Archive for the ‘Birth Complications’ Category

When The Journey to Motherhood is Painful

I read a humbling and beautiful blog post the other day and had to share it. I think I need not expand on it any more, except to say that I need to remember myself to be grateful for the blessings I have and sensitive to those who struggle. Please read, enjoy, and share.

The Road to Motherhood (Isn’t Always Easy)

I recently heard one of these statements myself: “If I were at home, my baby wouldn’t have made it.” While tragic outcomes can happen in any location, it is important to remember that one cannot extrapolate hospital events to home birth situations, nor home to hospital. The environments and practices of caregivers are far too different to make a judgement call as to whether or not you and your baby would have survived elsewhere.
I find that one of the most difficult challenges as a doula is knowing when to dispel the myriad of birth myths floating around, and when to quietly listen to a mother’s story without speaking up. There is a time and place for everything, and I am working on knowing the right times for each role. Any suggestions, anyone? Please read the whole post over at erinmidwife.com

erin ellis midwife

A midwife in North Carolina was recently charged with practicing midwifery without a license because her state does not offer licensure for  Certified Professional Midwives (CPMs) and other direct entry midwives.  There was some local news coverage of the arrest and the ongoing efforts of North Carolina families to legalize CPMs.  One of the local news stories included a mother’s birth story from the “If I were at home, I would have died” perspective.

When I hear statements like this I cringe on the inside.  Being a midwife, I hear it a lot.  Women love to talk about their birth stories, as they should; Storytelling is a natural and beautiful part of our collective journey as women and mothers. In the park, at mom’s groups, among new friends, anywhere women gather there are stories of births and babies being told.  When I hear a story being told from the “I…

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Letter to My Sweet Friend’s Little Girl

Dearest little girl,

I was so excited when your mommy told me she was pregnant with you. I thought: a friend for my son! They’ll be a year apart- how perfect! I eagerly tracked your mother’s pregnancy and talked with her often about her plans for you.

One day, unexpectedly, Mommy had to go to the hospital. You were trying to join her earlier than was healthy for you. The doctors tried to keep you inside and help you to grow a little bit longer. They succeeded, but Mommy and Daddy had to play the waiting game for a while, never knowing whether you were staying or coming, never knowing quite how big you were, or whether or not you would breathe on your own when you came.

After a while of waiting, you made the announcement: you were coming, ready or not, about 3 months too early. Mommy labored with you slowly, thinking about your future and the special care you would need after you arrived. During labor, some serious complications that arose required a cesarean delivery to ensure your safety.

I heard that it all went very fast, and before Mommy and Daddy knew it you were out of the womb and into the NICU. But I heard good news- your eyes were OPEN, and you were crying lustily as you were born! Praise God! Just a few short hours later, your parents got to meet you, touch you, talk to you, admire you…

Little girl, you are so strong. May God strengthen your lungs and your heart and help you to grow ounce by ounce. May He give your mother peace, healing, and plenty of rest, so that she may care for you soon. May He grant courage and steadfastness to your father, so that he may have the energy he needs to watch over both you and your mother. May He renew your parents’ faith and sustain them through this challenging trial.

Grow, baby, grow. We all love you fiercely, but probably none so dearly as your parents. They have sacrificed so much on your behalf. Never forget how much they care for you- that they would gladly give all so that you might live. I hope you can come home soon so I can officially meet you, sweet child. You are beautiful beyond words, and I am so happy for your safe arrival.

Much love to you, little girl.

Homebirth: Preventative Medicine

When I would tell people that I was planning a homebirth, the same question would inevitably come up: what if something happens? You better get yourself to the hospital!

What if, what if, what if… The fact of the matter is that all those “what if’s” are a lot less likely to happen in a low-risk, unmedicated, physiologic, well-supported, calm birth. I would like to argue that, in many cases, having a homebirth with qualified midwives and the proper precautions (or a hospital birth where they treat you pretty much like a homebirth midwife would) is good preventative medicine against all of those “what if’s.”

(Disclaimer: I am well aware that not all hospitals are pushy, and there are many that are making huge improvements in providing evidence-based care. However, there are far too many out there that are still sorely lacking. It is these hospitals against which I hold complaint, not every single one. Also, I am quite aware that there are sometimes medical reasons for some of the interventions I list below. I am not against them as a whole. I only protest those which are done routinely or for unacceptable reasons. If the mother or baby need them for a medically indicated reason, by all means, they should be used.) That being said…

What if your labor stalls? Labor is much less likely to stall if the mom is comfortable in her environment and has freedom of movement to keep her baby coming down.

Having no epidural also keeps labor moving (epidurals often slow labor down) and sudden drops in blood pressure are much less likely. Mom will also probably feel much better after the birth since she won’t have any residual side effects from the drugs.

No narcotics for pain? Well, I suppose that means the baby will have less of a chance of abnormal heart rates and will be more alert to nurse after the birth.

No Pitocin to speed labor up? Baby will be less likely to suffer fetal distress since he won’t be subjected to the long, hard contractions caused by Pit.

What if you need a cesarean? Without all of these interventions causing complications, your chance of needing a c-section are greatly lowered.

What if the baby goes into distress? A watchful midwife at home will most likely catch problems in the early stages since she is only focusing on one patient-probably earlier than one nurse monitoring several patients in the hospital.

The list goes on and on…

Am I off my rocker? Please let me know if I am. It’s just that I’ve heard so many people who are concerned about the possible complications at a homebirth, but they don’t realize that those complications are FAR less likely if you are having an umedicated, physiologic, and carefully watched birth.

I obviously know that there CAN still be complications in any birth setting, some of them quite serious. For me the determining questions were:

1) In which birth setting would this complicatication be more likely to occur in the first place?

2) Where would the complication be caught faster?

3) Could they do anything in the hospital to change this that they couldn’t at home?

I think the answers to these three questions will be different depending on your individual care provider and birth setting. There is only one hospital to birth at in my area, and after much research I determined that home was the safest place for me to have my baby. I will let my readers decide for themselves, however, which location is safer based on their individual maternity care options. Please share your experiences- I would love to hear them.

Why I Chose Natural Birth

Why have a natural birth? If I told people during my pregnancy that I wasn’t planning on an epidural, I was asked, “Why put yourself through that if you don’t have to?” Why, indeed? Is it so I could pat myself on the back afterwards? It is so I could feel like a martyr? Is it to prove something to other women, or to feel more like an “earth mother?”

Well, no. I did not choose a natural birth for any of these reasons. Here are three important reasons why I chose to birth naturally:

1) For my body.

The term “Natural Childbirth”, or “NCB,” as some like to call it, loosely means that the mother gives birth without any drugs or interventions. It seemed to me that it was best for my body to avoid the risks and possible complications caused by commonly used medication and interventions if at all possible.

For example, the hailed epidural, while often providing excellent pain relief, can also bring about a fall in maternal blood pressure, nausea, and vomiting. It can slow labor down considerably. Epidurals are also associated with a higher cesarean rate, which can certainly be considered harder on the mother’s body than a vaginal delivery. They sometimes create long term side effects for mothers, such as spinal headaches,  and its possible to have rare but life threatening reactions to an epidural.

However, it’s not only the epidural that carries risks and adverse effects on mom’s body. Pitocin, the commonly used tool to augment labor, creates harder and much more painful contractions for mom. This often leaves the mother asking for more meds to ease the pain. Narcotics can depress mom’s breathing. IVs can lead to fluid in the mother’s lungs and diluting of red blood cell concentration (this anemia in labor predisposes mom to bleeding). Artificial rupture of membranes makes contractions harder on mom before they need to be, as well as increase the risk of infection.

These interventions all create secondary effects. Once mom takes medication, she needs electronic fetal monitoring (EFM) to watch the baby. If it’s internal monitoring, this means she is now attached to the machine. If she has an epidural, she’ll most likely need a urinary catheter since she cannot feel to go herself. And an epidural itself significantly decreases or completely cuts off mom’s mobility. Lack of mobility makes for slower labor, makes for a less physiologic birth because it doesn’t help the baby make her way down the birth canal , and often restricts the mother to the lithotomy position for pushing (this creates even more complications for mom’s body).

Phew! Maybe my body could handle labor a whole lot better if I just let it do it’s thing!

2) For my mind.

I’ve heard several mothers say that the narcotics given in labor made them feel drunk or drowsy, but didn’t take the edge off the pain too much. Some moms might prefer this sleepy, “out-of-it” state of mind, and it might help some mothers relax enough so that labor can progress smoothly when tension otherwise might have taken over. I personally, however, felt it was important to be “all there” for labor and delivery. I wanted to be alert and aware for my first meeting with baby- not half-asleep.

I’ve heard the argument that all the interventions in labor can create adverse psychological effects. How so? Well, they say that being hooked up to an IV, EFM, urinary catheter, and having an epidural in the back, along with being on my back, legs up high in stirrups, and constantly being poked at “down there” (frequent internal examinations) can make a woman feel helpless, non-participant, exposed, and more like a sick patient than a mother working on meeting her child. I cannot attest to this personally because I have not had this experience. I’m sure that some women might not mind this process so much, but to me, it sounded terrible. I wanted to remain active and feel in control of my labor.

This part might sound weird to some mothers, but for me, it was emotionally important to feel everything. I wanted desparately to experience the process as fully as possible. I wanted to be in touch with my body and my baby, to listen to his cues to move this way or that way, sit, dance, moan, or bellow. I felt that I wouldn’t appreciate the process of labor as much if I didn’t feel it. I felt like meeting the baby would be all the more enthralling if I had to work to get there. It seemed that the absolute bliss of delivering my child would be even more magnified if I fully understood and lived and smelled and tasted and breathed every second of labor and delivery.

3) For my baby.

Most importantly, I chose to birth naturally for the sake of my little one. We are so careful during our entire pregnancies to do the best for our babies. We (hopefully) give up smoking and alcohol (if you partook in your non-pregnant state), we limit our caffeine, and we make sure we don’t eat anything undercooked. We take prenatal vitamins religiously, avoid anything with the label, “If pregnant or breastfeeding, ask a doctor,” and are extra careful of our growing bellies. Yet, at birth, so many women quickly and sometimes carelessly sign up for medication that can and often does have adverse effects on the baby (in their defense, often without knowing the possible effects).

What are some of these risks I avoided by choosing to birth naturally?

An epidural can cause serious drops in baby’s heart rate, makes for longer labors (sometimes less tolerable for baby), and makes for an increased rate of vacuum extractions, forceps deliveries, and cesarean sections (which can create additional risks for baby). Are narcotics safer? Remember that they can depress mom’s breathing, leading to less oxygenation for the baby. Narcotics can also adversely affect fetal heart rate. Pitocin, often used to augment labor after an epidural (or for other reasons, some of which are not medically indicated) makes for longer, harder, stronger contractions, making the baby much more likely to experience fetal distress. Artificial rupture of membranes makes for higher risk of infection for mom and baby. IVs dilute mom’s red blood cell count, therefore also reducing oxygenation to the baby. Glucose containing IVs can have adverse effects on baby’s sugar levels and lack electrolytes. These IVs lead to low blood sodium in the newborn (putting the baby at risk for seizures and apnea). They also cause fluid overload. This excess fluid can get into the baby’s tissues and lungs (making for breathing diffuclties). Excess fluid can increase the likelihood and severity of newborn jaundice, and can also cause a type of transient pneumonia. Internal EFM requires a prick in the baby’s scalp, which isn’t at all a major injury, but I didn’t like the idea of it unless I really needed it to check for suspected fetal distress.

Keep in mind that many interventions decrease mom’s mobility. When this happens, mom can’t help baby move down, open up the cervix, and travel through the birth canal nearly as easily. However, if mom can get upright and move, she helps the baby to keep shifting downwards. Being upright in the second stage of labor means a shorter pushing time and more oxygenation to the baby (no pressure on major blood vessels this way). A physiologic birth is good for the baby too!

Finally, just as I wanted to be “all there” for the first meeting of my child, I wanted him to be “all there” too! It is widely acknowledged that babies whose moms receive medication during labor are more likely to be sleepy and have trouble suckling at birth. The drugs get to the baby too, and can interfere with initial bonding. Those first moments are so precious, and I really wanted my baby to be just as alert and aware as I was.

Disclaimer

I do understand that in a true emergency interventions can be life saving, and I am certainly not opposed to them as a whole. Even in non-emergency situations, when the benefits of interventions outweigh the risks and they are needed for medically indicated reasons, they can sometimes make birth safer for mother and baby. I do believe that most of the aforementioned interventions exist for a reason, have a place, and can have some positive effects. It is less than helpful to vehemently deny them in every single circumstance. However, I strongly feel that it is important to know the risks and benefits of each intervention before signing up for any of them.

Also, for the record, I don’t believe that asking for an epidural or nartcotics makes you a sissy or a weakling. Every mom has her breaking point, and I don’t think any of us can judge when that might be for someone else. Sometimes having some pain medication (perhaps in an extremely long labor, for example) might be what can give rest or some peace of mind to the mom and allow her to look back on the birth as a positive experience.

Concluding Thoughts

I think the important thing here is that we weigh our choices in childbirth carefully, with full understanding of the risks and benefits of each intervention. That way, if mom does decide she needs medication, or if she truly does need Pitocin (as I did for post-partum hemmorage), or if a cesearean might actually be needed, she understands her options and is prepared to work with the outcome of her choices. This also helps her to feel more in control and more positive about her labor and delivery choices.

For me, the benefits of routine interventions didn’t seem like they could outweigh the risks, especially when there are so many effective natural means of pain relief and labor progression. Every intervention, even if effective, also creates side effects that may be less than desirable. I felt that labor went much more smoothly when I allowed my body to do what it was made to do naturally- work that little baby out! Overall, my natural childbirth was the best experience of my life. If my future health, labors, and babies allow it, I would love to do it that way again.

Much of this information gleaned from:

Goer, Henci. The Thinking Woman’s Guide to a Better Birth. The Berkley Publishing Group, New York, New York. 1999.

More Reasons to Stay Off Your Back During Delivery

Ever since the delivery of her first baby two and a half months ago, my sister-in-law Michelle has been having problens with her hips. She just went to her first physical therapy appointment a couple of days ago to address the problem. It turns out that her therapist was also a labor doula, and was able to give her helpful exercises as well as information as to why her hips were acting up.

As the baby moves down the birth canal, normally the tailbone can move out of the way to help him to come through. However, the tailbone cannot move as easily when the mother is laying on her back. It is for this reason that one of Michelle’s hips has literally been twisted out of the way to make room for her baby’s passage. Her pubic bone also suffered a crack during pushing, due to the lack of space provided for the baby in the lithotomy position. She is now doing daily exercises to help correct these problems.

Michelle also had an episiotomy, possibly made more likely by laying down to deliver. Her therapist told her that since she has had one, it will be difficult to find a doctor who won’t want to give her another in the future. Also, the cut will make natural tears more likely during subsequent deliveries.

Neither Michelle nor I knew that there could have been such lasting consequences from birthing in the lithotomy position. There’s a few more reasons to get upright, moms!

(Story shared with permission.)