What does birth mean to me?

We are celebrating the birthday of my first child. It was three years ago today that I became a mother. Three years ago, I fought for an unmedicated, vaginal birth. Three years ago, that I breastfed for the first time. Why then am I still writing and talking about birth?

There is something profoundly special about birth and in recent months there has been alot of talk about what that something is. Rixa clued me this discussion with her post "Thinking No Conclusions Yet". I was also inspired by this post by Keyboard Revolutionary and how she describes how birth impacted her as a maturing, developing individual and mother.

I originally wrote the following statement about birth in April of 2009 when I was 8 months pregnant with my little girl. The top paragraph is a statement of what I believe about birth followed by the logical implications I could think of as well as explanation for why I believe my statements to be true. This post is an exercise for me to see if my thoughts have changed in anyway now that I've given birth a second time and grown in my logic, knowledge and though processes regarding the life event.

Birth is a normal process in a woman's life much like the menstrual cycle. Typically, in the majority of cases, it is a process that women can handle on their own without medical assistance. Sometimes the process goes outside the normal range so its a very good thing that traditional and medical knowledge and intervention is available for consultation and judicious use. Menstruation, like birth, can be a painful (intensely painful) experience for some, even most experience pain in relation to that womanly process. Therefore it is perfectly reasonable for women to seek out ways to minimize that pain.

What are some of the implications of this belief?:
1) Drs, hospitals and midwives are not necessary in most cases for birth. It would be like going to a hospital when menstruation starts and staying for the duration of the bleeding cycle while efforts are made to speed the shedding of the uterine lining, reduce pain and discomfort and prevent excessive bleeding.

2) Sometimes consultation is needed when something is varying widely from normal and its a good thing that those experts and facilities exist.

3) Those facilities and trained experts need to exist, know the role they are intended to play and use practices that are based in logic, evidence, safety and effectiveness with minimum intervention. I cannot say that I believe that current obstetric and even midwifery practices support this.

4) I'm not going to begrudge anyone who seeks to find pain relief for either womanly process, but I will point out that the big guns of anesthesia are not typically warranted for pain associated with such a normal event (and I'm going to say it) everyday event.

5) Birth is not treated like an everyday event in our world, but in many ways it is. Its a normal part of life that is filled with significance and symbolism, but its just birth like defecating is just taking a poop and menstruating is just the shedding of the uterine lining.

6) There needs to be levels of involvement based on need when something is going wrong. The first response to derivations from normal is the individual relying on knowledge sought and shared by peers and women who have taught her about the process. Self-comfort measures, then possibly herbs, then possibly stronger pain relievers, then consultation with an outside trained consultant who offers the minimum of support for a normal process. As more is needed, those services can escalate to meet the need presented before them. But prophylaxis is not really warranted. Treatment of symptoms and finding the root cause while supporting the overall process ought to be maintained as the standard of care. What this implies is that midwives need to be able to consult freely and make referrals to obstetricians without fear or reprisal. OBs need to remember their place in the process not as the director but as consultant. Women need to accept and act on the belief that help and assistance is not needed and its something that they, their bodies and their babies do as an everyday fact of life.

7) Where does trauma fall into this? When things goes serious wrong with any health related concern, the emotional trauma can be profound. Women in childbirth aren't the only ones who are traumatized by a major health crisis: cancer, injury, surgery, hemorrage all are scary because there is a threat to our sense of safety within our own bodies. Those crises are scary and its no wonder that people have long term emotional effects from those experiences. For birth, there's also another cause for trauma besides the pain, besides the fear of when things go wrong. There is what happens when people who shouldn't be meddling in a normal process get involved and screw things up. Providers don't realize the physical and emotional damage they are doing when they push for unecessary and not evidence based practices to control and process that they are afraid of. Its not something to be afraid of in most cases. Yes, sometimes it can be scary but that doesn't mean that every poop needs to be closely monitored and controlled. Doing things that don't need to be done will just make things worse.

Since experiencing Belle's birth, I have to say that the similes between birth, menstruation, and defecation hold true for me. Her birth was such a normal and as I experienced, pedestrian process that it was in some ways boring for me. It certainly doesn't make for an exciting story, there was little drama. Just an emergence and a completion for a normal bodily process.

I did fail to state in my original writing however to emphasize that birth is altogether a more physically demanding bodily process and it is a very special life event for a mother. I do not believe that it the most important events of a mother's life like Jan Tritten states, as I believe that it is overstating a simple transition from one state to another. As a mother who as been traumatized by events relating to childbirth, I know too well the long-lasting emotional effects that a mismanaged, "pushed" birth produces in a woman.

For the baby, the birth (and the manner thereof) is important bio-chemically and throughout development. This is reflected in the research suggesting that babies exposed to pain relief drugs in childbirth are more likely to become drug addicts when they become adults, as well as the research linking birth practices to autism and maladaptive attachment between parents and child. But to say that the events of childbirth are a strong predictor of child's health, well-being and capability as an adult ignores the functional adults (often the mothers who are now fighting for natural births themselves) who experienced less than ideal births when they were babies. It is safe to say that most of the adults up to at least age 70 were brought into this world not in the way that research shows as optimal for development and bonding. How one was born does not often make that child less capable of facing their life's challenges.

So if I just stated the ways that birth is not special, why is it special and what does it mean to me?

Birth is special because it was the moment I got to meet my children. The emotions, environment, thoughts and feelings of my body are still strong in my consciousness as I remember what it was like to bring them into the world and hold them in my arms for the first time. With Willem, I was frustrated with the people around me that is caused my focus to not be solely on my child and I still resent that he was born into a moment of bitterness and frustration. With Belle, the laughter and excitement of the final moments of her birth and the joy of having my husband and child look on still cause me to relive those feelings. With Willem's birth, when I relived his birth. It was in the form of flashbacks and PTSD. With Belle, I relive her birthday and I know joy.

Birth is a woman's battleground where the inherent and supremely unique strength of womanhood is exerted in its fullest. A woman each time she gives birth "walks through the valley of the shadow of death" because there is the possibility that she will die bringing life into the world. So in a sense, a woman faces death and walks away conquerer bearing new life in her arms. Its amazing! No wonder, Goddess worship is common throughout history! She faces fear and pain, discouragement, exhausted and comes out experiencing the highest high of her life (granted she's not facing the commonly disturbed birth environments of today). With both of my children, I fought to bring them into the world without experiencing things that I felt could be damaging to their health. One the fight took place while I was laboring. The other I fought and prepared and schemed before labor so the actual event of her birth could be peaceful and private.

Its because I had to fight, and that all women who are seeking a normal birth the way nature is intended are having to fight for it, that is why birth is so important to me. That its become a cause that I feel like I have something I can do to keep other women from experiencing the emotional suffering and stress that I experienced. Its a matter of right and wrong for me too. Its simply wrong for a woman to be told by authority figures that she is not capable of making decisions for herself. Its wrong that an entire system is structured in a way that many women and babies suffer unnecessary risk, damage, ill-health and distress in the name of what is culturally acceptable. Its these issues that I'm taking on and that I want to work to correct for my daughter and my sister-women so they can give birth undisturbed, in joy and have access to the help they need when it is appropriate.

What does birth mean to you?
How is it special?
In the course of life, how important is it?
How important is mode of entry (vaginal, cesarean, medicated or not)?

Revisiting Birth Plans

I'm always on the look-out for birth plans that catch my attention for using a novel technique or strategy that in some way can garner cooperation and respect from hospital workers when parents try to communicate their needs. Since there is such a disparity between practice and evidence in birth services, most of the time, women who prepare birth plans are trying to get the evidence based practices employed in their births rather than what is on the contrary typically done during hospital births.

Below is a birth plan a mother shared with me recently. The reasons I think it is worth sharing are:

• It recognizes the need for intervention in some situations and does not overinflate or minimize the risk of birth. Perhaps by framing the topic with "birth in inherently dangerous" hospital workers will be more receptive to reading the desires of these parents. While recognizing the risks and dangers, it emphasizes the fact that birth is typically normal. This balanced view, I hope, will earn the respect of birth workers.

• The parents include the reminder that they have the right to informed consent and given concessions when consent might not be able to be obtained, while at the same time remaining firm that consent is necessary.

• The father is explicitly stated as medical proxy if the mother at some point becomes unable to make decisions for herself, or even if she wishes at some point to grant the proxy to her husband verbally. This shows in a clear manner that the husband is involved and needs to be respected in the case that he states any decision.

• Hospital staff are not obligated to support the provisions listed in the birth plan, but are merely stating that they have read it. This should be less threatening than the typical birth plan which generally presents a document asking hospital workers to make some sort of commitment to upholding the provisions; something that most workers are very hesitant to do for fear of liability.

I understand that birth is inherently dangerous, and, if the situation warrants it, interventions can be good, even lifesaving, that being understood, the vast majority of births are a normal, natural process that need little more than ‘the tincture of time’ to reach a safe and healthy end.

I understand that, at any time, my written or witnessed verbal consent may be given and will override any previous non-consent or refusal. I understand that in a true emergency there may not be time to fully explain or receive consent for a life saving procedure, and I will not attempt to interfere with life saving interventions. I expect every attempt will be made to give me any information possible before, during, or immediately following any emergency situation.

My husband and I, as legal guardian and rightful biological parents of Baby (last name here) have the right to informed consent and to choose to consent or refuse any and all medical interventions or procedures given to our child, both before and after birth. I, as an adult of sound mind and legal rights, have the right to informed consent and to choose to consent or refuse any and all medical interventions or procedures to my body, before, during, and after labor. My husband is my chosen medical proxy for all medical and legal decisions should I be unable to make decisions on my own behalf.

_____________(patient/mother)

_____________(medical proxy/father)

I/We do not consent to:
Ø Artificial rupture of membranes (AROM) before full dilation and effacement
Ø Induction of labor prior to 42 weeks by any means physical or medical
Ø Augmentation of spontaneous labor by any pharmaceutical means
Ø Epidural or other pharmaceutical pain management
Ø Continuous electronic fetal monitoring (EFM)
Ø Frequent pelvic exams
Ø Episiotomy
Ø Cesarean Section
Ø Coached pushing
Ø Immediate cord clamping or cutting
Ø Formula or glucose water for infant
Ø Separation from infant
Ø Eye salve for infant
Ø Vitamin K shot for infant

I/We will:
Ø Eat and drink as my body demands during labor
Ø Labor and deliver in any position comfortable
Ø Allow intermittent fetal monitoring using a Doppler or fetoscope
Ø Allow rupture of membranes if waters have not naturally broken by full dilation and effacement to avoid a birth in the caul
Ø Allow pelvic exam at least once per four hours of labor provided consent is obtained before each exam
Ø Use water, heat, cold, massage, movement, change in position, and other non-pharmaceutical means to cope with labor pains and to help labor progress naturally
Ø Push as my body demands, making every attempt to inform provider when I am ready to start and when I am pushing

I/We expect/demand:
Ø My husband will be there for labor and birth unless life saving measures require all non-medical personnel be removed.
Ø Immediate skin to skin contact with infant unless life saving measure makes this impractical: Baby is to be taken from my womb to my stomach or chest, depending upon length of cord. Any vitals or physical check of baby can be accomplished while baby is on my chest. If cord is extremely short, too short for baby to be safely placed upon my lower abdomen, every attempt will be made to retain cord connection for at least 60 seconds before clamping and cutting.
Ø Cord will be left intact until it stops pulsing: Baby and mother are to remain connected unless life saving measure makes this impossible, many life supporting measures can be safely and readily done with cord intact, allowing baby to continue to receive oxygen and blood through the cord, which has been show to increase positive outcomes.
Ø Placenta will be allowed to birth normally: Cord traction and forced delivery of placenta has been shown to increase risk of hemorrhage, we will attempt to nurse, try nipple stimulation, and continue to push during contractions as my body indicates until placenta is delivered naturally.
Ø Baby is to remain in room: Baby will not be separated from mother/father, all vital checks, physical exams, and other medically indicated newborn procedures can be done with baby in the room, after a reasonable amount of direct skin to skin bonding we will allow baby to be weighed and, if agreed upon, washed in room by nursing staff/hospital staff as needed.
Ø To be consulted and given full information on all procedures performed on baby:

We consent to standard weight/measurements and heel prick for state mandated blood testing, however, we expect to be informed when these things or any other procedures or tests are about to be done, we may ask for a delay or more information before continuing.

Signing does not indicate personal or medical agreement, opinion, or recommendation, it indicates only that signee has read the document.

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Review of "Pregnant in America"

For Christmas, I was given a copy of Pregnant in America a documentary film that chronicles an expectant couple as they learn about the process of birth and their options as parents and consumers. Over the course of the pregnancy, they unearth the whole drama that is choosing between hospital and out of hospital birth with all the propaganda employed against parents who desire to become apart of the statistical exception.

In some ways, I liked this movie more than the Business of Being Born. I like that the film follows the journey of a family and especially enjoyed how the filmmaker connected personally to the experts that he interviewed. Robbie Davis Floyd was featured in a touching interview where she turned it around and became the interviewer anthropologist that she is. I was touched by her compassion, astuteness and understanding. Another interview that I found very compelling took place outside the FDA offices where Maddie Oden delivered a petition to stop the administering of Cytotec to pregnant women. It highlights the story of the Tatia Oden French Foundation in such a way that the issue is made clear how its misuse can harm families.

The facts and statistics presented were consistent with all that I've read and learned about birth and provides a companion film to the Business of Being Born and Orgasmic Birth.

All three are great movies to share with expectant families who may be among the uninitiated in the discrepancy between evidence and practice. In a way, I feel that Pregnant in American is more convincing on this score, showing how the choice to birth at home is a valid choice where help when needed is effective and accessible.


*Spoiler* The family chooses to transfer to the hospital after a peaceful home birth because of concern over the baby's breathing. The transfer may not have been necessary, but the parents chose to consult with experts over a valid concern. They, and the viewers, learned how a transfer can occur smoothly, without harm coming to baby or mother and that emergency care is available when needed.

The style of the documentary imitates the style of Michael Moore pretty closely. I don't have a problem with this because I had been hoping that the controversy with birth issues would be presented in the same style. In fact, if Michael Moore tackled the topic, I don't think he would have done it as well. Michael Moore enjoys being over the top and for birth, that's not necessary. The tone of Pregnant in America is sweet and endearing with just enough anger and frustration to highlight the injustice inherent in the American maternity system.

I'm hoping to host a screening of this movie soon for a Meet-up group I belong to.

Friday Fill-ins

1. You have a chance to finally get rid of some big baby toys that were rarely used
2.Eat breakfast right now!
3. There is a surprisingly fast baby and surprisingly imaginative toddler playing in my bedroom.
4.Charge it and pay later.
5. It's time to get dressed.
6. Baby up in the air but mama below catching.
7. And as for the weekend, tonight I'm looking forward to nothing in particular, tomorrow my plans include going to yoga, cleaning and playing as a family and Sunday, I want to play outside in sunshine! (Will there still be sunshine?)

Cool en utero photographs

A friend passed this link on to me showing photographs of various mammals en utero. Techinically, the shark is not a mammal or en utero, because they gestate in egg cases inside the mother and are then born live, but I only know that because my husband is in the process of becoming a shark expert.

These photos come from a National Geographic documentary viewing various gestations of animals aside from humans, for more information on it, see here.

The EC Potty Song

In what has become a series on recent silly songs, this is my show-stopper.

I have a song for Elimination Communication and use it as cue for Belle when she sits on the potty. It also incorporates the Pss sound often used for cueing.

Is there Pee in your body?
tune: There's a Song in My Tummy by Laurie Berkner

Is there pee in your body that needs to come out?
Is there pee in your body?
Is there pee in your body that needs to come out?
Is there pee in your body?
Is there pee in your body that needs to come out?
And when it does its going to go in the potty!
Pss, pss, pss, pss, pss, pss
But your pee in the potty!

Variations include:
"Put your pee in the potty"
"Is there poop in your body/put your poop in the potty"

Recent birth news

There has been a lot going on in news about birth in the last couple of weeks.

First there was the mom in Australia who had police show up at her door after she chose not to show up for the induction that her doctors scheduled her for. Her doctors decided to call the police to escort her in.

Later, the hospital issued her an apology. Ironically, they claimed that they were not trying to pressure her into an induction. Right..sending police isn't an intimidation tactic?

If The Birth Survey was available for mothers around the world to take, I'm sure Rochelle would be able to report that she did in fact feel pressure to induce from her providers.

Then there was the mom who is going to court over being court-ordered to remain on bedrest while confined in a hospital and undergo a mandatory C-section.

Both of these stories are disturbing to me because it shows the lengths that medical professionals will take to force women to act according to their recommendations.

I have been on the mothers end of disagreeing with the medical professionals I'm paying to advise me on my health. In the two cases described above I see enough evidence to know that the mothers were informed about the research and known risks of the proposed treatments and in good conscience chose what was actually more evidenced based and better for them personally. My experience fighting to prevent an induction leads me to empathize with these two women who experienced much stronger attempts to manipulate their choices and force them into things that they knew they had the right to refuse.

It may be unfair to expect, but I would not be surprised with either of these women were traumatized by these experiences where they had to fight for their bodily integrity and to make health choices for themselves; without fear of reprisal. I hope that if they are experiencing trauma, that they will find the support they need and know about Solace for Mothers as a resource for women who have been traumatized by experiences relating to childbirth.

To quote directly from an ACOG publication:

"Even if a woman's autonomous decision seems not to promote beneficence-based obligations (of the woman or the physician) to the fetus,...the obstetrician must respect the patient's autonomy, continue to care for the pregnant woman, and not intervene against the patient's wishes, regardless of the consquences."

More Silly Songs: Toddler and Early Preschool

Willem is at the age where he loves hearing songs that are song about him. There are lots of songs by many children's artists that are designed to replace children's names like Willoughby Wallaby from Raffi (which works so nicely for the name of Willem).

Here are some others that we've adapted to sing about Willem, family members and friends.

My Friends Lie Over the Ocean
tune: My Bonny Lies Over the Ocean
This one is pretty simple you insert other peoples names in the place of "Bonny." This was in someways therapeutic for Willem when we were separated from our friends and home over the summer. He really enjoyed being able to remember the friends he had back home and sing about them. He was so happy to see them again when we got home.

C is for Cookie or ___ is for ______
This one we got from a youtube video of Cookie Monster from Sesame Street. Willem knows and recognizes the letter C and that Cookie starts with the letter C!
Here's the video:


We have adapted it for Willem and Belle's names and for that reason he knows and recognizes the Letters W and B.

Here's how our version goes:

W is for Willem
He is my little boy
W is for Willem
He is my little boy
W is for Willem
He is my little boy
Oh, W W W is for Willem!
Willem, Willem Willem starts with W!

or

B is for Belle
She is my little girl
B is for Belle
She is my little girl
B is for Belle,
She is my little girl
Oh, B B B is for Belle!
Belle, Belle, Belle starts with B!

You get the idea. We also sing C is for Carolyn since that is Belle's first name.

More Silly Songs: For infancy

With WIllem, I've had a lot of fun using the melodies of songs that I know and changing the words to include themes from our day to day life, or names of people we know. To see some of them that I came up with when Willem was younger, search "silly songs" on my blog and you'll find other examples.

When Belle was born, I felt like I needed some that were more specific for non-mobile infants and the following are what I came up with.

Rock and Roll (the baby!)
tune: Raffi's Shake the Sillies Out

You gotta rock, rock, rock until you roll
Rock, rock, rock until you roll,
Rock, rock rock until you roll
Rock till you roll all the way over!

I sang this while rocking Belle's body from side to side and then at the end rolling her over unto her stomach. She thought this was great fun and then enjoyed being able hold her arms out to prevent me from rolling her over (and who says babies don't have other ways than crying to communicate!) Of course, Willem wanted to join in on this game so I'd take turns. First with the baby, and then with the 2 yr old!

Tickle Tickle
tune: Alouette

Tickle, tickle, tickle tickle tickle
tickle tickle tickle tickle tick
Tickle all the way up to the neck
Tickle all the way down to the hips
Tickle up here,
Tickle down there
Tickle Tickle

As suggested by the lyrics, I tickle all over and then specific parts. My favorite is tickling the feet on "tickle down there" and making sure I sing with a deep voice as I do so.

Intervals at 6-7 months

ECing with intervals is a way to understanding the frequency in which a baby pees. Sometimes, they don't communicate with a fuss or a squirm or the blank look or whatever, or mom/dad misses the cue. When Belle is busy playing, she will often not given an indication that she needs to pee, but I can use another clue to know that its time to put her on the potty.

I can know when she peed the last time.

Between 4-5 months, she was peeing every 20 minutes. I figured this out using an iPhone ap where I can record pees and poops and their times. Its designed for diapers but I use it instead to track eliminations, wherever they occur, in the potty or otherwise.

Around 6 months, the interval switched to every 40-45 minutes. Now I find that I need reminders or I get distracted or engaged in something else and I miss it. Using my iPod Touch, I set a timer to go off. This has been helping.

Its been fun choosing the timer sounds too, right now we've using the old car sound-- a horn that sounds like like "Oh-oooo-gah!" Sounds perfect for a poop sound!