MAYD to Birth: At Your Doorstep

Promoting gentle, empowering mother journies…

Katherine

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Misty, age 32 

 When I found out I was pregnant with Katherine I knew that I was going to have a natural birth no matter what. My first three babies were all born with the assistance of an epidural. I felt so strongly that I needed to do this without pain relief and began searching for the method right for me. I decided to use the Bradley method because it encouraged my husband to be my partner and coach in the process. I also loved how simply it explained childbirth and relaxation techniques. Because I live in a small town I had no access to assistance from a midwife or way to take natural childbirth education classes in this method so I ordered Natural Childbirth The Bradley Way book from amazon.com and my husband became my coach. 

We prepared well together. We practiced all the exercises and I learned to relax my entire body. Learning to relax has always been difficult for me and following their methods helped me in many ways during the 9 months of Labor. Especially in my ablility to sleep at night. Out of 4 pregnancies this was the only one that I was able to sleep comfortably up until the day I had the baby. 

 So…on with the birthing story… Before the labor began I preregistered at the hospital. I sent in a note with my paperwork stating that I did not under any circumstance want an epidural. I didn’t want to meet with an anesthesiologist, I didn’t want the nurse to tell me it was time for an epidural. I just wanted no talk of one in my room. They were amazing nurses and no one brought it up…not once. They were very supportive. Excluding the fact that I have been contracting for weeks and quite ill for the last week of my pregnancy this was the easiest labor and delivery I have ever had. My husband and I spent most of the labor joking and talking. It was actually a relaxing experience and I never would have thought I could say that. My first 3 experiences with childbirth where extremely long and painful deliveries! I just needed to learn to relax. 

 After contracting all night on Wednesday, all day on Thursday, and into Friday morning I called Labor and Delivery because I was experiencing quite a bit of bloody show with the contractions. The contractions were very strong but I was able to relax through them. After visiting with them for a few minutes they asked me to come and be checked. I was actually upset they wanted to see me. My contractions were tapering off. They were only coming about every 5 minutes and the intensity was not as strong as I thought they should be. I went in and found I was dilated to a 4-5. That was shocking to me! I am usually admitted at a 2 or 3 and in so much pain I am begging for an epidural. Labor and delivery decided to observe me for an hour. I was upset because I only had about 10 contractions that hour and they were wimpy. But I kept walking around, squatting, etc. and resigned myself to the fact they would send me home until the contractions came closer together. I was emotional and crying a bit because I wanted to have my baby. The doctor came and checked me and informed me that I was a 7. I couldn’t believe it. The contractions weren’t painful enough in my mind! Actually they weren’t consistent, hard, long or following any pattern…but they were working and I was relaxing through them as I should. My husband and I frequently joke that I relaxed the contractions away. I probably did! 

I was finally admitted at 6:00 am on Friday morning. With a smile on my face I began the work I prepared myself for bringing my baby into the world! I took a picture of myself at a 7 and sent it to my mom. I remember just thinking over and over “See me! Smiling! Happy! Almost done! What the heck?” I had a really good labor coach (my sweet husband) and apparently The Bradly Method really works… The scary part of the labor was ahead for me! It took me 4 hours to contract to a 9 and after another 3 hours I was still at a 9. It had been too easy. My really nice contractions were not quite enough to get the baby out so they gave me a very little bit of pitocinn. I didn’t like that at all but I knew if the baby was going to come out I needed some help with the contractions. They also broke my water at that time and the pressure was so intense and the urge to push just overwhelmed me. (I wouldn’t let them break my water earlier because I knew it would make the contractions much more difficult) The doctor quickly came in to check and they discovered why I wasn’t progressing to a ten. The baby was turned face up…so the doc got to put his hand inside and turned her around. The moment he put his hand in to turn the baby I thought I was going to maybe die and the tears and nausea began to flow. It took a few contractions for me to recover from that before I could focus and push. For the next half hour the pain was intense. Yet it was amazing to be able to feel the baby as it was time to push. It was also great that I was able to run my own show. I had studied so well I knew exactly what my body needed and what was going on. It was invigorating. 

From this point on Relaxing was getting more difficult and My husband said that I kept sobbing that I should have got an epidural over and over. He kept responding sweetly that all I needed to do was give it a good push and our little baby would be here. He was right and after I finally convinced myself to push really hard little Katherine began her final descent. . A few pushes later and she was out. Beautiful little thing. I sure am happy I didn’t give up and that my husband helped me stay strong to the end and not have any pain medication. I kept my eyes shut the entire time I was pushing and when they placed her on me I finally cracked them to see my beautiful baby was a girl. That was a pleasant surprise! With no epidural recovery was fast…with all the labor practice and preparation there was no tearing. (This was a first for me!) I didn’t even swell after birth. I was a little shaky but I could walk around the room, go to the bathroom on my own and best of all I could take care of my baby without being stuck to the bed. With the best labor coach in the world there were no tears or stress and he even helped me through the last hour with all one could wish for in a husband/coach. The nurses were so supportive of me having a natural birth! They joke about how some women can just come to the hospital and give a baby as if there was nothing to it. Apparently that is me. Good thing they didn’t witness the other three long painful labors I have had. I like the reputation I have here. 

1. When did you decide you wanted to deliver your baby naturally? As soon as I found out I was pregnant with #4 I told my husband we were going to have her natural. It just needed to be that way. 

2. What reasons or factors went into your decision?After having 3 births with epidurals I just knew I had to do it. I had some odd things happen with the last two epidurals and I didn’t want to worry about those with this delivery. Plus I wanted to prove to myself that I could master the pain and bring my baby into the world naturally. I wanted to understand how my body worked and see for myself what an amazing experience natural childbirth was. 

 3. What did you do to prepare for natural childbirth? (midwife, classes, methods, books, etc.) I wanted to have a midwife when I decided to go natural but I moved to a small town where they didn’t have midwifes or classes. I did contact an instructor for The Bradley Method via email and she answered my questions. My husband and I read, studied and practiced the exercises in the book entitled Natural Childbirth The Bradley Way. 

 4. What was the hardest part of your experience – before, during, or after childbirth?The hardest part was the last 30 minutes. The contractions were intense and I was terrified of feeling the pain of actually giving birth. 

 5. What was most helpful to you during labor to help make pain from contractions manageable? Breathing, relaxing, having my husband by my side reminding me of how to relax and let the contractions do their work. 

 6. What do you wish you would have known going into delivery? This time was number 4 so I was really prepared. When I had number 1 wish I would have known how to relax fully and let my body do the work. It made all the difference! 

7. Is there anything you would have done differently?Nothing…except I wish I hadn’t cried for an epidural at the end. I didn’t get one…but I wish I would have stayed a little tougher. 

 8. What did you feel were the positive benefits to your natural childbirth – were the benefits what you expected? It was empowering to feel the process that my body went through to bring Katherine into the world. The benefits were above and beyond what I would have expected. It was educational, wonderful, exciting. I just absolutely LOVED it! I loved that all the work I did educating myself and preparing myself really paid off this time. 

 9. Is natural childbirth something you recommend to other mothers, or something you’d do again?I think so. I realize that every delivery is different. I felt very empowered this time and happier than I have ever felt before at the end of a birth. But it took a lot of studying, practicing and emotional preparation to get to that point for me. I think you have to be really strong and really determined to make it work. If you aren’t willing to work for it then it isn’t going to be successful! 

10. What advice do you have for other mothers interested in natural childbirth?Read everything there is on the internet about natural childbirth. Watch movies of other natural deliveries. Be prepared. Find a method that works for you and stick to it. The Bradley Method worked for me…if it doesn’t work for you for you find something that does and stick to it. Relaxation is the key. When you are relaxed your body just does the work for you

A cutting comic

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One of my favourite comedians is Dara O’Briain. I love his forthright take on issues and his ability to spin off on a fantasy tangent, so imagine my joy when I was watching recently and he began talking about antenatal classes, both NCT and NHS. My ears perked up in rediness for some insightful side-swipes at the presentations he had sat through. It started well, the tone of voice we (some of us) use and the way midwives voice their opinions about doctors being over involved (true). It was during this second observation that my ears pricked up and I started shouting at the TV, something that only usually happens during One Born Every Minute. Mr O’Briain began talking about how the facilitator of the class exhorted the attendees not to let ‘the doctor near them with a knife’, it may have been scissors, or it may have been to cut them, but basically ‘Don’t let a doctor do an episiotomy’. The person went on to say that it was better to tear rather than to be cut, and it was this aspect which Dara went on to disect, using the fact that his wife is a surgeon to support his jocular comments which were ridiculing this attitude.

Tears versus cuts. Research has shown that the use of episiotomy should be restricted, for various reasons, but the one I shall highlight here is healing. As the person presenting Mr and Mrs O’Briain’s classes said, ‘a tear generally heals better than a cut’, this is especially true with muscle. During a caesarean section the surgeons tear the muscle. Why do they perpetrate this violence? If you tear a muscle it generally separates in the direction of the fibres, the fibres can then knit together better following surgery. Move from the abdomen to the perineum and the same logic must apply, with an episiotomy you just cut in a straight line, with a tear it is more likely to follow the fibres, therefore the chances are that it will heal quicker and with less pain. My final thought on this is that an episiotomy ‘may produce a larger wound to heal than would have been produced without intervention‘.

Less pain, better healing and a smaller wound? I know which option I would choose.

That’ll be $120. Merry Christmas!

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Remember last year when I told you we had a minor health scare with Aminah? It basically amounted to a visit to a pediatric nephrologist and two ultrasounds to make sure her kidneys were functioning properly. She was born with a small skin tag on her ear, and since ears and kidneys develop at the same time in utero, her pediatrician suggested we get her kidneys checked out just to make sure everything was working as it should be.

Our pediatrician referred us to a pediatric nephrologist who is one of the best in the business. We are lucky to live near an amazing pediatric hospital that is world renowned and this guy is not only the medical director of the pediatric nephrology program, he also teaches at a top tier university medical school.

Of course after the ultrasounds bills starting trickling in. We quickly met our deductible for the year, even though Aminah was born in October. I never did receive a bill from the nephrologist and at some point I forgot all about it. Until today when the statement showed up.

My portion of the bill for one office visit with this guy? $120. His original bill to my insurance for a new patient visit? $750.


Now, I know I am lucky to have decent insurance and the means to pay this bill. I am not in love with the timing (a full YEAR after the fact), especially because we just splurged on a trip to Disney for Miles’ 5th birthday. But you know, I’ll figure it out. It will get paid. At the end of the day it is a small price to pay for the reassurance that my baby is perfectly healthy. We are lucky that she didn’t need follow-up care. And I know it.

I just still can’t believe the healthcare system we have in this country and that we all put up with it. The day I took Aminah for this visit, the office was crawling with kids, from newborns like my daughter, to tweens. Some of them had obviously been coming there for a long time and knew the office staff well. That was so heartbreaking. What kind of bills do those parents get in the mail every month? Can they pay them? What other bills do they put to the side in order to pay the doctors who are keeping their kids alive?

I’m sure you all have your own health insurance woes and horror stories, which you can feel free to spill in the comments section. I hope that none of you are surprised with any huge healthcare bills any time soon. Happy holidays!

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Christmas Stock Up!

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This post is sponsored by The Children’s Place.




Every year before the holidays I head to The Children’s Place to stock up. I get a cute Christmas outfit for the kids to wear to church and scoop up all of the discounted tees, pajamas and shorts that I can. This year TCP had the most gorgeous blues and teals and so I decided to get some matching outfits for the kids. For Miles, a blue V-neck sweater, a woven plaid long-sleeved shirt and a new pair of jeans. He got to pick one licensed Tee and chose Sonic.

For Aminah, I went with a cute tiered dress, leggings and some sparkly flats. The leggings were a steal and I stocked up here, getting different colors and styles.

 
I found this adorable faux fur shrug on deep discount for $3.99! There were only two left so I was thrilled to find it in her size.

I also loaded up on tunic dresses which were marked down to $7.99 each. These are perfect for daycare paired with ruched leggings. Thankfully it’s not too cold here in the winter, but I did pick out fleece jackets for each kiddo, plus an adorable knit hat for the baby. $4.99 for this fantastic cat hat (and there are tons online! Get some now!)
If you still need to pick up some winter clothes, you can shop online and save an additional 30% with coupon code E4K3012 until December 24! Happy shopping!

A non-violent world

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If we hope to create 
a non-violent world 
where respect and kindness
replace fear and hatred…
We must begin with
how we treat each other
at the beginning of life
For that is where
our deepest patterns are set
From these roots
grow fear and alienation…
or love and trust
– Suzanne Arms
Birth is empowering!

Lazyitis

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Nearly every night I think ‘I must blog’, and every night I get carried away with something else. Tonight I shall put fingers to keyboard though, after all  I started blogging to maintain an on-line diary, to recount my journey into Grandparenthood. I was amazed when I started receiving comments, I was amazed but I was also gratified. I used to blog freely about my family, but I drew my horns in when a reader took huge issue about a piece I had written and told me that she had discovered who I was and that she was going to notify my employers, and the NMC about my Blog. I was horrified. I was fairly sure that the NMC would not have complaint with me, after all I didn’t break confidentiality or bring the profession into disrepute  however, once my anonymity was compromised then confidentiality issues may have arisen. My employers, they may not have been too happy about my ‘musings’ as they sometimes referred to employment topics and local employment topics at that. I could have been in serious trouble. I closed down my blog for a couple of months, deleted the writing she found offensive and held my breath. Months later, when I had heard nothing, I started writing again. Momentum was suffered though and I had lost the ‘discipline’ of regular blogging. I am going to make a New Years resolution, blog at least once a week.

I’m still a midwife. Recently I received a ‘promotion’, really it is just an official recognition of a role I have been helping with for over a year, but it does give me a new job title. Over the last 18 months I have also assumed two other roles within the maternity services, one clinical and very few hours, the other non-clinical but together they take me up to full-time hours, and more. I am approaching retirement age but, due to my husbands pension having become negligible since G Brown did something, don’t know what but it made Hubby’s pension pot leak a huge amount, and my state pension age running away from me at breakneck speed, I can see that I shall have to put in the elbow grease for a few years yet. Midwives and childbirth have been much in the news over the past few months and, with Will and Kate announcing her pregnancy, I expect procreation will remain in the spotlight.

My family are all well. 16 of us now and all spending Christmas Day together. Hectic week ahead but culminating in a fabulous, chaotic, noisy but joyous celebration and, of course, Ruby’s first Christmas

Ruby Rose

Ruby Rose

What I’m Reading This Week

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Here’s some of the blog posts and news articles I’ve been reading and thinking about this week. Feel free to link me to anything you’ve loved as well!


Why do black moms die more often in childbirth? From Women’s eNews:
(WOMENSENEWS)–It’s been called a conundrum. A mystery. A disgrace. A national crisis. But when you ask why black women in the United States die from complications of pregnancy and childbirth at three to four times the rate of other ethnic/racial groups, the answer is usually the same: “We simply don’t know.




How much milk should you expect to pump? From Nancy Morhbacher at Breastfeeding Reporter:
Do you ever second-guess your milk production after pumping? Do you compare it with the volume of milk your friend or neighbor pumps? Do you compare it with the milk you pumped for a previous baby? Before you start to worry, you first need to know how much pumped milk is average. Many mothers discover—to their surprise—that when they compare their own pumping experience with the norm, they’re doing just fine. Take a deep breath and read on.




36 Black-Owned Etsy Stores from Huffington Post:
OK so Black Friday is way past over, but you may still need to do some holiday shopping for your loved ones. Here’s a great list of black-owned Etsy shops you can support. Most are women, many are moms. I love the cute stuff in IkdKids’ shop, including a sling for your little girl to wear her dolls in. Lots more links in the comments, as well as on this post, 800+ Creative Black Women You Can Support.




Going for a Non-Stress Test/Biophysical Profile from Navelgazing Midwife:
This is a fantastic post on how to level the playing field if your pregnancy is going past dates or if there are any concerns about the baby and your OB or midwife requires you to get an NST and biophysical profile ultrasound. As Barbara states, When going for an NST/BPP, a little preparation can help you make sure you are hydrated and the baby will be as active as possible before being hooked up to the monitors. This is not to fool the doctor, but to set yourself up for success. If, after following this regimen, the baby or amniotic fluid still shows there is something amiss, you will know you did your part to make sure both were as normal as possible. “


Rethinking Pelvic Typologies and the Human Birth Mechanism from Current Anthropology (2003):
A conversation popped up in my Twitter timeline on whether or not freebirthing (or unassisted childbirth or UC) was smart or asinine. I’ll admit I am pretty much against UC, but I understand why some women do it. For many, there really is no “choice” involved. If you’ve had a C-section and live in a state that outlaws midwives from caring for you and prevents you from using a birth center, you are typically forced to have another C-section because the number of OBs who will consider VBAC is so low. From what I am hearing and reading this is changing slowly, but many mothers live in places where they have few options. I remembered that I had read an article that explained why humans need help during birth and why, unlike our mammalian cousins, we don’t birth solo. Fascinating read if you’ve got the time and are interested (hat tip to Sol for finding the link!)


What have you been reading this week?

Hypnobabies home waterbirth 2012

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Video of a home waterbirth using Hypnobabies tools.

Lydia’s Birth Story

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Congratulations to Divia and Will on the amazing birth of their daughter, Lydia Eden.
Divia has shared her story with us here.

Birth is empowering!

If Mama Ain’t Happy, Ain’t Nobody Happy

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A local mom recently posted an article on taking antidepressants while pregnant.  I imagine most people in our area will read that article and conclude, well of course it should be the mom's decision!  I can't help but wonder, if the topic of conversation changed from antidepressants to home birth, would readers be as adamant about supporting mom's ability to make decisions that SHE believes will optimize her and ultimately her baby's health?  Is the decision to birth at home much different from a mom's decision to take an antidepressant during pregnancy?  In both cases she is doing what she feels is best for her body and her baby and, ideally, she is balancing psychological and physical benefits.

The author, Jennifer Kogan, points out that "A recent study in the scientific journal Human Reproduction claims that there are risks — and no clear benefits — associated with taking certain antidepressants during pregnancy" and then goes on to discuss the problems associated with this claim.  Interestingly enough, as with home birth, the lack of good evidence is connected to the lack of randomized controlled studies.1   As with the home birth debate, there is a tendency to focus on physical risks while ignoring psychological ones and for the media to use fear-based headlines.2

Let's take a quick look at psychological related morbitidy in childbirth.  I am currently reading Optimal Care in Childbirth by Henci Goer and Amy Romano (c 2012) so I am going to refer to this book (fabulous book by the way!).   In their chapter, "If Mama Ain't Happy, Ain't Nobody Happy," Goer and Romano point out that in fact:

childbirth-related psychological morbidity may be a more significant public health problem than childbirth-related physical morbidity.  While women and babies heal completely from most forms of physical morbidity, psychological morbidity can have a prolonged effect on the individual woman, her infant and other children, her partner and her community.  It can even lead to mortality: suicide is one of the leading causes of maternal death (emphasis mine)" (Optimal Care in Childbirth by Henci Goer and Amy Romano, p 531).                

     In our culture we tend to focus on childbirth-related physical morbidity when we look at risk. Goer and Romano, however, reminded me that a large percent of moms in the Listening to Mothers II Postpartum Survey reported that their emotional wellbeing interfered with their ability to care for their babies and 5% of mothers had considered suicide.  Wow. The research shows that "lack or loss of control is an independent risk factor for both dissatisfaction and, more importantly, symptoms of childbirth-related posttraumatic stress, a condition present in up to 9% of women having hospital births in the U.S."  (Opitmal Care p 503).    In other words the homebirth mom (and the mom on anti-depressants) understands deeply what she needs to be a successful parent, and makes her choice of birth place (or the choice to take antidepresants) based on this knowledge.  In fact Goer and Romano point out that women choose home birth do so, among other reasons, because they "recognize that having control… over the birth environment and the ultimate say in decisions about care contribute to long-term emotional health and preparedness for parenthood (emphasis mine)" (Optimal Care p. 503).

I remember being frustrated after reading a commentary on home birth written by Monica Sakala, another local mom.  Commenting on parents who decided to birth a breech baby at home, Monica writes,  "Why aren’t they being held accountable by the courts?"  If a mom took antidepressants during her pregnancy and her baby died from persistant pulmary hypertension (rare but associated with antidepressant use and fatal in approximately 10% of cases), would Monica wish to hold those parents accountable as well?

When it comes to birth, absolutely we need to improve our maternal health system so that physiological birth (and vaginal breech birth) is an option in US hospitals (that is a whole other topic of conversation). But we also have to understand that some women will do the research and soul searching, and come to the conclusion that the needs of their journey to motherhood are best met at home, even in cases where there might be a slightly elevated risk (this risk is not eliminated by hospital birth). We have to have faith that as a rule, a mom ultimately understands what is best for her and her baby. For some, this will mean taking anti-depressants while pregnant.  For others, this will mean a vaginal birth after cesarean (or a breech) birth at home.

 

1 Reading Beyond the Headlines: A Closer Look at the Study on Taking Antidepressants During Pregnancy, posted 11/05/12 on the Lamaze Blog, http://givingbirthwithconfidence.org/2012/11/reading-beyond-the-headlines-a-closer-look-at-the-study-on-antidepressants-during-pregnancy/. 

2 Ibid See reference to Study on Antidepressants and media hype