women who have worked as an apprentice under an out-of-hospital (homebirth or birth center) midwife. They have to attend, literally, hundreds of births. In order to receive their license to practice they have to pass a very intense exam. In some states there are other requirements as well, some type of "schooling," but generally, this midwife has hands-on experience and has thoroughly studied pregnancy, labor, birth, and postpartum. If you are or become high-risk, you will be referred to the midwife's back-up doctor. This type of midwife will be with you as much as you want her to be when you are in labor.

There are also lay midwives. These women have been around birth most of their life and often "work" where there are no other options, maybe where people live far from healthcare or are very poor. This midwife has no license, just varying degrees of experience. In this day and age, a lay midwife is likely someone who is practicing homebirth in a state where homebirth is illegal. These women believe that women should have the right to choose homebirth and are willing to take risks to make that possible.

I hope this answers some of your questions. No matter which type of midwife you think you'd like to try, interview them just like you would a doctor. You should feel very confident in who you choose. Remember, as long as that baby is still inside, you have choices!

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OB vs. midwife -- the debate

OK, I went a little crazy yesterday and was really harsh on the doctors. Every now and then I find one that is really great and does believe that a woman's body can do this without his/her help. They are extremely rare, however. They are trained to look for things to go wrong.

Likewise, I've run into midwives who do the profession a disservice by calling themselves such. I call them "doctors in midwives clothing!" There are some who are very medically minded and think intervention is appropriate in nearly every birth. One of my students in Albuquerque was giving birth with a large group of midwives at a local hospital and was insistent on little intervention. The midwife scolded her for birthing in a hospital, telling her she should have birthed at home because this (interventions) is how it is done in the hospital.

So, here is some advice. When you are looking for a great OBGYN or midwife, call your local Birth Boot Camp Instructor. They will know who supports natural birth.

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From OBGYN to Midwife

When I was researching midwives, I came across some numbers that I'd like to share. Forgive me, for I don't remember my source, but I remember very clearly what it said: At a typical office visit with an OBGYN, he/she will give you five minutes. If your appointment is with a Certified Nurse-Midwife (CNM), usually practicing in a hospital group, appointments will last on average 15 minutes. If you are meeting with a Certified Professional Midwife (CPM) or a Licensed Midwife (LM), practicing usually at a free-standing birth center or homebirth, you can expect your appointments to last about an hour. In my experience, this has absolutely been true.

The midwife typically considers the entire woman and her family, not just the vaginal opening, when it comes to labor and birth. Birth is affected by so many factors. A midwife who has spent, literally, hours with her client, knows her and her concerns very well. She is able to work with the laboring woman and help her because she knows her and her desires. A doctor is focused on getting the baby out. The focus is on the cervix, not the whole person.

Our Licensed Midwife with our third baby said to me, and I quote her often, "Birth is 90% in your head, and 10% what happens to you." I believe this.

I had a miscarriage between our first and second children. It was very early on in the pregnancy. I went in to talk to the OBGYN, Dr. Brian Wolsey, that we had used with the first baby, I guess to be sure that everything was fine. While I was there, I asked him if I chose to give birth in a different position with the next baby, would he support me? He got down on one knee, contorting his body with his hands in the air, up around his head, and said, "Well, it's kind of hard to catch a baby like this." I knew immediately that he didn't care for my question.

Let's let that sink in for a moment. Read his answer to yourself again.

This is where I take issue with the term, "delivered." A woman does not need to be "delivered." I saw this picture recently where the doctor is holding a baby in the foreground, all proud, that he "delivered" this baby to the mother. She was sitting in the hospital bed, smiling at the doctor, like she couldn't have done it without him. Maybe I read more into that than the average person, but I was so offended. Who is the hero here?

The professional a woman chooses to have at her birth should be "attending" her birth, not "delivering" her. Dr. Wolsey, by making that comment, made it all about him. I would be the one giving birth. I always teach that the laboring woman should follow her instincts. If her body needs to be upright (there's a number of reasons why you'd want to be in this position), then who is her doctor to tell her that she is inconveniencing him?!

Sitting there on that table, I remember watching him on the floor, dressed in his nice clothes and tie, and thinking, "What a jerk." How many c-sections has this guy given to women who could have given birth vaginally just fine? Remember, he told us at the end of my first pregnancy that my body had just reached a point where it didn't know what to do. My body grew the baby, but it doesn't know how to birth it? Am I going to be pregnant forever if you don't remove this baby from my body? I could have easily have had a c-section with this doctor. I was one of the lucky ones who did not.

There are thousands of doctors out there just like Dr. Wolsey. I knew at that moment, watching him on the floor, that I would never have an OBGYN attend any of my births again. I am lumping all doctors into one awful heap, but I am fairly comfortable with that at this point in the game. The c-section rate continues to rise all over the country, but in areas where there are a significant number of midwives attending births, the c-section rates are lower.

Take my home state of New Mexico -- they have one of the lowest c-section rates in the country, and about 1 in 3 births are attended by a midwife. This is not a coincidence. I in no way want to make NM sound like they have a low c-section rate, as they don't. It's too high everywhere. It's just lower than the majority of other states. The World Health Organization has stated that the c-section rate should be between about 10-15%. The US rate averages 1 in 3, or 33%, of American babies are born via c-section. Will we ever see it reverse? Frankly, it's become so accepted, it's hard to imagine the rate actually going down.

There are other contributing factors to the outrageous c-section rates -- decline in VBACs (vaginal birth after cesarean) inflicted by ACOG (American College of Obstetricians and Gynecologists) and malpractice suits, to name a few. And we can't forget the very ignorant women electing to have a c-section over a vaginal birth. This is a topic for another day, but I just wanted to address c-sections briefly as I "attack" the OBs.

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