Tuesday, July 3, 2012

Trimester 1 - Home or Hospital?

If you have your baby at home with a midwife, instead of in the hospital with an OB:
  • you are twice as likely to survive giving birth
  • your baby is three times more likely to survive his birth
  • your baby is six times more likely to survive his first year
Therefore, the rational woman, seeking to maximize her and her baby's chances of survival, will choose to give birth at home. 

Hospital births cost around $10,000 ($20,000 if you have a c-section). Home births cost around $3000. Yet only .65% of American women choose to give birth at home. Despite their high price tag, most insurance companies only cover hospital births. Home birth is illegal in 23 states. Someone doesn't want you having your baby at home. 

In addition to the above, anyone who watches television has been programmed to think hospitals are the only place one should have her baby and only freaks and hippies have their babies elsewhere.

So maybe it's not so much that people who have their babies at home don't need the establishment. It's not so much that they think for themselves that is the problem, no, it's Machiavelli 101--it's the babies. The establishment wants to parent our babies; they want to establish whose babies they are. A hospital birth serves to recruit your baby into the medical industry. Toss in an intensive regime of pediatric visits throughout the first year and your baby has been indoctrinated from birth into a lifelong dependence on medical intervention. Seeing the doctor is normal. Trusting your body is not. Doing what you are told is normal. Thinking for yourself is not.

A personal note on how my research changed my pregnancy (and my life):

The above was not what I was expecting to find out when I began my research. If you had talked to me when I was twelve weeks along, I would have said that I was "going with a midwife for now" and that I was still looking into where I wanted to have my baby--as in, I wanted to tour at least three different hospitals in the Los Angeles area and pick my favorite. I was absolutely against giving birth at home.

Then I did my always-over-the-top research and told my husband that we should probably have the baby at home. "Only .65% of Americans have their babies at home," I said. "We're rational," he said, "If less than one percent of Americans agree with us, that sounds about right."

So how did it all work out? I went into labor at 2am on a Thursday. My baby was born 3 hours later. Unmedicated birth was fine. Doing it at home was WONDERFUL! After the baby was born I took a shower and got into bed with my newborn and my husband. The midwives cleaned everything up.

I didn't have to travel anywhere while I was in labor. I got to wear what I wanted (or didn't want). I didn't have to have an IV in my arm. I wasn't attached to any monitors. I moved when I wanted to where I wanted. I ate and drank what and when I wanted. I had one vaginal exam by someone I knew well. I had as much privacy as I wanted. I got to push in the position I wanted. There was no pressure, no timeline.

If you read the books I recommended in my previous posts, you already know that the key to having a quick, easy labor is feeling safe. My lower, primal brain felt very safe in the comfort of my own home. It's not just the drugs at the hospital that prolong labor--it's the strangers, the noises, the lights, the fact that no matter how much your higher brain insists this is a safe place, your lower brain instinctually knows it's not.

If you only read two of the books I have recommended, read Baby Catcher and How to Raise a Healthy Child in Spite of Your Doctor.

*Update on this post: A huge backlash has come out against homebirths since I wrote this post. Fascinating that before homebirths started gaining popularity, the mortality rates I could find showed homebirths to be safer. Those same reports that I read have disappeared. Now all I can find is (A LOT OF) zealous reports about how dangerous homebirth is. I imagine if homeschooling gets too popular the same thing will happen there too. We've got to get the population incensed so we can regulate birth and force those crazy homebirth women to have their babies how we say! Go government propaganda machine go!

Monday, July 2, 2012

Midwife vs Medical Establishment

As a rational person you have done your research and you know you want to give birth without drugs. You also know that women can give birth naturally with a doctor, it's just much less likely they will be successful at it. 30-50% of women who want to give birth naturally will fail if they choose a doctor for delivery compared to 5% of women who will fail with a midwife. If you are a rational woman, it's a very simple decision: the goal is to succeed at having an unmedicated birth and using a midwife maximizes your chances of success.

Due to the philosophical differences between how midwives and the medical establishment view pregnancy and labor, the choice to use a midwife will hugely impact, not just your birthing day, but your entire 40-week experience of being pregnant.

To summarize the philosophical differences:

  • Midwives encourage women to stay in tune with their bodies and think for themselves throughout the entire pregnancy. Doctors encourage women to do as they are told.
  • Midwives schedule 90 minutes for every prenatal appointment. Doctors schedule 15.
  • Midwives believe birth is a normal physiological process. Doctors believe birth is unpredictable, unreliable and often unsafe.
  • Midwives seeks to let the woman be in charge of her birth. Doctors seek to control the woman's birth.
  • Midwives believe giving birth without medication is an emotionally empowering and transformative experience leading the woman to feel that she can conquer the world. Midwives believe medical intervention is undesirable. Doctors believe medical interventions improve labor
A personal note on how these philosophical differences played out in my pregnancy:

When I found out I was pregnant, my OBGYN recommended I go on progesterone to ensure that I didn't miscarry. There was no medical reason for her to make that recommendation. She recommend it purely based on my age--29. I told her that I was a very healthy person who hadn't even had a cold since 2004 and she told me that was irrelevant. I was 29 and I should not trust my body to make enough progesterone to keep the baby.

Of course my emotional brain acquiesced to her controlling mentality but my rational brain knew better: if the tiny bunch of cells in my uterus wasn't genetically healthy and my body wanted to get rid of it--why would I want to prevent that?

After a quick Google search I learned that taking progesterone came (of course) with side effects: bloating, breast tenderness, diarrhea, dizziness, drowsiness, dry mouth, fluid retention, headache, heartburn, irritability, muscle pain, nausea, stomach pain, stomach cramping, tiredness, vomiting, bleeding or spotting, amenorrhea, edema, weigh changes, cervical erosion, cervical secretions, cholestatic jaundice, skin reactions including a rash or acne, mental depression, pyrexia, insomnia and somnolence.

I said "no" to the progesterone. My doctor, with the air of an all-knowing mystic, said she didn't approve but that I could take that risk if I wanted to.

Then she told me that I was not allowed to eat alcohol, caffeine, sushi, raw dairy or take hot baths. I had heard those things before so I asked what was on my mind:
"Don't pregnant Japanese women eat sushi?"
"Pastuerized dairy has only been popular for 80 years--doesn't that mean pregnant women have been consuming raw dairy for thousands of years?"
"How does a hot bath hurt my baby and not my internal organs? What about women who live in hot climates--are they hurting their babies every time they go outside?"

My doctor practically growled at me and repeated her recommendations with a dramatic flurry that included the phrase "hot baths will cook your baby". Then my fifteen minutes were up and the appointment was over.

It was time to check out the other route, the route only 5% of women choose. I went to a presentation called "meet the midwives" at The Birth Sanctuary, a birthing center in Los Angeles. The presentation was held in their "birthing suite", a large, elegantly-decorated apartment with a bathroom and full kitchen.

The midwives were sweet, emotional types and neither their personalities nor the way they tried to sell a midwife birth did anything for me. I hadn't chosen a natural birth for emotional reasons (though that video of the drugged newborn trying to nurse and failing does haunt me a little).

The business manager sold the idea of a midwife birth to me a little better. She was from New York; she thought fast, spoke fast and didn't sugar coat anything. She talked numbers; she said things like, "Only 5% of midwife assisted births require medical intervention, unlike 30-50% of OBGYN/hospital births." Unfortunately, she didn't deliver babies.

But whether or not the birthing center was a little too touchy-feely for my taste, I loved their philosophy on prenatal care: first prenatal appointments should be somewhere around twelve weeks--unless you are feeling anxious, then you could come in earlier. It was a different world from my OBGYN who had demanded to see me immediately, like it was an emergency, when I was only six weeks along. The midwives trusted me and my body to be pregnant for the entire first trimester without their input. Oh to be treated like I have a brain!

At my first prenatal at the birthing center (at twelve weeks), I asked the same questions I had asked my OBGYN. On raw dairy and sushi, I was told to use my common sense and not eat things that smelled or looked funky. Getting really bad food poisoning while pregnant could cause a miscarriage--but more food poisoning is caused from lettuce these days than raw dairy. If the milk and sushi I had been eating for the last thirty years hadn't given me food poisoning yet, there was no reason to assume it would give me food poisoning now. On hot baths, I was told to use my common sense and that if I felt dizzy or woozy, I should get out of the tub. If it felt good, however, it was probably helping me relax which would benefit me and my baby.

And what about an occasional glass of wine? The facts on the no-drinking rule are: a full-on alcoholic will only have a 4% chance of giving her baby fetal-alcohol syndrome if she eats healthily. An alcoholic who doesn't eat healthily will have an 80% chance of harming her fetus. It's not the alcohol that harms the baby but the nutritional deficiencies related to drinking too much that harm the baby. A healthy eater who has a glass or two of wine every day is unlikely to harm her baby. Women used to be encouraged (by doctors) to drink throughout pregnancy for relaxation and then get raging drunk for labor.

So why does the medical establishment give pregnant women so many rules? Because just like in elementary school, rules are made for the lowest common denominator. There are women who will eat some pretty funky stuff, stay in hot tubs until they pass out and not know that a handle of vodka every day is drinking too much. It's easier (and faster) to just give women a blanket list of "don'ts" than to explain to them what's going on and then trust them to use their common sense and self-control.

The one downside (or so I thought) to having a midwife instead of an OBGYN is that midwives don't usually offer ultrasounds. This made me sad as I longed to see my little fetus! Then I read Birth: The Surprising History of How We Are Born. Here is the paragraph that made me glad my midwives weren't into ultrasounds: "Frenchman Paul Langevin discovered that high intensity ultrasound could destroy schools of fish in the ocean, and when a person put a hand in a tank of water that had ultrasound waves running through it, they experienced pain, a discovery that led doctors to use the technology to destroy tissue, such as a brain tumor." That's high-intensity ultrasounds. On modern prenatal ultrasounds Susan McCutcheon says, "We do know that in the short term cells behave abnormally after just one diagnostic ultrasound exposure. The shape of cells so radiated changes temporarily and their movement becomes frenetic."

An ultrasound would make my little blueberry a frenetic glob of cells? I was happy to skip them. (I did get one, at 20-weeks, to find out the gender of my baby though, figuring since my little one was no longer a glob of cells it would be safer.)

I have to say that this was not a hard philosophical decision for me--did I think pregnancy was a natural process and I could trust my body and evolution to do it right or did I think pregnancy was a disaster waiting to happen? Did I want someone who would take my questions about baths and food seriously or someone who would bark rules at me? Did I want to maximize my chances of succeeding at natural birth?

I chose the midwife route.

Sunday, July 1, 2012

Numbing Out vs Natural Birth

What you will hear from the pop culture herd: giving birth is a personal experience and the best path for you--natural or drugs--only you can determine.

If you don't subscribe to the cult of moral grayness that denies objective reality, there is only one choice and the thinking about it goes like this:
-Is it rational to not want to experience the pain of childbirth? Yes.
-Is it rational to sign up for an epidural unconsciously, without looking into the costs? No, unconsciousness is unacceptable.

Therefore, inform yourself by reading the following:

When you sign up for an epidural, you also sign up for an IV and a bag of fluids, a urinary catheter, a blood pressure cuff to tighten on your arm every 15 minutes or less and continuous fetal monitoring.

The forced fluids in the IV may cause your perineum to become engorged and not able to stretch so you will be at a higher risk for needing an episiotomy. The urinary catheters will put you at a higher risk of getting a UTI. The epidural itself will likely cause hypotention, a sudden drop in your blood pressure--hence the blood pressure cuff monitoring you. Your baby will also have to be monitored as a drop in your blood pressure decreases the amount of blood (and therefore oxygen) going to him/her which can lead to fetal distress.

Epidurals eliminate the normal hormone process of labor which will make your labor take three times longer than a natural birth. The epidural will slow down or stall your contractions. That is why most women who get an epidural will also require Pitocin. Common side effects of Pitocin include: nausea, vomiting, and much more painful contractions. Less common side effects include: rash, hives, itching, difficulty breathing, tightness in the chest, swelling of the mouth, face, lips, or tongue, blood clotting problems, changes in heart rate, cardiac arrhythmia, pooling of blood in the pelvis, postpartum hemorrhage and a ruptured uterus. Side effects for your baby include: bleeding in the eye, irregular or slow heartbeat, seizures, jaundice and low Apgar scores. Less common side effects for your baby include: brain damage, neonatal retinal hemorrhage and death.

Epidurals make pushing more difficult and increase the likelihood of forceps or vacuum delivery by 20-75%. Common side effects for the mother of a forceps delivery include: cuts and heavy bleeding. Common side effects for the baby include: heavy bruising. Less common side effects for the mother include: permanent loss of urinary and bowel control. Less common side effects for the baby include: broken bones, brain damage and death. Vacuum assisted deliveries are less risky for the mother but have common side effects for the baby that include: abrasions on the scalp, cephalohematoma (a collection of blood under the fibrous covering of the skull bone), jaundice and eye hemorrhage. Less common side-effects for the baby include: retinal hemorrhage, subgaleal hematoma(a collection of blood just under the scalp, injuring the underlying veins), intracranial hemorrhage and brain damage.

Epidurals increase the risk of a C-section by 25-50%. Some common C-section risks for the mother include: infection, heavy blood loss, blood clots in the legs or lungs, nausea, vomiting, severe headache, bowel problems, a recovery that takes three times longer than a vaginal birth and complications in later pregnancies (uterine rupture and placenta problems that cause severe bleeding after birth which may require a hysterectomy). C-section risks for the baby include: injury during the delivery, need for special care in the neonatal intensive care unit and immature lungs and breathing problems if the due date has been miscalculated.

If you just get the epidural (and manage to give birth without Pitocin, forceps, a vacuum assisted delivery a or a C-section) common side effects include: feeling like you are not able to breathe, uncontrollable shivering, ringing in your ears, itching around your face, neck and throat, nausea and vomiting. Epidurals also double your risk of hemorrhage.

Less common side effects of epidurals include: allergic shock, convulsions, respiratory paralysis, loss of bladder control for months, severe headache caused by leakage of spinal fluid that lasts for weeks and requires bed rest and a blood patch, epidural fever (which will result in your baby being sent to the neonatal intensive care unit), permanent nerve damage, brain damage, cardiac arrest and death.

Common side effects for your baby when you get an epidural include: respiratory depression, fetal malpositioning and an increased risk of jaundice. Your baby will be born drowsy and will exhibit the same drug toxicity symptoms as a baby born to a woman taking cocaine and opium.

The epidural-experience doesn't end with birth. For hours afterward the lower half of your body will be numb. You won't be able to walk and you might not be allowed to hold your baby. Later you might get tingling, shaky and numb sensations in your legs, a severe backache, soreness where the needle was inserted and urinary or fecal incontinence. You will heal more slowly than a woman who had an unmedicated birth.

Because the epidural prevented your body from releasing labor hormones, you may have trouble bonding with your newborn. You will have an increased risk of breast milk production problems and you will be at a greater risk for postpartum depression.

Because the epidural prevented your body from releasing labor hormones, your baby may have trouble latching on (which can lead to breastfeeding difficulties). Your baby may also have trouble bonding with you.

For up to six weeks after birth, a baby that was drugged (because you aren't just drugging yourself) will exhibit neurbobehavioral effects such as irritability, inconsolability and decreased ability to track an object visually or to shut out noises and light i.e. epidurals will make you are much more likely to have a crabby, difficult newborn.

To conclude, getting an epidural carries many serious health risks to you and your baby. It prevents you from experiencing a couple hours of intense pain in exchange for extra weeks of recovery (i.e. pain...) and over a month of caring for a miserable infant.

95% of unmedicated births have no scary side-effects. Less women tear. Tears are less bad. Babies are born wide awake. The wide awake babies nurse right away. Moms get hormone rushes that make them fall in love with their babies and prevent postpartum depression and hemorrhage. The babies get the hormone rushes and fall in love with their moms. Moms get hormones that make their milk come in. Moms heal faster... the list goes on. The 5% of natural births that have complications end up as vacuum/forceps/C-section births with all the risks listed above.

The medical establishment makes a lot of noise about breech babies but breech babies can be born naturally and easily--this is not a complication. Neither is the cord around the baby's neck--the baby is getting his air through that cord and does not need to breathe through his mouth until that cord is cut. Big babies are not a complication either.

For your entire life you have watched women pretend to give birth on television--they scream and it's horrible and doctors have to save the baby and then the mother. This is nothing like reality. The reality is: your baby is three to four times more likely to die if you give birth with a doctor at a hospital than with a midwife at home. Birth isn't a medical emergency. It's a natural process. Your body was made to do this. Your body evolved to be successful at this--that is why your genes were passed on.

Moreover, it is not rational to compromise the health and well-being of your body or your baby to avoid some perfectly natural pain. The average unmedicated birth is around five hours. What is five hours over the course of a lifetime?

A personal note: when I started researching this I was desperately hoping to find evidence that would free me from facing an unmedicated birth. I thought, "I'm so healthy! A little drugs every now and then aren't so bad, right?" Instead, I found no way to escape the reality that the best thing for the health and well-being of my body, my baby and our relationship was to take the pain.

When I decided that I was going to give birth with no medication, I cried. I was so afraid of how much it would hurt. Then someone said to me: "Why be so afraid of something you have never experienced? You know the fear of pain is always worse than the pain."

They were right. I had a natural birth, no drugs whatsoever. It took three hours. There were no tears or other complications. It hurt, but it was a fascinating life experience that I wouldn't give up.

The side effects of my natural birth have been:
-A certain fearlessness that comes with knowing pain is just pain. It isn't that scary after all.
-Intense admiration in my husband's eyes when we tell people about the birth of our son.
-A baby that was born wide awake and healthy with a perfect Apgar score, a baby that settled into life easily and comfortably, a baby that was never poked, prodded, stuck with needles or taken away from me and his dad, a baby that never got jaundice, baby acne or cradle cap, a baby that doesn't spit up. My baby is now five months old and has yet to catch a cold. He is that healthy, happy, glowing, beautiful example of life-thriving that every mother dreams of having. Everywhere I go people comment on how healthy, conscious and beautiful he is when they see him. My reward for all the hard work I put into the choices I make is that everyone tells me how "lucky" I am. Only the very few know it's not luck.

To be more informed about what kind of birth you think is rational:

The Business of Being Born: why the medical establishment wants you to have a medicated birth.

Birth: The Surprising History of How We Are Born: how the medical establishment took over birth. On a side note, the author totally neglects doing thorough research into current birth practices (like epidurals) but the rest of the book is awesome.

Baby Catcher: Chronicles of a Modern Midwife: an enjoyable and enlightening read. This book taught me how to think about birth and was instrumental for me when I went into labor i.e. it's possible my labor was only three hours long because of what I learned from this book.

How to Raise a Healthy Child in Spite of Your Doctor: This book won't just help you keep your kids healthy, it will teach you how to keep yourself healthy.

http://www.homebirth.net.au/2008/06/homebirth-vs-hospital-statistics-to-die.html: See for yourself some mother and baby survival statistics when midwife births are compared to hospital births.

Sources I used in this post series (Trimester 1):
Weighing the Pros and Cons of the Epidural by Penny Simkin