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
Wednesday, August 25, 2010
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
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