Well Rounded Birth Prep

Well Rounded Birth Prep

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Wednesday, September 29, 2010

Myth-conceptions: "My water wouldn't break on its own..."

If I had a dollar for every time I've heard that one. Here's the thing: while your water will likely break on its own sometime during labor (if not one of the 10% whose water breaks pre-labor), your baby can possibly be born with the amniotic sac intact, and that's perfectly fine! It's OK to break the amniotic sac after the birth and peel it back from baby's face if your water hasn't broken on its own before that. It's called being born "in the caul," and it's considered to be good luck in many cultures. Maybe that's because of the many important ways that the amniotic sac and amniotic fluid protect the baby.

I always advocate for true informed consent. Before moms are given the option to have their water broken artificially (also called amniotomy, or AROM--artifical rupture of membranes), are they warned of the potential risks? Are they informed that the amniotic sac functions to protect the baby from infection so long as it is intact? Are they told that every time something is inserted into mother's vagina during labor, it increases her risk of infection as well (including vaginal exams), especially after AROM? What about the risk of cord prolapse from AROM, which necessitates an immediate emergency cesarean? What about the increased pressure on the baby from each contraction, now that the somewhat protective cushion of amniotic fluid and amniotic sac is removed before its time, which can contribute to fetal distress or non-reassuring heart tones?

Here is an informative blog describing the function and importance of the amniotic sac during labor. A fascinating read (if you're fascinated by the same stuff that I am.)

Are moms informed that the research (specifically Cochrane review, at this link) concludes, "Evidence does not support the routine breaking the waters for women in spontaneous labour... There is little evidence that a shorter labour has benefits for the mother or the baby. There are a number of potential important but rare risks associated with amniotomy, including problems with the umbilical cord or the baby's heart rate... The evidence showed no shortening of the length of first stage of labour and a possible increase in caesarean section. Routine amniotomy is not recommended for normally progressing labours or in labours which have become prolonged." That ought to be proof enough that America's routine obstetrical practices are far from evidence-based.

When we have well established, accredited resources stating the risks of AROM (without any benefits), why is it still occurring routinely? "Routine artificial rupture of membranes increases the likelihood of intrauterine infection because it eliminates the physical barrier (the amniotic sac) between the baby and the mother's vaginal flora. This study suggests an additional mechanism for the prevention of infection when the membranes remain intact: A baby bathed in amniotic fluid benefits from antimicrobial proteins that are found in the fluid and in vernix caseosa." We're all still speaking English, right?

So, why have I heard literally dozens of women tell me some variation of the following? "My water could never break on its own. My OB had to break my water for me with all four of my births." Gah! The frustration! People, I assure you that at some point before you hold your baby in your arms, the amniotic sac will tear on its own! I can promise you that!

I've seen lots of awesome birth photos online of births in the caul, and in the future, I'll bookmark photos like that here. For now, here are a few "in the caul" photo or video links.

awesome (graphic) waterbirth with amniotic sac intact on YouTube

graphic homebirth in the caul, water breaks immediately after birth, mom delivers on hands & knees

This one's my favorite.
Incredible (graphic) photo series birth story. You can see vernix floating in the amniotic sac surrounding baby's face after the head is born, while the amniotic sac is still intact. Note that the cord is wrapped around baby's neck, which is not an emergency, as I posted in my previous blog.

Oh and before I forget, can we once and for all dispel the myth of the dry birth? There is NO SUCH THING as a dry birth. Seriously. Amniotic fluid is replenished continually after the amniotic sac is broken (whether naturally or artificially) and this is one of the reasons why it's so important for momma to remain well hydrated (by oral fluid intake) during labor.

I once heard a mom describe how her birth was painful and difficult because it was a dry birth. She stated that since there was "no fluid" it made her baby's descent full of friction. I politely explained to her what I just told you ("There's no such thing as dry birth, amniotic fluid is continually replenished, etc."). I kid you not, she blinked twice, then continued with her story about dry birth. Folks, I'm not making this stuff up. There were, no doubt, many factors that contributed to that birth being painful and difficult, and those factors are beyond the scope of today's discussion. What I'd like to impart is that it is *strong, effective contractions* that bring a baby down and out. They do not ride out on a log flume of amniotic fluid.

The final trigger for today's topic was this morning when I read Tiffani Amber Thiessen's birth story on People.com. You know, Kelly Kapowski on Saved By the Bell. I'm sorry that she and her daughter had a difficult experience, but I'm deeply saddened by the fact that there was no informed consent, and I'm saddened even more that she is perpetuating birth myths. Tiffani clearly had no understanding of what she agreed to, which is obvious from her statements:

"“First my water didn’t break; they had to do it for me. Then the baby wasn’t descending, because the cord was wrapped around her neck,” the White Collar star — who ultimately delivered via c-section after 30 hours of labor — tells PEOPLE.

"“Once she was finally out, I didn’t even get to hold her before they whisked her away… The whole thing was very surreal.”"

Can we discuss this bit by bit? Not to tear her apart or make fun or anything of the sort, but to hopefully prevent iatrogenic birth catastrophes that are utterly avoidable? If we can learn from others' mistakes and prevent suffering, that's a worthwhile discussion, in my humble opinion.

I realize that I don't have Tiffani's medical charts in front of me, but I can say without any hesitation that "they" did NOT "HAVE" to break her water "for her." See the above reference links.

The cord is wrapped around the baby's neck in approximately 30% of all births and is not an emergency or a problem in and of itself, as we established as well. True cord problems are extremely rare, and while it's possible that Tiffani was one of those rare percent of women, odds are against it.

The fact that the preventable problems with her birth led to some sort of complications with the baby is a sad but common situation. See CIMS Fact Sheet on cesarean risks for full details.

Would Tiffani Thiessen have made the same decisions had she been well informed of the potential risks involved with the interventions she chose? Maybe, maybe not, but I don't want for people to hear such a well-publicized birth story and believe that women need to be rescued from the amniotic sac that's holding their baby captive. I want to make sure that my blog readers don't fall for the same Myth-conceptions.

Wednesday, September 22, 2010

My OB said WHAT?!?

Where to start. Hoo boy. For quite a while, I've been following the site My OB Said WHAT?!?, which features outrageous (but true) things said by pregnancy and birth care providers. In April 2010, I submitted my own quotation from the OB attending my first child's birth in 2002, then forgot about it. I received an email recently alerting me that my submission had been published, here.

Yes, my OB *actually said* "I bet you wish you had gotten that epidural now," while she was stitching my second degree tear. To be more specific, it wasn't *said* so much as it was *sneered*. I've been wanting to write the backstory to the birth and it has felt too overwhelming. How much to include? I'll try to make a long story short.

I was pregnant with our first child back in 2002, in the days of dial-up internet. Before I had heard of Google. Before I had even heard of Henci Goer or Ina May Gaskin. I've always been an eager learner, but apparently during my entire pregnancy, I didn't run across a single birth junkie or mom who was really self-educated on birth or even a doula. Everyone told me that I *had* to go buy What to Expect When You're Expecting as soon as I found out I was expecting. (I plan on writing a blog on that soon, too. Just wait.) I *thought* I was educated on birth since I read WTEWYE and the free parenting magazines that they send when you get on mailing lists. (I plan on writing a blog on those, too.)

I wanted an unmedicated birth for the simple fact of not wanting to put my baby at any risks that could have been prevented. I thought that making up my mind to have said drug-free birth was enough. I couldn't have been more wrong. I was really blessed that the hospital where I had my first baby was more hands-off and consumer-oriented than the competition, but it could have turned badly at any point had my birth and breastfeeding experience not been textbook.

My labor was straightforward and the nurses left me alone for the most part, thankfully. I remained mobile and active in different positions until it got very intense and I started feeling rectal pressure. I got up repeatedly to go to the bathroom but couldn't produce any more. I didn't know that this was the sensation of my daughter descending and pressing the nerves in my rectal area. I did, however, feel that my contractions were so intense that I thought it might be time soon for the baby to come, and asked her whether she would call the doctor in. (The doctor was at home, asleep, since it was 2 a.m.)

The nurse was sweet but condescending. "Oh no, sweetie, I just checked you at (whatever time) and you were only at (however many cm). You're nowhere near time to push yet. Besides, for a first time mom, you'll probably be pushing around 2-3 hours." Famous last words. I should probably submit that quote to MyOBsaidWHAT.com as well.

I had been in the bed for this intense period for no reason other than believing that it was what I was supposed to do. I didn't realize that there is NO WORSE POSITION than on your back in a bed for laboring and pushing. Live and learn. No, really. Learn. Please. From my mistakes. So you can keep your perineum intact.

By the time the urge to push came upon me, it was as involuntary and irresistible as the urge to vomit. Telling a woman who has the urge to push "Don't push yet! The doctor isn't here yet!" is truly akin to telling someone "Don't vomit yet! We don't have a bucket ready!" Seriously. The time frame is a blur, but pushing felt like it couldn't have been more than 10 minutes. The nurse believed me when she saw my baby's hair and decided that maybe she *should* call and wake up the OB.

The OB lived in an apartment building right next to the hospital and arrived there very quickly, just in time to put on gloves and catch. Meanwhile, I was scared because the baby's heart tones were dipping, most likely because I was on my back the way they told me to lie. It makes no sense to have a mother push lying in a position that compresses the artery that supplies blood to the lower half of her body, potentially causing lower oxygenation for baby and heart decels. They turned me somewhat on my left side and thrust an oxygen mask on my face. I didn't know what was happening, but I wanted reassurance and didn't receive it. I didn't understand what was going on that all of a sudden my baby wasn't getting enough oxygen.

They kept telling me not to push yet, but like I said, yeah right. My husband describes the delivery thusly: "Imagine you took the cap off a brand new tube of toothpaste, then set the tube on the floor. Then you stomped on it." *That* was why I tore. Why didn't someone explain to me that the rectal pressure I had mentioned for the past 45 minutes meant the baby was descending, that it was progress, and that I needed her to descend slowly so that she could stretch my tissues gently so I wouldn't tear? Why didn't someone encourage me to get in ANY position other than on my back, for my baby's health and my own? (I know the answer to that, but that's another blog.) Why didn't anyone at all tell me that if I worked *with* my body's cues, I could ease my baby out and keep my perineum in one piece?

Not only did I suffer what I was told was a 2nd degree tear, but I also broke my tailbone in the delivery. That's another casualty of delivering on one's back. It's more common than I realized. Dumb stranded-beetle-position.

I was so wrapped up in wanting to hold my baby that I didn't even hear the OB say her snide little comment. My husband and friend/doula told me about it afterward. I must have been in a baby haze/ pain stupor. It hurt so much as she stitched me that I thought I had not received local anesthetic. My husband and friend/doula confirmed that I did indeed receive a shot of local anesthetic. I'm not sure whether the local anesthesia didn't take or whether she took so long stitching me that the anesthetic wore off.

What a kick in the gut. "I bet you wish you had gotten that epidural now." After all I sacrificed to ensure the safest delivery possible for my baby? After all that work, that long and tiresome yet rewarding work? Really? "I bet you wish you had gotten that epidural now." I wish I *had* heard her say it at the time, so I could have retorted with... I don't know, some witty and snide comeback. Who am I kidding? I wouldn't have come up with any comeback at the time. I guess it was better this way.

What's most offensive is that there's no factual basis at all to her statement! Epidurals are well known to be the cause of perineal tears, both in number and in their severity. When a mother is numbed, it's not uncommon for her to be unable or less able to push effectively, resulting in more intense tearing. Since there would have been no benefit to having had an epidural, I guess what the OB really meant was, "You shouldn't have woken me up at 2 a.m."


I suffered from intense pain recovering from the 2nd degree tear. For months, I was basically out of commission. It hurt so bad that I had to hold on to the walls to walk, hunched over. I cried every time I thought about how bad it hurt, with that recovery. I was glad that I delivered med-free and proud of that accomplishment for the sake of protecting my baby, but I hurt so much that I dreaded giving birth ever again for fear of tearing.

I hurt so much with the recovery that I had a hard time enjoying my precious newborn. I remember thinking to myself how wonderful it would be to become a grandparent and be able to enjoy and love a baby without being in pain. It hurt to sit up. It hurt to lie down. It hurt to move. It hurt to hold still. (It was so unnecessary and preventable! How tragic!)

A year after that birth, I visited my dear friend Denise at the same hospital where I delivered my first baby. Less than 24 hours after this, her first birth, Denise felt great! She had a drug-free birth like I did, but did not tear at all. She was bopping around, moving at a normal pace, and could even sit in normal chairs. (I needed to sit on a donut or Boppy for weeks after that first birth.) When I asked her how she managed to move around so well and she explained that she felt fine and normal since she didn't tear, that's when my gears started turning. I got to thinking, "Maybe what happened to me WASN'T normal and expected." This began my quest for birth info, especially when I found out a month later that I was pregnant with baby #2.

Once I discovered that tearing is NOT the norm and does not necessarily have to happen, I wanted to do everything I could do to prevent it. I never wanted to go through that again.

Babies # 2, 3, and 4 were born at home in water, with midwives attending. I didn't tear at all with any of my subsequent births due to spontaneous pushing encouraged by my midwives, as well as self-support for my perineum and, of course, the benefit of waterbirth for preventing a tear.

Baby #1, 2002: 7 lb. 3 oz. 2nd degree tear.

Baby #2, 2004: 7 lb. 3 oz. Perineum intact.

Baby #3, 2006: 8 lb. 2 oz. Perineum intact.

Baby #4, 2008: 9 lb. 1 oz. (after she pooped twice.) Small surface tear that did not require any stitches. I couldn't tell it was there.

Epilogue posted here: OB office manager's reply to MyOBsaidWHAT.com submission

Thursday, September 16, 2010


Yesterday had one of those rare moments where I deliberately slow down and try to savor babyhood. Not that I don't enjoy my kids; I do. It's just that as a homeschool mom of 4 kids age 7 and under, I don't get a whole lot of time to just lie with my babies. Correction: I get no such time. At her afternoon nap time, I tend to either lie down with Baby K (22 months old) for as briefly as I can get by with, nurse her on both sides, then wave night-night so I can go get more school done, or worse--I send my 6-year-old or my 7-year-old to go put her in bed and tuck her in (then I can get by without nursing her; I don't mind nursing her but it's just time consuming).

But yesterday, for some reason, I laid Baby K down in my comfy, king size bed, as opposed to the twin bed with rails where I usually lay her for nap. I nursed her and she had her sweet little arms wrapped around my neck, playing with my hair. Her eyes started drooping. Her warm little body cuddled up to mine in a reverse spoon, her legs tucked against my thighs, her tummy to my tummy. Her little legs are still so squooshy like fresh marshmallows. She felt so wonderful that I decided to stay. I remembered all those admonishments you hear to let the housework go and enjoy the babies. In theory, Baby K is "supposed" to be our last baby (as have been our last *3* babies). But maybe this time, this baby really will be our last baby. I had better treasure this time.

I'm proud of myself for staying with her, and telling the big girls to read a book while Mommy lies down with K. I know I did the right thing. It took a lot of effort to quiet my Type A, racing mind and quell the guilt for what I "should" have been doing. Baby K and I enjoyed an hour-long nap together. I don't know how many more of these I will be blessed to experience.

Song for a Fifth Child
By Ruth Hulburt Hamilton

Mother, oh Mother, come shake out your cloth
empty the dustpan, poison the moth,
hang out the washing and butter the bread,
sew on a button and make up a bed.
Where is the mother whose house is so shocking?
She's up in the nursery, blissfully rocking.

Oh, I've grown shiftless as Little Boy Blue
(lullaby, rockaby, lullaby loo).
Dishes are waiting and bills are past due
(pat-a-cake, darling, and peek, peekaboo).
The shopping's not done and there's nothing for stew
and out in the yard there's a hullabaloo
but I'm playing Kanga and this is my Roo.
Look! Aren't her eyes the most wonderful hue?
(lullaby, rockaby, lullaby loo).

The cleaning and scrubbing will wait till tomorrow,
for children grow up, as I've learned to my sorrow.
So quiet down, cobwebs. Dust, go to sleep.
I'm rocking my baby and babies don't keep.

P.S. Yes, she's sleeping with her shoes on. She won't let us take them off her until she's in a very deep sleep. If we try to remove her shoes at nap time or bedtime, she cries brokenheartedly. It's not a big deal to us whether she has shoes on at bedtime, so we let her go to sleep with them on. Priorities.

Wednesday, September 15, 2010

Co-sleeping, "House Beautiful"-style

I've been meaning to post this cool example of high-style co-sleeping from House Beautiful magazine. Did you know that co-sleeping means "mother and baby sleeping within easy reach of one another"? It can mean having a crib, bassinet, or other bed near mother's bed (or it can mean bedsharing, depending on personal preference--see askdrsears.com for tips for safe co-sleeping, however you choose to do it).

I was pleasantly surprised to see this master bedroom featured in the July/August 2010 issue of House Beautiful.

The text reads:

"The trundle bed for our daughter only comes out at night, and gets pushed back under the bed first thing in the morning," Kaihoi says. "So for all practical purposes, we never really see it." They use the windowsill in the 64-square-foot room as their bedside table.

Their daughter is 3 years old, the article says. I was happy to see co-sleeping mentioned in a positive light as if it were a normal,healthy occurrence (which it is).

Using a trundle bed like this is a great option for co-sleeping. It's low to the ground, so it's safe if a toddler rolls off (although rails of some sort could be fashioned if this were a concern), and it gives toddlers independence of getting in and out of bed by themselves as they would with a traditional toddler bed. It can roll away at night so it doesn't take up room in the day. For younger babies or toddlers, mom could easily lie down with baby to nurse to sleep or cuddle, then roll away to get up and have the rest of the evening.

I think I need to post a blog on the many options for safe co-sleeping. There are as many sleeping arrangements as there are families!