Blessings of Homebirth

"Knowing comes from the place within us that is connected to our source." From A Still, Small Voice by Echo L. Bodine

A month before the due date of my second pregnancy, I had a dream that there were two little girls with pigtails in their hair joining our family. When I told my husband about my dream, he joked, "there had better be only one baby in there. We only have one more bedroom!"

We were planning a homebirth for this pregnancy. Our son had been born at home without complications. In fact, his birth had gone so quickly, that we had barely enough time to fill the birth tub before he emerged. This time, my husband planned to fill the birth tub right away at the start of contractions.

My second pregnancy was "normal" as far as anyone could tell. I had regular prenatal care with my midwife and our family practitioner. Both felt I was a fine candidate for a second home birth, and that ultrasound wasn’t necessary for me. I measured a little big, but that had been the case with my son as well. Several people joked to me about possibly carrying twins, yet when my practitioners checked me, they both only heard one heartbeat. As part of our preparation for birth, we reviewed the "Emergency Childbirth" pamphlet from our midwife, and consciously visualized a positive birth outcome.

A week before my due date, my husband and son set up the rented birth tub in our home. When I saw the tub sitting there ready to go, I felt a spasm of fear for what was to come. My husband held me as I cried out my fears, and as the tears subsided, the fear was still real to me, but from the bottom of my heart I knew that everything would turn out alright.

Early on the morning of my due date, I woke my husband, David, to tell him that contractions had begun. He immediately called my mom and the midwife, and started to fill the birth tub. After a few contractions I needed David to put pressure on my low back. Between contractions he opened our birth kit, adjusted the faucet temperature, and gave me sips of water. As soon as the tub was deep enough I climbed in. It was much easier to handle the contractions in the water.

Nevertheless, I suddenly needed to roar through the contractions. I made deep, low moaning noises. I started crying. I knew I was in transition from the emotions that were flowing. I felt like pushing, and started to blow air through my mouth to hold back until the midwife could arrive. I needed to squat. I panted, blew air, and then started pushing because there was no way not to push. David briefly wondered where the midwife was. After a couple of pushes the baby came out all at once. We gently lifted her up out of the water and held her close. While we tried to start nursing I felt strong contractions resume, and again experienced the urge to push. I reached down and felt a second head with my fingertips.

Now, instinctively, I knew it was a second baby, and my body knew exactly what to do, though this certainly wasn't planned! I softly cradled Baby 1, as I squatted and pushed. It was easier this time, and after two pushes Baby 2 shot out into the water. Her head was covered with the sac. David removed the membranes and lifted her to my other breast.

The babies were slippery, and my arms were coated with vernix. As Baby 2 latched on to nurse, finally both the midwife and my mom arrived at the same time. We were all in a state of shock and disbelief. My midwife consulted the clock and realized that my labor had lasted less than 50 minutes. We weighed the babies: 5 lbs. and 5 lbs. 12 oz. The placenta weighed 8 ½ pounds!

While I dozed in bed with the babies, I remembered the dream about the two little girls with pigtails in their hair. I realized then, that deep down, on some level, I had known all along that I had been carrying twins. The pieces fell into place as I relived my pregnancy with this new information. No wonder I had felt so tired!

My family was incredulous. Each visitor who stopped by with good wishes needed to see both of the babies to believe that there really were two of them. Every time I looked at the twins I was full of wonder. Most of all I was euphoric: I had handled the birth by myself, twins or not, and it had gone beautifully. Everything had turned out just fine.

Over time, I have realized, with much gratitude, how we had been living in a protected space during the twins' pregnancy and birth. I believed my care providers who told me that I was carrying a singleton. I trusted in my strength as a woman to give birth, and I trusted my body to tell me what I needed to know, and to do what needed to be done. In not noticing the signs that I was carrying twins, I was able to view my pregnancy as completely normal. And I was free of the interventions that are standard in multiple pregnancies and births today, such as bed rest, fetal testing, continuous monitoring, and obligatory c-sections.

Now that my twins are four, I find I am still processing their birth mentally, emotionally and spiritually. As the haze of hormones has lifted, I see that their birth was a blessing on many levels.

I feel blessed to have been held in a bubble of safety, in not being conscious of the fact that I was carrying twins. I feel so fortunate to have been surrounded by care providers who believed in me and in the birth process. And I feel privileged to have experienced my own power during unassisted homebirth. I believe that things happen for a reason, and I attribute this experience to the work of the Divine.

The birth process taught me that I have inner wisdom and my twins' births gave me further impetus to explore my intuition. After the birth of my twins I had an awakening of the soul. I came to respect the power of my intuition, and have since decided to use it and cultivate it more. This "knowing", which Echo Bodine talks about in her book A Still, Small Voice, has connected me to my calling: planning and facilitating gatherings of women and girls to honor life's passages as sacred. My intuition told me that women's life passages, like pregnancy, birth, coming of age, and loss, need to be honored and celebrated.

The legacy of my twins' births is my conviction to tell this birth story again and again. Not only because I am an example of uncomplicated, unassisted homebirth of unexpected twins, but also because by sharing my story, I honor this passage and my body's message to me. And these are some of the many blessings of homebirth.

Growing Number of Women Want Birth to Be a Natural Process, Not a Medical One

By SUSAN DONALDSON JAMES

July 28, 2008 —

Pregnant with her first child, Julie Speier prepared to deliver with the help of a midwife at a New York City birthing center. But in June -- three weeks before the due date and 600 miles from home -- her water broke.

Speier gave birth at a Cincinnati hospital, where she and her fiancé tried desperately to keep the birth natural -- a vaginal delivery without pain medication.

"I believe in the power of nature and that creation is next to perfect," said Speier, a 34-year-old yoga teacher. "I knew what I wanted and I had the confidence."

But as labor pains increased and Speier asked about breathing techniques, the doctor replied, "How do I know? I've only ever done two [natural childbirths]."

Today, natural childbirth is a medical anomaly in the United States, so much so that doctors are often thrown off guard by a determined woman like Speier.

A small but growing number of women who seek to avoid aggressive medical techniques like induced labor, epidural blocks and Caesarean sections find they are a lone voice among their friends and doctors.

"All of my friends think I am a little nuts," Speier said. "They say why would you do it natural?"

Speier said her own mother told her traumatic stories of her brother's breech birth. "Everyone I know has an 'I can top you' gory birthing story."

Pre-planned Caesareans are also in vogue. Women want to avoid future complications of multiple vaginal births, like uterine or bladder collapse. And today's body-conscious women worry needlessly about loss of muscle-tone.

'Too Posh to Push'

With the latest feminine plastic surgery rage -- so-called "pimping the vadge" -- some women prefer what the British call the "Posh push," referring to the planned Caesarean births of soccer celebrity David and Victoria Beckham's three boys.

Like the generation that pioneered the first wave of feminism in the 1970s, women like Speier want to take an active role in their health care. They view childbirth a normal, healthy process that requires time, patience, strength and endurance.

But in the decades since, new technologies, the rising cost of malpractice insurance and even the changing attitudes of women have all contributed to the near-demise of natural childbirth.

"It's a little tsunami," said Dr. Ben Sachs, chief of obstetrics at Tulane University in Louisiana. "All these forces are coming together at the same time."

Both doctors and midwives have been hit hard with the high cost of liability insurance. All agree they must take on more patients to keep their practices lucrative, giving them less time to wait out a long labor.

Doctors more frequently induce labor, using synthetic hormones like pitocin to strengthen and quicken labor, an intervention that was once used only as a "last resort."

But induction also heightens the pain of labor and can precipitate the use an epidural -- an injection in the lower back that blocks the pain of contractions while the woman is awake. And some say that, in turn, can delay the pushing mechanism and even trigger the need for a Caesarean.

Induction rates rose 5 percent in 2005 to 22.3 percent of all births -- double the rate since 1990, according to the National Center for Health Statistics. Caesarean deliveries have also jumped -- to more than 30 percent of all births, a 46 percent rise in the last decade and a 4 percent increase over the 2004 record.

Hospital Costs Spiraling

So, too, have hospital costs spiraled, and doctors say the first cuts are in obstetrical care. Hospitals in many parts of the country can now be sued for malpractice, further eroding support for what is perceived as the economic risk of natural childbirth.

"Childbirth doesn't get the attention and respect it should," Sachs told ABCNews.com.

But he said it isn't only doctors driving the medicalization of pregnancy, but women themselves.

Many women are having their babies older, necessitating more Caesarean sections for high-risk pregnancies. Younger women who fear the pain or the cosmetic consequences of a vaginal birth pre-plan a Caesarean with their doctor's blessing.

"The question is, has it done harm to women or the experience of childbirth?" Sachs asked. "Positive things are coming out of this. There is a concentration on patient safety and reducing medical errors."

But a national survey by Childbirth Connection found just one incidence in 1,600 of a planned c-section, for no underlying medical reason. The non-profit also said the rate of Caesareans is going up in all groups of birthing women.

"The American healthcare system is increasingly dependent upon medical interventions to address what is, most often, a normal and safe physiological process," said Rebecca Benghiat, executive director of the New Space for Women's Health in New York City, where the Caesarean rate has just hit 31 percent of all births.

"Quite often, women are not fully informed of the risks associated with commonly performed obstetrical interventions, nor do they know there are options beyond hospital birth," she said.

But, childbirth advocates say that for women with uncomplicated and low-risk pregnancies, a natural birth can be safe.

"This is a big mess and no one is sure how we got there," said Erica Lyon, director of the education center RealBirth in New York City and author of the "The Big Book of Birth."

"We had a wonderful movement in the 1970s when women wanted to take control of their bodies," she told ABCNews.com "When we got to the eighties, we assumed it was fixed. But it wasn't."

Today, about 95 percent of all births occur in hospitals, 3 percent in birthing centers and only 1 percent at home, according to the National Center for Health Statistics. About 6 percent of all births are attended by midwives, but those numbers are dropping as their liability insurance rises.

Natural childbirth experts say they have seen a modest increase in interest in natural childbirth following a recent film by actress Ricki Lake, who gave birth at home with the help of a midwife.

Lyon charges that hospitals have "no standards of practice," bowing to the demands of overburdened doctors and women who don't understand the benefits of natural childbirth -- quicker recovery time, better baby bonding and more successful breastfeeding.

"It's good technology, but we do it over-aggressively," she said. "What we tend to do is treat it as an absolute rather than with a tiny bit of healthy skepticism."

But natural "means different things to different people," according to Dr. Lauren Streicher, an obstetrician gynecologist at Northwestern Memorial Hospital in Chicago, who said current medical practices are safe and what women want.

'Go Ahead and Medicalize It'

"Most women say go ahead and medicalize it," she told ABCNews.com. "Low-intervention birth is on the decline because people are no longer interested. They say, 'I want an epidural and a C-section is fine for me.'"

Streicher opted for "zero pain" in her own pregnancy and planned to get an epidural even before her first contraction. But when her water broke weeks early, her anesthesiologist was on a ski holiday and her obstetrician was having a hysterectomy.

"I didn't panic," she said. "I had three or four very painful contractions, but after that it was a very lovely, easy labor and I pushed her [daughter] out."

She also agrees with women who say "there's no shame in doing a C-section."

But Dr. Louis Weinstein, chair of the obstetrics and gynecology department at Thomas Jefferson University, points out that although the mortality rate is "very low," a Caesarean is 6 to 20 times more dangerous than a vaginal delivery.

Though he will agree to an elective Caesaean, he makes sure the woman is informed and understands all the risks.

Weinstein also warned of the misuse of induction hormones, which he says studies show are the second most common source of medical errors.

Still, he said the use of epidurals, which carries its own risks, is safe when properly administered. "With all due respect, labor is uncomfortable and the reason someone coined it is you are working your rear end off," he told ABCNews.com. "Labor is very, very uncomfortable."

"I believe in choice, but this is a women's issue," Weinstein said. "We get more nasty letters that we didn't have time to put in the epidural."

But midwives say women are not encouraged by their doctors to explore alternatives such as birthing centers, where low-risk women can give deliver naturally, balancing technology with a home-like environment. There, no pain medication in administered, but women receive the support of a trained midwife and an assistant, who work with doctors to ensure safety. A warm and intimate environment -- and sometimes hot tubs and whirlpools -- provide a soothing atmosphere to experience the birth naturally.

"Most women don't know about their choices," said Asya Portnaya, 29, and a certified midwife from the Brooklyn Birthing Center in New York. "They are only aware of a hospital birth and just go as the doctor tells them to."

Midwives Show Lower Caesarean Rate

According to the Public Citizen Health Research Group, certified nurse-midwives have a Cesarean section rate of 11.6 percent compared with a national average of 23.3 percent.

"In a hospital, you get lost in the system, even as a midwife," she said. "If you take a child birth class in the hospital, they don't talk about natural birth as much. They talk about the epidural and the whole system supports an unnatural birth. You can't fight that."

Meanwhile, Julie Speier fought hard to see that the Cincinnati hospital team respected her wishes for a natural childbirth.

When the doctor seemed unable to guide the process, Speier's fiancé called a midwife friend and relayed her instructions to the doctor.

"At one point, the baby's head came out and the doctor pulled, but I said, 'Don't pull the baby, wait!'," she said. "Every doctor and nurse we spoke to knew it was important for me to have a natural childbirth. It was hard for them, but they stood back."

Despite the initial drama, Aine Joy, now 7 weeks old, was born healthy. Now ensconced in the joys of parenthood, Speier said she feels more empowered after going through the birth naturally.

"I have more faith in my body than in medical systems," she said. "This is what a woman's body is meant to do."

Cloe Shasha contributed to research in this report.

No need for pregnant women to fast during labor

Megan Brooks

Wed Jan 20, 2010 11:18am EST

NEW YORK (Reuters Health) - There is no reason why pregnant women at low risk for complications during delivery should be denied fluids and food during labor, a new Cochrane research review concludes.

"Women should be free to eat and drink in labor, or not, as they wish," the authors of the review wrote in the Cochrane Library, a publication of the Cochrane Collaboration, an international organization that evaluates medical research.

Dr. Jennifer Milosavljevic, a specialist in obstetrics and gynecology at Henry Ford Health System, Detroit, who was not involved in the Cochrane Review, agrees that pregnant women should be allowed to eat and/or drink during labor.

"In my experience," she told Reuters Health in an email, "most pregnant patients at Henry Ford are placed on a clear liquid diet during labor which includes water, apple juice, cranberry juice, broth, and jello. If a patient is brought in for a prolonged induction of labor, she will typically be permitted to eat a regular diet and order anything off the menu in between different induction modalities."

Milosavlievic has "not seen any adverse outcomes by allowing women the option of liquids and/or a regular diet in labor."

Standard hospital policy for many decades has been to allow only tiny sips of water or ice chips for pregnant women in labor if they were thirsty. Why? It was feared, and some studies in the 1940s showed, that if a woman needed to undergo general anesthesia for a cesarean delivery, she might inhale regurgitated liquids or food particles that could lead to pneumonia and other lung damage.

But anesthesia practices have changed and improved since the 1940s, with more use of regional anesthesia and safer general anesthesia.

And recently, attitudes on food and drink during labor have begun to relax. Last September, the American College of Obstetricians and Gynecologists (ACOG) released a "Committee Opinion" advising doctors that women with a normal, uncomplicated labor may drink modest amounts of clear liquids such as water, fruit juice without pulp, carbonated beverages, clear tea, black coffee, and sports drinks. They fell short of saying food was okay, however, advising that women should avoid fluids with solid particles, such as soup.

"As for the continued restriction on food, the reality is that eating is the last thing most women are going to want to do since nausea and vomiting during labor is quite common," Dr. William H. Barth, Jr., chair of ACOGs Committee on Obstetric Practice, noted in a written statement at the time.

But based on the evidence, Mandisa Singata of the East London Hospital Complex in East London, South Africa, an author on the new Cochrane Review, says "women should be able to make their own decisions about whether they want to eat or drink during labor, or not."

Singata and colleagues systematically reviewed five studies involving more than 3100 pregnant that looked at the evidence for restricting food and drink in women who were considered unlikely to need anesthesia. One study looked at complete restriction versus giving women the freedom to eat and drink at will; two studies looked at water only versus giving women specific fluids and foods and two studies looked at water only versus giving women carbohydrate drinks.

The evidence showed no benefits or harms of restricting foods and fluids during labor in women at low risk of needing anesthesia.

Singata and colleagues acknowledge that many women may not feel like eating or drinking during labor. However, research has shown that some women find the food and drink restriction unpleasant. Poor nutritional balance may be also associated with longer and more painful labors. Drinking clear liquids in limited quantities has been found to bring comfort to women in labor and does not increase labor complications.

The researchers emphasize that they did not find any studies that assessed the risks of eating and drinking for women with a higher risk of needing anesthesia and so further research is need before specific recommendations can be made for this group.

SOURCE: Cochrane Library, 2010.

http://www.reuters.com/article/idUSTRE60J40520100120

You Have Choices

Delayed Cord Clamping

Delayed Cord Clamping

by JENNIFER LANCE

Do you know what delayed cord clamping is? I remember first coming across this information in anatural childbirth book my midwives had loaned to me, and I was struck at how barbaric it is not to delay umbilical cord clamping. In a typical hospital birth, the baby’s umbilical cord is clamped immediately after it has left the birth canal. Yet, if you observe the umbilical cord, it is still pulsing and delivering oxygen rich blood to the baby, even though the newborn has taken its first breath.

Why did doctors begin early cord clamping? According to Empowered Childbirth, it was to prevent anesthesia from “heavily medicated births” from entering the newborn’s bloodstream. Empowered Childbirth goes on to explain:

When a human baby is born it needs to begin breathing air into its lungs in order to survive. However, it would be a mistake to imagine that a baby’s first breath contains their body’s first experience of life-giving oxygen. Oxygen is provided for the fetus throughout the entire pregnancy by the mother, through the placenta. Following birth the placenta continues to provide oxygen for approximately 5 minutes while blood pumps, to and fro, through the umbilical cord. This is part of an ingenious plan of God’s (or nature’s) to allow the newborn time to “unfold” his/her lungs and to gently make the switch from living underwater to breathing air through the lungs. Remember, the infant is not receiving “placental” blood or even the mother’s blood through the umbilical cord. The baby is retrieving its own blood supply from one of its own functioning organs that just happens to be inside its mother’s body.

With both of my children, we delayed tying off and cutting the umbilical cord for well over 15 minutes. In fact, not delaying cord clamping can cause a host of injuries to infants, including:

newborn anemia, respiratory distress leading to brain damage and/or death (rare, yes, but it happens), inadequate blood supply resulting in a need for transfusion, possible heart defects resulting from problems closing off the hole in the heart valves following birth. There are a few doctors now theorizing that the rise in autism is due to brain damage caused by early cord clamping.

Judith Mercer, CNM, further explains problems related to blood flow from early cord clamping:

Early clamping of the umbilical cord at birth, a practice developed without adequate evidence, causes neonatal blood volume to vary 25% to 40%. Such a massive change occurs at no other time in one’s life without serious consequences, even death. Early cord clamping may impede a successful transition and contribute to hypovolemic and hypoxic damage in vulnerable newborns.

No matter where you deliver you baby or with a midwife or doctor, you can advocate for delayed cord clamping. It’s not just doctors, but many midwives also clamp early, so don’t assume your midwife will not clamp right away. Moving from the womb to the outside world is change enough for the baby without having your lifeline severed before it has stopped pulsing. Delaying cord clamping or tying is advice I think every pregnant woman should receive.

Accidentally in Love

By: by Pinky McKay

You may have heard the term ‘accidental parenting’ which implies that you, the parents, have inadvertently caused (or will cause) your baby to have sleeping difficulties if you encourage ‘bad habits’ such as letting your baby fall asleep in your arms or not following a strict regime of one sort or another.

The truth is, there is no accident about how you feel when your baby calms and dozes in your arms, opening heavy eyelids to meet your gaze then perhaps giving a tiny smile before his eyes flutter shut again with delicate lashes resting against little pink cheeks, his warm body snuggled next to your own. Nor is it a sign of weakness or indulgence on your part that you can’t resist your baby’s cries to be soothed to sleep. Rather, it is due to what scientists call the ‘chemistry of attachment’.

This is a massive hormonal upheaval that begins during pregnancy, ensuring that you and your baby are chemically primed to fall in love when you meet each other face-to-face or rather, skin-to-skin, at birth. It is nature’s insurance that your baby will signal for exactly the care she needs to grow and thrive and that your strong connection with her will help you understand and meet these needs as she adapts to the world outside the womb.

During the last trimester of pregnancy your body brews a cocktail of hormones, and your pituitary gland, which produces this ‘mummy margarita’, doubles in size and remains enlarged for up to six months postpartum. This means that for as long as six months after your baby is born, your emotional mindset will be irresistibly affected by shifting levels of hormones. This powerful hormonal hangover has such universally intense effects on mothers inner lives that it is documented by researchers under a variety of labels including ‘maternal pre-occupation’ and ‘motherhood mindset’. This more intuitive mindset can be quite at odds with our modern lifestyles and often comes as a shock to women who have previously been in a more goal-oriented and solution-focused space prior to having a baby. Now, it seems that control is out the window and logic has left the building, as the skills that used to keep things neat and tidy (literally) are no longer relevant. This is why the baby instruction manual that advised an efficient program of sleep management seemed so sensible while you were pregnant, but now makes you feel like a failure as neither your baby nor you seem able to slot neatly into the prescribed timetable.

If you can appreciate this new, responsive state as nature’s preparation for creating a synchrony between you and the instinctual world of your newborn, you will understand why there is such a struggle between the logic of sleep training advice and your urge to respond to your baby.

“I was thinking about what keeps you going in the early days, especially the ability to function on barely any sleep, and I think it’s love. The love you feel for your baby, and the need to nurture the little one is what keeps you going and gives you this almost superhuman ability to be patient and gentle and strong through those difficult times. Of course everyone copes differently but I think for me it was the love that really kept me going on an otherwise empty tank. I am so in love with Luna. It is the purest, most all-encompassing, most divine feeling – she is such a delight. When she wakes up and I hear her little voice it means I have to stop whatever it is I’m doing, no matter how important, and see to her. I think ‘Yay! I get to hold my precious darling again!’ and I can’t wait to go in and pick her up and cuddle her.”—Alice

Two of the major players in this magical baby love potion are prolactin, a hormone that promotes milk production and is often referred to as ‘the mothering hormone’ because of its calming effect that is said to make you more responsive to your baby, and oxytocin, also known as the ‘love hormone’. Oxytocin encourages feelings of caring and sensitivity to others and helps us to recognise non-verbal cues more readily. It is released during social contact as well as during love-making, but the release of oxytocin is especially pronounced with skin-to-skin contact. Oxytocin itself is part of a complex hormonal balance. A sudden release creates an urge towards loving that can be directed in different ways depending on the presence of other hormones. For example, with a high level of prolactin, the urge to love is directed towards your baby.

Breastfeeding is a powerful enhancer of the effects of these love hormones, which are released by both mothers and babies, who produce their own oxytocin in response to nursing. However, physical contact with your baby will also stimulate the release of oxytocin, so if you are bottle-feeding you can chemically boost the bond with your baby if you ‘bottle nurse’ with cuddles and skin contact, rather than prop him up to feed (something you should never do, for safety reasons) or hand him to others.

Fathers, too, can succumb to the influence of these love drugs of family (not just baby) bonding (and you thought you were the ‘voice of reason’, didn’t you?). Men’s bodies are instinctively programmed to respond to their partners’ pheromones, which are steroid hormones made in our skin that emit barely detectable odours. Through closeness with your baby’s mother (and signals from her pheromones), your own oxytocin and prolactin levels rise toward the end of your partner’s pregnancy, and then, when your baby is born, an even greater surge of these hormones occurs when you spend lots of time holding your baby. And so a self-perpetuating cycle begins, close contact with your baby releases your own oxytocin and prolactin and encourages you to become more involved with your child.

Whichever parent you are and whether you are an adoptive parent or a same sex partner, the more you connect with your baby through touch, eye contact, smell and talking, the stronger your connection will be and the more difficult you will find it to ignore your baby’s signals.

And this is exactly as nature intended.

This is an edited extract from ‘Sleeping Like a Baby’ by Pinky McKay (Penguin). Pinky McKay is an international board certified lactation consultant, infant massage instructor, mother of five and the author of ‘Parenting by Heart’, 100 Ways to Calm the Crying, Sleeping Like a Baby, Toddler Tactics and her baby massage DVD, Gentle Beginnings. Based in Melbourne, Pinky regularly holds workshops and is available for mothers groups and conferences. See her website at http://www.pinkymckay.com.au.

Avoiding Cesareans in Stalled Births

Tips from a Doctor.
"Ask for 2 more hours, if baby is fine. 3/4 of the time, women go on to have vaginal births."