The Doctor is In

Josiah is two weeks old today. How can it be, we've only had him two weeks and he is such a part of us, such an integral part of our family? We had our first visit to the pediatrician yesterday. She offered me formula, in case of an emergency. I tried to envision some emergency, short of a coma or death, that would induce me to give my little guy formula. Funny, I couldn't think of a one. Other than the formula offer, (and I still can't figure out why she felt compelled to ask ME that, twice!) Josiah was in fine form and had gained a pound. He had a little jaundice the first week but it had mostly cleared up by yesterday, to my relief. When last I worked in the hospitals (earlier this year) the bilirubin protocols were simply out of control. Picture two pages of algorithms briming with risk factors (of which breastfeeding was one), designed to keep kernicterus on high alert. (There must have been a high dollar malpractice suit here in town lately.) I was concerned that the Ped would want bili levels but she was satisfied that he was fine, (as was I). We did have to have his PKU redrawn. The midwife did it but it came back. What an ordeal! It took forever to get it done in the hospital lab, but fortunately, Josiah slept through the procedure. The lab went and got someone who was good at baby sticks, so I shouldn't complain about how long it took. We talked about immunizations (which I do 'selectively'). I must say, it's nice to have a Ped that I don't have to argue with about this. I've had to change Peds over this issue in the past. All in all, my Ped and I don't tend to bump heads, but I'm skittish about Peds in general. I do think they tend to be lukewarm on breastfeeding when they should be (in my opinion) its biggest promotors. I did love the fact, that as we went from the Ped office to the hospital lab, I realized that Josiah had never been in a hospital nursery, out of my sight. I took such comfort in that thought. The Ped also asked about a circ, which I refuse to have done. What a horrific procedure to inflict upon a newborn, and for what? I'm tired of the AAP's lukewarm policy on circs (changed 3 times in the last decade) this last time to say nothing definitive. But Josiah will, like my younger boys, remain intact.

Josiah also attended his first play yesterday, as he and I and my 18 year old went to see my friend Julie in the lead role of "The Hiding Place" the story of Corrie Ten Boom, whose family hid Jews in their home during the German occupation of The Netherlands. I had read the book when I was in my twenties and remembered it in detail as the play progressed. It was a stunning performance (Josiah slept through the whole thing) and I was so proud of Julie, and got to tell her so, as she cuddled Josiah after the performance. There was a scene where a young Jewish mother with a newborn came to the Ten Booms seeking refuge. I held Josiah tight thinking what would I do if he were in danger, at risk in some way. How I would give my very life to preserve his. His little life is in my hands. It is at once a joyous and somber task. He makes me want to be a better mother.

Processing the Process

My doula, Nadah came over yesterday so we could chat about the birth. I love an opportunity to talk about it with someone who witnessed it and may have a different perspective on things. She said she had never seen anyone give birth upright on their feet before. Perhaps its just a fluke, but I had my last 4 babies that way, it just seems right for me. She also said I seemed very calm. I think thats because all my processing was internal. It was very hard for me to come out of myself. Plus, I'm not a worryer by nature. I assume things will go fine, and then if they don't, I start to worry at that point, not before. Nadah also said she felt like she didn't do much. I had to laugh since her presence was the only one I was really registering and felt essential to my ability to cope. We talked a little about what I wrote about not liking the assessments and interventions. I do think most of that was tied to the realization that I did those things to women (and much much worse) as an L&D nurse without realizing the impact it had on them. We also talked about the documentary. I meet with Larry and Lucy next week, before they return to the UK to look at some snippets of what they've put together and get some final postbirth footage. Nadah seemed surprised that I want no input in the production of the film, but I think it will be more powerful if they edit it as they see fit from an outsiders perspective. I know they've learned a lot just going through the birth of their own daughter the past year. I trust them, to do justice to the project. I'm excited for the film, but its really their work. My work is to finish the book by the end of the year. My head is swimming with ideas. I am equally afraid and excited.

Sweetylicious

Following the birth, my kids all came down to see the new baby. I remember sitting on the sofa (covered in plastic) and cuddling Josiah. After the placenta came, only a few minutes later, we decided to move upstairs to my bedroom. I walked up the stairs and settled into bed. My bleeding was still free flowing so I took some po methergine and a little later a shot of pit. I felt fine, and was mostly just focused on the baby. A little while later my husband bought me a plate of pancakes. You know how the first food you eat after labor tastes so good. Those pancakes were like manna from heaven. All tucked in with my baby, I felt so pampered. A little while later after the doula, videographers and midwives had left I snuggled with the baby and napped. I had made several attempts to nurse him, but without success. It took him the better part of the day to get the hang of things. A week later he's doing great. Working with Josiah on breastfeeding has made me think a great deal about how I worked with my patients in the hospital. Josiah sleeps a lot. I never stress if he's been asleep for four hours or six hours till he eats again. But in the hospital we doggedly had to document breastfeeding every 2-3 hours or hear about it from the oncoming shift nurse. It feels so luxurious to feed him when he wants to be fed, not when someone else thinks he should be, to never have him out of my sight, not to have to send him to a nursery to have them do things to him that I can't see (things I used to have to do to babies). I feel overjoyed that I get to do things my way, and at the same time, guilt that other women were and are denied this same luxury, guilt that I denied them these things. I so treasure the ability to birth this way, to recover this way, to parent my baby this way. Every time I make one of these little "discoveries" it makes me renew my vow, never to return to hospital nursing. How can I? How can I choose to care for women in a way that is so personally unacceptable to me? I want women to know instead, how this feels. How it feels to birth and breastfeed intuitively and to trust one's own wisdom is such a gift. I love spending my days cuddling with my sweetylicious. To watch him nuzzle at the breast, even watching him sleep is a marvel. This is my little guy, my little baby. I grew him, and birthed him, and now I nourish him with my own milk. I inhale his baby sweetness and feel great contentment.

Birth Musings

I spoke to Lucy (the videographer) a couple of days after the birth. I found out later after the birth that the filmmakers actually missed the birth. I was in transition and not terribly aware of my surroundings. I had long ago drowned out everyone around me and retreated into my labor. Just prior to my pushing the midwife had sent everyone upstairs for breakfast. Apparently my husband was making pancakes (I didn't even know he was gone!) I didn't know that only the doula and midwife remained as I entered into that very last contraction. I just assumed that as Iwent into that one and only push that someone was standing behind me to catch! My doula was there, but she was the only person I actually saw. Fortunately the midwife was there to catch, but unfortunately it was her apprentices turn to catch. (Sorry!) When Kirsten caught and passed the baby between my legs, I saw the nuchal cord and passed the baby back (between my legs) to Kirsten again. (I couldn't lift the baby up to me because of the wrapped cord.) Kirsten unlooped the cord (that explains the decels) and passed him back to me. He was squalling his head off and was so slippery I almost dropped him, but just then my husband was by my side helping me grab him. I lifted him up and saw that little penis. Oh, a boy, I just knew he was a boy. My little boy, Josiah. I realized in that moment that I was meant to have him. We had selected his name years ago. I wanted to name him after my father-in-law who died a few years ago, and whom I miss dearly. I knew I would have a little boy named Josiah when I was in my 20s. I had predicted as a child that I would have 9 children (one of my cousins reminded me). Once I held his warm, wet, squiggly body next to me, I just knew it was meant to be. Josiah, Josiah what blessed luxury to hold you in my arms and inhale your sweet baby smells. I spend hours just looking at him, I can't get enough of seeing him, holding him, smelling him. I love the look of bliss on his face as I nurse him. His little fists balled in utter concentration as he imbibes the milk I make for him. He has captured me. I absolutely and resolutely adore him. He's simply fabulous- I love this baby.

Leaving the Cocoon

As labor progressed, Kirsten the midwife had requested hourly heart tones. I knew ahead of time that that was her protocol. Still I was surprised when I heard the decelerations down to the 80s. I knew this was not good. At Kirsten's request, I began to drink lots of water. I was content to stay in the labor coccoon and just work the contractions- that was work enough. I didn't want to deal with anything else. I was in a tug of war with myself. The decel forced me to leave to cocoon and work with my birth team as a team. Up to that point I had been flying solo. Now I had to come out and join the others. I had to admit to myself, some dependence on them. Drinking the water was an intervention (yes a simple, and effective one I know) but it still meant that someone had to intervene and I had to comply. It was another role shift- a necessary one, but one that was difficult for me to make. After the decelerations continued for a few more contractions, I was checked for dilation and found to be 6-7 with a bulging bag. Kirsten suggested breaking the water, but I was unsure. She then suggested prayer. That was the best intervention yet. Kirsten prayed. It was powerful and I knew something had changed. I continued to drink and pee, drink and pee. The contractions grew stronger and closer together. About an hour after the check, I stood up for my next contraction, the strongest yet, I felt pressure and pushed with it. I pushed again and felt the familiar burn-stretch sensation of the baby crowning. "Baby's coming" I said to whoever was near enough to hear then, whoosh, the baby was out.

The Parellel Universe of Labor

Now it is time to continue my story. When I left off, it was about 4am Saturday morning and the midwife, her apprentise, and the doula had arrived. The filmmakers were already here and sleeping in the downstairs bedroom. I had set up my birth space downstairs in the family room because my bedroom was too small, and I don't birth on a bed anyway. The doula arrived and bought her big birth ball which would turn out to be my best friend in labor. I had one also but is was smaller and as we later found out, had a slow leak in it. The doula, Nadah was lovely and wooed me with herbal teas and a scented hanky. She put my frangrance, lavender, on a hanky and I kept it near me my entire labor. She changed the scent as I entered transition to clarysage, and again to rose postpartum. I don't know how it helped or why, but I sniffed it all through my labor. Its still sitting on my dresser with the rose scent still on it and I smell it several times a day. Nadah always stayed near, but didn't speak much. When I needed her she was just there. She made a few suggestions for this and that but mainly I appreciated her presence. She did provide counter pressure toward the end that I found invaluable- hers was the only touch I wanted- not even my husband's would do (he wasn't doing it right anyway). Anita, the apprentice arrived just shortly before the midwife. She immediately wanted a set of vitals. I quickly realized that not only was I going to be annoyed by interventions (of course there had not been any yet) but that even assessments were a constant irritation. I submitted without comment, but inwardly I knew I had not prepared myself for the interruption of assessments- vital signs, heart tones and the like. These simple seemingly uninvasive procedures made me feel like a patient- the very feeling I was hoping to avoid. Yet there it was staring me right in the face- patients require baseline assessments. How many times had I done these procedures on women without thinking what an intrusion and irritation they are? I didn't like the feeling at all. I could dish it out, but I couldn't take it. I birthed at home to avoid being made to feel like a patient, yet a simple request for vitals brought it all rushing back to me. I immediately thought about my conversation the previous day with Dotty about autonomous birthing. She and her husband had six of their eight children at home, unassisted with her husband catching. I had toyed with this idea many times, but was committed to the presence of a midwife. I realized that just as the presence of filmmakers would be a sacrifice of privacy in this birth, so would the presence of a midwife represent a sacrifice to some degree of my autonomy. After the midwife arrived the whole entourage moved downstairs to the birthing space. The filmers woke up and started filming. I cleansed the room with my burning sage, gifted to me at my blessingway by Sr. Morningstar. I lit my candle and insence and put my selected CD into the player. The music was short-lived as the filmerstold me it was copyrighted and couldn't be a part of the film without permission. It was turned off. Another sacrifice. I was laboring heavily at this point and needed to focus on the contractions and worked hard to shut everyone else out- it wasn't that difficult. My husband was upstairs sleeping and I decided I wouldn't send for him till it was time to push. I knew he was tired, so I just let him sleep. The doula, my hanky, and the birthball were all the tools I needed. Between contractions, I sat on the sofa with my eyes closed. I could still hear their whispered conversations but was glad noone tried to address me directly. During contractions, which were deep and hard, I stood up, Nadah put the ball on the sofa and I leaned onto it and rock back and forth, stretching my legs far apart and standing on my tippy toes. When the contraction ended, I sat back down again with my eyes closed. I had no interest in communication with those around me. I only wanted Nadah to be there with the ball, giving counter pressure, to pick up my hanky if I dropped it, or to refill my water bottle. This was my whole world. Managing the contractions and resting between them. I had a thought- this is too easy, I should make it seem harder or they won't really believe I'm going to deliver in the next few hours. There were no vag exams so up to this point no one really knew how dilated I was- we were just going by how I said I felt, the baby was low, the contractions every 10 minutes lasting 45 seconds to a minute. I knew the baby would be born in the morning but did everyone else know it? I could not or would not communicate- I only wanted to cocoon into my little world and be left alone.

Midwife Musings

http://topekamidwife.blogspot.com/

Here is the link to my midwife's blog, per reader request.

Baby Pics

It's A Boy!!!!

Josiah Thomas, 6 lbs. 14 oz., made his speedy entry into the world at 8:30 am this morning! He came after about 24 hours (give or take) of the lovliest labor, in one push over an intact perineum. He cried and pinked up almost immediately. More details to come later. We are both resting and doing very well. I did get a shot of pit for bleeding but nothing major. I appreciate all the love, support and well wishes received through this blog. Thanks everyone for your comments of support- they really did make the labor extra special! Blessings to you all.

Upright Birthing

It's almost 4 am. The midwife, apprentice and doula are here. I've achieved a plenary birth team at last! Baby is working its way down. Contractions are deep and hard but I dive right in. I have to stand upright for each contraction- the pain is worse if I sit or god forbid, lay down. My body wants to be upright. Everyone I've shown my birth space to, keeps saying, where's the bed? I won't birth in a bed, perhaps a squat or on all fours if I don't feel like standing. I'll do what my body tells me when the time comes. Now my job is to get through each contraction that comes faithfully every 10 minutes- the downward pressure is all encompassing- like diving into the deep end of a pool.

Labor of Love

The photos were taken by my good friend Rebecca. She is very talented with a camera, so good at getting good angles. My husband and I had a double date with Rebecca and her husband, Tom tonight. Obviously, we had to amend our plans. Rather than cancel, we decided that they would pick up dinner, at an Italian deli and bring it over. What a feast! Lasagna, stuffed portabella mushrooms, spaghetti squash, salads, and breads, and for dessert some magnificent bowl shaped cake, the inside of which was filled with Italian cream. We had the best time, talking about our kids (we met when our 15 year olds were newborns) and sharing this labor with them. After dinner, Rebecca took the pictures and helped me upload them onto my computer and into the blog. After that, we did a belly cast! I tried to get my husband to take a picture with me- it would have been a lovely contrast, his pale skin again my dark, but he refused (too shy to take off his shirt for Rebecca!) My three daughters got into the act though. Its now about 1 am. The Brits have been here filming since about 8pm. I can no longer sleep through the contractions. Thats when the midwife said to call her. I'll call her and the doula to come now. The contractions are about every 10 to 15 minutes but hurt like crazy and last at least a minute and the pressure is so low. I always labor at night and birth in the morning, so I think this is it.

Labor Neclace

Labor Photos

From Active Back to Latent

Just as I was going to call my doula to come over this morning, I felt an incredible drowsiness come over me. I decided, why call her to watch me nap? So I napped first. When I woke up my contractions had spaced out few and far between. Oh well. I took advantage of the lull and ran some errands, you know, bank, store, post office, that sort of thing. Stopped by the office to check the mail. When I got back, I was in the mood for another nap, so I slept some more. I'm just getting up, its about 3pm. Still contracting intermittently with pressure on my bladder, I know the baby has moved down. I'll call my friend Dottie to come over and visit with me a while. I'm ready for company now. I'll wait just a little bit more to call the Brits and doula, I really want to save them for active labor. My dear husband has been shampooing carpet ALL day just to please me. What a sweetie (I really did want those carpets cleaned!) Right now I noticed our bathroom needs to be cleaned so I'll do that till Dottie gets here.

My Birth Plan

Birth Plan

My plan for this birth is that it be (birthing) woman-led which includes the following tenets:

· No interference or medical intervention without medical provocation
· Respect for intuitive wisdom and knowing of the mother and caregiver
· Obedience to the mother’s bodily wisdom and functioning
· Limited reliance on technology and pharmacology
· Positive and readily available emotional and physical support for mother and caregivers
· Silence when requested, and respectful speech and touch
· Presence, when desired, of those who have been selected by the mother to
support the birthing process
· Recognition of mother and baby as the primary focus of the birthing process
· Responsible and informed decision-making
. Faith in divine design and reliance on divine presence

Friday the 13th

Well it looks like Stephen Covey and the DMV (Department of Motor Vehicles- for my international readers) will have to wait. It looks like my baby will be born on Friday the 13th. Good thing I'm not (too) superstitious. I got up at midnight awakened by contractions, cleaned house until 3am, then took a much needed snooze. Mercifully, I slept till 7am, even though the contractions kept coming every 10 minutes and actually got stronger. I did feel them in my sleep but they didn't wake me. I can only attribute that to the prayers of so many. I really needed the sleep. Using the pain scale (0-10), I would rate my contractions right now as a 4-5. Pretty painful, but manageable. I'll call the Brits over now, and my doula. The midwife doesn't want to be called till the contractions are 5 minutes apart, but I'll give her a head's up around 8am. The kids are out of school today (how did that happen?) but I'll call my mother-in-law to see if she will take them costume shopping or something. All is proceeding well, baby is kicking a lot, and the sleep has renewed my energy.

From Latent to Active

I went to bed at 9pm and woke at midnight with contractions 10 minutes apart. Not sure whether or not to start calling folks, or try to sleep some more. Decided on laundry instead. Will clean a little and get things ready first.

The Prodromal Ooze

No new news to tell. The cramping continues, but is harder to ignore. Went to the elementary school to help with the haunted house- part of my room mother duties. I'll be working behind the scenes to get the Halloween party done, since I probably won't be in actual attendance. I feel slow, and heavy, like I have maple syrup for blood. Tomorrow, if things don't pick up, I'll face my greatest challenge yet- go to the DMV to get my new liscense. Its time to do it, and I'd rather get it done BEFORE the baby comes. I already went once but the computers went down shortly after I arrived and there were like 30 people in front of me in line. (That place really is like purgatory.) I'll try and get there as the doors open and hopefully get it done fairly quickly. I also want to get in a trip to the library and get some reading material for when I'm resting after the baby. I've been wanting to read Stephen Covey's new book and a few others on leadership and marketing. The kids are out of school tomorrow and want to shop for Halloween costumes- we'll see if I have the energy for it. I may punt that task to my husband. I'll turn in early tonight and get some extra rest.

Sweets for the Cantankerous

Having a lovely day. I went for my massage this morning. It was heaven on earth. Nadah is a master with her hands. After the massage, we talked about my birth plan and how she could best serve me as a doula. I still keep going back to my desire for woman guided birth. I think everything is flipped. Everyone in the room should be taking their cues from me and following the direction that my body leads. As the person experiencing the birth, I should be giving directions, not following them. Thats my birth philosophy in a nutshell. Still cramping/contracting intermittently, but mostly ignoring them and going about my business. Working on my corn chowder, doing laundry, and organizing the linen closet. Nadah inspired me to get out the candles, incense, and soft music. I so enjoyed all those elements at her place this morning. Since I was in the neighborhood, I stopped at my favorite chocolatier's and purchased some nice chocolates, just because.

Night Moves

The mild cramping has definately transitioned into uterine contractions, albeit, mild to moderate ones. Its about 4:30 am, got up to get a drink of water and pee and wanted to post. I'll try to sleep a couple more hours then get the kids up for school. I did about 4 loads of laundry last night, but resisting the urge to start another. I still need to vacuum downstairs also- will start that after kids are up and going. I think I'll sleep better if I plan my work. I'd like to get in a massage tomorrow and a quick trip to the library- we'll see.

Good Night and Good Luck

As soon as I icing my cake, I'm going to bed. Husband should be home a little before midnight, kids all sent to bed. Mild cramping unchanged. I'm hoping to have another day or two (I refridgerated my food, it'll keep) to get more stuff done. I really really wanted the carpet shampooed and hubby promised to do it for me tomorrow if I haven't delivered! Tomorrow I'm making corn chowder and will maybe go for a massage- also need to order more lungs for my manikins. I'll post again in the morning.

The Beat Goes On

My blissfully quiet afternoon is past. Now the kids are home and want dinner. The mild intermittent cramping continues. I've made a lasagna and a pot of chicken noodle soup for labor food for my helpers. I've washed all my bed linens and set up my birthing space. I haven't called anyone to come over yet, still too soon to tell if this will go anywhere. After I get the kids some dinner, I think I'll bake a cake.

Have Chux, Will Travel

I lost a little bit of mucus plug this morning and have been cramping throughout the day. My son really saved my bacon. I had two classes to teach today and he came through and taught both of them for me. What a relief. I came home after helping him get started with the first one and packing for the second one. Now I can concentrate on getting my house ready for the birth. My birth kit came in the mail today (in the nick of time) so I'll be busy setting things up and cooking some more. Don't know if this will turn into real labor yet, I just want to be ready if it does. The kids are all at school and hubby's at work. Its nice to have some quiet time.

38 Weeks and Counting

No baby yet! I've spent the last several days trying to learn to add photos, links, and other stuff without success I'm afraid. I've started several blog entries but couldn't complete them. I guess its back to plain old text for now. I've been in a flurry getting things ready for the birth. I ordered my birth kit (I shouldn't have waited so long) and am assembling other things my midwife requested. I'm cooking and freezing food, and purchased a new nursing gown and sling. The crib is assembled and all the baby's things put away. We had to rearrange our bedroom to fit it in, but it looks nice. I made a stunning discovery. I reported last time that I had Braxton Hicks contractions, but now several days later, I don't think I've had any. I think I only dreamed every night that I was having them- crazy huh? I haven't had one uterine contraction during the day, only vague remembrances of having them in my sleep. I'm almost sure now that I only dreamed that I was having them. The only discomfort I continue to have is this unrelenting heartburn, but I know the cure is coming. I'm writing my birth plan and my to do list is growing shorter every day. Still lots of cleaning and organizing around the house to do but everyone is pitching in. I hate to leave the house these days but still have several classes to teach. I'll have to teach till I go into labor, still short of trainers, but it can't be helped. Still easily annoyed but not yelling as much. I was greatly annoyed today when I went to the breastfeeding store to purchase my sling. The owner of the store was telling me about mutual aquaintances who both delivered their babies by induction last week, one for postdates, the other because she wanted to deliver at the same time as the first so they could share a hospital room (You see the hospital where they both worked and were delivering is remodeling so everyone has to double up while the construction is going on. She chose to induce so she could bunk with her co-worker rather than a stranger.) If that isn't the stupidest reason for an induction I've heard yet, please enlighten me. Have you heard anything stranger than that one? If so, please share. In fact lets take a poll, please share for all our devoted readers the strangest/goofiest reason for an induction that you've ever heard of. Stories like this make me want to climb on the roof and shout to the world that this is why I'm having my baby at home- to counteract all the madness in the world surrounding birth. What kind of dumbshit induces because her friend is inducing? Especially when she's 37 weeks and the friend is postdates? What kind of dumbshit doctor goes along with it? Even in plain text, I bet you can hear my annoyance.

From the Sublime to the Ridiculous

My midwife sent me this great list of research abstracts from the Lamaze International website:
(I bolded the meaty parts and put my (smart ass) comments in red)


Home Birth and Breastfeeding May Set the Stage for Healthy Immune Systems in Infants (Cool!)
Penders, J., Thijs, C., Vink, C., Stelma, F. F., Snijders, B., Kummeling, I., et al. (2006). Factors influencing the composition of the intestinal microbiota in early infancy. Pediatrics, 118(2), 511 - 521. [Abstract]
Summary: In this prospective cohort study, researchers examined the influence of several factors on the microbial environment of infants' gastrointestinal tracts. Fecal samples from 1,032 infants between 3 and 6 weeks of age were collected by the parents and presence and quantity of various "beneficial" (e.g., bifidobacteria and lactobacilli) and "harmful" (e.g., C. difficile, E. coli, and B. fragilis) species of microbes were determined by polymerase chain-reaction tests. The study took place in the Netherlands where home birth and exclusive breastfeeding are common. In this study, 47.5% of the infants were born vaginally at home (n = 480), and 70% were exclusively breastfed during the first month of life (n = 700). The cesarean-section rate was 10.7% (n = 108).
After adjusting for confounding factors, infants born by cesarean section had a significantly higher rate of colonization with C. difficile and lower rates of colonization with bifidobacteria and B. fragilis than those born vaginally at home. Each day of hospitalization after birth was associated with a 13% increase in the rate of colonization with C. difficile. Exclusively breastfed infants were significantly less likely than formula-fed babies to be colonized with E. coli, C. difficile, B. fragilis, and lactobacilli. Term infants born at home and breastfed exclusively had the highest numbers of bifidobacteria and the lowest numbers of C. difficile and E. coli compared with any other group of infants.
Significance for Normal Birth: The newborn's gut, sterile at birth, rapidly becomes colonized with millions of microbes. The number and type of gut flora have been shown to influence immune system development, the risk of allergies and asthma, and metabolic functions such as the production of vitamin K.
In normal vaginal birth, newborns encounter their own mother's microbes during the critical first hours. Some of these microbes are beneficial and promote healthy gastrointenstinal development. Other microbes are pathologic (may cause disease), but maternal antibodies, passed to the baby via breastfeeding, help ensure that the baby tolerates their presence. When a baby is born by cesarean surgery and/or subjected to prolonged hospitalization, unfamiliar hospital-borne pathogens such as C. difficile dominate the microbial environment of the newborn's gut. Minimizing the baby's contact with these harmful organisms by avoiding hospitalization for normal birth while maximizing newborn's exposure to antibodies and beneficial microbes by promoting exclusive breastfeeding may decrease the likelihood of newborn infection and optimize the baby's developing immune system for lifelong health benefits. (I love this finding- more proof that the hospital environment in and of itself can be toxic to the newborn- yet another reason to breastfeed, you can bet I'll be bringing this up at my next LLL meeting.)


Physiologic Pushing, Birth of the Head Between Contractions Reduce Genital Tract Trauma at Birth
Albers, L. A., Sedler, K. D., Bedrick, E. J., Teaf, D., & Peralta, P. (2006). Factors related to genital tract trauma in normal spontaneous vaginal births. Birth, 33(2), 94 - 100. [Abstract]
Summary: This secondary analysis of a randomized, controlled trial of perineal management techniques evaluates the maternal and clinical factors associated with genital tract trauma during vaginal birth. The researchers analyzed data from 1,176 midwife-attended, spontaneous vaginal births where episiotomy was not performed.
Greater maternal education, directed pushing while the woman holds her breath, and higher infant birth weight increased the risk of trauma requiring suturing in primiparous women; however, birthing the infant's head between contractions reduced the risk of trauma requiring suturing. In multiparous women, prior sutured trauma and higher infant birth weight increased the likelihood of trauma requiring suturing, and birthing the infant's head between contractions was protective.
Significance for Normal Birth: This study provides strong evidence that two modifiable factors may reduce trauma to the mother's genital tract at birth: physiologic pushing (when the woman follows her own urge to push without direction from maternity-care providers) and birthing the baby's head between contractions.
The authors note "a calm and unrushed approach to vaginal birth improved the health of new mothers by lowering overall trauma rates and reducing the need for suturing" (p. 99). In normal birth, the woman follows her own body's cues to give birth. (What?? Women following their own internal cues to push??? What kind of madness is that? Everybody knows purple pushing is what gets the baby out! Besides, who cares if women's coochies get all torn up- they should just be happy to have a healthy baby. After all, we'll sew them back up and even put in an extra stitch for Daddy!)Attendance by caregivers who are confident in normal birth, such as the midwives who conducted this trial, supports the natural unfolding of the birth process and, thus, reduces maternal injury.


Quality-Improvement Study Finds Induction, Early Labor Admission Predictive of Cesarean Surgery in Low-Risk Mothers (no shit, Sherlock)
Main, E. K., Moore, D., Barrell, B., Schimmel, L. D., Altman, R. J., Abrahams, C., et al. (2006). Is there a useful cesarean birth measure? Assessment of the nulliparous term singleton vertex cesarean birth rate as a tool for obstetric quality improvement. American Journal of Obstetrics & Gynecology, 194, 1644 - 1652. [Abstract]
Summary:This prospective, quality-improvement study provides data on the association between elective obstetric practices and the cesarean-surgery rate in "nulliparous, term, singleton, vertex" (NTSV) births (those with one baby born in the head-down position after 37 weeks to a mother who has not previously given birth). The American College of Obstetricians and Gynecologists and the U.S. Department of Health and Human Services have identified the NTSV cesarean rate as an appropriate proxy for the cesarean rate in low-risk mothers. The study took place in 20 birthing units in a large hospital system that serves a diverse population of childbearing women.
Researchers analyzed 41,416 NTSV births taking place between 2001 and 2003. Data on the frequency of induction of labor prior to 41 weeks, admission in early labor (less than 3cm dilation), and 5-minute Apgar scores <> 25%. Statistical tests of the correlation between NTSV cesarean rates and low Apgar scores failed to reveal an optimal NTSV cesarean rate but demonstrated that lowering the rate to 19% did not compromise newborn outcomes. Some of the hospitals with NTSV cesarean rates below 19% had excellent newborn outcomes while others in this category showed the possibility of increased risk to newborns. Due to this wide variation the researchers call for further research into the conditions that support both low NTSV cesarean rates and favorable newborn outcomes.
Significance for Normal Birth: Low-risk nulliparous women are 4 - 10 times more likely to undergo cesarean surgery than their multiparous counterparts, and this population contributes significantly to the overall increasing cesarean rate. This study suggests that induction of labor and admission in early labor are strong determinants of the rate of cesarean surgery among low-risk women giving birth for the first time. This is of particular concern because, in today's climate, almost all women who give birth to their first child by cesarean will go on having surgical births for all their future children. Although the study did not differentiate among elective or medically necessary inductions, the authors acknowledge that many inductions in low-risk nulliparas are purely elective or performed for "soft" indications (i.e., those without evidence-based medical rationale). The study suggests that the wide variation in NTSV cesarean rates across hospitals has less to do with intrinsic differences in the populations of women served than with the hospitals' obstetric practices. Expectant families should be counseled that avoiding unnecessary inductions and laboring at home until an active labor pattern is established are two of the most important means of avoiding cesarean surgery. Choosing the birth setting carefully, with attention given to rates of elective and routine obstetric practices, may also help avert surgical births. (This one really pisses me off- how many times did I see this as an L&D nurse (and with my daughter-in-law)? Potentially perfectly normal labors and births ruined by arbitrary inductions and interventions. This is why normal healthy first time 20-30 year olds can't have a damn baby. Once they have that first cesarean they are forever branded, internally and externally as being unable to birth vaginally. They think they can't birth vaginally and the system works to deny them VBACs for subsequent births. Early admission can be a big culprit, these first-timers fall off 'the curve' before they're even on it. If Friedman were still around, I'd bust a cap in his ass.)


Cochrane Systematic Review Confirms Effectiveness of Breastfeeding for Reducing Procedural Pain in Newborns
Shah, P. S., Aliwalas, L. L., & Shah, V. (2006). Breastfeeding or breastmilk for procedural pain in neonates. The Cochrane Library, Issue 3. [Abstract]
Summary: This systematic review by the Cochrane Collaboration evaluated the effectiveness of breastfeeding or supplemental breast milk on pain in newborns undergoing painful procedures. The researchers extracted data from 11 studies that met predetermined eligibility criteria for inclusion in the review. All of the studies compared the effect of breastfeeding or supplemental breast milk versus a control intervention on pain in newborns during a single procedure (heel lance or venipuncture). Pain was determined by physiologic (heart rate, respiratory rate, etc.) and/or behavioral (cry, facial actions) indicators. In some cases, validated composite pain scores were used. Both term (≥ 37 weeks) and preterm (<>In this case, strong evidence emphasizes the role of breastfeeding in alleviating pain in newborns undergoing venipuncture or heel-stick procedures. Whether the mechanism of pain relief is the comfort of being close to the mother, the sweetness of her milk, the hormonal composition of breast milk, or a combination of these factors remains to be determined. Although many different interventions were compared with breastfeeding in the 11 studies included in this review, breastfeeding was consistently beneficial. The evidence is compelling enough to command a change in the practices of all birth settings where infants are denied breastfeeding during painful procedures. Nonseparation of mothers and infants and unlimited opportunities to breastfeed in the newborn period are the culmination of normal birth and optimize mother-infant bonding and the breastfeeding relationship. When painful procedures are necessary, these care practices also optimize pain relief, potentially decreasing trauma to the newborn and reducing anxiety in the mother. (I've been glad to see more attention paid to neonatal pain. Remember the days when it was thought babies couldn't feel? Perhaps hospitals could look at letting mothers nurse babies during heel sticks and other pain-inducing procedures rather than the use of sugar coated pacifiers, sucrose water bottles and other artificial agents.)

Lunch with the Girls

My midwife and her apprentice did a home visit yesterday. Plans are moving along nicely. I need to order my birth kit, but otherwise have what I need. We talked about the possibility of a postpartum hemmorhage and her management protocols. She uses pit, rectal cytotec, and methergine (no hemabate). Sounds okay, I never saw cytotec used for anything but inductions in the hospitals around here. Its nice to know for precaution. We talked about emergencies. My back up hospital is 7 minutes away (if its not rush hour) and there should be no impediment for ambulances should one need to be called. I've decided to deliver downstairs in the family room rather than our bedroom, since its so cramped. There is a bathroom down there, the laundry room, and two bedrooms (belonging to the teenagers). The downstairs is much cooler (temperature-wise) and a lot more spacious. The space needs to accomodate myself, husband, midwife, apprentice, doula, and the Brits for filming. The whole thing is beginning to feel like an orchestration- one I'm starting to get a handle on.
Finally found the baby bed I wanted, after 3 stores. Hubby can put it together today so I can organize baby's things.
Two of my girlfriends who missed my shower took me to lunch at one of my favorite haunts and gave me the stroller that was on my registry list. How sweet! I felt so loved and pampered. I shamelessly ordered whatever I wanted off the menu. They took me to Webster House, a turn of the century converted school, that now holds a fancy imported antique shop downstairs and an equally fancy restaurant upstairs. I love going there, my favorite former boss is manager there so I get to visit her whenever I stop by for lunch. The restaurant is first rate. I ordered tenderloin blue cheese soup to start, Croque Monsiour for main course (fancy french grilled ham sandwich), my favorite peach ginger tea to drink, and black and white bread pudding for dessert. I tasted my friend's parsnip and lobster bisque, but like my soup better. I think I smiled all the way home. I just felt so full- not just of good food, but of good love and acceptance. My visit with Sarah and Kathleen was such a lift to my spirits. They are long time friends. We knew each other when we were all struggling, single moms. We talked about how our children have grown into adulthood, and second generation motherhood (we all have a new younger set of children), our husbands (some marraiges turned out better than others) how life changes and becomes more wonderous as one ages, and lifestyle. They quizzed me about our move to the suburbs last year, they both live next door to one another in the city in a neighborhood I can only fantasize about, full of the most fabulous turn of the century mansions. I had to confess, after a lifetime of city living, the move to the burbs was not traumatic. I have wonderful neighbors, and my kids go to good public schools (though I miss the historic old houses and ancient tree lined streets of the city). This conversation gave me such perspective on how much we've all grown as women. Its such a sweet thrill for me to see my friends children grow into adulthood and watch as they bloom- Sarah's daughter persuing an acting career in California, and Kathleen's son entering law school - the same with my girlfriends how we grow and change and absorb the lessons of life and become who we were truly meant to be. Of course we talked about the baby as well. I still have no idea how this baby will fit in my life- but I'm gaining a stronger sense that he or she should be, even must be in my life. Kathleen asked a marvelous question. She asked why I think this pregnancy came into my life and what the lesson was? I confess I probably won't begin to know the answer except in retrospect, but I like the idea of pondering it. A sense of peace came over me as I thought about her question- driven by the notion that the pregnancy was no accident after all, but very intentional (if not on our parts- surely by greater divine design) that all of this was meant to be. I've fought this idea for many months now, choosing instead to cast myself as a victim, but now I let it wash over me. What if my life is not ruined or even inconvenienced, what if I was meant to have this child at this time of my life? The reasons have yet to be revealed but the master plan was set in place long ago. I feel a shift in my perception, a desire to embrace was has come upon me and a sadness at its lateness in coming.

The Angst of Uncertainty

I'm tiring more easily these days. Its nice to be home and not running around to appointments though. I'm working on press releases and drumming up PR for the upcoming birth/documentary. I feel a sense of angst- not sure why- all the birth blogs have been so heavy and downbeat of late. I should probably stop reading them for a while, but I can't- too addicted. Will what I'm doing make even a drop in the bucket's difference? I just don't know. All I know is I love birth and want to make a difference. I'm offering all that I can- hoping there will be an impact.

One Mean Mama

Boy am I getting cranky. I yelled at the kids all night last night. I stayed away from them because I didn't think I had enough impulse control not to take a swing at one of them. I'm incredibly discontent with my husband and saying the meanest things to him. I'm a straight shooter, but not ususally this bad. Why am I being so mean? I hope I'm not like this for the birth, being bossy and pushing people around. Part of me thinks its hormonal, part of me thinks that no excuse for bad behavior.
I have a new doula. My initial doula was overcommitted with school, and such, so I let her off the hook and asked someone else. The new doula, was the same one with my son and his wife, and with the Brits. She's one of the best in town, and a massage therapist to boot. Nothing will be ready when the midwife makes her home visit- oh well, I still have a couple more weeks to prepare. The main thing I want to talk about is the birth itself and her treatment protocols for postpartum hemmorhage- the one complication I think I'm at risk for and only because its baby number nine. I've been drinking my uterine stregnthening teas and have never had a problem before- just covering my bases. I'm feeling stronger and stronger about a hands off birth. I don't know why I feel so strongly about not being talked to or touched, but I do. Is this an outpouring of my newfound crankiness or am I just feeling the need to truly birth independently?