Whose birth is it anyway?

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Why does it seem that so much about birth has to do with who controls what? For many people who choose to give birth outside the box, some of the most irritating things about the hospital environment have to do with control. The hospital seems to have a great need to control every aspect of the birth and hospital stay of the mother and baby. They have rules about just about everything!

  • There are rules about the birth tub — IF there’s a tub, you can stay in it for labor, but typically not for the birth, and sometimes not at all if your membranes have ruptured (depending on the hospital).
  • There are rules about the hours that your loved ones can be with you — partner 24/7, grandparents can stay until midnight, children until 8pm, etc.
  • Rules about bathing your baby — the baby is considered a biohazard, so most hospitals require the baby must be bathed ___ hours after the birth.
  • Rules about whether your baby can go home in the car seat you brought with you — don’t even get me started about the car seat test!
  • Rules about whether you can even take your baby home from the hospital — can’t take the baby home if you don’t have a car seat. Not a bad rule, but a rule nonetheless.
  • Rules about doulas — some hospitals don’t even allow them!
  • Rules about what you can eat and drink — pretty much nothing, although your labor partner should eat and drink frequently to keep his strength up. (Hmmm… who’s the one laboring here?)
  • Rules about the Vitamin K and Erythromycin ointment — they look at you like you just grew a third eye if you even question it.
  • Rules about how many people can be in the room — usually no more than 3 plus the laboring woman (depending on the hospital, some are more lenient) and usually only 1 if the birth is a cesarean birth. But, there can be as many hospital staff members as the hospital wants.
  • Rules about having to have an IV — must have it unless your doctor “allows” you to opt for a hep-lock instead.

Yeesh! All of those rules! How does the presence of these rules affect a laboring woman? My thought is that just having someone else calling the shots on things you may or may not care much about, hands your power over to that person or institution for the things you do very deeply care about. The woman gives up her power and her responsibility to think for herself because the institution has a rule for every decision she would normally have to make for herself. Giving up this power and responsibility for the most basic decisions about food, comfort, companionship, and her baby’s treatment puts her in a position of relinquishing control of the bigger decisions by default. She’s already accepted the hospital and doctor as the decision makers for her basic needs, so how could she have the gumption to question the more complex decisions they make for her? Birth becomes something that is done to her, rather than by her.

When listening to women talk about their hospital births, how often do you hear something like this: “I’m not sure why, but they did ____ to me. I’m sure they had their reasons.” Or, perhaps, something like this: “The doctor allowed me to _____.” Something like that would just not fly in midwifery care! In midwifery, the woman takes part in just about every decision made. She becomes informed about the options available, she learns about the objective evidence regarding the risks vs. benefits of those choices, hears her provider’s perspective about her own clinical experience, considers that information along with her own goals and preferences, and then makes a decision about her care based upon this informed choice process. This participative style of decision making is the cornerstone of midwifery care.

Are there rules for out-of-hospital birth with midwives? Sure, of course there are. Each midwife has her own practice guidelines, and there is a community standard of care, but midwives support the mother’s informed choices, even if those choices are not exactly the choices we would make for ourselves. Skip the eye ointment and the vitamin K? If you’re informed about the risks and benefits and feel like that’s the best choice for your family, yes, of course. Eat and drink in labor? Absolutely. In fact, most midwives insist upon it. Get in the water after membranes have ruptured? Sure, why not? Have your loved ones with you 24/7? Absolutely. We wouldn’t have it any other way, provided that’s what you want. Skip the bath? It’s your baby, why not? If someone is worried about disease, they can wash themselves after they touch the baby! Car seat? Yes, but we’re not going to do the car seat test! Ultrasounds? If you want them, you can get them, but that’s up to you. Want to catch your own baby? Go for it, but if you want your midwife to do it, she’d be happy to do so.

The point is that you have as much control as you want to have. You have choices in your birth. Your midwife might guide you, and she might point you to information to help you make decisions about your care, but having a midwife means you have the control to make the choices you believe are best. It’s your birth. You own your choices, which means you own your birth.

Home birth with midwives is not a trend. Hospital birth with doctors was a trend that lasted 70-80 years before women began returning to what they know truly works.

A Traditional Hospital Birth is an Oxymoron

Home birth with midwives is not a trend. Hospital birth with doctors was a trend that lasted 70-80 years before women began returning to what they know truly works.

When I ask someone whether they’ve considered having their baby at home or at a birth center, I often hear them respond with something like, “I decided to have a traditional birth in the hospital.” This generally makes me smile, because giving birth in a hospital is hardly the traditional way to give birth! Traditionally, women have been the healers in communities. Women have traditionally held the wisdom of the healing power of herbs, and carried the rich oral history of birth and healing from generation to generation. Traditionally, older women taught younger women how to care for their own families and neighbors, thus training the next generation of community healers. Women tended to the sick and the dying, as well as to the birthing women in their communities. The experimental way to give birth is this relatively new idea of giving birth in the hospital with doctors. It has been only recently that healing became the more male-oriented profession of medicine.

Nigerian Midwife Assisted Birth

Note the upright position adopted by Nigerian women. U.E. Egwatuatu.

Midwives have been helping women give birth since before recorded history, and most of the people alive today were born into the hands of midwives. Just a little over a century ago, in 1900, midwives attended half of the births in the US, and only about 5% of births happened in hospitals. By 1939, about half of women gave birth in hospitals, virtually all with twilight sleep. By 1960, 97% of births happened in hospitals. Why the dramatic change? Was it because hospital birth was safer?

No. In fact, when doctors first began attending births, and births began their shift to the hospitals, outcomes for mothers and babies worsened significantly for a while. The experiment was a horrible failure! Part of this decline in safety was due to a lack of care taken in prevention of the transmission of infections. Doctors would go from doing autopsies straight to catching babies, without even washing their hands. It was no wonder that infection became rampant. Once the connection was made between hygiene and infection control, outcomes began to improve. Men in obstetricsOne big reason births moved to the hospital was women’s desire for pain control. It was an attractive option for those who could afford it, which made hospital birth a show of affluence and status, as well as a desirable choice for women who were afraid of the pain of childbirth. The use of “twilight sleep,” where women were given amnesic medications during labor and knocked out for the birth, became a popular option. Doctors would have to use forceps to help the babies be born, because the mothers were unconscious and unable to push the babies out themselves. Of course, these deliveries were risky, causing a lot of damage both to mothers and babies.

Now, we have generations of people in the United States who have only known hospital births for their family members. Looking at my own extended family, I believe I may have only one living relative (other than my own children) who was born at home, and she will be 104 years old this year. Most people’s reference point for birth is that it is a medical procedure. In the media, we see hyped up shows like “Maternity Ward” and “A Baby Story” that show highly interventive, medicalized, often scary births. Most people see that as traditional, normal, and oddly somehow safer than an out-of-hospital birth, rather than what midwives know as the truth of birth: birth with midwives is traditional, normal, and safe, emergencies are rare, and birth almost always works or there wouldn’t be so many people on the planet. Midwives, and more specifically midwives who attend out-of-hospital births, are the birth practitioners who are guardians of traditional, natural, physiologic birth. We’re the only health care providers who ever see births that are truly natural.

Hospitals have made huge improvements over the years in trying to make birth more family-centered, but even the most natural-minded hospital-based practices don’t come close to a home birth or freestanding birth center experience. When was the last time you heard of a hospital birth where a woman with no IV (or saline lock) gave birth attended by the midwife she’d seen for all of her prenatal visits, birthed her baby in a quiet, dimly-lit room, and caught her own baby in a birth pool in whatever position she wanted to be in? We home birth and birth center midwives see that kind of stuff all the time. Fortunately, as people become more educated about midwifery and about the benefits of the midwifery model of care, the tide is beginning to turn. People are increasingly seeking the help of midwives for their babies’ births, and are returning to traditional care. Modern day midwives are increasing in numbers, especially in out of hospital settings. The Internet, films like The Business of Being Born and Orgasmic Birth, as well as help from organizations like The Big Push for Midwives, MANA, and NARM have all helped to increase awareness of birth options for families. The links below are full of historical information about midwifery, traditional birth, and about continuing struggles for the freedom to choose where and with whom a woman may give birth. Something to think about the next time says they want a traditional hospital birth.

The midwife difference: Are you trying to get a gourmet meal at a fast food restaurant?

I was recently at a local birth circle. It was “Meet the Midwives” night, and I was one of the midwives asked to attend and answer questions about midwifery, home birth, and birth center care. One of the attendees asked this question:

What’s the difference between the medical model and midwifery model of care?

Wow, I could go on and on for hours about that one! But, a simple analogy came to mind. I remembered something a midwife said years ago: “No matter how nice you ask, when you go to McDonalds, they’re not going to give you shrimp.” True that!

The difference between midwifery care and medical model care is like the difference between having a personal chef cook you a gourmet meal vs. going to a fast food restaurant and getting a burger.

theplantbasedblogger_comWith the medical model, you’re getting care that’s one-size-fits-all. A fast food restaurant has food that’s made in a way that’s efficient, suits the masses, and has little (if any) room for customization to your needs or preferences. The food has the minimum level of nutrition (if you can call it that) to meet governmental standards. Any quality that surpasses that minimum is seen as going above and beyond. It’s all about getting people through the line as quickly and efficiently as possible, while avoiding any major food-borne illnesses. It’s convenient, fairly cheap, available on just about every street corner, and you’ll get the same food at each restaurant of that particular chain, so you know what to expect. It gets the job done, but you may not feel great afterwards, and you may not be very healthy in the long run when you make that choice.

image6 (1)Your personal chef knows your preferences and tailors your meal to your unique needs. The meal is all about you and your experience and your satisfaction. You can make it as healthy as you want – organic, paleo, grass-fed, gluten-free… the choices are up to you. It may take a little research to find the best personal chef for you. You may have to interview a few until you find just the right one. You’ll need to be involved in making the decisions about the food they make for you. It may be more expensive to hire a personal chef, but eating that really great food instead of the fast food is an investment in your health and in the health of your entire family. Pay now or pay later, so to speak.

So, what kind of birth experience do you want? A lot of women are looking for midwifery care, but they’re trying to get that care at a place where it isn’t offered. If you’re looking for shrimp at McDonalds, you’re not going to find it.

 

9 Essential “Must Haves” for Your Birth

I posted this question on Facebook:

Mama and baby waterbirth“People ask us what to bring to their birth center birth or to have at their home birth. What is the one thing at your birth that helped you the most?” The women who responded had a wide variety of answers, but there were some common themes.

1. The Right People

The most often mentioned essential item for a great birth was some sort of support person or team of support people. Having great support, the comfort of loving touch, and words of encouragement are so important for a great birth.

“Someone whose sole job is to remind me how strong I am and that my body was made for this work.”
– Chrysta N.

“To me, all that mattered was having my people around me and knowing I was in the safest, best environment possible.”
– Liz C.

“…the most important ‘thing’ was not a ‘thing’ it was the words spoken to me and around me, the touch given to me in the form of comfort and support (sometimes literally holding me up) and the countenance of those in the room…the loving smiles and the shared joy once the baby arrived…just like with a newborn baby, lots of ‘things’ aren’t necessary for birth…it is far more important to choose your ‘company’ wisely.”
– Carrie B.

Think about who you want at your birth. Support can come from many sources, but everyone present should, ideally, support your choices and help you feel safe and loved.

  • “My Husband.”

“… all I really wanted was my husband to let me pull his hair or push on him. All the rest was nice, good friends, a good meal afterwards, snacks, a favorite robe, but I didn’t really need those things. The straw and my husband’s hair were what I couldn’t have done without.”
– Kelly H.

“…most of all, my wonderful trusted birth team and the father of my children, love of my life, my strength and my inspiration!”
– Anne S.

“For me the #1 thing was having my rock of support with me (my husband). Everything else could be left at home.”
– Lindi J.

  • Other Family & Friends

“My amazing family helped me the most!”
– Meghan H.

“My daughter. Seriously. From literally the first signs of labor, her snuggles, smiles, energy and love reassured me that every contraction was worth one hundred if I got another like her.”
– Jenn A.

  • Midwives and Doulas

“My midwife, my doula, my hubs…”
– Liz C.

“Bring Mari (doula). That was all I really needed.”
– Kate D.

“My doula and her bag of tricks.”
– Jessica G.

“The number one must-have would be THE MIDWIFE!!!!!”
– Angela S.

2. Food & Drink

Hydration during birth is super important. Water is great, but in order to keep your electrolytes in balance, varying your hydration drinks is really helpful.

“…coconut water, and labourade ice cubes…”
– Beth H.

“…plenty of gatorade!”
– Anna M.

“Popsicles to suck on, either homemade or not. I was so thrilled at the prospect of being able to eat what I wanted in labor at home, unlike at a hospital, and I didn’t eat or drink anything except water and like three popsicles.”
– Meredith E.

“…some snacks, coconut water…”
– Liz C.

“LOTS of cold water. This time, I’m planning to bring at least two huge jugs so that one will always be full and I don’t have to keep refilling my too-tiny-for-labor regular water bottle.”
– Sara D.

“Coconut water. Also, pre baggied snacks so your favorites are easily accessible.”
– Meggen H.

We’ve always included bendable straws in our home birth kit. People usually ask us “what are the straws for?” Our answer — “for drinking!” As these mamas will tell you, straws seem to be quite important!

“With my first, I made sure to bring plenty of electrolyte drinks. They were in individual containers with straws, like juice boxes. Really helped keep my energy levels up and the straw was helpful.”
– Holly D.

“A water bottle or cup with a straw.”
– Kelly H.

“Favorite drink with a bendable straw and lots of ice.”
– Anne S.

“Depends and a water bottle I could use to drink from any angle.”
– Rebecca S.

As one of our students often says, you need enough calories to get you through a 50 mile hike. While you don’t need to eat huge meals during your labor, unless you want to, it is important to eat little bits here and there to keep your energy up.

“Something you will eat and drink, even when you don’t want to eat and drink.”
– Meghan H.

“Peanut M&Ms.”
– Debbie S.

And, of course, after the birth, you’ll probably be quite hungry!

“I’d recommend some light snacks for afterward, like a double cheeseburger & waffle fries, or maybe an entire pot roast.”
– Kate D.

3. Clothing

We are often asked what to wear during the birth. Hospital gowns are unlikely to be part of your home or birth center experience. What should you wear?

“Comfy, large cotton tshirts.”
– Sheryl R.

“…some jammys to change into afterwards.”
– Liz C.

“…my favorite pair of oversized, comfy, dark-colored, yoga pants.”
– Katie R.

“Socks…yoga pants…I preferred staying clothed while laboring (it was December…cold!!). I went from the shower to the bed to birth tub then back to the bed…but I hated that my favorite nightgown was soaked. I ended up with my husbands huge oversized tshirt, which was too big and got annoying! So if I could go back…I’d have 3 or 4 of the same nightgown on hand.”
– Meggen H.

“I also brought a cozy pair of pajamas to put on afterwards. It was nice to have something from home to wear.”
– Holly D.

“The thing I greatly underestimated was the amount of clothing to pack. I had an outfit for the tub, a gown and the outfit I wore to the Birth Center. I didn’t imagine I’d get in and out if the tub several times and in an out of the shower several times. No one wants to put wet clothes back on, so I ended up naked for most of my labor. Turned out I was comfortable naked, but had I not been, I would have been very uncomfortable.”
– Jenn C.

“A comfy shirt with buttons all the way up the front. Easiest for nursing in the first hours.”
– Julie D.

Some people are happiest with no clothes at all.

“Getting naked.”
– Angela S.

Of course, clothing (for mom) is optional! Dads, bring your swim trunks!

4. Music/Videos/Distractions

Some women find it helpful to listen to music or watch movies. Early in labor, a movie can be a great distraction and can help you relax.

“My favorite Pandora station playing with some of our “special” songs was just the final touch that made (my baby’s) birth feel absolutely perfect! I can still remember specific songs playing at certain points during the labor/delivery. 18 months later when I sing those same songs to her it’s like I get to relive those beautiful moments all over again!”
– Elisabeth G.

“Something that relaxes you to keep your mind off the pain, mine was comedy DVDs…”
– Anna M.

“Harry Potter DVD. It relaxes me.”
– Hannah N.

“I watched my favorite Star Trek: The Next Generation episodes. I usually put those on just before bed, and fall asleep to them. Having that on in the background really helped me relax during the hardest parts of labor, because those shows were a relaxation trigger for me.”
– Kim P. (yes, me!)

5. Preparation

Birth is likely to be the hardest work you’ll ever do. It is a marathon. You wouldn’t show up to a marathon without at least going for a jog first, right? Preparing yourself mentally and physically for birth will help you have a much better experience.

“…overall the most helpful thing was the reading I did in the long last few weeks. Breathing exercises I learned from a pregnancy yoga book and tips/stories from Ina Mays Guide to Childbirth were the most useful things I used in labor.”
– Beth H.

“Hypnobirthing tracks….after 8 babies, I used the hypnobirthing tracks with number 9, and it was my best labor/delivery yet . Totally calm through the whole thing…and I would almost go so far as to say “pain free”….amazing!”
– Angela H.

6. Chux Pads

Chux pads are disposable pads used to catch all sorts of fluids at the birth. I was surprised to see this one on the list, but as a midwife, I can honestly say, there is no such thing as too many chux!

“Chux pads for a homebirth. They leave no trace of birth…like magic.”
– Sheryl R.

“From the Midwife perspective.. Chux pads…please have chux pads. Not newspaper, not paper towels, not extra bath towels..chux pads.”
– Jennifer R.

7. Birth Tub

Water is a wonderful tool for labor and birth. It takes the edge off the contractions and helps relax you. It is often called, “the midwife’s epidural.” It is a safe, low-tech option that many women enjoy.

“For the actual labor- the birthing tub was wonderful.”
– Makendra B.

“FISHY POOL…”
Anne S.

8. Birth Ball

Birth balls (aka yoga ball, exercise ball) are a great tool for birth. They come in various diameters to accommodate women of different sizes, and can be pumped up to the level you find works best for you. Birth balls can be something to lean on when you’re on hands and knees, and can be used to help the baby descend into the pelvis. Sitting on the ball and rotating your hips can help with discomfort during the contractions, too.

“A nice, firm yoga ball.”
– Sara D.

“For three births now, it’s been a birth ball. That’s what got me through labor and helped baby descend and my pelvis open up (roll those hips!)”
– Amy D.

“…I used my exercise ball to help me through both labors.”
– Kelly B.

“It’s funny, because I only used it for a few minutes at E’s birth, but I hung on my birth ball for almost the entire birth with M. That thing was a life-saver, as that was truly a freight train birth at just under 2 hrs. It gave me great support in a number of positions while I tried my best to relax and surrender while AJ was on the road back home. So, I say birth ball.”
– Kimberly F.

“…birth ball, birth song list, candles (flameless or real), Christmas lights, nursing bra and sarong.”
– Anne S.

9. Other Comfort items

“…beloved rice sock (more than one so there is always a warm one available), lavender oil (a few drops on the rice sock or in the birth pool).”
– Anne S.

“Some essential oils”
– Hannah N.

“Ice packs (that’s right, plural) for afterwards.”
– Angela K.

“Rebozo, for someone to do the double hip squeeze for hours.”
– Amy B.

“…birth affirmations, a yoga ball, wash cloths for cooling down.”
– Jessica R.

“Chapstick. Lotion. Post birth…pads, peribottle, soft icepacks, and plenty of people to help you at home!!”
– Meggen H.

“Birth affirmations were also very helpful and essential oils you think you might like to use.”
– Jenn C.

“Gum. lip balm. super cold pregnancy tea. music playing in the background. multiple tank tops (in case the others get wet). personal fan (I was always burning up).”
– Rissa J.

“If you have a pillow you love, you need it. Bring the things that give you comfort when you’re sick – maybe your thing is a rice sock or a nice smelling blanket – bring those things.”
– Natalie E.

“Didn’t help with labor but birth photos are priceless. Camera for birth and/or the first newborn pics.”
– Beth H.

You are unique. You will likely find other things that will help you during that time, but this list can give you a head start. Have a great birth!

P.S.: After your birth, come back and let us know what helped you most!