Sunday, February 22, 2009

Recent News Articles

I've found and read these recent news articles that have interesting implications for women who are mothers:

This piece in TIME magazine is getting a lot of coverage: The Trouble with Repeat Cesareans
A follow-up story to the TIME article: Childbirth Without Choice

Breastfeeding Benefits Moms with MS
Baby Food: If breast is best, why are women bottling their milk? : article from the New Yorker offering a stunning history of expressed milk

Changing Ideals for Birth

On discussion boards and surveys, the question has been posed, "What is your ideal birth?"

In preparing for another pregnancy, my ideal birth was something very close to this: I go into labor at home with my little boy. I do my typical thing until the contractions get closer together and more intense. I pray throughout to my Father in Heaven that all will be well. I either call or wake up my husband and he starts to fill the labor pool with water. I take walks with my husband and toddler. I eat a little and drink the special tea and laborade blends that I've prepared. I cuddle with my little boy and encourage him to nurse. Maybe my husband and I will have sex if my waters haven't broken. Maybe I ask him to give me a priesthood blessing. I labor in the pool submerged in water. Maybe I'll get out of the pool when I feel the urge to push, but maybe I will stay and the baby will be born with just me, my husband and my little boy present. I'll give the baby the opportunity to do the breast crawl to nurse for the first time and then baby and I will rest. Maybe husband and toddler will rest with us. When we wake up, we call the chiropractor who promised to come by and adjust me and new baby after birth, as well as grandparents, friends and the midwife to schedule a postpartum visit for the next day.

My plan has stayed pretty static for sometime, and my preparations during the pregnancy have been to support that end result. However what I consider my ideal for this birth has begun to change since I've started reading the book "Rediscovering Birth" by Sheila Kitzinger. She describes the history of birth through a cultural anthropology lense and describes how birth is viewed across cultures and history. If you were to analyze my ideal birth story above using her presentation of ideas, you would find that it has shades of contemporary American (no surprise there), tribal African, and medieval European birth practices.

I thought an unassisted birth a home with my family was what I really wanted. That it was even what I would choose in a perfect world where maternity care was appropriate and family and friends were nearby and culturally accepting of my choices. However reading Kitzinger's book I am realizing that my "perfect world" birth experience would be surrounded by women like in medieval Europe where it was a party atmosphere were the birthing woman's husband, mother, mother-in-law, sisters, aunts, cousins, friends, neighbors and young women of the community gathered together to support and comfort the mother, to celebrate the birth a baby with food, laughter and bustle.

I see the drawback of that setting: my husband would be terrified to have that many women around and can you imagine the offense taken if the birthing mother tells someone to leave? The largest reason why I do not feel I can in good conscience invite a group of women to support and surround me during birth is that almost every woman I know is strongly steeped in the American culture of birth. And the ones that aren't live very far away from me and I only know them through the internet. I know the women who could gather around me during would be fearful and concerned about not being in a hospital or not having a midwife or doctor present would permeate the atmosphere. They wouldn't have the experience of being present at many births except their own.

So I guess I basically am wishing that I was living in medieval Europe or that the entire way birth is viewed, engaged in and celebrated in the US dramatically changes before June. Of course its not going to happen but as a result, I am struggling to not feel that I am settling for what I believe is realistic given the circumstances and climate of birth.

I wish that women in our society were included in the birthing room for other women, without being paid as consultants or providers, but that their presence was the loving, benign presence of friends and family rejoicing in a typical life event. I wish that my daughters will not be strangers to birth when they birth their first babies, but will have been exposed to the gentle, natural birthing practices that take place at home surrounded by love, without fear and without unnecessary intervention.

Saturday, February 21, 2009

Update: Week 25

Last week, I saw the midwife at 25 weeks and it was a very good visit.

I learned how amazing cool it is to hear a fetus's heartbeat using a stethoscope rather than a doppler. The doppler sounds to me like a"woosh-woosh" sound while the heartbeat using the stethoscope sounds like a quick little heartbeat. Mine could even more heard slower and deeper in the background. I could listen to that sound for hours. Which is why I'm seriously contemplating buying a stethoscope for home.

In my pregnancy with Willem, the only way I ever heard his heartbeat was using the doppler device, in spite of some researchers' concerns that doppler sound waves can harm the fetus. This pregnancy I'm trying to avoid the doppler and I'm so glad I did because I've discovered listening with the stethoscope. To me, the experience doesn't compare. I don't feel like I'm intruding on the baby at all, but that I'm listening without disturbing her at all.

In the week leading up to that appointment, I had had two birth dreams. This was exciting and unusual for me because I longed to dream about birth and the baby when I was pregnant with Willem, but never did. These recent dreams of mine had two things in common: they were wonderful, perfect, gentle and loving unassisted births and in each the baby was large. In the first dream, I gave birth to a 15 pound baby! I've never even heard of baby that big being born vaginally and it was a wonderful birth. The second dream, I was submerged in water to my shoulders (I've never heard of birthing in a swimming pool, but in the dream it was great!), I watched as the baby emerged from my body, she twisted in one of the cardinal movements and looked into my eyes through lovely blue gray eyes. During that dream, she wasn't weighed but I knew by looking at her that she weighed at least 10 pounds.

Of course, I have been puzzling over what this meant. Is it a premonition that I'll be birthing a baby at least 4 pounds heavier than my first? Or does it mean I'm just that confident in my ability to have a joyous birth?

I seem to be getting some indications that its not likely for me to have a large baby, especially since Willem was born at 38 weeks and not quite 7 pounds. At the recent week 25 appointment, my fundal height was measuring at 24 weeks. That could easily be normal variation and she's small for dates but in the normal range, or it may be an indication that the calculated due date is off.

Since gestational dating is such an imprecise science, I am not about to try to determine if that supposition is correct using any obstetric techniques. Instead I decided to do what I vowed to do at the start of the pregnancy: turn to God who I believe is the source for all knowledge for guidance and truth regarding this pregnancy. If anyone can or will know, it is my loving Father in Heaven. To me it is an application of the scriptures "trust the Lord with all thine heart and lean not to thine own understanding (Proverbs 3:5)" and "I will not put my trust in the arm of flesh; for I know that cursed is he that putteth his trust in the arm of flesh. Yea, cursed is he that putteth his trust in man or maketh flesh his arm (2 Nephi 4:34)." I knew that taking this matter to the Lord might not matter in big picture (applying the principle in Doctrine and Covenants where the Lord says, "it mattereth not unto me") but if it was something that he felt I should know that I wished to know if the dating was off.

I have suspected from the beginning that instead of the EDD being the last week of May, it should be the first week of June based on when the baby was conceived, my menstrual cycle, as well as just a feeling that she is going to be a June, rather than May baby. The fundal height measurement was enough to make me consider that possibility once again. When I asked of God, I felt strongly impressed by the spirit that indeed the more accurate EDD should be placed during the first week of June.

I have been enjoying throughout this pregnancy what I believe to be revelation concerning the baby and my body's work at carrying the baby. Before this baby was conceived, I felt the strong impression that a little girl was on its way to our family and then I believe it was the Spirit whispering to me that I was pregnant which is what prompted me to take a home pregnancy test in the first place. After the pregnancy was confirmed, I once again felt impressed that the baby was indeed a girl, which was then confirmed by ultrasound at week 22. I would have been perfectly content to have the gender confirmed at birth, however. The biggest question weighing on my mind however is the Lord's support and knowledge of the best birthing environment and situation for the baby. I have received impressions that he is supportive of my plans and that all will be well with the birth. That assurance is the greatest knowledge I can receive in regards to this pregnancy.

An interesting part of the impression is actually that to God, it doesn't really matter which birth setting I choose for this pregnancy, the outcome will be the same. That leads me to believe, that the Lord doesn't prescribe one "right" or ideal way to birth and that it is one of those things that he would prefer for us to study it out in our minds and our hearts (Doctrine and Covenants 9: 8) what is best for us and he will guide and support that learning process. To me that means that with each pregnancy the situations and therefore decisions made regarding birth will be different. How thankful I am that I can trust in Him to be there every step of the way in making those decisions.

That was week 25-26 of this pregnancy. I'm feeling well--particularly active and energetic. For a while that had me concerned but then I realized that I am probably rejoicing in the fact that I am done with my thesis and master's program and can now throw myself into other activities that I had to restrict myself from previously. I'm excited that in the next couple of months before the baby comes, I can focus on working with Solace for Mothers, assisting progress with The Birth Survey and reading from my book list.

Thursday, February 5, 2009

Mothers and Fetuses: Whose Rights Trumps Who's?

One of the fears facing homebirthing and unassisted birthing mothers is a transfer to the hospital where their motives and "fitness" as a mother are called into question by hospital staff; sometimes resulting in CPS taking the newborn from its mother and the mother faces criminal charges. Another fear is the court-mandated Cesarean where a women is forced into a surgery that maybe against her wishes.

Lorna A. Turnbull discusses these issues in the article "The Legal Characterization of Pregnancy and Mothering: Does Mother Know Best?" in the Spring/Summer 2001 issue of Journal of the Association for Research on Mothering.

She states that the legal system has historically relied on a medical model of pregnancy that dictates the behavior and decisions made by a women. The state has then attempted to regulate pregnant women's behavior through criminal prosecutions or by allowing civil actions against the mother.

"The medical model removes the power of women with respect to their pregnancies and places it in the hands of doctors, or in some cases, the state. The model allows women to be depicted as self-interested or incompetent. The standards of medicine become the norm against which a pregnant woman's behavior is judged and a woman who decides against the norm of medical science is cast as irrational and selfish. A woman who defies the truth of medical knowledge becomes a bad mother, one who has declined to put the perceived needs of the foetus ahead of her own concerns."

Homebirthing and unassisted birthing mothers know this frame of reference all too well. By choosing to birth a home with or without a professional who is not a doctor, women are considered to be flouting what the medical establishment has deemed proper behavior for birthing women. The American College of Obstetrics and Gynaecologists have repeatedly decried the dangers of homebirth calling mothers "selfish," "irresponsible" and "incompetent." Conversely the vast majority of mothers who do choose to birth their babies at home do so beleiving that it is within the best interests of their baby and themselves; as to not be exposed to the risks attended with hospital birth. Ironically, the evidence based research of the most appropriate care for birth aligns with homebirth practices moreso than hospital births for low-risk women. Yet women are still being framed as unable to understand medical practices and then stupid and irresonsible for choosing to go against those practices. It seems that we still live in a world of "doctor knows best."

Rixa of Stand and Deliver also gave a talk discussing Risk, Responsibility and Safety at the 2008 Trust Birth Conference.