Thursday, April 30, 2009

Pictures, 1-4 days old

1 day old
Grandma and Zari admiring Dio

2 days old

3 days old

Eric and Zari goofing around

4 days old

First bath
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Wednesday, April 29, 2009

Dio's birth story

Birth stories usually begin when labor starts. With Zari’s birth, labor began fairly unmistakably (although I didn’t admit that to myself until halfway through) and 10 hours later I had a baby.

With Dio’s birth, I could say labor began at any number of points: on Saturday morning, when I began to have painful, though sporadic, contractions that felt better if I moved through them. On Saturday night at midnight, when I first saw bloody show and had labor diarrhea. On Sunday morning before church, when the contractions seemed more consistent and required that I sway my hips through them. Or on Sunday late morning while Eric and Zari were away at church, when the contractions became undeniably intense and I knew that labor was definitely happening.

I’ll start my story, though, at 7 am on Sunday morning, when I finally let myself get out of bed and stop ignoring the contractions. I rocked on the birth ball, checked my email, and wrote a blog post wondering if I was in labor or not. I called the midwife to let her know I’d been feeling something kind of like labor contractions for the past 24 hours and that I had bloody show and diarrhea at midnight. I told her not to be surprised either way; maybe things would pick up, but maybe not.

Then I got ready for church, since I was not at all convinced that I was really in labor. I was dressed from head to toe—earrings, necklace, nice shirt and skirt, and my oh-so-sexy thigh-high compression hose—and ready to head out the door. Eric looked at me circling my hips through every contraction and said, “Rixa, I really think you should stay home.” I admitted I probably would make a bit of a scene at church, because I had to move through the contractions at this point. So I sent him and Zari off at quarter to nine with the assurance that I’d call him if I needed anything. After all, he was only two minutes away.

Eric got asked a million questions when he and Zari showed up without me. I didn’t think it at all strange to send them off while I was (maybe?) in labor, but I guess some people at church did!

Since I was playing hooky from church, I figured I’d devote some time to meditating and reading about spiritual matters. So I sat at the computer, reading and rocking on my birth ball. Eric called periodically to check in with me while he was at church. After the first call around 10:15 am, I could still talk through contractions. When he called again an hour later, things were getting really intense.

For fun I timed contractions on Contraction Master—another first, since I never timed them during Zari’s labor--and they were always at least a minute long. That surprised me; they seemed much shorter than that. They became closer together during the hour or two when I was timing them. They started out at 5-6 minutes apart and were less than 4 minutes apart by 12:30 pm.

I loved having the time at home alone. It was a beautiful, warm, sunny spring morning. The house was quiet. I had time to slowly gather my supplies and put everything in order: eat snacks and drink juice, go to the bathroom multiple times, do laundry, and get things ready upstairs in the birth room.

Eric and Zari came home shortly after noon. He fed Zari lunch and put her down for a nap. At this point I was starting to lose my desire to eat, even though I was still a bit hungry. I tried eating a bite of the morel mushroom dish we had made the night before. Nope. Not interested. I’ve discovered a new way to tell if you’re in labor: when even morel mushrooms don’t taste good, you know it’s the real thing!

Like during Zari’s labor, I had to stand during contractions, leaning over a table or counter, and sway my hips. I would put much of my weight on my arms and dip my hips back and forth in a big U shape, or rock them from side to side. I breathed in and out deeply, exhaling a deep, silent haaaaaaaaa or whooooooo or yeoooow. I circled my head back and forth. I felt contractions in the same place as my first labor: low down above my pubic bone from hip to hip. They were like sharp, knifelike menstrual cramps.

Labor was really picking up. I started filling the tub when Eric came home, knowing it would take at least an hour and a half until it was ready. I also noticed that familiar endorphin rush: a dizzy, spinney, floaty feeling.

I called the midwife around 1 pm and let her know I was definitely in labor. I wasn’t quite ready for her to come over yet, but I would call when I was. I called her back at 1:30 pm and said “come over—I don’t want to think any longer about when to call you!”

By this time, labor was crazy intense, more than Zari’s labor ever was. I started feeling flushed and dizzy and shaky. I also started feeling discouraged and overwhelmed. I wanted it to stop. I didn’t want to do this any more. I really understood, for the first time, why women take drugs in labor. To know that someone or something can just make it go away is almost irresistibly seductive. That’s one of the reasons I don’t put myself in an environment where I have that option, because I know that I really don’t want it to go away and I know that I can do it. I recognized that these were all classic signs of transition. I remember thinking, if this isn’t really transition, I am screwed.

Once Zari was sleeping, Eric helped me get some last things ready: filling the birth pool the second time, bringing any last supplies upstairs, pulling off my compression hose. I was still dressed from head to toe in my church clothes at this point! I took off my necklace and earrings and my Hypnobabies mp3s, which I had been listening to on and off. He gave me a blessing, which was specific and very reassuring that my body was healthy made to do this, that I would be able to give birth to this baby. When I was pushing and wondering if I wanted to check myself for dilation/progress, I recalled the blessing and thought, nope, not necessary, I know everything is working as it should be.

Shortly before 2 pm, I had a contraction while leaning over the entryway table. I heard that familiar catch in the back of my throat and felt some rectal pressure. I had an urge to drop down on my knees. Oh great. I knew what was coming next—pushing—and I wasn’t all that excited. I don’t like pushing. Sure, it means the baby will be here soon, but for me pushing doesn’t feel better. It feels worse!

Eric suggested we head upstairs, which was really a brilliant idea. I’m not sure I would have made it up because I was still in the “I hope I am really in active labor and not deluding myself” headspace. I got dressed in my bikini, top and bottom. Not sure what I was thinking when I put the bottoms on, since I had to pull them off a few contractions later. You can see them floating behind me in the pool in several of the pictures.

The tub was full but way too hot, so we pumped out some water and added more cold until it was pleasantly lukewarm. It was warm upstairs, about 80 degrees, and the water felt heavenly. It did take the edge off the first contraction (which mas the last real labor-only contraction). I knelt in the tub, facing outward and leaning my elbows on the edge.

The midwife arrived a bit after 2 pm. I started having pushy contractions, each one more and more pushy and less and less labor-y. She took heart tones, then left us alone for a little bit. As soon as the pushy contractions hit, I needed something to grab onto. I asked Eric to kneel down on the floor facing me. I grabbed both of his forearms, like we were double arm wrestling, and held on for dear life as my body began pushing.

I had an almost irresistible urge to bite on something during the contractions. Eric was very, very lucky that I didn’t chomp down on his arms. Twilight moment averted.

More pushing, more rectal pressure, more grunting and vocalizations. The midwife came back in the room. My water broke. Another first—I never noticed it breaking during Zari’s labor (it did at some point, of course, since she didn’t come out in the caul). I said, “my water just broke!” I looked down and saw specks of vernix floating gently downward in the water. The baby’s head descended rapidly. When I felt it hit my perineum, I slapped my right hand down to support my tissues while maintaining a death grip on Eric’s arm with my left hand. As I was doing this, this passage from Gloria Lemay’s article Midwife’s Guide to an Intact Perineum flashed through my mind:
The next distinct feeling is a burning, pins-and-needles feeling at the opening of the vagina. Many women describe this as a “ring of fire” all around the vaginal opening. It is instinctive to slap your hand down on the now-bulging vulva and try to control where the baby’s head is starting to emerge. This instinct should be followed. It seems to really help to have your own hands there.
I felt something really funky—a large blob or bubble of tissue sticking out in the front. Behind it was the familiar oval slit of the vagina with a bit of wrinkly baby head. I said, “something feels funny.” The midwife asked if it felt wrinkly, assuming I was referring to the sometimes surprisingly soft folds of the baby’s scalp as it first crowns. No, I felt that, too. This was something else. I poked and pinched it gently, hoping it wasn’t some part of my anatomy that was coming out with the baby! Then I figured it out—it was a little bubble of amniotic sac. I pressed it a little harder, and it deflated. (In a video right after the birth, you can see me telling Eric and the midwife what that “funny thing” was).

With each contraction, the head emerged more and more. I applied counterpressure to the head, varying the pressure between the front and back depending on where I felt more pressure and stinging. As much as crowning, and pushing in general, was wild and crazy and painful, it was amazingly cool to once again support my baby’s head as it emerged out of my body. There’s nothing like feeling your baby’s head come out, bit by bit, into the palm of your hand. Every woman deserves that experience.

The midwife listened to heart tones once more (they were always great with lots of variability), then began taking pictures, for which I was very grateful. I had wanted to also film the birth, but things went too quickly to get the camcorder set up. I was really vocalizing: grunting, growling, panting, and lots of other sounds that don’t really have a name. All totally instinctive and spontaneous.

Then that glorious feeling of the baby’s head emerging fully. No pause between the head and body this time, just a great spiraling sensation as the baby’s body emerged. I looked down as its body was halfway out and saw a face, eyes wide open, looking up at me through the water. I grabbed the baby, its body still slipping out of mine, and lifted it gently out of the water. It was about 2:33 pm—we all forgot to look at the clock, so the time of birth is our best guess—and I had only been pushing in earnest for 15 or 20 minutes.
You can see the bottom half of his face at the very top of the photo.
The baby seemed impossibly tiny to me. I said something about it being so small. It began crying right away, and I caressed its smooth body.
By this time Eric was filming. I took a peek between its legs and found that we had a boy!
I sent Eric down to wake Zari up from her nap and meet her new brother. He came back alone, unable to wake her up.

Note: click on "HD" and maximize the screen to see the videos in high-def!

The cord was a bit on the short side and the water wasn’t overly warm, so I got out probably 5 or 10 minutes after the birth. We snuggled in bed with a towel over me and Dio. He cried for a few minutes, then calmed down and began opening up his eyes.

Eric helped me sit up a bit more so he could nurse.

The midwife left us alone, as we had discussed beforehand. I don’t remember seeing her again until we asked her to come up about an hour after the birth to help cut the cord. Eric was finally able to wake Zari up at 3:30 pm. She touched Dio, hesitantly at first. One of the first things she said was, “he has little tiny ears.”

Note: this video shows a few seconds of bare breast, so be warned!

We cut the cord and I asked if the placenta was detached. It was, so the midwife encouraged me to bear down a bit as she held onto the cord. It came out with a few pushes. The assistant took the placenta and collected some cord blood with a syringe, to check the baby’s Rh factor. I handed the baby over to Eric and Zari and took a quick shower. The midwife weighed and measured Dio and did a newborn exam. Everything was perfect. She checked me for tears. I had two periurethral tears, but they were perfectly straight and approximated, no stitches needed. No perineal tears and just a tiny skidmark inside my vagina. Yay! My bottom feels great, besides the normal after-birth tenderness and some minor stinging when I pee.

The next few hours were spent snuggling, admiring the baby, and ingesting large quantities of food and juice. I am always ravenous right after I have a baby. The midwife and her assistant were busy doing laundry, cleaning up, and heating up food for me to eat. They left around 5 pm with smiles and well-wishes. The midwife said to me laughingly, “this birth will really make you wonder why you didn’t go unassisted!” since she really didn’t do much midwifey stuff at all, except check heart tones and examine me and the baby a while after the birth. But that was exactly what I had wanted and what we had talked about beforehand, so I assured her that it was just perfect. And it was.

I have no regrets about anything, nothing I’d nit-pick over and wish I’d done differently. (Okay, except I wish I had filmed the birth, but that doesn’t really count!) The midwife's presence didn’t disturb me or interrupt my labor at all, and I was very glad she was there to take pictures. I also loved having the postpartum help with cleaning and food. The timing of everything worked out perfectly—having the quiet time alone in the morning, Zari napping during the most intense part of labor when I really needed Eric around, the midwife arriving just as I began pushing.
A few hours old

Some final comments:

Faster does not mean easier. Although this birth went more quickly than Zari’s, if you count from when labor really kicked into gear, it was not necessarily any easier. In fact, I’d say that it was much more challenging and intense, both physically and mentally, than my first birth. I skipped the classic transition phase the first time around, but during this labor it really hit me.

Posterior? I don’t think Dio was posterior during labor. Heart tones indicated he was always ROT, as he had been during the last several weeks of pregnancy. I also felt no back labor at all. What the midwife and I think happened is that he stayed ROT during the whole labor and spun posterior at the very end, as he barreled down through the pelvis. It’s a lot faster to go from ROT to OP than to spin the other way around! I didn’t look down until after his head and half his body were out, so I can’t say for sure whether the head itself came out OP, or just rotated that way after it had emerged.

Denial is your best friend in labor. I could have easily exhausted myself, both physically and psychologically, if I had paid too much attention to my contractions. I almost didn’t go to bed on Saturday night because the contractions were quite strong and painful and because I was seeing bloody show, which had signaled the start of labor when I was pregnant with Zari. Making myself stay in bed and sleep, if only fitfully between contractions, was a lifesaver. Because I did this, labor only seemed to begin some time between 10 and 11 am on Sunday. I could technically claim to have been in labor for 28+ hours, or 14+ hours from the onset of bloody show. But instead, labor lasted between 3 ½ and 4 ½ hours long in my mind. Much easier to integrate and work through!
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And the winner is...

Meredith H!

Of the four people who guessed both the date and the gender correctly, she was the closest on height and weight. Email me your mailing address and I will send the sling off shortly!
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Tuesday, April 28, 2009

Quick update

Still working on the birth story, but it's getting late and I need to sleep! We're doing well over here. I feel so good that I have to force myself to lie down and rest more. Dio is lovely, nursing really well, a very calm, gentle person. My breasts have gone up several sizes since yesterday and the colostrum is turning milky-white. My mom arrived yesterday and has been a lifesaver, amusing Zari and cooking meals and cleaning the house and letting us rest with the baby. Will write more tomorrow, but here are some stats on me and baby:
  • Dio weighed 7 lbs 1 oz and was 20 3/4" long.
  • His head was 34 1/2 cms around and he had Apgars of 9 & 10.
  • Active, kick-butt labor was about 3 1/2 hours long, and I only pushed for 15-20 minutes total this time!
  • My blood loss was minimal at less than 150 mls.
That's about all that I can think of at the moment. Loving this baby more every day!
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Monday, April 27, 2009

Birth pictures

Just a few minutes before the baby emerged, the midwife grabbed my camera and began taking pictures. I was hoping to take more pictures of me laboring and to film the birth, but things went too quickly.

Here I am supporting the baby's head as it crowns and emerges. My other hand has a death grip on Eric's arm.
Insert various funky sounds here
Dio surprised us by coming out direct OP (occiput posterior). This is the only picture I have of him emerging, and you can make out his face if you squint a bit.
Bringing Dio out of the water
Eric began taking videos. I am saying things like "I can't believe we have a baby!" I don't know what else I expected to come out--a puppy? kittens?
Resting in bed together
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Sunday, April 26, 2009


A baby boy, born at home in the water this afternoon! We forgot to look at the clock when he was born, so we are guessing 2:33 pm. He'll be named Dio, after Eric's grandfather. Still working on a middle name. More later, but here are a few pictures:
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New territory

This second pregnancy has brought a lot of "firsts":
  • First time being pregnant for more than 38 weeks. I'm now 39.1 weeks from LMP.
  • First time I've started wondering, although not impatiently yet, I wonder when this baby will be born? I wonder when I will go into labor?
  • First time seeing a midwife in a formal relationship, which I have found enjoyable especially for the social and emotional aspects of prenatal care. The routine clinical stuff is just a side note that I do myself on a weekly basis anyway (blood pressure, fundal height, heart tones, weight) because I love keeping track of these changes. I also really appreciate having access to lab work and referrals when needed, such as when I got superficial clots in my varicose veins.
  • First time I've had to really slow down physically toward the end of pregnancy. There is no way I could go for a brisk 2-3 mile walk right now, like I was doing daily with my dog right until Zari was born. If I try to pull that off now, I get constant contractions and pelvic pressure, and my belly feels like it's going to explode.
  • First time getting stretch marks. This week a few of them appeared on my lower belly. Last time I had a few prick marks on each hip, as if I had been stabbed by a giant fork. But now I have the real deal.
And now, I am in the middle of another first of sorts. I'm trying to figure out if I am, or will be soon, going into labor! I've been feeling crampy on and off for the past two weeks, like I'm getting my period. Yesterday, that morphed into those all-too-familiar sensations of labor: contractions coordinated with a sharp, intense menstrual-cramp-like feeling. The kind that you need to move your hips through. I've had these sporadically for the past 24 hours. I can't say how long they are, or how close together they are, since I am trying my darnedest to be in denial for as long as possible.

I just kept on doing my usual activities yesterday, with occasional time-outs to swivel my hips. We went morel mushroom hunting on some friend's land and found 10 big ones! I can't tell you how excited we were. There's nothing on earth like the taste of morels. We cooked them up for dinner in a simple cream sauce over linguine. I also did quite a bit of gardening. Over the past few days I've planted or transplanted: 10 Eutin rose bushes around our brick patio, 5 raspberry, 5 blackberry, 10 asparagus, 25 strawberry, leeks, shallots, parsnips, and potatoes. Once we finish building wire mesh cages over our raised bed gardens (to keep squirrels, rabbits, and other wildlife out), I have a lot more seeds and seedlings to plant.

Then at midnight last night, I started seeing bloody show and having labor diarrhea--both of which signaled the start of my labor with Zari. I stayed up until 1 am, since I wanted to have things in order in case labor really kicked into gear. The contractions, if I can call them that, were intense enough that I almost didn't go to bed, but still sporadic enough that it seemed a bit silly to give them so much attention. So I went to bed and slept on and off all night, waking up through the contractions and wishing I were upright and moving when they came, but not enough to actually get out of bed! I feel well-rested considering I was having fairly intense contractions all night. I knew this already, but it is SO much more painful to be lying still during a contraction! Movement makes it a million times better. I listened to the Hypnobabies "easy first stage" track the last half of the night, and it really helped me sleep between the contractions.

I'm up now--obviously!--now that it's light out, checking email and rocking through the contractions on my birth ball. Still, I don't know if I can mentally call this labor yet. With Zari, it demanded my full attention pretty much as soon as it started, and 10 hours later I had a baby. I suppose I can just hang out in denial until my body starts pushing, right?

So now I'm trying to figure out if I should go to church and risk some strange looks if I start rocking back and forth. Or do I stay home and putter around? I just don't feel that overwhelming sense of concentration and focus that I had with Zari's labor.
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Friday, April 24, 2009

World's most expensive sling?

If you have $1,120 to blow, you can spend it on a Sakura Bloom handwoven and hand dyed Laotian silk ring sling. The fabric does look beautiful, but I keep thinking of all the things I could buy with $1,120: a used car, enough cloth diapers for many new mamas, several months of groceries...

Speaking of slings, though, I've been thinking about starting to make silk dupioni slings, along with my usual linen ones. They wouldn't be handwoven or hand dyed, but they also wouldn't cost over $1,000. I'd probably charge around $70, depending on the price of silk dupioni. So I need your input: would you pay that much for a fancy silk ring sling?
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Thursday, April 23, 2009

An OB on industrialized childbirth and maternal autonomy

Just after I posted my book review of Policing Pregnancy, someone sent me a link to a fantastic article about the factory model of childbirth, the rising cesarean rate, and the limits of pregnant women's autonomy. It was written by an obstetrician, Lauren A. Plante: "Mommy, what did you do in the industrial revolution? Meditations on the rising cesarean rate." International Journal of Feminist Approaches to Bioethics Spring 2009, Vol. 2, No. 1, Pages 140-14.

For some tantalizing excerpts from Plante's article, read An Essay on the Factory Model of Childbirth at the Our Bodies, Ourselves blog. I have the full text of the article, so email me (stand.deliver at if you'd like a copy. It is definitely worth the read!

A few of Plante's observations about autonomy that I can't resist including here:
In the US, we have heard arguments that women are entitled to autonomy in making their birth choices, and that therefore it is ethical to perform cesarean for no reason other than maternal request. Curiously, this vaunted autonomy stops at the door of the labor room. Women are implicitly allowed, or encouraged, to make only those choices which increase the power of the physician and which decrease their own....

The American College of Obstetricians and Gynecologists calumniates not only women who want a home birth but anyone who advocates leaving that option open. Once in the hospital, women who might like to exercise their right to self-determination by choosing vaginal birth after cesarean, or vaginal breech delivery, will have a hard time of it. Is it not the opposite of autonomy to support only those choices which increase the woman’s reliance upon the physician?...

We must clearly understand that real autonomy does not mean cesarean on request, but instead a spectrum of birth options that honor women’s authentic choices. Real autonomy also means, to borrow a sentiment from Gandhi, that women should bring forth the change they wish to see in the world.
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Wednesday, April 22, 2009

Policing Pregnancy: Book Review

I recently finished reading an outstanding book about legal battles over pregnant women's rights to refuse treatment or to deviate from medical recommendations. It's called Policing Pregnancy: The Law and Ethics of Obstetric Conflict by Sheena Meredith (Ashgate Publishing, 2005). Meredith explores the legal and ethical implications of laws dealing with obstetric conflict--when pregnant women's wishes or behavior conflicts with medical recommendations. She focuses primarily on legal battles over pregnant women's autonomy in the U.S. and U.K. Although both countries theoretically uphold a person's legal right to consent to and refuse medical treatment, the two countries have seen cases of court-ordered obstetrical interventions, from cesarean section to blood transfusions to incarceration due to drug or alcohol use during pregnancy.

From the preface, Meredith explains the primary objectives of her book:
In the past two decades, a series of high-profile court cases in both the UK and the US have highlighted a novel problem for both medical law and society. In intervening in situations when pregnant women and those charged with their care do not agree on management options or appropriate behaviour, the law has been forced to try to reconcile the often competing demands made in the name of foetal "rights," maternal autonomy and medical authority. Society's interests, for instance in preserving life and safeguarding future citizens, may also be brought to bear.

This book examines the legal and ethical background to such cases and attempts to give an overview of the development of the law as it affects pregnant women; the current legal position, and potential future complications.

In addition to assessing those cases that have come before the courts, and the ensuing ramifications, it examines the legal principles underpinning such aspects as medical care in pregnancy and during childbirth, patient autonomy, foetal status and potential maternal liability, as well as the operation of these principles at the practical level of the doctor's office, clinic or obstetric ward. It discusses the varying ethical viewpoints about foetal rights and maternal duty, assesses the interaction between medicine and the law in this area, and examines those factors--medical, legal, ethical and social--that may in the coming years pose even further challenges within the already complex relationship between pregnant women and their health care providers....

[T]he book does not attempt to discuss the vast subject of abortion law per se, nor the enormous ethical questions it poses, except insofar as it relates, directly or indirectly, to issues arising when a pregnant woman and her medical advisers are in conflict over appropriate intervention or behaviour in pregnancy....
This book is a fascinating (and frightening) exploration of the various ways maternal autonomy has been undermined by law, social opinion, and medical practice. I was struck by the threat that right-to-life legislation in the US poses to maternal autonomy. Although unintended, laws attempting to grant fetuses personhood undermine pregnant women's ability to make crucial decisions about their health care and about their own bodily integrity.

Meredith has a both a medical degree and postgraduate education in law. Her approach is thorough and meticulous, but her writing always stays articulate and readable. I will be including several excerpts from her book in future posts. To end this post, I quote from a chapter section titled "Hijacking the Language of Debate," about her choice of the term "obstetric conflict" rather than "maternal-fetal conflict."
Without in-depth analysis of such issues, it is understandable that emotional entreaties to safeguard the welfare of 'unborn babies' against the actions of mothers presented as feckless and self-seeking find instinctive appeal, with both the courts and the public. The concept of 'foetal rights', which has both arisen from and perpetuated attempts to find legal solutions to problematic medical encounters, has contributed to a prevailing notion of pregnant women and foetuses as potential adversaries. In the wake of the Carder forced Caesarean case in the US (Re AC), it was recommended that all hospitals should have a 'maternal-fetal conflict' policy. Yet it has been argued that the very use of such language sets the woman up as a selfish, irresponsible being unwilling to do what is best for her baby.

This notion that there is an opposition between the interests of the woman and those of the foetus overlooks the fact that these interests are inextricably linked, and that the few women who do risk harming their foetuses are not usually seeking actively to cause such harm. It carries the implication not only that doctors possess superior knowledge but also that they have a greater claim to having the foetus's best interests at heart, and obscures the vital point that the conflict is actually between the mother and others who believe that they know best how to protect the foetus.

Yet women too may be acting according to their view of their baby's best interests in avoiding unnecessary interventions and the hazards and sequelae thereof - and, in some instances at least, they may be right. In practice, the mother's autonomy is not actually to be subordinated to her baby, but to the medical profession - the issue might be more accurately termed 'obstetric conflict'. It is interesting that in the UK, as Douglas points out, such issues of judicial compulsion surfaced just when women had begun to reassert some control over pregnancy and childbirth. Obstetric conflict may have reached the courts in the attempt to maintain medical paternalism in the face of patients increasingly questioning doctors' natural authority; such tactics also serve to discount women's experiences of their own bodies and previous birth experiences, instead elevating medical knowledge and technological interpretation to a superior position, to demonstrate the need for 'professional' intervention and control.

A further criticism of the notion of 'maternal-foetal conflict' is that such language obscures the fact that it is not only maternal actions which may harm the developing foetus — the father (vide infra), doctors (thalidomide) and the wider society (chemical contamination) may also be 'hostile' agents. In one study that demonstrated 'substantial exposure of neonates to xenobiotic agents' (foreign substances), 82.7 per cent had positive tests, of which only 11 per cent were accounted for by illicit drugs, compared with 30 per cent for local anaesthetics, 25 per cent for food additives and 10 per cent for medical analgesics. Moreover, state intervention that primarily attacks women's behaviour and choices is arguably hypocritical given widespread tolerance for the unacceptable and sometimes dangerous living conditions of many mothers and children. Court cases utilise disproportionate resources in terms of both time and cost; arguably attention would be more productively directed to measures that improve the status and well-being of all women and children.

It could also be argued that much of the language of everyday obstetrics is designed, consciously or otherwise, to reinforce medical control of the birthing process and to negate or deny women's collective experiences - for example, most women (or 'standard nullipara', etcetera) now are generally passively 'delivered' of their babies rather than actively giving birth to them, yet even then the medical profession judges the woman's 'obstetric performance,' as well as her 'reproductive success'.

Many of those women at greatest risk of forced interventions have been described (often scathingly) by medical staff as having had little or no pre-natal care - yet there is evidence, at least in the West, that input by obstetricians (as against midwives) into the antenatal care of women with normal pregnancies offers little or no clinical or social benefit. Moreover, the word 'care' in this context 'masks domination as well as self-deception among medical workers', according to anthropologists Irwin and Jordan. There has been little attention paid to medicine's role as an agent of social control and the arbiter of reproductive behaviour, according to Stephenson and Wagner. They suggest that the medical profession makes arbitrary decisions in individual cases and attempts to intervene in problems that are essentially social in nature. In cases of forced intervention, criminal sanctions for foetal abuse and attempts to limit the practice of midwifery, home birth, or the operation of alternative birth centres, 'medicine has been complicit or proactive in attempts to control the behavior or health care options of pregnant women.'
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Tuesday, April 21, 2009

Jennifer Block responds to Hannah Rosin

In The Backlash to Breast is Best: Why exactly is breastfeeding under attack?, Jennifer Block responds to Hannah Rosin's article "The Case Against Breastfeeding." Towards the end, Block argues that the problem isn't breastfeeding--it's the tremendous obstacles American women face in initiating and sustaining a breastfeeding and mothering relationship.

We tell women that breast is best, we tell them to breastfeed exclusively for the first six months, we even tell them it will raise their kid's IQ (and we should give that a rest), and then we send them home with formula samples, or with a baby whose throat is too sore to suckle, or a mom whose milk is delayed because of surgery, and we don't teach technique, and we are offended when a woman breastfeeds in public, so we make her feel housebound, and we don't give a mother and her partner paid leave, and we send her to go back to a workplace without on-site childcare, and so her only alternative to formula is to plug her nipples into a machine, and if she's lucky she gets periodic breaks and a "non-bathroom lactation room" in which to pump, and if she's not she gets a toilet, and so on and so forth....

It's not simply the milk that's inimitable; it's the mothering. (Indeed, "We actually don't know if feeding infants human milk has the same benefits as breastfeeding," says Labbok.) And mothering is something that our culture does not value enough to support. It is this dissonance between physiology and culture that has women so frustrated, and feminists like Rosin grasping at the bottle as a proxy for equality....

Why did American feminism evolve in such a way that we think of biology as destiny, and that destiny as a prison? Why are we so willing to surrender the parts and processes that makes us female rather than demanding that society support them? We've broken down doors and cracked glass ceilings, when what we need to do is redesign the building.

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Monday, April 20, 2009

Breastfeeding and eye contact

TopHat wrote a great post about how to be comfortable around breastfeeding. Her comment about eye contact was particularly insightful:
Like a friend of mine said, "It's like when you're with a friend at an ATM--do you try to look away when they put in their pin or do you continue facing them in conversation?" I was afraid that the mom would be nervous if I was looking at her. Would she be uncomfortable if her baby popped off and I saw a millisecond of nipple? I realized something though: if she's comfortable to be breastfeeding in front of you, then she's comfortable with whatever you might happen to see, so just keep talking and enjoying yourself. Would you turn away if she was handing the child pieces of fruit or crackers?
Before I had a child, I remember having the same thoughts myself: where do I look? do I try and act casual and pretend I don't notice at all? do I make a comment about her nursing (positive one, of course, but it would draw attention to the fact)? Once I had a nursling of my own, I got so used to seeing & doing breastfeeding that I never had to think about the eye contact question again.
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Sunday, April 19, 2009

Guess & win!

Let's guess the weight, length, gender, and birthday of baby Freeze #2! The person with the closest guess will win this Second Womb ring sling:

Pink & green jacquard ring sling: The warp and weft are different colors--green and pink--resulting in a shimmery, iridescent appearance. The fabric is a stiffer weave, similar in texture to taffeta or dupioni. The sling rings and decorative stitching are pink. Available in medium or long. 100% polyester.

How to enter:
  • Leave a post guessing the baby's birth date (50 points), gender (10 points), weight (20 points), and length (20 points). The best score out of 100 wins the contest!
  • Zari was born at 38 weeks exactly at 7 lbs and 20" long. Today I am 38 weeks and 1 day from LMP.
  • Contest is open until the baby is born!
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Friday, April 17, 2009

From UC to a midwife

A blog reader, Emily, recently sent me this email in response to my post about not staying true to my word. I'm reposting it here with her permission. I agree with her about the need to move away from the nebulous slogan of "trusting birth" and towards "taking responsibility."

Thanks so much for writing a lot about your journey from a UC to a midwife. I also UCed my last baby, and am considering a midwife for the next, although I'm not pregnant yet. When I UCed it was definitely something I needed to do. I needed to step outside the system; to push all the boundaries, so I could know which boundaries I would like to set. Now that I've done that, I don't feel a need to do it again.

Also, having done a UC, I learned a few things: even though my husband and friends were prepared for the "what-ifs," I learned I'm not comfortable putting that pressure on them. If something were to go wrong, they had zero experience, and I'm not sure they were emotionally prepared for the fall-out in case something Really Bad were to happen. Not many people are. That's why only a few go on to be midwives/OBs, etc.

In addition to that, I found that the postpartum care offered by one of my friends was beyond valuable. If I hired someone to provide that for me, I wouldn't need to worry if my friend was unable to stay, or have to deal with her own little kids if she wanted to stay, but had to bring her little ones. And I would be guaranteed postpartum care. And the midwife would file all the paperwork for me. Not that I can't do those things myself--I already did. But honestly, it is just really really nice to have.

I find I am getting a lot of crap from my natural childbirth groups, because they all think I've become a "hypocrite" to the cause. That is completely ridiculous. It's not like I'm having a hospital birth with an epidural. It's still a HOME BIRTH! Same team! Same team! It is a symptom of a larger problem in the NCB crowd right now--the tendency to view UC as the ultimate goal; as the upper end of the NCB spectrum. But it's not. UC is not the epitome of NCB, it is the epitome of personality. UC is certainly not for everyone, and not even for every birth. It is not an indication of how much one "trusts birth."

In fact, I think we need to get rid of that phrase: "trust birth." Instead, we need to say "take responsibility." After all, if one is birthing outside the hospital at all, they must obviously trust that birth is inherently normal and safe. The point is not to have a competition over who "trusts birth" more--sort of like a game of chicken, birth-style. The point is to learn to take responsibility for your birthing choices, and decide how much responsibility one wants to have for the outcome.

I have been a subscriber to your blog for a long time now, I know you're pretty much facing the same kind of criticism. I just wanted to say I support you, and I am apparently in the same position. Good luck with your birth, and I am sure you will be happy with your experience.
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Thursday, April 16, 2009

Mothers and Babies Giveaway

Check out this fantastic giveaway at Etsy's Mothering Street Team!
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Dutch home birth study

A few days ago the results of a large study of midwife-attended births in home and hospital in Holland were published. This study examined a remarkably high number of births: 529,688 to be exact. 60.7% (over 321,500) of those were planned home births. Previously, the largest study of home birth outcomes was the CPM 2000 study, published in the British Medical Journal, which examined the outcomes of 5,418 planned home births in North America with Certified Professional Midwives.

The Dutch study concluded that "planning a home birth does not increase the risks of perinatal mortality and severe perinatal morbidity among low-risk women, provided the maternity care system facilitates this choice through the availability of well-trained midwives and through a good transportation and referral system."

In Holland, 30% of women give birth at home. Whether planning a hospital or home birth, pregnant women see a midwife unless there is a medical indication for obstetrical care (or unless they opt to pay out-of-pocket to see an OB).

This new study has been a prominent feature in the news recently, especially in the UK, where the government is attempting to expand access to home birth. Here's a sampling of some of the news articles:
And in Australia, several major papers have picked up on the study. This comes just a week or two after a national furor over several home birth deaths (which appear to have been unattended home births, but we have very little information on the details, other than what one physician reported to the media). More about this later. Anyway, here are a few media reports coming out of Australia:
Here in the U.S., we still face many challenges to making home births safe and accessible. As the study's authors noted, there are three key elements that they feel contributed to the overall safety of home births in Holland: access to well-trained midwives, a good transportation system for home birth transfers, and a referral system that allows midwives to collaborate and/or refer to specialists when indicated. In many states, women desiring home births lack access to least one or two of these key elements.

My university does not have full-text access to this journal. If any of my readers do, please send me a copy!

Article Citation:
de Jonge A, van der Goes B, Ravelli A, Amelink-Verburg M, Mol B, Nijhuis J, Bennebroek Gravenhorst J, Buitendijk S. Perinatal mortality and morbidity in a nationwide cohort of 529 688 low-risk planned home and hospital births. BJOG 2009.


Objective: To compare perinatal mortality and severe perinatal morbidity between planned home and planned hospital births, among low-risk women who started their labour in primary care.

Design: A nationwide cohort study.

Setting: The entire Netherlands.

Population: A total of 529 688 low-risk women who were in primary midwife-led care at the onset of labour. Of these, 321 307 (60.7%) intended to give birth at home, 163 261 (30.8%) planned to give birth in hospital and for 45 120 (8.5%), the intended place of birth was unknown.

Methods: Analysis of national perinatal and neonatal registration data, over a period of 7 years. Logistic regression analysis was used to control for differences in baseline characteristics. Main outcome measures Intrapartum death, intrapartum and neonatal death within 24 hours after birth, intrapartum and neonatal death within 7 days and neonatal admission to an intensive care unit.

Results: No significant differences were found between planned home and planned hospital birth (adjusted relative risks and 95% confidence intervals: intrapartum death 0.97 (0.69 to 1.37), intrapartum death and neonatal death during the first 24 hours 1.02 (0.77 to 1.36), intrapartum death and neonatal death up to 7 days 1.00 (0.78 to 1.27), admission to neonatal intensive care unit 1.00 (0.86 to 1.16).

Conclusions: This study shows that planning a home birth does not increase the risks of perinatal mortality and severe perinatal morbidity among low-risk women, provided the maternity care system facilitates this choice through the availability of well-trained midwives and through a good transportation and referral system.
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Wednesday, April 15, 2009

Midwife's role at my birth

I figured I probably should update on the conversation I had with my midwife, back when I was having some concerns about her role at my birth. So here are some excerpts from my journal, back in January, when we spoke at length about my worries:
Well, I met with the midwife today and had a very fruitful discussion and felt much better afterward. I felt like I could be completely honest and open with her, without any passive-aggressiveness or hiding of information. She asked a lot of questions that indicated she really understood my concerns. She talked about how she had seen a lot of "bossy" midwives (direct-entry ones) in action. She asked whether my fear was about having a midwife present in general, or just whether or not she'd really do what she said she'd do, in the heat of things. (And I replied: a little of both). She said she'd be thrilled to sit back and just silently observe the birth and not have to "do" anything, since usually her women want her to do more things.

We talked about some specifics like 3rd stage routines, hats/suctioning/towels (she doesn't do hats or suctioning anyway), whether or not I wanted guidance when the baby was crowning if she saw me blasting the baby out or something like a nuchal hand (I still would prefer not for the most part). I indicated my wish to have her remain silent and out of sight until I initiated contact, except of course if there was something worrisome that warranted action or extra observation (SD, hemorrhage, baby struggling with the transition to breathing). She said that she gets the feeling that I know what I'm doing and also that I am being completely upfront with her. She still would like to be in the room for the actual birth, but provided all is well would be happy to step out fairly soon after the birth and just periodically peek in the room to be sure we both look well. She said (even without my asking) that it would be no problem to only have her there and keep the assistant(s) somewhere else in the house the whole time, only calling them in in the case of an emergency. Which is exactly what I would have wanted anyway.

When we were talking about heart tones, she said that the normal protocol is, once pushing begins, to listen every other contraction but if the baby has been quite happy, she will listen less frequently, knowing the baby has the reserves to make it through labor. Good to know she doesn't have to rigidly adhere to certain protocols. There was lots more we talked about--I was there for 1 1/2 hours after all!--but I think I summarized all the basic points of our conversation....

I do admit that there is part of me having a hard time admitting that I am hiring a midwife--the vain part that does find a certain sense of pride in having an unassisted birth, the part that wants to do everything myself and sees assistance as a sign of weakness. Just being honest here; I do recognize that I have those fleeting thoughts. I know that I need to let that need for an image, a certain label on my birth, go. It doesn't matter at all, except that I am doing what is best for this particular pregnancy and birth. It is not a sign of weakness to have someone there if that is what is right.
I've been thinking a lot about how my unassisted birth has changed what I want in a midwife. This is something that I mentioned in my dissertation: women who have had UCs, and then choose a midwife for a subsequent birth, usually look for midwives who are very hands-off and who take a backseat role, rather than directing or managing the birth. I know some women really like midwives who are very hands-on and in-your-face, who coach you through contractions, give lots of direction and suggestions, provide perineal massage or support, etc. But I prefer otherwise.
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Birth quilt in progress

Here's the birth quilt pieced together. I am still waiting for 4 more squares before I can go any further (you know who you are!). Since I am a perfectionist and like things nice and symmetrical, I might make 4 additional squares so I can add two full rows, one on top and one beneath.
I made the large square in the middle. Notice the lifesize LOA baby with its head nicely tucked and the placenta high on the fundus. Just in case this baby needs some positive imagery! So who made the other squares? Clockwise, from the upper left:
  • My older sister
  • Jill
  • Kelley
  • My mom
  • Jen
  • Ellen
  • My youngest sister. I had to laugh when I opened up her square. I guess our enthusiasm for Obama does show, eh?
  • Joy aka Housefairy (I zig-zag stitched around your hearts to make sure they wouldn't fray in the wash--hope you don't mind!)
  • Jenne
  • My younger sister (the one with 3 kids, just found out #4 is on the way!). She made the applique to look like my placenta print from Zari's birth.
  • Nutrition Momma
  • Pamela aka Midwife: Sage Femme
I can feel the personalities of all these friends and family members through their quilt squares. I'm excited to finish the quilt. I'll probably hang it on the wall above Zari's bed.
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Stand and Deliver!

A recent Cochrane Review has found that upright labor positions--walking, sitting, kneeling, etc.--reduce the overall length of labor and lead to fewer requests for epidurals.
Women who walk, sit, kneel or otherwise avoid lying in bed during early labor can shorten the first stage of labor by about an hour, according to a new Cochrane evidence review. Women who labored out of bed during the early stages were also 17 percent less likely to seek pain relief through epidural analgesia, the review found....

"The ability to change positions, to utilize a wider variety of positions, and try other options, such as hot showers, birthing balls and beanbag supports, may help reduce overall pain and give women a greater sense of control over the progress of their labor," [Annemarie Lawrence, lead review author and a research midwife at the Institute of Women's and Children's Health at Townsville Hospital in Queensland, Australia] said.

When women are upright, there is also more room for the baby to move downward because the diameter of the pelvis expands slightly. This puts less pressure on nerves in the spine, which could mean less pain.

"It may also be that women are more distractible when up and moving around," Teri Stone-Godena [director of midwifery at the Yale School of Nursing] said. "When you are lying there looking at clock, it's a lot different from being up and about."
Read more about it at Stand And Deliver? Upright Labor Positions Reduce Pain, Speed Birth.

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Tuesday, April 14, 2009

Pregnant UCers wanted for Good Morning America interview

I've been corresponding with a producer at Good Morning America, and they are doing a piece about unassisted birth. They want to interview a woman planning a UC, preferably pregnant and due fairly soon, since their show will air in mid-to-late May. They'd also like to show video footage of the labor & birth if you're willing to share it. If this applies to any of you, please contact:

Mable Chan
Coordinating Producer
Good Morning America Weekend Edition
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Belly shot: 37 weeks pregnant

Now that I have those gorgeous photos that my friend Julie took last week, this picture from yesterday (37.2 weeks from LMP) seems anti-climactic...and the lighting was poor so it's a bit grainy.
Anyway I feel good. Fatigue is my biggest complaint; I often wake up at night and can't fall back asleep, sometimes for several hours. And of course I'm up 5-6 times a night to pee. I've been feeling a lot of pelvic crampiness too, as if I'm having my period--a constant low, dull ache in the cervix and pelvic bones. Nothing sharp or rhythmic like labor, but something is definitely going on down there.

I've also had to slow down physically this pregnancy. When I was pregnant with Zari, I was taking brisk walks with my dog up until I gave birth. But this time, anything more than a slow amble sets off contractions, and my belly feels like it's going to explode if I try to speed up. I've started swimming once or twice a week, and I love it; it's the only physical activity I can do without triggering contractions.

The baby has been ROT for the past few weeks, but yesterday it moved around a lot and now it's anywhere from OP to LOT to who knows where? Heart tones are in the 120s (occasionally, when the baby is sleeping) to more typical 140s-150s. Fundal height is spot on at 37 cms. So basically, nothing out of the ordinary to report.

And just for kicks, a recent photo of Eric and Zari:
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