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.

Free downloadable e-book "What Every Pregnant Woman Needs to Know About Cesarean Section"

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

From 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.

"Pain in Labour: Your hormones are your helpers"

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.

Julie's miscarriage story, from Christian perspective

This is Julie's story of her miscarriage. She asked that only her first name be published, so if you know this family personally, please do not include identifying details in the comments. Thank you!

October 15th

October 15^th, 2012 will mark a very sad but monumental day in my life. That was the day my little baby was born, never to live here with me but to be safe in the Father’s arms.  Sharing my story comes from wanting to have some sort of closure but also stems from the desire to help those who are looking for some information during this difficult season of their life. Perhaps someone needs these exact details that will ease the pain or help with the process of losing a very precious part of a mommy’s life. 

When I found out that I was pregnant with my 6^th child, I was tickled and nervous. Five living children, homeschooling, and very active in my community, I could barely wrap my brain around adding another baby to my already busy schedule. On top of that, I would be 41 years old and my husband nearing 50 when our baby would be born. It was hard not to feel nervous about it, however, every child has been an incredible blessing to our family and I had absolutely no regrets. I felt like an old pro so I wasn’t in a rush to go to the OB/Gyn and get an ultrasound. I felt fertile and experienced so I got my vitamins, ordered my iron pills and watched my sugar (I often get an early onset of gestational diabetes). My husband and I started planning which large van to get come Spring as we would no longer be able to transport our growing family in our current one. I was excited as we anticipated this new baby! My children were also happily involved in dreaming about the baby. My 12-year-old daughter was especially excited as her little maternal instincts kicked in. We were thinking up names, imagining what the baby looked like, and overall enjoying the pregnancy. 

I finally got in to see the doctor at 12 weeks. Prior to the appointment, I had my first ultrasound. That morning, I woke up early to this dreadful feeling that the baby was not alive. I was cramping for 3 hours and if I had actively checked for discharge I believe I would’ve noticed something. However, I passed the cramping off to being backed up due to the extra iron pills I was taking. However, I couldn’t shake this foreboding that I wouldn’t see my baby alive. I think every pregnant mom has that fear in the back of her mind but usually it’s dismissed with a blinking heartbeat on the monitor. My fears would be confirmed, however, as the wand panned around my belly. I saw a gaping black hole and no heartbeat. I knew within 3 seconds that the baby was not alive. The technician was very quiet and didn’t say much but she was able to tell me that she didn’t see any activity. She checked and checked and we saw that the baby only measured 6 weeks, the gestational sac only 10 weeks and looked very irregular. She went to get a room for me to await the doctor so I wouldn’t have to go back into the waiting room. At that time, the tears rushed in and I sat crying while my husband held my hand. I couldn’t believe the baby was dead. 

My OB is a kind and experienced doctor. While not a believer, he is respectful of his patients’ beliefs and desires to make me comfortable. He gently explained what would happen while miscarrying, the option of the D&C now or later, as well as affirmed that there was nothing I could have done to prevent all this. I think one of the most helpful things he said was that it wasn’t my fault at all. I can’t blame it on age, that glass of wine during my anniversary dinner, that I didn’t take my vitamins early enough, or whatever it was. I know that many women carry guilt about what they did or could’ve done differently to prevent a miscarriage. I still wonder about my age, however, I will never know what happened exactly and feel that he eased my concerns early on. Whatever you did or didn’t do, you have to understand that it wasn’t your fault and be at peace knowing that every baby is a miracle. 

That day, I spent time at home crying and praying. I told the children and while the boys didn’t seem terribly affected, my girls were very sad, especially my 12-year-old. I could see that she was grieving as she stayed very close to me. She drew pictures expressing her grief that I’ve captured on camera and will hold dear to my heart. She stayed with me at night and we talked about things. I was very open with her as to what was happening and why. My dear husband was such a support at this time. He took her to a craft store to get a tiny wooden box that she could decorate in case we saw the baby. She painted it and waited for the baby to come. 

The hardest part was waiting. Every day, I spotted more and more. It was Tuesday when I started spotting. My husband took time off on Friday and Monday so he could help with the kids and the homeschool group I am in charge of. I prayed that the baby would come by the weekend. I started taking black and blue cohosh in order to speed the miscarriage along. 20 drops of each in a tiny bit of water, held under my tongue for about a minute five times a day was what I was told. The cohosh tasted nasty but I chased it with OJ and it was palatable. Sure enough, within a few days, the bleeding started and I felt confident that it was to happen on the weekend. 

The spotting turned to intermittent bleeding by Friday. Whenever I went to the bathroom and wiped, I turned up some brown blood as well as some blackened tissue. The lining was shedding slowly but surely. I also started cramping more and had a loss of appetite. I took this time to distract myself with cleaning and doing some other quiet projects I wanted to get done. I also prepared myself with what I was going to do to ‘catch’ the baby. You see, I suddenly had an incredible desire to see the baby. I felt so sad when I thought about my baby being flushed down the toilet. Please, if this happened to you, don’t feel badly. I know that if I didn’t see the baby, that was God’s sovereign plan, for whatever reason, but I really wanted to see it if I could. I was able to secure one of those ‘hats’ that you can put under the lid of the toilet that you go into to measure the volume of output. This assured that I would be able to see everything that came out before I flushed it. It definitely helped me feel less anxious about going to the bathroom.

I also had a few other supplies ready: a small, clear container of water that I could put the baby in, craft sticks in case I had to sort through, disposable gloves, and paper plates. I also had some extra trash bags. I know these are a lot of details and I think at one point I would’ve thought this a bit macabre but I feel strongly about sharing details in case you are clueless what to do. This worked for me and I needed everything I had prepared. It was truly a blessing to be ready rather than panicked. 

I also checked out some websites that a friend sent to me. Several of these prepared me for what to expect. The one I found very useful was Still Birthday: Pregnancy Loss is Still a Birthday. This had links to different developmental stages of your baby. It really helped me to visualize what size the baby might be as well as what it might look like. There are stories and actual pictures tastefully done. 

On Sunday evening, the bleeding started much more heavily. I started having to rush to the bathroom as the discharge gushed out in chunks. I felt stronger contractions – they were much stronger than menstrual cramps and were in intervals just like contractions. I was surprised by how strong some of them were. With each contraction, there was more bleeding and blood clots. I knew it had started. 

That night, I bled for hours and I stayed on the toilet for the majority of the night. I was surprised by how heavily I bled. I was able to see exactly how much volume of blood I was losing as I was going into the ‘hat’. Every 10-15 minutes, I had 300-500cc of discharge. Much of it was clotting and sometimes the clots were larger than the palm of my hand. I literally peed blood. Everything I had read said go to the doctor if you soak more than one pad an hour or if you bleed much more than a heavy period. That’s laughable as it was SO much more. (I found out later that earlier miscarriages (under 6 weeks) would bleed less but over 12 weeks this much blood was more normal.) I called my husband who stayed up with me. I think most husbands - and I sure don’t blame them! - would faint at the sight of so much blood. It truly looked like a murder scene. Terrible! My resolve to see the baby outweighed the grossness of the grim scene. My husband took over examining the discharge for any fetal parts. Thank God for a doctor husband! At one point we wondered, ‘How much bleeding during a miscarriage is too much?’ Neither one of us had seen so much blood. Yet, I wasn’t willing to go to the hospital until I knew I had passed the baby. 

After a few hours, I cramped terribly and when I looked, there was a tiny yolk sac and something fleshy near it. I knew in my heart that this was the baby. I put it in the container with some water to wash it off. After a while, it was obvious that it was different than the other mess that was coming out. It was irregular and very deformed and it had the color of flesh. The size indicated that it was definitely around 8-10 weeks rather than 6. It had degraded some and the parts were barely recognizable. However, I felt relieved. After bleeding heavily for about 2 hours more, I decided to go in to the hospital in case I had lost too much. I wasn’t scared or panicked. I did feel lightheaded and shaky though – most likely because of lack of sleep, no food, and an intense night on top of the loss of blood. Incredibly, I found a sitter at 5am and by 7am I was in the hospital. 

Yolk sac

(I’ve decided not to post pics of the baby)

I’m sharing what happened at the hospital in case you need to go. I didn’t know what to expect. First of all, I was surprised to see only one other person waiting (when I was discharged the waiting room was completely packed). I was taken back immediately and had a very kind doctor. She ordered some IV fluids, blood work, and an ultrasound first to determine whether I needed the more invasive step of a blood transfusion and a D & C. I prayed that I would need neither. The nurse was considerate about putting in the catheter when she heard that the ultrasound was ready for me, otherwise, I would be bed-ridden and uncomfortable for hours. Indeed it took 2 hours for the u/s to be ready for me. 

My husband was asked to stay in the waiting room during the u/s. I knew that this would happen and wasn’t too miffed about it. It was very different than the happy exciting ultrasound of my OB as the situation was more serious. She didn’t show me the screen, which I expected and she was very quiet while performing the procedure. I didn’t ask questions at this point because I know that techs are not supposed to say anything even though it is very hard for a person like me who wants to know everything and see it all not to say anything. I did answer her questions and tried to let her know that I knew what to expect and that I was not afraid of what she found out. I was sad but at peace. Near the end, I did ask her if the doctor would be able to tell me whether they saw the baby or not as this was very important to me. I wanted to be 100% sure that the ‘specimen’ I had at home was indeed my baby. She quietly confirmed that the baby was not there and that she only told me because I seemed ready to hear it. I was. 

Everything else was routine. My blood work came back within safe limits. I was anemic but not terribly so. I had taken some iron pills that night and morning and I’m sure that helped my levels some. I was sent back home with the assurance that we had done everything we could. 

I slept the whole day and night. The next morning, I woke up with an urge to run to the bathroom. There was a huge ‘whomp’ and I delivered the placenta. I didn’t expect that exactly as I thought I had passed bits of it earlier. It was a bit smaller than the size of my fist and one giant ball. After that, the cramps disappeared and the bleeding substantially subsided. I felt peace and closure (but a terrible migraine!).

Was it a coincidence that October 15^th marked my baby’s birthday as well as The Pregnancy and Infant Loss Remembrance Day? Was it by chance that dozens of my friends were remembering and lighting candles for their own children who they’ve not been able to hold or see and that they added one for me? Was it pure luck that one of my favorite bloggers, Tim Challies, had a podcast on Early Infant Loss that very day? No. None of that is chance, my friends. It is pure grace. My heavenly Father showed such care and tenderness to me in so many ways during this time. I know that not everything goes according to our plans and they really don’t have to. However, at times, His sweetness overwhelms me as I find myself being supported, cared for, loved and cuddled by friends, family and especially, by my dear husband. 

I had so many sympathetic notes and remarks via texts and Facebook. I received kind and encouraging words and friends shared stories of their own miscarriages. I had the occasional person say, “Well, at least you have 5 kids.” or “Well, guess this is a sign that you’re getting old.” but I expected these remarks as not everyone has the education on what not to say during a miscarriage but most people have good, albeit awkward intentions. It really doesn’t matter how many children you have, what the chances are on having more, if you already have one boy and one girl, if you are getting along in your age, if you weren’t ecstatic upon the news that you were having another one, if you couldn’t afford to raise another baby. The pain is really there. Your baby has died. You’ve suffered a great loss and the grief can be as deep and as intense as if you’ve given birth to, raised, and bonded with your child. However, I want to extend the same grace to others as the Lord has to me as they help me cope with my loss. I don’t expect them to understand the deep sense of grief I feel as I never could truly sympathize when my friends miscarried. I could only imagine the pain.

Honestly, as I reflect on the last week, I have gratefulness in my heart. Grateful that I have six children and one is completely loved and perfect in heaven. I have Biblical reassurance that this is the case (see the books: Little One Lost: Living With Early Infant Loss by Glenda Mathes and Safe in the Arms of God: Truth from Heaven About the Death of a Child by John Macarthur). I’m also grateful for the opportunity for this life experience for my daughter; for her to see the folly of evolution (one kink in the DNA and it cannot survive) versus the miracle of a beautiful baby created by a living and loving Maker. 

And he said, “Naked I came from my mother’s womb, and naked shall I return. The LORD gave, and the LORD has taken away; blessed be the name of the LORD.” Job 1:21

Drawn by 12-year-old sister

Weighing VBAC vs. repeat c-section

I frequently get emails from mommas who are considering VBAC (Vaginal Birth After Cesarean) vs. ERCS (Elective Repeat Cesarean Section). Are you interested in the possibility of VBAC and wondering what your options are? Here are a few places to start your research.

This post is not intended to try to talk moms who want a repeat cesarean birth, into having a VBAC, or vice versa. There isn't one right answer for everyone. For some, repeat cesarean is best. For others, VBAC is best. It depends on your situation. My goal is to give a springboard for research for those who might want VBAC, but aren't sure where to start with looking into it.

Even if you are still just in the planning stages of your next pregnancy, talk to your care provider about your options now. If you are interested in the possibility of VBAC but your OB doesn't attend VBACs, your best option for having a VBAC will be switching to a care provider who DOES attend VBAC. (You can always change your mind later, if you decide you do want ERCS.) Current research supports the safety of VBAC for the majority of VBAC candidates and some VBAMC (Vaginal Birth After Multiple Cesarean) candidates. Some of the factors to consider are personal health history, reason for prior cesarean(s), how many prior cesareans, type of incision (low transverse incision is lowest risk, but other incisions don't necessarily mean that VBAC isn't a possibility), length of time between pregnancies, whether there were any post-op infections, how recovery/healing went, and more.

Another good step is to request your full medical records of your cesarean(s), including notes from anyone who attended the birth (doctors, nurses, etc.) so you can get the fullest picture possible of what led to the cesarean and all the circumstances surrounding it. You can also ask to have your medical records forwarded to another care provider (OB or midwife) who does attend VBAC and can give you a second opinion about your options.

Some OBs will not attend VBACs regardless of evidence of the safety of VBAC, simply because of their liability. Depending on their malpractice insurance, some OBs are forbidden to attend VBACs or their insurance company will drop their coverage. Some OBs aren't aware of the research and evidence supporting the safety of VBAC and VBAMC. For some, it's a matter of their personal perception of risk (regardless of the research) or anecdotal experience. For others, it's just their personal preference because cesareans are quicker and easier for OBs. Some hospitals have policies outright forbidding (intentional) VBACs, regardless of physician preference. Regardless of your OB's reason, he or she is highly unlikely to change his/her policy and begin attending VBACs or VBAMCs if he or she doesn't do so already. If you want to plan for a VBAC (or even just leave your options open to the possibility of VBAC), your best odds may be to change providers and/or birth location to a VBAC-friendly one.

The number one factor that with whether or not a mother will have a vaginal birth (whether VBAC, VBAMC, or even a mom's first birth) is choice of hospital and choice of care provider. Know your hospital's cesarean rate, and make sure that both your hospital's policies and your OB's or midwife's standards of practice are evidence based and support normal, physiologic birth.

Here is a link with WV hospital cesarean rates:

http://www.cesareanrates.com/west-virginia-cesarean-rates/

In our region, the 4 major hospitals are Thomas (54.5% cesareans), CAMC (43.0%), Cabell (40.6%), and St. Mary's (24.3%), as of 2009 stats (the latest statistics available as of Sept. 2012).

You can find cesarean rates for other states and regions here:

CesareanRates.com

About 50% of US hospitals either have an outright or de facto ban on VBACs. De facto ban means there is no outright ban on VBAC at that hospital, but there are no care providers who attend births there who are willing and able to attend VBAC, for whatever reason (personal or legal). Some moms find that they have to travel a little or a lot to find a hospital that will support their desire to VBAC. The hospital closest to your house might not necessarily be the best hospital for your needs. Check out Joy Szabo's story. She traveled 6 hours away to a hospital that would support her wish to VBAC her 4th child when she discovered that her prior hospital had banned VBACs after her previous successful VBAC with her 3rd child. 

This article helps moms make sense of the National Institutes of Health recommendations for VBAC and VBAMC (most current research & recommendations). It looks at various factors and helps you know what questions to ask when you talk to your care provider.

http://givingbirthwithconfidence.org/2-2/a-womans-guide-to-vbac/

Additionally, we are blessed to have the first ICAN in WV here in Charleston. ICAN is International Cesarean Awareness Network, the world's premiere organization for cesarean recovery, healing, support, prevention, and VBAC info.

Their website has a lot of great info for research on VBAC vs. ERCS.

http://ican-online.org/

Our local ICAN's website:

http://icangreatercharlestonwv.weebly.com/

and their Facebook page where you can get local meeting info:

https://www.facebook.com/ICANGreaterCharlestonWV

An excellent free podcast on preparing for VBAC by Desirre Andrews, the former president of ICAN:

http://motherloveblog.com/2012/04/02/podcast-preparing-for-a-vaginal-birth-after-cesarean-vbac-with-the-president-of-ican/

ChildbirthConnection.org is one of my favorite sites for evidence-based birth info. Here are a few of their resources.

VBAC or Repeat C-Section?

Options: VBAC or Repeat C-section

Best Evidence: VBAC or Repeat C-Section

Tips and Tools: VBAC or Repeat C-Section

For moms who have a cesarean scar other than the traditional low transverse incision (including other uterine surgeries such as myomectomy), the group Special Scars ~ Special Women provides support and info on options.

Their website: http://www.specialscars.org

Their Facebook page: https://www.facebook.com/specialscars

The medical term for "attempting a VBAC" is TOLAC (Trial of Labor After Cesarean), just so that you're not alarmed by that. That term can sometimes be a little bit unnerving or less-than-confidence-inducing for some moms, but nothing negative is meant or implied. It's just the terminology used.

If you are still in the planning stages of your next pregnancy, now is the time to work toward improving your health and resolving any current health concerns, such as working toward a healthy weight for your build, getting diabetes under control, seeing a specialist if there are any endocrine issues (thyroid, PCOS, etc.) that can be treated now, reducing or eliminating environmental toxins and cleaning chemicals, and researching the pregnancy diet and supplements that are recommended for your needs. An early pregnancy class might benefit you, to let you know what preventative measures can be taken for best health for you and baby prenatally, and another comprehensive birth class later in the pregnancy if you have not already attended one.

VBACfacts.com is a great source for statistics on VBAC vs. ERCS. Its owner periodically offers online classes for parents who are preparing for VBAC.

Moms who choose a repeat cesarean may choose options for a family centered cesarean, but that's another blog post.

I hope this gives you a place to start your research! Please let me know if I can serve you with preparing info for a private (in person or via Skype) or group class for you, whether it's info on TTC, for a healthy low-risk pregnancy to increase your odds of vaginal birth, and/or birth class for later pregnancy. I specialize in informed options.

Pacifier clip = teether tether. You're welcome.

Why did it take me 5 children before I figured this out? Regardless, here's a little lifesaver for you. Use a pacifier clip as a teether tether and never lose another teether (or small toy).

I'm sure some of you figured this out before your 5th child. How many of you have tried this before? What other ridiculously simple, "a-ha!" tricks have made getting out and about with baby a little easier?

2 Mommy Necklaces Giveaway! (Ends 8-21-12)

I'm so excited to offer you not just one, but TWO beautiful, practical Mommy Necklaces up for giveaway! I contacted Raelynn Hughes, to ask her for her business cards for my clients, since I love my Mommy Necklaces so much, and Raelynn generously provided an Ambience Dangling Donut Mommy Necklace and a Nourish Rainbow Necklace with 5 extra rings, to match your outfit! For the record, Mommy Necklaces did not provide me with any of my personal Mommy Necklaces. I paid full retail for some of them, and received others as gifts from my friend. I'm not being compensated in any way for my review. I really believe in Mommy Necklaces (MN)! I own 7 Mommy Necklaces so far, which is a pretty good start to my collection.

Several of my friends had MNs before me, and raved about how sturdy they are, how high quality, how on-trend, and how comfortable they are. They are "Jewelry, Justified." MNs are strong, lightweight, and designed with you in mind: meant to be worn with little sweethearts tugging on them. One of their signature features is their "breakaway clasp" that is designed to come apart if your little one is tugging very hard at the necklace, as an extra insurance that your MN will not break.  Read here to see more benefits of Mommy Necklaces.

Left: Ambience Mommy Necklace Dangling Donut & Strand: Center: Nourish Mommy Necklace & 5 ring set.

Up for giveaway are two beautiful, durable Mommy Necklaces.

Ambience Dangling Donut Strand, 32", which can be worn with the Donut, or without it, as a chic strand necklace. $27.50 retail value.

Nourish Necklace for feeding time fiddlers, a must-have accessory for moms whose babies twiddle, pinch, or are easily distracted. Included is a set of 5 rings to wear on the Nourish Necklace, one at a time or in combination to match your outfit. Retail value $25.

Love these necklaces and want to buy one now, or in a different color? Dangling Donut Mommy Necklace collections are available here, and Nourish Mommy Necklace selections are available here.

Thanks again to Mommy Necklaces for their generosity!

Winners, I'd love to see a pic of you wearing your necklace, if you have a chance to upload a pic to Well Rounded Birth Prep and/or Mommy Necklace Facebook Wall or Tweet it to us!

ENTRY RULES:

• The only way to enter is through the Rafflecopter app below.
• All steps must be completed to qualify for an entry (I will verify each one.)
• This giveaway is open for US and Canada.
• You MUST use a valid, accessible email to enter. If I can’t contact you, you can’t win!
• Giveaway ends at midnight on August 21. Winner will be announced August 22.
• You have 7 days to respond, otherwise another winner will be drawn.
• Contest is void where prohibited.

  a Rafflecopter giveaway

6 y.o. son wants to be a lactation consultant (video)

My 6 year old son informed me that he wants to help mommies nurse their babies when he grows up. He has encouraged me as I nurse his baby brother, and he himself weaned at an age that we'll call "well into his toddler years."  He remembers nursing and I'm thankful that he knows that breastfeeding is the biological norm. I'm pretty sure that he isn't aware that an alternative feeding method exists.

He has heard me on the phone, consulting with moms who need breastfeeding info and support. When he started telling me what he wants to do when he grows up (in addition to the other things he wants to do when he grows up, like being a superhero, owning a bakery like on Cake Boss, and winning bike races), I recorded it and here's the result. It's heartwarming (to me, anyway) and too cute (in my biased, humble opinion.) He'll be a wonderful, supportive husband and daddy someday.

Have your kids ever talked about helping mommies learn to nurse?

WV DHHR wants to know what I think about WV births

I was "randomly selected" to receive a questionnaire on the health of mothers and babies in WV. "PRAMS: Pregnancy Risk Assessment Monitoring System. You can help improve the health of West Virginia babies," the cover states. WV Department of Health & Human Resources sponsors the questionnaire.

An aside. I do find it a bit odd that 1 out of 14 WV new mothers receive the questionnaire, yet I received one following my 2008 homebirth as well. Coincidence?

Most of the questions were multiple choice or yes/no demographic questions or asking about health during the pregnancy, whether I had insurance, whether I smoked or drank or took vitamins, whether my baby was in NICU, etc.

At the end was this gem. "Please use this space for any additional comments you would like to make about the health of mothers and babies in West Virginia." Why, I don't mind if I do.

Here's what I wrote. I could have done better with time to prepare, but I wanted to get it finished and in the mail.

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WV has the 5th highest cesarean rate in the US, 36.3%. (cesareanrates.com) The World Health Organization has stated that the cesarean rate should never exceed 15% or else more harm is being done than good. Clearly, WV's cesarean rate is adversely affecting the health of mothers and babies through both preventable mortality and morbidity.

"According to the World Health Organization, midwives should be the preferred medical caregiver for low-risk pregnant women, reserving OB-GYN's for high-risk pregnancies for emergency birth complications only." (http://www.choicesinchildbirth.com/Choose_Your_Medical_Caregiver.html)

World Health Organization "Definition of the Midwife," 1992:

"The most appropriate person to care for pregnant women is someone with midwifery skills who lives close to the community. People trained in midwifery are qualified to provide preventive care to pregnant women, detect abnormal conditions in mothers and infants, assist women through labor and delivery and prescribe essential drugs. When delivery complications arise, those providing midwifery care especially at the community level- need to be able to carry out emergency measures if medical help is absent and get medical assistance or refer women to an appropriate health facility."

The answer to safer, healthier pregnancies in WV and around the world, is MORE MIDWIVES, both in and out of hospitals. More midwives means huge savings in healthcare dollars, too.

Following the 6 recommendations for the safest birth possible (as recommended by the World Health Organization) would dramatically improve outcomes:

1. Let labor begin on its own.

2. Walk, move around, and change positions throughout labor.

3. Bring a loved one, friend, or doula for continuous support.

4. Avoid interventions that are not medically necessary.

5. Avoid giving birth on your back, and follow your body's urges to push.

6. Keep your baby with you--it's best for you, your baby, and breastfeeding.

Details, free videos and print materials at mothersadvocate.org.

* WV MOMS DESERVE EVIDENCE-BASED CARE. * Their babies--our babies--depend on it.

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This is what I wrote on the back of the return envelope.

I don't know how to rotate that, so here's what it says.

"WV cesarean rate: 36.3%
World Health Organization max recommended cesarean rate: 15%"

"Treating normal labors as though they were complicated can become a self-fulfilling prophecy. --Rooks"

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What would YOU say in the write-in section about the health of mothers and babies and birth in your state/region?