We need more OBs to support vaginal breech deliveries

Dr. Howard Vogel, Third From Left, Is Assisted...

“Recent studies reaffirm earlier World Health Organization recommendations about optimal cesarean section rates. The best outcomes for mothers and babies appear to occur with cesarean section rates of 5% to 10%. Rates above 15% seem to do more harm than good (Althabe and Belizan 2006).

The national U.S. cesarean section rate was 4.5% and near this optimal range in 1965 when it was first measured (Taffel et al. 1987). In more recent years, large groups of healthy, low-risk American women who have received care that enhanced their bodies’ innate capacity for giving birth have achieved 4% cesarean section rates and good overall birth outcomes (Johnson and Daviss 2005, Rooks et al. 1989). However, the national cesarean section rate is much higher and has been increasing steadily for more than a decade. With the 2007 rate at 31.8%, about one mother in three now gives birth by cesarean section, a record level for the United States.”  ChildbirthConnection.org

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One in three births are cesarean?

Okay, so I have shared that my soul is at peace with my cesarean. Spiritually, I can use this experience to learn and grow. I trust that life brings me what I need when I need it.

But I think some clarification may be needed: I am still a great believer in natural birth and continue to think the political and economic pressures (well, I am talking insurance, mostly) as well as well-meaning concern from doctors (who live at the edge of where ‘everything could go wrong’) can sometimes lead to unnecessary interventions – meaning mother and child would have done just fine without them but it made everyone feel better that ‘everything possible’ was done. Yes, there is a place for intervention – but I still believe they should be a very last, break-in-case-of-emergency resort. And stats tell us it is not so. 5 to 10% of women medically need cesareans. 30% of women birthing in the US have cesareans. Shocking, right?

In fact I may be one of the cases where no intervention was *needed* as such and where arguably having the surgery did more harm than good. There was no medical emergency. Baby was breech but otherwise all was well. Labour was progressing. Baby was not distressed. I had even had a cat-scan (after much agonising – as nobody takes an X-ray of their pregnant belly, lightly) that proved my hips were wide enough to birth a breech baby, naturally. Indeed, millions of women have delivered breech babies vaginally, perfectly safely (including my mom – I was a breech footling). There is a slight increase in the risk of complications, yes, but most women birth breech babies just fine. The ONLY reason they stopped my natural birth process (after over 20 hours of labour) and said it was time to go to the OR is because it was 8 o’clock on New Year’s Eve and the only doctor with a specialty that includes vaginal breech deliveries (out of 5, I think, on the whole West Coast – all 5 in this one, fab hospital, UCSF) she was the only one who was even in the area during the hols and she was now off to her own New Year’s Eve party. As I say, I feel at peace with this. I believe God gives us the experience we need, in order to grow. But in purely practical, human terms it is pretty sad that there is only one hospital in the Bay Area (and allegedly in the whole of Western USA – covering, nearly 100,000,000 people) that will even consider doing vaginal breech deliveries, now – which really should be the mother’s choice, wherever possible, in my view. It is crazy that if your labour starts on the ‘wrong’ day, you are automatically scheduled for a cesarean whether it is in your child and your best interest or not. Parties and leave days come first. Not that I begrudge doctors their time off. I think they deserve and NEED it. I just wish there were more qualified doctors assisting this kind of birth so that the schedule could be fully covered!!

Why not use a home midwife, you say? Why, I had one of those. If you remember, I was planning a homebirth but my midwife, lovely as she is, had never taken the lead on supporting a breech delivery and did not feel qualified/experienced to do so on her own, without calling in back-up, and it turns out that was not easy to find. So, here too: please midwives do not neglect this important skill. Make sure you can confidently identify a breech baby in the womb and that you have the experience you need to deliver a breech baby vaginally, please!

Cesareans, as we know, decrease chances of successful breastfeeding – which in linked to all sorts of things from improved immunity, higher IQ and even decreased behavioural problems. Cesareans are major surgeries with risks for the mother – and even if it goes well it takes time and care to heal properly and completely. And cesareans deprive children from the final ‘inoculation’ of good bacteria that other children acquire passing through the birth canal, such that cesarean born children are two to eight times more likely to have allergies, later in life. Natural birth also gives babies a ‘massage’ that stimulates their whole skin and pumps out the lungs – cesarean babies miss out on this and can be born with water in the lungs. Cesareans should never be a given, don’t you agree?

So, yes, modern medicine can be a life-saver, literally. But in this case, it more saved a doctor’s chance of seeing the New Year in, in style. My plea: please train more midwives and OBs in normal, natural, vaginal deliveries of breech babies. Our babies deserve a chance at natural birth and all the health benefits that come with that!

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Cesarean saves me from… myself

I planned for a homebirth. I got a cesarean. Life gives you the experiences you need, in order to grow – not the experiences you ‘want’, right? What often comes to mind, actually, is that if I had had the natural, water birth I had planned… I might now be the unbearable hippy from hell. I have a propensity toward advice-giving. I try to perform some alchemy on it and channel it into blogging nowadays, ‘cos I think it is a nasty habit… but, oh my, my tongue would be bitten raw had I had that perfect Ina-May-esk, enlightening birthing experience.

As it is, what this whole experience of the unexpected brought me was a lot of humility and a lot of perspective. If I had beautifully breathed out a baby while meditating and listening to whale song, what are the chances that I would have come out of this thinking ‘if I did it anybody can do it, if they put their mind to it’ (with hidden corollaries like ‘they didn’t really want it’ or ‘they chickened out’ or ‘they don’t understand how important this is for the health of their kids’ – cripes!). Well, maybe motherhood would have taught me humility in many other ways. Usually my friends and the myriad of experiences they each go through and share with me, (eventually) teach me to see the ‘other’ point of view. This time, though, I don’t need to try and put myself in anybody’s shoes. The life learning was served up fresh, just for me.

And it worked, as I mentioned before, I think this journey from planned homebirth to OR  helped me open my heart to mainstream medicine a little more. I really did delight in the miracle of the triumphant arrival of my gorgeous daughter and all else paled into the background. Whoever helped was, in my eyes, an Earth-angel. You see, I am a natural health fan, all the way, this was my first exception, really, apart from dentistry but I found my peace with it, remarkably quickly, considering. Even my parents were surprised. I mean, really, only herbs and food as medicine for me – ever.  You have to be or know a hard-core crunchy to really grasp what a big shift this was for me. I had, for example, never taken antibiotics before the cesarean or pain-killers for that matter. And, yet, when the time came, I did what I needed to do to safely bring my child into the world, given the human constraints I was moving within. And it felt divinely ordained that it should be this way, for her, for me.

Obviously I am still processing this on some level, as it is over two years, now, since Nica’s birth and here I am writing about it, again. It came up when we were swapping birth stories among some mama-friends, the other day, and it got me to thinking about how rare and lucky it is to say that I didn’t get the birth I planned, at all, and I am fine with that, even knowing that had it not been New Year’s eve and the fact that the specialists I needed were at NY parties, I most likely would have had that vaginal breech delivery I worked so hard to secure a shot at. I hear all the time how not having the birth you want and in particular not finding acceptance of the birth you did have is strongly correlated with post-partum depression. How lucky am I to have been blessed, early on, with a different outlook on this situation? And how lucky are all my friends that life found a way to make sure I was not too up my own arse over the whole ‘natural birth’ thing to really listen to what is true for them, what they went through, what they were able to accomplish given the circumstances or what they wish could have been… I am lucky and blessed and truly believe we had the perfect birthing experience for us, mother and daughter – if not in the physical sense, at least in the spiritual/life-learning sense. Thank you, Universe.

10 things I thought I knew about motherhood… and was just plain wrong about

Motherhood changes you. It changed me – in ways I did not see coming.

Before giving birth:

  1. I was sure I was going to have a beautiful homebirth
  2. I thought breastfeeding was easy and happened naturally
  3. I was clear that Post Partum Anxiety was something that only happened to other women
  4. I saw how much my friends who had children seemed to age suddenly compared to their pre-baby selves… but ‘knew’ that would never happen to me as I take my omega 3s and omega 6s. I’ll be fine, right?
  5. I thought my baby would effortlessly start sleeping through the night from about 3 months or so, no?
  6. I was planning to just strap my baby to me and go, to continue leading a life of travel and adventure – only, plus baby
  7. I imagined my life with baby would be all bliss and butterflies, all the time
  8. I expected I’d get so much done. It would be so easy staying at home: the baby would sleep for so much of the day that I could do some writing, some photography, get some chores done…
  9. I felt moms who let their babies ‘cry it out’ were cruel
  10. I imagined motherhood would be challenging but fulfilling

After giving birth and having a baby:
  1. I discovered you have the birth you have. You can plan for the best, visualise the fairies and rainbows that are going to be present for your water birth… and then let go and let God take care of it. What will be will be and you are not in charge of it. That doesn’t mean let the medical establishment do what they will with your body and that of your unborn child – learn, prepare, take breathing and pain management classes and whatever else you can do to look this experience, this humongous life trial that only women can go through in the eye; don’t go into denial or pretend it will be easy (as ‘failing to plan is planning to fail’, as they say), do everything you can to have the birth you want… but know that ultimately you will have the birth you need as part of your own life journey.
  2. It became clear that breastfeeding though it is completely natural is a skill that must be acquired. There is lots of information and knowledge that can really help you overcome all the barriers, fears and apparent pitfalls that will most likely come up for you. Arm yourself with this knowledge, it will serve you well. Read this. No, really, if you are pregnant or a new mom and have never breastfed before, READ THIS! It is too easy in this society (where formula feeding is so ‘normal’) to mis-read the signals, give into the fear that your child ‘isn’t getting enough to eat’ or that your kid is in some way suffering because your milk production or the balance of your foremilk and hindmilk are not ‘perfect’ and before you know it you are supplementing or even full time formula feeding even though that wasn’t your plan (if it was your plan from the start, that is your right and your choice and then this does not apply to you). I got through it but I had a few scares along the way and lots of awesome support from La Leche League and some pretty clued up, nursing-loving lactation consultants.
  3. One in Three mothers have post partum disorders – one in three! I have mentioned before that I have Post Partum Anxiety. This is not easy to talk about for two reasons: it is taboo, we don’t talk about these things in polite conversation, right?; I hate being self-pitied and don’t want people to take this as a cue to treat me like a ‘poor little’ anything. I am strong, I am healthy. I LOVE my daughter and this is just a challenge along the way. I welcome support and love but say ‘no, thank you’ to people suddenly viewing me like I am different than they thought of me yesterday when they didn’t know. Ahh, well. I can’t control other people’s thoughts about me, right?! Anyway, the point is, before pregnancy I remember seeing sections about post-partum mood disorders in books and I literally skipped over them thinking, well this will never apply to me. Hah!
  4. I saw photos of me and realised I look like I have aged 10 years since before I had a baby. My daughter is only 1.5 years old!
  5. If you don’t sleep train them, many if not most babies do not magically start sleeping through the night by themselves. My baby is, as I say, 18 months old and still wakes up to feed during the night. I never thought I’d have her in my bed, either. I thought she’d sleep in our room, sure, but in her own cot or side-car. She was having none of it, though… so here we are, still co-sleeping and more than accepting of the fact that she is probably not going to sleep through the night until she is three!!
  6. I learned. It turns out babies – especially the little ones – need attention 24 hours a day. No exaggeration. I realised what every mama knows, that we are lucky enough in those early months to do a pee on our own… and having a shower all by ourselves is pure luxury. As for travel and adventure, I found my priorities just shifted, completely unexpectedly. Suddenly risking even a mild bout of diarrhea for travel to some exotic corner didn’t seem something I was willing to put my tiny, sweet little baby through (I favour third world/wild country destinations, you see). She can travel when she is a bit older. Plus it turned out she didn’t like being strapped in a car and isolated. She is surprisingly fine in airplanes on my lap but road travel was out, therefore not only exotic but also close by destinations were out. So, here I am having shifted gear completely from a life of exuberant freedom (as it now looks to me) to the life of a suburban housewife… uh, what?!
  7. I realised that though there is a lot of bliss (and some butterflies) but there are a lot of other emotions mixed in there, too. And now, 18 months into it, I welcome them all – but it was not always easy letting go of who I was and the feelings that came with struggling with what is now.  (see points 3 and 6)
  8. I assumed when I wasn’t out being the change I wanted to see in the world (hahaha) that I’d be at home writing about it, or the like… and then the baby came and slowed me right down. Now, the only change in my day is to my daughter’s dirty diaper.
  9. I still don’t want to let my baby cry-it-out… but I have a lot of empathy for those who do. The same goes for all kinds of parenting choices that I used to judge, oh, so flippantly. Now I take a minute, pause, and think ‘there but for the grace of God go I’. I am blessed with having an incredible AP support network (including all of you readers and fellow mama-bloggers) and some outstanding role models (starting with my mom who raised me AP before there was a name for it, it was just what felt right to her). Because of this, I hold certainty in my heart that even though it is hard – VERY HARD – I can do it. If my mom can do it, I can dig deeper in myself and find the energy, the stamina, the self-care to put my child first for just a little bit longer. Yes, I can keep on nursing even though it takes so much out of me, it almost literally drains me some days. Yes, I can keep on co-sleeping and being responsive to my child’s needs including through the night, even though that means I haven’t had a full night’s sleep in nearly two years – me who LOVES sleep and really does not function well without good rest. These things are not easy and I have, I confess, looked over the fence at those babies in their cribs peacefully sleeping through the night with more than a little envy on many a day. So I know, I know how easy it could have been for me to say, ‘I can’t do this anymore, I need help. I need rest. I need to sleep train my baby’. I haven’t done that… but I no longer think ‘evil’ mommies do it. Now I think tired mommies do it. Mommies lacking in support do it. Normal, loving mommies who would do anything for their kids AND need to be able to function through the day do it. I didn’t do it but I am no better, just luckier.
  10. I have come to see motherhood is challenging – so much more so than I imagined. I often said, in the early months of mothering, that this is by far the hardest job I have ever done and I have done some pretty demanding and stressful ones. This is way harder than those of us that don’t live in extended families and haven’t had much contact with real babies (as opposed to the ones Hollywood puts on my screen, all cuddles and cute burps) often imagine. It does test you in ways you never saw coming. And it is also rewarding, far more deeply but also, frankly, in more prosaic ways than I would have guessed. It is some times the simplest little things that hold us enraptured – that she can hold a cup by herself, that she can say the word ‘sofa’, that she can pick out the sound of a guitar on a tune on the radio – crazy little things that would never have held any magic for me are now so beautiful they could make me cry. It is like I see life, this journey, our bodies, this planet in a whole new light and hold so much awe for each creature that is able to do anything. I see the cost and investment that goes into each life and then into each movement that new life makes… and I like it. I feel it. I breathe it in and everything above is just a blur of words from the mind of one dwelling in the heart, in love with her daughter.

the spiritual teachings of a cesarean

Imagine if an angel kissed you and it left a mark on your flesh. That is kind of how I feel about my scar. Anya was born by cesarean. This was not the plan… at all. In fact we had envisaged a homebirth, had midwifery care, at home, throughout, hired a birthing tub, the whole shebang and then it turned out Baby was breach and would not – NOT – be turned. We tried everything every culture had to offer and baby was staying put, butt down! We even tried for a vaginal breech delivery but that didn’t pan out either.

So it came to pass that I had a highly medicalised, surgical birth and I am fine with it. I am surprised to say, I feel super-fine about it. Not that I would choose it again, of course not, just that I found my peace with it and am confident that my daughter’s birth, her arrival on this Earth and outside my womb was a blessed, magnificent occasion – and the means doesn’t really concern me.

I know many of the mama bloggers I ‘hang out with’ online are very political about this. And I get that. I have read Ina May, seen ‘The Business of Being Born’ and read ‘MisConceptions’. I am all for natural births and that would have fit in with my lifestyle and choices so well. But I am also for accepting what is, meeting it on the path – greeting reality as it comes hurtling toward you – with a smile, wherever possible. And hey, if my reality included some violent, unexpected feelings in reaction to this intervention-filled birth then that would be welcomed, too (eventually, at least). You can only take it one day at a time, see what comes and ‘eat the food on your plate’, right?

There are things that catch me out, don’t get me wrong. There are experiences I find harder to take in my stride and accept, zen-like. But this, even though it was seemingly against everything I stand for, felt just as it was meant to be. I credit my Birthing from Within classes for this, largely, actually. Birthing from Within is a pre-natal preparation course (summarised in a book of the same name). It is a bit wu-wu in nature (which is probably why I was drawn to it). They had us doing art as a couple to express our fears and hopes about the upcoming birth both verbally and visually, they got us to hold ice (the closest they can come, legally, to inflicting pain on us) to practice different breathing, relaxation and pain-management techniques and, crucially to this story, they encouraged us to visualise our worse-case scenarios and then re-imagine the same situation but with everything that we need to be able to cope with even this, our biggest fear. So, though we didn’t know for sure if Baby was breech at this point, I imagined that she was. I realised that didn’t freak me out that much after all, so I took it one step further and imagined I had to have, *gasp*, a c-section. And in that moment, even in the round when we had to imagine the ‘bad version’ of this story all I could see was my baby, coming out of me and onto the Planet – and nothing else mattered. I saw the doctors extracting her from my belly and the moment looked glorious, triumphant to me. I could see the energy and it looked and felt beautiful. And that was it, the fear was gone – discarded right there and then. [If only I had prepared this well for other things.]

What is more, I think this ‘crisis’ was (as the Japanese characters for this word point to) not just a risk but an opportunity. I took this as a huge hint from Life that it was time to make peace with the medical establishment. Yes, I like natural/traditional medicines and yes that is all I have used in this lifetime (up until now) but I acknowledge not just in theory but in action that there is a place for modern medicine in my life, too. That these two modes of healing are, truly, complementary. Now that was a lesson worth opening to (even if, frankly, I had no choice!)

So, now still, when I look down and see that scar on my belly I smile. I see beauty. I questioned this many times in the months after the birth: was I repressing some dark unexpressed feelings about this? Was I kidding myself about being okay with this? No, I really don’t think so. It has been 16 months now and I am still fine with it. That scar is where my angel came out of me and into the world and that ‘kiss’ is cause for celebration, nothing else.

Turning a Breech Baby (and Empowering an Expecting Mother)

This is one awesome post with information about choices and paths for mothers carrying breech babies. If you find out your baby is breech (like mine was), read this before doing anything else and know that you do have choices, beyond cesarean, which may suit you and your baby more:

KellyNaturally.com | Techniques for Turning a Breech Baby.

Thank you Kelly for writing this. This is both beautiful and practical.

How to become a hippy-mama in 20 easy steps!

Faces of the Anti-War Movement 12

Image by theqspeaks via Flickr

The ‘You know you are a hippy-mama (or papa) when…’ post has been updated and now has tons of links to websites with useful information about the various practices referenced from Elimination Communication to Baby Led Weaning, from the advantages of extended breastfeeding (for mother and baby) to the benefits of eating your placenta. So, if you didn’t know what the ‘eck I was going on about before, go here and find explanations for all the weird and wonderful hippy parenting practices of California – perfect for the beginner hippy-mommy!

You know you are a hippy-mama (or papa) when…

How many of these can you tick? Frankly, two or more and you are a hippy-mamma! I know, I know, you don’t think of  yourself as a hippy… the question is ‘do other people?’

For the record, I am not the hippiest hippy in the valley, I tick 14 out of 20 of those. Now, fess up and leave a message if any of these sound like you :p  Feel free to add your own on, too!

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Edit [Jan/6/2013]: Yes, I went for sillyness here rather than full acuracy. My back never ached wearing my baby – who I continued to carry in an ergo until she was past 2, for example…