Planning for a homebirth

By now you may have gathered that instead of choosing to have an OB-attended hospital birth this time around, we are planning to have a midwife-attended homebirth. There are a number of varied factors that have led me down such a different path with this baby and I’d like to share some of them here.

I have to first admit that I’ve been a little reticent to post about this, not because I’m not excited about it, but because homebirth in our culture is not seen as a safe or wise choice (though in reality it is as safe or safer than hospital births in most cases – there are a number of studies that indicate as such). I am open to questions about why I’ve made this decision or things specific to homebirths, but I don’t wish to be attacked for my choice. I have no desire to get into a debate over which is better – hospital or home. Rest assured I’ve done a lot of soul searching and research to come to the conclusion that planning a homebirth is right for me. In the event that a condition arises during my pregnancy or labor that indicates that a homebirth is no longer a safe, responsible choice, I have no qualms about going back to my OB (whom I like and respect) or being transferred to a hospital (which is literally less than five minutes from our house) if necessary.
OK, now that we’ve gotten that out of the way, let’s dive in, shall we? 🙂

First of all, I believe that – in the majority of cases – birth is a normal, natural and healthy process. I believe in a woman’s (and my own) ability to give birth naturally, normally, without intervention, as women have been doing for thousands of years.

I am drawn to the midwifery model of care because it feels normal and natural. I like that a typical midwife prenatal visit lasts 60 minutes (as opposed to the typical 6 minute OB prenatal visit) and does not feel rushed. I like that I am getting to know the woman who will be there for my labor and birth and that she will gain my trust so that I feel comfortable with her while laboring and birthing. I like that my midwife is interested in my nutrition and in suggesting preventative measures (such as acupuncture) to help ensure that I have a healthy birth.

My midwife in particular has a 15 year background as an EMT (emergency medical technician). I feel her experience in that capacity has helped her develop critical thinking skills and the ability to think quickly on her feet. After all, how can you be an EMT without that ability? So I feel very comfortable that if a situation should arise that is beyond her comfort level, she will know what steps to take (i.e. a hospital transfer). Because of my history of complications with Ava, this was very important for us. Both Jody and I feel very confident in her experience and abilities.

I love the idea of birthing at my own home, where I am comfortable and able to relax without worrying about who’s going to be walking in the door next (nurse shift changes, etc.), where Ava can play or sleep or do whatever she needs to (in a safe environment) and still be in close proximity to me and Jody. (My sister will be her primary caregiver while I am in labor.) And when the baby is born, Ava can chose whether or not she wants to be present. (Yes, we will be preparing her with regard to what to expect when mommy is in labor, etc. We actually watched a birth video – “Giving Birth: Challenges and Choices” by Suzanne Arms – this week.) I’d like her to be there, but I’m not going to force her. If she is meant to be there, she will be. After seeing her interest in watching the birth video though, I am pretty certain she’ll want to see baby brother join us.

I also love the idea of being able to sleep in my own bed after the birth. That was one of the hardest things for me in the hospital, not being able to sleep. I eventually had to ask for sleeping pills because it’d been something like three days since I’d slept for more than a few minutes at a time, and having hallucinations while trying to care for a newborn is no fun. Having my own bed will be heavenly. And I’m sure Jody would agree as well after sleeping on a flimsy mattress on the cold, hard hospital floor for 5 days after Ava’s birth.

Another compelling reason for me to have a homebirth is I’d like to labor and possibly birth in water and my midwife has a birthing pool that we can set up right in our house.

Because of all of this and more, I feel planning for a homebirth makes sense for us.
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The following information was taken from The Homebirth Choice by Jill Cohen and Marti Dorsey and further illustrates why I’ve decided a homebirth is the right choice for me and my family. I cut and pasted some things that I feel are particularly important to me.

A BRIEF HISTORY OF MIDWIFERY:
“Midwife means “with woman.” Traditionally, women have attended and assisted other women during labor and birth. As modern medicine emerged in the West, birth fell into the realm of the medical. Since women were barred from attending medical schools, men became the birth practitioners. Having never had a baby themselves, they were unable to approach women and childbirth with the inner knowledge and experience of a woman. Childbirth became viewed as pathological rather than natural; unnecessary, and often dangerous or unproven, medical techniques and interventions became commonplace.

During the 1960s and 1970s, along with the women’s movement and renewed interest in homebirth, the midwifery movement rekindled. It has been growing steadily ever since. Midwives are becoming more and more involved with birthing families and have been instrumental in redefining birth as a natural event in women’s lives.

Midwifery empowers women and their families with the experience of birth.”

PRENATAL CARE:

“Prenatal visits may take place at the midwife’s home or clinic or at the family’s home. Prenatal visits are a time for the midwife to get to know the family and friends, neighbors, or other children who plan to be present at the birth.

Prenatal care for the pregnant woman includes discussion of nutrition, exercise and overall physical and emotional well-being, as well as overseeing the healthy development of the fetus.

Midwives include the family during prenatal care, inviting them to ask questions and to listen to the baby’s heartbeat. Intimate involvement of the family throughout the pregnancy allows for early bonding of the newly emerging family unit.

The midwife and family will often discuss the mechanics of birth. The more people know what’s going to happen, the more comfortable they may be while awaiting the birth.”

LABOR:
“In the safety and security of her own home, the mom is likely to be less inhibited about trying different labor positions and locations. She can sit on the toilet or go for a walk outside. She can eat or drink whatever she wants. She writes her own script. When it’s time to deliver, she can often try whatever position she wants: on her side, squatting, sitting or kneeling.”

BIRTH:
“Homebirth allows for full participation of family members. Under the guidance and assistance of the midwife, the opportunity is available for husbands or partners to “catch” their child as it is born. These moments can be very powerful and transformational in the lives of the new parents.

At homebirths, babies are usually immediately placed on the mom’s stomach or breast, providing security, warmth and immediate bonding between mom and baby. This contact provides security for both mom and baby.

In the rare case when the baby has difficulty breathing on its own, midwives are fully trained in infant CPR. Usually, putting the baby right to the breast and having mom talk to her baby will encourage it to take those first breaths.

Putting the baby immediately to the breast helps reduce any bleeding the mom may have. The sucking action stimulates the uterus and causes it to contract. This closes off blood vessels and reduces bleeding.

Some members of the medical community have recently acknowledged that having a homebirth decreases the mother’s and baby’s chances of contracting an infection. The mother is used to the bacteria in her own environment and has built up immunities to it. This is passed on to the baby through the colostrum. Even when women are segregated in maternity wards, infections are much more commonplace after hospital births than homebirths.”

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“Breast-Feed or Else” – new article

The article below “Breast-Feed or Else” appeared in The New York Times today. I’m sure many will find it a tad bit, if not a great deal, controversial. I found myself wondering if warning labels on formula (as the article suggests) are really necessary. But then I am reminded of how many doctors offices (even the “good” ones) often don’t fully support breast-feeding mothers and put out information that suggests breast-feeding moms should follow a schedule and not their infant’s cues, that babies only need to nurse x-number of times per day, that babies should sleep through the night by x-number of months, etc. I’m also reminded how the media bombards us with formula ads – on TV, in parenting magazines, at doctors’ offices, over the loud speaker at stores, etc.

I think the warning labels would be good to educate those who really are unaware that breastmilk is the perfect nutrition, but might such labels also make those moms who are truly unable to breast-feed feel more guilt than they already do? It’s a slippery slope.

And then there are the moms who *have* to go back to work and, due to busy schedules or whatever, can’t commit to pumping at work.

What we really need is longer maternity leave in the U.S. (like a year paid as they get in Canada) so that we truly can support mothers AND support breast-feeding.

There’s so much room for change in the system as it currently stands. I think that until broader changes – such as longer maternity leave, better education, information and support for moms – are implemented, we can’t expect there to be a big shift towards breast-feeding. Although I’d love to be proven wrong. 😉

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NY Times article – “Breast-Feed or Else”

The New York Times
June 13, 2006
Breast-Feed or Else
By RONI RABIN

Warning: Public health officials have determined that not breast-feeding may be hazardous to your baby’s health.

There is no black-box label like that affixed to cans of infant formula or tucked into the corner of magazine advertisements, at least not yet. But that is the unambiguous message of a controversial government public health campaign encouraging new mothers to breast-feed for six months to protect their babies from colds, flu, ear infections, diarrhea and even obesity. In April, the World Health Organization, setting new international bench marks for children’s growth, for the first time referred to breast-feeding as the biological norm.

“Just like it’s risky to smoke during pregnancy, it’s risky not to breast-feed after,” said Suzanne Haynes, senior scientific adviser to the Office on Women’s Health in the Department of Health and Human Services. “The whole notion of talking about risk is new in this field, but it’s the only field of public health, except perhaps physical activity, where there is never talk about the risk.”

A two-year national breast-feeding awareness campaign that culminated this spring ran television announcements showing a pregnant woman clutching her belly as she was thrown off a mechanical bull during ladies’ night at a bar — and compared the behavior to failing to breast-feed.

“You wouldn’t take risks before your baby’s born,” the advertisement says. “Why start after?”

Senator Tom Harkin, Democrat of Iowa, has proposed requiring warning labels, on cans of infant formula and in advertisements, similar to the those on cigarettes. They would say that the Department of Health and Human services has determined that “breast-feeding is the ideal method of feeding and nurturing infants” or that “breast milk is more beneficial to infants than infant formula.”

Child-rearing experts have long pointed to the benefits of breast-feeding. But critics say the new campaign has taken things too far and will make mothers who cannot breast-feed, or choose not to, feel guilty and inadequate.

“I desperately wanted to breast-feed,” said Karen Petrone, an associate professor of history at University of Kentucky in Lexington.

When her two babies failed to gain weight and her pediatrician insisted that she supplement her breast milk with formula, Ms. Petrone said, “I felt so guilty.”

“I thought I was doing something wrong,” she added. “Nobody ever told me that some women just can’t produce enough milk.”

Moreover, urging women to breast-feed exclusively is a tall order in a country where more than 60 percent of mothers of very young children work, federal law requires large companies to provide only 12 weeks’ unpaid maternity leave and lactation leave is unheard of. Only a third of large companies provide a private, secure area where women can express breast milk during the workday, and only 7 percent offer on-site or near-site child care, according to a 2005 national study of employers by the nonprofit Families and Work Institute.

“I’m concerned about the guilt that mothers will feel,” said Ellen Galinsky, president of the center. “It’s hard enough going back to work.”

Public health leaders say the weight of the scientific evidence for breast-feeding has grown so overwhelming that it is appropriate to recast their message to make clear that it is risky not to breast-feed.

Ample scientific evidence supports the contention that breast-fed babies are less vulnerable to acute infectious diseases, including respiratory and gastrointestinal infections, experts say. Some studies also suggest that breast-fed babies are at lower risk for sudden infant death syndrome and serious chronic diseases later in life, including asthma, diabetes, leukemia and some forms of lymphoma, according to the American Academy of Pediatrics.

Research on premature babies has even found that those given breast milk scored higher on I.Q. tests than those who were bottle-fed.

The goal of a government health initiative called Healthy People 2010 is to get half of all mothers to continue at least some breast-feeding until a baby is 6 months old. Though about 70 percent of new mothers start breast-feeding right after childbirth, just over a third are breast-feeding at 6 months and fewer than 20 percent are exclusively breast-feeding by that time, according to the 2004 National Immunization Survey. Breast-feeding increases with education, income and age; black women are less likely to breast-feed, while Hispanics have higher breast-feeding rates.

For women, breast-feeding can be an emotionally charged issue, and a very personal one. Even its most ardent supporters acknowledge that they have made sacrifices.

“It’s a whole lifestyle,” said Kymberlie Stefanski, a 34-year-old mother of three from Villa Park, Ill., who has not been apart from her children except for one night when she gave birth. “My life revolves around my kids, basically.” Ms. Stefanski quit working when her first child was born almost six years ago, nursed that child until she was 4 years old, and is nursing an infant now.

She said she wanted to reduce the risk of breast cancer for herself and for her three daughters, referring to research indicating that extended breast-feeding may reduce the risk for both mother and daughters.

Scientists who study breast milk almost all speak of it in superlatives. Even the International Formula Council, a trade association, acknowledges that breast-feeding “offers specific child and maternal health benefits” and is the “preferred” method of infant feeding. The American Academy of Pediatrics states in its breast-feeding policy that human breast milk is “uniquely superior for infant feeding.”

Dr. Haynes, of the Health and Human Services Department, said, “Our message is that breast milk is the gold standard, and anything less than that is inferior.”

Formula “is not equivalent,” she went on, adding, “Formula is not the gold standard. It’s so far from it, it’s not even close.”

Formula manufacturers say infant formula is modeled on breast milk and emphasize that it is the only safe alternative recommended by pediatricians for mothers who cannot, or choose not to, breast-feed.

But while formula tastes the same way at every feeding, advocates of breast-feeding say, the smells and flavors of human breast milk change from day to day, from morning to evening, influenced by the mother’s diet. Many nutritionists believe that exposing an infant to this bouquet of flavors early on may make for less fussy eaters who are more flexible about trying new foods and more likely to eat a healthy, varied diet.

“I think of human milk not just as food, but as a sophisticated and intricate infant support system that has evolved over millions of years to provide the infant with nutrition, protection and components of information,” said Dr. E. Stephen Buescher, a professor of pediatrics at Eastern Virginia Medical School in Norfolk, who heads the inflammation section in the school’s Center for Pediatric Research.

“It isn’t just calories,” Dr. Buescher said.

The protection that breast-feeding provides against acute infectious diseases — including meningitis, upper and lower respiratory infections, pneumonia, bowel infections, diarrhea and ear infections — has been among the most extensively studied of its benefits and is well documented, said Dr. Lawrence M. Gartner, chairman of the American Academy of Pediatrics’ breast-feeding section.

Breast-fed babies have 50 percent to 95 percent fewer infections than other babies, Dr. Gartner said, adding, “It’s pretty dramatic.”

One reason for the reduction in the incidence and the severity of infections is the antibodies contained in the mother’s milk. “A lot of this has to do with the mother and baby interacting,” he explained. “Whatever the baby is exposed to, the mother is exposed to, and the mother will make antibodies within three to four days.” The baby absorbs them through breast milk.

Breast milk also protects the baby through other mechanisms. For example, it contains agents that prevent bacteria and viruses from attaching to cells in the baby’s body, so the foreign agents are expelled in the stool, Dr. Gartner said.

The protection is not ironclad, so breast-fed babies will often get a mild infection that does not make the baby sick but acts almost like a vaccine. “What we think is that human milk creates an environment where you get your immunity without the cost of an infection, the vomiting and the diarrhea,” Dr. Buescher said. “That’s a bargain.”

Neonatologists are urging the mothers of their tiniest patients to express breast milk because premature and low-birth-weight babies are particularly vulnerable to infections. Studies have found that premature babies who get breast milk are discharged earlier from the hospital and are less likely to develop necrotizing enterocolitis, a potentially deadly disease.

Breast milk has also been shown to lift the cognitive development of premature babies, presumably because it contains certain fatty acids that aid brain development.

Experts say it is possible that human breast milk produces permanent changes in the immune system, in a sense “educating” the baby’s immune system, Dr. Gartner suggested. That may explain why children who were breast-fed appear to be at lower risk for autoimmune diseases like Crohn’s, asthma and juvenile diabetes. Several studies also indicate that breast-fed children are at reduced risk for the cancers lymphoma and leukemia.

Officials with the International Formula Council say there is not enough evidence to prove a relationship between early feeding and serious chronic diseases.

Dr. Myron Peterson, director of medical affairs for Cato Research, a private independent research organization which reviewed the literature on breast-feeding for the council, said that studies have found a link between nursing and health benefits but that they do not prove a causal relationship. “It’s like the old statement about the rooster crowing making the sun come up,” he said. “If you did an observational study on that, what would you say?”

An unpublished report the council commissioned from Cato says “it is not scientifically correct to conclude the lack of exclusive breast-feeding plays a causative role in the development of these diseases.”

But scientists are so intrigued about the potential to protect children from juvenile diabetes that a large 10-year multinational study called Trigr (for Trial to Reduce Insulin-dependent diabetes mellitus in the Genetically at Risk) is under way to find out whether breast-feeding protects at-risk children from developing the disease.

And public health officials, excited about mounting evidence suggesting that children who were breast-fed are at lower risk of being obese, have been promoting breast-feeding as a strategy to combat alarming rates of childhood obesity.

The health benefits of breast-feeding may extend to mothers as well. According to the American College of Obstetricians and Gynecologists, extended breast-feeding reduces the risk of ovarian cancer and breast cancer. New studies have also found that women who breast-feed face a lower risk of adult-onset or Type 2 diabetes, and they seem to be at lower risk for osteoporosis later in life.

Immediately after childbirth, nursing accelerates healing by reducing the amount of bleeding and causing the uterus to contract more rapidly back to its normal size. Making milk burns up to 500 extra calories a day, so nursing mothers get help shedding extra pounds from pregnancy, experts say, especially if they nurse for an extended period.

Experts say lactation also seems to have a calming effect on the mother, which may be an adaptive mechanism to ease the transition to life with a new baby. Every time a mother nurses, she gets a spike in oxytocin, which may have an antianxiety effect and help promote bonding with the new baby, said Kathryn G. Dewey, a professor of nutrition at the University of California, Davis, and an expert on breast-feeding.

Nursing may even produce a euphoric feeling, she said.

Dr. Michael Kramer, a professor of pediatrics and of epidemiology and biostatistics at McGill University’s medical school in Montreal who has been studying the health effects of breast-feeding among infants in Belarus, found a strong protective effect against gastrointestinal illnesses and a lesser protective effect against respiratory infections. Dr. Kramer is still analyzing data on obesity, I.Q., behavior and blood pressure.

“It can’t do all of the things that are being claimed for it,” Dr. Kramer said, injecting a note of caution into the debate. “But it probably does some of them.”

What a great day!

I had a wonderful Mother’s Day yesterday. 🙂

It started off with Jody having breakfast ready when Ava and I woke up in the morning. Then I got some cards from Jody, Ava and my parents. And Jody and Ava got me some nice oven mitts (which I was desperately in need of since mine had holes in it and has been caught on fire, etc.) and a lazy susan (which I really wanted) for all of my spices. Jody said he also wants to get me a gift certificate for a pregnant massage, but he didn’t have time to track down someone who specializes in that.

After that we went for a walk around the block to a lilac tree near the park (lilacs are one of my favorite smelling flowers) and Jody took some pictures of me and Ava (and belly baby) and then I cut some lilacs to take home and put in a vase.




Then we stopped at Starbucks for some frosty beverages (that blackberry green tea frapaccino they have is so tasty – Ava agrees too) and went to Vitamin Cottage to pick up some things for our trip and for a recipe I have for banana muffins (which I plan to make today).

In the afternoon we headed into Boulder for some lunch, which we ordered “to go” and then had a picnic by the Boulder Creek. Ava ran around in the grass while Jody and I ate, stopping by every now and then for a bite herself.



After that we went for a walk on Pearl Street Mall (a great outdoor pedestrian “mall”) and shared a brownie. Then Jody took some pictures of me and Ava in front of the tulips which we also did last year. 🙂


After walking around for a bit, we headed back to the car and came home. I thought Ava would go down for a nap since it was quite past her naptime, but she was content to stay up. So we went to the grocery store and picked up some food for dinner (stuffed salmon and potatoes which we had accompanied by broccoli) and some other things we needed. Jody grilled the food and we had a nice dinner.

It was a very full, very nice day. It’s amazing to me to think that next year at this time I will be a mommy of two. I’m a lucky woman. 🙂

By the way, Ava’s outfit (dress and matching diaper cover) is something Grandma just made and sent to her. It’s pretty darn cute.

P.S. These pictures were taken with our old P&S (point and shoot) camera. I decided not to take my Olympus on the trip to CA since it’s really primarily for my business and I’d be up a creek if something happened to it while I don’t have a good back-up camera yet. So I dusted off the old P&S to play with yesterday. It’s not nearly as fun (nor are the pictures anywhere near the quality) as my Olympus. ::whine:: I’m such a camera snob now. ;oP

Happy Mother’s Day

I’ve seen variations of this floating around the Internet lately and thought it was particularly appropriate for Mother’s day. It’s quite touching and made me tear up when I read it.

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FOR ALL THE MOMS…

This is for all the mothers who DIDN’T win Mother of the Year in 2005. All the runners-up and all the wannabes. The mothers too tired to enter or too busy to care.

This is for all the mothers who have sat up all night with sick toddlers in their arms, wiping up barf, laced with Oscar Mayer wieners and cherry Kool-Aid saying, “It’s okay honey, Mommy’s here.”

This is for all the mothers who froze their buns off on metal bleachers at football games Friday night instead of watching from cars, so that when their kids asked, “Did you see my tackle?” they could say, “Of course, wouldn’t have missed it for the world”…and mean it.

This is for all the mothers of Sudan who fled in the night and can’t find their children.

This is for all the mothers of the victims of the latest school shooting and the mother of the shooter. For the mothers of the survivors, and the mothers who sat in front of their TVs in horror, hugging their child who just came home from school, safely.

For all the mothers who run carpools and make cookies and sew Halloween costumes. And all the mothers who DON’T.

This is for the mothers who gave birth to babies they’ll never see.
And the mothers who took those babies and gave them homes.

This is for reading “Goodnight, Moon” twice a night for a year. And then reading it again…”Just one more time.”

This is for all the mothers who mess up. Who yell at their kids in the grocery store and swat them in despair and stomp their feet like a tired 2-year-old who wants ice cream before dinner.
And for all the mothers who count to 10 instead, but realize how child abuse happens.

This is for all the mothers who sat down with their children and explained all about making babies.
And for all the (grand) mothers who wanted to, but just couldn’t find the words.

This is for all the mothers who go hungry, so their children can eat.

This is for all the mothers who taught their daughters to tie their shoelaces before they started school. And for all the mothers who opted for Velcro instead.

For all the mothers who bite their lips–sometimes until they bleed–when their 14-year-olds dye their hair green.

Who lock themselves in the bathroom when babies keep crying and won’t stop.

This is for all the mothers who show up at work with spit-up in their hair and milk stains on their blouses and diapers in their purse.

This is for all the mothers who teach their sons to cook and their daughters to sink a jump shot.

This is for all mothers whose heads turn automatically when a little voice calls “Mom?” in a crowd, even though they know their own offspring are at home.

This is for mothers who put pinwheels and teddy bears on their children’s graves.

This is for mothers whose children have gone astray, who can’t find the words to reach them.

This is for all the mothers who sent their sons to school with stomach aches, assuring them they’d be just FINE once they got there, only to get calls from the school nurse an hour later asking them to please pick them up. Right away.

What makes a good mother anyway? Is it patience? Compassion? Broad hips? The ability to nurse a baby, cook dinner, and sew a button on a shirt, all at the same time? Or is it heart? Is it the ache you feel when you watch your son or daughter disappear down the street, walking to school alone for the very first time? The jolt that takes you from sleep to dread, from bed to crib at 2 a.m. to put your hand on the back of a sleeping baby? The need to flee from wherever you are and hug your child when you hear news of a school shooting, a fire, a car accident, a baby dying?

I think so.

This is for young mothers stumbling through diaper changes and sleep deprivation. And mature mothers learning to let go. For working mothers and stay-at-home mothers. Single mothers and married mothers. Mothers with money, mothers without.

This is for you all. For all of us.

Today’s Thought:

A mother can touch a whole generation just by loving her own child well.
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I love that thought and truly believe in it.

Happy Mother’s Day to all the moms out there!

And happy Mother’s Day to you, Mom. 🙂 I love you.