"Please Just Get the Epidural" said the OB

A while back, an out-of-state couple of mine was trying to find a good care provider who is supportive of natural birth.  I posted the question on my BFBS Facebook page and several of you jumped right in with some great responses.  One person simply stated, "Just tell the doctor you don't want medicine."  She deleted the comment, but it had gone to my email first.  I'm not sure why she deleted it.  I reflected on her comment the rest of the week.

If only it were that easy - just tell your OB that you don't want medicine.  And yet, for the majority of women that choose to birth without medication, it's an uphill battle.

Why I (Your OB) Push the Epidural

First, if I'm an OB, I rarely see a birth without medication, mostly because the majority of women want the epidural.  It's what I am comfortable with.  It's what I learned in medical school and in my residency.  It's what I do.  When you tell me that you don't want the epidural, I think, "I've heard this one before!"  Lots of women tell me that, but few actually follow through.  I can have a great influence in how your labor goes.  I'll play along though and tell you exactly what you want to hear.  A couple of my favorite lines:

"You can hang from the rafters for all I care!" (She's making fun of you with a statement like this.  She believes that a civilized woman would never choose to birth without an epidural.  She doesn't get it.)

"As long as everything is going smoothly for baby and everyone is safe, I'll let you do whatever you want."  (A statement like this reminds a confident woman that birth is dangerous and she might need to be rescued.  It's definitely passive-aggressive.  You think you're getting what you want, but really, the doctor is putting you exactly where she wants you -- on the verge of thinking you and your baby are not safe. She will come up with a reason to interfere with your labor.)

Unless your care provider is actively helping women have unmedicated births, she doesn't know how to help you.  Just because she is catching babies doesn't mean she knows a thing about natural birth. 

The noises of a laboring woman make me very uncomfortable, all the moaning.  If she's doing it "right" they sound a little too sexy. Eew.  You can tell a lot about where she is in her labor, and more importantly, how she is handling her labor.  Are the sounds high-pitched and short breathed?  She's struggling.  Are they low and long deep breaths?  She's on top of it.  Is she tightening during contractions or letting it all hang out?

Back to my roll-play as the OB, I like it when you have an epidural because ultimately, I'm in control of your labor.  I can increase the pitocin and really get this show on the road!  I don't want to be at your labor all day/night.  With an epidural, you will do whatever I want you to do.  If I think breaking your water should be done (I can come up with a million reasons why this is good or necessary for your labor/baby to progress), you'll do exactly what I say.

I also prefer you to stay in the bed on a monitor.  When you have an epidural, I like this.  You aren't going anywhere - none of this silliness of walking around, bouncing on a birth ball, or moaning like a wild animal in the shower or tub.  No, I like you acting civilized in a bed, on a monitor, preferably sleeping.

I also prefer to "deliver" your baby while you are flat on your back with the bright lights on your vagina.  Then I can see what I am doing.  You can't feel how uncomfortable this is anyway since you have an epidural.  This really makes my job much easier.  I like a compliant patient.  It's easier on my back too.  Imagine leaning over a birth tub to catch a baby!  Honestly!

In the end, if I decide a c-section is the way to go, you already have an epidural.  I can make that call and have things move super fast.  If you don't have an epidural placed early on, this delays the c-section.  I can always use general anesthesia, but then I really have to justify the emergency factor.  The epidural is just so .... easy.

So, please.  Just have the epidural and make this easier on us all.  Thank you.

Love-
Your Typical American OB

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Welcome to the Olive Garden...

In case you missed it, the American Association of Birth Centers released The National Birth Study II this week.  You can read the article here.  The findings are HUGE!  I want to give you the condensed highlights and then we'll chat....

The study included 15,574 women at 79 birth centers across the U.S. between the years of 2007 and 2010.  This is a respectable sized study.  About 80% of the women were married and about 3/4 of them had at least some college education.  Half of them were having their first baby, while the other 50% had given birth previously.

Here's the awesome part of the study - 94% of the women planning a birth center birth had a vaginal birth!  This means that only 6% of these women had a cesarean section.  It's true, they were all low-risk.  But in the hospital, the rate of cesarean section for low-risk women is 27%!  Read this paragraph again.  I'll give you a minute...

There were no maternal deaths ("I would have died if I would have had my baby out of a hospital!") and the stillborn/newborn death rate was very consistent with other birth places.  In other words, these babies likely would have died regardless of where they were born.

Interestingly, the rate of cesarean birth in the hospitals has dramatically increased over the decades, while it has remained stable - and low - in the birth centers between 4.4%-6%.  The women in this study saved more than $30 million simply by birthing in a birth center instead of a hospital.

According to Rebecca Dekker, "The National Birth Center Study II shows that when women receive midwifery-led care in birth centers, preventable C-sections are prevented...  Legislation is needed to align payment methods and regulations so that we can better promote the proliferation of birth centers."  In other words, if you are low-risk, hire a midwife, birth out of hospital, and demand that insurance cover midwifery care at a birth center!

For years I have said that birthing in the hospital is like eating at the Olive Garden.  Before I go any further, let me just say that I worked for Darden Restaurants at the Olive Garden for nearly 4 years.  They are a fabulous company to work for.  Seriously.  I got vacation, insurance, incentives.  Sometimes I still miss it.  It's also still one of my favorite places to eat.  With that being said....

When you walk in, you are welcomed by the hostess.  Hopefully you don't have to wait too long for a table.  You have a lovely meal, but if you camp out, your server starts getting nervous.  Because of all the refillable items, the server's section only consists of 3 tables in order to give great service.  If he/she is going to make any money, they've got to turn those tables.  When one table hangs out, it hurts the profits of both the server and the restaurant, and the lobby starts filling and backing up, especially if several tables are "camping out."

When you are birthing at the hospital, you simply cannot labor in a room for hours upon hours, or sometimes days.  The lobby (triage) is filling up and your table (room) is needed.  Even the best care providers working in the hospital will tell you to "come in pushing" because they know that women are much more likely to have things done to them to speed things along once they are in the hospital - things that interfere with and interrupt the natural process.

One of the most significant points worth repeating from the study is that low-risk women have a 6% c-section rate at a birth center, but in the hospital, they are more than 4 times as likely to have a c-section, at 27%!  Some of the reasons for higher c-section rates when mom plans a hospital birth include:

* We need your table - i.e. Failure to Progress - Mom has "failed" to progress within her time limit imposed by the hospital.

*  High rate of induction and not allowing labor to start on its own - A first-time mom is twice as likely to have a c-section when her labor is induced.

*  The use of epidurals and IV drugs do affect the course of a woman's labor.  These are not options in a birth center.

*  Baby is more likely to have heart decelerations with pitocin and other drugs in mom's system, causing care providers to worry more - not just about the baby but also about lawsuits.  The what-if factor is huge and a lot of cesareans are performed as a direct result.

*  We cannot ignore the money factor.  C-sections make more money.

*  We cannot ignore the time factor.  The more time the OB is in the hospital, often, his lobby is full over at his office.  Ever wonder why you wait for 3 hours at your OB appointment?  He/she is aware they are getting further behind the longer you are taking to have your baby.  They don't have time to wait around.  (I actually get this one.  I am super selfish with my time.  I can't stand to wait - on anything - and know I'm getting behind with other things.  I would make a terrible midwife for this reason.)

Personally, I believe at the root of choosing hospital birth is the desire for an epidural.  I believe that if women (and men) weren't so afraid, they wouldn't ignore this evidence about the safety of out-of-hospital birth.  Education takes the fear away.

 "You CAN have an amazing birth!"  -  Birth Boot Camp

Now, go enjoy a delicious meal at the Olive Garden and tell them Banned From Baby Showers sent you!

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How to Have a Natural Birth

Recently, I had a conversation with someone about wanting a natural birth and how hard it is to get that without a fight on your hands.  She asked the question, "Why can't you just say 'I don't want the drugs.'?"  It was an interesting question, really.  Why is it so difficult in American obstetrics to have a natural birth?

I think there are many factors here.  Fear is at the top of the list.  Fear of pain, fear of lawsuits, fear of the time commitment.  I think loss of control is also a factor.  We like to control everything.

And as much as we glorify the "superhero," we hate her when it comes to birth.  We want her to fail.  Her natural birth makes me feel bad about my medicated birth.  It's easier to believe that no one can do it than it is to believe I couldn't do it. 

The media is at fault here too, but it's largely because they feed the fear.  I have a mom right now doing Birth Boot Camp online classes that was thinking about transferring to a natural-birth-friendly hospital but it's an hour away.  We get this idea from all the sitcoms that the minute labor begins - or water breaks - the baby is going to fall out.  Women and men are fearful of a birth place that is more than a few minutes away. In reality, they could probably cross state lines with plenty of time to kill!

And then there's the noise factor that I've been talking about for years - the majority of the people at the hospital want you to have the drugs because of the noises you might be making, be it moaning, grunting, or even screaming.  Those noises make people uncomfortable when they are not used to hearing them. Personally, I like to hear the noises a woman is making in labor because you can tell how well she is handling things. Those noises let her support team know what she needs. Who needs a vaginal exam?!  Just listen to her!

In addition to making the laboring woman be quiet, the control is now shifted to the medical staff.  They do not have to wait for your labor to progress.  Like magic, they can force your uterus to contract whenever they want it to with pitocin.  What power!  The laboring woman is powerless at this point.

Frankly, people just don't understand why someone would want an unmedicated birth.  I was that way with my first baby.  I couldn't believe it when people would ask me if I was having the drugs.  Of course I'm having the drugs!  I get it.  I've heard a million different reasons for wanting a drug-free birth over the years, but in the end, a couple has to be willing to do what it takes.

HOW TO INCREASE YOUR CHANCES OF GETTING A NATURAL BIRTH

1.  Believe that your body and baby will work together.

2.  Choose a care provider very carefully.  They may make or break this experience.  If you have chosen wisely and you do have a cesarean or are encouraged to induce, you will not second guess them EVER.

3.  Take a thorough childbirth class.  As the founder of Birth Boot Camp®, I believe our 10-week curriculum is the best program out there, preparing both partners for an empowering birth experience. If there is not an instructor in your area, take the online course. After you have an amazing birth, become an instructor!

4.  Communicate with your partner.  This is an opportunity to grow closer together.  It's not every day you bring a baby into this world.

5.  Hire a doula.  She will help you achieve a drug-free birth.

6.  Know your options.  If your chosen birth place is not natural-birth-friendly, RUN.  If you take the attitude of  "I'll stay with my OB this time and switch to a midwife next time," they may set you on a path of cesareans that will make it harder next time around.

7.  Practice relaxation on a regular basis.  Eat well.  Stay fit.  If you become high-risk because you eat junk food and have a sedentary lifestyle, your plans for an intervention-free birth may go out the window.

8.  Surround yourself with people that believe in YOU!

9.  Don't be afraid to ask the hard questions and read between the lines with your care provider.  If you feel like you are jumping over red flags, you probably are.  As long as the baby is still inside of you, you have options.  Regardless of what you may have heard, it's never too late to switch care providers.

10. Read positive birth stories.  Read - and believe - affirmations that you can do this.  You are strong and capable.  Embrace this experience.  It is yours and yours alone.

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Media Portrayal of the Labor Day Rally for Change

Nearly 10,000 women, men, and children attended the National Rally of Change by Improving Birth in 110 cities across 45 states in the US on Labor Day.  It was the largest women's rights rally in decades.  Expect more to come in the next few months.  The work is only beginning!

Rally at Medical Center of Arlington, TX 

Most rallies did get some media attention.  People say that some attention is better than no attention, but some of the attention perpetuated the problem!  Check out one of our media spots from Arlington, TX:

I don't want to nit-pick it to death -- and we are grateful for the coverage -- but when the anchor/reporter makes comments like "...They are calling for change in maternity care that shifts away from inductions involving  drugs and c-sections to, what they say, are safer methods of delivery..." it makes us sound like we are just making stuff up.  She kept calling it the Birth Change/Method Movement, which I thought was funny.

I sincerely don't understand why the media has to make birth advocates look ridiculous and on the fringe.  All the media clips make birth look so scary and the women look like they are beyond miserable.  Who wouldn't want an epidural after watching these clips!?

Take the clip here where the woman is screaming in one long tone.  The reporter's voice-over is actually valuable information that is pertinent to our cause, but you a) can't hear it because of the yelling, and b) can't take it seriously because who would ever want to have a natural birth if this is what you might sound like?!

The topic of birth makes people so uncomfortable that they have to make fun of it, or show "funny" movie clips to get through it.  I believe that is part of the bigger problem here.  No one wants to have a serious conversation about birth.

Abbey and I actually spent quite some time with a couple of reporters discussing some really pertinent issues.  Abbey, a VBA3C (we had 3 of them at our rally!) , gave these reporters lots to work with as far as VBAC myths, but none of that made it onto the news.  I really believe that people just don't want to know.

I'll leave you with the other media clip, which was only 49 seconds, but at least we didn't look like we are on the fringe, mostly because I told the reporter we aren't trying to take away anyone's epidural with our rally!  If they only knew...

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Don't Drink the Kool-Aid!

American women have drank the Kool-aid and have been completely brainwashed!  You know the Kool-aid I'm talking about:  The purple Kool-aid says that if the baby doesn't come out in 24 hours, it won't fit and the mom should be sectioned.  The red one says that if a woman is 40 weeks, she is overdue and the baby will die if she isn't induced.  The green Kool-aid says that an epidural is just an epidural.  And the orange one says that a cesarean is safer for mom and baby.  We won't even get to the Kool-aid that tells you that your baby can manipulate you!  The list goes on and on.  I just picked a few from some common American birth myths that I've heard repeated lately.

DON'T DRINK THE KOOL-AI

I just heard this story last night and I have permission to relay it here.  I am appalled that with such great birth choices, women are being sectioned 60% of the time not 20 minutes up the road from me.  Here's the story from the lactation consultant:

Saw another "victim" of Dr. Seligman & MCA (Medical Center of Arlington) today. At 38.5 weeks, her baby hadn't dropped so Dr. S told her they needed to induce on Tuesday and she would probably need a c/s at 39 weeks. After 10 hours on pitocin, baby still hadn't moved down so Dr. S. told her that the baby probably wouldn't fit through her pelvis anyway, so they needed to do a c/s. Baby was born weighing 7lb 4oz, still covered in lanugo and has very little suck reflex. :-( Mom is starting the make the connection that baby was NOT ready to come yet. Said her mom delivered all of her babies at 42 weeks. Oh, and she said that Dr. Seligman's parting comment to her was "Next time we'll just schedule the c/s for 39 weeks and avoid all of this other nonsense." 

This story really touched a nerve with me.  Frankly, her doctor is a complete idiot.  I feel horrible for the mom.  This is some bad Kool-aid she drank, but she trusted her doctor.  Very few don't trust their doctor and end up in the same situation.  He should not be practicing medicine.

What about the woman that labors "too long"?  "It's barbaric to expect a woman to labor for 24 hours without drugs.  Put her out of her misery!  If she's labored that long, surely something is wrong.  She should just have a c-section."  There is another OB at the Medical Center of Arlington in Arlington, TX, Dr. Udell, that tells her "patients" that the only humane way to have a baby is via cesarean.  She laughs if a woman tells her she wants to have an unmedicated birth.  Yes, this OB is a woman, and no, she does not have children.  I only know one woman who has had a vaginal birth with her, and frankly, it's because the labor was so fast, the OB didn't have time to intervene.  Although she did find a way to get her flat on her back despite the mom wanting to be on hands and knees...

I know of another OB in Mansfield, TX that routinely tells her "patients" that "nothing good happens after 40 weeks" and insists on induction at that time.  The baby must have a sticky note with the date circled in red ink on the side of the uterus so it knows just when it is expected.  It will be evicted by 40 weeks if mom is with Dr. W.  It is dangerous to stay pregnant another day!  Induce, induce, induce! 

"An epidural is safe and you are crazy if you don't sign up for one." This Kool-aid tastes so good, mostly because we want it to.  It's just an epidural.  Nevermind the cascading interventions when a mom says she wants "her epidural".  IV fluids, catheterization, blood pressure cuff, continuous electronic fetal monitoring, possible internal fetal monitoring (which includes breaking water - I'll come back to this one in a minute), fever reducer, pitocin, is more likely to have an episiotomy and assisted delivery (forceps/vacuum), and ultimately, she is more likely to have a cesarean.

I just want to mention briefly that I am hearing less and less about internal monitoring.  I honestly believe that we have become too blase about c-sections that everyone is just comfortable with going straight for the cesarean rather than use a more accurate form of monitoring.  Just an observation.

And the cesarean Kool-aid... This is the biggest lie of them all.  "Cesareans are safe -- even safer -- for mom and baby than a vaginal birth."  Shame on anyone who believes this to be an acceptable -- and even preferred -- way to get the baby out.  Women are going in for surgery and have no idea how this will impact them or their baby for the rest of their lives.  Someone always has to jump in and tell me why they had to have a cesarean.  Yes, folks, I am very aware that a cesarean does sometimes save a life and sometimes the baby really can't get out on his/her own.  Very aware.  What is the rate where you live?  What is the cesarean rate at your closest hospital?  You should know these things.  What can you do about it?  We're getting to that.

So many women (and men) feel defeated when it comes to the Kool-aid.  Everyone has drank it.  I think two things have to happen.  We can scream the truth from the rooftops, but that may or may not work.

1)  We have to start with the younger generation.  Don't be afraid to talk about birth with them.  Talk to your sons and daughters.  Just casual conversations.  Tell them about the day they were born, how their birth was amazing and special.  Just hearing different words associated with birth makes the Kool-aid not taste so good when they do hear it in our culture. 

2)  Get involved in making change happen.  You have to open your mouth, or at least get involved and help the people who are opening their mouths!  There is a rally being formed all across the country right now to take place on Labor Day, September 3, 2012.  Go to Improving Birth for details.  There may already be organizers putting a rally together in your community.  If not, YOU DO IT!  Change has to start with someone.  Why not YOU? 

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Tips for Becoming a Birth Activist

What an exciting weekend!  We just finished up our first Birth Boot Camp training workshop and it was AWESOME!  The November workshop is almost full, but we still have plenty of room in the September training.  It's just 3 months away, and there are a lot of certification requirements to be completed before the workshop.  I'd recommend it for people who are already birth professionals or have done a lot of the reading previously. 

I have another big weekend coming up.  June 22-24 is a  Birth Activist Retreat  sponsored by Where's My Midwife?  It is being held at The Farm in Tennessee, which is extra exciting because I'll be breathing the same air as Mr. Tim McGraw who lives less than 2 hours from there!  I am going with a couple of my favorite people from the Tarrant County Birth Network.  Really, getting there is half the fun!

I'm probably writing this post prematurely, as I'm sure at the end of next weekend, we will have come up with some great ideas for birth activism.  I just want to take a minute and talk about a couple of things in regards to this topic.

If I am an OB or a lawmaker, I'm thinking I am not going to listen to the "bra-burners" or picketers.  I need evidence and real stories.  I need to connect with the people who are trying to make change, including midwives and families who want birth options.  I have no interest in listening to (or taking seriously) people who are just loud -- demanding that I change my way of thinking.  I would be more apt to listen to people who are professional and rational.

I posted a question on my BFBS Facebook page asking what YOU do to change the culture of birth in your community.  A lot of answers were along the lines of talking to friends and posting on Facebook.  As you are probably well aware, birth is an emotionally charged topic, like politics or religion.  It's hard to bring it up on a personal level, but sometimes doing something on a bigger scale is less "in your face" to your friends and family.  It also has the potential to have a bigger impact, reaching more people.

I believe there are more and more women having amazing births and they want to change the way other women (and men) view birth.  We are seeing an influx of women wanting to become doulas because of this.  Many of them do a couple of births and realize "This is HARD!"  It is hard to be a doula and also have a young family.  Some people make it work and others aren't able to.  I think at the root of it all, however, is wanting to make a difference.  We all want that.

I know I am always touting starting or joining a Birth Network chapter in your area.  It really is a great way to get involved and make a difference.  You don't have to belong to a birth network however.  Some women have hosted a Red Tent event, encouraging women to listen to and tell birth stories.  This can be as simple or elaborate as you would like.

I know it doesn't sound as glamorous, but writing letters to the lawmakers, hospitals, and OBs in your state is a very important -- and real -- way to let them know what their constituents want. Back up your viewpoint with evidence and your experiences.  Birth is consumer driven.  In the 1980's birthing suites became popular and more "homelike" because women demanded it.  Some women were having their babies at home and the hospitals insisted that they were better than home, some even having full-size beds in many rooms.

Holding screenings (with appropriate permission and applicable fees) of various birth movies is something that has gotten a lot of positive attention for natural birth and is relatively easy to pull off.

Organize groups of women -- professionals and pregnant women --  to discuss various topics.  Sometimes giving people a forum is the most effective way to create change.

It is very rewarding to see women and families know their options and make informed decisions. No matter what you decide to do, think about your target audience and the message you want to send to them.  We should be taken seriously.  To be taken seriously, we need to take ourselves seriously.

Please share what you have done in your community that could be duplicated in other areas.  It's all about sharing ideas -- what works and what doesn't.

Until next week, my fellow birth activists!  Off to The Farm!

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Jessica Simpson's Fear-Based Elective C-Section

Another celebrity -- this time Jessica Simpson -- chooses a c-section and it makes the headlines.  Unfortunately, women are choosing to have surgery in order to avoid the "pain" of labor and childbirth every day in America.  I can't help but think that the media and the "horror stories" from friends and family about how hard and awful the experience is contributes to this elective e-section phenomenon. 

Some of the highlights, in case you missed it, are that Ms. Simpson is "terrified of pain" and "too scared to push."  ''The thought of going into labor scared the bejeezus out of her. She was so anxious, she was even breaking into cold sweats at night.  Jessica has no tolerance for pain. She even turned to hypnotherapy to calm her fears about it, but nothing was working.  She desperately wanted to experience the joy of a natural birth, but decided to go with what made the most sense for her.''

She obviously has her choice to elect to have surgery, and I don't really care about taking that choice away from her.  I am more concerned with where the fear comes from, and how do we conquer this fear that is so prevalent in our modern society?

I was scared to death when I was pregnant with my first baby.  I've written his birth story here, but in case you missed it, here it is again.  I was, like Jessica, terrified of the pain. Everything I knew about birth came from the movies and TV sitcoms.  Elective cesareans had not taken off (I wouldn't have chosen that option anyway) so I had to face my fear -- which I bravely did by demanding "my epidural"!

The two things that helped me overcome the fear of natural childbirth were:   
1)  Knowing someone who had actually done it
2)  Education

So, while I am sad that so many women are missing out on the amazing -- and even hard -- experience of natural childbirth, I understand the fear.  If you have had a natural childbirth, talk about it!  Encourage the women around you.  They are strong and capable.  I always believed I was strong.  Now I know I am strong because I faced my fear.  That knowledge is powerful as a woman becomes a mother.  It's powerful in other areas of your life too.  The more you know, the less you fear.  Get educated! 

Conquer your fears!  Each time you do, you become a stronger woman.  I spent my entire life being terrified of bees.  One year I planted a garden, and in doing so, learned how necessary the bees were to the survival of my 20 tomato plants. Without pollination, there would be no fruit.  You've seen The Bee Movie, I'm sure. As the summer went on, I welcomed the bees and simply worked around them.  I overcame my fear because the desire to have my garden flourish was stronger.

Birth is no different.  Get educated, surround yourself with people who believe in you, make informed decisions and conquer your fear!  You are stronger than any fear you currently have.  Put that in your pocket, Jessica Simpson!

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An All-American Birth Story

With permission, I'm sharing this email I received from a mom I met in Walmart.  I know what you are thinking, and, yes, I talk to pregnant mamas everywhere I go!  I rarely hear what happens after our encounters, however.  This is one of those emails that has been hard to forget.  This story is indicitive of how women are treated in American hospitals everyday.  It makes me terribly sad that women reflect upon their birth with sadness and powerlessness.  There is a saying that a woman will always remember how she felt -- or was made to feel -- on the day she gave birth. 

Hi, Donna. You probably don’t remember me because we met only briefly almost a year-and-a-half ago, but our meeting had a very profound impact on my last birth experience and on the way that I am looking at my present pregnancy and future labor. My husband and I lived in Mansfield for a short while when I was pregnant with our third child. We were shopping at Walmart when I was seven months pregnant when you approached us at the check-out lane. You asked where I was going for maternal care and when we told you, I was surprised to see your facial expression change so dramatically to serious and concerned from happy and congratulatory. We were so thrilled to be accepted at such a ritzy clinic because it is difficult to find quality care with Medicaid. I had not yet met with my doctor, but I was excited to receive good care at such a late time in my pregnancy. You informed us that our OB group had an extremely high c-section rate and encouraged us to look further into our decision before you gave us your card and told us about your work. We had considered ‘alternative birth methods' with our son, but home births are illegal in South Dakota where we had moved from so we had never followed through – midwives, although not as expensive as hospitals, are still a luxury that we cannot afford. This is why we have Medicaid.

However, since I had already toyed wistfully with the idea in my head, I was intrigued with the idea that natural births are better than hospital births and doctors and hospitals are the equivalent of the Big Bad Wolf and I went home and looked around on The Unnecesarean and Banned From Baby Showers websites. I was shocked to find so many statistics and the underhanded methods of physicians. The things that they will say to coerce a woman into a cesarean and the way that they will take cruel control in the name of ‘health’ shocked me. I showed the site to my husband and we went to meet my new doctor fully prepared with a few questions about his personal cesarean rates and a list of my expectations for my birth.

I told him my doctor the only way that I would have a cesarean is if my baby was in serious and immediate risk of death. Period. He quoted a cesarean rate much lower than the one that you gave us and explained that many cesareans rates quoted from their clinic included the cesareans for women who have already had cesareans in the past. He completely agreed that I should not have to undergo surgery unless the situation called for it loud and clear. We left feeling more confident and happily attended our ritzy high-end doctor’s appointments for the next several weeks, until…

I went in for a regular appointment at 35 weeks and the doctor checked to see if I had begun to dilate yet. To both of our surprise, baby girl had moved from the head-down to the butt-down position near the end of my pregnancy! This had happened with my son at 38 weeks as well, and my previous doctor had simply done a little sliding motion across my belly and he went right back into place quickly and almost painlessly. She then sent me next door to the hospital to be monitored for an hour and sent me home.

Dr. Ritzy informed me that this is a very difficult and risky procedure and I would need to go to the hospital in Arlington in a week to have baby moved if she hadn’t already done so on her own. So we went into the hospital a week later and found that our baby had not yet moved. They put me on a bed, prepped me for surgery for ‘just in case’ and gave me a drug in the IV to relax my uterus and make moving the baby easier. I thought that this was quite a bit of hoopla just so that the doctor could gently run his hand over my belly as my previous doctor had done for me, but I let him have his way and waited for the magic. What happened next was not magical, at all. He dug his hands into my belly and wrenched the baby to the side. It hurt more than anything I can describe to you, more than anything I have ever felt. They kept telling me to breathe, but I just couldn’t. Over and over he wrenched at my belly until I thought I might die. Just before his last try, he asked me if he should just stop and schedule my cesarean. I gasped out ‘no’ and he did it again. He failed. He moved her, but she was still not in the head down position and he didn’t dare try anymore. He informed me that he would schedule me for a cesarean in a week. I asked why we needed to do this- what if the baby moves herself? He told me that if the baby moved we wouldn’t need a cesarean. He would simply induce me and I would have they baby vaginally as I wished- YAY… wait. Why wouldn’t we just wait until I went into labor myself? That would give the baby more time to move and grow and become ready for the outside world, right? 37 weeks is not premature, but it is still early. Then he started with the lines that I read about on your site: ‘The baby is getting too big’, ‘You’re tired, it’s time’, ‘For your safety and the baby’s’… He went on and on over my protests and then walked out of the room. The nurse came in a couple minutes later to inform me that the doctor had scheduled me for the next week and had ordered me off of my Valtrex (I have genital herpes. Taking Valtrex in the end of my pregnancy ensures that I won’t break out and require a cesarean). I told her that I needed to take it. What if the baby moved? She walked out and came back to tell me that the doctor said I could continue taking the Valtrex.

We left the hospital devastated. I cried the whole way back to Mansfield and spent about an hour-and-a-half in despair, trying to accept what had happened to my pregnancy. I couldn’t though. I kept on thinking about your site and I slowly became angry. I spent the rest of the day trying to find a clinic that would take me in the end of my pregnancy. I found one and made an appointment for the day that my doctor had scheduled my cesarean. They did ultrasounds and monitored the baby immediately. Not only was she head-down already, but she was NOT too big at all. She was perfect.

You would think that this would be the happy ending, right? No. I went into labor at forty weeks and went to the hospital. My doctor was not on call. I spent the day being bombarded by all these different nurses and doctors that I had never met. Some were nice, some were pissy to be at work and it showed. When shift change came, I was assigned my last nurse. She came in from time to time to ‘check’ me but basically just kind of left us alone, which is what we wanted.

I had an epidural (I blame this on uneducation) and it started to wear off so my husband called her in. She told me that the anesthesiologist was working on a cesarean and would be about another 25 minutes. She checked my dilation and I was 6 ½ centimeters. Less than two minutes after she left, I had another contraction and felt the baby move into my birth canal. I almost jumped, it was such a surprise. I told my husband and had another contraction that sent the baby even lower. I sent my husband out to find the nurse. She told him that there was no way because she had just checked me and sent him back to the room alone. The next 25 minutes were so beyond painful that, again, I am unable to describe it. The act of fighting my urge to push only made my labor more painful and I was so scared. My husband went so far as to tell me to just push. I didn’t though. Who would catch the baby? (silly me) I wish I had. When the anesthesiologist came in I told her that I needed to push now and she immediately got my nurse. My nurse came in scolding me. She scolded me again when she checked me and was unable to find my cervix because the baby's head was in the way.  "Girl! I just checked you!" and then she put my legs in the stirrups, turned on the bright light, and told me to push. Half-way through my first push, her head crowned, but was blocked by the hand of my nurse. Half-way through that wonderful, relieving push I was ordered to stop and my baby’s exit was blocked. The nurse then paged the doctor and made us wait in that position for the doctor to arrive. When I asked if this was safe for my baby, the nurse scolded me again and told me that it was her job to worry, not mine. My baby was born with her cord wrapped around her neck and a slight case of jaundice.

Thankfully, they allowed me to nurse her for an hour before they whisked her off to a room where, contrary to the information in their brochure, my husband was not allowed to follow. Privacy and all that. Just as my husband was not allowed to tape or take pictures of our daughter’s birth.

If not for our chance meeting at Walmart that day, I may have let that first doctor cut me open. I may have fallen for his lines. My daughter was born 8lb 3oz, smaller than my son who was 8lb 8oz so his whole ‘baby too big’ line was a complete lie. I wish I had not gone to the hospital at all. Now I am pregnant again and I am facing a dilemma that I am sure many women face. I can’t afford a midwife or a birth center. My husband is unemployed and I am a stay-at-home mom. I get nauseous and anxious when I take my kids to their doctor’s appointments. I feel like I will be coerced into some sort of treatment that I don’t want for them. My last birth experience seems to have turned me into a bit of a mouse with doctors and I often take my husband to their appointments for support and a little bit of muscle.

(The midwives we are seeing) still go through the hospital and I am afraid of another hospital birth. I fear their policies, and I fear that when I am in pain and in labor they will take advantage.I fear that I don’t have the strength to stand up to them. 

 I don’t want wires and tubes stuck to me. 

I don’t want to have my water broken or a timer set for me.

 I don’t want my baby taken into another room at any point after his birth. 

I don’t want to be checked over and over by strangers who change with every shift. 

I don’t want my control over my body to be taken forcefully when I am at my most vulnerable. 

 I’m scared. 

I want a wonderful empowering beautiful birth experience where I find myself and my child. I want long hours of bonding and nursing uninterrupted by strangers and tests. What can I do? Please give me advice.  Is it possible that the hospital could drop their policies for a patient? If I was experienced at all I would consider an unassisted birth, but I am not and I don’t have the money for supplies. Thank you for taking the time to read this and for intervening with my last pregnancy. Things would have been very different without your concern for my baby and I.

I cried while I wrote this, as it is the first time that I have told my story to someone outside of immediate family. It took me quite a while to recover from (my daughter's) birth. I felt kind of empty afterwards and even a little bit ashamed. I felt like it was partially my fault because I didn't stop the nurse. Sometimes when I remember it I change the ending so I can kick the nurse out of the way and deliver my own baby or give birth to her before the anesthesiologist came in. I keep remembering the smug look on her face when the doctor walked in. She waved her hand over my daughter's crown like we were a show piece on The Price is Right, or like she had done something great and deserved a cookie. The doctor wasn't surprised which tells me that this is some sort of normal procedure there and they have done it to other women.  

I am working on a list of my birth expectations, complete with arguments for why it should be that way in case I come across any resistance. I get pretty busy with the kids and school so I haven't finished and I don't want to go to my first appointment unprepared. Also, it's always so busy there and I'm not even sure that the doctor will have time to listen to me. 



I have put her in touch with a fabulous Certified Professional Midwife that lives in her area since recieving this email.  I don't want to be a loud-mouth (well maybe I do), but I believe that change begins with each one of us.  We must speak up for ourselves and for each other.  Fathers need to know how to advocate for their wives and their babies.  Spread the good news of natural and normal birth, my friends.  Support the care providers -- in and out of the hospitals -- that provide Mother-Friendly maternity care.  Don't be afraid to speak out against the ones who are not.  If the demand is great, the change will be great! 

Send good thoughts this mama's way come September, that she'll have an empowering birth experinece, feeling loved and supported along her journey. 

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Pushed into Supine Pushing Positions

When I was thinking about getting pregnant with my second baby, I visited my OB, Dr. Brian Wolsey, that "delivered" my first baby.  I had been gathering lots of information and knew I would do things differently with the second baby.  One of the questions I asked him was how he felt about me pushing in a different position besides flat on my back.  He got down on the floor (in his very nice clothes), and on one knee, contorted his body, and while looking and reaching up, said, "Well, it's kind of hard to catch a baby in this position."  He was more concerned with his comfort than mine when it came to pushing my baby out.

I never returned to his office.  

This is an important question to ask your care provider. The answer should be a respectful "Let's see how you feel when it comes time to push.  The benefits to using gravity and an upright position are ...    An example of when you might not want to use gravity is ..."

I've had a number of people return to class saying things like, "My doctor said I can hang from the rafters for all he cares" or "I can squat on the floor like I'm in the jungle!"  They seem happy with these responses, but in reality, your doctor is making fun of you.  He thinks its undignified and foolish.

If I am an OB -- or even a Certified Nurse Midwife -- working in a hospital, chances are, approximately 90% of the births I attend is with an epidural.  The mom is mostly on her back.  Like it or not, this is how I get used to catching babies.  This is what I am comfortable with.  Even to have a mom on hands and knees, well, this looks different to me, and I am not as comfortable with this situation.  I will find a way to get this mom on her back.  I will give her lots of excuses that sound really good, such as, "The baby is caught on the pubic bone and I need you to lean back."

If a woman is left alone to choose her birthing position, very often she will use gravity in some form or another.  Rarely will she lay flat on her back to push her baby out.  Squatting, for example, is known to widen the pelvis up to 30%.  Many OBs will not suggest a mom get up and squat, but instead, will cut an episiotomy to get the baby out quicker.  Or worse, perform a c-section because her hips were "too small."

I simply wanted to let women know that what position you birth your baby in is your choice.  This seems common sense, right?  I routinely hear women talk about their doctor wanting them in a certain position when it comes time to push.  Pushing while flat on her back can cause more problems that it fixes.  The only person benefiting from this position is the OB. 

When you ask your care provider this important question, listen for silly answers that are really meant to make fun of you.  Listen for responses that put his/her comfort above your own.  The good answers are the ones that inform and respect you and your comfort.  Follow what your body is telling you to do.  Don't let them push you around when it comes to pushing your baby out!  

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It's Just an IV -- What's the Big Deal?

I posed a question on my Facebook page this weekend asking if an IV was required at your place of birth.  As expected, the majority of those birthing in the hospital said yes.  I recently had an IV when I went for a colonoscopy, and I must admit, I did not like it.  My number one complaint is that feeling of cold fluid running through my veins.  Not a fan. 

What about for labor though?  Should an IV be a part of a normal labor?  The hospitals think so.

Let's face it -- nearly everyone who finds themselves on the Labor & Delivery floor will have an epidural.  Or an induction.  Likely both.  Before an epidural is placed, a mom will receive a couple of bags of IV fluid.  Epidurals are notorious for causing the blood pressure to drop, so these fluids are necessary.  Here's why they want you to have an IV when you walk through the door:  The minute you say you want an epidural, they can give it to you.  Otherwise, they have to wait for these IV fluids to be administered.  They believe that you will eventually beg for the epidural, no matter how many times you say that you want an unmedicated birth.  I hate to sound paranoid - or make others paranoid - but the truth is quite ugly when we talk about IVs.  You will very likely have other things running through an IV besides saline water, with pitocin at the top of that list.  Even if you don't have pitocin during the labor, you will assuredly have it after your baby is born to "aid" in the delivery of the placenta.  If you have an IV, you won't even know pitocin was added.  They simply do not ask your permission. 

Antibiotics are often added to an IV.  This is given, typically, under three scenarios: 

1) Mom develops a fever.  This could be due to infection, but epidurals cause fevers in many women.  Since we aren't sure either way, antibiotics are administered.
 
2) Water is broken so antibiotics are given routinely, you know, just in case she might develop a fever.  (Can you hear my eye roll?)   

3) Mom tested positive at 36 weeks for Group B Strep and antibiotics are standard procedure.  This post is not a post about GBS, but suffice to say, antibiotics are very necessary if the baby actually acquires GBS on the way out of the birth canal, but only 2 out of 1000 babies that are born to GBS-positive mothers will be affected.   One-third of women will test positive, so that is a lot of women receiving antibiotics -- just in case.   I have strong feelings about antibiotics from my own personal experiences, but you may not care one way or another.  Maybe you feel that it is better to be safe than sorry.  It's a decision each parent needs to make for themselves.

Is an IV ever necessary in labor?  In short, yes.  A woman in labor should be eating and drinking plenty of water.  Water is crucial in helping the uterus work effectively.  Without it, the uterus can become "irritable," often making an IV necessary.  Under these conditions, she'll often experience contractions close together and intense, but only lasting about 30 seconds.  An IV might help her stay hydrated and therefore causing more effective contractions.  If a mom can't keep fluids down, she might also require an IV.  As with all interventions, there is a time and place for everything.  IVs should not, however, be a routine part of a normal labor. 

 It seems that many moms end up consenting to a hep-lock, which is an open vein.  If they need to give you an IV quickly, they won't have to "fumble" to find a vein.  To quote one of my Facebook readers, "They said it was in case there was an emergency and I started to bleed out.   I said "If you're telling me if there isn't anyone here that can save me in an emergency if I dont have an IV line in already then I need to leave because I don't feel safe." They laughed, said good point and left me alone."  The hospital group I refer to in the Fort Worth area, the UNT Health Nurse-Midwives, have not required even a hep-lock for my students unless there was a medical reason to do so.  

One more thing I found extremely interesting about IV use in labor.  This can have a negative effect on breastfeeding.  Mellanie Sheppard, IBCLC, explained this at a Tarrant County Birth Network meeting one evening:  When a woman has IV fluids, she becomes swollen and puffy until the extra fluid has time to leave her body.  This can include extra fluid in the breast.  A woman who didn't think she had flat nipples before now may have a problem with the baby latching properly.  She might be started on a nipple shield and thus started down a road that could have been prevented by simply avoiding the IV in the first place.  

Last week I wrote about various policies that contribute to the high c-section rates and neglectfully left routine IVs off that list.  It should have been there.  Drink your water.  Talk to your care providers.  If you are choosing to birth in the hospital, search out the care providers who practice evidence-based maternity care.  You will likely have to concede on some issues, but choose your "battles" carefully and thoughtfully.   

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Hospital Policies that Encourage these Outrageous C-Section Rates

Over the years, I have narrowed down the hospital policies that are the biggest problem for moms who want to have an unmedicated birth.  Short and sweet!  Here are your red flags:

1)  The use of continuous Electronic Fetal Monitoring (EFM).  I wrote about this one last week.  This chains mom to the bed.  She's not moving around, helping her baby figure his/her way out.  This policy is applied in nearly all hospital births.  It's very convenient for the nurses, but not for the mom.  Evidence indicates that it is not safer for the baby and the c-section rates rise when EFM is used.  Check with your hospital and your care provider.  If your care provider "approves" intermittent monitoring, make sure that gets written in your chart.  (Just a heads up -- while this improves your chances of not having EFM, it is not a guarantee.)

2)  If your water breaks, you are in bed for the duration of your labor.  They claim this is for your benefit, saving you from a c-section, as the umbilical cord could suddenly slip out, endangering the baby, making a c-section necessary.  The chances of this actually occurring are about .3% of all births.  How can you prevent this from occurring?  Don't let anyone break your water!  This is more likely to happen if the baby is high in the pelvis.  If your baby is low, this is not really a risk.  Also, if this is going to occur, it usually happens when the water breaks. 

A couple other things worth noting that may or may not seem obvious:  You will be on a time clock once your water breaks (find out what that means at your place of birth - usually 12-24 hours), so you really want to do things that encourage the baby to come.  Laying in bed on a monitor doesn't really do that!  Pitocin is usually started after water breaks.  Evidence just doesn't make a lot of sense with this policy.  They say that they are trying to prevent you from having a c-section, but by keeping you in bed, that is exactly where you are headed!

3)  Vaginal Exams every two hours.  The reason women are given vaginal exams are because they have epidurals and can't feel when they are ready to push.  A woman who isn't numb doesn't need to be told how dilated she is or when to push.  Failure to Progress is the 2nd most common reason women have c-sections (2nd to already having had a previous c-section).  So let's add this up:  She's in bed, on a fetal monitor, having vaginal exams every two hours.  She's not moving or using gravity. I know of a hospital midwifery group that hardly ever does vaginal exams, unless there is a medical reason to do so.  This is how it should be.  Many women will stay at a certain number of dilation for many hours and then suddenly dilate in a short amount of time.  Labor is not all about the dilation of the cervix!  Vaginal exams are directly related to the dreaded time clock. 

4)  Does your hospital employ midwives?  This is a big deal.  If there are not midwives at your hospital, only the medical model of care is practiced.  This is the only model the OBs use and the only model the nurses see.  The midwifery model of care views labor and birth as a normal process.  The medical model views childbirth as a medical emergency waiting to happen. They believe that medicine and technology improve the safety and process of birth.  

5)  Does your hospital have a no-VBAC policy?  Then they don't trust birth and they don't read the evidence.

Finally, don't ignore the red flags.   I could go on and on about policies that the majority of hospitals have that are problems for a natural birth mama.  Follow your gut.  There are great places to have your baby.  Seek them out.  Hopefully this list will be helpful on your journey.  Don't be a victim!  Like I always say, as long as your baby is still inside, you have options.  This is your birth.  Choose a birth place that respects your wishes and shows reverence towards your special day.

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Electronic Fetal Monitoring -- Is it really saving babies?

 As Tim McGraw's biggest fan, I subscribe to a number of Country news emails and Facebook groups.  I skip over most of it, but sometimes I'll see something that catches my eye that is not even related to Tim.  As you can imagine, it usually has to do with someone having a baby.

A couple of weeks ago it came across my News Feed that Jewel was showing off her new baby.  She lives in this area of Texas, about an hour from me, and because we have about a 50% c-section rate, I was very curious how things turned out for her.  (I had heard that she had desired a "natural birth.") 

The story goes that she was doing Hypnobirthing -- no details available.  Could have been self-study or CDs, maybe a class.  So I assume that desiring a "natural birth" really did mean an unmedicated birth, not just a vaginal birth.

The article went on to describe how violent the Braxton-Hicks contractions were and put the baby at risk.  Yadda, yadda, yadda... she had an emergency c-section that miraculously saved her baby.


The singer, who studies hypnobirthing, was eager to have a natural birth, but things didn’t work out as planned. When Jewel started having early Braxton Hicks contractions, Kase’s heart rate dropped. She admits, “I feel lucky to be pregnant in the modern age where they could actually tell he wasn’t well during those contractions.”  

In the end, Jewel says her scheduled birth plan wasn’t what was important to the young family. “We felt thankful that we had good doctors and a good hospital nearby, and that everything was OK,” she says. “I’m so lucky that we have a healthy baby boy. That’s all I cared about.”

I can't help but think this poor reporter got his terms mixed up about the contractions, and there's little information to go on from there.

Regardless, how many women have had c-sections that truly believe they were necessary -- that their baby would have died without the surgery?  Countless.  The year the Electronic Fetal Monitor was introduced, we went from a 5% c-section rate to 23%.  Studies have shown time and again that a baby who is truly in distress will be picked up with intermittent monitoring.  (Side note:  "intermittent" means different things to different care providers.  It may mean during and between a couple of contractions per hour, or 20 minutes per hour.  Find out what intermittent means at your place of birth.)

One of the problems with the continuous monitoring is the lack of communication between the birth team and the parents.  Mom is monitored from down the hall, and when a nurse does walk in, she tends to look at the monitor and not the laboring woman.  Another problem is obvious:  mom can't move around and help her baby out.  The baby is left to figure it out on his/her own. 

Problem number 3:  Any time a mom receives drugs of any kind, she'll be put on a monitor to be sure the baby is handling it OK.  This can mean hours and hours of a baby being exposed to ultrasound.  That's what Electronic Fetal Monitoring is -- ultrasound.  I've written posts on the risks of ultrasound in the past.  Click here and here and here.  You need to decide how comfortable you are with this intervention.

Problem number 4:  The biggest problem of all is simply that they have to do something with the results of the readout.  Take a baby that has a cord around the neck, for example.  This baby will have decels of the heart rate on the printout.  They aren't sure why the baby's heart rate is dropping, but better safe than sorry, right?  Lawsuit alarms start going off and a c-section is performed.  The baby is fine (Jewel's baby looked great!), but there is this perception -- or defense mechanism -- that thank goodness the c-section was performed and saved the baby. 

Was the baby ever in trouble?

We'll never know.  But now, because it's so hard to find a VBAC-friendly doctor, we've put this mom on a c-section path for all her children -- unless of course she becomes informed of her VBAC options.  As an OB, this is exactly where I want her.  Easier for me and twice as much money.  Few women will question the c-section because it makes her look like a bad mom.  She trusts her doctor.   It's easier to believe that the surgery saved the baby.

Another side note:  The cord around the baby's neck occurs in about one in three births.  When a c-section is performed where the cord is around the neck, the OB often makes a big deal about it, making the parents feel like this was very dangerous.  It's not.  The OB or midwife, after the head is out, will simply lift it over the baby's head.  It could be wrapped around the neck several times!  The most I've seen from one of my student's was 4 times!  Had she stayed with her original hospital and OB -- who required continuous monitoring -- she assuredly would have had a c-section.  Instead, she had a fabulous water birth with CNMs at a different hospital.

So, I feel bad for Jewel.  Maybe her baby really was in distress, but I suspect that the doctor didn't want such a public birth taking a chance at going sour.  Given the high c-section rate in our area, perhaps he was less comfortable with (unmedicated) vaginal birth than cesarean birth.  He knew he could perform a mean c-section and spin it like he saved the baby.  Again, just me speculating.  I do believe that she was likely another victim of our broken maternity system and doesn't even realize it.  While I always advocate for women being informed of their choices in childbirth, sometimes ignorance is probably quite blissful.

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No Ingles? C-Section for You!

This might raise more of a ruckus than anything I've ever said here.  I believe -- with good reason -- that English being your second language puts you at risk for a c-section in America.  Think about your friends or acquaintances for a minute.  Maybe you are from another country and gave birth in America.  Did you have a vaginal birth?

I have a couple of friends that work at a local hospital in the Dallas-Ft. Worth area with a c-section rate of 60%.  They have both told be they think the statistic is higher than that, however.  They have said there are days (and nights) where they don't see a single woman that has had a vaginal birth.  When I asked them why they think the numbers are so high, one of them said it's because that particular hospital has such an influx of Mexican women.  What?!  She went on to explain that when they don't speak the language (English), things just happen to them, the labor "spirals out of control," ending in surgery.

Surely in the United States of America they are getting the best health care in the world, right?  Frankly, I believe they are taken advantage of by a system -- doctors, nurses, hospitals -- that don't want to deal with them.  They know that these women and families are often scared, and frankly, trust the doctors to take care of them to do what is best for them.  I think they are being scammed.

It is not just Mexican women.  I know people from several other countries that have had the same experience in the DFW area.  I believe it is happening all over the United States.  One of the women I know who had a cesarean at the mentioned hospital said that in her Discharge Class, only 2 of the 15 women had had a vaginal birth.  She is Italian and will be VBACing this September at a different hospital with a VBAC-friendly doctor and she has hired a doula.  She will not be a victim this time around.

Very few women -- American or otherwise -- are truly aware of their choices when it comes to childbirth.  We place our faith and trust in the doctor's hands and become good little patients.  Less than 1/3 of women take a childbirth class when they are pregnant.  We make it unbelievably easy for the system to take advantage of us.  Plenty of American-born women have been a victim of the system and don't even realize it.  They just didn't take the time to educate themselves about labor and birth and were not active participants in their labors.  Birth was something that happened to them.

Women from other countries and cultures bring their own ideas of birth to the table which may or may not mirror our own.  The third step of the Mother-Friendly Childbirth Initiative is:  "A mother-friendly hospital, birth center, or home birth service provides culturally competent care -- that is, care that is sensitive and responsive to the specific beliefs, values, and customs of the mother's ethnicity and religion."  That is rarely happening in this country!

Thoughtfully consider your place of birth regardless of where you are from.  Is your care provider respectful on all levels?  If English is your second language and you are having a baby in America, I hope that you will follow your intuition.  If you feel like your hospital or doctor is not respectful, don't ignore those red flags.  There are people who want to help you have a wonderful birth.  Seek out a midwife, a Bradley (TM) teacher, or a doula, for recommendations in your area.  It's only too late after the baby is here.

The diversity of this country is one of the many things that make is so interesting.  All women deserve to have a wonderful birth-day and not be a victim of a broken maternity system.  If you know someone in this situation, don't be afraid to speak out.  Help put her in touch with your midwife or doula. Language should never be a barrier to compassion or the beginning of motherhood.

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When We Want our Friends and Family to Birth Like We Do

Natural birth advocates get a bad name sometimes because people perceive us as cramming our opinions down their throat.  The same could be said about all the folks who tell you to "just get the drugs!"  They often encourage a pregnant mom to be induced, find out the sex of their baby, and of course, get the epidural.  Rarely do I have people sitting in class who say that everyone in their life is supportive of their natural birth choice.  Often, class is the only "safe" place where they can talk about their desires for a natural birth and prepare accordingly.

I used to encourage friends to have a natural birth and talk to them about my class.  Some cases have worked out great, but more often than not, it backfires.  I have learned over the years that the desire to have a natural birth must come from within.  I have a friend from church who says of "the other side" that they just aren't ready to hear "the gospel of natural childbirth!" 

I heard of a couple recently that took a Bradley® class, hired a doula, and birthed with a group of CNMs in a hospital.  She has family members that are natural birth advocates and encouraged her to do all the "right" things as listed above.  Now, I don't know this woman, so I am speculating.  She ended up with a c-section, one that was very likely not necessary based on what I heard of the story, but I don't think her heart was in it at all.  In hearing the story, I've heard the midwives blamed and also the Bradley® teacher.  I don't think either is at fault.  The mom just wasn't committed to having a natural birth and was subconsciously looking for a reason to abandon the natural process.

I believe that when people want you to get the drugs, it's because it makes them feel better about their own birth.  I did this with my friend, Alisa.  I had given birth to one baby with an epidural. I didn't feel a thing and narrowly escaped a c-section.  Alisa was planning an unmedicated birth.  I wanted her to fail.  Somehow, that would justify my birth choices.  A bit twisted, I know.  I think that a lot of women that have c-sections want others to have them as well.  They would never come out and say it, but I think it's there.

I love it when women have a natural birth and everyone says to her how lucky she is that her labor was only 3 hours (the hardest 3 hours of her life!) -- "If my labor had only been 3 hours, I could have done it too!"  I had someone in my class a few years ago who said to me after her labor, "I just think my labor was harder than everyone elses, so I had an epidural."  Women who have natural births are working hard and are committed to the process!  They aren't lucky, have high pain tolerances, or have easy labors!  It comes from within.

It is interesting to ask people on the first night of class why they have chosen to have a natural birth.  Rarely is the answer, "My friend had one and so now I want one."  I will admit, however, that was a factor in my decision to birth naturally with the second baby.  I knew that if Alisa did it, I could do it too.  I don't remember her telling me that I should do it though.  Reading the birth stories of Martha Sears in The Birth Book played a big role in my decision, and also the history of childbirth in America.

Ultimately, I believe the reason we want our friends and family to birth naturally is because we have seen how powerful it has been in our own lives.  In most cases, it was probably the hardest thing you have ever done, but the joy and empowerment that followed was unbelievable!  We also know that they can do it but are choosing not to.  That's the most frustrating part of it all.  If they would just give in to the process and let go of the fear, they too could have this amazing experience.

Our reasons for wanting our friends and family to have natural births is anything but selfish.  We want this experience for them, to feel that they accomplished this amazing goal -- one that most of us will only experience a few times in our lifetime.  If they didn't grow into teenagers, I'd have a dozen babies!

So, my natural birth "junkies," lead by example, like Alisa did.  Give your friend or sister a book to read full of good birth stories.  Be available for questions.  Let her borrow your copy of "The Business of Being Born" or "Orgasmic Birth."  Everyone is coming from a different place.  Sometimes we have to have our own (bad) experience to start listening to other options.

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"My" Epidural

Have you ever noticed that when a woman refers to getting an epidural, she uses the word "my" epidural, not "an" epidural?  It is the only time I can think of off the top of my head that someone refers to pain medication as "mine."  If I have a headache, I don't say, "I took 'my' ibuprofen."  I say, "I took 'some' ibuprofen." 

So why is there ownership of the epidural?  Even the L & D nurses refer to it as "your" epidural, or "her" epidural.  You own it -- you better claim it before someone else steals it!  It is the weirdest thing.

When doctors in Europe were using a combination of different drugs to "help" women through childbirth towards the end of the 19th century, American doctors didn't want to use them.  They didn't feel they were safe.  I know, hard to imagine now, isn't it?  It was the women who demanded to have the rights to these drugs.  Up to this point, the majority of American births were assisted by midwives, not doctors.  More than 95% of all American births took place at home.

Much like today, women were afraid of childbirth, just for different reasons.  When male doctors started assisting in childbirth, women were willing to put modesty aside (no small thing) at the promise of having "pain-relieving" drugs for childbirth.  The doctors found it easier for the women to come to them in the hospital rather than have to travel to their homes.

And so it began.  Hospital birth.  In the beginning, only the affluent could afford to birth in the hospital.  It was fashionable to be "delivered" by a male doctor with his drugs and forceps.  Eventually, if you had a midwife-attended homebirth, you were obviously too poor to afford a hospital birth.  By 1940,  two-thirds of American births took place in the hospital.  (Both my parents were born at home.  They lived in southern Illinois in the middle of nowhere and were poor!)  By the 1950's, only 1% of babies were born at home.  It has largely remained the same after 60 years.

Historically, women fought for the right to vote just a couple of decades after drugs in childbirth were introduced, and birth was migrating from their bedrooms to the hospitals.  Women entered the workplace in the late 1930's during WWII to support their families.  During the Women's Rights Movement of the 1960s, women wanted equal pay and treatment.  We deserved it!  We wanted rights!  In the same decade, midwives began to resurface and the natural birth movement began rising up.  Make no mistake, 99% of women were still giving birth in a hospital with the drugs.  Just like today.

For the last 110 years, women have demanded drugs in childbirth because we should not have to endure the pain of childbirth, no matter how dangerous it may be for the baby, right?  As a woman, I have rights to those drugs!  I owned an epidural from the minute that pee-stick told me I was pregnant!  The doctors warned the women early on that the drugs went straight to the baby and were not good for the baby.  The women didn't care.  Today, we have doctors telling women that epidurals are safe -- there are no risks.  Why would you not have one, they say?  "There is no medal at the end of this race."  Oh, I beg to differ --  a drug-free mama and baby is quite a reward to behold.

Yes, women's rights have done some very important things.  But at what point did we get so wrapped up in our own discomfort that we can't see beyond ourselves?  Is it just human nature?  That sense of entitlement?

Here's the real kicker -- if women only knew the absolute empowerment that comes with giving birth to your baby without intervention or medications, they would understand that that is real Women's Lib.  Don't own the epidural ladies, own your birth!

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