Well Rounded Birth Prep

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Monday, August 30, 2010

Myth-conceptions: "I trust my doctor" and elective inductions

This post goes along with my previous post, "How to avoid the ol' bait-and-switch with your OB/midwife/pediatrician." I'd like to go one step further, though.

I wish I had a dollar for every time I heard someone say something absolutely absurd that their doctor "believes" or "doesn't believe." I have a great idea. HOW ABOUT WE "BELIEVE" IN EVIDENCE-BASED MATERNITY CARE???? That would be a fantastic place to start and it would stop conversations like this from making my head explode:

Facebook acquaintance: "Would you all like to guess the date my baby will arrive? (My last baby was induced at 41 weeks.)"

Me: "Would you like resources and research regarding the pros & cons of induction, when it's medically indicated, etc.? I'd be happy to help."

Facebook acquaintance: "My doctor doesn't believe in letting mothers go past 41 weeks so I have my induction scheduled already in case I don't have my baby before then."

*facepalm* *facedesk* *facelaptop*

What do you mean, your OB "doesn't believe in letting mothers go past 41 weeks"? The same way he doesn't believe in Santa Claus? Because I can assure you, there are plenty of mothers who go past 41 weeks safely and healthily, including the majority of first-time mothers. The statistical average length of gestation for a first-time mom is 41 weeks 1 day. AVERAGE.

Can we please, just please, once, read the research instead of just "trusting our doctors"? Are our doctors informing mothers that induction doubles a first-time mother's risk of a cesarean? I cannot understand why some women will trust what their OB says even if it flies in the face of all the current research. Doctors are fallible, just like all other humans.

Trusting your doctor (or midwife) is great. I'd highly recommend that you do whatever it takes to find a care provider who you can trust. Just not with a god-like trust.

Oh, and this isn't even close to all I have to say about inductions (those which are preventable, i.e. "most of them"). I have to break down into manageable chunks.

Friday, August 27, 2010

Myth-conceptions: cord wrapped around baby's neck

Hello, readers. Thanks for your patience with my spotty attendance. It's back-to-school time in our household of 4 kids age 7 and under, and that means homeschooling first and second grades simultaneously while attempting to throw a few Pre-K activities for my busy 4 y.o. son and nursing my toddler daughter as she wants up on my lap, then down, then back up again, and repeat. I've also spent a lot of time trying to secure a regular venue for my Well Rounded Birth Prep classes.

I would like to start a blog series called Myth-conceptions, addressing common myths regarding pregnancy, birth, and breastfeeding. I have so many things I'd like to address in this series that I don't know where to start. It's actually a bit daunting.

I've heard and read hundreds of birth stories over the years, and it didn't take long to begin to see patterns. Research has established the cause-and-effect relationship between routine birth interventions and potentially preventable complications.

Since I have to start somewhere, why not this one: "The cord was wrapped around his neck--twice!!!--and if we hadn't been in the hospital, we both would have died!" True cord emergencies are extremely rare. In God's perfect design for the umbilical cord, the two arteries and one vein that make up the cord are covered with a rubbery substance called Wharton's jelly that helps protect the cord from kinks. The normal blood pressure through the arteries and vein in the cord help put positive pressure outward on the cord to help keep it from kinking as well. Even in the event of a true knot in the cord, Wharton's jelly usually prevents problems for the infant by keeping the cord from compressing. A knot in the cord isn't typically discovered until after the birth anyway, which means that nothing could have been done to have foreseen or prevented any true cord issues.

I once read a comment in response to a friend's informative post about homebirths, stating something to this effect, "I'm glad that worked for you, but my wife and son would have both died had she not been in the hospital. The cord was wrapped around his neck 3 times, and it even had a knot in it. Then there were heart decels while she was pushing and the doctor had to perform an episiotomy to get him out faster."

Let's take a look at this scenario piece by piece, shall we? First off and foremost, having the cord around the neck (in and of itself) at birth is not an emergency. In fact, it occurs in about 30% of all births. OBs and midwives will check around the neck to see whether the cord is wrapped around the neck after the head has been born. If the cord is wrapped around the neck, they will gently slide the cord over the neck without any problem. If the cord is wrapped multiple times, they will attempt to slide the first loop over the baby's head and sometimes this gives enough slack to the rest of the loop that the body is delivered with no complication at that point. If there isn't enough slack for that, a midwife will hold the baby's head near mother's leg and allow the body to be delivered in a maneuver resembling a somersault (pictured below), which doesn't put extra strain on the cord around the neck. (Most doctors will not do this, as they have not been trained to do so.) In a rare, true wrapped-tight-cord situation, the birth attendant will clamp the cord twice and cut in between, then help the mother to deliver the baby quickly as his/her oxygen supply (cord) as been severed.

As for the knot in the cord, in this particular birth story, nothing was done about it during that birth (nor could anything have been done about it) and there was no indication that the knot caused any problems. When and how did this dad think that knot got there, anyway? True knots can only occur early on in pregnancy when baby has enough room in the uterus to flip and spin freely to do a loop-the-loop and create the knot. This knot had been present for months.

As for the fetal distress during delivery, it's hard to say, since no details were given in this man's account of his wife's birth. However, it is well established that fetal distress can be an indicator that the baby is not tolerating mother's position well. The first thing a midwife will suggest if baby's heartrate is dipping, is to switch positions to see whether baby's heartbeat responds in a more favorable way. Sometimes it's something as simple as baby's cord getting slightly compressed due to the mother's positioning. Changing positions to help baby's heart rate would be difficult if the mother had an epidural, which has issues all its own that I will address in a moment.

It's also well established that the lithotomy position (a.k.a. "stranded beetle" position, lying flat on her back: the most common position for pushing in America) can cause fetal distress. Remember how expecting moms are cautioned never to lie on their backs for extended periods of time beyond the 5th month of gestation, since sleeping or lying on their backs (for more than a few minutes) can cause the weight of the uterus to compress the main artery providing blood flow to the lower half of the body (including baby)? What makes anyone think this would suddenly be a good idea during labor and delivery????

Epidurals are sometimes responsible for fetal distress. I wonder how many women are told this before they get an epidural: blood pressure drop is a common epidural side effect. They try to combat this by giving IV fluids or medications, but it doesn't always work, which sometimes causes fetal distress. Directed pushing (a.k.a. "purple pushing" = "hold your breath and push as hard as you can while we count to 10") is also associated with higher incidence of fetal distress.

Was the mother on Pitocin (synthetic oxytocin, a drug given to speed up labor)? Pitocin can also cause fetal distress. Insiders from our local hospitals have told me that the overwhelming majority of labors they have attended are induced or augmented with Pitocin.

So, were there other factors with this particular fetal distress? I don't know. I'm just pointing out some common situations so that readers can have an understanding that "fetal distress" doesn't often happen out of the blue, and it's even more rare that it would happen "without any apparent reason." (Yes, I'm aware that it *can* happen that way. I'd just like to reassure readers that those are the rare exception, not the rule.) And as for that poor woman's episiotomy, was it truly medically necessary? Perhaps. They are medically indicated approximately 5% of the time. Sometimes true fetal distress means that an episiotomy would save 5-10 minutes of pushing time; if changing pushing positions and giving mother oxygen to help fetal oxygenation doesn't help, then the episiotomy can help. Most of the time, however, episiotomies are entirely preventable and amount to nothing more than genital mutilation.

I think this episode of Myth-conceptions has melded into many posts at once. I'll try to delve into the other topics in greater detail in future posts.

To sum it up, this guy's argument was that his wife and child would have died had they given birth anywhere but in the hospital. I totally respect their right to give birth anywhere they want, and that's their personal decision, but nothing he said indicated any care provided by hospital staff that would not have been available at a birth center or a homebirth (namely, episiotomy, which is available at either a birth center or homebirth but rarely performed since most midwives understand the true indicators for an episiotomies and do not perform them routinely).

I'll close by sharing a birth story that a local doula shared with me. One baby whose birth she attended at an independent birth center had his umbilical cord wrapped all around his body *five times* in different ways: around the neck, around the chest, above and under the arms, etc. The baby was fine. When the cord is wrapped multiple times like that, it is usually long enough to compensate.

The bottom line is that true cord issues are rare and unpreventable. There's no need to fear them. A skilled birth attendant (whether OB or midwife) knows to look for a cord around the neck, and knows what to do if it occurs. There's no need to panic, people. It's only birth.

See also : Doula'ing my nephew's gorgeous home waterbirth! My nephew was born with his cord wrapped twice around his neck.

Wednesday, August 25, 2010

Wordless Wednesday: Ripe with son

2006. About 25 minutes before I delivered my 8 lb 2 oz son into the birth pool in my foyer. 3rd child, 2nd homebirth.

Thursday, August 19, 2010

Who "delivered" your baby?

Am I the only one who is annoyed when people talk about OBs (or less commonly, midwives) "delivering" babies? I mean, don't get me wrong, I realize that OBs and midwives have important jobs in being guardians of safety and will sometimes necessarily intervene with tools, techniques, or even surgery for the betterment of mom and/or baby. I'm not denying that or minimizing that. Here's the thing: the birth belongs to the mother. Besides that, the mother (usually) did all the work in getting the baby out. The bulk of the time, nurses or OBs will periodically check in on a laboring mother, but it's not uncommon for an OB to show up literally in time to put on gloves, catch the baby, and sometimes stitch the mother back up if a tear (or worse: episiotomy) has occurred. The OB and nurses were not there for continuous labor support (most of the time).

Who really delivered that baby? And what definition of "deliver" are we using? I pulled out my trusty Webster's Dictionary, 10th edition, and it had 6 definitions of "deliver," each with several sub-entries.


1: to set free < and lead us not into temptation, but ~ us from evil -- Mt 6:13 (AV) >

2 a: to take and hand over to or leave for another: convey <~a package>
b: hand over, surrender <~ed the prisoners to the sheriff>

3 a (1): to assist in giving birth
(2): to aid in the birth of
b: to give birth to
c: to cause (oneself) to produce as if by giving birth < has ~ed himself of half an autobiography --H. C. Schonberg>

4: speak, sing, utter <~ed their lines with style>

5: to send (something aimed or guided) to an intended target or destination < ability to ~ nuclear warheads >

6 a: to bring (as votes) to the support of a candidate or cause
b: to come through with: produce < can ~ the goods >

I remember reading in a book (Readers: help me? Where did I read this? A Henci Goer book?) an interview with an OB who openly admitted that the only time when he felt that he actually DELIVERED babies was when he performed cesareans. That was worrisome to me. It smacks of ego. Are there power situations at play if highly trained surgeons want to feel as though they are *doing* something "productive" at a birth (whether or not the interventions were medically necessary)?

It seems that, in America, the term "deliver the baby" is used with definitions 1: and 2: above, when I'd like to see the term used more the way it is in definition 3:. Even within definition 3:, I'm not sure I can agree with "aiding" or "assisting" with a birth as being the same as "delivering." I was a doula at my sister-in-law's birth last month. I think that she would say that I "assisted" and supported her birth even though I performed no medical services and did not catch the baby. Could I take credit for "delivering" her baby? Absolutely not! The mother *delivered* her baby.

We had an accidental unattended home waterbirth with our 4th baby. Let me clarify: we were planning a home waterbirth (our third), but we were planning on the midwives getting there in time. My husband caught the baby. It irks me when people ask incredulously, "So your husband delivered your baby???" Well, no. He caught her. It wasn't hard. I did all the work!

What do you think, readers? Does this have to do with the difference between being an active participant vs. a passive participant in our births? Who "delivered" your baby? Who SHOULD claim credit for "delivering" babies? What about cesarean births vs. vaginal births? Should there be a difference in who claims credit for the delivery? Are you bothered by others taking ownership of or credit for your work, or is it just an insignificant matter of semantics? What does "deliver" mean to you? "To give birth," "to catch the baby," "to set free," or "to take and hand over to or leave for another"?

Wednesday, August 18, 2010

Boba baby carrier giveaway at Familylicious Reviews

Quick! Head over to Familylicious Reviews and enter to win a gorgeous Boba soft structured baby carrier!

Boba baby carriers are MADE IN THE USA and are 100% organic cotton. They offer a higher, more supportive back than some other carriers. They also have optional (removable) foot straps (think saddle stirrups) to support your toddlers' feet and legs as they grow.

I love wearing Baby K, but she is now 21 months old and weighs enough that I really need a supportive carrier to wear her for any amount of time. I'd love to win this Boba for Baby K and also to allow my clients to try-before-they-buy in my Well Rounded Birth Prep Babywearing Workshops.

Familylicious Review's Boba giveaway is accepting entries until September 5, 2010. My favorite is the Tweet fabric.

Which fabric Boba would you choose?

Wordless Wednesday: Babywearing: Close enough to kiss

Feb. 2010. 15 months old. Ergo Baby Carrier.

Tuesday, August 17, 2010

Babywearing FAQ

I get this type of email a lot: "I need some advice on babywearing and types of carriers. I know you're an expert so any advice or references would be appreciated!!" I have so much to say about babywearing that I will have to break it down into chunks of several blogs.

One great site for comparing different styles, brands, and functions of slings/carriers is The Baby Wearer.

Babywearing Safety Facebook fan page is an excellent resource for positioning tips and other necessary safety tips. They have lots of links on safe positioning with various carriers.

There's more to baby positioning than this, but if I could tell you 2 quick laws for newborn positioning, they would be:

1. Baby's head should ALWAYS be close enough to kiss. This ensures that he is close enough for you to observe his breathing and that his airways are unobstructed.

2. Never allow baby to be in the chin-to-chest position, which can cause positional asphyxiation. You should be able to tuck (at least) two adult fingers between baby's chin and chest when baby is properly positioned.

Here's a quick video on safe positioning for newborn. It's shown with a ring sling but applies to all carriers for newborns.

The proper physiological position for a newborn is vertical between his mother's breasts. This helps them assimilate neurologically and benefits breastfeeding. Researchers have noted that cradle or other positions for newborns can confuse them and even potentially cause breastfeeding problems. Here's an excellent article outlining the physiology of proper babywearing positioning regardless of brand of carrier:

Babywearing: Safe Positioning

Love that link.

As for my personal preferences, I own 8 slings of various styles/brands, depending on the function & my outfit.

For newborn, I recommend a soft, stretchy wrap such as Moby Wrap, Sleepy Wrap, or Cuddly Wrap.

I don't know whether or where I have photos of me wearing our littlest one in our stretchy wrap when she was an infant, but here's one of my midwives, Jennifer Stewart, wearing Baby K in my stretchy wrap when K was 3 months old. (She's more than a midwife; she's my friend!)

One alternative to the stretchy wrap is a hybrid that's similar in function but fitted (not adjustable, must buy your tight fitted size) so it doesn't require wrapping: the Baby K'Tan. Personally, I do prefer the adjustability and versatility of a traditional wrap sling, but I realize that some parents are intimidated by wrapping one. That's when a Baby K'Tan is handy.

Stretchy wraps' websites say they are safe until 3 y.o. or so, which is true, but they are really not comfortable beyond 20 lb or so (in my humble opinion). The soft, T-shirt type of material stretches w/ the weight & doesn't provide as much support as a soft structured carrier (like an Ergo) does at that point.

For newborn stage through 4-6 months, I *love* a stretchy wrap. It has a teeny tiny learning curve, but worth it. I could teach you how to wrap it in 2 min or less. Easy to wrap & tie before you even leave the house & leave tied & throw your coat on over it & slide baby inside once you arrive at your destination. You don't have to untie/retie to get baby in & out.

Stretchy wraps also should never be used for back carry, despite what their websites say. This 56 second clip shows why.

Woven wraps, on the other hand, ARE safe for back carry (or front carry, for that matter). Here's a 58 second clip showing why woven wraps are secure with baby on back in the same scenario as above.

Some examples of a woven wrap are the GypsyMama Wrapsody and Ellaroo's wrap.

Here's my sister-in-law safely wearing her toddler on her back (Tibetan tie) in a woven wrap while pregnant with her littlest one.

On a side note, are you aware that baby car seats are now warned only to use *in* cars, not as carriers out and about? They put babies at risk of low oxygenation & shouldn't be used as stroller systems and the like.

Infant safety in car seats and carriers

Here's one on other reasons to leave the car seat in the car:

Car Seats Are For Cars (Mothering Magazine)

My favorite sling/carrier overall is the Ergo, hands-down for comfort for long term (many hours straight babywearing) from newborn thru toddler years. It distributes baby's weight comfortably across both shoulders, around the hips via a padded waist belt, and across the back. It's safe for newborn when used w/ the extra infant insert or you can use receiving blankets to make a pocket of sorts so he/she doesn't slide down. It can be used without the infant insert around 15 lb or so. It's super easy to nurse from, while walking around, hands-free, without anyone seeing. It's so ergonomic (thus the name). It's safe thru 45 lb. Browse my Facebook photos and you will see Baby K in my chocolate brown Ergo in 90% of the photos. It's for front carry, back carry, or hip carry. If it tells you anything, it's the carrier that the Duggar family uses for their babies.

Here is a pic of me w/ Baby K in my Ergo (she's 15 months old here) and Trebor with her son in a Tre'Slings ring sling (and our friend Connie--hi, Connie!) at Chuck E. Cheese, chasing our older kids hands-free.

Other brands that offer a soft structured carrier similar in style to an Ergo are BabyHawk's Oh Snap!, Beco's Gemini (but NOT their Butterfly carrier, which has an internal harness and makes breastfeeding difficult while wearing baby in the carrier), and Boba Baby Carrier.

For a dressy sling (church, weddings, Christmas parties, graduations, baby showers, funerals, etc.), multi-purpose everyday sling, and for my water sling (pool, the beach, water park, hot summer days), I recommend ring slings from one of my best friends, Trebor Sutler. She's a SAHM who homeschools her 4 kids and makes these slings on the side. You can see pics of me wearing Baby K in her slings on her fan page under Fan Photos. Trebor's slings are top quality. The rings are safe for baby to teethe on, in addition to the superior sling craftsmanship. You can see comparison pricing from Sakura Bloom ring slings; a sling that Trebor charges $50-60 for would cost double that at Sakura Bloom. Trebor will ship your sling order anywhere.

Tre'Slings Facebook Fan Page

Ring slings are easy-on, easy-off, which makes them great for popping baby in and out when running errands. It folds very small, so it's easy to keep in your diaper bag for when baby *might* do OK sitting in the grocery cart, but will probably want out and want held in 10 minutes. It's very easy to nurse discreetly from a ring sling. Ring slings are adjustable, which makes them useful for more than one wearer of different builds/sizes. There is very little learning curve with a ring sling. They are quick and easy to use.

Here I am wearing Baby K in my cotton Tre'Sling:

My mesh water sling by Tre'Slings, pictured below, has been a lifesaver. Baby K *lived* in my water sling for our entire beach vacation last summer (when she was 9 months old). We also use it every time we take our kids to our local pool because our pools forbid anything inflatable, including swim wings and baby boats. This means that unless you have a Tre'Sling water sling, you have to either stay on the sidelines with your baby or hold a squirming, wet baby in your arms while in the water while trying to tend to your older kids. With my Tre'Slings water sling, I can actually manage to take our 4 kids ages 7 and under to the pool by myself!

Here's a beautiful photo of Kelly Moles wearing her beautiful baby girl in a Tre'Slings dressy sling at a formal ball. Don't you just love this pic?

Mei Tai carriers, also called Asian style carriers, are another very comfortable option. They are similar in feel and function to Ergo (front or back carry) but with ties instead of buckles. They can be used from newborn through toddler (30-35 lb). You can nurse from them, but a bit more effort: you must untie, reposition baby, then retie, as opposed to quick loosen-tighten strap with Ergo (then reverse the process when finished nursing, untying and retying).

BabyHawk makes top quality Mei Tai carriers from trendy fabrics.

Trebor (Tre'Slings) has made several gorgeous Mei Tais as well. They take longer to make than ring slings, so she doesn't advertise them, but may make them custom order. You can also find many beautiful Mei Tais on Etsy.

Here's my friend Lynette Berger's Facebook fan page for her WAHM business, Designs by Lynette (who made my dressy Mei Tai).

She makes gorgeous, quality Mei Tais. Mei Tais are supremely comfortable when made with a cotton woven fabric. I picked a fabric that was well suited to a ring sling (like the photo above of the red ring sling) but isn't well suited to a Mei Tai. It wasn't her fault; I picked it. That kind of dressy, silky fabric looks & feels great on a ring sling, but due to the Mei Tai straps, the silky fabric digs. Lynette is a great option for ordering a Mei Tai carrier, and has photos of several she has made. Her workmanship is the highest quality, and her fabrics are gorgeous. My pics are in her fan photos, too.

Here I am at a Christmas party wearing Baby K (at 13 months) in my dressy Mei Tai made by Lynette.

One popular carrier is the pouch sling (brands such as Hotsling and New Native Baby Carrier). While they *can* technically be used safely for newborns, I don't recommend them because most versions are not adjustable (unlike a ring sling which is similar in shape but infinitely adjustable for perfect fit) and thus are far more difficult to properly position your newborn. Especially for newborns, proper positioning to ensure an unobstructed airway is essential. Pouch slings can be useful for an older baby or toddler (4 months or older through 30 lb or so) in a hip carry position. They fold so compactly that they are about the size of a diaper, so they're great to take with you in the diaper bag when you're not sure whether your toddler will want up or down. Most versions are not adjustable for size, however, so keep that in mind if you want a carrier that more than one adult can use.  Here's me carrying my son in hip carry in a New Native Baby Carrier pouch sling when he was 20 months old. Personally, I have used my pouch sling exclusively for about 1 year old through 3 years old for the hip carry position.

Please remember that bag style baby carriers were recalled and are always unsafe. Even if someone gives you one for free, please throw it away. They are the equivalent of sticking your baby in a duffel bag and hanging it over your shoulder. They put baby in danger of positional asphyxiation (chin-to-chest position restricting airway) as well as re-breathing carbon dioxide from the fabric obstructing baby's face. There is no way to safely wear a baby in these unsafe carriers. Here's an article showing what a bag style carrier is and why it's dangerous.

I also do not recommend "crotch-dangler" style baby carriers such as Baby Bjorn, Snugli, some Infantino carriers and other similar ones. These are not ergonomic for the parent or for the baby. For the baby, it can put undue pressure on the spine and just feel uncomfortable in general. For best spinal support, newborns' legs should be in the fetal position in slings, and older babies' legs should be in the "M" shape position with knees higher than bum (as described by this babywearing article).

As for mom or dad's back, "crotch-dangler" front carriers leave baby's legs hanging straight down. This pulls the child's weight away from the parent's body, causing unnatural strain on the parent's back and shoulders. Quality baby carriers position the baby/child in a similar position to one you would use when you carry him or her in your arms, and at the same height as you would carry him or her.

Allow me to demonstrate the difference.

When properly positioned, look how my daughter's weight is distributed evenly around my body, close to my center of gravity, with her legs wrapped around my waist (as they would be with any of the carriers I advocated above). Her legs are in the "M" shape (well, close to it--they would be in "M" shape if she were in an actual carrier as opposed to my arms).

Now compare that photo to the one below, which mimics the position of a front carry "crotch dangler" carrier. Look how her weight is pulled away from me, throwing off my center of balance as well as putting much strain on my back and shoulders.

Worse yet, the next photo mimics front-facing position with a "crotch-dangler" carrier such as a Baby Bjorn. If you thought the last photo looked uncomfortable, wait until you see this! I don't know how or why people carry their babies like this!

OK, that oughta get you started. ;-) Let me know when you've browsed all that and have more questions.

I was not paid in any way to give this review of baby carriers. The opinions stated are my own. There are many other brands of baby carriers that offer safe, quality carriers. I don't have the time or energy (or space) to list them all; this is a sampling. Baby K'Tan did provide a sample carrier for parents to try on in my Well Rounded Birth Prep babywearing classes. I paid full price for all my other carriers.

Do you have babywearing questions? Email me at wellroundedbirthprep (at) gmail (dot) com and I'll answer your question on my blog.

Edited to add:

"Strollers, baby carriers, and infant stress" is a fantastic article explaining why babywearing is what baby expects and needs biologically, physically, emotionally, and neurologically, while artificial baby carriers (strollers, car seats, swings, bouncy seats) should be used sparingly. Lots of photos, including baby's head molding as a result of spending too much time lying flat in a crib or in a car seat instead of being held.

Thursday, August 5, 2010

Guest post: MamaSpud's hospital induction birth story

Monday, January 19th, started off with my now weekly doctor's appointment at 9:20am. Everything seemed to go fine until the doctor noticed a bulge on my right side while I was laying down. He said, "Does that baby look sideways to you?" I said no, that's just the way her feet lay and that she's usually in a "7" configuration - her feet under my ribs, her bum in the middle of my tummy, and her head straight down. He checked me to see if I was progressing and then measured my tummy. At 38 weeks, I should have been 38 cm from my pubic bone to the top of my uterus. He claimed that I was much smaller than that, even though last week I was supposedly right on track - 37 cm for 37 weeks!

The doctor said he wanted to get an ultrasound to see how big she was and it turned out she was in the 10th percentile for weight and size. They estimated her weight to be 5lb, 14oz and assumed the cause to be a problem with the placenta. Apparently, it had stopped producing nutrients for her and she stopped growing. The doctor said that the best course of action would be to have her on the outside, rather than in so she could thrive (even though she would only be a week and a half early). He quickly scheduled an induction to be started Tuesday night at 8pm. My responses were that my mother is flying in on Wednesday afternoon and that my 26th birthday was on Tuesday. He wanted to put me in the hospital right away, actually, but I had breakfast that morning and they like you to not have eaten for 8 hours before an induction.

So the rest of Monday, and through Tuesday (my birthday) was spent cleaning the house, packing my bags, doing laundry, buying preemie clothes, going for a birthday dinner, and putting finishing touches on the nursery. By 8pm on the 20th, we were ready to go to the hospital.

And then, I got a back cramp. And then a few in the front. And a few more back and front.

When they hooked me up to a monitor, once we arrived in the Labor and Delivery Unit, I was contracting around every four minutes and was one centimeter dilated. I wanted to go home and work through this on my own but that idea was shot down because the doctor and nurses really wanted this baby to be out soon. With all the problems with her growth and the placenta, we all agreed that it was best to start on Pitocin and try to get her out of me as soon as possible. Which was a shame, I thought, because my body KNEW what it had to do and was going at it's own pace to safely birth this baby. And the doctor didn't have enough confidence in my body's own ability to progress. At least they didn't need to use Cervadil or Cytotec to help prep for dilation - I was already on my way!

I talked with the nurse (Sue - wonderful lady) about my wishes for wanting to give birth as naturally as possible, to use the bath tub to help labor, to be able to sit and walk and kneel and lean as I needed to, and how I wanted to wear my own nightgown to give birth. All of my requests were denied. I also was not able to eat or drink for over 24 hours (once it was all done with) and with all of these frustrations and limitations.... I started to cry. Nothing seemed to go like how I wanted. One thing after another that I had read about, been told to request, and given advice upon was quickly been cast aside like my wishes didn't even matter. When I asked if I can try a natural method of induction, my nurse said, "Your doctor doesn't really like to do that kind of stuff." Well, he's not the one pushing a baby out of his whoo-ha!!

So after my crying spell, the nurse came back in and asked me why my chest was red and splotchy (if you know me, you know that when I'm nervous, upset, over-heated, or stressed out that my chest breaks out in hives). I said simply, "It does that sometimes," and then she noticed that I had been crying. She pulled up a chair and sat and talked with me for a long time about my birthing experience. That's when things started to change for me and I started to relax a little about everything. Sue said that what really matters is having a healthy baby and I knew that deep down inside, I think. Relaxation had to be key and then we tried to change things up a little bit so I wasn't stuck in the bed all night long. She got a rocking chair and slid it into my room so I could sit (even though I was on a MILLION monitors and wires), which was nice of her.

6am finally arrived, as did my doctor (who had been absent and sleeping peacefully all night long - unlike us!). After 10 hours on Pitocin, I was still at 1cm so he decided to sweep my membranes. Which hurts. Very much. Then, without hardly talking to me or looking at me, he asked my nurse for the amnihook to break my water. I started to object because then I would have to be confined to the bed, not even allowed to get up and go to the bathroom. He just said, "You're not going to progress on your own," and went ahead anyways. I thought that wasn't very fair because I MIGHT have been able to progress on my own if I was allowed to move and walk and bounce on my birthing ball (which was still sitting, deflated, in my tote bag).

8am - still 1 cm. The rest of this hour is a little personal, but lets just say that Jeff was a trooper and helped me out a lot. Some very embarrassing instances, and lots of crying and apologizing, but my body is just doing the things it does while giving birth! I get a new nurse named Karen who encourages me, tells me about her 7 natural births, and wants me to flip and flop from side to side and most important of all - RELAX!

9:30am - still 1cm. I start asking about my pain relief options. I absolutely don't want an epidural (in my mind, Pitocin + Epidural = C-section!) but I start asking about Staydol. They mention morophine but I rule that out because that just seems so... extreme. Right? Isn't morophine, like, for drug addicts??

9:45am - I ask if they can just get a syringe ready of Staydol for me. Just in case.

10am - These contractions are out of control. I have about 15-30 seconds of relief between each one and am not relaxing at all! It doesn't help that my bed is as hard as a rock, I keep having to pee, and my stomach feels like I've taken Saran Wrap and suctioned the baby to me. I can now feel every kick, every knee and elbow, and everytime I lay on one side and switch to another - everything "melts" down towards the bed. The lack of amniotic fluid is really an odd sensation!

Oh, by the way, I'm still 1cm after 14 hours of labor. I give in and get some Staydol. Jeff is able to take a nap (he was getting WAY too cranky and I was pretty "snappy" too) and I don't neccessarily nap, but I zone out during my contractions. I began focusing on a little icon of a TV on the side of my hospital bed. It works. We play some music and I begin to visualize the lyrics. Stevie Nicks was doing some awesome things in my drug induced haze. I also tell my nurse, who's name is Karen also, that we're both cool because we spell our names "K-A-R-E-N" and not some retarded way like, Caryn.

12pm - Whoo-hoo! 6cm! The window is also closing on whether I'd like another dose of Staydol. Thinking I had a lot more time to go until she arrives, I say, "Yes, please!"

12:30pm - I get a strong urge to push all of a sudden. I'm shaking, starting to go crazy, can't keep my eyes open because I'm on just a bit too much medicine, and these contractions are one on top of another. I yell out, "Can we turn this frickin' Pitocin off?!? I need a chance to catch my breath!" Then it feels like I have to retch. But not upwards - downwards. My body curls and tightens on it's own, like I'm going to uncontrollably vomit. It's the oddest sensation that no one really ever explained to me before. They check me again. 10cm. I've progressed 10cm in 2 and 1/2 hours!

But my lovely doctor is no where to be seen. In fact, I've actually only seen him for 5 minutes when he broke my water! Apparently, the good doctor is in the parking garage, on his way into the Labor & Delivery Ward. They tell me to "Hee hee hoo" breathe in order to stave off the uncontrollable urge to push. I guess it works, but I would rather just hurry up and do it. They strap an oxygen mask to my face and before I can protest, they say that it's not for me, it's for the baby. That's enough to make me keep it on, even though it's hot and forces my stinky breath back into my nose!

Finally, the Great Nurse Karen says, "He's here, go ahead, start pushing," and she gets into position. She's a great coach, as is Jeff who stays by my side and helps hold me (and my right leg) up. Jeff told me later that everything happened so quickly once it was showtime. The nurses wheeled in tables full of instruments, my bed was raised up to standing height, the overhead light dropped down from the ceiling and was turned onto full blast. Furniture was moved out of the way and our computer and blankets were all shoved into closets. I had no idea about any of this. And even though I wanted my glasses on, I totally forgot about them once it was time. Turns out, they weren't so important after all.

I heard someone say, "See? That Staydol did the trick! You just had to relax!" That made me feel better, even though the most recent dose was bothering me because I just couldn't keep my head clear and focused. Then the good doctor finished his cheeseburger, wiped off his mouth (I assumed), and strolled leisurely into the room. He waited, at my crotch, with his arms and palms open like Jesus, and just stared non-chalantly. Karen, the awesome-ness, started helping me out saying things like, "Get mad, Karen! Get mad at Dr. (Blah Blah)! Come on! Push! You're doing it! She's right there!" When she told me to get mad at him, it didn't take much. I just laughed (yes, laughed, in the middle of the most painful thing ever) and had a renewed strength.

My blood pressure cuff went off on my right arm at one point during a push and I yelled, "Get this frickin' thing off of me!" I waved my arm and Jeff was totally confused, thinking that I was talking about my hospital gown. Another nurse knew what I was talking about and hit the switch to shut it off. I had been concerned earlier that my blood pressure was getting too high (150/90's - eek!) and that interventions were going to have to happen. But luckily, everything turned out just fine!

The baby nurse, Thelma, was a kindly old woman, who I later found out had been there for over 40 years. She saw me in distress and looked at me and said, "You need to relax in between contractions (pushes). Just think of a beach." My eyes, she said later, had a twinkle in them when she said that and Jeff started to talk to me about our wedding just three and a half years earlier on the beach. It was enough to help me calm down and then, all of a sudden, there was her head.

It was the oddest looking thing. At first, I thought her head was really small, like a doll's. Turns out, it was just the tip of her "cone-head." A few more pushes, and then there she was. They told Jeff to get his camera ready and he took a few pictures of her getting wiped off and the cord clamped. Turns out, too, that I forgot to mention that I wanted the cord to be cut after it stopped pulsing. Guess that's not as important as I thought either.

As soon as she's out, they rip the oxygen mask off of me and I pull my hair out of the disgusting ponytail that it's in. Ever the narcissist, I fluff out my hair and await my first picture with my daughter. Then they tell Jeff to cut the cord and I rip the camera out of his hands (seconds after birth, mind you) and take a picture of him cutting the cord!

Then she's placed on my stomach, "cream cheese" and all and I kiss that little, screaming face. God, she's beautiful! Baby Nurse Thelma takes her to the warmer and she and Jeff fill out paperwork while I'm being worked on and cleaned up (which, by the way, still hurts.... a lot). He asks me, "Kathryn, right? With a 'y'?"

I answer, "Yeah, whatever! ARruughhhh!!!!"

"Honey, do you want her to have a Hepatitis B shot?"

"Oh my God, I don't care! RRaawwwrrrrr!!!"

She's wrapped up, cleaned up, and so is her mommy. They leave us alone for a little bit and I say hello to my little Mckenna Kathryn. 6 pounds, 4 ounces. 18 inches long. January 21st, 2009**. Just one day after my own birthday. What a wonderful birthday present!

*As a friend of my dad's mentioned, she'll never have to live one day under the Bush administration. :-D

Kentucky, USA

Thank you for sharing your story, MamaSpud. <3 I'm sorry you didn't feel supported in your wishes/birth plan in some ways, but I am so glad that you had such kind nurses who helped you make it through.

I love reading birth stories, and from the sounds of it, you readers do, too. Would you like for your birth story to be featured on the Well Rounded Birth Prep blog? If so, please email your submission to wellroundedbirthprep (at) gmail (dot) com, with or without photos, and how you would like credited (first and last name? first name only? initials? anonymous? location? link back to your blog?). Hospital, birth center, or homebirth stories are all welcome.

Wednesday, August 4, 2010

Tuesday, August 3, 2010

How to avoid the ol' bait-and-switch with your OB/midwife/pediatrician

I've run across this situation enough times by now that I feel pressed to warn those who are unaware: when you ask a friend, family member, co-worker, etc. for a referral for an OB, midwife, or pediatrician, for crying out loud make sure you ask them WHY they loved or hated that care provider.

Here's the thing. Your friend (or family member, co-worker, etc.) may value completely opposite things than you do! I have a friend who loved her OB because he routinely encouraged scheduled, elective inductions, which she thought was so convenient. Another friend's choice of hospital was based on the fact that she knew that if she was admitted in early labor, they wouldn't send her home, but rather, that they would proceed to augment or induce labor so that she could be "guaranteed" what day she would deliver. It's a mother's right to make these (hopefully fully informed) decisions, but I would certainly like to know that *these* are the reasons a friend referred a provider or place to give birth, if it were me.

It's hardly a case of bait-and-switch if a mother had a preconceived notion of what to expect if the doctor/midwife is very upfront with his/her expectations and standards of practice, but it can feel that way if the mother feels that she was misled (or if she neglected to ask what was the norm for his/her practice).

Two different friends have told me about their experiences with a certain OB, whom I'll call Dr. J (not his real initial). One told me that "tried really hard to make it seem like he was understanding and would be flexible" regarding their birth wishes. The first warning sign, however, was when Dr. J told this first-time-mother, who was only a few months along and in excellent health, "Sure, you can have the natural birth you want, so long as your baby doesn't get too big." When she told me that, I encouraged her to have a more in-depth conversation with him at her next checkup because his statement set off warning bells in my mind. A provider who says something like that to a mother (especially a healthy, low-risk mother, early in pregnancy) is sometimes just waiting for a "reason" to intervene. I told her to ask open-ended questions that would allow him to tell her what he thinks about different aspects of her birth plan, as opposed to yes/no questions. She had an eye-opening experience at the next appointment and promptly fired Dr. J and sought a provider who was more supportive of her wishes.

Another mother told me a similar experience with her delivery with Dr. J. When she asked Dr. J about her options regarding her birth wishes, he replied, "We don't do that here." Not because of safety, but because of "policy." Unfortunately, she found out about Dr. J's policies too late to switch providers and was really nervous about having him there for the delivery. Nobody should have to go through that kind of trepidation while trying to give birth.

It's not uncommon for doctors who do not practice evidence-based care to have sweet personalities and the kindest, gentlest bedside manner, leading their patients to trust them and care for them. I'm not implying that all sweet, kind doctors will mislead patients, nor am I implying that doctors or midwives who act like jerks are more straightforward. I'm simply stating that their personalities alone are not--or, at least, should not be--the sole factor in selecting a doctor or midwife.

Another mother shared that she disliked her previous midwife because she asked about her diet, which made her feel guilty about what she ate. We talked a bit about the fact that diet during pregnancy has a huge part to play in growing a healthy baby and preventing PIH (toxemia, pre-eclampsia, HELLP syndrome, and Pregnancy Induced Hypertension) and gestational diabetes, but she wanted a care provider who wouldn't ask what she ate. She didn't imply that the midwife was improper in her attitude or demeanor in asking about the mother's nutrition, just that she didn't want to talk about it. Again, good to know if you hear a referral like that, so that you can assess whether that's how you feel about nutrition during pregnancy.

This same issue comes up with pediatricians. If a friend refers her pediatrician, is it because he or she is nice? Or is it because he or she will prescribe an antibiotic any time she brings her children in with the slightest sniffle? Is that what you are looking for in a pediatrician?

I believe that this misconception of nice=competent is one of the primary reasons that so many care providers get by with "bait-and-switch." This is what it's called when a care provider promises one thing and delivers another, no pun intended. Some moms are apt to trust any advice their doctor/midwife gives them because they trust their doctor/midwife. Sometimes that trust hasn't been earned by proof of skill or knowledge or competence; sometimes that trust is because he or she is "so nice." Ask questions. Dig deeper. Sometimes, *how* they answer you is more telling than *what* they say. (Are they offended that you are asking questions? Do their egos seem bruised? Do they seem miffed that you would question their authority?)

Be informed consumers and informed advocates for yourself and your family. That's all I'm sayin'.

Here are a few resources for choosing a care provider who will line up with your birth philosophy:

Mother's Advocate: Choosing a Care Provider (free printable pdf)

CIMS (Coalition for Improving Maternity Services): Having a Baby? 10 Questions to ask (free printable pdf)

Preparing For Birth's printable PDF "Questions to ask when choosing birth location and care provider"

Ten Ways to Spot an Incompetent Midwife by Birth Sense

In Search of Dr. Right: 11 Questions to Ask by Birth Sense

Here are a few questions to ask yourself when shopping for a pediatrician. (Source: Connie Livingston's Parent's Yellow Pages For the Greater Dayton Ohio Area; Birthsource.com)

6 Tips for Choosing a Pediatrician

1. Does he/she have the same philosophy as you? What about their partners?

2. Is there more than one office for convenience? What are the hours? Is the office clean? Do they mix well babies with sick babies?

3. Are the staff friendly?

4. What does the pediatrician do to stay current?

5. Do they take your insurance?

6. Do they make you feel comfortable no matter what type of question you ask?

I would add, 7. Do they respect your right and responsibility to make informed decisions for your child, even if those decisions differ from common protocol?

What have been your experiences (positive or negative) with finding a care provider who supports your birth philosophy or parenting philosophy?