Arie Brentnall-Compton
I've spend 10 years (!!) as a loud, active protector of breastfeeding. I've worked within the breastfeeding community, as an LC, been the first person to connect babywearing & breastfeeding as public health issues, a writer & so much more. I've attended countless conferences, tradeshows, speakers' events & taught at just as many. I've been observing an unnerving trend and a concept that James Akre introduced to me over 4 years ago has crystalised of late.
A very large, capital I Industry has built up around "breastfeeding". What started as a small group of committed, WHO Code supporting companies has morphed into thousands of companies marketing "feeding products". Previously Code compliant companies have shifted their focus to "Feeding", offering little or no breastfeeding imagery, or products directly known to interfere with the success of breastfeeding. By creating an industry around the ostensible support of nursing mothers, companies have changed the culture around breastfeeding. The average new mother today is inundated with blog posts, ads, product samples and more more for things like breastfeeding cookies, bracelets, apps, creams, teas, menu plans, covers, hot/cold packs and so much more.
It's an individual's choice to purchase & use what they'd like, make no mistake. The sum total of the entire industry and it's rapid growth over the past few years has accelerated to give the impression to today's first time mother that breastfeeding is expensive, time consuming, requires a lot of paraphernalia & often doesn't work the way they'd planned. It's important to know that the vast majority of these products simply didn't exist even a few years ago. It's also important to note the changes:
-Lansinoh, a beloved product for nursing mothers long endorsed by La Leche League, now sells bottles & other "feeding accessories" in violation of the WHO Code.
-Boppy, one of the first commercial brands of nursing pillow, have rebranded as feeding pillows. There is currently not a single image of breastfeeding on their site or in their marketing.
-Medela, once a Code compliant supplier of pumps & accessories, is now marketing bottles & low quality pumps to mothers.
-Generically, many larger brands of nursing covers (a non-existent product category until about 10 years ago), have shifted their marketing from being a breastfeeding aid (which is debatable) to providing a cover while pumping, bottlefeeding, or simply holding a sleeping baby. The imagery infrequently shows women actually nursing anymore.
I spent upwards of 7 years as a nursing mother. I used a variety of products to make our time nursing a little bit easier, mainly bras & other nursing clothing. There isn't anything at all wrong with using & appreciating the often innovative products designed to serve us during our nursing careers. Indeed (full disclosure), I owned a retail store for 4 years that focused partially on breastfeeding items, although we never sold items we knew interfered with the normalisation of nursing. I also do work as a lactation consultant & breastfeeding educator, with the longterm goal of teaching my way out of a job.
My experiences tell me that all the growth we are seeing does not equate to progress. It appears that breastfeeding initiation/duration rates in many areas are actually on a downward trend. The industry, as a whole, is a death knell for normal breastfeeding.
It's hard for women who have yet to develop a successful nursing relationship to sort out the useful from the useless, the harmless from the harmful. Part of the problem with the growth in items available has been, as I've said, the overall cultural change. While covering with a blanket used to be a choice for women who felt modest or private, mom's groups now regularly have women aplologise to other attendees for having forgotten their nursing cover. When a mother worried about her supply out loud a few years ago, a La Leche League Leader may have helpfully made some suggestions for evaluating if her supply was in fact dropping (it's usually not) & suggested she nurse the baby more to increase the production. That same mother expressing concern on social media today is likely to be sent to purchase a bag of lactation cookies marketed with dubious medical claims. Other products prey on the same fears: bracelets, charms & apps imply you may not remember to nurse on the "correct" side; cookies, teas, supplements imply your supply may be inadequate without them. Nursing covers, hiders, hats & more suggest it's more appropriate to nurse covered with a commercial product.
I want to reiterate that while there will be individuals who found benefit from each of these products, it's not looking like the longterm result of their availability will be a societal increase in breastfeeding initiation or duration. Of perhaps more concern is how quietly some of the lactation industry's biggest players have simply removed the breast from the feeding entirely.
Monday, October 3, 2011
Monday, July 4, 2011
Announcing World Milksharing Week!!!!!
http://www.worldmilksharingweek.org/
I'm so excited to be asked to be a representative for the first ever World Milk Sharing Week!!!! From September 24-30, 2011, our goal will be to further the mission of promoting human milk as the biologically normal nourishment for babies and children, as well as to celebrate milksharing itself! Stay tuned for more details!
I'm so excited to be asked to be a representative for the first ever World Milk Sharing Week!!!! From September 24-30, 2011, our goal will be to further the mission of promoting human milk as the biologically normal nourishment for babies and children, as well as to celebrate milksharing itself! Stay tuned for more details!
Monday, June 13, 2011
The Marketing of Marketing, or Why You Won't "Be Wildly Successful if you Just Hire The Right Guru"
I'm from Alberta, a province where young families tend to make a boatload of money thanks to the oilpatch & other industries where skilled trades make 6 figure incomes without blinking. While these families are growing, they want to spend their disposable income on their children, buying them clothes, toys & accessories from businesses selling mainly online & at trade shows. This means we have more than our share of start up businesses aimed at that demographic, with new ones opening daily.
Way back in the day (2006!!), when my partner & I opened our business, there were a handful of local stores where you could purchase a few brands of baby carriers & cloth diapers from, as well as a handful of online Canadian stores. As quickly as we grew, the marketplace did too & there are now more than 20 (at my count) Edmonton-based businesses selling those items.
What's really grown exponentially are the hand made accessories & the trade shows they're sold at. Again, where only a few years ago there were a handful of major trade shows, craft fairs & local markets where companies selling baby & childrens products could exhibit, there are now dozens in the area.
I realise these are local examples, but I think they illustrate the trend really well. No one is making a living doing this because the market is so saturated, so when solicitations for marketing pop up (we get offers weekly!), they're totally tempting to small business.
"Hey Mompreneurs, want to increase sales while looking fabulous & having the dream life you've always dreamed of?!? Subscribe to my blog/e-book/website & attend my momseveningout/wine&cheese/fabworkshop & learn all my secrets!!!"
For no charge, you can often glean some ideas or tips; for a pretty small fee, usually a few hundred bucks, you can hire a marketing consultant to help build your brand. What annoys me as a small business owner is that the marketing of the marketing seems to take precedence over the substance of evaluating the viability of growth of your business.
The tips provided essentially boil down to:
-Network, network, network, at gatherings, trade shows, etc. Get to know other business owners & make sure they know you.
-Tweet, Facebook & Blog so you develop a big fan base
These aren't bad suggestions & they certainly reflect the business plan of most small companies these days. The problem is that to charge for your advice, you should be able to establish that these strategies work. I want to see hard data- increased sales volume, sales to a new customer base, increased market share, etc. Hiring marketing help can be a great use of money, if they can provide results- but I don't think the marketing of marketing offers that. Time & money spent on this kind of marketing is likely wasted, save it for a company with legitimate experience in your industry & ability to prove their effectiveness with increased sales.
Legitimate marketing takes a look at your product, the market, your pricing, customer base etc & establishes a concrete & realistic plan for advertising and growth. It does not suggest you spam other businesses by posting your links on their Facebook wall. It does not see "networking" with similar local businesses competing for the same share of the same market as key to your growth and success.
There's nothing wrong with being a small business, making a nice product and earning income you're satisfied with. There's nothing wrong with dreaming big, either!! In a market like ours, though, where it's quite saturated & we're all fighting for pieces of a shrinking pie, a reality check is needed. At the end of the day, I think we as business owners need to stick to what we do best and avoid the fluffy marketing/happiness/lifestyle gurus. Simple concepts like knowing your customers, listening to their needs and providing them with what they're asking for are what builds business long term.
Way back in the day (2006!!), when my partner & I opened our business, there were a handful of local stores where you could purchase a few brands of baby carriers & cloth diapers from, as well as a handful of online Canadian stores. As quickly as we grew, the marketplace did too & there are now more than 20 (at my count) Edmonton-based businesses selling those items.
What's really grown exponentially are the hand made accessories & the trade shows they're sold at. Again, where only a few years ago there were a handful of major trade shows, craft fairs & local markets where companies selling baby & childrens products could exhibit, there are now dozens in the area.
I realise these are local examples, but I think they illustrate the trend really well. No one is making a living doing this because the market is so saturated, so when solicitations for marketing pop up (we get offers weekly!), they're totally tempting to small business.
"Hey Mompreneurs, want to increase sales while looking fabulous & having the dream life you've always dreamed of?!? Subscribe to my blog/e-book/website & attend my momseveningout/wine&cheese/fabworkshop & learn all my secrets!!!"
For no charge, you can often glean some ideas or tips; for a pretty small fee, usually a few hundred bucks, you can hire a marketing consultant to help build your brand. What annoys me as a small business owner is that the marketing of the marketing seems to take precedence over the substance of evaluating the viability of growth of your business.
The tips provided essentially boil down to:
-Network, network, network, at gatherings, trade shows, etc. Get to know other business owners & make sure they know you.
-Tweet, Facebook & Blog so you develop a big fan base
These aren't bad suggestions & they certainly reflect the business plan of most small companies these days. The problem is that to charge for your advice, you should be able to establish that these strategies work. I want to see hard data- increased sales volume, sales to a new customer base, increased market share, etc. Hiring marketing help can be a great use of money, if they can provide results- but I don't think the marketing of marketing offers that. Time & money spent on this kind of marketing is likely wasted, save it for a company with legitimate experience in your industry & ability to prove their effectiveness with increased sales.
Legitimate marketing takes a look at your product, the market, your pricing, customer base etc & establishes a concrete & realistic plan for advertising and growth. It does not suggest you spam other businesses by posting your links on their Facebook wall. It does not see "networking" with similar local businesses competing for the same share of the same market as key to your growth and success.
There's nothing wrong with being a small business, making a nice product and earning income you're satisfied with. There's nothing wrong with dreaming big, either!! In a market like ours, though, where it's quite saturated & we're all fighting for pieces of a shrinking pie, a reality check is needed. At the end of the day, I think we as business owners need to stick to what we do best and avoid the fluffy marketing/happiness/lifestyle gurus. Simple concepts like knowing your customers, listening to their needs and providing them with what they're asking for are what builds business long term.
Monday, February 21, 2011
I don't believe in Unassisted Childbirth AKA a rose by another name
By Lee-Ann Grenier
Two months ago I gave birth to my third child at home in what many would describe as an unassisted childbirth (UC) or freebirth. Throughout the pregnancy and up to his birth this is how I thought of it as I prepared for the arrival of our second son. I felt uneasy with the terminology and others I spoke to felt the same way. "Unassisted Childbirth" sounds reckless and cavalier; to some it implies a complete disregard for medical care even in the event of a true emergency. No one I know who has had a planned unassisted birth would avoid seeking appropriate medical care when necessary. In fact many women attempting freebirth have transferred to hospital when they felt it necessary. Sometimes it can be hard to separate from those who plan to birth without professional assistance and those who have their babies at home (or in the car, or Wal-Mart) by mistake. Media portrayals of these births where everyone is "miraculously fine" often confuse the issue.
The term itself causes some dissension among the families who choose this type of childbirth. The discussion usually centres around what qualifies as UC. Does having an unregistered midwife or a traditional birth attendant count? What if you have a doula, family member, or friend attend the birth? Some people even go so far as to define an unassisted birth as one where no one is present but the mother. Does a birth where one hires a midwife but doesn't call them count, or one where the couple camps out in the vicinity of the hospital qualify? These discussions can become very heated and polarizing.
The term Freebirth can be equally confusing but on a more emotional level. I find this wording invokes feelings of easy painless birth that, in my experience, can be quite deceiving. Free- from what, and for what, were concepts that I wrestled with both during the pregnancy and after the birth. Although a couple that chooses this type of birth might find freedom from the medical establishment, it comes with the heavy price of taking complete responsibility for the birth. There is the freedom to choose how one labours and delivers in this type of birth, but that can also be experienced by a strong woman in a hospital setting (with the right kind of support ;). There is the freedom to provide ones own care and comfort, but there is cost of doing so. The more I wrestled with these concepts the more apparent it became to me that the terms didn't fit.
My son's birth was not unassisted. We had friends come to help in the way that one needs with a homebirth. They dealt with the older children, fetched food and drink, provided warm towels, warmed up the pool and took pictures. We had friends light candles and provide us with their warm thoughts throughout the labour day. My husband supported me both physically and emotionally. We called upon the sage advice of a doula friend over the phone. At the moment of my son's arrival his birth was assisted by me; pushing him into the world, my husband; holding my body, and my dear friend Kirsten providing pushing support and calling the play by play. I suppose the biggest assistance came from the force or energy that created me and gave my body the ability to birth my baby (I call it God, but you have your name for it). So the question that came to my mind after he was born was how could I call this unassisted? Many asked and I felt hesitant to use these words in reply. I felt that if I said Elijah's birth was unassisted it would be very unappreciative of all the people who gave us their love and support on that day.
Elijah's birth was also not free. It was hard work, mentally and physically. It took a whole 12 hour day, and the toll on my body was (understandably) high. We paid a price for operating outside the system (imagine how hard it is to register this kind of birth) in terms of providing our own care and dealing with the feelings other had about our birthing choices. I will admit that we did have the freedom to let my son's birth unfold unhindered.
In the reflective moments since his birth I struggled to come up with the right words to describe the way in which we chose to bring our second son into the world. Eventually it came to me, what we had was a traditional homebirth. We called upon the support we needed to have the birth unfold in the way we wanted it too. If we had required it we would have sought the care of a midwife or the services provided at our local hospital. But we didn't, and this is how birth happened, traditionally. Sisters, mothers and women friends have been birth assistants for eons and at these births more experienced midwives or doctors were only called in when things got tricky, and in this way birth worked, assisted appropriately. So the next time someone asks me if I had an unassisted birth I'll say "No, I had a traditional homebirth." and leave it at that.
Two months ago I gave birth to my third child at home in what many would describe as an unassisted childbirth (UC) or freebirth. Throughout the pregnancy and up to his birth this is how I thought of it as I prepared for the arrival of our second son. I felt uneasy with the terminology and others I spoke to felt the same way. "Unassisted Childbirth" sounds reckless and cavalier; to some it implies a complete disregard for medical care even in the event of a true emergency. No one I know who has had a planned unassisted birth would avoid seeking appropriate medical care when necessary. In fact many women attempting freebirth have transferred to hospital when they felt it necessary. Sometimes it can be hard to separate from those who plan to birth without professional assistance and those who have their babies at home (or in the car, or Wal-Mart) by mistake. Media portrayals of these births where everyone is "miraculously fine" often confuse the issue.
The term itself causes some dissension among the families who choose this type of childbirth. The discussion usually centres around what qualifies as UC. Does having an unregistered midwife or a traditional birth attendant count? What if you have a doula, family member, or friend attend the birth? Some people even go so far as to define an unassisted birth as one where no one is present but the mother. Does a birth where one hires a midwife but doesn't call them count, or one where the couple camps out in the vicinity of the hospital qualify? These discussions can become very heated and polarizing.
The term Freebirth can be equally confusing but on a more emotional level. I find this wording invokes feelings of easy painless birth that, in my experience, can be quite deceiving. Free- from what, and for what, were concepts that I wrestled with both during the pregnancy and after the birth. Although a couple that chooses this type of birth might find freedom from the medical establishment, it comes with the heavy price of taking complete responsibility for the birth. There is the freedom to choose how one labours and delivers in this type of birth, but that can also be experienced by a strong woman in a hospital setting (with the right kind of support ;). There is the freedom to provide ones own care and comfort, but there is cost of doing so. The more I wrestled with these concepts the more apparent it became to me that the terms didn't fit.
My son's birth was not unassisted. We had friends come to help in the way that one needs with a homebirth. They dealt with the older children, fetched food and drink, provided warm towels, warmed up the pool and took pictures. We had friends light candles and provide us with their warm thoughts throughout the labour day. My husband supported me both physically and emotionally. We called upon the sage advice of a doula friend over the phone. At the moment of my son's arrival his birth was assisted by me; pushing him into the world, my husband; holding my body, and my dear friend Kirsten providing pushing support and calling the play by play. I suppose the biggest assistance came from the force or energy that created me and gave my body the ability to birth my baby (I call it God, but you have your name for it). So the question that came to my mind after he was born was how could I call this unassisted? Many asked and I felt hesitant to use these words in reply. I felt that if I said Elijah's birth was unassisted it would be very unappreciative of all the people who gave us their love and support on that day.
Elijah's birth was also not free. It was hard work, mentally and physically. It took a whole 12 hour day, and the toll on my body was (understandably) high. We paid a price for operating outside the system (imagine how hard it is to register this kind of birth) in terms of providing our own care and dealing with the feelings other had about our birthing choices. I will admit that we did have the freedom to let my son's birth unfold unhindered.
In the reflective moments since his birth I struggled to come up with the right words to describe the way in which we chose to bring our second son into the world. Eventually it came to me, what we had was a traditional homebirth. We called upon the support we needed to have the birth unfold in the way we wanted it too. If we had required it we would have sought the care of a midwife or the services provided at our local hospital. But we didn't, and this is how birth happened, traditionally. Sisters, mothers and women friends have been birth assistants for eons and at these births more experienced midwives or doctors were only called in when things got tricky, and in this way birth worked, assisted appropriately. So the next time someone asks me if I had an unassisted birth I'll say "No, I had a traditional homebirth." and leave it at that.
Thursday, October 7, 2010
Babywearing Caregiver!!!
Christina Dawn Monroe
What babywearing has meant to Lennox this our journey:
Lennox is 11 months old. He came into my care at 6 months of age. He is exclusively breastfed; his mom was the only one to ever put him to sleep. He is a boob man, for bed time. I was also warned he was not a stroller fan.
I have worked in the childcare field for 15 years (have a degree in early childhood education). As I just recently went back to having a day home. I had not owned a carrier for years. I ordered a babyhawk with my first pay check from Lennox’s parents. Then we waited a further 2 weeks for it to arrive. For one whole month we were carrierless. It was a pretty shitty month.
We had the challenge of dealing with transitioning to reverse cycle breast feeding. You see Lennox does not like bottles (regardless of how many different kinds I tried) and the same went for sippy cups. For liquids we went to feeding with a spoon and mom coming to feed at lunch if needed. Then there was the whole I do not sleep without a breast thank you. Apparently dad had never had any luck either. Did not matter that I walked around with him, he was not left alone to cry. He was only going to sleep because he screamed himself out. Then there was the strollers 3 different kinds. He screamed even louder, with summers so short here we had to go out regardless of the yelling.
The day the package came is the day everything went up hill. It changed everything for the better.
I opened my pretty package and strapped him in and he just relaxed. He was calm for the first time in a month. He quickly learned to sign for his carrier if he needed to be up instead of on the floor exploring. If he needed to be closer to me. We figured out that if we are close and feel safe we can fall right to sleep. He kind of just gives a sigh and passes out. I can then transfer him to a mat or keep in there if we are out. We learned by watching closely that straws are cool (I have an addiction to iced lattes) He would watch me intently, so focused as it is so close to his face. We got him a litter-less juice box and away we went! He snuggles the juice box full of breast milk right between my breasts and drinks it all down! No more spoon feeding milk! We no longer have to use a stroller to go out so we can go many more places; he has a bird’s eye view. We can climb rocks and he can see! He can choose not to wear mittens and be inside my coat instead! Life is wonderful.
Mom thought this was cool borrowed my carrier then ordered herself her very own. Now dad can put him to sleep too!
Babywearing has made Lennox into a much happier little person.
What babywearing has meant to Lennox this our journey:
Lennox is 11 months old. He came into my care at 6 months of age. He is exclusively breastfed; his mom was the only one to ever put him to sleep. He is a boob man, for bed time. I was also warned he was not a stroller fan.
I have worked in the childcare field for 15 years (have a degree in early childhood education). As I just recently went back to having a day home. I had not owned a carrier for years. I ordered a babyhawk with my first pay check from Lennox’s parents. Then we waited a further 2 weeks for it to arrive. For one whole month we were carrierless. It was a pretty shitty month.
We had the challenge of dealing with transitioning to reverse cycle breast feeding. You see Lennox does not like bottles (regardless of how many different kinds I tried) and the same went for sippy cups. For liquids we went to feeding with a spoon and mom coming to feed at lunch if needed. Then there was the whole I do not sleep without a breast thank you. Apparently dad had never had any luck either. Did not matter that I walked around with him, he was not left alone to cry. He was only going to sleep because he screamed himself out. Then there was the strollers 3 different kinds. He screamed even louder, with summers so short here we had to go out regardless of the yelling.
The day the package came is the day everything went up hill. It changed everything for the better.
I opened my pretty package and strapped him in and he just relaxed. He was calm for the first time in a month. He quickly learned to sign for his carrier if he needed to be up instead of on the floor exploring. If he needed to be closer to me. We figured out that if we are close and feel safe we can fall right to sleep. He kind of just gives a sigh and passes out. I can then transfer him to a mat or keep in there if we are out. We learned by watching closely that straws are cool (I have an addiction to iced lattes) He would watch me intently, so focused as it is so close to his face. We got him a litter-less juice box and away we went! He snuggles the juice box full of breast milk right between my breasts and drinks it all down! No more spoon feeding milk! We no longer have to use a stroller to go out so we can go many more places; he has a bird’s eye view. We can climb rocks and he can see! He can choose not to wear mittens and be inside my coat instead! Life is wonderful.
Mom thought this was cool borrowed my carrier then ordered herself her very own. Now dad can put him to sleep too!
Babywearing has made Lennox into a much happier little person.
Friday, October 1, 2010
Wearing My Son Through His Withdrawal
by Stacey Freeman
I am a mom of 5 and foster mom to 3, and huge fan of baby wearing!! My foster baby was dropped off at 10 days old extremely small, sick looking and going through withdrawal. At the same time he was arched backwards and impossible to hold he would just scream. After the first horrible night I went and dug through all by baby boxes in desperate need of my sling (he had been dropped off with only half hour notice, so I had no baby supplies handy. Honestly within 5 minutes he was asleep and content!! For the next 3 weeks he lived in that sling until the withdrawal symptoms had passed only coming out for diaper changes. I slept sitting up on the couch with him snuggled against my chest even.
I am adopting this baby now and he is the most precious happy little boy. I am SO thankful I had that sling!!
I am a mom of 5 and foster mom to 3, and huge fan of baby wearing!! My foster baby was dropped off at 10 days old extremely small, sick looking and going through withdrawal. At the same time he was arched backwards and impossible to hold he would just scream. After the first horrible night I went and dug through all by baby boxes in desperate need of my sling (he had been dropped off with only half hour notice, so I had no baby supplies handy. Honestly within 5 minutes he was asleep and content!! For the next 3 weeks he lived in that sling until the withdrawal symptoms had passed only coming out for diaper changes. I slept sitting up on the couch with him snuggled against my chest even.
I am adopting this baby now and he is the most precious happy little boy. I am SO thankful I had that sling!!
Wednesday, September 8, 2010
On Consent
Vyky Staples
(professional body piercer and fierce mama)
Informed consent is something I see discussed ad infinitum on blogs, message boards and in print in magazines. Informed consent is a powerful tool to have in our journeys as Fierce Mamas- being able to make an educated decision in regards to our health and wellbeing and the health and wellbeing of our babies. We are their advocates, and it's a duty I hold with utmost importance. We choose for our babies who are not able and ready to choose for themselves.
I want to share with you an event I experienced recently that radically shook me and cemented my beliefs. I was shopping. Seeking retail therapy, actually, as a way to relieve myself of some pent-up stress and to soften the blow of leaving my baby in the care of someone else as I am enrolled in school. My shopping trip was winding down, and I was making my way to the food court to grab a coffee to enjoy on the way home. I was approaching a jewelry store and as I neared it, I witnessed something that made my heart jump into my throat.
A very young baby, I'd guess to be around 3 months old, thrashing and screaming as her mother held her arms with one arm and immobilized her head with the other as a store employee was piercing her earlobes. I noticed the mother herself had tears in her eyes.
I was absolutely shocked and appalled. The whole scene had reduced me to tears, an I quickly had to flee the building where I sat in my car and sobbed over what I had just seen. I couldn't make sense of why the mother of that poor baby would subject her to such a thing. She was clearly acting against her maternal instincts- she herself was in tears- she knew what she was doing to her child was wrong.
Yes- WRONG.
It is absolutely, without a doubt wrong to modify the body of a person unable to consent- whether it be female genital mutilation, male circumcision or piercing the earlobes of a young girl. When a child or baby is unable to make informed consent, you are violating their bodies and you are violating their trust. Children are vulnerable and inherently rely on their parents to make decisions on their behalf. And by making permanent changes to their bodies when they are unable to understand the risks, the procedure, the aftercare and the permanent affects, you are revoking their right to choose for themselves.
Furthermore, the stress respond to the stimulus in question can have devastating effects on the infant. When put under extreme duress, the hypothalamus excretes cortisol. When the brain excretes large amounts of cortisol or is forced to excrete it chronically (such as when a parent allows the child to "cry it out"), it can increase the risk of SIDS, and can, in the long term, affect the memory, attention, and emotional wellbeing of the child. Studies also suggest that this can manifest in adulthood into anxiety and depressive disorders.
This brings me to the question of why anyone would subject their child to such a procedure? Is it that important that complete strangers that you'll never speak to or see again know the sex of your baby? Children are not born with a sense of vanity- that is instilled in them by their surroundings as they grow. Baby girls have no need for bedazzled earlobes- they have a need for parents she can trust unconditionally to make sound decisions on her behalf until she is able to utilize informed consent of her own accord.
(professional body piercer and fierce mama)
Informed consent is something I see discussed ad infinitum on blogs, message boards and in print in magazines. Informed consent is a powerful tool to have in our journeys as Fierce Mamas- being able to make an educated decision in regards to our health and wellbeing and the health and wellbeing of our babies. We are their advocates, and it's a duty I hold with utmost importance. We choose for our babies who are not able and ready to choose for themselves.
I want to share with you an event I experienced recently that radically shook me and cemented my beliefs. I was shopping. Seeking retail therapy, actually, as a way to relieve myself of some pent-up stress and to soften the blow of leaving my baby in the care of someone else as I am enrolled in school. My shopping trip was winding down, and I was making my way to the food court to grab a coffee to enjoy on the way home. I was approaching a jewelry store and as I neared it, I witnessed something that made my heart jump into my throat.
A very young baby, I'd guess to be around 3 months old, thrashing and screaming as her mother held her arms with one arm and immobilized her head with the other as a store employee was piercing her earlobes. I noticed the mother herself had tears in her eyes.
I was absolutely shocked and appalled. The whole scene had reduced me to tears, an I quickly had to flee the building where I sat in my car and sobbed over what I had just seen. I couldn't make sense of why the mother of that poor baby would subject her to such a thing. She was clearly acting against her maternal instincts- she herself was in tears- she knew what she was doing to her child was wrong.
Yes- WRONG.
It is absolutely, without a doubt wrong to modify the body of a person unable to consent- whether it be female genital mutilation, male circumcision or piercing the earlobes of a young girl. When a child or baby is unable to make informed consent, you are violating their bodies and you are violating their trust. Children are vulnerable and inherently rely on their parents to make decisions on their behalf. And by making permanent changes to their bodies when they are unable to understand the risks, the procedure, the aftercare and the permanent affects, you are revoking their right to choose for themselves.
Furthermore, the stress respond to the stimulus in question can have devastating effects on the infant. When put under extreme duress, the hypothalamus excretes cortisol. When the brain excretes large amounts of cortisol or is forced to excrete it chronically (such as when a parent allows the child to "cry it out"), it can increase the risk of SIDS, and can, in the long term, affect the memory, attention, and emotional wellbeing of the child. Studies also suggest that this can manifest in adulthood into anxiety and depressive disorders.
This brings me to the question of why anyone would subject their child to such a procedure? Is it that important that complete strangers that you'll never speak to or see again know the sex of your baby? Children are not born with a sense of vanity- that is instilled in them by their surroundings as they grow. Baby girls have no need for bedazzled earlobes- they have a need for parents she can trust unconditionally to make sound decisions on her behalf until she is able to utilize informed consent of her own accord.
To Induce or Not to Induce?
Tegan Vanden Bosch
It was my ten-week pregnancy check up. Being the nervous new-to-be mother, I had a lot of questions for my OB when I went to my appointment. One of many questions asked, and answered, was as follows:
“So at what point in the pregnancy do we start talking about the labor and delivery process?” I was just curious, I looking for answer akin to “Oh, about 30 or 35 weeks”. I’m a planner; I just wanted a time-line for myself to mentally prepare for every step in the pregnancy and birthing process. Instead I got something quite different.
“Well, we’ll probably induce you at thirty-eight weeks, most likely on a Thursday.”
What?!? Induction? What in the world for??? “I don’t really believe in being induced for a non-medically necessary reason . . .” I started timidly, completely taken for surprise. I hadn’t really been prepared to defend myself in such a manner at this point in my pregnancy.
In a very brisk, business-like manner, the doctor replied “It really is best, that way your husband will know ahead of time and can get off work (she nodded her head to my husband who was sitting in the chair next to the exam table), you’ll be able to get a full night’s rest before the baby comes . . .” and she continued to rattle off another half dozen or so reasons of why she wanted to induce me.
I couldn’t believe it, and at the same time that I was forming an argument in my head for every single reason, I felt powerless to respond. I felt as though my beliefs had just been trampled upon. From previous visits and conversations with this doctor, I knew that she and I stood on the same ground on many issues including contraception, natural family planning and God’s presence in the entire process of marital bliss, including conception. And here she was telling me she was going to induce me? I was only ten weeks pregnant; I wasn’t carrying twins, I didn’t have two uteruses or a uterus with a septum, I didn’t have any reason for being high risk and needing to have my labor induced. This OB had delivered three of my good friend’s babies and they all were able to have completely natural labors (without ever mentioning induction). Why did she suddenly say she wanted to induce me? Why didn’t she listen to what I wanted to say about being induced? Aren’t I the one who will have to carry and birth this baby and live with the choices and decisions and consequent life long memories, not her? I left her office that day stunned, disappointed, ignored and bewildered. I knew that I had a lot to think about.
My attributing factor to this news was that she had recently moved into a solo practice, away from a group practice. In a group practice, an OB is freed from being on call twenty-four/seven; an OB in solo practice doesn’t have that luxury. So for strictly business reasons of pure convenience, it is not unusual for an OB in solo practice to try to schedule as many inductions as possible, whether they are medically necessary or not.
I am not saying I am against inducing women into labor; there are certainly a number of reasons where a woman should be induced for her safety and/or the safety of her child. For example, preeclampsia or eclampsia (where the mother’s blood pressure is extremely high due to the baby), if the baby has had their first bowel movement prior to the water breaking and/or prior to being born, being two weeks past the due date (greater than 42 weeks), and the list of reasons goes on. For the purpose of this paper, I would like to explore medical induction of labor and the reasons for and against doing so. Personally, I think that a healthy baby being born to a healthy mother should be able to arrive in their own time and that the convenience of the mother, or especially the doctor, should not come into play at all.
Therefore, to be induced, or not to be induced, that is the question. The answer, ultimately, will depend on the beliefs of the mother, the beliefs of the doctor, and hopefully foremost, the health of the baby and the mother evaluated together. Technology has progressed a long way in our society, which has given many babies a chance at life whereas before the technology existed, they, and mostly likely the mother as well, might have died in labor. Unfortunately our society has taken that technology and used it for a purpose that is not its original intent: personal convenience.
According to Wilson, the onset of labor, once considered a naturally occurring event, has become one of timing, control, and convenience for both obstetrical providers and expectant women, with nearly two thirds of all labor induction in the US now initiated for non-medical reasons (208). Is this the best practice for the baby and the mother? The induction of labor for non-medically necessary reasons is one of the most controversial issues in maternity care in this country today (Amis 16). The National Center for Health Statistics wrote that in 2002, the rate of labor induction in the United States had a 129% increase from 1989, the first year that data on induction was collected (Simpson and Thorman, 135). Wilson writes that because labor induction is a relative new event, data collection was not routinely collected for induction until 1989 (208).
In the last few weeks of pregnancy, the mother’s body and the baby are preparing for the birthing process. These last weeks are vitally important for a mother and her baby, writes Lothian (43). For a first-time mother, the baby often “drops down” into the pelvis in the weeks before birth (Amis 16). This is part of the preparation for labor by the fetus. The last weeks also allow the baby to prepare for his or her entry in the world by allowing the baby to gain weight and strength, store iron, develop more coordinated sucking reflexes and swallowing ability, develop lung maturity further and also allow for important antibodies to be passed on from the mother to the infant (Lothian 44). Also according to Lothian, waiting for labor to begin on its own is the best way to determine if the baby is ready to enter the world and if the mother is ready to begin the birthing process (44).
Normal term labor is the culmination of a sequence of interrelated hormonal shifts that are mediated primarily by the fetus, the placenta, the fetal membranes, and the mother’s endocrine system (Romano and Lothian 94). In an article by Amis, she states that researchers now believe that when a baby is ready for life outside his mother’s uterus, his body releases a tiny amount of a substance that signals the mother’s hormones to begin labor (16). When a woman goes into labor naturally, there are hormones called prostaglandins, which cause the cervix to soften and ripen. The quantity of prostaglandins released increases when the body is ready to deliver the baby (Moran and Kellem, p 32). There are also hormones released that stimulate uterine contractions to begin. According to Romano and Lothian, spontaneous onset of term labor signifies the fetus’ readiness to be born as well as the mother’s physiological receptiveness to the process (94). As the birth approaches, the mother may have a surge of stress hormones that may aid in the birth of the fetus (Romano and Lothian 95). All of these phenomena’s are completely natural and doctors and midwives agree that the natural onset of labor is the best way to deliver the baby.
To define what exactly labor induction is: labor induction is the intentional initiation of uterine contractions before their spontaneous onset. According to ICEA (International Childbirth Education Association), labor induction is a process using various mechanical methods and chemicals to initiate uterine contractions before the onset of spontaneous labor with the goal of accomplishing a successful birth (31). According to Wilson, “an indicated induction is recommended as a therapeutic option when the benefits of birth outweigh the risks of continuing the pregnancy, as seen in certain high risk conditions with fetal compromise. Such conditions include eclampsia, preeclampsia (hypertension in the mother that is directly related to the pregnancy), premature rupture of the membranes, and suspected intrauterine fetal growth restriction” (208). Labor may be induced if it is more risky for your baby to remain inside your body than to be born. According to the American College of Obstetrics and Gynecologists, labor may be induced if: you water has broken and labor has not begun; your pregnancy is post term (more than 42 weeks), you have high blood pressure caused by your pregnancy, you have health problems such as diabetes that could affect your baby, you have an infection in the uterus, your baby is growing too slowly (Amis 16-17).
When labor is brought on artificially, a number of events are not allowed to occur or occur prematurely. When labor is induced artificially, the drug Pitocin (oxytocin) is given intravenously in the hospital setting. Two main functions of prostaglandins are to regulate hormone activity and to contract the smooth muscle of the uterus (ICEA 36). Sometimes drugs called “ripening agents”, such as Cervidil or Cytotec, are given to soften the cervix and prepare it for labor (Amis 17). Pitocin is given after the cervix has ripened (ICEA 37). “Interfering with or replacing the natural hormones that orchestrate labor, birth, breastfeeding, and maternal attachment may have consequences that we do not yet understand,” writes Amis (19).
As with all obstetric conveniences, there is growing evidence that the decision to induce for non-medically necessary reasons increases risks of interventions and complications, including, but not limited to: a longer labor compared to spontaneous labor, artificial rupture of membranes, significant discomfort, epidural anesthesia or increased need of other types of analgesia, maternal fever, hypotension, prolonged second stage of labor, operative vaginal birth, episiotomy, vacuum or forceps assisted vaginal birth, fetal heart changes, shoulder dystocia (where the baby’s shoulder gets stuck behind the mother’s pelvic bones), babies born with low birth weight, need for birth by cesarean section, need for admission to the Neonatal Intensive Care Unit (NICU), jaundice that required treatment and a lengthened hospital stay (Simpson and Thorman 135) (Amis 18) (Romano and Lothian 96). “Medical induction of labor also nearly doubled the risk of overall cases of amniotic-fluid embolism, and the association was stronger for fatal cases” (Kramer et al 1444). Because due dates are not an exact science, and there can be up to a two week error window for the actual due date, a medically induced baby at 38 weeks can actually only be 36 weeks old. This is one of the reasons that babies born after elective induction can have poor outcomes such as low birth weight or jaundice requiring treatment. They were accidentally born before they have reached full maturity, which is defined as reaching 37 completed weeks (Amis 8).
Besides, adverse maternal outcomes, such as cesarean sections, there are other reasons that might warrant waiting for spontaneous onset of labor, such as the addition of escalating health care expenditures, including additional supply and labor costs, added lengths of hospital stay, and increased neonatal and maternal morbidity and mortality. Delivery with spontaneous onset of labor is significantly lower than the cost of delivering following induction, particularly those ending in a cesarean birth (Wilson 212). There is also the chance that the mother may have to an intravenous line and continuous electronic fetal heart monitoring. In many settings, the mother must stay in bed or very close to the bed, and this does not allow the mother to walk freely or change positions in response to labor contractions, possibly slowing the progress of labor. The mother may be unable to take advantage of a soothing tub bath or a warm shower to ease the pain of labor contractions. Artificially induced contractions often peak sooner and remain intense longer than natural contractions, increasing the mother’s need for pain medication (Amis 8). The afore mentioned natural interventions all help the mother to have an “easier” labor and to help the labor progress along at a natural rate. A tub bath or a warm shower can be relaxing to the mother and may even help with pain distraction. Being artificially induced removes the ability to utilize these techniques, which can lead to an increased need for pain relief in the form of medications.
When it comes to the increased cost that is associated with elective induction of labor, Romano writes that women with induced labors were twice as likely to end up having their baby by cesarean delivery and in addition to this, their baby was more likely to need to be admitted to the Neonatal Intensive Care Unit (NICU). These factors resulted in a significantly high increase in the average cost of labor (53).
The matter of convenience is often brought up as a reason to induce labor artificially. According to Amis, hospitals can provide extra nurses on during shifts when inductions are scheduled, the family can prepare for the birth by making work and family arrangements and the physician can schedule the birth on days and during hours that are convenient for them (17). However, the benefits must be weighed with the risks (Simpson and Thorman 135). What is not convenient about artificial induction is when the induction doesn’t go as planned: for example, the induction does not work and the mother is sent home only to return another day and try again, when there are delays in the hospital and when the induction leads to a cesarean birth, consequently leaving the mother to recover from major abdominal surgery rather than vaginal birth, or if the baby has breathing problems and/or has to be admitted to the Neonatal Intensive Care Unit (NICU) (Amis 17).
What are the alternatives for the impatient healthy mother who wants to induce? Do chemical and mechanical interventions have to be used to bring about labor? No, labor can be induced by natural means, such as sexual intercourse or nipple stimulation. In ICEA’s statement, they state that sexual intercourse and nipple stimulation are natural methods that may help to stimulate contractions and improve the inducibility of the cervix. During the act of intercourse, prostaglandins are released into the bloodstream and may act on the uterus and the cervix. Prostaglandins are also contained in semen and may act directly on the cervix after ejaculation during intercourse. Nipple stimulation increases oxytocin that may also act on the uterus to start contractions (34).
If these methods do not work, and the mother is still considering elective induction when there is not a medically necessary reason, then elective inductions for primiparous (first time) women should be offered with caution, particular for women with advanced maternal age (Wilson 213). Furthermore, studies have indicated that medical procedures, such as “epidural analgesia, induction, augmentation of first stage of labor, instrumental vaginal delivery and emergency caesarean section, and a prolonged labor” were all associated with a negative experience of labor and birth (Waldenstrom et al 22). Kramer writes that the “substantially raised risk in women whose labor was medically induced should be a cause for concern, in view of the increasing tendency for clinicians to induce labor, and especially for routine induction at term or after term” (1448). Both the mother and the practitioner should take all of these things into consideration when making the decision for elective induction. The mother should be fully informed of all the risks and possible complications, as well as the comfort techniques (walking, tub bathes, etc) that a medical induction does not always allow.
Ultimately, waiting for labor to begin on its own increases the likelihood that you will have positive lifelong memories of your birth experience and decrease the possibility of complications for both you and the baby (Amis 6). Though I did not have all of the knowledge that is contained in the paper at that ten-week OB appointment, I knew in my heart that waiting for my baby to be born in her own timing was the best way to go. Instinctually, I felt that inducing my baby when there was no medical reason present was not what was best for her, and for me. Having reviewed the literature in the writing of this paper, along with taking birthing classes and reading various birthing books and non peer-reviewed journal articles, I can now say that my instincts were right on. As for the OB that wanted to induce me, I decided not to continue with her for the duration of my pregnancy and found a midwife who has treated me with much more respect for my wishes, for which I am truly grateful.
Works Cited
Amis, D. "Care practice #1: labor begins on its own." Journal of Perinatal Education 16.3 (June 2007): 16-20. CINAHL with Full Text. EBSCO. 7 Mar. 2009.
Amis, D. "Care practices that promote normal birth #1: labor begins on it own... including commentary by Gaskin IM." Journal of Perinatal Education 13.2 (Mar. 2004): 6-10. CINAHL with Full Text. EBSCO. 7 Mar. 2009.
"ICEA position statement and review: induction of labor." International Journal of Childbirth Education 18.1 (Mar. 2003): 31-40. CINAHL with Full Text. EBSCO. 7 Mar. 2009.
Kramer, MS, et al. "Amniotic-fluid embolism and medical induction of labour: a retrospective, population-based cohort study." Lancet 368.9545 (21 Oct. 2006): 1444- 1448. CINAHL with Full Text. EBSCO. 7 Mar. 2009.
Lothian, JA. "Saying "no" to induction." Journal of Perinatal Education 15.2 (Mar. 2006): 43-45. CINAHL with Full Text. EBSCO. 7 Mar. 2009.
Moran, DE and Kallam,GB The Gift of Motherhood: Your Personal Journey Through Prepared Childbirth. Customized Communications, Inc: Arlington. 2008.
Romano, AM. "Research summaries for normal birth." Journal of Perinatal Education 15.1 (2006 Winter 2006): 52-55. CINAHL with Full Text. EBSCO. 7 Mar. 2009.
Romano, AM, and JA Lothian.. "Promoting, protecting, and supporting normal birth: a look at the evidence." JOGNN: Journal of Obstetric, Gynecologic, & Neonatal Nursing 37.1 (2008 Jan-Feb 2008): 94-105. CINAHL with Full Text. EBSCO. 7 Mar. 2009.
Simpson, KR, and KE Thorman.. "Obstetric "conveniences": elective induction of labor, cesarean birth on demand, and other potentially unnecessary interventions." Journal of Perinatal & Neonatal Nursing 19.2 (Apr. 2005): 134-144. CINAHL with Full Text. EBSCO. 7 Mar. 2009.
Waldenström, U, et al. "A negative birth experience: prevalence and risk factors in a national sample." Birth: Issues in Perinatal Care 31.1 (Mar. 2004): 17-27. CINAHL with Full Text. EBSCO. 7 Mar. 2009.
Wilson, BL. "Assessing the effects of age, gestation, socioeconomic status, and ethnicity on labor inductions." Journal of Nursing Scholarship 39.3 (Sep. 2007): 208-213. CINAHL with Full Text. EBSCO. 7 Mar. 2009.
It was my ten-week pregnancy check up. Being the nervous new-to-be mother, I had a lot of questions for my OB when I went to my appointment. One of many questions asked, and answered, was as follows:
“So at what point in the pregnancy do we start talking about the labor and delivery process?” I was just curious, I looking for answer akin to “Oh, about 30 or 35 weeks”. I’m a planner; I just wanted a time-line for myself to mentally prepare for every step in the pregnancy and birthing process. Instead I got something quite different.
“Well, we’ll probably induce you at thirty-eight weeks, most likely on a Thursday.”
What?!? Induction? What in the world for??? “I don’t really believe in being induced for a non-medically necessary reason . . .” I started timidly, completely taken for surprise. I hadn’t really been prepared to defend myself in such a manner at this point in my pregnancy.
In a very brisk, business-like manner, the doctor replied “It really is best, that way your husband will know ahead of time and can get off work (she nodded her head to my husband who was sitting in the chair next to the exam table), you’ll be able to get a full night’s rest before the baby comes . . .” and she continued to rattle off another half dozen or so reasons of why she wanted to induce me.
I couldn’t believe it, and at the same time that I was forming an argument in my head for every single reason, I felt powerless to respond. I felt as though my beliefs had just been trampled upon. From previous visits and conversations with this doctor, I knew that she and I stood on the same ground on many issues including contraception, natural family planning and God’s presence in the entire process of marital bliss, including conception. And here she was telling me she was going to induce me? I was only ten weeks pregnant; I wasn’t carrying twins, I didn’t have two uteruses or a uterus with a septum, I didn’t have any reason for being high risk and needing to have my labor induced. This OB had delivered three of my good friend’s babies and they all were able to have completely natural labors (without ever mentioning induction). Why did she suddenly say she wanted to induce me? Why didn’t she listen to what I wanted to say about being induced? Aren’t I the one who will have to carry and birth this baby and live with the choices and decisions and consequent life long memories, not her? I left her office that day stunned, disappointed, ignored and bewildered. I knew that I had a lot to think about.
My attributing factor to this news was that she had recently moved into a solo practice, away from a group practice. In a group practice, an OB is freed from being on call twenty-four/seven; an OB in solo practice doesn’t have that luxury. So for strictly business reasons of pure convenience, it is not unusual for an OB in solo practice to try to schedule as many inductions as possible, whether they are medically necessary or not.
I am not saying I am against inducing women into labor; there are certainly a number of reasons where a woman should be induced for her safety and/or the safety of her child. For example, preeclampsia or eclampsia (where the mother’s blood pressure is extremely high due to the baby), if the baby has had their first bowel movement prior to the water breaking and/or prior to being born, being two weeks past the due date (greater than 42 weeks), and the list of reasons goes on. For the purpose of this paper, I would like to explore medical induction of labor and the reasons for and against doing so. Personally, I think that a healthy baby being born to a healthy mother should be able to arrive in their own time and that the convenience of the mother, or especially the doctor, should not come into play at all.
Therefore, to be induced, or not to be induced, that is the question. The answer, ultimately, will depend on the beliefs of the mother, the beliefs of the doctor, and hopefully foremost, the health of the baby and the mother evaluated together. Technology has progressed a long way in our society, which has given many babies a chance at life whereas before the technology existed, they, and mostly likely the mother as well, might have died in labor. Unfortunately our society has taken that technology and used it for a purpose that is not its original intent: personal convenience.
According to Wilson, the onset of labor, once considered a naturally occurring event, has become one of timing, control, and convenience for both obstetrical providers and expectant women, with nearly two thirds of all labor induction in the US now initiated for non-medical reasons (208). Is this the best practice for the baby and the mother? The induction of labor for non-medically necessary reasons is one of the most controversial issues in maternity care in this country today (Amis 16). The National Center for Health Statistics wrote that in 2002, the rate of labor induction in the United States had a 129% increase from 1989, the first year that data on induction was collected (Simpson and Thorman, 135). Wilson writes that because labor induction is a relative new event, data collection was not routinely collected for induction until 1989 (208).
In the last few weeks of pregnancy, the mother’s body and the baby are preparing for the birthing process. These last weeks are vitally important for a mother and her baby, writes Lothian (43). For a first-time mother, the baby often “drops down” into the pelvis in the weeks before birth (Amis 16). This is part of the preparation for labor by the fetus. The last weeks also allow the baby to prepare for his or her entry in the world by allowing the baby to gain weight and strength, store iron, develop more coordinated sucking reflexes and swallowing ability, develop lung maturity further and also allow for important antibodies to be passed on from the mother to the infant (Lothian 44). Also according to Lothian, waiting for labor to begin on its own is the best way to determine if the baby is ready to enter the world and if the mother is ready to begin the birthing process (44).
Normal term labor is the culmination of a sequence of interrelated hormonal shifts that are mediated primarily by the fetus, the placenta, the fetal membranes, and the mother’s endocrine system (Romano and Lothian 94). In an article by Amis, she states that researchers now believe that when a baby is ready for life outside his mother’s uterus, his body releases a tiny amount of a substance that signals the mother’s hormones to begin labor (16). When a woman goes into labor naturally, there are hormones called prostaglandins, which cause the cervix to soften and ripen. The quantity of prostaglandins released increases when the body is ready to deliver the baby (Moran and Kellem, p 32). There are also hormones released that stimulate uterine contractions to begin. According to Romano and Lothian, spontaneous onset of term labor signifies the fetus’ readiness to be born as well as the mother’s physiological receptiveness to the process (94). As the birth approaches, the mother may have a surge of stress hormones that may aid in the birth of the fetus (Romano and Lothian 95). All of these phenomena’s are completely natural and doctors and midwives agree that the natural onset of labor is the best way to deliver the baby.
To define what exactly labor induction is: labor induction is the intentional initiation of uterine contractions before their spontaneous onset. According to ICEA (International Childbirth Education Association), labor induction is a process using various mechanical methods and chemicals to initiate uterine contractions before the onset of spontaneous labor with the goal of accomplishing a successful birth (31). According to Wilson, “an indicated induction is recommended as a therapeutic option when the benefits of birth outweigh the risks of continuing the pregnancy, as seen in certain high risk conditions with fetal compromise. Such conditions include eclampsia, preeclampsia (hypertension in the mother that is directly related to the pregnancy), premature rupture of the membranes, and suspected intrauterine fetal growth restriction” (208). Labor may be induced if it is more risky for your baby to remain inside your body than to be born. According to the American College of Obstetrics and Gynecologists, labor may be induced if: you water has broken and labor has not begun; your pregnancy is post term (more than 42 weeks), you have high blood pressure caused by your pregnancy, you have health problems such as diabetes that could affect your baby, you have an infection in the uterus, your baby is growing too slowly (Amis 16-17).
When labor is brought on artificially, a number of events are not allowed to occur or occur prematurely. When labor is induced artificially, the drug Pitocin (oxytocin) is given intravenously in the hospital setting. Two main functions of prostaglandins are to regulate hormone activity and to contract the smooth muscle of the uterus (ICEA 36). Sometimes drugs called “ripening agents”, such as Cervidil or Cytotec, are given to soften the cervix and prepare it for labor (Amis 17). Pitocin is given after the cervix has ripened (ICEA 37). “Interfering with or replacing the natural hormones that orchestrate labor, birth, breastfeeding, and maternal attachment may have consequences that we do not yet understand,” writes Amis (19).
As with all obstetric conveniences, there is growing evidence that the decision to induce for non-medically necessary reasons increases risks of interventions and complications, including, but not limited to: a longer labor compared to spontaneous labor, artificial rupture of membranes, significant discomfort, epidural anesthesia or increased need of other types of analgesia, maternal fever, hypotension, prolonged second stage of labor, operative vaginal birth, episiotomy, vacuum or forceps assisted vaginal birth, fetal heart changes, shoulder dystocia (where the baby’s shoulder gets stuck behind the mother’s pelvic bones), babies born with low birth weight, need for birth by cesarean section, need for admission to the Neonatal Intensive Care Unit (NICU), jaundice that required treatment and a lengthened hospital stay (Simpson and Thorman 135) (Amis 18) (Romano and Lothian 96). “Medical induction of labor also nearly doubled the risk of overall cases of amniotic-fluid embolism, and the association was stronger for fatal cases” (Kramer et al 1444). Because due dates are not an exact science, and there can be up to a two week error window for the actual due date, a medically induced baby at 38 weeks can actually only be 36 weeks old. This is one of the reasons that babies born after elective induction can have poor outcomes such as low birth weight or jaundice requiring treatment. They were accidentally born before they have reached full maturity, which is defined as reaching 37 completed weeks (Amis 8).
Besides, adverse maternal outcomes, such as cesarean sections, there are other reasons that might warrant waiting for spontaneous onset of labor, such as the addition of escalating health care expenditures, including additional supply and labor costs, added lengths of hospital stay, and increased neonatal and maternal morbidity and mortality. Delivery with spontaneous onset of labor is significantly lower than the cost of delivering following induction, particularly those ending in a cesarean birth (Wilson 212). There is also the chance that the mother may have to an intravenous line and continuous electronic fetal heart monitoring. In many settings, the mother must stay in bed or very close to the bed, and this does not allow the mother to walk freely or change positions in response to labor contractions, possibly slowing the progress of labor. The mother may be unable to take advantage of a soothing tub bath or a warm shower to ease the pain of labor contractions. Artificially induced contractions often peak sooner and remain intense longer than natural contractions, increasing the mother’s need for pain medication (Amis 8). The afore mentioned natural interventions all help the mother to have an “easier” labor and to help the labor progress along at a natural rate. A tub bath or a warm shower can be relaxing to the mother and may even help with pain distraction. Being artificially induced removes the ability to utilize these techniques, which can lead to an increased need for pain relief in the form of medications.
When it comes to the increased cost that is associated with elective induction of labor, Romano writes that women with induced labors were twice as likely to end up having their baby by cesarean delivery and in addition to this, their baby was more likely to need to be admitted to the Neonatal Intensive Care Unit (NICU). These factors resulted in a significantly high increase in the average cost of labor (53).
The matter of convenience is often brought up as a reason to induce labor artificially. According to Amis, hospitals can provide extra nurses on during shifts when inductions are scheduled, the family can prepare for the birth by making work and family arrangements and the physician can schedule the birth on days and during hours that are convenient for them (17). However, the benefits must be weighed with the risks (Simpson and Thorman 135). What is not convenient about artificial induction is when the induction doesn’t go as planned: for example, the induction does not work and the mother is sent home only to return another day and try again, when there are delays in the hospital and when the induction leads to a cesarean birth, consequently leaving the mother to recover from major abdominal surgery rather than vaginal birth, or if the baby has breathing problems and/or has to be admitted to the Neonatal Intensive Care Unit (NICU) (Amis 17).
What are the alternatives for the impatient healthy mother who wants to induce? Do chemical and mechanical interventions have to be used to bring about labor? No, labor can be induced by natural means, such as sexual intercourse or nipple stimulation. In ICEA’s statement, they state that sexual intercourse and nipple stimulation are natural methods that may help to stimulate contractions and improve the inducibility of the cervix. During the act of intercourse, prostaglandins are released into the bloodstream and may act on the uterus and the cervix. Prostaglandins are also contained in semen and may act directly on the cervix after ejaculation during intercourse. Nipple stimulation increases oxytocin that may also act on the uterus to start contractions (34).
If these methods do not work, and the mother is still considering elective induction when there is not a medically necessary reason, then elective inductions for primiparous (first time) women should be offered with caution, particular for women with advanced maternal age (Wilson 213). Furthermore, studies have indicated that medical procedures, such as “epidural analgesia, induction, augmentation of first stage of labor, instrumental vaginal delivery and emergency caesarean section, and a prolonged labor” were all associated with a negative experience of labor and birth (Waldenstrom et al 22). Kramer writes that the “substantially raised risk in women whose labor was medically induced should be a cause for concern, in view of the increasing tendency for clinicians to induce labor, and especially for routine induction at term or after term” (1448). Both the mother and the practitioner should take all of these things into consideration when making the decision for elective induction. The mother should be fully informed of all the risks and possible complications, as well as the comfort techniques (walking, tub bathes, etc) that a medical induction does not always allow.
Ultimately, waiting for labor to begin on its own increases the likelihood that you will have positive lifelong memories of your birth experience and decrease the possibility of complications for both you and the baby (Amis 6). Though I did not have all of the knowledge that is contained in the paper at that ten-week OB appointment, I knew in my heart that waiting for my baby to be born in her own timing was the best way to go. Instinctually, I felt that inducing my baby when there was no medical reason present was not what was best for her, and for me. Having reviewed the literature in the writing of this paper, along with taking birthing classes and reading various birthing books and non peer-reviewed journal articles, I can now say that my instincts were right on. As for the OB that wanted to induce me, I decided not to continue with her for the duration of my pregnancy and found a midwife who has treated me with much more respect for my wishes, for which I am truly grateful.
Works Cited
Amis, D. "Care practice #1: labor begins on its own." Journal of Perinatal Education 16.3 (June 2007): 16-20. CINAHL with Full Text. EBSCO. 7 Mar. 2009
Amis, D. "Care practices that promote normal birth #1: labor begins on it own... including commentary by Gaskin IM." Journal of Perinatal Education 13.2 (Mar. 2004): 6-10. CINAHL with Full Text. EBSCO. 7 Mar. 2009
"ICEA position statement and review: induction of labor." International Journal of Childbirth Education 18.1 (Mar. 2003): 31-40. CINAHL with Full Text. EBSCO. 7 Mar. 2009
Kramer, MS, et al. "Amniotic-fluid embolism and medical induction of labour: a retrospective, population-based cohort study." Lancet 368.9545 (21 Oct. 2006): 1444- 1448. CINAHL with Full Text. EBSCO. 7 Mar. 2009
Lothian, JA. "Saying "no" to induction." Journal of Perinatal Education 15.2 (Mar. 2006): 43-45. CINAHL with Full Text. EBSCO. 7 Mar. 2009
Moran, DE and Kallam,GB The Gift of Motherhood: Your Personal Journey Through Prepared Childbirth. Customized Communications, Inc: Arlington. 2008.
Romano, AM. "Research summaries for normal birth." Journal of Perinatal Education 15.1 (2006 Winter 2006): 52-55. CINAHL with Full Text. EBSCO. 7 Mar. 2009
Romano, AM, and JA Lothian.. "Promoting, protecting, and supporting normal birth: a look at the evidence." JOGNN: Journal of Obstetric, Gynecologic, & Neonatal Nursing 37.1 (2008 Jan-Feb 2008): 94-105. CINAHL with Full Text. EBSCO. 7 Mar. 2009
Simpson, KR, and KE Thorman.. "Obstetric "conveniences": elective induction of labor, cesarean birth on demand, and other potentially unnecessary interventions." Journal of Perinatal & Neonatal Nursing 19.2 (Apr. 2005): 134-144. CINAHL with Full Text. EBSCO. 7 Mar. 2009
Waldenström, U, et al. "A negative birth experience: prevalence and risk factors in a national sample." Birth: Issues in Perinatal Care 31.1 (Mar. 2004): 17-27. CINAHL with Full Text. EBSCO. 7 Mar. 2009
Wilson, BL. "Assessing the effects of age, gestation, socioeconomic status, and ethnicity on labor inductions." Journal of Nursing Scholarship 39.3 (Sep. 2007): 208-213. CINAHL with Full Text. EBSCO. 7 Mar. 2009
Wednesday, August 25, 2010
Freebirth FAQ
Fierce Mamas support the choice to freebirth! We have been persecuted for it, sometimes very publicly, so it is essential that we keep talking about it to make sure women understand it as a valid birthing option.
We need audience participation to do this well!! Please post your questions about freebirth in the comment section here. Over the next few days, 3 freebirthing women will answer your questions; we will reassemble the entire thing to create an FAQ here on Fierce Mamas. No question is too big or small, although I will be deleting questions of the disrespectful variety ;)
-Arie
We need audience participation to do this well!! Please post your questions about freebirth in the comment section here. Over the next few days, 3 freebirthing women will answer your questions; we will reassemble the entire thing to create an FAQ here on Fierce Mamas. No question is too big or small, although I will be deleting questions of the disrespectful variety ;)
-Arie
Tuesday, August 10, 2010
Rowan’s Birth Story
by Laurinda Reddig
Two years ago today, I gave birth to a beautiful 8lb 11oz baby girl named Rowan. She never breathed on her own, and lived for just one day, so I never felt up to writing her birth story. Now, with my second daughter Willow asleep on my chest, I will try to write Rowan’s story…
My second pregnancy was much more difficult than the first. We had decided not to find out the gender but everyone thought that since my morning sickness was much worse than with my son, continuing throughout the pregnancy, it was a good chance she was a girl. Unlike my first birth, I had a lot of Braxton Hicks and regular early contractions every evening for weeks before my due date. After the fourth false alarm, we headed back home on Friday morning to wait for the real thing.
When I woke up from a nap on Saturday evening, my due date, I told my 3 year old son Griffin to tell the baby it was time to come out. He did just that, and about 15 minutes later my water broke. We headed to the birth center, stopping for ice cream to share with the midwives. Things progressed slowly, as we watched a movie and enjoyed the ice cream. I perched on a birth ball, crocheting a cocoon for the precious life we awaited.
Once the battery ran out on our laptop the movie was over, so we tried to get things moving. I started walking up and down the stairs, pausing for contractions, and realizing the difference between these and the ones I had been feeling for weeks. As things intensified, I went into the birthing suite to try the tub. After a little while I got a little overheated and decided to get out to go to the bathroom.
As I sat in the bathroom, I suddenly felt my baby drop and engage. My son had also not dropped until I was almost ready to push. But this time was different. I could feel my baby struggling, thumping on my pelvic bone repeatedly. My midwives immediately checked her heart rate and discovered it was erratic. They moved me to the bed, trying all sorts of different uncomfortable positions, but her heart rate did not improve. All of the strange positions flared up my asthma, so they gave me an oxygen tube. Meanwhile, they had called the paramedics who were in the lobby of the building. They checked inside to be sure that the cord was not tight around the baby’s neck and gave me the option to try pushing.
As soon as I was in position on the birth stool, which helped to open the way, the baby’s heart rate went back up. After just 3 or 4 long, hard pushes, our baby was born into the waiting arms of her father who handed her to me. As he handed me this tiny slippery baby, my first thought was to check the gender, a girl. Then I held Rowan to me and realized that she was not breathing.
My midwife immediately gave her oxygen from the tube, and began CPR. As I knelt next to them, still attached by the umbilical cord, my midwife and I saw a spot where the cord appeared to have been kinked at some point. As soon as the cord was cut, the paramedics loaded the gurney with our precious baby. My midwife and one assistant went along to continue CPR, and my husband stayed with them and Rowan.
I was left with the second apprentice midwife and my doula. We were informed that another ambulance was there, “to take mom to be with her baby”. We tried to push the placenta out, but it was not coming, so we went along to the hospital.
When we arrived in the hospital ER, I could not even see my baby. No one would give me any answers. They finally explained that Rowan’s organs were in severe failure, and they needed to cool her body down to slow it down and transport her to a hospital with a NICU for further tests. I was finally able to see Rowan when they wheeled her incubator into my room on her way to the ambulance which would transfer her. She looked so small, connected to so many tubes which were all that were keeping her alive. For a few moments, they opened the incubator so I could hold her cold, motionless hand.
My midwives tried to help me get my placenta out, but after the adrenaline of the situation and the ambulance transfer it may not have been possible. Apparently the OBs upstairs chose not to answer their calls and the ER guy actually asked the midwives if they could help. I was left bleeding in the ER for several hours, nearly passing out more than once. It was also during this time that the ER guy pulled off what was left of the umbilical cord and tossed it out with the rest of the waste, so we will never know exactly what the kink we saw was. It may have been caught when her head engaged, or been a kink that had gradually cut off her oxygen over the course of time, or even an aneurysm at some point. We will never know.
When an OB finally deigned to see me, I was put under full anesthesia for a D&C. When I came to in the recovery room, I choked on the oxygen they shoved into my throat raw from a breathing tube. Again, no one would answer my questions. The nurses would not even look me in the eye. I could not stand their looks of pity, when no one would tell me what was going on.
I was relieved to be greeted by a smiling nurse who brought me to my room and made me as comfortable as she could. I will never forget that nurse. As soon as I was settled into the room I was told that my husband needed to talk to me on the phone. He tried to explain to me what the doctors had said, but it basically meant that they were waiting for me to get there before they took our little Rowan off life support. He also asked if we should bring Griffin to the hospital, but at the time I did not see the point and thought it would scare him. The same kind nurse discovered that they could not send me because the other hospital was short staffed. She offered to drive there on her own to transfer with us so I would not have to wait any longer.
My mother rode in the ambulance with me, feeding me the chocolate chip oatmeal cookies she and my son had made when I first went in to labor. The same recipe we have made during each of my labors. I did not taste the cookies at all. The trip was slow as the bridges were blocked off for a bike race. The paramedic asked if they were waiting for me to make decisions about our baby and I said yes. I actually smiled when they used the sirens to pass the blocked traffic, even though we were not technically an emergency.
I finally arrived at the hospital where my baby was, but I still could not see her. They wheeled me into a postpartum room, complete with nursing gown hanging in the bathroom and large print of a father laying with his baby on his chest, much like the first picture we took of my husband when we came home with our son. I immediately asked them to take the picture down, and noticed that the next time we came back to the room it was gone.
Eventually I was wheeled into the NICU to see my daughter. My family was all there, gathered around our poor baby who lay motionless except for the small movement of her chest from the machines that kept her breathing. The doctor explained again, the second time for my husband and my father. Even if they could repair the damage to her body, at some point her oxygen was cut off too long, damaging her brain too severely for normal functioning.
Once the decision was made, I was wheeled back to my room to eat and rest. As we passed through the postpartum ward, I saw older children there to meet their new siblings. I suddenly realized how important it was for Griffin to come meet her. My sister had had a baby just 4 months before and he had been in the waiting room when her son was born. At three years old, he knew what was supposed to happen, and would be very confused if we just did not come home with a baby. But that is another story*.
When I returned to the NICU they wheeled me into a large closet to choose a handmade quilt to wrap Rowan in. That quilt, and the crocheted afghan she was wrapped in are some of the few things we were able to bring home to remember our baby. Looking through the pile of handmade quilts to choose a bright pink and green one for Rowan, I began to think of how Rowan’s short life could make a difference to other parents going through the same thing. As we prepared to say goodbye to our first born daughter, I was envisioning the Remembering Rowan Project*, donating blankets in her memory.
My husband and I got the chance to bathe our baby, wash her hair, and dress her in a simple white gown. My father played his harp, something beautiful for Rowan to experience during her short life. They removed the tubes pumping oxygen and medicine which was all that kept her body going. They had a large double rocking chair where we sat with Griffin to introduce him to his baby sister and explain why she was not coming home with us. Then he took a walk with his uncle while the rest of the family gathered together to each have a chance to hold her, kiss her, and say goodbye to our precious baby. Then the nurse took her vitals and recorded her time of death.
I had to stay overnight in the hospital after all of the blood loss. As they wheeled me back to my room, it felt so strange to leave our baby in the NICU knowing we would never see her again. They told us we could bring her back to the room with us, but that just seemed creepy. We had already said goodbye. It was only her body and holding it longer would not have brought me any comfort. I am not sure her spirit ever really inhabited that body. I have come to believe that there is a small spark that comes at the moment of birth, seems to me babies would get really bored in there for nine months. Call it the soul or the spirit or whatever. But I have to believe Rowan’s tiny spark just never connected, and instead she is everywhere, in everything.
* Read more about the Remembering Rowan Project and her other crafty ventures on Laurinda's Blog. She also wrote an essay on helping her three year old understand the loss of his sister.
Two years ago today, I gave birth to a beautiful 8lb 11oz baby girl named Rowan. She never breathed on her own, and lived for just one day, so I never felt up to writing her birth story. Now, with my second daughter Willow asleep on my chest, I will try to write Rowan’s story…
My second pregnancy was much more difficult than the first. We had decided not to find out the gender but everyone thought that since my morning sickness was much worse than with my son, continuing throughout the pregnancy, it was a good chance she was a girl. Unlike my first birth, I had a lot of Braxton Hicks and regular early contractions every evening for weeks before my due date. After the fourth false alarm, we headed back home on Friday morning to wait for the real thing.
When I woke up from a nap on Saturday evening, my due date, I told my 3 year old son Griffin to tell the baby it was time to come out. He did just that, and about 15 minutes later my water broke. We headed to the birth center, stopping for ice cream to share with the midwives. Things progressed slowly, as we watched a movie and enjoyed the ice cream. I perched on a birth ball, crocheting a cocoon for the precious life we awaited.
Once the battery ran out on our laptop the movie was over, so we tried to get things moving. I started walking up and down the stairs, pausing for contractions, and realizing the difference between these and the ones I had been feeling for weeks. As things intensified, I went into the birthing suite to try the tub. After a little while I got a little overheated and decided to get out to go to the bathroom.
As I sat in the bathroom, I suddenly felt my baby drop and engage. My son had also not dropped until I was almost ready to push. But this time was different. I could feel my baby struggling, thumping on my pelvic bone repeatedly. My midwives immediately checked her heart rate and discovered it was erratic. They moved me to the bed, trying all sorts of different uncomfortable positions, but her heart rate did not improve. All of the strange positions flared up my asthma, so they gave me an oxygen tube. Meanwhile, they had called the paramedics who were in the lobby of the building. They checked inside to be sure that the cord was not tight around the baby’s neck and gave me the option to try pushing.
As soon as I was in position on the birth stool, which helped to open the way, the baby’s heart rate went back up. After just 3 or 4 long, hard pushes, our baby was born into the waiting arms of her father who handed her to me. As he handed me this tiny slippery baby, my first thought was to check the gender, a girl. Then I held Rowan to me and realized that she was not breathing.
My midwife immediately gave her oxygen from the tube, and began CPR. As I knelt next to them, still attached by the umbilical cord, my midwife and I saw a spot where the cord appeared to have been kinked at some point. As soon as the cord was cut, the paramedics loaded the gurney with our precious baby. My midwife and one assistant went along to continue CPR, and my husband stayed with them and Rowan.
I was left with the second apprentice midwife and my doula. We were informed that another ambulance was there, “to take mom to be with her baby”. We tried to push the placenta out, but it was not coming, so we went along to the hospital.
When we arrived in the hospital ER, I could not even see my baby. No one would give me any answers. They finally explained that Rowan’s organs were in severe failure, and they needed to cool her body down to slow it down and transport her to a hospital with a NICU for further tests. I was finally able to see Rowan when they wheeled her incubator into my room on her way to the ambulance which would transfer her. She looked so small, connected to so many tubes which were all that were keeping her alive. For a few moments, they opened the incubator so I could hold her cold, motionless hand.
My midwives tried to help me get my placenta out, but after the adrenaline of the situation and the ambulance transfer it may not have been possible. Apparently the OBs upstairs chose not to answer their calls and the ER guy actually asked the midwives if they could help. I was left bleeding in the ER for several hours, nearly passing out more than once. It was also during this time that the ER guy pulled off what was left of the umbilical cord and tossed it out with the rest of the waste, so we will never know exactly what the kink we saw was. It may have been caught when her head engaged, or been a kink that had gradually cut off her oxygen over the course of time, or even an aneurysm at some point. We will never know.
When an OB finally deigned to see me, I was put under full anesthesia for a D&C. When I came to in the recovery room, I choked on the oxygen they shoved into my throat raw from a breathing tube. Again, no one would answer my questions. The nurses would not even look me in the eye. I could not stand their looks of pity, when no one would tell me what was going on.
I was relieved to be greeted by a smiling nurse who brought me to my room and made me as comfortable as she could. I will never forget that nurse. As soon as I was settled into the room I was told that my husband needed to talk to me on the phone. He tried to explain to me what the doctors had said, but it basically meant that they were waiting for me to get there before they took our little Rowan off life support. He also asked if we should bring Griffin to the hospital, but at the time I did not see the point and thought it would scare him. The same kind nurse discovered that they could not send me because the other hospital was short staffed. She offered to drive there on her own to transfer with us so I would not have to wait any longer.
My mother rode in the ambulance with me, feeding me the chocolate chip oatmeal cookies she and my son had made when I first went in to labor. The same recipe we have made during each of my labors. I did not taste the cookies at all. The trip was slow as the bridges were blocked off for a bike race. The paramedic asked if they were waiting for me to make decisions about our baby and I said yes. I actually smiled when they used the sirens to pass the blocked traffic, even though we were not technically an emergency.
I finally arrived at the hospital where my baby was, but I still could not see her. They wheeled me into a postpartum room, complete with nursing gown hanging in the bathroom and large print of a father laying with his baby on his chest, much like the first picture we took of my husband when we came home with our son. I immediately asked them to take the picture down, and noticed that the next time we came back to the room it was gone.
Eventually I was wheeled into the NICU to see my daughter. My family was all there, gathered around our poor baby who lay motionless except for the small movement of her chest from the machines that kept her breathing. The doctor explained again, the second time for my husband and my father. Even if they could repair the damage to her body, at some point her oxygen was cut off too long, damaging her brain too severely for normal functioning.
Once the decision was made, I was wheeled back to my room to eat and rest. As we passed through the postpartum ward, I saw older children there to meet their new siblings. I suddenly realized how important it was for Griffin to come meet her. My sister had had a baby just 4 months before and he had been in the waiting room when her son was born. At three years old, he knew what was supposed to happen, and would be very confused if we just did not come home with a baby. But that is another story*.
When I returned to the NICU they wheeled me into a large closet to choose a handmade quilt to wrap Rowan in. That quilt, and the crocheted afghan she was wrapped in are some of the few things we were able to bring home to remember our baby. Looking through the pile of handmade quilts to choose a bright pink and green one for Rowan, I began to think of how Rowan’s short life could make a difference to other parents going through the same thing. As we prepared to say goodbye to our first born daughter, I was envisioning the Remembering Rowan Project*, donating blankets in her memory.
My husband and I got the chance to bathe our baby, wash her hair, and dress her in a simple white gown. My father played his harp, something beautiful for Rowan to experience during her short life. They removed the tubes pumping oxygen and medicine which was all that kept her body going. They had a large double rocking chair where we sat with Griffin to introduce him to his baby sister and explain why she was not coming home with us. Then he took a walk with his uncle while the rest of the family gathered together to each have a chance to hold her, kiss her, and say goodbye to our precious baby. Then the nurse took her vitals and recorded her time of death.
I had to stay overnight in the hospital after all of the blood loss. As they wheeled me back to my room, it felt so strange to leave our baby in the NICU knowing we would never see her again. They told us we could bring her back to the room with us, but that just seemed creepy. We had already said goodbye. It was only her body and holding it longer would not have brought me any comfort. I am not sure her spirit ever really inhabited that body. I have come to believe that there is a small spark that comes at the moment of birth, seems to me babies would get really bored in there for nine months. Call it the soul or the spirit or whatever. But I have to believe Rowan’s tiny spark just never connected, and instead she is everywhere, in everything.
* Read more about the Remembering Rowan Project and her other crafty ventures on Laurinda's Blog. She also wrote an essay on helping her three year old understand the loss of his sister.
Tuesday, August 3, 2010
A Lesson In Security
When I was a freshman in high school, my grandpa died. And as a family we made the 12+ hour car trip to go to the funeral and be a part of the family.
We stayed at my grandma's house. My parents and brothers slept upstairs and I slept downstairs in the livingroom on the couch. One night I woke up to a guy rubbing my leg. Twice. I kicked him. Twice. And then I went upstairs to sleep with my parents.
Yes, as a freshman in high school, I went and slept with my parents. Why? Lots of reasons.
I knew the difference between good touch and bad touch. Not necessarily because I was "told" the difference, but because I grew up with good touch. Lots of it.
Also, I was obviously secure enough in my relationship with my parents that I could, even as a teenager, seek them out in the middle of the night in a strange house because something was wrong.
Why am I telling you this? Because it's important.
Recently one of my facebook friends asked how to get his five-month-old to sleep on his own. My response was that he shouldn't have to sleep on his own. Mom and dad are their children's security. And as they grow older, even if they aren't sleeping with you, you are still their security. And if the roots of security are there, your children, even as teenagers, will know even in the middle of the night in their grogginess that they can come to you if they need to. Period.
I taught high school for four years. Several times each year I had a girl come to me with a boy problem. It's just how it is. But of those several times, I remember a select few and their reactions when I said, "You know you dont' have to . . . " The stunned silence and then the anger that suddenly flooded her face made me cringe. I distinctly remember one storming out of the room, not mad at me, but mad. And another one responded with, "Why didn't anyone tell me that?!"
Things could have been so much different that night when I was sleeping in that livingroom. But I knew that I didn't have to.
No, we did not co-sleep with our parents, but their bed was not off limits. We were always close to our parents, physically and emotionally, and our needs were always met in a timely manner. We knew that we could count on them and it was as simple as that. We were their priority. They were our security.
Before we had children, my husband and I took a vacation and went to the coast for a week. I distinctly remember walking up a path behind a family with two girls who looked to be about age 10 and 13. Both of them were holding hands with their dad on the way up the trail. I remember thinking that is how I wanted it to be when we had our kids.
Now, watching our girls attack their daddy when he gets home and seeing them pile on him to read books every night, I know that they are getting their fill of appropriate touch. And to me, that is one fo the very best ways to build their security and protect them from the realities of this world. They are still little, yes. We do our best to keep them safe. But some day they won't be little any more. And when they are big, I want them to be able to come to us, even in the middle of the night, crawl in bed and feel safe.
Please don't push your children away. They need you. You are their security. They are your priority.
By Heidi Donnelly
We stayed at my grandma's house. My parents and brothers slept upstairs and I slept downstairs in the livingroom on the couch. One night I woke up to a guy rubbing my leg. Twice. I kicked him. Twice. And then I went upstairs to sleep with my parents.
Yes, as a freshman in high school, I went and slept with my parents. Why? Lots of reasons.
I knew the difference between good touch and bad touch. Not necessarily because I was "told" the difference, but because I grew up with good touch. Lots of it.
Also, I was obviously secure enough in my relationship with my parents that I could, even as a teenager, seek them out in the middle of the night in a strange house because something was wrong.
Why am I telling you this? Because it's important.
Recently one of my facebook friends asked how to get his five-month-old to sleep on his own. My response was that he shouldn't have to sleep on his own. Mom and dad are their children's security. And as they grow older, even if they aren't sleeping with you, you are still their security. And if the roots of security are there, your children, even as teenagers, will know even in the middle of the night in their grogginess that they can come to you if they need to. Period.
I taught high school for four years. Several times each year I had a girl come to me with a boy problem. It's just how it is. But of those several times, I remember a select few and their reactions when I said, "You know you dont' have to . . . " The stunned silence and then the anger that suddenly flooded her face made me cringe. I distinctly remember one storming out of the room, not mad at me, but mad. And another one responded with, "Why didn't anyone tell me that?!"
Things could have been so much different that night when I was sleeping in that livingroom. But I knew that I didn't have to.
No, we did not co-sleep with our parents, but their bed was not off limits. We were always close to our parents, physically and emotionally, and our needs were always met in a timely manner. We knew that we could count on them and it was as simple as that. We were their priority. They were our security.
Before we had children, my husband and I took a vacation and went to the coast for a week. I distinctly remember walking up a path behind a family with two girls who looked to be about age 10 and 13. Both of them were holding hands with their dad on the way up the trail. I remember thinking that is how I wanted it to be when we had our kids.
Now, watching our girls attack their daddy when he gets home and seeing them pile on him to read books every night, I know that they are getting their fill of appropriate touch. And to me, that is one fo the very best ways to build their security and protect them from the realities of this world. They are still little, yes. We do our best to keep them safe. But some day they won't be little any more. And when they are big, I want them to be able to come to us, even in the middle of the night, crawl in bed and feel safe.
Please don't push your children away. They need you. You are their security. They are your priority.
By Heidi Donnelly
Wednesday, May 26, 2010
Sometimes, we do not win.
You can fight and be fierce and never surrender your power...and still not win. Sometimes they are stronger, sometimes they have power you do not. Sometimes, they take what is yours from you, without your consent. You still need to fight- we are counting on you. Your children, your partner, your self, are all counting on you. You can be loud, or quiet, you can fight actively or resist passively, whatever suits your heart and the situation.
Our world is one that does not respect the autonomy of women as mothers.
When we are pregnant, we are offered threats and fear tactics. We are not given evidence based health care.
When we are birthing, we are cut- more than 1 in 4 of us are cut. We are threatened with the lives of our babies. We are not given evidence based health care.
Some of us choose midwives, who are threatened by the medical system as well. Increasingly, they cannot provide evidence based care, when they must answer to the traditional standards of care provided by OB/GYNs.
Wishing to avoid those threats, some of us choose freebirth. We are threatened with the removal of our children from our homes. We are punished when we seek appropriate care from mainstream practitioners.
We try to breastfeed our babies- most of us do not succeed in breastfeeding them to recommendation. We struggle to receive proper care in a system that does not want us to nurse our babies.
If any of the above sound extreme, they are. Some of us have great experiences, others are raped, abused, punished, lied to. Some of us go home with no baby, victim of the infant mortality rates. Some of us do not go home, victim of the maternal mortality rates.
As long is it is happening to one, it is happening to us all. It is happening to us all. We need to fight- quietly or loudly, with the weapons we have at hand- the love for our children, our sisters, our friends, our selves.
Our world is one that does not respect the autonomy of women as mothers.
When we are pregnant, we are offered threats and fear tactics. We are not given evidence based health care.
When we are birthing, we are cut- more than 1 in 4 of us are cut. We are threatened with the lives of our babies. We are not given evidence based health care.
Some of us choose midwives, who are threatened by the medical system as well. Increasingly, they cannot provide evidence based care, when they must answer to the traditional standards of care provided by OB/GYNs.
Wishing to avoid those threats, some of us choose freebirth. We are threatened with the removal of our children from our homes. We are punished when we seek appropriate care from mainstream practitioners.
We try to breastfeed our babies- most of us do not succeed in breastfeeding them to recommendation. We struggle to receive proper care in a system that does not want us to nurse our babies.
If any of the above sound extreme, they are. Some of us have great experiences, others are raped, abused, punished, lied to. Some of us go home with no baby, victim of the infant mortality rates. Some of us do not go home, victim of the maternal mortality rates.
As long is it is happening to one, it is happening to us all. It is happening to us all. We need to fight- quietly or loudly, with the weapons we have at hand- the love for our children, our sisters, our friends, our selves.
Wednesday, May 5, 2010
Young Punks.
Punk: A young person, especially a member of a rebellious counterculture group.
Anarchist: It seeks to diminish or even abolish authority in the conduct of human relations.
I am raising punks. Anarchist punks. 3 of them. Maybe more.
The alternative parenting bubble I live in seems to be mostly inhabited by 2 groups- punks (& other alternative types appropriate to the era during which they came of age) & conservative people devout to various religions. Seems like an odd convergence, but it really isn't. We all live outside the largely secular, conformist mainstream that encompasses most of North America. We all believe that mainstream society & culture has more potential to hurt our children than to help them grow safely. We all want better for our families & are finding better, more often than not, on the fringes of society.
The punk scene has always centred around questioning &/or rejecting authority, so it should come as no surprise that as they become parents, those in the counterculture will question & reject the norms around birth & parenting too. Hospital birth? Fuck that. Public school? Fuck that too. And fuck your vaccines, your processed garbage food and your behaviouralist parenting too.
Wow, I sound angry, don't I?! That's because I am. I am angry that in order to birth my babies safely, to feed them in a healthy way, to educate them in a way that respects their individuality, I have to say fuck so much. Really. I am angry that it is so much work. Why do I have to be fierce to protect my kids? You mean society won't do that for me? Hell no, they won't. It is up to me & their dad. So I choose to raise tiny little anarchist punks.
I don't make them share. I don't make them go to school. I don't make them eat junk food that will kill them before their time, making them sick on the way there. I don't subject them to public health policy that I am nowhere near convinced is in their best interest. I don't make them follow rules that don't make sense. I let them choose their own birth day.
I am teaching them to question authority. Yes, even mine. I certainly do say "Because I am your mama & I said so!!" more often than I ever intended to, but I also am ok with them standing up to me. I am fierce, I can get over that. We talk about how to be safe in the world, how to make their own choices & be responsible for those outcomes. I let them fall, cry, hurt. I help them get back up.
I am teaching them that the world is good, despite the negative aspects. I point out how many people love them, how we can always count on friends to be there for us. I make sure our door is always open & that there is always food & drink & friendship to share with anyone who shows up at it.
I am teaching them to rock out- to sing and scream and dance their joys & frustrations loudly enough that the heavens will hear them. I am teaching them to love art, music, the land, everything that holds beauty. I want them to trust the earth we stand on, the plants & animals & people that grow on it. I want them to travel, so they see that our culture, our political system, our way of being is not the only one.
I am teaching them to take care of themselves. To eat, sleep, make good food from scratch, to move their bodies as much as they need. I want them to care for their souls by having integrity. I want them to be intuitive, spiritual beings who know God. Whoever that is. I want them to love; themselves & others.
I want them to stand up, to speak up, when they see something wrong. I want them to say "shut up" when they hear bigotry, to say "fuck that" when they see violence. I want them to always be willing to help those being marginalised. I want them to know they are perfect beings worthy of everything good this life has to offer them. I want to empower them to take it if no one is giving that to them.
I am raising punks. Maybe you should too.
By Arie Brentnall-Compton
Anarchist: It seeks to diminish or even abolish authority in the conduct of human relations.
I am raising punks. Anarchist punks. 3 of them. Maybe more.
The alternative parenting bubble I live in seems to be mostly inhabited by 2 groups- punks (& other alternative types appropriate to the era during which they came of age) & conservative people devout to various religions. Seems like an odd convergence, but it really isn't. We all live outside the largely secular, conformist mainstream that encompasses most of North America. We all believe that mainstream society & culture has more potential to hurt our children than to help them grow safely. We all want better for our families & are finding better, more often than not, on the fringes of society.
The punk scene has always centred around questioning &/or rejecting authority, so it should come as no surprise that as they become parents, those in the counterculture will question & reject the norms around birth & parenting too. Hospital birth? Fuck that. Public school? Fuck that too. And fuck your vaccines, your processed garbage food and your behaviouralist parenting too.
Wow, I sound angry, don't I?! That's because I am. I am angry that in order to birth my babies safely, to feed them in a healthy way, to educate them in a way that respects their individuality, I have to say fuck so much. Really. I am angry that it is so much work. Why do I have to be fierce to protect my kids? You mean society won't do that for me? Hell no, they won't. It is up to me & their dad. So I choose to raise tiny little anarchist punks.
I don't make them share. I don't make them go to school. I don't make them eat junk food that will kill them before their time, making them sick on the way there. I don't subject them to public health policy that I am nowhere near convinced is in their best interest. I don't make them follow rules that don't make sense. I let them choose their own birth day.
I am teaching them to question authority. Yes, even mine. I certainly do say "Because I am your mama & I said so!!" more often than I ever intended to, but I also am ok with them standing up to me. I am fierce, I can get over that. We talk about how to be safe in the world, how to make their own choices & be responsible for those outcomes. I let them fall, cry, hurt. I help them get back up.
I am teaching them that the world is good, despite the negative aspects. I point out how many people love them, how we can always count on friends to be there for us. I make sure our door is always open & that there is always food & drink & friendship to share with anyone who shows up at it.
I am teaching them to rock out- to sing and scream and dance their joys & frustrations loudly enough that the heavens will hear them. I am teaching them to love art, music, the land, everything that holds beauty. I want them to trust the earth we stand on, the plants & animals & people that grow on it. I want them to travel, so they see that our culture, our political system, our way of being is not the only one.
I am teaching them to take care of themselves. To eat, sleep, make good food from scratch, to move their bodies as much as they need. I want them to care for their souls by having integrity. I want them to be intuitive, spiritual beings who know God. Whoever that is. I want them to love; themselves & others.
I want them to stand up, to speak up, when they see something wrong. I want them to say "shut up" when they hear bigotry, to say "fuck that" when they see violence. I want them to always be willing to help those being marginalised. I want them to know they are perfect beings worthy of everything good this life has to offer them. I want to empower them to take it if no one is giving that to them.
I am raising punks. Maybe you should too.
By Arie Brentnall-Compton
Friday, April 23, 2010
How Every Mother Can Improve the U.S. Maternal Mortality Rate
Christine Sheets-Nutile
In January of this year, the Joint Commission issued an alert1 to U.S. hospitals which stated, “trends and evidence suggest that maternal mortality rates may be increasing in the U.S.” The national rate is currently three to five times GREATER than that of European countries.2 Unbelievably, a woman giving birth in the U.S. today has a greater risk of dying than a woman birthing in 40 other countries.2
The Commission (which is the leading health care accreditation and standards group in the United States) went on to state that between 28-50% of maternal deaths were PREVENTABLE. In fact, half of the most common errors were related to post-operative care following caesarean sections.1
Recent reports also show that, in the U.S.,3 rates of both labor induction and c-section are TWICE the World Health Organization’s recommendations.2 As we are seeing, these medical interventions (while common) are not without risk.
Labor induction typically involves the use of synthetic oxytocin. This artificial substitute interferes with a woman’s own oxytocin receptors and can lead to postpartum hemorrhaging, delayed or inhibited bonding with her newborn and difficulty establishing breastfeeding.4 A medically induced labor also significantly increases a woman's chances of having an unplanned c-section.5
The risk of a mother’s death after a c-section is more than three times greater than a mother who gave birth vaginally.6 Over a 10 year period, California had a 50% increase in c-sections AND a 50% increase in maternal mortality.7
A Climate of Coercion
The current mainstream birth culture in the U.S. is simply appalling. Pregnancy and birth are treated as a disease and acute trauma-waiting-to-happen. Many women are not given complete information about the birth process. More and more cases are being reported of maternity patients being coerced into submission; their basic human rights are ignored or even revoked through the courts.
Serious medical interventions are presented as a matter of course and focus exclusively on the expected benefits. Risks and adverse effects are usually not even acknowledged! The provider states whatever he or she believes will result in the mother's compliance with the provider’s desired course of action.8
According to “Evidence-Based Maternity Care” (Sakala and Corry), a truly informed choice “requires access to a range of options, good understanding of best evidence about benefits and harms of offered care and of alternatives and solid support for the choices women make.” This rarely occurs among U.S. maternity patients. 4
In a 2009 interview, Dr. Debra Bingham, Executive Director for the California Maternal Quality Care Collaborative and a member of a Maternal Mortality Review Committee, told Amnesty International that the process of gaining an obstetric patient’s consent is highly variable and can depend on who provides information, what information is shared, and how that information is presented to a pregnant woman. “For example, someone who will benefit financially from the woman’s decision may provide information differently than someone who is not financially affected by her decision. Currently, there is limited documentation on what information is shared, how and by whom.”9
Astonishingly, this behavior is not limited to maternal care providers for disadvantaged, low-income or uneducated women. Time and time again, I’ve seen high-powered, confident, educated women become completely submissive. They forgo asking questions and just trust their doctors to make decisions for them, and then accept whatever course of treatment may result.
The Alternative Birth Movement (or What’s “Normal” for the Rest of the World)
83% of women in the U.S. have low-risk pregnancies.10 In most countries, these low-risk women would receive their maternal care from midwives or family practice physicians and often give birth at home. Outside of the U.S., the goal is to minimize risks and maximize good outcomes for mothers and babies, rather than maximize income for a provider and facility. So most obstetricians limit their practice to treating women with high-risk pregnancies and those who develop unexpected complications.11 Ironically, many OB’s in the U.S. no longer have the aptitude or knowledge possessed by their predecessors for such uncommon procedures as: external version to manually turn a baby, vaginal breech birth or vaginal birth of twins.4
It’s interesting to note that groups of maternal care providers identify their roles very differently. OB’s feel it is their responsibility to actively manage childbirth. Midwives and other physicians perceive their function to be facilitators in the birthing process.12 This fundamental distinction is evidenced in the care and treatment of their patients: 4 Midwives possess more hands-on skills and are better able to support a woman in labor and assist her during birth than OB’s; midwives use medical intervention more judiciously than OB’s; and midwives understand that a woman’s individual mind-set, desires and personal history play an important part in her birth, while OB’s deny these influences. 12
In low risk situations, intervention can, in fact, actually impede the birthing process and create those life or death situations that doctors claim to be trying to avoid. Despite their lengthy and expensive educations, far too many U.S. care providers have little or NO experience in observing a normal, natural birth. Therefore, they have no idea what a normal birth looks like, much less what a woman in that situation may need.
Not surprisingly, across the nation, low-risk women and their babies have better outcomes when attended by a midwife, rather than an OB.4, 8
Loss of Faith, Rise of Fear
In contrast to the rest of the world, almost all pregnant women in the U.S. choose to receive their care from an OB and give birth in a hospital. When it's truly needed, medical intervention can, of course, mean the difference between life and death.
But women’s bodies are designed to give birth -- without any interference! It’s only been in the past 100 years13, that birth was appropriated from women and transformed into a paternalistic, medical, mechanized event.14 As such, women lost the knowledge that comes from witnessing and assisting their mothers and sisters give birth. And women lost faith in their bodies’ innate abilities.
Today’s mother-to-be has probably heard more birth-related horror stories than she can count. From the time she was a young girl, she may have heard her mother, her aunts, and even her friends discuss childbirth as a painful, frightening injury. Unfortunately, these misconceptions are perpetuated and reinforced through popular culture of television and movies. In reality, a normal birth wouldn’t bring in big ratings or box-office dollars.
Follow the Money
The U.S. spends more on health care than any other country.15 And more money is spent on maternal health than ANY other form of hospital care.8 Unfortunately, the majority of OB policies, routine procedures and official recommendations are woefully out of date in regards to evidence-based care.4
Outside of the U.S., hospitals typically have a variety of low-tech equipment to aid a woman giving birth – tubs, birthing balls, robes, birthing stools, squatting bars, etc. Any of these can help make birth safer and more comfortable. Unfortunately, very few U.S. hospitals can offer anything besides pharmaceuticals. For the hospital administrator, a birth free of medical interventions is a lost billing opportunity.11
The vast majority of births do NOT require any intervention; but 50-80% of births in U.S. hospitals have AT LEAST one. In reality, any one of these procedures is truly medically necessary in fewer than 20% of all births.8 Ergo between 30-60% of women giving birth in U.S. hospitals are having unnecessary medical procedures performed upon them! But, necessary or not, all of these medical procedures and interventions allow physicians to maximize their billing opportunities.11
In some parts of the country, it’s extremely difficult to find a provider willing to intervene ONLY when truly medically necessary -- especially if the woman has had a previous c-section. Fewer and fewer facilities are willing to accept VBAC (Vaginal Birth After Cesarean) patients.
After years of increased c-sections, most hospitals have reconfigured their maternity units to accommodate more surgical deliveries: more services scheduled during weekday hours, and more post partum beds – needed for the longer stays required after c-sections. These changes required costly capital investments. Now administrators need to see a return on those investments. So it’s not surprising that hospital policies reflect the facility’s increased dependence on the revenue generated by c-sections. After all, a c-section brings in TWICE the revenue of a vaginal birth.4 A surgical birth is also easier on the doctor. It takes less time and is much more predictable than a normal labor and delivery.
For years, the medical establishment has been working to limit birthing options. They've fought against birthing centers, homebirth, midwives, even against their own accountability.
Many believe that they’re more interested in protecting their revenues than improving outcomes for our mothers and babies.11
Rather than abolishing choices, vilifying alternatives and criminalizing their competition, I'd prefer to see them working for other, more worthy goals – such as educating their patients, encouraging normal/natural births and working with facilities to update protocols to reflect evidence-based medicine, all of which will ultimately reduce maternal mortality.
Until then, it’s up to us to change the birth culture!
Improve Your Own Chances of Survival
If you are pregnant or planning to become pregnant:
* Examine your pre-conceived ideas on birth. How were these formed? From stories of women of previous generations? From fictional or sensationalized movies and tv shows? YouTube is awash with amazing, joyous videos of women experiencing normal, natural births. Use these to visualize the kind of birth YOU want.
* Take responsibility for your own education on birth! While pregnant, you have months to prepare and can seek out accurate, complete information. Labor is a time of extreme, internal focus. It would be difficult to absorb and comprehend a significant amount of new information. So preparation is key, in case you need to make decisions quickly. Research common interventions such as: ultrasounds, fetal monitoring, induction of labor, epidurals, extractions and c-sections. Learn the risks and what factors determine when each may truly become necessary. Insist that your provider obtain informed consent for each procedure.
* Read books on natural birthing options. Consider alternatives to the standard OB-attended hospital birth. Choosing a high-tech OB at a high-tech hospital doesn’t guarantee you a safe birth. But it WILL increase your risk for high-tech interventions which may or may not be medically necessary.16 Certified Nurse Midwives (CNM’s) are licensed in all 50 states and can attend births in hospitals, birth centers or even your home. Don’t be afraid to make an unusual choice when it comes to what’s best for you and your baby!
* Don’t choose your provider or facility simply based on location or insurance coverage. Seek out like-minded mothers and local doulas and get their recommendations.
* Schedule a consultation with potential providers before committing to one. Get their rates of various interventions – fetal monitoring, inductions, episiotomies, forcep delivery, vacuum extraction and c-sections. Ask how much freedom you’ll have during labor – particularly on movement, eating/drinking and positioning for birth. Are there limitations on who is allowed to attend your birth? If they’re anything less than forthcoming with these answers, find another provider. Tour the facility. Ask questions there as well, specifically regarding their procedures for newborn care, policies on rooming-in and breastfeeding support.
* Listen to your instincts. More women are educating themselves and seeking providers based on their shared philosophies of birth. Unfortunately, medical professionals can also offer the all too familiar “bait-and-switch.” The provider will agree with everything the mother-to-be wants for her birth throughout her pregnancy, but has NO intention of letting the birth happen on those terms. Shockingly, some will even go out of their way to make SURE it doesn’t, regardless of what’s in the best interest of the mother and her baby. So if you have any reservations about your provider or facility, especially if you feel they are patronizing you, don’t be afraid to make a change – no matter how far along you are.
* Surround yourself with others who have had intervention-free births. Listen to their stories. Ignore those who tell you that you won’t be able to handle it.
* Take a childbirth class, preferably one OUTSIDE of a hospital setting. (Too often, classes hosted by the hospital are more about “How to Be a Good Patient.”) Bradley and Hypnobirthing are excellent choices.
* Choose your labor support team wisely. While your partner, family members and friends may want to be present at the birth, consider hiring a doula. She can provide physical and emotional support throughout your pregnancy, birth and post-partum period. She is knowledgeable about the process of birth, familiar with area providers and facilities and can facilitate communication with staff to help you make informed decisions. A woman in labor is vulnerable – both physically and emotionally. A doula can help protect your space and your choices.
Empower yourself to have the birth YOU desire! Birth is a business. As more mothers demand normal, natural births, providers and facilities will be forced to adapt to attract consumers. Reducing unnecessary interventions will lead to healthier mothers and babies!
Christine Sheets Nutile is a mother of three. She was supported by a doula and used Hypnobirthing for each of her midwife-attended hospital births. She is the co-founder of an Attachment Parenting group in the south suburbs of Chicago. She is also an advocate for natural childbirth, breastfeeding, babywearing and home education.
REFERENCES
1 The Joint Commission, Sentinel Event Alert, Issue 44 from January 26, 2010, “Preventing Maternal Death”; available at http://www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_44.htm
2 WHO, UNICEF and Wellstart International, “Baby-friendly Hospital Initiative: Revised, Updated and Expanded for Integrated Care”, 2009; available at http://www.who.int/nutrition/publications/infantfeeding/9789241594967_s1/en/index.html
3 J. A. Martin et al, Centers for Disease Control, Births: “Final Data for 2006”;
National Vital Statistics Reports, Volume 57, Number 7, from January 7, 2009; available at http://www.cdc.gov/nchs/data/nvsr/nvsr57/nvsr57_07.pdf
4 C. Sakala and M. P. Corry, “Evidence-Based Maternity Care: What It Is and What It Can Achieve,” Childbirth Connection and the Reforming States Group, 2008, pages 37, 47, 62-67; available at http://www.childbirthconnection.org/pdfs/evidence-based-maternity-care.pdf
5 K. E. Kaufman, “Elective Induction: An Analysis of Economic and Health Consequences”.
6 C. Deneux-Tharaux et al, “Postpartum Maternal Mortality and Cesarean Delivery”, Obstetrics & Gynecology, Volume 108, Number 3, Part 1, September 2006; available at
http://www.acog.org/from_home/publications/green_journal/2006/v108n3p541.pdf and
J. Villar et al, “Maternal and Neonatal Individual Risks and Benefits Associated with Caesarean Delivery: Multicentre Prospective Study”, BMJ, 2007; 335; 1025; page 5; available at
http://www.bmj.com/cgi/reprint/335/7628/1025?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=Caesarean+delivery+rates&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT
7 California Maternal Quality Care Collaborative, www.cmqcc.org/maternal_mortality and www.cmqcc.org/maternal_disparities
8 R.M. Andrews, “The National Hospital Bill: The Most Expensive Conditions by
Payer, 2006”, Healthcare Cost and Utilization Project, Statistical Brief 59, 2008, page 7;
available at http://www.hcup-us.ahrq.gov/reports/statbriefs/sb59.pdf
9 Amnesty International Publications, “Deadly Delivery: The Maternal Health Care Crisis in the USA”, 2010, page 1 and 79, available at http://www.amnestyusa.org/dignity/pdf/DeadlyDelivery.pdf
10 National Center for Health Statistics. 2006. 2003 Natality Data Set. SETS 2.0, Rev. 805. Vital and Health Statistics. CD-ROM Series 21, Number 17, May.
11 S. Goodman, “Piercing the Veil: The Marginalization of Midwives in the United
States”, Social Science & Medicine, 65, 2007, pp. 610–21; available at
http://www.collegeofmidwives.org/Citations%20or%20text%2002/Marginalizing_NurseMfry_May07.pdf
12 B Reime et al, “Do Maternity Care Provider Groups Have Different Attitudes Towards Birth?” BJOG: An International Journal of Obstetrics & Gynaecology, Volume 111, Issue 12, Pages 1388-1393; available at http://www3.interscience.wiley.com/cgi-bin/fulltext/118813477/HTMLSTART
13 Y. Lapp Cryns, “Homebirth: As Safe as Birth Gets” The Compleat Mother Magazine 1995; available at http://www.compleatmother.com/homebirth/hb_safety.htm
14 J.J. Mathews and K. Zadak, “The Alternative Birth Movement in the United States: History and Current Status”, Women Health, 1991, Volume 17, Number 1, Page 39; available at http://www.ncbi.nlm.nih.gov/pubmed/2048321
15 Organisation for Economic Co-operation and Development, OECD Health Data 2009–
Frequently Requested Data; available at http://www.oecd.org/document/16/0,3343,en_2649_33929_2085200_1_1_1_1,00.html
16 M. Wagner, “Technology in Birth: First Do No Harm”, Midwifery Today, 2000;
available at http://www.midwiferytoday.com/articles/technologyinbirth.asp#sources
In January of this year, the Joint Commission issued an alert1 to U.S. hospitals which stated, “trends and evidence suggest that maternal mortality rates may be increasing in the U.S.” The national rate is currently three to five times GREATER than that of European countries.2 Unbelievably, a woman giving birth in the U.S. today has a greater risk of dying than a woman birthing in 40 other countries.2
The Commission (which is the leading health care accreditation and standards group in the United States) went on to state that between 28-50% of maternal deaths were PREVENTABLE. In fact, half of the most common errors were related to post-operative care following caesarean sections.1
Recent reports also show that, in the U.S.,3 rates of both labor induction and c-section are TWICE the World Health Organization’s recommendations.2 As we are seeing, these medical interventions (while common) are not without risk.
Labor induction typically involves the use of synthetic oxytocin. This artificial substitute interferes with a woman’s own oxytocin receptors and can lead to postpartum hemorrhaging, delayed or inhibited bonding with her newborn and difficulty establishing breastfeeding.4 A medically induced labor also significantly increases a woman's chances of having an unplanned c-section.5
The risk of a mother’s death after a c-section is more than three times greater than a mother who gave birth vaginally.6 Over a 10 year period, California had a 50% increase in c-sections AND a 50% increase in maternal mortality.7
A Climate of Coercion
The current mainstream birth culture in the U.S. is simply appalling. Pregnancy and birth are treated as a disease and acute trauma-waiting-to-happen. Many women are not given complete information about the birth process. More and more cases are being reported of maternity patients being coerced into submission; their basic human rights are ignored or even revoked through the courts.
Serious medical interventions are presented as a matter of course and focus exclusively on the expected benefits. Risks and adverse effects are usually not even acknowledged! The provider states whatever he or she believes will result in the mother's compliance with the provider’s desired course of action.8
According to “Evidence-Based Maternity Care” (Sakala and Corry), a truly informed choice “requires access to a range of options, good understanding of best evidence about benefits and harms of offered care and of alternatives and solid support for the choices women make.” This rarely occurs among U.S. maternity patients. 4
In a 2009 interview, Dr. Debra Bingham, Executive Director for the California Maternal Quality Care Collaborative and a member of a Maternal Mortality Review Committee, told Amnesty International that the process of gaining an obstetric patient’s consent is highly variable and can depend on who provides information, what information is shared, and how that information is presented to a pregnant woman. “For example, someone who will benefit financially from the woman’s decision may provide information differently than someone who is not financially affected by her decision. Currently, there is limited documentation on what information is shared, how and by whom.”9
Astonishingly, this behavior is not limited to maternal care providers for disadvantaged, low-income or uneducated women. Time and time again, I’ve seen high-powered, confident, educated women become completely submissive. They forgo asking questions and just trust their doctors to make decisions for them, and then accept whatever course of treatment may result.
The Alternative Birth Movement (or What’s “Normal” for the Rest of the World)
83% of women in the U.S. have low-risk pregnancies.10 In most countries, these low-risk women would receive their maternal care from midwives or family practice physicians and often give birth at home. Outside of the U.S., the goal is to minimize risks and maximize good outcomes for mothers and babies, rather than maximize income for a provider and facility. So most obstetricians limit their practice to treating women with high-risk pregnancies and those who develop unexpected complications.11 Ironically, many OB’s in the U.S. no longer have the aptitude or knowledge possessed by their predecessors for such uncommon procedures as: external version to manually turn a baby, vaginal breech birth or vaginal birth of twins.4
It’s interesting to note that groups of maternal care providers identify their roles very differently. OB’s feel it is their responsibility to actively manage childbirth. Midwives and other physicians perceive their function to be facilitators in the birthing process.12 This fundamental distinction is evidenced in the care and treatment of their patients: 4 Midwives possess more hands-on skills and are better able to support a woman in labor and assist her during birth than OB’s; midwives use medical intervention more judiciously than OB’s; and midwives understand that a woman’s individual mind-set, desires and personal history play an important part in her birth, while OB’s deny these influences. 12
In low risk situations, intervention can, in fact, actually impede the birthing process and create those life or death situations that doctors claim to be trying to avoid. Despite their lengthy and expensive educations, far too many U.S. care providers have little or NO experience in observing a normal, natural birth. Therefore, they have no idea what a normal birth looks like, much less what a woman in that situation may need.
Not surprisingly, across the nation, low-risk women and their babies have better outcomes when attended by a midwife, rather than an OB.4, 8
Loss of Faith, Rise of Fear
In contrast to the rest of the world, almost all pregnant women in the U.S. choose to receive their care from an OB and give birth in a hospital. When it's truly needed, medical intervention can, of course, mean the difference between life and death.
But women’s bodies are designed to give birth -- without any interference! It’s only been in the past 100 years13, that birth was appropriated from women and transformed into a paternalistic, medical, mechanized event.14 As such, women lost the knowledge that comes from witnessing and assisting their mothers and sisters give birth. And women lost faith in their bodies’ innate abilities.
Today’s mother-to-be has probably heard more birth-related horror stories than she can count. From the time she was a young girl, she may have heard her mother, her aunts, and even her friends discuss childbirth as a painful, frightening injury. Unfortunately, these misconceptions are perpetuated and reinforced through popular culture of television and movies. In reality, a normal birth wouldn’t bring in big ratings or box-office dollars.
Follow the Money
The U.S. spends more on health care than any other country.15 And more money is spent on maternal health than ANY other form of hospital care.8 Unfortunately, the majority of OB policies, routine procedures and official recommendations are woefully out of date in regards to evidence-based care.4
Outside of the U.S., hospitals typically have a variety of low-tech equipment to aid a woman giving birth – tubs, birthing balls, robes, birthing stools, squatting bars, etc. Any of these can help make birth safer and more comfortable. Unfortunately, very few U.S. hospitals can offer anything besides pharmaceuticals. For the hospital administrator, a birth free of medical interventions is a lost billing opportunity.11
The vast majority of births do NOT require any intervention; but 50-80% of births in U.S. hospitals have AT LEAST one. In reality, any one of these procedures is truly medically necessary in fewer than 20% of all births.8 Ergo between 30-60% of women giving birth in U.S. hospitals are having unnecessary medical procedures performed upon them! But, necessary or not, all of these medical procedures and interventions allow physicians to maximize their billing opportunities.11
In some parts of the country, it’s extremely difficult to find a provider willing to intervene ONLY when truly medically necessary -- especially if the woman has had a previous c-section. Fewer and fewer facilities are willing to accept VBAC (Vaginal Birth After Cesarean) patients.
After years of increased c-sections, most hospitals have reconfigured their maternity units to accommodate more surgical deliveries: more services scheduled during weekday hours, and more post partum beds – needed for the longer stays required after c-sections. These changes required costly capital investments. Now administrators need to see a return on those investments. So it’s not surprising that hospital policies reflect the facility’s increased dependence on the revenue generated by c-sections. After all, a c-section brings in TWICE the revenue of a vaginal birth.4 A surgical birth is also easier on the doctor. It takes less time and is much more predictable than a normal labor and delivery.
For years, the medical establishment has been working to limit birthing options. They've fought against birthing centers, homebirth, midwives, even against their own accountability.
Many believe that they’re more interested in protecting their revenues than improving outcomes for our mothers and babies.11
Rather than abolishing choices, vilifying alternatives and criminalizing their competition, I'd prefer to see them working for other, more worthy goals – such as educating their patients, encouraging normal/natural births and working with facilities to update protocols to reflect evidence-based medicine, all of which will ultimately reduce maternal mortality.
Until then, it’s up to us to change the birth culture!
Improve Your Own Chances of Survival
If you are pregnant or planning to become pregnant:
* Examine your pre-conceived ideas on birth. How were these formed? From stories of women of previous generations? From fictional or sensationalized movies and tv shows? YouTube is awash with amazing, joyous videos of women experiencing normal, natural births. Use these to visualize the kind of birth YOU want.
* Take responsibility for your own education on birth! While pregnant, you have months to prepare and can seek out accurate, complete information. Labor is a time of extreme, internal focus. It would be difficult to absorb and comprehend a significant amount of new information. So preparation is key, in case you need to make decisions quickly. Research common interventions such as: ultrasounds, fetal monitoring, induction of labor, epidurals, extractions and c-sections. Learn the risks and what factors determine when each may truly become necessary. Insist that your provider obtain informed consent for each procedure.
* Read books on natural birthing options. Consider alternatives to the standard OB-attended hospital birth. Choosing a high-tech OB at a high-tech hospital doesn’t guarantee you a safe birth. But it WILL increase your risk for high-tech interventions which may or may not be medically necessary.16 Certified Nurse Midwives (CNM’s) are licensed in all 50 states and can attend births in hospitals, birth centers or even your home. Don’t be afraid to make an unusual choice when it comes to what’s best for you and your baby!
* Don’t choose your provider or facility simply based on location or insurance coverage. Seek out like-minded mothers and local doulas and get their recommendations.
* Schedule a consultation with potential providers before committing to one. Get their rates of various interventions – fetal monitoring, inductions, episiotomies, forcep delivery, vacuum extraction and c-sections. Ask how much freedom you’ll have during labor – particularly on movement, eating/drinking and positioning for birth. Are there limitations on who is allowed to attend your birth? If they’re anything less than forthcoming with these answers, find another provider. Tour the facility. Ask questions there as well, specifically regarding their procedures for newborn care, policies on rooming-in and breastfeeding support.
* Listen to your instincts. More women are educating themselves and seeking providers based on their shared philosophies of birth. Unfortunately, medical professionals can also offer the all too familiar “bait-and-switch.” The provider will agree with everything the mother-to-be wants for her birth throughout her pregnancy, but has NO intention of letting the birth happen on those terms. Shockingly, some will even go out of their way to make SURE it doesn’t, regardless of what’s in the best interest of the mother and her baby. So if you have any reservations about your provider or facility, especially if you feel they are patronizing you, don’t be afraid to make a change – no matter how far along you are.
* Surround yourself with others who have had intervention-free births. Listen to their stories. Ignore those who tell you that you won’t be able to handle it.
* Take a childbirth class, preferably one OUTSIDE of a hospital setting. (Too often, classes hosted by the hospital are more about “How to Be a Good Patient.”) Bradley and Hypnobirthing are excellent choices.
* Choose your labor support team wisely. While your partner, family members and friends may want to be present at the birth, consider hiring a doula. She can provide physical and emotional support throughout your pregnancy, birth and post-partum period. She is knowledgeable about the process of birth, familiar with area providers and facilities and can facilitate communication with staff to help you make informed decisions. A woman in labor is vulnerable – both physically and emotionally. A doula can help protect your space and your choices.
Empower yourself to have the birth YOU desire! Birth is a business. As more mothers demand normal, natural births, providers and facilities will be forced to adapt to attract consumers. Reducing unnecessary interventions will lead to healthier mothers and babies!
Christine Sheets Nutile is a mother of three. She was supported by a doula and used Hypnobirthing for each of her midwife-attended hospital births. She is the co-founder of an Attachment Parenting group in the south suburbs of Chicago. She is also an advocate for natural childbirth, breastfeeding, babywearing and home education.
REFERENCES
1 The Joint Commission, Sentinel Event Alert, Issue 44 from January 26, 2010, “Preventing Maternal Death”; available at http://www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_44.htm
2 WHO, UNICEF and Wellstart International, “Baby-friendly Hospital Initiative: Revised, Updated and Expanded for Integrated Care”, 2009; available at http://www.who.int/nutrition/publications/infantfeeding/9789241594967_s1/en/index.html
3 J. A. Martin et al, Centers for Disease Control, Births: “Final Data for 2006”;
National Vital Statistics Reports, Volume 57, Number 7, from January 7, 2009; available at http://www.cdc.gov/nchs/data/nvsr/nvsr57/nvsr57_07.pdf
4 C. Sakala and M. P. Corry, “Evidence-Based Maternity Care: What It Is and What It Can Achieve,” Childbirth Connection and the Reforming States Group, 2008, pages 37, 47, 62-67; available at http://www.childbirthconnection.org/pdfs/evidence-based-maternity-care.pdf
5 K. E. Kaufman, “Elective Induction: An Analysis of Economic and Health Consequences”.
6 C. Deneux-Tharaux et al, “Postpartum Maternal Mortality and Cesarean Delivery”, Obstetrics & Gynecology, Volume 108, Number 3, Part 1, September 2006; available at
http://www.acog.org/from_home/publications/green_journal/2006/v108n3p541.pdf and
J. Villar et al, “Maternal and Neonatal Individual Risks and Benefits Associated with Caesarean Delivery: Multicentre Prospective Study”, BMJ, 2007; 335; 1025; page 5; available at
http://www.bmj.com/cgi/reprint/335/7628/1025?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=Caesarean+delivery+rates&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT
7 California Maternal Quality Care Collaborative, www.cmqcc.org/maternal_mortality and www.cmqcc.org/maternal_disparities
8 R.M. Andrews, “The National Hospital Bill: The Most Expensive Conditions by
Payer, 2006”, Healthcare Cost and Utilization Project, Statistical Brief 59, 2008, page 7;
available at http://www.hcup-us.ahrq.gov/reports/statbriefs/sb59.pdf
9 Amnesty International Publications, “Deadly Delivery: The Maternal Health Care Crisis in the USA”, 2010, page 1 and 79, available at http://www.amnestyusa.org/dignity/pdf/DeadlyDelivery.pdf
10 National Center for Health Statistics. 2006. 2003 Natality Data Set. SETS 2.0, Rev. 805. Vital and Health Statistics. CD-ROM Series 21, Number 17, May.
11 S. Goodman, “Piercing the Veil: The Marginalization of Midwives in the United
States”, Social Science & Medicine, 65, 2007, pp. 610–21; available at
http://www.collegeofmidwives.org/Citations%20or%20text%2002/Marginalizing_NurseMfry_May07.pdf
12 B Reime et al, “Do Maternity Care Provider Groups Have Different Attitudes Towards Birth?” BJOG: An International Journal of Obstetrics & Gynaecology, Volume 111, Issue 12, Pages 1388-1393; available at http://www3.interscience.wiley.com/cgi-bin/fulltext/118813477/HTMLSTART
13 Y. Lapp Cryns, “Homebirth: As Safe as Birth Gets” The Compleat Mother Magazine 1995; available at http://www.compleatmother.com/homebirth/hb_safety.htm
14 J.J. Mathews and K. Zadak, “The Alternative Birth Movement in the United States: History and Current Status”, Women Health, 1991, Volume 17, Number 1, Page 39; available at http://www.ncbi.nlm.nih.gov/pubmed/2048321
15 Organisation for Economic Co-operation and Development, OECD Health Data 2009–
Frequently Requested Data; available at http://www.oecd.org/document/16/0,3343,en_2649_33929_2085200_1_1_1_1,00.html
16 M. Wagner, “Technology in Birth: First Do No Harm”, Midwifery Today, 2000;
available at http://www.midwiferytoday.com/articles/technologyinbirth.asp#sources
Tuesday, March 30, 2010
An Essay on Circumcision
Making recent provincial and international headlines, the topic of male infant circumcision (herein referred to as MIC), brought up in any forum, is considered by some one of the most controversial debates of the century, with personal views ranging from dead set against it to why wouldn’t you. Many say it is a personal decision, but people are now asking whose decision is it: the boy’s or his parents’? According to a Men’s Health article, MIC became popular in the late 1800s after Lewis Sayre, MD claimed it could cure many diseases including epilepsy and TB; MIC soon became routine after John Harvey Kellogg, MD stated it was a successful remedy for masturbation, considered a major problem in those days.
There are many arguments for leaving a baby boy intact and here are four of the most common. First, MIC is a surgery, even though it is routinely done without sedation or local anaesthetic, with surgical side effects including bleeding and severe pain and surgical risks such as infection, various types of deformities and dysfunctions of the penis, and of course, death. Second, MIC frequently interferes with mother-child bonding and early breastfeeding. Third, recent studies, including Taddio’s, have shown it has detrimental effects of the developing brain and alters pain perception, decreasing pain thresholds in circumcised males. Finally, in later life, MIC causes significantly reduced sexual pleasure.
The four of the most common arguments for MIC are as follow. First, religious reasons including the covenant between Abraham and his descendants and God as written in Genesis 17:10-14 are often cited. Second, there are generations-old family traditions where boys are circumcised and the decision is not questioned as to why. Third, there is a belief that MIC results in decreased urinary tract infections, sexually transmitted infections including HIV and penile cancer, which has recently been disproved by newer studies. Finally, there is the thought that if done early enough in life the boy will not feel the pain or remember the procedure.
More and more research is coming out, or becoming public, about circumcision. Since 1975, the Canadian Association of Paediatricians has recommended against routine circumcision. Their US counterpart had taken a lighter approach until 1999 when they too, began recommending against routine MIC. According to the Canadian Paediatric Society's statement on circumcision in 1975 (and restated in 1982, 1989 and again in 1996), there is no medical indication for circumcision during the neonatal period.
Most of the commonly known reasons for routine circumcision are misunderstood or blown out of proportion. For example, the rate of UTI (urinary tract infection) for an intact baby boy is about 7/1000 and for a circumcised baby is about 2/1000. BUT, the rate of complication from the circumcision surgery is 20-30/1000 with 2-3/1000 being serious complications. Approximately 10/1000 circumcised babies need to have the surgery repeated in later life and only 10/1000 intact boys need to be circumcised in later life.
There is also a belief that the boy should look like his peers, but according to recent studies, Canada has a 31.9% circumcision rate, meaning 68.9% of new baby boys are intact. Currently, Alberta is the highest province with approximately 44% circumcised and Nova Scotia is the lowest with only 6%.
One cannot forget that foreskin has a purpose. It is designed to protect the glans, keeping it soft, moist and warm; it protects the boy from UTIs; it provides the extra skin needed for an erection; it reduces friction during sex and it maintains sexual sensitivity. Every circumcised male experiences an estimated 15% decrease in sexual sensitivity.
I am so glad that I am cheap and questioned getting my son circumcised because it cost so much (almost $400 is Alberta after doctors fee and tray fee). This led me to start researching why they charge for it, and, in turn, led me to question it in general. I have found that circumcision is one subject that the more I read and learn, the more against it I become. Therefore, yes, I am very pro-intact, anticircumcision. I intentionally did not use the word uncircumcised in any of my writing because that makes it sound like circumcision is the norm, which it is not. I also had a little difficulty getting in the opposing arguments, because some are no longer backed by fact and I do not want somebody to believe that some of the old arguments are valid.
While this debate rages on, more research is being done in hopes of ending the controversy. In the meantime, many are choosing to delay the procedure until the boy can decide for himself.
Jenkins, Mark. Separated at Birth. Men’s Health, July/August 1998, pages 130-135,163
Taddio, A. et al. Effect of neonatal circumcision on pain responses during vaccination in boys. The Lancet Volume 345, Number 8945: Pages 291-292, 4 February 1995.
Taddio, A. et al. Effect of neonatal circumcision on pain response during subsequent routine vaccination The Lancet, Volume 349, Number 9052: Pages 599-603, March 1, 1997.
Canadian Paediatric Society’s webpage: www.cps.ca
American Paediatric Society’s webpage: www.aap.org
Peaceful Parenting’s webpage: www.drmomma.org,
Circumcision Information and Research Pages: www.cirp.org
By Alicia Farvolden
There are many arguments for leaving a baby boy intact and here are four of the most common. First, MIC is a surgery, even though it is routinely done without sedation or local anaesthetic, with surgical side effects including bleeding and severe pain and surgical risks such as infection, various types of deformities and dysfunctions of the penis, and of course, death. Second, MIC frequently interferes with mother-child bonding and early breastfeeding. Third, recent studies, including Taddio’s, have shown it has detrimental effects of the developing brain and alters pain perception, decreasing pain thresholds in circumcised males. Finally, in later life, MIC causes significantly reduced sexual pleasure.
The four of the most common arguments for MIC are as follow. First, religious reasons including the covenant between Abraham and his descendants and God as written in Genesis 17:10-14 are often cited. Second, there are generations-old family traditions where boys are circumcised and the decision is not questioned as to why. Third, there is a belief that MIC results in decreased urinary tract infections, sexually transmitted infections including HIV and penile cancer, which has recently been disproved by newer studies. Finally, there is the thought that if done early enough in life the boy will not feel the pain or remember the procedure.
More and more research is coming out, or becoming public, about circumcision. Since 1975, the Canadian Association of Paediatricians has recommended against routine circumcision. Their US counterpart had taken a lighter approach until 1999 when they too, began recommending against routine MIC. According to the Canadian Paediatric Society's statement on circumcision in 1975 (and restated in 1982, 1989 and again in 1996), there is no medical indication for circumcision during the neonatal period.
Most of the commonly known reasons for routine circumcision are misunderstood or blown out of proportion. For example, the rate of UTI (urinary tract infection) for an intact baby boy is about 7/1000 and for a circumcised baby is about 2/1000. BUT, the rate of complication from the circumcision surgery is 20-30/1000 with 2-3/1000 being serious complications. Approximately 10/1000 circumcised babies need to have the surgery repeated in later life and only 10/1000 intact boys need to be circumcised in later life.
There is also a belief that the boy should look like his peers, but according to recent studies, Canada has a 31.9% circumcision rate, meaning 68.9% of new baby boys are intact. Currently, Alberta is the highest province with approximately 44% circumcised and Nova Scotia is the lowest with only 6%.
One cannot forget that foreskin has a purpose. It is designed to protect the glans, keeping it soft, moist and warm; it protects the boy from UTIs; it provides the extra skin needed for an erection; it reduces friction during sex and it maintains sexual sensitivity. Every circumcised male experiences an estimated 15% decrease in sexual sensitivity.
I am so glad that I am cheap and questioned getting my son circumcised because it cost so much (almost $400 is Alberta after doctors fee and tray fee). This led me to start researching why they charge for it, and, in turn, led me to question it in general. I have found that circumcision is one subject that the more I read and learn, the more against it I become. Therefore, yes, I am very pro-intact, anticircumcision. I intentionally did not use the word uncircumcised in any of my writing because that makes it sound like circumcision is the norm, which it is not. I also had a little difficulty getting in the opposing arguments, because some are no longer backed by fact and I do not want somebody to believe that some of the old arguments are valid.
While this debate rages on, more research is being done in hopes of ending the controversy. In the meantime, many are choosing to delay the procedure until the boy can decide for himself.
Jenkins, Mark. Separated at Birth. Men’s Health, July/August 1998, pages 130-135,163
Taddio, A. et al. Effect of neonatal circumcision on pain responses during vaccination in boys. The Lancet Volume 345, Number 8945: Pages 291-292, 4 February 1995.
Taddio, A. et al. Effect of neonatal circumcision on pain response during subsequent routine vaccination The Lancet, Volume 349, Number 9052: Pages 599-603, March 1, 1997.
Canadian Paediatric Society’s webpage: www.cps.ca
American Paediatric Society’s webpage: www.aap.org
Peaceful Parenting’s webpage: www.drmomma.org,
Circumcision Information and Research Pages: www.cirp.org
By Alicia Farvolden
Sunday, March 28, 2010
The Start of a Food Revolution
I watched Jamie Oliver's show "Food revolution" on TV the other night. I was shocked and horrified, but frankly not very surprised. Watching the show (and if you haven't yet you should) really made me think about how we (as a culture) feel about our food and what we know about our food. I wasn't at all surprised that the lunch ladies didn't feel that there was anything wrong with serving the kiddos processed chicken nuggets, and when Jamie asked them to read the list of ingredients on the package, the were not at all concerned about the paragraph of ingredients with unpronouncable names. "The first ingredient is chicken, it's fine". One lady said that if it wasn't ok to eat, the government wouldn't serve it to us right? Right.
This is what got me going. We expect the government to stand up for us little guys and protect us from the big bad corporations, but what we are expecting isn't reality. This is just not happening. AT ALL. Not in North America. We are all fools if we sit idly by and expect the government to save us from making choices that are killing us. In the food biz it may be hard to get at good information about the real value of what we are eating, but it is out there. We need to be responsible to ourselves and our families about what we put in our mouths. When we get this information we need to shout it from the roof tops.
This is the challenge. This is what Jamie is trying to do, and this is what I want you to do too. It might be hard, and we might feel regretful or even guilty examining some of the choices we have made in the past, but I feel like this is very necessary because we are KILLING ourselves and our children, and we should be FIGHTING for their health.
"I believe that every child in America has the right to fresh, nutritious school meals, and that every family deserves real, honest, wholesome food. Too many people are being affected by what they eat. It's time for a national revolution. America needs to stand up for better food!" - Jamie Oliver
Makes you think doesn't it? I love that Jamie is starting in the schools, and educating the children who don't even know what a potato is. I myself, being of a certain lactivist bent, wonder if we don't need to address the fact that this lack of real wholesome food starts with babies, how we feed them and how we feel about how we feed them.
So now I'm gonna start shouting. You may want to cover your ears, because it might hurt, but I feel that this is really vitally important.
We cannot ignore the connection between starting our children's lives on ultra processed food from a can and the growing inability to recognize healthy natural foods. A quick google search reveals over 300 referenced journal articles citing the increased risk of obesity associated with feeding artificial baby milks. One meta study published in the International Journal of Obesity finds a conclusive risk of obesity associated with not breastfeeding.
Another thing to consider is that breastmilk changes in taste, dependent on the mother's diet. So a normally fed baby experiences different flavors with each feed, while an artificially fed baby tastes the same processed mixture day after day. Consider the impact of sensitizing our children in this way from birth. It makes sense to me that if we start them off with mass produced unhealthy food from a can, children will have little or no choice to continue their life in this way. Especially if you consider how we feel about it.
"Formula is the same as breast milk" (or the next best thing)
"I was fed that way and I turned out fine." (with your glasses, obesity and asthma?)
It's terrifying to consider that our inability to feed our children NORMALLY as infant translates to an inability for them to eat normally as children. We do need to consider this, so that we can grieve, give our heads a shake and start to shout. Join me.
Lee-Ann Grenier
This is what got me going. We expect the government to stand up for us little guys and protect us from the big bad corporations, but what we are expecting isn't reality. This is just not happening. AT ALL. Not in North America. We are all fools if we sit idly by and expect the government to save us from making choices that are killing us. In the food biz it may be hard to get at good information about the real value of what we are eating, but it is out there. We need to be responsible to ourselves and our families about what we put in our mouths. When we get this information we need to shout it from the roof tops.
This is the challenge. This is what Jamie is trying to do, and this is what I want you to do too. It might be hard, and we might feel regretful or even guilty examining some of the choices we have made in the past, but I feel like this is very necessary because we are KILLING ourselves and our children, and we should be FIGHTING for their health.
"I believe that every child in America has the right to fresh, nutritious school meals, and that every family deserves real, honest, wholesome food. Too many people are being affected by what they eat. It's time for a national revolution. America needs to stand up for better food!" - Jamie Oliver
Makes you think doesn't it? I love that Jamie is starting in the schools, and educating the children who don't even know what a potato is. I myself, being of a certain lactivist bent, wonder if we don't need to address the fact that this lack of real wholesome food starts with babies, how we feed them and how we feel about how we feed them.
So now I'm gonna start shouting. You may want to cover your ears, because it might hurt, but I feel that this is really vitally important.
We cannot ignore the connection between starting our children's lives on ultra processed food from a can and the growing inability to recognize healthy natural foods. A quick google search reveals over 300 referenced journal articles citing the increased risk of obesity associated with feeding artificial baby milks. One meta study published in the International Journal of Obesity finds a conclusive risk of obesity associated with not breastfeeding.
Another thing to consider is that breastmilk changes in taste, dependent on the mother's diet. So a normally fed baby experiences different flavors with each feed, while an artificially fed baby tastes the same processed mixture day after day. Consider the impact of sensitizing our children in this way from birth. It makes sense to me that if we start them off with mass produced unhealthy food from a can, children will have little or no choice to continue their life in this way. Especially if you consider how we feel about it.
"Formula is the same as breast milk" (or the next best thing)
"I was fed that way and I turned out fine." (with your glasses, obesity and asthma?)
It's terrifying to consider that our inability to feed our children NORMALLY as infant translates to an inability for them to eat normally as children. We do need to consider this, so that we can grieve, give our heads a shake and start to shout. Join me.
Lee-Ann Grenier
Monday, March 22, 2010
Hospital Birth?
Just yesterday I was talking to a mom just for a couple minutes. Somehow the conversation turned to childbirth and she said her first baby was an emergency c-section. Her second was a c-section, too. I said something like, "You know you can have a natural birth after a c-section." She got this look of disgust and said, "I know, but I didn't find out until after my second, and then they told me no way." I haven't known this mom for very long, but her story is so familiar. A mom who was told she couldn't have something that she wanted for herself and her baby and felt she had no choice otherwise.
I have avoided for the most part being a mom with that story. Sometimes I think it's luck, but then I consider the decisions I've made along the way that have led to three beautiful, perfect, and natural labor and delivery stories. The decisions seemed small at the time, but in the end, they were of great magnitude. And I'm convinced that most of it had to do with the professionals I chose to help me along the way. I'm also convinced that knowing what I didn't want and listening to my gut also played key roles in my experiences.
I chose to have my babies in the hospital. I chose this because I was confident that I could do it on my terms. The midwife I was seeing for my first baby (the third one I had seen in my first few months of pregnancy because I just wasn't comfortable with the first two) was very supportive of my choices and even advocated for me when the OB wanted to induce me because I was overdue. I called my mom crying when we were told we would need to report to the hospital the next morning for an induction, even after the NST had shown everything was normal. My husband was furious because the OB hadn't even seen me. I resolved that if they felt that strongly about inducing me, they were going to have to come find me with sirens and flashing lights. Then my midwife called me and said, no, we had a plan and she would see me on Tuesday for our appointment.
But I didn't make it on Tuesday. Contractions started early Monday morning and after 11 ½ hours of un-medicated labor, we met our beautiful, perfect little girl. She showed no signs of being nearly two weeks overdue and nursed like a champ from the very beginning. My husband commented that I was much more pleasant while I was in labor than I had been in the weeks leading up to it. And even minutes after our baby girl was born, I remember saying, "I could do that again." (I had to laugh because when I got my charts a few years later, the mother/baby nurse had written that I was confident in my ability to nurse my baby, "maybe too confident?" I nursed that baby without any trouble for 22 months, as well as every baby after that.)
After our first was born, I was honored to be asked to be a friend's birth partner. I went to all the birth classes with her and I remember sitting there thinking that there was so much this nurse was not telling these new parents. I'll never forget the look on her face when I announced that if you are the pregnant woman, you still have a say in what they do to you, whether it's induce you or simply what drugs they put in your body or the tests they want you to take. And the same went for your baby. You can ask questions, ask them to wait, or just plain say no. The nurse was horrified. And I was equally as horrified at how horrified she was. It was like she was going to lose the control she had over that class because I had just told them they had choices.
Two years later, I was pregnant again. And my midwife was fantastic enough to write in my chart that I didn't need a hep-lock during labor (the first time it was just in the way) and that after the baby was born I didn't need pitocin to shrink my uterus since I planned to nurse my newborn. When we checked in, the triage nurse was pretty set on poking me. But after I insisted, she left, came back and announced it was okay. Thank you, midwife, for writing it in my chart.
This time I was in labor for 6 ½ hours before our second beautiful and perfect baby girl was born. During labor everyone was so nice and helpful making it a beautiful experience. My husband was again amazed at how pleasant I was during labor. He was a big advocate and super support during the whole process. And everyone just went with it because it was going so well. I remember at one point feeling as if I was stalling out, and I looked up to see the midwife just sitting in the rocking chair waiting so patiently. Then my water broke and we had a baby soon after that.
By the time I was pregnant with baby number three, our insurance had changed and I needed to find a new provider. I asked around and heard the name of one OB from several people. So I set an appointment and made my list of "I needs". At the first appointment I rattled my list off and he looked at me, smiled a goofy smile and said, "You sound like my wife." I could have hugged him.
My new OB was my best advocate and wrote everything in my chart. Everything from not poking me to my request for the placenta. He approved of all my requests, including the fact that I didn't want to take the glucose test, and I am forever thankful for him.
When I did go into labor and went to the hospital, the nurse looked at me kind of sideways when I told her I didn't want the hep-lock. Then I said, "I'm not a hysterical woman in labor. You can poke me later if you need to." I could tell she was somewhat confused by my statement, but as labor progressed, she was quite verbal with her observations of how the whole experience was unfolding. No, I wasn't hysterical (she actually wrote in my chart that I was "very pleasant") and my husband was super supportive and helpful. I've come to learn that all of these things are very rare in that hospital.
In the end, I went from 7 centimeters to my water breaking in two contractions. The next contraction the baby crowned, and the next contraction she was born-less than four hours after active labor had started. And the nurse who was originally hesitant about my requests got to catch my baby. She was thrilled.
My OB missed it by twenty minutes. I had to giggle when he walked in. "You know," he said with that same goofy grin he had given me at the beginning, "ninety percent of women can give birth at home."
After my baby was born, we suddenly had a room full of people busily doing what they were supposed to do. But one of them was pushing on my tummy in a not-so-gentle manner. Someone must have noticed because my baby's nurse came up to me after that nurse had left and said very gently, "I think I'll just be your nurse, too." I don't know what went down, but I didn't see the not-so-gentle nurse again. And I was thankful for it.
I had caused quite a stir in the birth unit. I got all sorts of questions about what I was going to do with the placenta, questions about babywearing, and comments on how labor and delivery went. Our delivery nurse was so thrilled to be a part of our experience, and I think she was talking to everyone about it. (Three days later when we came in for a post-partum baby and mommy check, they were still talking about us. We also have a picture of baby #3 with the nurse.) They let me walk to the recovery room and even when we were on our way home, they let me wear our baby out the door in my wrap rather than carry her or have her in the car seat, even though they weren't supposed to. I think they liked us.
I'm not saying everyone should have their baby in the hospital. I'm not against birth centers or home birth. What I am saying is that if you know what you want (or at least you know what you don't want), if you are a little picky, a little insistent, and you find the right people, (and you are nice about it in the mean time) chances are that you can have a really great experience giving birth in a hospital if that's where you choose to be. You should not have guilt for changing providers when you are uncomfortable. Yes, there are pregnancies that need special care due to special circumstances, but even then you can insist on what you deem your best educated choice is. And good providers will help and support you along the way and not make you feel that you are a crazy person.
By Heidi Donnelly
I have avoided for the most part being a mom with that story. Sometimes I think it's luck, but then I consider the decisions I've made along the way that have led to three beautiful, perfect, and natural labor and delivery stories. The decisions seemed small at the time, but in the end, they were of great magnitude. And I'm convinced that most of it had to do with the professionals I chose to help me along the way. I'm also convinced that knowing what I didn't want and listening to my gut also played key roles in my experiences.
I chose to have my babies in the hospital. I chose this because I was confident that I could do it on my terms. The midwife I was seeing for my first baby (the third one I had seen in my first few months of pregnancy because I just wasn't comfortable with the first two) was very supportive of my choices and even advocated for me when the OB wanted to induce me because I was overdue. I called my mom crying when we were told we would need to report to the hospital the next morning for an induction, even after the NST had shown everything was normal. My husband was furious because the OB hadn't even seen me. I resolved that if they felt that strongly about inducing me, they were going to have to come find me with sirens and flashing lights. Then my midwife called me and said, no, we had a plan and she would see me on Tuesday for our appointment.
But I didn't make it on Tuesday. Contractions started early Monday morning and after 11 ½ hours of un-medicated labor, we met our beautiful, perfect little girl. She showed no signs of being nearly two weeks overdue and nursed like a champ from the very beginning. My husband commented that I was much more pleasant while I was in labor than I had been in the weeks leading up to it. And even minutes after our baby girl was born, I remember saying, "I could do that again." (I had to laugh because when I got my charts a few years later, the mother/baby nurse had written that I was confident in my ability to nurse my baby, "maybe too confident?" I nursed that baby without any trouble for 22 months, as well as every baby after that.)
After our first was born, I was honored to be asked to be a friend's birth partner. I went to all the birth classes with her and I remember sitting there thinking that there was so much this nurse was not telling these new parents. I'll never forget the look on her face when I announced that if you are the pregnant woman, you still have a say in what they do to you, whether it's induce you or simply what drugs they put in your body or the tests they want you to take. And the same went for your baby. You can ask questions, ask them to wait, or just plain say no. The nurse was horrified. And I was equally as horrified at how horrified she was. It was like she was going to lose the control she had over that class because I had just told them they had choices.
Two years later, I was pregnant again. And my midwife was fantastic enough to write in my chart that I didn't need a hep-lock during labor (the first time it was just in the way) and that after the baby was born I didn't need pitocin to shrink my uterus since I planned to nurse my newborn. When we checked in, the triage nurse was pretty set on poking me. But after I insisted, she left, came back and announced it was okay. Thank you, midwife, for writing it in my chart.
This time I was in labor for 6 ½ hours before our second beautiful and perfect baby girl was born. During labor everyone was so nice and helpful making it a beautiful experience. My husband was again amazed at how pleasant I was during labor. He was a big advocate and super support during the whole process. And everyone just went with it because it was going so well. I remember at one point feeling as if I was stalling out, and I looked up to see the midwife just sitting in the rocking chair waiting so patiently. Then my water broke and we had a baby soon after that.
By the time I was pregnant with baby number three, our insurance had changed and I needed to find a new provider. I asked around and heard the name of one OB from several people. So I set an appointment and made my list of "I needs". At the first appointment I rattled my list off and he looked at me, smiled a goofy smile and said, "You sound like my wife." I could have hugged him.
My new OB was my best advocate and wrote everything in my chart. Everything from not poking me to my request for the placenta. He approved of all my requests, including the fact that I didn't want to take the glucose test, and I am forever thankful for him.
When I did go into labor and went to the hospital, the nurse looked at me kind of sideways when I told her I didn't want the hep-lock. Then I said, "I'm not a hysterical woman in labor. You can poke me later if you need to." I could tell she was somewhat confused by my statement, but as labor progressed, she was quite verbal with her observations of how the whole experience was unfolding. No, I wasn't hysterical (she actually wrote in my chart that I was "very pleasant") and my husband was super supportive and helpful. I've come to learn that all of these things are very rare in that hospital.
In the end, I went from 7 centimeters to my water breaking in two contractions. The next contraction the baby crowned, and the next contraction she was born-less than four hours after active labor had started. And the nurse who was originally hesitant about my requests got to catch my baby. She was thrilled.
My OB missed it by twenty minutes. I had to giggle when he walked in. "You know," he said with that same goofy grin he had given me at the beginning, "ninety percent of women can give birth at home."
After my baby was born, we suddenly had a room full of people busily doing what they were supposed to do. But one of them was pushing on my tummy in a not-so-gentle manner. Someone must have noticed because my baby's nurse came up to me after that nurse had left and said very gently, "I think I'll just be your nurse, too." I don't know what went down, but I didn't see the not-so-gentle nurse again. And I was thankful for it.
I had caused quite a stir in the birth unit. I got all sorts of questions about what I was going to do with the placenta, questions about babywearing, and comments on how labor and delivery went. Our delivery nurse was so thrilled to be a part of our experience, and I think she was talking to everyone about it. (Three days later when we came in for a post-partum baby and mommy check, they were still talking about us. We also have a picture of baby #3 with the nurse.) They let me walk to the recovery room and even when we were on our way home, they let me wear our baby out the door in my wrap rather than carry her or have her in the car seat, even though they weren't supposed to. I think they liked us.
I'm not saying everyone should have their baby in the hospital. I'm not against birth centers or home birth. What I am saying is that if you know what you want (or at least you know what you don't want), if you are a little picky, a little insistent, and you find the right people, (and you are nice about it in the mean time) chances are that you can have a really great experience giving birth in a hospital if that's where you choose to be. You should not have guilt for changing providers when you are uncomfortable. Yes, there are pregnancies that need special care due to special circumstances, but even then you can insist on what you deem your best educated choice is. And good providers will help and support you along the way and not make you feel that you are a crazy person.
By Heidi Donnelly
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