viernes, 25 de septiembre de 2009

Births that remind me why I love Birth

Some births are exceptionally special. They are undisturbed, physiological and divine. These are the births where I show up and the woman and her husband are loving each other secretly... where the lights are off. Births where the woman moves as she needs to and no one needs to talk or even whisper. Birth where the sounds remind us of Whales, swimming together.

These are births where the mother opens herself, emotionally, physically, spiritually... all of herself, to receive her newborn. Where when she touches fear she looks deep into her lovers eyes and says, "I can't do it anymore". and he says, "yes, you are doing it". Enough said.

These births remind us that birth is trusted when the midwife has nothing to do. Births where you are almost embarrassed from the intrusion on the sexual ritual that the couple is undergoing.

Births where the baby is born and the mother sings to her newborn, who just stares at her in recognition. Births where the baby didn't have to brake the mother to get through her and where everybody cried except for the baby.

I hope every woman can find this birth. Within herself.

These are the births that remind me of why I love Birth.

Reaching for straws

I heard this this week:

In an ultrasound exam a baby was detected to have femurs that are two weeks short. The physician therefore explained to the woman that they might as well schedule a cesarean because due to the short legs the baby wouldn't be able to push himself out of his mother's uterus when it came time for pushing- or stretching as this case might be.

Now thats really REALLY getting desperate.

viernes, 4 de septiembre de 2009

The Post Partum War

Its 2.30 am and she hasn't slept since about three days before her birth. Which was about 3 days ago.

The baby is screaming.

Her breasts are screaming.

She cannot tollerate another hour of the baby hanging from her nipple, sucking the life out of her. She can barely sit because the stiches have swollen. Her arms are sore. Her back aches.

All day long her family has sat around her, passing the baby around and thinking of creative new ways to shut the screaming up. They've given their expert opinion on her milk making capacity, they've commented on the babies weight less (apparent, they say) and question on whether she is really going to wait five days for the milk to come in??? is she sure???

2.30 am and she is alone. The family has dissappeared with their expert opinions and their wisdom and their oatmeals and fennel teas. Her mother appears at the door and looks at her, "Is there anything I can do dear?" "No Mom." "Why is the baby crying again?" "I don't know mom". "Here, give me the child...."

The post partum war has established itself deeply in the folds of the bedroom curtains. It hides in the bed sheets jumping out everytime someone rustles the covers. It hides behind the door jumping out at her everytime she, or someone else opens or closes the door.

Its either me or the baby. And since I'm bigger and older, its going to be me who wins this one.

Despite our childbirth preparation, parenting classes, women's groups, feminism, blogging and midwifery model of care, as new mothers we are completely unprepared for the postpartum war. And we think we won't fight it. And time and time again, I walk into a woman's home postpartum and find her thick in the battle.

So what is the postpartum war?

1. It is our intuitive mothering skills that we inherit from our mother. This is beyond reading and reason. This is the basic, unconditional, completely dedicated love that our mother gave to us during our post partum period. Yes, that was the 70's wasnt it? Mom was in some purple post-anesthesia haze, with some bizarre formula instructions in one hand and the absolute urgency to train us, 5 day old women, to be independent and assertive. 30 years later, with a Masters degree and 5 years of therapy to heal mom's deep mistakes, we find ourselves wondering why the baby won't just shut up and go to sleep and stop being so dependent on us for every little thing!!!!!

Regardless of what we have learned, we learned to mother during our first two years post partum. We learned that from mom, who did the best she could. But also was fighting a war with us. Because she, like us, was told that babies need to be disciplined, managed, not spoiled. That we must set boundaries and not lose our independence. That life is too complex for unconditional dedication. There's too much to do. And babies need to learn independence and rules. Get them out of the bed and off the breast or they will be there for 38 years!!!

2. We honestly believe that two needs and desires cannot live in one space. You want milk and I want to sleep. You want attention and arms and I need to go to the bathroom (and I've been constipated ALL WEEK!!!). You need me to stare at you in bed all day and I have about 56 emails to answer right now. You need my completely undivided 24 hour attention and I need a breast pump so I can get out of this trap as soon as possible and regain the independence that it took me 33 years to achieve!!!

The truth is, as mothers we can and must learn to live with two needs and desires in one space. It doesn't have to be one or the other, as long as we are completely, totally dedicated to our baby when it is time to do that. As skilled as we are, we cannot multi-task when it comes to giving our baby undivided attention, which is what our babies need. Even if it is only a few hours a day. No one needs to win this war. We need to stop thinking we need to fight it.

3. The baby doesn't need to shut up, the baby needs to be heard. If the baby is screaming, the mother is screaming. The mother and baby are so fused during the first two years that it is impossible for the baby not to manifest the mother's emotions. As polite women, we keep our emotions within. Only to find that after all the lactation experts have left our bed-side, our baby screams for about four hours. The baby needs to be heard and the mother needs to listen. The mother needs to talk and state her needs and the rest of us need to listen. The rest of us need to listen to the baby and attend to its needs. And baby needs are pretty simple. LOVE. Pure, Genuine, oxitocin induced, dedicated, unconditional, focused love.

Eventually a baby who is never heard will shut up. And 30 years later she will wonder why her beautiful postpartum bed has become a war.


I am writing about this for several reasons:
When men began to attend births (and other body issues) they would write about their findings and other men would discuss them.
I would like to know if anyone has ever seen this and what their thoughts are

A woman birthed with me (a normal homebirth). She incurred a small anterior tear which was not repaired and she was advised sitz baths with healing herbs (calendula, malva, rosemary and aloe) and to keep her legs closed. About one month ago at a post partum visit she stated that she felt her yoni had "closed". Assuming I understood what she was talking about I discussed pelvic floor with her and "things coming back together".

She was in fact right.

She came in for a pap smear one month after that conversation and I found that she had a "closed" yoni. She had grown a spider web type tissue across her inner labia leaving her introitus about the size of my pincky finger (which is by the way, very small). The tissue is very thin and only covers this area, from below her urethra to half way down her yoni introitus. I consulted our pediatrician who observed the woman and explained that this was a "Synercky" (sp. Sinerquia) and she had seen it in newborns, who are born with an overdeveloped hymen. She explained that basically this woman had revirginated. We giggled and stood in awe around her.

So we discussed a de-virgination plan between the three of us: she should come back without her baby, a bottle of wine and some romantic CDs and we would romantically "release" her of her new found virginity.

What is so stunning about this to me is the power of the mind and psyche to heal the body. The woman is question is a single mother with deep concerns about the fact that she became pregnant "out of wedlock". Her family had a hard time integrating the news as they are conservative and catholic. So this woman is a Saint?! She regained her virginity though a gentle postpartum after a beautiful homebirth. And through intention.

Now that may just be one more reason why homebirth is so special! And why women are so magical.

Once again, Science proves what Nature knows

Last week a study was published out of Canada comparing homebirth rates with midwives to hospital births with midwives and physicians. What is so good about this study is that is compares and compares and compares (three times because of the three factors it studies!). The study carefully looks at outcomes among Canadian women over four years within a common health care system, which means that in general these women can be compared. Also important to the study is that those who birthed at home had planned to do it- it wasn't an accident. The results show, as you will read below, that results of midwives are comparable to those of a physician. If you read the results of the study you will find that the results of the midwife attended homebirth are BETTER. Not just similar, B.E.T.T.E.R. This includes perinatal mortality (who new? in fact it appears in Canada LESS babies die at home). Homebirths also incurred LESS interventions (thats a no-brainer) or adverse maternal outcomes, which are defined as third and fourth perineal tear and post partum hemorrage.

So my question is- if the midwives are proving far better outcomes consistently then why is the research so controversial? Is it because women still have to work three times as hard to get half the recognition? Why is it that women's choice in birth is so controversial and questioned? Why is it that so few Maternal Health organizations recognize the Midwifery Model of Care?
How ss it that if midwives have BETTER outcomes than physicans, they are COMPARABLE?

If physicans had better outcomes than midwives than wouldn't they be deemed safer? So why doesn't someone just stand up and say it? OK, I will....


GOT IT??????

now, read the study! and congratulate the authors, they did a fantastic job.

Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician

Patricia A Janssen 1, Lee Saxell 2, Lesley A Page 3, Michael C Klein 4, Robert M Liston 5, Shoo K Lee 6

1 School of Population and Public Health, the Department of Obstetrics and Gynecology, Faculty of Medicine, University of British Columbia, Vancouver, BC; the Child and Family Research Institute, Vancouver, BC
2 Division of Midwifery, Faculty of Medicine, University of British Columbia, Vancouver, BC
3 Nightingale School of Nursing and Midwifery, King's College, London, UK
4 Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, BC; the Child and Family Research Institute, Vancouver, BC
5 Department of Gynecology, Faculty of Medicine, University of British Columbia, Vancouver, BC; the Child and Family Research Institute, Vancouver, BC
6 Department of Pediatrics and the Integrated Centre for Care Advancement Through Research, University of Alberta, Edmonton, Alta.

* Abstract

Background: Studies of planned home births attended by registered midwives have been limited by incomplete data, nonrepresentative sampling, inadequate statistical power and the inability to exclude unplanned home births. We compared the outcomes of planned home births attended by midwives with those of planned hospital births attended by midwives or physicians.

Methods: We included all planned home births attended by registered midwives from Jan. 1, 2000, to Dec. 31, 2004, in British Columbia, Canada (n = 2889), and all planned hospital births meeting the eligibility requirements for home birth that were attended by the same cohort of midwives (n = 4752). We also included a matched sample of physician-attended planned hospital births (n = 5331). The primary outcome measure was perinatal mortality; secondary outcomes were obstetric interventions and adverse maternal and neonatal outcomes.

Results: The rate of perinatal death per 1000 births was 0.35 (95% confidence interval [CI] 0.00–1.03) in the group of planned home births; the rate in the group of planned hospital births was 0.57 (95% CI 0.00–1.43) among women attended by a midwife and 0.64 (95% CI 0.00–1.56) among those attended by a physician. Wo men in the planned home-birth group were significantly less likely than those who planned a midwife-attended hospital birth to have obstetric interventions (e.g., electronic fetal monitoring, relative risk [RR] 0.32, 95% CI 0.29–0.36; assisted vaginal delivery, RR 0.41,95% 0.33–0.52) or adverse maternal outcomes (e.g., third- or fourth-degree perineal tear, RR 0.41, 95% CI 0.28–0.59; postpartum hemorrhage, RR 0.62, 95% CI 0.49–0.77). The findings were similar in the comparison with physician-assisted hospital births. Newborns in the home-birth group were less likely than those in the midwife- attended hospital-birth group to require resuscitation at birth (RR 0.23, 95% CI 0.14–0.37) or oxygen therapy beyond 24 hours (RR 0.37, 95% CI 0.24–0.59). The findings were similar in the comparison with newborns in the physician-assisted hospital births; in addition, newborns in the home-birth group were less likely to have meconium aspiration (RR 0.45, 95% CI 0.21–0.93) and more likely to Abstract be admitted to hospital or readmitted if born in hospital (RR 1.39, 95% CI 1.09–1.85).

Interpretation: Planned home birth attended by a registered midwife was associated with very low and comparable rates of perinatal death and reduced rates of obstetric interventions and other adverse perinatal outcomes compared with planned hospital birth attended by a midwife or physician.