Well Rounded Birth Prep

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Sunday, May 19, 2013

Teen Questions About Birth & Our Bodies: Part 1

I had the privilege this week to be a guest speaker in a high school biology class this week, to teach on the topic of birth. I only had 50 minutes, so I really had to condense to the basics. My normal class series for pregnant couples is 12 hours of class time, and I really could use more time than that! So keeping it to "just" 50 minutes was really a challenge!

Since this was the first such class I had taught, I misjudged my timing and ran out of time for questions. I'll try to do better if I have another such opportunity in the future. Fortunately, the teacher had the students write up questions for me before the class, and I brought those home with me to answer here on my blog.

I ask that if you are under the age of 18 and reading this blog, especially if you go to the school where I spoke, ask your parents' permission before proceeding. I am comfortable discussing any of these topics and teaching from an honest, evidence-based, and God-honoring perspective about the incredible design of our bodies, but I do not want any angry parents calling or emailing me or the school.

Here are the questions that were submitted.

  • "What is the umbilical cord?", "What does the placenta do?", and "What happens to the umbilical cord after you give birth?"
The umbilical cord connects the baby to his placenta. The blood in the placenta and in the cord belong to the baby, not the mother. The mother's blood and baby's blood do not mix. 

The placenta provides all the nutrients, oxygen, etc. to the baby via the cord, and the cord transfers waste materials from the baby back to the placenta to be processed and eliminated.

The placenta is typically the size of a dinner plate and looks a bit like liver or other organ meat. It's not gross, it's pure awesome, once you discover how incredible it is and what it does.

This is the baby's side of the placenta, with the umbilical cord coming from the middle. The baby is attached to the other end of the cord. Source: http://www.pampers.com/common/pdf/pc/hb/CBE_book_for_students.pdf

The cord provides oxygen and other essentials to the baby in the womb and in the first few minutes after the birth, while the baby's lungs are inflating and acclimating to breathing air for the first time. It's essential for baby's oxygenation that the cord remain intact for a *minimum* of 3 minutes after the birth, according to the World Health Organization. Additionally, since the blood in the placenta and cord are part of the baby's total blood volume and designed to be returned to the baby through the cord after the birth, if the cord is clamped and cut prematurely, the baby is deprived of 30-40% of his total blood volume, which means that many babies have low iron levels due to that blood loss. This is a health problem called "anemia," and it's measurable for 6 months or more after the birth in babies whose cords were cut too early.

Here's a video that explains how this transfer of baby's blood occurs after the birth, and why it's important to wait for it. Many hospitals are in the habit of clamping and cutting the cord within 15 seconds after baby's birth, just out of routine.

You can tell the cord is ready to be clamped and cut when it quits pulsating. After the birth, you can put your fingers on the cord and gently squeeze it and and feel a pulse, just like feeling your own pulse. What you are feeling is the baby's pulse. While that pulsing is still going on, baby is still retrieving his blood from the placenta and cord. When it feels and looks empty, then it's ready to clamp and cut.

The OB or midwife will place one sterile, plastic clamp a few inches from where the cord attaches to baby, leave a bit of space, then sometimes place a second clamp. A lot of dads like to be the one who cuts the cord. It's done with surgical scissors, and it's very easy to do. My then-5-year-old son cut his baby brother's cord, in fact. 

That's my 5 y.o. on the left, cutting his baby brother's cord about 20 or 30 minutes after he was born.

It does not hurt the baby at all when the cord is cut.

  • "Why are the testicles separated from the rest of the body?"
I think I get what you're asking. As in, hanging down from, as opposed to as an internal organ? The primary purpose of that is to keep the testes away from the body so that they stay at a lower temperature. Sperm die at high temperatures. This is why men who have low sperm counts are advised to stay away from hot tubs, and to wear boxer shorts as opposed to tighty-whities.

  • "Does your stomach go back to normal size after birth?"
For the first few days or weeks after giving birth, many moms still look pregnant. It takes a while for internal organs to go back to where they are supposed to be, and for the uterus to shrink down to its normal non-pregnant size. There is much variation from one mother to the next. Some moms go right back to pretty much the way they looked before pregnancy. Others hold onto pregnancy weight for a variety of reasons; the body needs extra fat reserves to be able to produce milk. That weight is there for a reason (provided it was gained on high quality nutrition)! My midwife always says, "It took 9 months to put that weight on; it should take at least 9 months to take that weight off."

Some moms get stretch marks; others don't. There are many factors to this: genetics, nutrition & hydration, amount of weight gain, speed of weight gain (skin has time to stretch gently if it's gradual as opposed to quick weight gain), and if there are multiples (twins, triplets, etc.). Some moms' skin stays stretched even after the muscles & organs go back, sort of like a balloon that has been filled and then emptied. And some moms look like they never were pregnant, with smooth, taut bellies. 

All of these variations are normal and healthy. In my personal opinion, we need to be focusing on health and wellness more than looks. Many moms feel unnecessary pressure to get back to "pre-pregnancy weight" or "pre-pregnancy shape." Why should we feel outside pressure to conform to societal ideals that moms should look like pre-pubescent or pubescent young women who have never been pregnant? There's no reason to deny our basic biology. Personally, I'm at peace with my stretch marks. God designed our bodies to be capable of incredible miracles in creating, growing, and sustaining human life. My body's marks are proof of that.

A really neat website where you can see the many variations of mothers' bodies after pregnancy is Shape of a Mother, but there is some nudity on that site, for educational purposes of accepting the human form. Please get parental permission before viewing.

  • "What is a C-section?"
A C-section, also called cesarean or cesarean section, is major abdominal surgery to deliver a baby. In most cases, a vaginal delivery is safest for mom and for baby, but in some instances, a C-section is helpful or even life-saving for mom or baby or both. Other times, a C-section could have been prevented, and exposes mom and baby to unnecessary risks both short-term and long-term. Since C-sections have become so common (32.8% of all births in the U.S. are surgical births; in WV, the rate is 36.3% of all births, the 5th highest rate in the U.S.), it's important for all pregnant moms to get informed on risk/benefit and factors that contribute to higher cesarean risk.

Source: http://www.pampers.com/common/pdf/pc/hb/CBE_book_for_students.pdf

"Most of the time, epidural or spinal anesthesia is used, allowing the mother to be awake during the birth. In almost all cases, a labor partner can also be present... Once the cesarean begins, it only takes a few minutes for the baby to be born through an incision in the mother's lower abdomen. Then it usually takes around 45 minutes to complete the operation."
  • "What is the pain level of having a baby?"
That question is tough to answer, because it's so subjective, and varies not just from one mother to the next, but also from one birth experience to the next, even with the same mother.

There are many factors regarding the pain level, but one important one to note is FEAR. The more the mother fears birth, the more painful she will perceive it, the longer her labor is likely to be, the more likely she is to undergo preventable medical interventions, and the more likely she is to end up with a cesarean. Cesarean recovery is a whole different situation, as it is a major abdominal surgery, and if a mother has had more than one cesarean, recovery can be even more difficult.

The antidotes to fearing birth are often education and support. We are in a cultural crisis of fear of birth and negative stories about birth. Many times, the only things a pregnant woman knows about birth prior to giving birth, are what she has seen on reality TV shows about birth. Sadly, instead of giving moms confidence in their bodies' wonderful design and ability to give birth to their babies, these shows terrify viewers with drama and horror stories. (Peaceful, positive births aren't good for ratings or ad revenue.) This is well documented. I highly recommend that expectant moms and their birth partners take a comprehensive childbirth class, fairly early in their pregnancy, to an independent childbirth educator who isn't under a gag order by their employer not to share details beyond their policies and protocols.

There is a difference between pain and suffering in labor. Labor can be intensely painful, but for moms who are confident, well supported, and not fearful, this doesn't mean she will suffer. Moms in labor who are supported emotionally and physically to listen to her body and allow her to move, eat, sleep, and cope as her body tells her to do, are usually able to labor and give birth without pain medications. The positions that feel most comfortable to mom in labor are usually the ones that help the baby move down and through the pelvis, making labor more efficient and safe.

The more intense and painful labor becomes, the more endorphins (morphine-like hormones) the body produces, in an unmedicated birth. The mom actually enters a dreamlike state, a sort of altered state of consciousness, that helps her cope with the increasing pain. So, the more painful it gets, the more capable the body is of handling the pain and reducing the mom's perception of that pain.

Dr. Sarah Buckley has an excellent topic elaborating on this topic.

There are a number of options, both non-pharmaceutical and pharmaceutical, for pain relief in labor. Full explanation would take way too much space here. I encourage all expectant parents to take a class on all their options for coping with labor pain, so they can have the info on risk/benefit well in advance.

Personally, I've had 5 vaginal births with no pain medications whatsoever. Each experience was different; all were painful, but I have no regrets at all. If we were to have another baby, I would make the same birth choices. The benefits of a safe, drug-free birth, not exposing my baby to narcotics unless there were a medical emergency for doing so, getting a good start bonding and breastfeeding, and having that "birth high" from endorphins, far outweigh the hours of pain in the process, for me personally.

On a side note: a very small percent of moms who have unmedicated births will have pain-free or even physically pleasurable labors and/or births, sometimes called ecstatic or orgasmic births

  • "How far along is it until you can tell the sex of the baby?"
After the birth. Seriously. Sort of. Even with all of today's technology, ultrasounds are still not 100% accurate with predicting baby's gender. I've read figures around 85-90% for accuracy of prediction. It depends on the type of ultrasound equipment used, how far along the baby is, baby's position and whether the sonographer can get a clear view of the genitals, skill of the sonographer, and more. Sometimes the baby's genitals are swollen from mom's hormones, which is normal, but can make girl parts look like boy parts, or vice versa. You think that's impossible? Ask the scores of parents who already painted the nursery the wrong color and had all the wrong clothes for the baby.

With that in mind, typically parents can find out (the best guess for) baby's gender at the 20-week ultrasound that is usually performed to help rule out health problems. If an ultrasound is performed earlier for elective or medical reasons, *sometimes* gender can be viewed as early as 13 weeks, but with way less accuracy. (There are risks associated with ultrasounds in pregnancy, so it's not recommended to have them without medical indication for them.)

To be continued in Part 2...

**UPDATE** link to

Part 2 of Teen Questions About Birth & Our Bodies.

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