Sundance Doula

15 Reasons to Exclusively Breastfeed

2010-09-11T08:55:00.000-07:00

1. Breast milk sugars give infants a protective coat

2. Breast milk is so beneficial even HIV positive mothers are encouraged to nurse their

babies

3. Nursing mother's don't feel guilty about not nursing

4. Breastfeeding cuts risk of SIDS in half

5. Breastfeeding until 4 months is linked to lower rates of respiratory and

gastrointestinal infection

6. Formula makers have been lying to you about the safety and benefits of formula

feeding

7. Breastfeeding reduces risk of diabetes

8. Not being breastfed has a statistically significant association with ADHD symptoms

9. Breastfeeding cuts breast cancer risk

10. Early bottle feeding with cows milk (i.e. formula) may play a role in the development

of constipation and anal fissure in infants and young children

11. Infants who are strictly breast fed are more resistant to tooth decay

12. Breastfed infants have higher IQ scores

13. Breastfeeding enhances the antibody response to vaccines

14. Formula feeding in the first few days of life may lead to obesity

15. See the video below:

NRP Certified II

2010-09-02T19:11:00.000-07:00

The following was written in December of 2009. I saved it as a draft and promptly set it aside, needing to get my client's permission prior to publishing it. I got busy... life went on.

Having finally decided to spend some more time writing, I realized it was time to clean it up and share it. Client's permission has been obtained.

December 26, 2009

I've been processing this for a few weeks now and I think it's about to time to share it. If it wasn't for my attendance at a neonatal resuscitation class last month, this story may have turned out much differently.

I attended ahome birth on December __. The midwife and her assistantleft four or five hours after the birth. Approximately 20 minutes afterthey left, the baby began to change colors (he looked rather purple), suddenly made a strange sound and stoppedbreathing.

It was one of the scariest moments of my life. Iwas so terrified I was going to have to resuscitate this little guy andI'd have no idea what I was doing. I wanted the floor to open up andswallow me up. His parents were pretty much frozen.

Ipicked him up, laid him flat on his back and made sure his airway wasopen. I remembered the first thing to do is to stimulate the baby (checking to see if the baby was in primary apnea and praying that he was... to whom I was praying, I have no idea) so Ijust started tickling the bottoms of his feet with my nails. I did itfor about 10 seconds (maybe less? maybe more?) and he got MAD. He sucked in a big breath andstarted screaming his head off. It was one of the most beautiful soundsI've ever heard in my life. Within seconds he was pinking up again.

Dad called the midwife and she said just to keep a close eye on him. About ahalf hour later Baby spit up a big wad of phlegm and he's been doing justfine ever since.

I am so VERY grateful I attended that class (literally, only about 3 weeks prior to this birth),but even more grateful that I studied for it. Otherwise I would have been totally and completely unprepared.We'd have had to call 911 and that little guy would have ended up beingtransported and subjected to all kinds of hideous interventions at the hospital.

It wasa great experience for me because I got a very tiny taste of what itwould be like to be the midwife responsible for the mother and baby...things don't always go smoothly and when you are the only personavailable to provide potentially life saving care to someone... whoa. Imean... whoa.

Sometimes things just happen fora reason. I'm not a religious person... but if I ever were toreally believe in God... well, it would be an event like that thatwould do it.

American Academy of Pediatrics - Neonatal Resuscitation Program

American Hearth Association - Infant CPR

Search Terms

2010-08-31T21:16:00.000-07:00

Inspired by Navelgazing Midwife, I decided to take a look and see if Blogger offered any sort of functionality to see what search terms people have used that ended them up at my blog.

The winners are...

banning of anesthesia by catholic church in childbirth

Wow. I suspect Catholic women around the world would revolt in the millions. Probably not a good idea if the church wants to stay in business.

birth centers v. home births

You can take your pick. Personally I prefer home. Read more here.

birthing centers san fernando valley

I'm not aware of any, but there are several fabulous midwives that do home birth in the valley.

moorpark catholic church

catholic church augora hills california

catholic church in oxnard ca

carmelite monastery carmel ca

catholic churches in santa barbara california

I can explain. I wrote a scathing blog about local Catholic hospitals earlier this year. I just think its interesting that someone looking for a church would click on a search result called Sundance Doula Blog.

Go figure.

Fetal Heart Rate Monitoring

2010-08-12T21:04:00.000-07:00

TEST LEADS TO NEEDLESS C-SECTIONS

I came across this article in June. I read it. I re-read it. And re-read it again. This is what I found most chilling: "No test is perfect. But almost every time we whisked a mother back to the operating room, and I cut through skin, fat, fascia, and finally the muscle of the uterus, expecting a blue, floppy baby, the child I delivered emerged pink, healthy, and a little bit angry."

I have been exceptionally lucky in my (still somewhat new) career as a doula. Only a handful of times have my client's had "bad strips". But the last two births I attended caused me to finally write about this.

Client A was planning a home birth with an obstetrician and a midwife. She labored throughout the night and finally began pushing around 5:30 in the morning. The midwife, working as the obstetrician's assistant, hand-held a doppler to my client's abdomen every few contractions and occasionally in between contractions. As the baby progressed through the birth canal, I could hear his heart rate slow. I was exhausted, having only had three hours of sleep in the previous thirty-six hours and I couldn't remember if we were supposed to listen for six seconds and multiply by ten or ten seconds and multiply by six. Luckily as the doula, it was not my job and I continued to assist my client with her concentration and pushing. Regardless, I was hearing a heart-rate at a bit under one hundred beats per minute.

As the baby began to crown, the doctor instructed my client to reach down and pull out her baby. He said something like, "Reach down and pull out your baby. He may be a little floppy, but he'll be okay". Client A reached down as her son turned, slipped her hands under his little armpits, he opened his eyes and gave out a cry. He was not yet out past his belly, yet he was most definitely NOT floppy. He was pink, breathing and crying. His APGARS were 9 and 10.

22 hours later I was at the hospital, waiting for Client B to deliver her baby. I wasn't actually with Client B during her delivery. When I arrived at the hospital, Client B was being rushed off to the OR. She had arrived at the hospital at 8-9 cm dilated, but the baby's heart rate was very low. He was having huge decelerations during contractions. In between contractions, which were coming every couple of minutes, his heart rate would recover somewhat, but never above 110 beats per minute. During contractions it would plummet to around 60 beats per minute. My client's doctor rushed her off to the OR with the intent of trying a vaginal delivery, but told her an emergency cesarean may be necessary.

Luckily, Client B was able to deliver vaginally. Out came a pink, breathing baby that cried just a few seconds after being born. Client B, her husband and new son joined me back in the labor and delivery room less than 20 minutes after the birth.

All of this caused me to wonder... I could HEAR these babies heart rates myself. They WERE low. No one was making it up, no one was misinterpreting the low heart rates. But BOTH of these little boys were born perfectly healthy. Neither one needed to be resuscitated, neither one was floppy, neither one was blue. So what do low heart rates mean?

The American Academy of Family Physicians says, "The major risk associated with electronic fetal heart rate monitoring is a false-positive test that may result in unnecessary surgical intervention."

They also say, "The most important risk of EFM is its tendency to produce false-positive results. Unfortunately, precise information about the frequency of false-positive results is lacking, and this lack is due in large part to the absence of accepted definitions of fetal distress."

The American Congress of Obstetricians and Gynecologists says, "Although EFM is the most common obstetric procedure today, unfortunately it hasn't reduced perinatal mortality or the risk of cerebral palsy. In fact, the rate of cerebral palsy has essentially remained the same since World War II despite fetal monitoring and all of our advancements in treatments and interventions."

They also say, "The false-positive rate of EFM for predicting cerebral palsy is greater than 99%. This means that out of 1,000 fetuses with nonreassuring readings, only one or two will actually develop cerebral palsy."

WHAT????!!! We're subjecting laboring women to a test with a 99% false positive rate that may result in unnecessary surgical intervention?

What exactly does false positive mean? Merriam-Webster: : relating to or being an individual or a test result that is erroneously classified in a positive category (as of diagnosis) because of imperfect testing methods or procedures (emphasis mine).

It seems to me that in spite of all of the fancy medical technology, we may not know what a healthy heart rate for a baby is. Could it be that we really don't know how long a baby can sustain a low heart rate? Is it possible that what is dangerous for one baby may be perfectly healthy for another? Is it possible that the machines we rely on to monitor our babies need to be calibrated? I don't have the answers... but I know what I've seen and I know what isn't working.

Home Birth in the Hospital: The Biggest Scam of All Time?

2010-06-26T18:13:00.000-07:00

A client of mine recently told me that she hoped to have a home birth in the hospital. "But you won't be at home!" I responded.

"Well, I want to make the atmosphere as cozy and home-like as possible" she retorted.

"Okay, well we can make the atmosphere cozy and relaxed" I replied, "But you CANNOT have a home birth in the hospital".

Anyone that knows me would probably agree with these statements: I'm opinionated. I'm strong-willed. And it takes a great deal of evidence to get me to change my mind once its made up. To date I've been to 28 births as a doula. I've been to the hospital before, during and after labor with several friends. And I've had my own hospital birth as well as a home birth. So far I have never, ever, not once, come close to seeing anything remotely like a "home birth in the hospital".

Lets start with the basics. Wikipedia defines home birth as: A home birth is an attended or an unattended childbirth in a non-clinical setting, typically using natural childbirth methods, that takes place in a residence rather than in a hospital or a birth centre.

So a home birth takes place at home. NOT in a hospital or a birth center.

About.com says: The word clinical comes from the Greek word "kline," which means couch or bed. Clinical medicine is practiced at the bedside or with patients who are sick, injured or otherwise debilitated.

Sick, injured or otherwise debilitated. That doesn't sound like most pregnant/laboring women that I know. And certainly not the kind of women that are seeking a "home birth in the hospital".

So where did this myth originate? I just had to find out.

My first step was to google "home birth in the hospital". And what do you know? There's a website called Homebirth in the Hospital! This website is run by a physician with strong roots in midwifery. Okay, sounds good. She believes that women that choose to birth their baby in a hospital should be able to do so without unnecessary medical technology and interventions. Okay, sounds good. Err, wait. So the women are giving birth in the hospital, not at home?

I happen to know that several local childbirth educators in my community tout this so-called "home birth in the hospital". I even understand WHY they promote it. They don't want women to go into the hospital terrified of the experience. They are trying to show their students that there are alternatives to highly-medicalized birth experiences. But are they doing them a disservice? Are these women being set up?

It is my personal opinion, that a home birth in the hospital is BS. I think you can have a good hospital birth experience. I've been to several myself. I even think it is possible to have a hospital birth with minimal medical intervention, where you are relaxed and aren't pressured by hospital protocol. But I do NOT believe a home birth in the hospital is something that women should be striving for. I believe its a set-up for a disappointing birth experience.

Let's review. At a hospital birth:
1) You WILL be subject to some medical intervention.
2) Your birth WILL be attended by people you have never met.
3) You WILL be pressured to have some electronic fetal monitoring.
4) You WILL be asked to put on a hospital gown.
5) You WILL be in a situation where you have to decline interventions you do not want.
6) You WILL be pressured to have your newborn separated from you at some point.

and perhaps most important of all...
YOU WON'T BE AT HOME!

Encouraging Joyful Outcomes

2010-03-14T17:04:00.000-07:00

Birth is a natural process. Women’s bodies were designed to become pregnant, nurture the life grow inside of them and give birth to their young. This process works well without any intervention over 90% of the time.

After attending a few rather unpleasant hospital births, I began to feel very negative about my work as a doula. I began to doubt myself and whether or not I was capable of providing the support my clients deserved. No one will be surprised to hear that I was feeling very pessimistic about hospital births in particular.

Luckily, I am blessed to have a strong network of doula-sisters that love me and challenge me to look past my frustration and negativity and work out WHY I was getting frustrated. I began to realize that I believed it was my responsibility to create joyful outcomes for my clients’ births.

When a woman chooses a hospital birth it is important that she understands she is going to be birthing her baby in an institution that has the primary goal of maintaining and increasing revenue. Hospitals earn revenue by maximizing the number patients that come through their door and the number of procedures that their staff performs. They lose revenue when they do not perform procedures, don’t fill beds with patients or they are successfully litigated. Therefore, it stands to reason that a lengthy birth with minimal interventions is not in the hospital’s favor. It also stands to reason that no matter what the evidence says, hospitals will encourage medicine to be practiced based on the ‘current standard of practice’ which likely contradict the birth plan/preferences of most labor & delivery patients. The ‘current standard of practice’ protects hospitals during the litigation process.

There are some obstetricians that literally and figuratively sabotage the natural birth process. When I say 'natural birth' I do not mean free of pain medications. I am referring to the natural process that a woman's body goes through to birth her baby.

What I have sadly discovered is that the majority of the women that seek me out for labor support do not trust their doctor. They feel the doctor is competent to handle an emergency, but they don't trust him. For example, they may be told they need to be induced because their pelvis is too small, their baby is too big, their fluid levels are low or they are a few days past their 'due date'. Intuitively women usually don't believe this... but they are too intimidated by their doctor, whom they view as an authority figure, to say 'no' or question the care provider further. When a woman doesn’t have complete faith and trust in her care provider, her decisions will be based on fear and uncertainty. My experience has taught me that decisions made out of fear or uncertainty, usually result in undesired outcomes.

Often women indicate to me that they are leaning towards a natural birth and/or a birth with minimal medical interventions, yet they are aware their care provider generally does not support that type of birth experience.

"You are constructing your own reality with the choices you make...or don't make. If you really want a healthy pregnancy and joyful birth, and you truly understand that you are the one in control, then you must examine what you have or haven't done so far to create the outcome you want."
--Kim Wildner

As a doula, I cannot create the outcome my clients want. The power is in their hands to do that. Even a birth that doesn’t go as planned can produce a joyful outcome. I offer support and guidance through this process, but I cannot create the outcome, nor do I want to. That is in the hands of the birthing woman and her partner.

The Catholic Hospital Contradiction

2010-02-25T14:15:00.001-08:00

Beginning February 8, 2010, Certified Nurse Midwives were banned from delivering babies St. John’s Pleasant Valley Hospital in Camarillo, California. St. John’s Pleasant Valley and its sister hospital, St. John’s Regional Medical Center are members of Catholic Healthcare West. Catholic Healthcare West is an organization founded by Catholic Sisters. Their website states:

Catholic tradition of using the gift of reason to think our way through our ethical obligations is strong at CHW. That’s why we take our responsibility to ask the right questions and to promote integrity both in patient care and business practices very seriously.

Because we recognize the importance of the values people bring to this ministry, we utilize explicit processes for making ethical decisions. Some decisions are obvious, some are routine, some are automatic; other decisions are more complex and may put our values to the test. Some decisions clearly touch the heart of who we are. In these instances, we want to be as clear as possible about our values, our multiple responsibilities and our mission.

In all our deliberations, we are guided by two foundational documents. Our Catholic hospitals observe The Ethical and Religious Directives for Catholic Health Care Services. Our non-Catholic hospitals observe the CHW Statement of Common Values, which outlines the values CHW shares with our secular partners.

Due to copyright restrictions, I am unable to repost the Ethical and Religious Directives for Catholic Health Care Services here. However I’ve provided a link for the convenience of my readers:

The Ethical and Religious Directives for Catholic Health Care Services

I suggest you open The Ethical and Religious Directives for Catholic Health Care Services in a separate window so that you are able to follow my comments below.

The Social Responsibility of Catholic Health Care Services

Second Mandate. The second mandate is very clear; Catholic Hospitals are mandated to ensure adequate health care to the poor, uninsured and under-insured, yet Pleasant Valley/St. John’s Hospital is not complying with this mandate. The pediatrics department recently terminated their contract with Medi-Cal, the main source of health care for the poor and needy in California. Who is needier than a new baby born into a low-income family?

Directive 3. The behavior of various administrators and physicians on the pediatrics and obstetric committees is appalling. Mutual respect is non-existent; this is evident by the poor treatment of the certified nurse midwives along with the OB committee’s refusal to work with Dr. Fischbein and create a mutually agreeable set of standards under which he could provide much needed services such as VBAC and vaginal breech deliveries.

Directive 6. One might think that a steward of health care resources would be interested in providing unique services that are those in need may have trouble accessing. St. John’s/Pleasant Valley Hospital’s illegal VBAC ban and their recent banning of Certified Nurse Midwives along with refusing to allow Dr. Fischbein to deliver breech babies vaginally is case in point.

Directive 7. In the real world ‘a workplace that promotes employee participation’ would be a workplace that would include employees in workplace policy making, particularly policies that directly affect those employees. ‘Equal opportunity for anyone qualified to for the task’ would not exclude Certified Nurse Midwives licensed by the state of California from delivering babies.

Directive 9. Professional standards would normally include employee participation, mutual respect, and upholding the church’s directives. Not lying to the media and the community which the hospital serves would also fall in the category of professional standards.

The Professional-Patient Relationship

Directive 26. Free and informed consent went out the window with the VBAC ban. Women being duped into unnecessary surgery is most definitely outside the realm of informed consent. The obstetricians serving St. Johns Regional and PV Hospital are telling women before they even leave the hospital that all future babies will have to be delivered surgically. They aren’t giving them the other side of the coin sharing the dangers of repeat cesarean sections.

Directive 28. If the “free and informed health care decision” made by a woman is to refuse a cesarean section, how can the hospital ban vaginal birth after cesarean and vaginal breech birth? Since when does a vaginal birth violate Catholic principal?

Directive 29. Most women of childbearing age believe protecting their uterus from unnecessary surgery fall under the category of ‘protecting and preserving bodily function’.

Directive 32. These hospitals are obliging women to submit to health care procedures (i.e. cesarean sections) every day! If a woman tells her obstetrician that she believes a repeat cesarean imposes excessive risks and burdens, St. John’s Hospital physicians are currently mandated to insist on performing the surgery despite her decision. THIS IS HUGE! THIS POLICY IS BEING VIOLATED EVERYDAY BY THE PHYSICIANS AND HOSPITAL POLICY.

Forming New Relationships with Health Care Organizations and Providers

Directive 67. I think St. John’s has a scandal brewing already. They’ve gotten a lot of bad press over the last few weeks and the last time I checked there were some angry pregnant women with signs marching out in front of the hospital.

I implore you. If you are Catholic, please contact your priest, monsignor or bishop and/or write a letter to the Vatican. If you know someone that is Catholic, please let them know what is going on with these hospitals and ask them to get involved. If you aren’t Catholic and don’t know any Catholics, you can still reach out by writing letters, making phone calls, and letting the hospital administration know their policies are not okay with the people in the community they serve.

Contact Catholic Healthcare West

Sheila Browne, RSM
Judy Carle, RSM
Lillian Anne Healy, CCVI
Maureen McInerney, OP
Patricia Rayburn, OSF
Judy Rimbey, OP
Susan Snyder, OP
Lloyd H. Dean, President/CEO
Catholic Healthcare West
185 Berry Street, Suite 300
San Francisco, CA 94107
Phone: 415-438-5500

Contact your local Catholic Church

Blessed Junipero Serra Catholic Church
Fr. Jarlath Dolan

5205 Upland Road
Camarillo, CA 93012
Voice: 805 482 6417
Fax: 805 987 8100

jaralthdolan@padreserra.org

St. Mary Magdalen Catholic Church

Reverend James Stehly, Pastor

Rev. Msgr. John Hughes (Pastor Emeritus)

2532 Ventura Boulevard
Camarillo, CA 93010
Voice: 805 484 0532
Fax: 805 987 2941

Holy Cross Catholic Church

Msgr. Paul Albee, V.F. Pastor
13955 Peach Hill Road
Moorpark, CA 93021
Voice: 805 529 1397
Fax: 805 529 3939

St. Julie Billiart Catholic Church

Rev. Msgr. Michael Bunny

2475 Borchard Road
Newbury Park, CA 91320
Voice: 805 498 3602
Fax: 805 376 2332

St. Thomas Aquinas Catholic Church

Pastor Fr Michael. Mc Fadden OSA

185 St. Thomas Drive
Ojai, CA 93023
Voice: 805 646 4338
Fax: 805 646 5928

St. Anthony Catholic Church

Fr. Sang Tran, Pastor

2511 South 'C' Street
Oxnard, CA 93034
Voice: 805 486 7301
Fax: 805 486 3142

Santa Clara Catholic Church

Rev. Jon F. Majarucon, Pastor

323 South 'E' Street
Oxnard, CA 93030
Voice: 805 487 3891
Fax: 805 483 1734

Mary Star of the Sea Catholic Church

463 West Pleasant Valley Road
Oxnard, CA 93033
Voice: 805 486 6133
Fax: 805 483 6913

Our Lady of Guadalupe Catholic Church

500 North Juanita Avenue
Oxnard, CA 93030
Voice: 805 483 0987
Fax: 805 486 2434

Our Lady of the Assumption

Father Steve Davoren

3175 Telegraph Road

Ventura, CA 93003

Phone: 805-642-7966

San Buenaventura Mission Catholic Church

Fr. Michael J. Carcerano (Parish Pastor)

Fr. Damian Fernando (Senior Priest)

211 East Main Street
Ventura, CA 93001
Voice: 805 643 4318
Fax: 805 643 7831

St. Jude the Apostle Catholic Church

Fr. Peter Foran - Pastor

32032 West Lindero Canyon Road
Westlake Village, CA 91361
Voice: 818 889 1279
Fax: 818 889 3405

St. Maximilian Kolbe Catholic Church

Fr. Tom Anslow

Fr. Michael Carroll

Associate Priest Fr. Jim Maher

5801 Kanan Rd.
Westlake Village, CA 91362
Voice: 818 991 3915
Fax: 818 991 7152

Our Lady of Mount Carmel Catholic Church

1300 East Valley Road
Santa Barbara, CA 93108

Phone (805) 969-6868
FAX: (805) 565-5959

Msgr. Stephen Downes Pastor

Rev. Maurice O'Mahony Pastor Emeritus

Santa Barbara Mission

Fr. Daniel Barica, O.F.M., Pastor

2201 Laguna St.
Santa Barbara, CA 93105
Voice: 805 682 4151
Fax: 805 687 7841

Our Lady of Sorrows Catholic Church

Rev. Paul D. Devot, S.J., Pastor

21 East Sola Street
Santa Barbara, CA 93101
Voice: 805 963 1734
Fax: 805 965 6461

St. Peter Claver Catholic Church

Reverend Monsignor Gary P. Bauler

5649 East Pittman Street
Simi Valley, CA 93063
Voice: 805 526 6499
Fax: 805 526 7233

St. Paschal Baylon Catholic Church

Rev. Dave Heney

155 East Janss Road
Thousand Oaks, CA 91360
Voice: 805 496 0222
Fax: 805 379 2506

daveheney@stpaschal.org

Contact your local Convent

The Sisters of Notre Dame

Sister Valerie Marie Roxburgh, SND

1776 Hendrix Avenue

Thousand Oaks, CA 91360

Monastery of Poor Clares
215 E. Los Olivos St.
Santa Barbara, CA 93105—3605

Franciscan Sisters of the Immaculate Conception

Sr. Cristina Knoell, OSF

11320 Laurel Canyon Blvd.

San Fernando, CA 91340-4350

Phone: 818-898-1546

Fax: 818-365-6646

comeandseeosf@yahoo.com

Carmelite Monastery
27601 Highway 1
Carmel, CA 93923

Phone: 831-624-3043

Contact your local Bishop & Diocese

Most Reverend Gabino Zavala
San Gabriel Pastoral Region
16009 East Cypress Avenue
Irwindale, CA 91706-2122

Most Reverend Gerald E. Wilkerson

San Fernando Pastoral Region
P.O. Box 7608
Mission Hills, CA 91346-7608

His Eminence Roger Cardinal Mahony
3424 Wilshire Blvd.
Los Angeles, CA 90010-2241
info@la-archdiocese.org

Most Reverend Edward W. Clark
Our Lady of the Angels Pastoral Region
5835 W. Slauson Avenue
Culver City, CA 90230

Most Reverend Thomas J. Curry
Santa Barbara Pastoral Region
3240 Calle Pinon
Santa Barbara, CA 93105

Most Reverend Alexander Salazar
Vicar for Office of Ethnic Ministry
3424 Wilshire Boulevard
Los Angeles, CA 90010-2202

Most Reverend Oscar A. Solis
San Pedro Pastoral Region
3555 St. Pancratius Place
Lakewood, CA 90712-1416

Contact the Vatican

Giovanni Battista Cardinal Re
Prefect, Congregation for Bishops
Piazza Pio XII, 10
00193 Vatican City, Italy, Europe
Phone: (011) 39-6-6988-4217

Contact the Pope

His Holiness Pope Benedict XVI
00120 Vatican City, Italy, Europe

benedettoxvi@vatican.va

Birth Centers vs Home Birth

2010-01-25T22:40:00.000-08:00

"Well, if I do a home birth and we transfer I love the idea of possibly transferring to a birth center."

"But if you transfer you're not going to a birth center. If you transfer it's because you need intervention."

Conversation between filmmaker Abby Epstein and her midwife Cara Muhlhahn in the documentary film, The Business of Being Born.

There's a stigma in the United States about giving birth at home. I believe this stems from ignorance about the birth process and misinformation about the care providers that attend home births.

The vast majority of births in the United States take place in a hospital setting. This includes hospital “birth centers” which for the most part are well-decorated labor and delivery suites with a fancy tub where a woman may or may not be allowed to actually birth her baby. Hospital birth centers are typically staffed by obstetricians and certified nurse midwives. They may have slightly more lax guidelines with respects to the position the woman can labor in or the option to labor in the water but as a general rule they must follow the same protocols as the official hospital labor and deliver unit.

A free-standing birth center is a birthing facility that is not only physically separate from a hospital but not affiliated with a hospital. Free-standing birth centers are generally staffed by midwives who may carry one of several different professional designations.(1) Occasionally obstetricians will deliver babies at free-standing birth centers, but this is definitely (and sadly) the exception rather than the rule. Free standing birth centers typically follow a protocol set by the state in which they reside based on the midwives’ licensing, however they generally provide for significantly more patient autonomy. Interventions frequently required in hospitals (2) such as routine IV fluids, continuous fetal monitoring, regular vaginal exams and Pitocin augmentation are usually forgone in free-standing birth centers. Free-standing birth centers are generally equipped with potentially life-saving emergency instruments such as oxygen, adult and neonatal resuscitation equipment and IV fluids. Prescription medications including Pitocin and Methergine are also often kept in stock.

Both of these options seem perfectly reasonable many people. They assume that a birth center is not quite as safe as a hospital, but certainly a reasonably safe place to have a baby. In fact, that has been established by at least one published study(4). Home birth, however, is a whole different story. I want to clarify the differences between birthing at a free-standing birth center vs home birth.

Wikipedia defines home birth as: A home birth is a birth that is planned to occur at home. It is contrasted to birth that occur in a hospital or birth center.

Okay, I think we had already established that. So what else is there to know about home birth?

Home births are generally attended by midwives who may carry one of several different professional designations(1). Occasionally obstetricians will deliver babies at home, but this is definitely (and sadly) the exception rather than the rule. Home birth midwives typically follow a protocol set by the state in which they reside based on the midwives’ licensing, however home births usually provide for significantly more patient autonomy than even at a birth center. Interventions frequently required in hospitals (2) such as routine IV fluids, continuous fetal monitoring, regular vaginal exams and Pitocin augmentation are usually forgone at home births. Midwives attending home births are generally equipped with potentially life-saving emergency instruments such as oxygen, adult and neonatal resuscitation equipment and IV fluids. Prescription medications including Pitocin and Methergine are also usually brought to the home birth.

Does anything seem familiar to you? Do I need to spell it out? Okay, here goes: The same emergency equipment and medications available at free-standing birth centers are available at home births(3). There is nothing special that comes out of the walls at a free-standing birth center(5).

I suspect the misconception that birth at a free-standing birth center is somehow safer than a home birth stems from the same misconception that hospital birth is safer than home birth. In fact, the general theme seems to be that birth is safest anywhere but at home.

Getting back on track:

Advantages of a Free-standing Birth Center

Usually offer large birthing tub for water births
Provide an alternative to parents not comfortable with home births
Discharge is usually hours after birth contrasted with days after birth in a hospital
More relaxed and aesthetically pleasing than a hospital environment

Advantages of Home Birth

No stress about when to go to hospital or birth center
Reduced risk of infection for mother and baby
Statistically as safe or safer than hospital birth for low-risk women
Many women find they have easier, shorter labors on their own 'turf'

Ultimately, it is up to each woman and her partner to determine the most suitable environment for the birth of their baby. However, it is my hope that expectant couples will take the time to thoroughly research their options and take the time to consider each option.

(1) What are the Different Types of Midwives?
(2) Routine Hospital Interventions
(3) Licensing laws vary state by state and not all licensed midwives are permitted to carry equipment or drugs as listed here. Contact your state medical board or advocacy organization such as Citizens for Midwifery additional licensing information.
(4) Outcomes, Safety, and Resource Utilization in a Collaborative Care Birth Center Program Compared With Traditional Physician-Based Perinatal Care
(5) To clarify, there are some free-standing birth centers that offer on-site surgical suites and anesthesia, such as the Babies By The Sea Birth Center, scheduled to open in May 2010. However the vast majority of free-standing birth centers do not offer these amenities as they are rarely needed.

Just the Two of Us

2009-12-28T08:07:00.000-08:00

I see the crystal raindrops fall
And the beauty of it all
Is when the sun comes shining through
To make those rainbows in my mind
When I think of you some time
And I want to spend some time with you

Just the two of us
We can make it if we try
Just the two of us, just the two of us
Just the two of us
Building castles in the sky
Just the two of us, you and I

Bill Withers sang it. Will Smith sang it. And who could forget Dr. Evil’s rendition in his loving tribute to Mini Me.

Now, I’ve yet to have a pregnant woman or her partner burst out in song when talking about labor support, but “just the two of us” is something I hear on occasion when talking with a couple and one or both of them will tell me they aren’t sure about hiring a doula because they were looking forward to their birth experience being ‘just the two of us’.

I always ask them what they mean by that. They usually respond that they are looking forward to the birth of their child as an intimate event. The thought of having a 'stranger' there would somehow lessen the experience. So I ask them who else they expect to be present at the birth. Typically they respond, "Our doctor and a nurse". I let them know that no only will their doctor be present (and it may or may not be the doctor they've been saying throughout the pregnancy... a strange doctor, I believe, would qualify as a stranger), but a minimum of two nurses (both strangers), sometimes more. In some hospitals there will be a medical student present (stranger). They'll likely go through several nurses as shifts change (strangers). And general hospital staff coming and going (strangers). I was once at a birth where the mom was laboring and a maintenance man had to come in and check the electrical outlets. In fact, birth in America is for the most part a strange event (pun intended).

Most American women would not consider birthing without their husband or partner, but how helpful is his presence in the birthing environment?(1) (2) The fact is, women tend to have faster, easier and less painful labors when allowed to labor alone; some believe ideally without their husbands. As Grantly Dick-Read, author of Childbirth without Fear writes, "If left alone in labor, the body of a woman produces most easily the baby that is not interfered with by its mother's mind or the assistant's hand. If left alone, just courage and patience are required. Faith, if she is a believer, is the secret to having a healthy baby and being a happy mother."

While that's all well and good, we know that less than 2% of women in the United States have midwife assisted home births, let alone unassisted births. The fact of the matter is that nearly all women in the US give birth in hospitals. And it is in the hospital that women are subjected to a cascade of medical interventions that ultimately lead to disappointing birth experiences; 1/3 of newborns in the United States are surgically extracted from their mother's womb.

Frankly, if you are going to have your baby in a hospital, it probably makes no difference whether or not your husband is there. Hospital births are stressful regardless of who is present and having him there will most likely be comforting to a large degree.

So what role does a doula fulfill at a hospital birth?

Birth doulas are trained and experienced in childbirth, although they may or may not have given birth themselves. The doula’s role is to provide physical and emotional support and assistance in gathering information for women and their partners during labor and birth. The doula offers help and advice on comfort measures such as breathing, relaxation, movement, and positioning. She also assists the woman and her partner to become informed about the course of her labor and their options. Perhaps the most crucial role of the doula is providing continuous emotional reassurance and comfort.(3)

More often than not, the birth partner finds the greatest value in the presence of a trained labor support person. Couples rarely consider what will happen if the mother has been laboring for 16 hours and the birth partner hasn't slept or eaten in over a day. 'Just the two of us' leaves them without anyone to support the mother so her partner can take a break or grab a bite to eat. 'Just the two of us' leaves them without anyone to turn to for support if the labor takes an unexpected turn. 'Just the two of us' leaves them with no one to rely on aside from hospital employees who may or may not have their best interest at heart. 'Just the two of us' leaves the mother alone on the operating table after her emergency cesarean when her partner leaves the operating room to accompany the baby to the nursery. 'Just the two of us' leaves the parents without anyone to advocate for their birth plan. 'Just the two of us' leaves the parents out of ideas when they've gone through the prepared comfort techniques they learned at their childbirth education class. 'Just the two of us' leaves a newborn or a mother alone when the father must choose between accompanying his newborn to the NICU (sometimes in a different hospital) or staying with his partner.

On the extreme side, I've been to a birth where a women and her partner were lied to about fetal heart decelerations by a physician seemingly eager to perform a surgical birth. I've seen a woman brutalized by an incompetent nurse. I've witnessed newborns treated roughly and subjected to unnecessary and invasive interventions. And over and over again I see a lack of informed consent (or at the very least, a skewed version of informed consent) and almost always a total and complete disregard for the welfare of the mother (i.e. "The most important thing is to have a healthy baby. How he gets here isn't that important").

Can a doula prevent undesirable outcomes? That depends on the situation. But certainly the presence of a woman experienced in labor and birth has an overall calming and positive effect on the birth environment.(4) Plus, you can always ask us to leave.

Finally, I'd ask any readers that have had a doula attend their birth if they felt the doula in any way interfered with the intimacy they expected. Was your experience good or bad? Would you hire a doula again? Did the doula help you or partner more? Perhaps both equally? Please, share your feedback and don't hold back if I was your doula and you want to tell the world how great I was.

(1) The Masculinisation of the Birth Environment
(2) Is the Participation of the Father at Birth Dangerous?
(3) The Birth Doula's Contribution to Modern Maternity Care
(4) Care in Normal Birth: A Practical Guide

Secret Birth Plans

2009-12-07T18:34:00.000-08:00

"Oh, we got to the point where we didn't even tell
people we were planning a natural birth. We were sick of trying to justify our
reasons for it."

This came up in a recent discussion with a client of mine.
This is not the first time I’ve heard a statement like that, and I’m sure it
won’t be the last. But in trying to figure out why so many people are against
natural birth, I was inspired to write about it.

I have a bad tendency to lash out in frustration and label people that disagree
with me as stupid. I know that’s childish so I’ve worked hard on coming up with
alternate labels. I find that labels like ‘ignorant’ and ‘uneducated’ are far
less offensive. 

But in all seriousness, I really think that ignorance and
uneducated apply here. It is human nature to be frightened of the unknown. Most
people in the United States have never witnessed a natural birth before; all
they know are their own experiences and what they’ve been exposed to in the
media. And we know how inaccurately child birth is represented in television
and film.

Who wouldn’t be frightened of an experience like that? A
highly medicalized, and most certainly a medicated birth sounds much better
than that, almost anyone would agree.

The fact of the matter is that birth isn’t anything like
what is portrayed in the media. It rarely starts suddenly. Most women have
ample time to drive themselves back home; in fact, labor rarely starts away
from home! Hundreds of thousands of years of evolution have nearly perfected
the birth process. Labor usually intensifies slowly, over a period of many
hours. This gives ample time for the woman’s body to adjust and produce an
abundant amount of endorphins (nature’s pain killers) to help her cope with the
pain. By the time the woman thinks she can no longer take it, she is usually
very close to giving birth.

When I told people I was having my second baby at home, I
also got negative responses from friends and family members. But instead of the
negativity discouraging me from sharing, I had a totally different attitude. As
a doula and educator, I used each opportunity as one to educate.

CONVERSATION ONE

Me: Hospital? Oh no, we are having the baby at home with a
midwife.

Friend: Whoa, so no prenatal care?

Me: Midwives provide very similar prenatal care as
obstetricians. In fact, in many ways it is superior because midwives usually
spend much more time with their clients, 30-45 minutes per visit. Midwives also
discuss all of the standard testing with you so you can make a decision as to
whether or not you actually want the test.

Friend: Hmm, that’s interesting. I remember my doctor would
just order tests up without even telling me. In retrospect I would have liked
it if he’d have discussed them with me beforehand.

CONVERSATION TWO

Me: Hospital? Oh no, we are having the baby at home with a
midwife.

Friend: What!!! You can’t do that. What if something goes
wrong?

Me: Goes wrong? What do you mean?

Friend: I dunno… what if the cord is wrapped around the
baby’s neck?

Me: Actually, nuchal cords are very common, about 1/3 of all
babies have cord wrapped around the neck. The midwife handles it the same way
as a doctor – she unwraps it as the baby’s head is being born.

Friend: But what if it’s tight? What if the baby isn’t
breathing?

Me: Midwives are prepared with emergency equipment and they
are trained to handle emergencies. They have oxygen and resuscitation bags. The
midwife and her assistant are both certified in neonatal resuscitation.

Friend: Oh, for some reason I guess I thought they just
showed up driving an old VW bus with some towels and hot water. It’s good to
know they are trained to handle emergencies.

CONVERSATION THREE

Me: Hospital? Oh no, we are having the baby at home with a
midwife.

Friend: Oh my god, what if you need a cesarean section?

Me: Did you know that about 30% babies in the United States
are born via surgical birth? But most homebirth midwives have a 5-10% cesarean
section rate. Most cesarean sections are due to the medical interventions done
to women in hospitals.

Friend: Okay, but what if you legitimately NEED one?

Me: Then we’ll get in the car and drive to the hospital.
Less than one-half of one percent of births result in a true emergency that
requires immediate intervention. I’m young and healthy, I trust that my body
and my baby will be just fine.

Here’s my confession… I used to be against home birth too. I
didn’t understand it and I trusted my doctors. I won’t go into what got me to
come around, but I will tell you this… Years ago my husband had a friend whose
wife planned an out-of-hospital birth. I thought she was crazy. She tried to
explain it to me, but I pretty much just shut her down. However she planted a
seed. Because she was open to trying to explain herself to my heard-headed, stubborn
ass, she planted a seed. And years later when the time was right and I was
ready to expand my own birthing options, that seed was there and ready to grow.
That seed sprouted into me choosing an out of hospital birth and pursuing a
career as a doula and childbirth educator.

In conclusion, please think it through before you keep your
birthing plans a secret. Don’t look at surprised responses as an attack (even
if they are); instead, look at them as an opportunity to educate. And if you
aren’t the educating type, or you aren’t comfortable spouting off like I am,
you can always just e-mail the person a few links to websites like gentlebirth.org or ican-online.org.

NRP Certified

2009-11-28T16:49:00.000-08:00

Well, it's official. I am now certified at neonatal resuscitation. I just keep thinking to myself, 'God help any baby that I have to resuscitate because I don't think I know what I'm doing'.

http://www.aap.org/nrp/nrpmain.html