Home birth advocate’s baby dies during free birth, prompts questions

Janet Fraser, a home birth advocate and founder of the site Joyous Birth, recently experienced a personal tragedy when her baby died at her home in Australia on March 27 during her free birth or unassisted childbirth (where a woman gives birth at home without the aid of a midwife or doctor).

When a tragedy like this occurs, people are often left scratching their heads wondering how something like this could happen, what went wrong, and lastly, who’s to blame? I don’t know if we need to point a finger to make ourselves feel better, but it seems to be human nature to ask, “why did this happen?”

While I did not consider giving birth at home without a midwife in attendance for my home birth, I know a handful of women who chose an unassisted birth and I respect them for it. I believe these women did a great deal of research in advance, knew what they were doing, trusted their bodies and their babies and were prepared to go to the hospital if any issues arose. Although I don’t know her, I trust that Janet Fraser would fall into this category as well. Not everyone agrees with me though and some, like Amber Watson-Tardiff, are suggesting that what Fraser did by having her baby unassisted was “reckless, neglectful and borderline criminal.”

Jessica Gottlieb of Eco Child’s Play says, “I support women who chose a home birth. But a free birth? I cannot see the wisdom in it. Neither can Ms. Fraser’s baby.”

Watson-Tardiff goes on to say, “I hope she is at least subject to an investigation for child endangerment.”

Ronda Kaysen of MomLogic says she sees the value of home birth as a way of reducing medical intervention, but believes giving birth without medical assistance is “absurd.”

Fraser’s “free birth” argument, which on the surface appears feminist, is actually the opposite. It doesn’t empower women to take control of their own bodies. It sends them and their babies into the dark ages of medical care – where women give birth with no medical care at all and face the very real possibility of death as a consequence.

For the record the police are investigating the death and have said “it was not clear whether the baby was stillborn or died after delivery. If a baby is stillborn, there is no autopsy. If a baby is alive at birth and dies soon after, it is considered a matter for the coroner.”

I guess I give Fraser the benefit of the doubt and assume that like most mothers she was doing what she thought was in the best interest of her baby. Although she coined the term birth rape (birth interventions done against the woman’s wishes), I don’t believe she would put her child in harm’s way rather than accept a potentially life-saving intervention. Then again I don’t know Fraser and have not spoken to her, so I can only speculate just as others are doing, but I prefer to give her the benefit of the doubt. However, I do believe that whenever a child dies, there should be an investigation into the death.

While many are blaming Fraser for her baby’s death since she did not have a doctor or midwife in attendance, no one seems to mention the fact that babies die in the hospital, where doctors are present, all the time.

Laura Shanley, author of the book Unassisted Childbirth and owner of the Bornfree! website who blogs at Letters from Laura – Thoughts on Unassisted Childbirth, brought up that point and shared another perspective many of us may not have thought of when she shared the following statement with me:

I don’t know Janet, but of course my heart goes out to her. An Australian friend of mine has told me that despite what the media is saying, Janet’s baby was stillborn and the outcome wouldn’t have been different had the baby been born in the hospital. Regardless of whether or not this is true, I find it sad that so many people are blaming Janet for her baby’s death. A baby is stillborn in an American hospital every fifteen to twenty minutes. According to a story on my local newscast, this is double what it was ten years ago. Yet almost no one blames hospital birth mothers (nor should they) for these babies’ deaths. This is because it’s assumed that if a baby dies or is stillborn in the hospital, everything possible was done to save the baby’s life. The possibility that at least some of these deaths might have been caused by early inductions, c-sections and other interventions is rarely discussed.

I can tell you, however, that as a homebirth advocate I have received numerous letters over the years from grieving mothers who wonder if their hospital born baby might have survived (or avoided injury) had they been born at home. The fact is, in most cases we may never know. Sometimes medical intervention saves lives, and sometimes it takes them. This is why I encourage parents to do their own research and decide for themselves where and with whom they want to give birth. In my case, I chose to give birth at home unassisted because from the research I had done I felt that the majority of problems in birth – both now and in the past – could be traced to three main causes: poverty, unnecessary medical intervention, and fear which triggers the fight/flight response and shuts down labor. Despite what most people believe, the act of birth itself is not dangerous. But our cultural beliefs and practices can make it so. In the end, it’s a personal decision. And just as the death of a hospital-born baby doesn’t mean that no baby should ever be born in the hospital, the same should be said for babies born at home. Regardless of the outcome of this case, I will continue to speak out about unassisted childbirth as I believe that in most cases it’s the safest and most satisfying way to give birth.

Genie, an Australian blogger who writes at Home Is Where the Heart Is, blogged extensively about her thoughts regarding Janet Fraser and defends her choice to have her baby unassisted at home. She feels the insinuation that women who birth at home do it to feed their own ego at the expense of their child is “a crock.”

Women choose to homebirth with their baby’s best interest at heart. They do it FOR the baby, not in spite of the baby. Yes they want to feel empowered and blissed out, but the lack of trauma and the satisfaction a mother gets after a natural birth all benefits the baby too. A mother’s health and well being has a HUGE impact on the baby. So why should we ignore the interest and well-being of the mother?

In the wake of this tragedy and surrounding media coverage, some feel the need to point out that there is a difference between home birth and free birth. Dr. Meredith Nash of The Baby Bump Project says homebirth and freebirth are not the same.

The media has failed to differentiate between freebirth or unassisted birth (no midwife or doctor) and homebirth (a birth at home, usually with a midwife or homebirth doctor). For the most part, for low-risk births that are attended properly, homebirth has been proven to be a safe alternative to hospital birth. Freebirthing is significantly more risky (sorry, I’m a supporter but also a realist). It is essential to make this differentiation. Now that homebirth is on the precipice of being banned given that independent midwives are likely going to be denied indemnity insurance from next year, the suggestion that all women who homebirth are crazy radicals or that homebirth represents the majority of birthing women in Australia (only about 2%) is ridiculous. If anything, midwives and their ability to attend homebirths will be the saving grace of the Australian maternity system. Rather than convincing the small proportion of women who avoid a medicalized birth, why not support these women in their choices by making homebirth safe and easy?

Summer Minor, who blogs at Wired for Noise and gave birth to her daughter at home a little over a week ago, references the recent Nederlands study that says home birth is as safe as hospital birth. “A new study is out from the Netherlands that gives us home birthing mothers a nice little pat on the back. Despite the labels of ‘dangerous’ and ‘unsafe’ by some, once again it’s been found to be just as safe as giving birth in a hospital.” From the BBC:

The largest study of its kind has found that for low-risk women, giving birth at home is as safe as doing so in hospital with a midwife.

Research from the Netherlands – which has a high rate of home births – found no difference in death rates of either mothers or babies in 530,000 births.

I think that Shanley said it best when she said, “In the end, it’s a personal decision. And just as the death of a hospital-born baby doesn’t mean that no baby should ever be born in the hospital, the same should be said for babies born at home.” We all must do our research and make the choices that we feel are the best for ourselves and our babies and then, find peace with our decisions.

I offer Janet Fraser and her family my deepest sympathy. My thoughts are with them.

Cross-posted on BlogHer.

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20/20’s Extreme Motherhood falls short, disappoints

As I found myself watching and live Tweeting the 20/20 episode on Extreme Motherhood on ABC Friday night, I felt disappointed that once again mainstream media had let me down. It didn’t come as a complete surprise, but I really had hoped for better from them.

The show, for those of you who were occupying your time with better things (wise choice), consisted of segments on Orgasmic Birth, fake babies – women who buy Reborn dolls and treat them very much like real babies (um, yes, it was more than a little freaky), long-term (extended) breastfeeding – including a mention of 2 1/2 yr old twins still nursing (uh, what’s extreme about that?) as well as a few older children, serial surrogates, and home birth. The majority of the time seemed to be spent on the fake babies and the serial surrogates, with lesser amounts devoted to the rest. The least amount of time (and what I felt should have received the most) went to home birth.

The home birth segment had very brief interviews with Ricki Lake and Abbie Epstein (producers of Business of Being Born) and Laura Shanley (author of Unassisted Childbirth). There were no interviews with any midwives. There was no talk of the training midwives go through or the preparation that women who choose unassisted birth generally undertake. It all seemed very much focused on fear rather than offering up real information. The AMA says blah, blah, blah – nothing we haven’t heard before.

One of my main issues with the show was that it was not objective journalism at all. The correspondents spewed a lot of shock value comments instead of asking intelligent, thought-provoking questions. Maybe I’m naive to expect better from them.

twitter fail whale for 20/20Overall, I have to say I’m sorry I wasted my time watching it. I felt it was very exploitative. 20/20 gets a big ol’ Twitter Fail Whale from me. I don’t feel the show gave much, if any, useful information, except maybe some women will seek out Business of Being Born or Orgasmic Birth (which has a lot more to it than the name implies) after watching 20/20.

For those of you who are looking for some real information, you might be interested in reading my thoughts (and others’ thoughts) on orgasmic birth – Giving Birth can be good, ecstatic and even orgasmic or long-term breastfeeding Breastfeeding until age 3, 4 or 5 – more common than you think? – including a list of moms who have breastfed older children. I’ve also written about planning for a home birth and my home birth story.

Giving birth can be good, ecstatic and even orgasmic

I know I just wrote about this topic last week, but I have more to share and wrote about it for BlogHer this week.

Last week, Lisa Belkin, parenting blogger at The NY Times, wrote about the upcoming 20/20 special on the film “Orgasmic Birth.” The topic apparently hit a nerve with many, many people as she quickly received more than 500 comments.

Many people, as to be expected, are skeptical.

Mir of Woulda Coulda Shoulda had the most humorous response I read to the idea.

As soon as I

1) Find a man with a 9-pound penis
and
2) Become drunk enough to let him put it inside me for thirty hours at a time

I’ll definitely see if those conditions can result in an orgasm.

But until then? Whatever, man.

Catherine, who blogs at Her Bad Mother, had similar feelings and said, “Me, personally …? I think that I’ll stick to getting my orgasms the old-fashioned way.”

The day after Lisa Belkin’s initial NY Times post she followed up with About that orgasmic birth… and went into a little more detail about the responses she received, the film and one of the women featured in the film.

I was not surprised at the number of comments that dismissed the possibility as a fairytale. I was very surprised at the number of women who wrote to say that they had experienced what the film explored. I was a little distressed at the hostility the first of these groups showed to the second. And I was somewhat surprised, and very pleased, to receive an e-mail from Tamra Larter, one of the subjects of the film, who had been following all the comments, and wanted to make a few of her own.

It’s really worth it to click over there to read what Ms. Larter had to say about the film and her birthing experience, but here’s a snippet.

“I hope people will see the film,” she wrote. “Then they will see that it is about much more than the title suggests. There are many choices and possibilities when it comes to birth.”

And she uses the word “orgasm” with conditions. “I never claimed to have a pain-free birth,” she wrote, “but laboring with my daughter was awesome and for the most part felt really good.” The actual “orgasmic experience” did not feel like the climax of sex, she says, but rather “sensations which were something different than sex, but similar enough I feel O.K. using the word orgasmic. It was a wonderful feeling.”

She also confessed that upon first hearing about the idea of orgasmic birth, she thought it was “gross,” “weird,” and “not possible,” but said it was before she had had any children and the only childbirth she had seen had been on TV.

After reading many comments and several blogs about this, I clicked over to the Orgasmic Birth web site, where I watched the trailer (again). The first time I watched it was many months ago and I felt a refresher was in order.

I admit that even with all of the birth videos I’ve watched in the past and my “crunchy” ways, it makes me shift uncomfortably in my seat to hear a woman making pleasurable sounds while in childbirth (or in any situation really). And yet, I see the whole “orgasmic birth” thing as being just a small piece of the film, and believe it is titled the way it is to grab our attention. (And it’s certainly worked, hasn’t it?) I still believe, as I wrote on my blog over a week ago, “that it does not appear they are not saying all women will have an orgasm or that an orgasm should even be the goal. I think the point is moreso that birth can be a good experience.”

Marsden Wagner, MD, who is interviewed in the film, makes an excellent point about childbirth saying, “It’s got to be like it is when you make love with someone. It’s got to be safe, secure and uninterrupted. And that is how you have an orgasmic birth.”

I do not want to turn this into a debate over home birth vs. hospital birth, but having had both types of births I will say I felt much more safe, secure and uninterrupted at home than I did in the hospital. Although I’m sure it’s possible, I think that for the most part, these “orgasmic births” are much more likely to occur in a birthing center or home environment than in the hospital.

I think the term “orgasmic birth” is subject to interpretation too and noticed that on the Orgasmic Birth site, in their call for birth stories they say, “Please share your ecstatic or orgasmic birth story with us.” I would never say that I had an orgasm while giving birth to my son, but the experience was amazingly intense and was one of the most empowering moments in my life. Does that mean it was an orgasmic birth? Maybe. Was it an ecstatic birth? I believe it was.

Ninotchka had an empowering birth experience as well and commented about it on my blog:

I can’t say that I had an orgasm while giving birth. But after birthing Elle right into my hand, I felt so triumphant and organically happy that I would certainly call that feeling “orgasmic.” It all happened so fast and we’d waited so long for that little sweetheart. It was a definite rush and I was absolutely elated.

I think giving birth will always conjure up different ideas and feelings for different people. No two births are exactly the same and I think that’s the way it should be. Innerbrat summed it all up nicely when she said, “The important thing here, as with everything regarding women’s health, is to give women the ownership of our own bodies, so we can make an informed, conscious decision about what’s best for us and our children; and the first and best way to be informed is to openly talk about the subject.”

ABC’s 20/20 special on Orgasmic Birth, which will also include segments on home birth (unassisted and midwife-attended) and long-term breastfeeding, is currently set to air Friday, Jan. 2, 2009.

Cross-posted on BlogHer.

Orgasmic birth on 20/20 this Friday

Update: The show has been pushed back. The new tentative air date is Jan. 2 now.

Just a quick note to let you all (but especially the birth junkies) know that ABC’s 20/20 is doing a segment on Orgasmic Birth this Friday, Dec. 12.

Have no idea what I’m talking about? OB-GYN Dr. Christiane Northrup, midwife Ina May Gaskin, and childbirth educator Debra Pascali-Bonaro all agree that under the right circumstances, i.e. when a woman is relaxed (and in my opinion very comfortable with her body), and due to the huge hormonal changes that occur in the body during labor, a kind of birth ecstasy is possible.

To learn more about the 20/20’s Orgasmic Birth, check out Labor Orgasms called ‘Best-Kept Secret’ – Moms, Experts Say Relaxation is Key to Pleasurable Childbirth. Then be sure to tune into 20/20 on Friday. I’ve already got my DVR set to record it.

What do you think? Is a segment on ecstatic birth “a bit too much information” as one woman on Twitter called it or, in a largely-medicalized, fear-based birthing society, just the kind of information women need?

Additional resources:
Orgasmic Birth, the film
Orgasmic Childbirth: The Fun Doesn’t End at Conception! by Laura Shanley
Pioneering midwife touts ‘orgasmic birth’ on MSNBC

Edited to add: I want to point out that it does not appear they are not saying all women will have an orgasm or that an orgasm should even be the goal. I think the point is moreso that birth can be a good experience.

For women who hope to create a similarly happy ending for their labor, Pascali-Bonaro hopes they realize that it’s possible, but the goal is not necessarily an actual orgasm.

“I hope women watching and men watching don’t feel that what we’re saying is, every woman should have an orgasmic birth,” she said. “Our message is that women can journey through labor and birth in all different ways. And there are a lot more options out there, to make this a positive and pleasurable experience.”

Consumer Reports: high-tech births=poor outcomes

Consumer Reports isn’t just for researching your next car purchase or washing machine anymore. That’s right, that longtime resource for product reviews has broadened its scope to include health and wellness. In a recent article Consumer Reports tackles the topic of childbirth, concluding that "Too many doctors and hospitals are overusing high-tech procedures."

Consumer Reports cites a new report, Evidenced-based Maternity Care by the nonprofit Childbirth Connection, which found that "in the U.S., too many healthy women with low-risk pregnancies are being routinely subjected to high-tech or invasive interventions that should be reserved for higher-risk pregnancies." Some of those interventions include:

  • Inducing labor. The percentage of women whose labor was induced more than doubled between 1990 and 2005
  • Use of epidural painkillers, which might cause adverse effects, including rapid fetal heart rate and poor performance on newborn assessment tests
  • Delivery by Caesarean section, which is estimated to account for one-third of all U.S births in 2008, will far exceed the World Health Organization’s recommended national rate of 5 to 10 percent
  • Electronic fetal monitoring, unnecessarily adding to delivery costs
  • Rupturing membranes ("breaking the waters"), intending to hasten onset of labor
  • Episiotomy, which is often unnecessary

The study suggests that high-touch, low-cost, noninvasive measures are underused in today’s maternity care for healthy low-risk women. These include:

  • Prenatal vitamins
  • Use of midwife or family physician
  • Continuous presence of a companion for the mother during labor
  • Upright and side-lying positions during labor and delivery, which are associated with less severe pain than lying down on one’s back
  • Vaginal birth (VBAC) for most women who have had a previous Caesarean section
  • Early mother-baby skin-to-skin contact

They’ve also included a quiz to test the consumer’s knowledge about maternity care and debunk several misconceptions. Here are a few examples from the quiz.

An obstetrician will deliver better maternity care, overall, than a midwife or family doctor.

False. Studies show that the 8 percent to 9 percent of U.S. women who use midwives and the 6 to 7 percent who choose family physicians generally experienced just-as-good results as those who go to obstetricians. Those who used midwives also ended up with fewer technological interventions. For example, women who received midwifery care were less likely to experience induced labor, have their water broken for them, episiotomies, pain medications, intravenous fluids, and electronic fetal monitoring, and were more likely to give birth vaginally with no vacuum extraction or forceps, than similar women receiving medical care. Note that an obstetric specialist is best for the small proportion of women with serious health concerns.

Once you’ve had a C-section, it’s best to do it again.

False. Studies show that, as the number of a woman’s previous C-sections increased, so did the likelihood of harmful conditions, including: trouble getting pregnant again, problems delivering the placenta (placenta accreta), longer hospital stays, intensive-care (ICU) admission, hysterectomy, and blood transfusion.

Labor itself can benefit a newborn’s immunity.

True. When babies do not experience labor (if the mother has a C-section before entering into labor, for example), they fail to benefit from changes that help to clear fluid from their lungs. That clearance can protect against serious breathing problems outside the womb. Passage through the vagina might also increase the likelihood that the newborn’s intestines will be colonized with “good” bacteria after the sterile womb environment.

The buzz in the blogosphere about this is mostly positive. Critics of the current state of birth in the United States are happy to see Consumer Reports raising awareness about the need for change and bringing this information to mainstream society.

The blogger at Rain Garden says, "I feel encouraged that a non-profit organization like Consumer Reports is picking this up on their radar – it is just one more spark that may ignite change."

Susan at Hug the Monkey agrees and says, "It’s kind of amazing that a mainstream and respected organization like Consumer Reports has gotten behind natural childbirth. This must signal a shift in our society’s ideas."

Shay at Augeries of Innocence says, "This just goes to prove pretty much everything that is in The Business of Being Born. If you haven’t seen the DVD, I highly suggest you watch it, rent it or buy it. Even if you’re not wanting to go completely natural for your birth, it has a lot of helpful information on it and really lets you see how wonderful the childbirth process can be."

Yogi Barrett, a prenatal class instructor who blogs at Five Points Yoga, says,

Though women and their partners shouldn’t have to become “experts” on maternal and fetal care when they’re pregnant, it’s very helpful to remember that you are a paying consumer. I recommend finding a doctor or midwife who will take the time to answer the questions you have, and who will talk to you about your choices, options and alternatives. Too often, women come to my class and say something like, “My doctor won’t let me go past my due date. She’ll induce me if I do.” We have to remember that we have a responsibility in all of this to ask questions, and know that it’s *our* decision whether we have that test or procedure. We cannot abdicate responsibility for our bodies and our babies, even if a doctor/midwife presents a procedure as non-optional. The time to set up this dynamic is before you’re in labor – it’s difficult to have rational conversation and decision-making in the midst of active labor!

If you’re pregnant, remember that you need to have confidence in your provider. It’s never too late to switch providers if you’re unhappy. I’ve had students switch providers mere days before giving birth! But also remember, the most important person to trust is yourself, and your baby.

I couldn’t agree more. As a natural birth advocate myself, I think the fact that Consumer Reports posted this study is huge and another step in the right direction. Women want to be informed, they want to make conscious choices regarding their prenatal care and their birthing care for their sake and the sake of their babies. The more information women and their partners easily have access to, the more empowered they will be to make choices that are best for themselves and their babies.

Cross-posted at BlogHer.

A wee bit bigger

I picked a couple of carrots from my garden yesterday to see if there really was anything connected to the leafy green bits that have erupted out of the earth. Here is what I found:
Baby carrots from our garden
I’m thinking they still have a bit longer to go. No? I mean, they are supposed to get bigger than my thumb nail, right? Nevertheless, the kids enjoyed the two itty-bitty baby carrots. 🙂

I’m hoping the carrots we’ll be picking today (along with a slew of other vegetables – potatoes, onions, butternut squash, pumpkins, cucumbers and more) will be just a wee bit bigger. 😉 We’re meeting up with some other families from our attachment parenting group and my sister at a local farm to pick veggies. The last time we went picking veggies at this farm I was 34 weeks pregnant with Julian. (We didn’t make it last year because the wind was awful on the day we were supposed to go.) My how time flies.

Anyone have any tips on storing veggies without a root cellar (like my friend Julie is building) for several months? Guess I’ll be doing some research this weekend along with cleaning my house since my in-laws are arriving in from Oklahoma on Monday. Oh, and there’s a Sustainable Living Fair and the play Birth happening this weekend in Fort Collins. Wish I could go to both, but I’m not sure there will be enough hours in the weekend for all of that! I swear autumn is always so much more busy for me than summer ever is.

Study: First-time moms want more information about life with new baby

A new study including 151 mothers in Brisbane, Australia has found that first-time moms want more information about what life with a newborn will be like and says they often don’t feel prepared for the recovery period after giving birth and emotional toll of caring for a new baby.

A new study published in The Journal of Perinatal Education finds first-time mothers want more information about how a newborn will impact their lives. Thirty-five percent did not feel prepared for the physical experience following birth and 20% did not feel prepared for the emotional experience.

“This study demonstrates that new mothers are eager for high-quality, accurate information of what to expect of life with a newborn,” says the study’s lead author, Margaret Barnes, RN, MA, PhD.

While I think there’s a definite benefit to educating expecting moms information on what life with a newborn may be like, (after all, knowledge is power), until every child comes with his/her own user’s manual, I think ultimately there’s only so much you can prepare for. Every woman’s birth experience is different, every child is different, and every new mother’s experience with her child is different. Each child has a unique temperament and will have different needs. Some will want to nurse every few hours, some will want to nurse much more frequently (or never let go of the boob). Every child’s sleep patterns will be different as well.

If you try to explain to a woman ahead of time how much a newborn will affect her life, is it realistic to think your words will have that much of an impact? Could it really help her prepare for what lies ahead? Is recovering from birth and caring for a newborn something anyone can really prepare for ahead of time (without having access to a full-time nanny, personal chef, housekeeper, etc.)? I feel like this is one of those things that a woman has to experience for herself to truly “get it.”

Before I had my first child I knew that once she entered the world nothing would be the same, that I would be sleep-deprived and have a baby nursing around the clock, but I couldn’t fully grasp the extent of how different my life would be, how beyond tired I would be, how sore I would be from an (unnecessary and unwanted) episiotomy, nor just how much love I could have for one tiny person until it actually happened to me.

However, I do think that it’s important to equip first-time moms especially with information and resources that will help and support them in their first few weeks and months of life with a new baby. Instead of sending moms home from the hospital with a diaper bags full of a few diapers and a can of formula, perhaps hospitals should instead give women lists of names, numbers, websites and email addresses of people, places and organizations they can turn to if they need help. Organizations like La Leche League International – with dates and times of local meetings, phone numbers to certified lactation consultants, warning signs of postpartum depression and who to call if you or someone close to you suspects you have PPD, links to groups such as Attachment Parenting International, house cleaning services, numbers of postpartum doulas, local moms support groups like MOMS Club, MOPS (Mothers of Preschoolers), etc. That is real information that new moms can use.

What do you think? Do you feel you were adequately prepared for life with a newborn? If not, do you think classes or a book could have helped? Do you have other suggestions?

Additional resources:


Cross-posted on BlogHer

Rate your doctor, midwife & hospital on The Birth Survey

If you’ve given birth in the United States in the past three years, you are eligible to participate in The Birth Survey. Thanks to The Birth Survey: Transparency in Maternity Care, “women can now give consumer reviews of doctors, midwives, hospitals, and birth centers, learn about the choices and birth experiences of others, and view data on hospital and birth center standard practices and intervention rates.” If enough women take this survey, it could have a serious impact on maternity care in the U.S.

The survey was developed by The Coalition for Improving Maternity Services or the CIMS. “Our goal is to give women a mechanism that can be used to share information about maternity care practices in their community while at the same time providing practitioners and institutions feedback for quality of care improvement efforts.”

tbs_button1_5×2.jpgFrom The Birth Survey:

We are dedicated to improving maternity care for all women. We will do this by 1) creating a higher level of transparency in maternity care so that women will be better able to make informed decisions about where and with whom to birth and 2) providing practitioners and hospitals with information that will aid in evaluating and improving quality of care.

Can I just say I really wish this type of resource had been available when I was pregnant with my daughter? If I had been able to read about my OB’s episiotomy rate for one, I think it may have helped me pass her by and find another doctor who’s intervention rates were more in line with the type of birth I was hoping to have. My doctor may be a great surgeon, but I felt that she was cut-happy and performed an unnecessary episiotomy that I still doesn’t feel right 4+ years later. Since my daughter was born more than 3 years ago I cannot complete the survey to rate this particular doctor, but boy, oh boy, do I wish I could to help other women with their choices.

However, on a positive note, I was able to rate the midwife that was in attendance for my son’s home birth 20 months ago. She received a glowing review from me and I am hopeful that the information I shared in the survey will influence women as well, just in the opposite direction.

The survey itself goes into quite a bit of detail about your prenatal care, labor, birth, and postpartum care with a doctor or midwife as well as asks you to rate the hospital or birthing center in which you gave birth (though you may complete it for home births as well – as I did – you just aren’t rating a facility in that case). I believe it took me about 30 minutes or so to complete. A very nice feature, especially for busy moms, is you have the option of saving your answers and returning to it later, something I definitely took advantage of.

I believe The Birth Survey has the potential to make a real impact on the maternity care in this country and I hope that many, many women will take advantage of it to share their experiences and their knowledge with other women. I really feel it is every woman’s duty to share her experience in an effort to educate others and, in turn, hopefully improve the quality of care. As Citizens for Midwifery points out, “For years, consumers have enthusiastically shared online reviews of movies, restaurants, products and services, but readily available information about maternity care providers and birth settings was nearly unattainable–but no longer.” Doesn’t it just make sense that there should be some sort of resource to compare care providers so that we can all make educated choices for our health and the health of our babies?

Heather at Meet the Heathons shares my excitement and optimism about the survey:

I am SO excited that this is FINALLY getting done. It was my dream as a public health graduate to do something like this. I’ve heard rumors that there are efforts to do this sort of thing for ALL types of medicine. So that say you needed a knee replacement, you could look up the hospital/doctor and see their success rate, compare prices, methods, etc… How AWESOME would that be. It would be one step towards changing health care in America– but I won’t get started on that one!

Giving Birth With Confidence says, “Hats off to the Coalition for Improving Maternity Services, the incredible women working within community based birth networks throughout the US, and to all the women who are sharing their birth stories. Finally, there is hope that birth, and women’s decisions about care provider and place of birth, will no longer happen ‘in the dark.'”

Upon completion of the survey, I found it interesting and helpful that there were additional resources listed for women who may have experienced negative feelings about their birth while taking the survey. Had I been taking it for my daughter’s birth instead of my son’s, I am sure a lot of the anger and negative emotions I have had in the past about the care I received during that time may have been brought to the forefront. (Heck, I’m experiencing some of them just writing the little bit that I did about it.) While it sucks that women may experience these feelings, it’s good to know there are resources available to help them deal with them.

If this survey brought up traumatic feelings for you regarding your labor, birth, or postpartum experience we encourage you to seek help from a licensed mental health professional who specializes in birth trauma. The following resources may also be helpful to you www.postpartum.net, www.ican-online.org, and Solace for Mothers.

Now let’s spread the word. Activistas says, “Share your story, voice your opinion, mamas. It’s important, and it feels really good (kind of like having a baby!). If you don’t, how will your experience help others?”

If you’ve given birth in the past three years, will you take The Birth Survey? Will you forward it on to your friends? Will you add a button to your blog? Let your voice be heard!

Other bloggers who have written about The Birth Survey:

Think Mama Think
Faith Walker
Mama Knows Breast
Finally Living Deliberately
…And a doula, too

Cross-posted on BlogHer

Guest post: The emotional aspects of being a doula

While I’m on vacation until Aug. 9, I’m featuring several guest bloggers. Today’s post comes from Sheridan of Enjoy Birth.

The Trust Birth Conference was very interesting. It was fun talking with other doulas there. We had one group discussion and someone talked about how our work as doulas can be effected by our births.

It made me think of my 2 cesareans I have attended as a doula.

I always was nervous how supporting a mom with a cesarean would effect me, because of my first birth. I had an emergency cesarean at 34 weeks. It was scary, my baby was in the NICU, I didn’t get to hold him for 24 hours. It was medically necessary, but still not anything I would want any mom to experience.

So I was talking to this doula about this and came to realize how God had really helped me deal with the ability to suport moms during cesareans, while not letting my emotions from my birth get in the way. He did this in an interesting way.

My first cesarean was Mom B and it was not an emergency situation. It unraveled over 24 hours. A long induction for a first time mom. Exhaustion was the real reason for the cesarean. She was well supported and respected and made the best choice for the situation she was in. It was still hard for me to accept in some ways. It was still quite devastating, because I knew what she was losing and gaining in her choice.

Since it happened slowly, I had time to come to grips with the situation and help support her through that. It wasn’t really until afterwards that I broke down. (There were many facets to that, it was the end of being away from my house for pretty much 57 hours for 2 long inductions.) But driving home I called Jenn, my good friend and all I could say was, “She got a cesarean.” and then started crying and couldn’t really stop. Jenn is a cesarean mom too, so she understood. I still tear up thinking about it and it was 5 months ago.

Fast forward to 2 months ago and I am at another birth. Mom K is on pitocin after supposed PROM. OB checks her and she has bulging forewaters, so she goes to break that, without even planning on telling mom. I jump in to say, “Looks like OB is going to break your water!”

Baby doesn’t tolerate it well at all, they try changing positions, then try amnioinfusion. I can tell things are getting dicey. Suddenly OB is in there and without telling K anything, putting in an internal monitor. I am calmly telling mom what is going on. Then OB goes for second Internal Monitor, I say to K, “It looks like you might be going for a cesarean.” OB calls Code Green, room fills with people. No one is talking to K at all. The room is in chaos. I feel totally calm. I say to K, “Go to your special place. You and your baby will be fine.” Mom and Dad are gone within minutes.

I am left alone in the room. I still feel calm. This was the situation I was most afraid of. Being in a situations close to Devon’s birth. But in reality I think that first birth with B, helped prepare me for this cesarean. It helped me deal with a lot of my emotions regarding Devon’s birth, so that I could be present and calm for K when I needed to be.

K and baby were fine. I loved that she was able to recover back in her room with baby in the room with her. She was holding him skin to skin within an hour after he was born.

It was a much easier birth for me to deal with as a doula. It was medically necessary (though I see very clearly different interventions may have caused that necessity). I was able to provide support before and after. I didn’t shed any tears, though I do feel sorry for K that she joined the sisterhood of the scar. It is something I do not wish for anyone.

Written by Sheridan Ripley –Hypnobabies Instructor, Hypno-doula, Proud VBAC mom, Loving Lactivist, Positive Birth Story Collector and mom of 3 Busy Boys.

Her OC Hypnobabies Website is www.enjoybirth.com. Her Positive Birth Stories Website is www.pregnancybirthandbabies.com.

Her Blogs http://enjoybirth.wordpress.com and http://hypnobabies.wordpress.com.

Guest post: The Longest Birth Story Ever

While I’m on vacation until Aug. 9 (and quite possibly for the day or two after I get back), I’m featuring several guest bloggers. Today’s guest post comes from Sonja from Girl with Greencard. Sonja shares the birth story of her son Noah who was born just weeks ago.

The longest birth story ever

The plan:

Midwife-attended, natural home birth, potentially in the water.

The Husband and I made this choice for many reasons, but mainly because a normal pregnancy is not a disease and does not need to be medically managed. We wanted to have control over the parts of the birth process you can have control over, like avoiding routine interventions, knowing all the attendants, being comfortable in our surroundings, and making choices ourselves rather than having doctors or nurses make choices for us. On top of that, I was radically and irrationally afraid of being admitted to the hospital. I haven’t been to a hospital in the last 15 years or so without becoming lightheaded – and that was just when I visited others!

The preparations:

Find a midwife.

Take Bradley class.

Take many a supplement.

Buy lots of plastic sheeting and cheapo towels and set up birthing tub (sans water, of course).

Prenatal care and due dateapalooza:

After we had found a midwife and decided on the home birth, I saw both her and a midwife at Kaiser for prenatal appointments. Generally speaking, the appointments at Kaiser were awful (low iron! too much weight gain! scary big baby stories!) and the appointments with The Good Midwife (TGM) were great. I was low-risk, happy, healthy, and progressing normally. From the get-go, I had two different due dates: June 17th from Kaiser and June 19th from TGM. Then, Kaiser did the 2nd trimester ultrasound, and on the print-out it said that my due date was June 23rd.

Forward to week 35 of my pregnancy, when the baby dropped (I carried my belly between my knees all of a sudden), and TGM told me that first babies usually arrive four weeks after they drop. So now I considered my “due date” to be between June 12th and June 23rd.

Waiting…:

I didn’t have a baby on June 12th. Nor on the 13th, the 14th, or even on the 23rd. TGM went to a conference in Canada (leaving me in the capable hands of a very sweet stand-in). She was due back on July 1st, which was also my “due date + 8” (first time moms on average deliver 8 days past their due date) from June 23rd. I dealt with some crampiness and mucousiness while she was gone, but I had decided that I would have the baby on July 1st (because at that point I had STILL not gotten it into my blonde head that this was NOT UP TO ME). Starting on Thursday (June 26th), the crampiness progressed into nightly occurrences of pre-labor (or false labor), which was exciting, but robbed both me and The Husband of sleep. And… it didn’t progress into anything serious at all.

I didn’t have a baby on July 1st. Nor on July 2nd. I was getting a little desperate. Okay. A lot desperate.

Finally! Labor! Wooohooo!

Thursday night, July 3rd, I could tell my contractions were different. The Husband and I decided that FINALLY! I was in labor, and called TGM to giver her a heads-up. I took the birthday cake out of the freezer. In between my contractions we talked about how our baby had just waited so he could have parades and fireworks for his birthday every year. Needless to say, we were excited. Of course, being obedient Bradley students, we went to sleep. That is, The Husband went to sleep. I realized that real contractions are a heck of a lot more painful lying in bed that in pretty much any other position, so I walked around and dropped to my knees a lot.

Towards the morning, I felt increasingly annoyed with the contractions and got in the birth tub. This of course slowed the contractions waaaaay down, but I managed to wedge myself in so I could take a floating nap, which was great.

TGM arrived around daybreak. I was only 3 cm dilated and incredibly discouraged. She recommended resting and distracting ourselves during the day and felt sure that my contractions would pick up again at night.

The next night went much like the night before. When TGM arrived at the house early the next morning, I was 3 cm dilated and clearly not in labor. Also ready to jump off a cliff – angry, annoyed, and just way too pregnant to deal with still being pregnant.

Hospital:

That Saturday was a long day. Saturday night was the first night in over a week that went by without so much as a single little cramp from ye olde uterus. Sunday morning, I had a really hard time peeing. By 9am, I couldn’t really pee at all even though I had been drinking water and juice like crazy. I figured that this was just a new nuisance of being extremely pregnant – baby is putting pressure on my bladder (because BOY did I have to go!) and simultaneously sitting on the exit. It wasn’t until I dissolved into tears trying to pee at church around 11am that it dawned on me that something was not right (I’m real bright sometimes, what can I say!). We went home. I called TGM who phone diagnosed me with a UTI (a diagnosis that proved accurate though I shrugged it off as preposterous because it didn’t feel like a UTI) and sent me to urgent care.

Of course, when we got to the Kaiser hospital, we were re-routed from urgent care to labor and delivery.

I was asked to pee in a cup (HAHAHA!) and actually managed to squeeze out a few drops. I had to exchange my clothes for the breezy gown and was hooked up to a fetal monitor. A surly midwife scolded me for not having come in for a biophysical profile at 41 weeks. And this, my dears, is when I found out that Kaiser only adjusts the due date based on the 2nd trimester ultrasound if it is more than two weeks different from the due date based on LMP (which I think is sound medically – I just wish I had asked that question back in January!). In other words, June 23rd had never actually been my due date, which now put me at almost 43 weeks pregnant. I felt like a giant fool. But not for long, because of the commotion – baby’s heart rate dropped! Dramatically! To the 50s! Nurses rushed into the room, The Husband was pushed out of the way, and an oxygen mask was pressed on my face. As soon as the monitor had been adjusted, baby’s heart rate was fine again, but this “random decel” turned into another Big Deal, though I am convinced that it only happened because the monitor moved on my giant belly.

An ultrasound determined that I had next to no amniotic fluid left (not good) and an exam revealed that my bag of waters had ruptured – unbeknownst to me. It had quite possibly (and likely) been ruptured for three or four days (really not good).

So here I was – with premature rupture of membranes, too little amniotic fluid, a “random decel” of baby’s heart rate, a UTI, and 2 weeks 5 days past my due date. Oh, and without any contractions. We agreed to induction, happy that they were offering it rather than arguing for a c-section right away.

Intervention carnival:

Before I knew it, I had an IV with fluids and antibiotics. My bladder was catheterized (oh, sweet relief!), fetal monitoring was done internally (sorry baby!), and I got an infusion of amniotic fluid. Once everything was situated, they hooked me up to Pitocin.

Fast-forward about 12 hours. I was stalled at 7 cm but felt veeeery pushy with each contraction. Baby’s head was tilted (not good) and his heart rate continued to have “random decels” (Pitocin side effect). TGM had come to the hospital to support us, and at this point, she recommended I get an epidural to give me the chance to continue dilating without having to try not to push, to relax me so that perhaps baby’s head would move into a more favorable position, and to allow me to get some rest. I went for it, and it really helped. I dilated to 9 cm while I took a little nap. Baby’s head turned. I got a second wind. But… I had to keep the oxygen mask on at all times to prevent baby’s heart rate from dropping (and take slow, deep breaths). Baby had turned posterior (no wonder – I had to labor on my back!) and I stalled at 9 cm with my cervix stuck between baby’s head and my pubic bone.

We decided that at that point, a c-section would be the best option to get the baby out safely.

Noah was born at 10:15am on Monday, July 7th. He was covered in meconium, but had APGARs of 8 and 9. His daddy fought the nurses for skin to skin contact while they were cleaning and suctioning him and then stayed with Noah until they had sewn me back up. I was able to hold and even nurse Noah in recovery – before I could even wiggle my toes (or actually really feel my boobs).

The aftermath

Healing from a c-section is no picnic. Getting into and out of bed was nearly impossible for the first few days – even in the hospital. At 16 days post-surgery, I still cannot carry Noah and the diaper bag at the same time. I don’t stand a chance lifting the stroller into or out of the trunk of the car. Sneezing, coughing, and blowing my nose are extremely painful – I feel as though those things rip me apart at my incision.

Healing emotionally

I’m actually doing pretty well emotionally. I certainly have learned a lot.

One of the reasons why I chose a home birth was my fear of hospitals. I didn’t want to have to assert myself and to fight for the natural birth I wanted. In many ways, home birth was the path of least resistance for me. Not only did the hospital turn out to be very accommodating of all of my special little requests, but I never felt judged for my decisions (like refusing the eye treatment and Hep B vaccine for Noah). My wishes were actually respected (I told the first nurse I did not want pain medication offered to me and nobody ever mentioned it after that.)! I felt well taken care of the entire time I was in the hospital, and I realized how strong I was. I was able to get what I wanted without having to drop-kick anybody (or even arguing for it).

I know that I did everything I could to have a natural delivery. I feel that all interventions were medically necessary. Sure, the Pitocin led to the random decels in baby’s heart rate which ultimately led to the c-section, but I did need the Pit to get me to go into labor. The stalling at 9cm and baby’s poor position could have been avoided (or remedied) had I been able to move around while in labor, but again – with the issues I came in with, laboring on the bed was my only option.

And so I learned that the hospital is not an evil place (though choose your hospital wisely if you’re planning to birth there), that I am stronger than I thought (I sort of want to cross-stitch “12 hours on pit with not pain meds” into a pillow), and that even though it can sometimes appear as though they are, medical professionals are NOT the enemy (but… do your research! I’m always amazed at people making decisions based on little to no background info. One of the nurses actually asked me if I was a nurse because of how much I knew about labor and birth.).

And to end the longest birth story ever told (which is fitting since it felt like the longest pregnancy known to womankind), here are some photos:

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Girlwithgreencard is the pseudonym of Sonja. She is a retired elementary school teacher and new SAHM living the high life of smog, terrible traffic, and crazy hot summers in Southern California. She has a green card because she came to the States from Germany eight years ago to get married to this guy she fell madly in love with. Sonja likes the smell of rain and her baby’s blissed-out smile when he comes off her boob. She very much dislikes crumply sheets and people talking on cell phones in public restrooms.

Sonja chronicles her daily life at Girl with Greencard and shows off her crafting endeavors at Girl with Fabric.