The Big Nurse-In and Other Thoughts

Last week, a friend of mine was harassed and kicked out of a local resale shop for breastfeeding her baby.

In response, the Crunchy Moms of DeKalb (a local mothering group I helped pioneer last summer), organized a "nurse-in." (Just typing those two words together makes me smile :). Unfortunately, Greg and I had already made plans and were on our way out-of-town Thursday morning, the day of the nurse-in, but I was cheering all those mamas on in spirit, and through facebook.

Driving along Rte 64, I called my mom to check in about a few things, and to share the excitement of the impending nurse-in with her. I was laughing with excitement and just the pure hilarity of it all, but quickly sobered up as she expressed concern and even mild disgust about the whole thing (she had read the article about it in the paper that morning)...

My mom. MY mom was on the other end of the line tell me how inappropriate it is for a mom to nurse uncovered in a public place. My mom, who was with me when I nursed Lucy for the first time in the hospital. My mom, who watched me nurse (covered) in her home, at coffee-shops, and at restaurants. My mom, who cheered me on as I put together our nursing pumpkin display at Pumpkinfest last fall. MY mom, who nursed ME when I was a baby!

Now, don't get my wrong--my mom is an awesome lady. Actually, the fact that she is awesome and has a problem with open nursing got me thinking. That the mother of a crunchy-granola-lovin', tree-hugging, garden-growing, nature-loving, one-grain-short-of-a-hippie daughter would still have a problem with this sort of thing.

And it got me thinking about my pre-mommy days, when I, too, was a little appalled when I saw or heard of a mother nursing her baby without a cover. Even after I had Lucy, though I had no problem nursing her in public, I always did it with my trusty hooter-hider covering me and my tiny baby. At church, I even retreated to the sectioned-off area in the nursery designated for nursing moms only. (Why I felt comfortable nursing Lucy at Borders but not at church is beyond me, and probably worthy of its own blog post...).

I have really grown a lot in my understanding and appreciation of the breastfeeding relationship since becoming a mother, and especially since becoming a party of the Crunchy Moms. Just being around other moms nursing comfortably and openly around each other in a public place has been so liberating! I'm sure with our next child I'll be even more open and comfortable with nursing in public.

But then I think again about my mom, and so many others who have just not been exposed enough to breastfeeding as a beautiful, normal, and essential activity, and have been exposed too much to breasts as strictly sexual objects.

With Lucy, I used my cover for modesty, yes, but mainly for the benefit of others--to avoid awkwardness and making them feel uncomfortable. Really, the last thing I want is to cause a big scene or to be looked upon as some sort of lactation extremist who has no regard for others around her. But the first thing I want is for our community and our culture to look kindly upon breastfeeding mothers, even when the breastfeeding happens in public.

And what better way to influence our culture for the better than to be a living example of the beauty of the breastfeeding relationship, just like my friend was doing last week??

I have no idea. Thoughts?

A Week of Birthy Goodness

I have had the best week.

It started off Thursday evening with a panel discussion/presentation by five AMAZING women (including, hopefully, my future midwife!! I <3 her :). Saturday, I took part in "Birth Matters: A Whole Life Event" at The House Cafe where I was blessed with a looong but super fun day of great conversation, networking, and meeting other moms and moms-to-be in our community! DeKalb's little community of natural birth and holistic living professionals is definitely taking off, and it's so fun to be a part of it!

To top off my awesome week, I'll be presenting at the Sycamore Library this Thursday at 6:30pm at a "Meet the Doulas" event, presented by the Whole Life Education Center (more on this center coming soon!). If you're free this Thursday, stop on by! I'd love to see you :)

Extremely Normal.

(names changed for the protection and privacy of the family and midwife)

Sometimes I wonder what runs through most people's minds when they hear of couples who choose homebirth.
Hippies.
Unsafe.
Reckless.
Selfish.
Extreme.

Those are certainly the kinds of thoughts I had long before my childbearing days. And my hunch is that the average person is quite similar. But while I was participating in my first homebirth this past weekend, I was struck by how normal it all seemed.

I was the first one to arrive at Mark and Karen's house at 12am Sunday morning. A post-it on the door read "come on in," and Mark came downstairs to greet me. It was dark, quiet, and peaceful. Karen was upstairs in their bedroom in early active labor (she had been contracting since 5am). She looked really good in-between contractions, and asked if she could get me anything (the true spirit of a mother!). I noticed her tensing up and straining her face during contractions, and my doula instincts kicked in as I encouraged relaxation, promising that it really would hurt less if she relaxed!

Thier midwife, Julie, arrived at around 12:30 with a calm and confident presence, and it was amazing how she blended seemlessly into this couple's labor. She got her things arranged on a chair in the bedroom, and showed me what each thing was in case she needed me to hand something to her (pitocin in case of hemmorage, suction tube for baby, oxygen tank, etc.). And then we waited. There was no unnecessary checking of the cervix, no hussle and bustle, no beeping machines.

Her mom and her sister arrived for help and support, and we filled the birth tub with warm water. Everyone was focused on helping Karen, and creating a comfortable and safe environment for her birth. Several hours later contractions started getting noticeably more difficult. At first, Karen would cope by stating simply "relax, relax"--almost as a reminder to herself. As it got more difficult to her, she would simply say "pain," or "hurt" as each contraction began, and then "relax." Since labor was obviously progressing, Julie decided to check her, and found that she was 7 centimeters! By this time the tub was full and warm, so Karen labored there for a long while. "It kills," "It's killing me," her chants shifted as she was deep into the hardest part of her labor. But it wasn't a cry of hopelessness or suffering. She remained present and in-the-moment, and was simply being raw and honest about the pain she was experiencing. We all empathized with her, and gently reminded her that it wasn't killing her, but bringing life. Her sister prayed for strength and comfort, and Karen called out to God as well.

Julie and I decided to leave the room and let Mark and Karen have some time to themselves before the birth of their baby. Thirty minutes later Julie decided to check her again, and found that she was completely dilated! Pushing was unusually long and difficult for a second-time mom, and after a while Julie wanted her to walk up and down the stairs a few times to encourage the baby's descent through her pelvis. She pushed in a variety of positions--lying on her side, squatting, and leaning on the bed. Finally the baby was close to being born, and Karen was lying on her side in her bed. During a particularly strong push, her water broke! Several contractions later, she pushed her baby down, and the head emerged! It was an exciting moment, but after a few more strong pushes the rest of the baby's body did not come. "Hands and knees, hands and knees," Julie commanded, collected but urgently. Karen turned over as quickly as possible, and Julie used her hands to help rotate the baby's shoulders, and hooked her finger under the armpit to help bring the baby out.

Audra Joy was born safely at home at 5:30 am. She was placed under her mother, who was still on hands and knees, and immediately latched on to nurse! We cleaned up all around them as they got situated in the bed. There was no rush to clamp the cord, and Julie made sure it had finished pulsing before she did so. The placenta took a while to detach, but it finally did and came out intact (and I got to hold it!!)

Today Julie wrote in an e-mail to me, "You saw a shoulder dystocia handled just fine at home. Baby and mom just fine. It is always such a big hassle in the hosp because most times mom has an epidural that inhibits her from moving onto hand and knees if needed. These situations can be hairy but resolved safely without being rough with the baby." People assume that hospital birth is a much safer option, but I observed the opposite. If this mom was in the hospital and had an epidural, the outcome could have been dire.

Mark and Karen were anything but reckless, or selfish, or extreme people; they were a kind, loving, and educated couple. They worked beautifully together to bring life into the world in the comfort and safety of their home, with the help of their family and midwife. Driving home I realized that though viewed as a radical choice, homebirth truly is extraordinarily normal event.

My Dilemma

My daughter turned two just before Christmas, and I can just feel it. Everyone is waiting for another big announcement.

It's true that my husband and I are starting to think about number two. But ideally, before I get pregnant again, I'd like to know where and with whom I plan to give birth.

With my first pregnancy, it was a given. We chose OB's for our prenatal care and gave birth in a hospital--any other type of birth was just not on the radar. I used the nine months of my pregnancy to get informed about birth, and decided I wanted a natural birth for a slew of reasons... but I really didn't know a lot! I had no idea that the c-section rate for our country (and my chosen hospital) was over 30%. I didn't know what pitocin was. And I thought doulas were for women who weren't confident in their husbands ability to support them in labor.

Against all odds, I was blessed with an amazing birth experience in the hospital, in spite of its routine procedures and distractions. My labor started spontaneously at 38 weeks on the nose, and I was able to stay at home until I was 7cm dilated, enabling me to have a truly intervention-free birth!

Since becomming a doula, though, I have realized many sad realities of the way birth is treated in our country--both through reading books and from firsthand experience as a doula. So despite my great experience in the hospital the first time around, I am plagued with the knowledge of what could happen should things not go as smoothly for me as they did the first time.

I've thought and thought about my options (and regretted the lack thereof), and I just cannot decide. Some days (usually after attending a hospital birth) I think, "No way. I am not doing that again." Other days, I feel like homebirth is just not worth the hassle.

So I thought it'd be helpful to write out a list of pros and cons. Here they are:

Hospital Birth.

Pros:

• I've done it once and had a great experience. I could probably do it again.
• I really do like my OB's, in spite of the way they sometimes practice.
• The hospital is equipped with a level 2 nursery should my baby need immediate medical attention.
• Both my doctor's office and the hospital are a mere 3-minute drive from my front door.
• Insurance would undoubtedly cover our expenses.
• Maid service.
• Room service.

Cons:

• One in three pregnant women who walks into our hospital walks out with a scar on her stomach. C-sections have many risks, the greatest of which is maternal death (which is why our nation's maternal mortality rate is shockingly high).
• Pitocin (which is not even approved by the FDA for non-medical induction NOR have any studies been published on its long-term affects on mom or baby) is given without a second thought to a large majority of laboring women.
• Because I will probably be diagnosed with gestational diabetes again, the doctors will threaten induction at 38 or 39 weeks. Now I know that I can refuse to be induced, (and I believe that in most cases induction is more risky than waiting for labor to begin on its own). But I've seen how much stress is caused by women butting heads with their doctors at the end of pregnancy. It can be so so stressful and terribly unhealthy.
• If my water breaks before labor begins, I will be on the clock. (They say a woman has 24 hours to deliver after her water has broken because of "risk of infection.") What she usually doesn't know is that if she is at home, and there are no doctors sticking their fingers up her vagina, the risk of infection is next to nothing. AND labor almost always starts up naturally within 48 hours.
• I will be cared for under the medical model of care as opposed to the midwifery model of care.

Homebirth.

Pros:

• My primary caregiver will be a midwife. This in itself is a very enticing factor.
• I will be cared for under the midwifery model of care as opposed to the medical model of care
• Statistically, planned homebirths are just as safe for babies, and are actually safer for moms.
• Countries where homebirth is normal and common have WAY better outcomes than we do in the United States.
• I will be able to spend my entire labor in the comfort of my home.
• Family members (my mom & my sister) will be able to be a huge support and help to me during my labor.
• I could labor and/or give birth in a tub.
• I will be in my own clothes.
• I will be able to eat and drink freely.
• My daughter could be involved with the birth, depending on the time of day.

Cons:

• Having to deal with the hassle of well-meaning albeit ill-informed friends and family members.
• If my baby needs intense and immediate medical care, I won't be at a hospital. (Although midwives are equipped to deal with most medical emergencies and our hospital is a mere three minutes away).
• The closest legal midwife is about an hour away. That means driving an hour for each prenatal visit, and risking that she may not make it in time if I have a quick labor (which I likely will).
• The closest "underground" midwife (that I know of) is about 30 minutes away. If I choose her, our chances of insurance covering the birth are slim to none. Plus my husband is uneasy about hiring an underground midwife (despite the fact that these midwives are legal in over half of the 50 states).

So there you have it. Honestly, I'm not 100% comfortable with either option, and ideally would choose a birth center for our next birth if it were an option. (The closest one is in Oak Park--an hour away, depending on traffic). There, I would be cared for by midwives in a home-like setting, in a facility that would be able to handle any unforseen medical emergencies. Another option would be seeing an OB in Sandwich (30 minutes away) who is not quite as intervention-happy as the OB's here in DeKalb, and would truly support me in my desires for a natural birth. (The C-section rate at his hospital is 24%). I could also see midwives who practice at a hospital in Aurora.

Aargh. I hate having to make this decision. I guess I'll do a little more reading and interview a few more midwives and that OB from Sandwich, and trust that my path will be made clear. There's really no rush to make a decision... at least not for now :)

I Think This is Why I Love Birth So Much

It's totally unpredictable. And you can't control it, no matter how hard you try.

I got a call last Sunday morning from a client's husband saying that his wife's water had broken. And she wasn't due until the end of September. Surprise! Luckily, I wasn't in Chicago visiting my sister, or in another state visiting friends. We were in town, so I dropped everything, grabbed my doula bag and put my DONA pin on my shirt, got my family situated with basic instructions and frozen pizza, and headed out the door. And despite the many interventions used to get this baby out, I loved it. It definitely wasn't an ideal birth, but I loved that I got called when I least expected it, and stayed up all night when I wasn't planning on it, and witnessed the absolute miracle of a child being born on a Monday morning when I otherwise would have been sleeping.

When people ask me why I am a doula, or why I love birth so much, I usually say something like, "I just love to push my body--it's such an empowering accomplishment!" or "I love trusting that my body can do what it was created to do!" But last night I was lying in bed thinking about it, and I realized that the real reason I love birth so much is because you can't control it. Unlike almost everything else in this on-demand culture, labor and birth cannot be manipulated to happen when and how we want it to. Not that people don't try, but when they do, a less-than-ideal outcome usually results.

Labor connects us with our bodies in a very unusual way. It just happens, and it doesn't stop until the baby is born! It takes a great deal of determination, focus, and self-discipline to come to grips with this fact, to turn inward, and let your body do what it was made to do. No matter how little sleep you're running on. No matter what time of day or night. No matter if you had plans to go shopping that day. Birth demands that you drop absolutely everything and come face to face with who you are in your deepest, most intimate parts.

At the birth last week, the mom said, "I wish I could just take a break from labor for a little bit, go out and grab some dinner, and then come back." I totally empathized with her, but the reality is that she couldn't! And that's the beauty of it.

There is a power in being powerless. In trusting that someone much greater than you has you in his hands. There is a beauty in giving up the control that we so desperately struggle to have every single day--in joyfully submitting to the power of labor and the divinely inspired design for birth. It is so empowering to be free of fear, in spite of the pain and your lack of control, and to embrace every single moment with thankfulness and trust.

And this is why I love birth so much.

A Birth Story

One of the many things that comes along with having me as a doula is a written birth story. Here is an example of one, from my last birth...

Madeleine’s Birth
28 June 2010

I got a call at around 5:45 on the morning of June 27th, saying that you had been having some consistent, albeit not too painful contractions since 2:30! You and Rob were both taken off guard because you were expecting the contractions to be coming more like 20 to 30 minutes apart, as opposed to the 5-6 minutes apart that you were experiencing. Since it was obviously early labor (and would be for a long time!), you labored at home with Rob all day.

I got another call that evening a little after 5. You said the contractions were becoming more uncomfortable, and we decided that I should come to your house in a half-hour or so. Christina (the doula-in-training) and I arrived there at around 5:45, and your contractions became more spaced out—up to nine minutes apart! We had a hunch that the new people in the room caused your body to slow down a bit, so you and Rob went for a walk at around 6:30 to try and get things moving again. It seemed to work, because when you got back at around 7:30 you were saying that your contractions were “not fun.” You were coping very well, though, standing up and pacing through each one, sometimes leaning on Rob or against a wall. You also started experiencing nausea around this time. Rob offered to get a saucepan in case you had to throw up. :)

At around 9:00 the contractions were getting more painful and closer together, so we decided to head to the hospital. We walked into the emergency room entrance, and the guy at the front desk tried to make you sit down in a wheelchair to go up to the maternity ward, but your contractions were much more painful when you were sitting, so you fought it. He eventually gave in and let you walk. When we got upstairs, they checked you in to triage, and our nurse, Gina, checked your cervix. Unfortunately and surprisingly you were only 1 to 2 centimeters dilated. This was super discouraging news, but you took it really well. After talking it over with Rob, you decided that you wanted to go back home to continue laboring there.

Shortly after we returned home, your body decided it was time to get down to business. Your contractions almost immediately picked up in both intensity and frequency (though they were never a consistent amount of minutes apart). At around 11 pm you noticed some bleeding when you went to the bathroom. Rob called Dr. Kruskol, who reassured you that it was most likely from the vaginal check at the hospital. You continued laboring upstairs with a fan blowing on you, while munching on frozen blackberries—it was HOT! We placed the exercise ball, which Rob had thankfully blown up earlier in the day, on the end of the futon. You got into a rhythm of lying down on the futon between contractions, and standing up and leaning over the ball during them. You and Rob were both so very tired, since you had been awake and in labor for almost 24 hours. You wanted so badly to be able to lie down during the contractions, but the pain was just too much! You had to stand up in spite of your exhaustion. You were also struggling with nausea, but were never able to throw up and relieve the sickness you were feeling. This was definitely active labor, and you were handling it so well in spite of the heat, your tiredness, feeling sick, and the intense pain.

At around 1 am, I suggested a shower to try and help with the pain, and you reluctantly agreed, but because of the heat it wasn’t much of a help. You and Rob got out after a short 10 minutes or so, and your contractions were becoming closer together, averaging at 4 to 6 minutes apart. We headed back upstairs, but after a several minutes of very frequent and intense contractions, we decided it was time to head back to the hospital.

We entered the emergency room entrance for a second time, and this time you could not talk them out of making you use a wheelchair. So you sat down, but every time a contraction hit, you made the guy pushing you stop the chair so you could stand up and lean on one of us for support. At around 2am, we arrived in triage and Gina checked you again—you had progressed to 7 to 8 centimeters dilated!!! There was a lot of blood, and your very intense contractions were right on top of each other. Your body was quickly approaching full dilation!

We were sent to room 2606, and you were hooked up to a fetal heart rate monitor and a capped IV was put in your arm. You were feeling a lot of pressure and shortly thereafter you began to feel an urge to push. Gina checked you and you were at 9cm. She told you not to push, but you couldn’t help it! I helped coach you through those contractions with light breaths, and finally, at around 3am, you were given the go-ahead to start pushing! That strong urge to push had gone away, though, and you were unsure about how to do it. But after a few good tries you were really making progress. Gina was checking you during one of those initial pushes, and she said she felt the baby’s head move down over an inch! Despite your tiredness and the extreme pain, you had so much power and strength!! The pain of pushing actually seemed to frighten you, but the nurse and I assured you that it was normal, and you buckled down to get your baby out.

At 3:12am Dr. Kruskol checked you and confirmed that you were fully dilated, and the baby’s head was moving down through your pubic bone. We could see her hair and her wrinkly little scalp! You were so focused and determined. Finally, at 3:36am Madeleine was born into the world, and was placed on your chest right away. All the pain and pressure of labor was immediately gone, and you were completely enraptured in your new little one. “Oh my god, she’s so little!” were your first words after seeing her. Rob cut her cord, and you and Madeleine were both anxious to breastfeed as the doctor was stitching you up. When he was finally through, you and Madeleine settled in for a nice, long nursing session. She latched on immediately and nursed contentedly for at least an hour—the first hour of your family’s new life together.

One more reason not to get induced...

Today I received the latest edition of DONA's International Doula publication, which I love. So I gave myself a much-needed break from mommy-hood (while Lucy was napping, of course) and sat out on the back deck with a glass of water and my new magazine, for what I thought would be a nice, relaxing little respite.

But after skimming through the opening pages, I came to the cover story, "Is Pitocin Associated with Childhood Autism?" and my mental state of relaxation quickly shifted to shock and alarm, and increased with each paragraph as I read.

I learned that in 1980, only one in 5,000 children was diagnosed with autism. Each year, this number has been climbing rapidly until today, when one in 110 children are diagnosed with the disorder. Shocking, I know. Extensive studies have been done on the possibility of a connection between vaccines, genetics, and environmental toxins and autism, but only recently have they begun to address the possibility that autism could be caused or triggered by the ever-increasing medical management of birth.

A letter written by an association of midwives was published in Autism Today, which stated that "...virtually 100% of medically managed births are subjected to a high level of pharmaceutical interventions that have never been approved for use in fetuses. It seems prudent to research the possible association with pharmaceutically augmented labors [with Pitocin] in an attempt to discover the cause of the rising tide of autistic disorders. It may be necessary to amend our current obstetrical practices..." Ya think!?

Also in the letter was cited the complete nonexistence of autism in children who were born under the midwives' care, with no medication during their mothers' labors (the practice is 20-years old).

The article went on to discuss further the probable connection between Pitocin and autism by addressing the fact that natural oxytocin is also called the "love hormone," and autism seems to be the absence of the ability to express or experience feeling, empathy, etc. In an article published in Newsweek in 1996, Dr. Eric Hollander (Director of an Autism Disorder program in NY) says that "Most of the mothers of patients we see have had Pitocin-induced labor," and that "Pitocin somehow messes up the newborn's oxytocin system, producing the social phobias of autism."

Actually, oxytocin is currently being used in autistic adult patients in a nasal spray. Benefits of the medication are an increase in "sensitivity, generosity, and trust," as well as inscreased "eye contact, facial recognition, social cues, and identification of emotions," which further demonstrates the hormone's connection with emotion and love. Research has already proven that autistic people have lower levels of oxytocin than normal.

Here's one more quote and then I'll wrap this up... Dr. Michel Odent, author and childbirth expert, states "we are learning that, among humans, the period surrounding birth is a period of dramatic reorganization of central oxytocin binding. Artificial induction of labour creates situations that undoubtedly interfere with the development and the reorganization of the oxytocin system in such a critical period." The information we glean from this quote, and the countless other studies and statistics on interventions during labor and birth, should be a serious reminder to us all that the natural birth process should not be tampered with unless absolutely necessary.

Now I know that this is pretty scary information, and probably almost every mother reading this has had Pitocin given intravenously at some point in her labor, either during or after birth. I also know that sometimes the use of Pitocin is necessary for a healthy outcome, and by all means the benefits of its use sometimes outweigh the risks. The last thing I want is for you mothers to feel bad, or guilty, or fearful for your child's future. But I DO hope that this encourages you to continue becoming informed and empowered for future births, and that you'll be able to spread the word to other mamas-to-be so that they can make the best choices for themselves and their babies. And by all means, get a doula, as their presence during labor has been proven to make labor progress more rapidly, minimizing the risk of your need for augmentation by Pitocin.