Positive Birth Stories
Women can overcome the fear surrounding labor and birth by hearing or reading Positive Birth Stories. I have asked a number of my Bradley Method® and Prenatal Yoga students to write their experiences down to share with other couples. Most of these stories on my blog http://prenatalyoga.wordpress.com are stories of natural birth. A couple of them are not, but these mothers were able to turn their baby's birth into an empowering experience and bring their babies into the world in the best, safest, and gentlest way possible.
"Women need to hear positive birth stories. Sadly, women who have positive, transformative, challenging but amazing births usually don't tell their stories. They may think it's not normal, or may not want to make other women feel inferior. Women need to share their birth stories, both positive and difficult, and when they're difficult, we should examine why and what could have changed. These stories have the power to transform how society looks at birth, to dispel the myths and relieve the fear." Debra Pascali-Bonaro
More women want to be able to have a baby naturally, even if they’ve had Caesareans. Research backs them up—so why won’t doctors?
Richard Schultz / Corbis
By Claudia Kalb | Newsweek Web Exclusive
Mar 23, 2010
It’s hard to imagine being fired by your doctor, especially just before giving birth. But that’s what Debbie Fields says happened to her last December when her desire for a vaginal birth after Caesarean (VBAC) was quashed by her obstetrician. Fields wanted to go into labor naturally; her OB insisted on scheduling a planned C-section one week before her due date. When Fields, whose first child was born by C-section in 2006, insisted on sticking to her plan, she was told to “find a new doctor.” She went home, had a good cry, then scrambled to track one down. Two days before Christmas, she went into labor and delivered a healthy baby boy. Despite her successful VBAC, Fields still bristles at what she endured to have the birth she wanted. “You feel like a beggar with your hat in your hands,” she says.
Back in the VBAC heyday of the 1980s, vaginal birth after a prior C-section was routine. But as the number of VBACs increased, so did reports about risks, including uterine rupture. In 1999, the American College of Obstetricians and Gynecologists (ACOG) issued guidelines stating that medical specialists be “immediately available” during a VBAC to treat a potential emergency—a standard that does not exist for routine labor. Many hospitals can’t afford round-the-clock anesthesiologists, and their OBs are busy attending to more than one patient. As a result, hospitals that didn’t have the resources to comply, and feared being sued if a birth went bad, stopped offering VBACs altogether. End result: the rate of VBACs dropped from a peak of 28 percent in 1996 to less than 10 percent today. C-sections, meanwhile, continued to shoot up. A new government report out this week says Caesarean rates increased by 53 percent between 1997 and 2007. Today, C-sections account for almost one third of all births in the U.S.—an all-time high.
The problem: the VBAC trend doesn’t make medical sense. Earlier this month, after poring over data at the National Institutes of Health, a panel of experts concluded that VBAC is a reasonable option for many women and urged professional organizations to revisit current guidelines, including the recommendation for “immediately available” emergency care. Uterine rupture is highly uncommon, occurring in less than 1 percent of patients. Women who have multiple C-sections, on the other hand, are at significantly higher risk of developing placental complications that can cause hemorrhaging and, in rare instances, maternal death. A “trial of labor,” as its known in medical jargon, is successful in nearly 75 percent of cases. What is clear, says Dr. Cathy Spong, chief of NIH’s Pregnancy and Perinatology Branch, is that VBACs are safe in the majority of women. Despite the scary-sounding risks, most mothers and babies do well, no matter how the babies are born.
VBAC advocates hope that health-care reform, with its emphasis on evidence-based medicine, might help turn the tide on VBACs. The VBAC stigma among doctors and hospitals, based more on fears about multi-million-dollar lawsuits than on data, has forced many women to switch providers, often traveling out of their way to find a supportive OB or midwife and a willing hospital. Since 1996, one third of hospitals and half of physicians no longer allow women to have a VBAC.
When she was pregnant with her second child, Allison Denenberg signed on with one of northern Virginia’s VBAC go-to doctors to avoid another C-section. Denenberg didn’t want to have to recover from abdominal surgery while taking care of a toddler and a new baby. She wanted to breastfeed, which can be more challenging after a C-section (positioning a baby to nurse can be uncomfortable and many women find that their milk takes several days to come in). She wanted her baby to pick his or her own birthday. And she wanted a positive birthing experience; after her first C-section, Denenberg worried that she hadn’t pushed effectively and blamed herself.
This time, Denenberg wanted to bond with her baby uninterrupted after birth without a surgical curtain in the way and she wanted to care for her baby “without having to call somebody for help,” she says. A Virginia chapter leader for the International Cesarean Awareness Network (ICAN), an advocacy group that supports VBACs, Denenberg feared that if she didn’t try to deliver her second baby vaginally, she might suffer postpartum depression. In the end—after a 24-hour labor, including three and half hours of pushing—Denenberg underwent a repeat C-section because her baby wasn’t budging. It wasn’t the outcome she wanted, but it was “awesome,” says Denenberg, because she was in control, and her OB cheerleaded her efforts. “It’s a woman’s right,” she says.
Often overlooked is a woman’s fundamental and primal desire to undergo the birthing rite of passage, to have a baby the way babies have been born from the beginning of humankind, complete with the roller coaster of emotional and physical experiences—pain, joy, power, and, ultimately, an overwhelming sense of accomplishment. That desire, and women’s frustration over the lack of support and accessibility, has led ICAN’s Barbara Stratton, based in Baltimore, to organize protest rallies at hospitals with “VBAC bans.” Their signs get right to the point: THANKS, BUT ONCE WAS ENOUGH and CHOOSY MOMS CHOOSE VBAC.
Choice, the ultimate imperative, has been lost for many women. When malpractice insurers refuse to cover VBACs and hospitals fear litigation, doctors can’t offer them and women can’t have them, says Dr. Howard Minkoff, chair of obstetrics and gynecology at Maimonides Medical Center in Brooklyn, N.Y. Now it’s up to ACOG, which sets professional standards, to respond to NIH’s call. What women need are doctors and hospitals that support VBACs, complete information about risks and benefits, and a medical provider who works with them in tandem. “Women are not irrational crazy creatures,” says ICAN president Desirre Andrews. They’re capable of making well-informed decisions for themselves and their babies. Having a VBAC should be one of them.
It was a sunny Friday afternoon, and Tracy was three days past the due date for her first baby. After finishing up the tenth call of the day from well-meaning but anxious friends and relatives, she headed out the door for her weekly checkup with her obstetrician. “If you don’t go into labor by your next appointment, we may have to induce you,” her doctor had advised. Tracy wondered if the slight menstrual-like cramps she’d had the past few days meant that something was happening at last.
At the doctor’s office, a vaginal examination revealed that Tracy was 2 centimeters dilated, her cervix 80 percent effaced, with the baby at minus one station. According to an ultrasound scan, her amniotic fluid levels seemed borderline low, and because she was having mild contractions, the doctor suggested that she “go on over to the hospital and have a baby today!”
Excited, Tracy called her husband at work. He rushed to meet her at the hospital, where she was admitted and hooked up to an IV. Eight hours later, with no further progress, Tracy received an epidural, and labor was induced by the intravenous administration of the commonly used drug Pitocin. A few hours later, her bag of waters was broken artificially; 36 hours later, Tracy was recovering from a C-section after delivering a healthy, 7-pound baby girl. Why did Tracy have to undergo a C-section? What, if anything, had gone wrong?
Nearly two decades ago, Roberto Caldreyo-Barcia, MD, former president of the International Federation of Obstetricians and Gynecologists and an eminent researcher into the effects of obstetrical interventions, made the stunning statement that “Pitocin is the most abused drug in the world today.”1 According to the Journal of the American Medical Association, 16 percent of expectant mothers are induced in the US; another 16 percent go into labor spontaneously but are helped along (“augmented”) by Pitocin or a variety of other labor-stimulating interventions.2 Other estimates range from 12 to 60 percent of mothers, depending on whether the numbers refer to type of induction or augmentation, the population sample, or the mother’s socioeconomic background.3-18
Pitocin is a synthetic oxytocin (the natural hormone that induces labor) made from pituitary extracts from various mammals, combined with acetic acid for pH adjustment and .5 percent chloretone, which acts as a preservative. The World Health Organization deplores routinely using Pitocin. The Physicians’ Desk Reference says that Pitocin should be used only when medically necessary, beginning with a minimal dosage, as there’s no way of predicting a pregnant woman’s response. The induced mother should receive oxygen, be continuously monitored by EFM, and have competent, consistent medical supervision. At the first sign of overdosage, such as or fetal distress, Pitocin should be discontinued, and the patient treated with symptomatic and support therapy. After being induced, the laboring mother can still help her labor progress through natural techniques such as walking (if she’s not had an epidural), changing positions, emptying her bladder once an hour, and nipple stimulation. Pitocin can cause increased pain, fetal distress, , and retained placenta; and recent research suggests that exposure to Pitocin may be a factor in causing autism.19-20
A survey by Robbie Davis-Floyd, a cultural anthropologist at the University of Texas, found that 81 percent of women in US hospitals receive Pitocin either to induce or augment their labors.21 Regardless of exactly how many labors are induced in the US today, the majority aren’t medically necessary, and between 40 and 50 percent resulted in failed induction.22 A review of the medical literature on routine induction of labor reveals that disagreement among medical researchers in different countries is rampant, and no conclusive evidence exists that routine induction of labor at any gestational age improves the outcome for either mother or baby.23 Caldreyo-Barcia concluded that induction is medically required in only 3 percent of pregnancies24 and that therefore approximately 75 percent of all inductions put both the mother and baby at risk.25
The “Cultural Warping of Childbirth”
Induction of labor is defined by the American College of Obstetricians and Gynecologists (ACOG) as “the stimulation of uterine contractions before the spontaneous onset of labor for the purpose of accomplishing delivery”–that is, artificially starting a labor that has not begun naturally on its own. Augmenting labor, often confused with induction, is a slightly different process, used to help or speed up a labor that began on its own. Midwives, physicians, and other healthcare providers have been inducing labor for as long as the human race has attempted to gain control over the processes of nature. A basic fear of the natural process of childbirth has led, over many centuries, to what President of the American Foundation for Maternal-Child Health Doris Haire describes as “the cultural warping of childbirth.” Justifiable fear about the possible death of a baby or mother in childbirth, combined with beliefs in magic, rituals, drugs, herbal remedies, and much later, technology, has led to the use of a whole host of “cures” for labors that didn’t seem to start “on time.”
In his classic book Husband-Coached Childbirth, Robert Bradley, MD, compares the arrival of human babies by nature’s schedule to fruit ripening on a tree. Some apples ripen early, some late, but most show up right in season. Along with Grantley Dick-Read, the father of what we now call “natural childbirth,” Bradley advocated relaxation, trusting nature, and allowing babies to show up when nature intended.
Artificial oxytocin, or Pitocin, was successfully synthesized in 1953, and two years later it was available to physicians for the inducing and augmenting of labor. By 1974 it was well known that Pitocin had a 40 to 50 percent induction failure rate;26, 27, 28 and in 1978, largely due to the work of Doris Haire, Pitocin was investigated by the US Senate and the General Accounting Office. Between 1978 and 1981, Haire testified at three congressional hearings on obstetric care, which included reports on the dangers to mothers and babies of the routine and elective induction of labor. (Elective induction is defined as the induction of labor without a clear medical indication.)
One compelling theory, presented at the 1996 annual meeting of the American Psychiatric Association by Eric Hollander of in New York, links autistic children with Pitocin-induced labors. Hollander suspects that Pitocin interferes with the newborn’s oxytocin system, producing the social phobias of autism. When he administered oxytocin to autistic patients, it made them four times more talkative, and according to the patients themselves, twice as happy, although not all patients responded.29
In 1978, the FDA advisory committee removed its approval of Pitocin for the elective induction of labor. (The drug has never been approved by the FDA for the use of augmenting labor.) The current Physicians’ Desk Reference clearly states that “Pitocin is not indicated for elective induction of labor.” An innovative New York , section 2503, passed in 1978, requires physicians and midwives to provide full, informed consent to laboring mothers regarding the use of drugs during labor and delivery.
Today, despite the problematic nature of inducing labor and the lack of hard data supporting these protocols from carefully designed controlled trials, the routine elective induction of labor in both normal and gray-area pregnancies (ones not yet showing clear medical indication, just possibilities) is still common.
Why Induce Labor?
According to ACOG, “Induction of labor is indicated when the benefits to either the mother or fetus outweigh those of continuing the pregnancy.”30 A very small number of babies (a typical estimate would be less than Caldeyo-Barcia’s 3 percent, mentioned above) actually need to be induced for medical reasons. Another 3 to 12 percent seem to want to drive their mothers crazy and hang out inside that wonderful, warm, loving womb. No one knows why these suspected “postmature” babies choose not to make an appearance exactly when those of us on the outside want them to.31
Actually, the percentage of babies born exactly on their predicted due date is so small it’s a wonder we bother with due dates at all. It’s perfectly normal for 80 percent of healthy babies to have anywhere from a 38- to 42-week gestation.32 Several generations ago, a physician might tell an expectant mother that she was due “sometime in late October or early November”; today, women are given a “precise” due date, often determined by ultrasound testing. Many instances of so-called postmaturity result from nothing more than an inaccurate due date.
Robert Mittendord of the University of Chicago Medical Center has isolated 16 factors that can influence the accuracy of a predicted due date. Ethnicity may play a role; African-American women, for instance, often have pregnancies that are, on average, three to eight days shorter than those of other women. First-time mothers can almost be counted on to deliver ten days or more after their due date. The length of gestation seems to peak for babies of mothers who are around 29 years of age, so maternal age may be a factor. Caffeine consumption makes pregnancies shorter. Taking The Pill up to two months before conception can cause havoc with due dates. Finally, because biologic variation in fetal size increases throughout gestation, ultrasound dating can be deemed somewhat reliable only in the first trimester.33
The gestational age of an unborn baby is best determined by looking at a number of different factors. If you combine an accurate date of the last menstrual period with a first-trimester pelvic exam, fundal measurement (from the pubic bone to the top of the uterus), date of “quickening,” and a fetal heart tone, then confirm these findings with a first-trimester ultrasound, you’ll end up with a due date that is still only 85 percent accurate, plus or minus 14 days. Second-trimester ultrasounds tend to be inaccurate by plus or minus 8 days, and third-trimester ultrasounds by a whopping 22 days.
It’s probably best to stick with the “late November, early December” method unless you are fortunate enough to know the exact date of conception, another way to attempt to pinpoint a due date. Medical science recognizes in vitro or artificial insemination as the only accurate means of determining conceptual age. However, if a woman was using an ovulation predictor test correctly, or her husband was home between business trips only once after her period ended (and she actually wrote this date down on a calendar), she could nail down her due date by counting forward ten lunar months from conception. Even so, she might end up with a baby who stubbornly decides to belong to that 10 percent who go beyond 40 weeks. Despite all of these calculations, an induced baby may turn out to be premature rather than postmature.
What Exactly Is Postmaturity?
ACOG defines a post-term pregnancy as one that lasts beyond 42 weeks of confirmed gestational age. The need to diagnose postmaturity accurately is important because , the risk of fetal distress, and the need for C-sections double by 42 weeks.34-38 Risks of true postmaturity include stillbirth, meconium aspiration, and “dysmaturity syndrome,” found in some babies adversely affected by being in a declining uterine environment. Robert Hamilton, assistant clinical professor of pediatrics at UCLA, says that in all his years as a pediatrician, he has seen actual postdate babies less than 5 percent of the time. Moreover, the vast majority of post-date babies overcome problems after birth and are ultimately healthy.39, 40 AGOC estimates that 95 percent of post-term babies are born safely between 42 and 44 weeks.41-45 (Perhaps these babies were meant to “ripen” a bit later than their “average” counterparts.)
The most accurate current criterion for diagnosing postmaturity is the mother’s amniotic fluid volume. As placental function decreases in a true postmature pregnancy, blood flow and blood pressure in fetal organs decreases. The result is lower levels of amniotic fluid, as measured by an amniotic fluid index. Fluid levels of less than 5 centimeters are considered low and greatly increase the risk of . A normal level is 8 centimeters or more; 5 to 8 centimeters is borderline. (Borderline fluid levels can be caused by something as simple as dehydration, so a woman should be sure to drink plenty of water throughout her pregnancy.)
It is not known whether the increased risk to the baby is caused by the postmature pregnancy itself, or if some babies who are inherently at greater risk are more likely to be overdue. Therefore, it is difficult to determine via research if the timely induction of labor decreases the risk in post-term pregnancies. The ‘ 1996 Assessment of Post-Term Pregnancies concludes that whether there is any “fetal testing modality that will provide the most accurate prediction of a healthy fetus is debatable.”46
How Does Labor Begin Naturally?
Up until recently very little was known about how natural labors actually begin. Scientists knew that the release of oxytocin resulted in both uterine contractions and milk production. Pioneering research by scientists at Cornell University, the University of Pittsburgh School of Medicine, and the University of Auckland, New Zealand, suggests that it’s the baby’s brain that initiates birth.47
These researchers discovered a pea-sized region of the fetal sheep brain called the , which actually serves as a biosensor designed to trigger the events leading to a birth. Two hormones, corticol and adrenocorticotropic hormone (ACTH), reach peak levels in the fetal bloodstream just before birth. Peter W. Nathaniels of Cornell University suggests that the “fetal brain may act as a tiny monitor, tracking its own development.”48 When the baby is ready for birth, the paraventricular nucleus signals the fetal pituitary gland to increase ACTH secretion. The pituitary, in turn, tells the fetal adrenal gland to secrete more cortisol. These hormonal increases cause changes in the mother’s hormones, including the release of oxytocin, which lead to uterine contractions. Because scientists speculate that a malfunction of the fetal biosensor may account for early or late births, this research may prove helpful in the future, both to stop premature labor or to effectively induce a truly postmature pregnancy.
All of the currently available methods of inducing labor bypass this important first step of fetal paraventricular nucleus biosensor interaction between the hormonal systems of both mother and baby.
Protecting Our Unborn Babies
Labor should be induced only when medically necessary, never simply for convenience or because a woman is sick of being pregnant. The risks in these situations far outweigh the perceived benefits. Determining postmaturity or a woman’s readiness to give birth are complex processes. We are just beginning to understand the long-term effects on the fetal brain of drugs such as Pitocin, and the exact long-term effects of inducing or augmenting labor are unknown. Pregnant woman wanting information on the safety of a drug can consult the Physicians’ Desk Reference or call the product safety officer at the pharmaceutical company where it is manufactured.
Not all babies appear to be harmed by the inducing or augmenting of labor, but these procedures do carry risks. According to Doris Haire, “The fact that Pitocin can shorten the normal oxygenating intervals that occur between contractions is a threat to the integrity of the fetal brain and can have lifelong consequences for the affected baby.”49
Pregnant women owe it to themselves and their unborn babies to do everything they can to stay healthy and thereby minimize or prevent the need for medical induction. Babies born from natural, spontaneous labors have the best overall outcomes, and their mothers experience easier labors and quicker postpartum recoveries.
Natural Methods for Inducing Labor
Suggestions for the natural induction of labor have ranged from taking castor oil to having sex. Before turning to a few techniques that might actually work, let’s take a look at some of the “old wives’ tales” that have made the rounds.
Castor oil simply causes the person taking it to empty her bowels quickly and efficiently. Because the uterus is so tightly wedged against the intestines, movement in the bowel can sometimes trigger uterine activity. Castor oil looks like a pretty silly remedy when one realizes the complex interaction between the brain chemistry of the mother and the baby leading to labor. Take castor oil only under the supervision of a midwife or a doctor. Balsamic vinegar and senna tea have similar but much weaker effects on the intestines.
Uterine-stimulating herbs, such as black cohosh (Caulophyllum), blue cohosh (Cimificugua), achyranthes root, goldenseal, motherwort, wild ginger, and red raspberry leaf, have been used to induce labor. No long-term follow-up study has ever been carried out to show that the use of herbal remedies is safe for inducing labor. All drugs, including medicinal herbs, reach the baby, and any dosage that has an effect on the mother is going to have an overdosing effect on the baby simply because the mother’s body weight is about 20 times greater. A pregnant woman, therefore, should never self-prescribe any medicinal herb. Anyone who must be induced for a medical reason, and who wishes to use alternative induction methods, should be guided by a knowledgeable herbalist, acupuncturist, or aromatherapist.
Essential fats and oils such as pennyroyal and safflower have historically been used to treat all manner of female complaints and are considered to be alternatives to cervical gel (artificial prostaglandins applied directly to the cervix to “ripen” it). Safflower is simply a safe cooking oil, but pennyroyal is known to have potential abortive effects.
Acupressure is considered by some American practitioners as potentially effective in jogging a late labor, but traditional Oriental practitioners almost never use acupuncture on women at any time during pregnancy. Traditionalists believe in trusting Mother Nature.
Aromatherapists advocate the use of the oils of lemon, clarysage, and fennel, which are massaged into the abdomen and inhaled by the expectant mother. Anything inhaled by a pregnant woman, however, is also inhaled by her baby, and cannot therefore be deemed safe.
Sex is an age-old method of induction that seems to be effective. Prolonged and continuous nipple stimulation results in the natural release of oxytocin and is a proven nonmedical method for inducing labor.50, 51, 52 The release of semen onto the cervix during intercourse can promote cervical ripening because semen contains prostaglandin, a hormone partially responsible for cervical softening.
Finally, relaxation–mental, physical, and emotional–prevents the pregnant woman from releasing adrenaline, a hormone that stops labor so that the expectant mother can find safety first before her baby is born.
All of these things, together with a healthy lifestyle, good nutrition, and a healthy pregnancy, combine to produce healthy babies who show up on time–the exact moment when nature intended.
1. Diana Korte and Roberta Scaer, A Good Birth, A Safe Birth (New York: Bantam, 1984).
2. JAMA Statistical Bulletin (January 21, 1998).
3. “Induction of Labor,” Technical Bulletin 217 (December 1995).
4. “Induction of Labor in Postterm Pregnancy,” ICEA Review 12, no. 1 (February 1988).
5. See Note 2.
6. ” While Waiting for Spontaneous Labor Compared to Immediate Induction Following PROM,” New England Journal of Medicine (1996).
7. Assessment of the Postterm Pregnancy, American Academy of Family Physicians, 1996.
8. “A Critical Review of the Recent Literature on Postterm Pregnancy and a Look at Women’s Experiences,” Birth (1985).
9. “Elective Induction v. Spontaneous Labor: A Retrospective Study of Complications and Outcomes,” American Journal of Obstetrics and Gynecology (1992).
10. “Postdate Pregnancy, Part 1 and 2,” Journal of Nurse-Midwifery (1985).
11. “Postmaturity: Much Ado about Nothing?,” British Journal of Obstetrics and Gynecology (1986).
12. “Prolonged Pregnancy: The Management Debate,” British Medical Journal (1986).
13. “Elective Induction of Labor,” The Lancet (May 1975).
14. Henci Goer, Obstetrical Myths v. Research Realities (Westport, CT: Bergin and Garvey, 1995).
15. See Note 1.
16. Sally Inch, Birth Rights (New York: Pantheon, 1984).
17. “Care in Normal Birth,” The World Health Organization.
18. Robbie Davis-Floyd, Birth as an American Rite of Passage (Berkeley: University of California Press, 1992).
19. See Note 17.
20. “Life in a Parallel World: A Bold New Approach to the Mystery of Autism,” Newsweek, May 13, 1996.
21. See Note 18.
22. See Note 16.
23. See Note 14.
25. See Note 1.
26. The Physicians’ Desk Reference, 52nd ed. (Montrale, NJ: Medical Economics Co., 1998).
27. See Note 10.
28. “Neonatal Morbidity and Mortality and Long-Term Outcome of Postdate Infants,” Clinical OB-Gyn (1989).
29. See Note 20.
30. See Note 3.
31. See Note 7.
34. See Note 4.
35. See Note 7.
36. See Note 8.
37. See Note 10.
38. See Note 11.
39. See Note 4.
40. See Note 7.
41. See Note 4.
42. See Note 7.
43. See Note 8.
44. See Note 10.
45. See Note 11.
46. See Note 7.
47. “Fetus Tells Mother It’s Time for Labor,” Science News.
49. Personal interview, Doris Haire, September 23, 1998.
50. Jacques Gelis, History of Childbirth (Boston: Northeastern University Press, 1991).
51. Richard Wertz, Lying-In: A History of Childbirth in America (New Haven, CT: Yale University Press, 1989).
52. See Note 18.
The Bradley Method. The American Academy of Husband-Coached Childbirth. 91413-5224 PO Box 5224, Sherman Oaks, CA 91413. 800-4-A-BIRTH (800-423-2397) www.bradleybirth.com
The American Foundation for Maternal and Child Health. 439 E. 51st Street, New York, NY 10022. 212-759-5510
International Childbirth Educators Association. PO Box 20048, Minneapolis, MN 55420. 612-854-8660. www.icea.org
American College of Obstetricians and Gynecologists (ACOG). 409 12th Street, SW, Washington, DC 20024-2188. 202-863-2518 (Resource center). www.ACOG.org
National Association of Parents and Professionals for Safe Alternatives in Childbirth (NAPSAC). Rt. 4, Box 646, Marble Hill, MI 63764. 573-238-2010.
Internet Resources (available by subscription or at libraries)
Infotrac, Medical Lexus, Medline, Elsevier
Brackbill, Yvonne. The Birth Trap. C. V. Mosby, 1984.
Bradley, Robert. Husband-Coached Childbirth. Bantam Books, 1996.
David-Floyd, Robbie. Birth as an American Rite of Passage. University of California Press, 1992.
Dick-Read, Grantley. Childbirth without Fear. 5th ed. Harper & Row, 1984.
Edwards, Margot, and Mary Waldorf. Reclaiming Birth. The Crossing Press, 1984.
Elkins, Valmai Howe. The Rights of the Pregnant Parent. Shocken Books, 1980.
Goer, Henci. Obstetric Myths versus Research Realities. Bergin and Garvey, 1995.
Inch, Sally. Birth Rights. Pantheon Books, 1984.
Korte, Diana, and Robert Scaer. A Good Birth, A Safe Birth. Bantam, 1984.
McCutcheon, Susan. Natural Childbirth the Bradley Way. E. P. Dutton, 1984.
Mitford, Jessica. The American Way of Birth. Penguin Books, 1992.
Romalis, Shelly. Childbirth: Alternatives to Medical Control. University of Texas Press, 1981.
Rothman, Barbara. In Labor: Women and Power in the Birthplace. W. W. Norton, 1982.
Nancy Griffin, MA, AAHCC, is the mother of a 16-year-old daughter and owner of the Mommy Care Mothering Center in Los Angeles. She is a Bradley Method childbirth teacher at St. John’s Hospital, a lactation educator, and an expert in pregnancy and postpartum exercise. Nancy would like to thank Haire for her invaluable assistance with this article.
The mucus plug started coming out two days before. My bag of waters broke around 9:30 Wednesday evening. It felt like I was leaking, Mildly annoying. Then I got period like cramps. Because I just had a dr appt that day and was told I was 1 cm dialited, I figured the cramps may be a result of the pelvic exam. The cramps kept coming. I couldn’t lie down with the intense pain so I moved out to the living room. And stayed there all night. I couldn’t rest for more than four minutes without being woken up. At 3:45 Josh heard me vocalizing and asked if everything was alright. He asked me how far apart the contractions were and grabbed a stop watch. I told him when each one started, or at least tried to. At 6 a.m. I called my work to let them know I wouldn’t come in, I might be in labor. I told Josh not to worry about it, I’d call him if I needed him. I just wanted my mom to drive me to the OB. so she could tell me what was going on. After Josh took a shower and dressed for work I told him he should stay. The OB didn’t open until 8. I could wait. The contractions kept coming. Finally around 9 Josh drove me straight to the hospital. I had a strong contraction in the emergency room waiting room and a nurse drove me up to the LDR waiting area. As Josh was taking care of the paperwork I heard “active labor” and slowly started to believe that this was it.
I was wheeled into a delievery room and told to change into a gown. When I got into bed the first thing they wanted to do was put a heprin lock in place. I explained I didn’t want anything like that. They hesitated and said they still wanted to use it just in case.
When I was set up with a room a team of people came in and told me to start pushing. I was 9 cm dilated. I was alarmed at this and not quite sure what to do. My dr. told me there was a slight crescent of the cervix left and I could push the baby right through. I did not feel the urge to push and was rather frightened of the whole thing, I needed time to process what was happening. Then, everyone left.
My next contraction came and I looked at Josh asking What do I do? Josh called for the nurse and she told me do what you feel you need to. I needed time and to practice pushing. I tried several pushes with Josh at my side and became comfortable with what was going on.
The pushing progressed and it was show time. The nurse rushed to get the dr. who told me to wait and not push while they got ready. I told her, sorry, no can do, need to push. The pushing lasted a little over 2 hours. The delievery was tough (they wanted three big pushes per contraction) but memorable in every way.
Logan James Thibodeaux was born at 11:41 a week ago today. I needed stiches for a natural tear. My dr. was very helpful and my coach was incredibly encouraging through the pain and the overwhelming experience. I am so greatful for Josh’s coaching. It was the one thing I could focus on.
Posted in Uncategorized |
Written on April 12, 2010 at 3:04 pm by The Midwife Avoiding the first c-section: Five simple precautions to take
Why is it so important to avoid the first one?
* It’s major abdominal surgery, and carries increased risks for mother and baby
* It often puts the mother in the position of having repeat c-sections, because she cannot find support for vaginal delivery after a cesarean
* It increases the risk of abnormal implantation of the placenta, which can lead to hemorrhaging or need for hysterectomy
* It increases the risk of unexplained stillbirth in a subsequent child.
Far too many first-timers make the mistake of doing everything they can to speed labor along. All too often, their efforts succeed at nothing but making them miserable and exhausted. Allow labor to unfold in its own time.
No one will argue that c-sections can be lifesaving under certain circumstances. Placental separation, placenta previa, cord prolapse, and certain abnormal presentations of the baby might cause injury or death to mother and child if it were not for the ability to deliver a baby by cesarean. I am thankful we have the ability to perform this surgery in a very safe manner. However, the majority of c-sections are not done for emergent, life-saving reasons. It’s those c-sections I want to focus on preventing.
Since most women having a primary (first-time) c-section are also having their first baby, I have five simple precautions that have been invaluable in my practice in helping women to avoid a c-section. I am writing from the perspective of hospital birth, knowing that the majority of women will not choose home birth, although I believe this is the number one way to avoid a c-section:
1. Stay at home in labor as long as possible, and consider giving birth at home. Why?
* Consider an animal in labor. If you’ve ever observed a cat or dog preparing to give birth, you may have noticed that they seek solitude. If they are disturbed during labor, they ahve a natural “fight or flight” reflex that slows or halts labor, allowing them to move to a safer location. While we as human women can intellectually understand the reasons for moving to another location (the hospital) to give birth, our bodies may still respond with a slowing of the labor process.
* It is understood that pain relieving medications can have a slowing effect on the process of labor. Epidurals are associated with a higher rate of vacuum, forceps and cesarean births in some studies. Yet it is difficult for a woman in hard labor to resist the offering of total relief of her pain. When you are at home, you know the pain medication is not available, and so the mind does not focus on it. It is easier to work with the contractions when you aren’t constantly thinking of the epidural available to you in only minutes.
* Staying home in the earlier stages of labor helps you to avoid the urge that hospital staff will feel to “speed things along” if your first part of labor takes many hours. It is common for dilation from zero to four or five centimeters to take many hours, and sometimes more than one day. If you are in the hospital and you are not yet dilated to four centimeters and having contractions three or four minutes apart, you are not in active labor. This part of labor is best spent at home.
2. Hire a doula if you can possibly afford it. If not, seek out an older woman who has had several children naturally herself, or has been present at several natural births, to be with you at home until you decide to go to the hospital.
* A woman who is familiar with the process of a normal birth will be invaluable to you in helping you know when it is time to got to the hospital. She can reassure you that what you are feeling is normal, that you can do it, and that you are stronger than you think.
* Many women are afraid to stay home in labor. A doula or experienced woman will be aware of the normal process of labor and be able to help you feel calm about laboring at home.
3. Find a practitioner who does not put arbitrary time limits on how long you can be in labor. If you are feeling strong, the baby is doing well, and you want to keep going, there should be nor reason to rush to a c-section simply because the labor is taking longer than average.
4. Carry on your usual activities as long as possible. Far too many first-timers make the mistake of doing everything they can to speed labor along. All too often, their efforts succeed at nothing but making them miserable and exhausted. Allow labor to unfold in its own time. Ignore the contractions until you are physically incapable of doing anything else during a contraction as well as in between contractions. This is where many women take their labor too seriously. They think because they have to breathe with a contraction, they are in hard labor. The actions of the mother between contractions are more indicative of the stage of labor. During the latter stages of dilation, the woman is usually quiet, tired, and may even fall asleep between contractions. She does not feel like talking much, or doing anything but resting before the next contraction. If your labor starts in the day, do what you normally would have been doing if you’d not started labor. If your labor starts at night, stay in bed and try to sleep, at least between contractions. If you cannot sleep, at least rest until your normal getting-up time.
5. Stay off the fetal monitor! The American Congress of Obstetricians and Gynecologists has published guidelines for intermittent auscultation of the baby, stating that it is just as safe for low-risk pregnancies as continual monitoring. It has the added benefit of having a lower c-section rate. This suggests that many c-sections are done for “fetal distress” seen on the monitor tracing, when the baby is actually fine. Once you allow someone to connect you to the continual monitor, you most likely won’t be off of it for the rest of your labor. What is intermittent auscultation? It is not being connected tot he monitor for 20 minutes out of every hour, as many hospitals’ protocols require. Rather, it is listening to the baby’s heart rate with a hand-held doppler before, during, and after a couple of contractions every 15-30 minutes during the first stage of labor. A skilled practitioner can determine if the criteria indicating fetal well-being are present, even with a hand-held doppler.
There you have it–my top five precautions to avoid the first c-section. I’d love to hear your ideas for other ways to avoid an unnecessary cesarean.