Prevent C-sections — learn about cervical scar tissue

This was an interesting post, and I thought I’d pass it along. If you’ve ever had a procedure done on your cervix (including, surgery to remove pre-cancerous cells, and, rarely, a D&C), you may have scarring, which can cause slow or no dilation, despite adequate contractions. One to save in the files…

“Blonde Jokes” and other self-fulfilling prophecies

The other day, my Page-a-Day calendar had the following bit of trivia:

Researchers at International University Bremen in Germany monitored 80 women with different hair colors as they took intelligence tests. Before the test, half the women were told “dumb blonde” jokes. (Like: “Why do blondes open containers of yogurt while they’re still in the supermarket? Because the lid says, ‘Open here.’”) Findings: The blondes who were told dumb blonde jokes took longer to complete their tests than the blondes who weren’t told jokes. Did the dumb blonde jokes make blondes dumber? No, the researchers say: The jokes made them more self-conscious.

If hearing subtly or not-so-subtly that you’re stupid can make you take longer to take a test, I wonder what effect being told that your body is broken can have on your labor?

Often, when women are in labor, they are subjected to various drugs and interventions that are not necessarily necessary nor beneficial. What effect can being put into a gown for sick people have? Or being made to lie down in bed, as if you’re too frail and helpless to do things yourself? Or being given an IV as a standard practice? Or being not allowed to go to the bathroom, instead being forced to use a bedpan? What subtle messages are sent by all the poking and prodding and monitoring that women undergo on a regular basis during labor? Certainly, some women are high-risk, so they or their babies may benefit; and intermittent auscultation of the fetal heartrate is good; but when low-risk women are being told that their bodies are defective until proven otherwise… how can that be beneficial? Does it hurt?

There are so many stories I’ve read of women who felt like, as soon as they went into the hospital, or as soon as the machines were hooked up to them, that it was the machines and the drugs that took over and did the work — they were just empty vessels, non-persons, that things were done to, rather than women working to give birth to a new life, as countless other women have done before. So sad.

On the other hand, what messages does a woman hear, when her birth team encourages her, tells her that she is doing it, that she’s strong and powerful, that things are going well, and everything will be fine!

Finally! A use for white rice

Ok, so I’m a fan of brown rice — it’s just about all I buy and cook any more, and I’ve even got my husband not complaining about it, which is always a plus! White rice has nothing on brown rice, nutritionally speaking. So… maybe it’s not exactly the food of the devil, but just as with its color, white rice pales in comparison to brown. I’m so used to the flavor of brown rice that when I happen to eat plain white rice (which is rare, because usually the only time I eat it is at a Mexican or Chinese restaurant, and it’s pretty well seasoned), it tastes kinda like styrofoam. Just sorta “blah.”

However, I do have an excellent use for white rice (which many of you may already know about) — hot packs! I recently saw a post by a doula, about how she always keeps a rice sock in her “doula bag” for when she goes to a labor. I’d heard about that before, actually, numerous times, but had never done it because, well, I’m not a doula, and I just never decided to put rice in a sock and sew it up for the heck of it. But, when I found out I was pregnant, my mind started turning over with all these things I wanted to do while pregnant and/or have in place before the baby came; and to read that post, I thought, “If I don’t do this now, I’ll forget about it, and then I won’t have a rice sock in labor, when I need it!”

So, since brown rice is more expensive than white rice (and brown rice is a health food, and white rice is, well, “not quite”), I bought a bag of white rice at the grocery store next time I went. [And got a deal, because there was a four-pound bag that had gotten a hole in it, and a few ounces of rice had spilled out, so I was able to buy it for $1 — yes, 25 cents per pound! Ok, so maybe that doesn’t rock your world, but I’m also a frugal nut, so that’s a thrill for me. ;-)]

Anyway, I had some old socks of my husband’s — the big, long tube socks that go nearly up to his knees — and I put about half the bag (two pounds) of rice in one sock, and sewed up the top. It’s easier if you use a funnel to pour the rice into the sock; and I hand-stitched the socks closed, using a whip-stitch, but it would be even faster and easier if you have a sewing machine and can just zip-zip make a seam or two to sew them shut. I made two of them, and enjoyed them so much, that I got some more rice and some more old socks and made more rice socks — in different sizes, as well, sometimes cutting down the socks, so they wouldn’t be so big. I think you can also put in some essential oils or fragrances, so that they smell like lavender or whatever when you heat them up, but I didn’t have anything like that, so didn’t use any.

To “use” them, just heat them up in the microwave. There may be some “trial and error” as to how long you can cook your socks. I made a couple of small ones from my 5-year-old’s old socks, and put them in the microwave for 5 minutes, and forgot about them. Then I wondered what smelled like burnt popcorn… The smell dissipated, and I think it’s okay to use; but if you’re going to use them in labor, you probably don’t want to be smelling burnt rice while relaxing. Also, if they get too hot, you’ll need to make sure you don’t burn yourself — they probably won’t be scalding hot just from picking them up, but if you keep them on you (particularly right on your skin), then they can become much too hot (so, just as with a heating pad, don’t use them on someone who can’t tell you if it’s too hot).

The first night I made the rice socks it got really cold, so I heated up my two long rice socks, and put them in bed, to warm up where my feet go — like the old-fashioned hot water bottle. Ahhhh… lovely! Because they were so long, I could have them reaching from my feet up to my torso, providing warmth all along the way. However, because they were so long, they were sometimes unwieldy, which is the main reason why I made smaller ones. My kids think they’re neat, and also enjoy having them heating up their feet at night.

When I began to miscarry, I frequently felt a desire to have heat on my abdomen, but it wasn’t always feasible to have a heating pad on me (while cooking, or otherwise being on my feet and active). These rice socks came in handy, though. I was able to tuck a bit of the sock into my waistband, and just have the rest of it hanging down, right where it felt best. And it was completely portable, with no cords to get tangled up.

Another use, particularly for the smaller socks, was for hand-warmers when it’s cold outside. I had heated up several of them for just that purpose, when we went out searching for a Christmas tree to cut down (there are some advantages to rural living!); but forgot them at home. But as cold as it is this year (it snowed the last day of summer in Colorado!!), I think most people in the US will also be able to put this idea to use.

I’ve also put them on my car seats, so that it’s not quite so cold when I sit down — especially good for leather! (At least, it’s good for not having that shocking cold right on your legs and tush; I don’t know if it harms the leather itself… but then, my car is a ’97, so it’s not exactly like I’m ruining a $30,000 car if it does.)

And, it’s like having an extra heating pad, at least for a while, without the expense of buying one. While watching a movie, I had the real heating pad on my stomach because it felt good, and had the hot rice socks at my feet and draped on my legs, because they were cold.

How long the heat lasts depends on a few different factors — obviously, how hot the sock is to start with has something to do with it. The heat can last for hours under the right circumstances — one morning when I woke up, the rice sock was still giving off heat because it had been under the covers and also next to my body; but another morning, even though it was still under the covers, it was cool because it was shoved to the foot of the bed.

Finally, you probably won’t want to stuff the sock full with rice — having it big and bulgy can be awkward to use in some situations, such as making it nearly impossible to drape over a woman’s back, though it might be preferable for a small hand-warmer. If you’re going to make one, you might as well make two — one to use and one to heat up.

So you want to be a midwife?

Finishing out National Midwifery Week, I thought it fitting to link to Navelgazing Midwife’s post “Apprentice Midwife Material?” It’s an eye-opening look at the unglamorous side of midwifery (particularly home-birth midwifery).

“I want to hold babies” is a common refrain from the women who sit across from me. I smile and say, “Listen, we only hold babies from here (the vagina/vulva) to here (the abdomen).” Taken aback, I’m assuming they just hadn’t thought of that since their faces goes blank. I then begin listing the things a midwife does hold: sweaty hair, the barf bowl as the woman throws up in it, the laboring woman as she dangles and the mother’s hand as she squeezes it white and bloodless. We hold placentas as we demonstrate their amazing beauty. We hold scrub brushes as we wash blood off our instruments. We hold needle holders as we suture vulvas. It’s important to me to make sure the woman knows the unglamorous parts of the “calling”/”job”, just as much as she knows about the good parts.

No boys allowed?

A few different things have come together for this post, but let me say that in referring to “boys” I’m not talking about fathers at birth.

  • Would you hire a male doula to attend you in labor?
  • If a male doula and a female doula were equally qualified and you liked them both equally well in a prenatal interview, which one would you pick?
  • Would you choose a male OB or a female OB — or does sex matter for a doctor?
  • Would you choose a male midwife or a female midwife? — or does sex matter for a midwife?
  • Would you ask your female birth attendants if they have given birth themselves? (doula, midwife, L&D nurse)
  • Would you ask your female OB if she’s given birth, or your male OB if he has any children, and if so, if he attended their births?
  • Would you choose a female OB who has given birth over one who has not?
  • Would you choose a male midwife over a female OB?
  • Would you want a male nurse to attend you in labor?

Rebirth Nurse explored this question a bit in this post, “Revisiting My Barren Uterus.” She just recently became a CNM and was an L&D nurse before this, and has been asked if she has any children. She asked several female OBs if they’ve been asked that question and the universal answer is “no.” Obviously no male has ever given birth. Is it sexist to ask these questions? Is there a subtle thought that midwives (and doulas and L&D nurses) “ought” to have given birth, so they know how it really is? Does this not apply to OBs, either male or female? She garnered quite a few responses, which I think worth reading.

When a male British midwife suggested that epidurals were overused and that labor has benefits for the mom, he was roundly criticized by many a woman, simply because he’s a man so has never been in labor nor given birth. That’s a sexist, knee-jerk reaction. Most birth junkies I know would say exactly the same thing. But they’re women. And have given birth. Without drugs. So they’ve “earned” the right to say that. But here’s the deal — it’s still true, regardless of who says it. Or else it’s false, regardless of who says it.

My “obstetric history” as relates to this question — I’ve had two midwives, each with a birth assistant/doula, and all were female; their backup doctors were both male. Personally, I’d have a hard time hiring a male doula or a male midwife, but I would not necessarily choose a female OB over a male OB. I did not ask any of my female attendants whether or not they had children, although I know all of them did. Honestly, I can’t remember when I found out for sure that they did — in the course of a 30 or 60-minute long prenatal visit, you can talk about a lot of things. I don’t think that any of the midwives (my first pregnancy had two midwives alternating prenatal care and whoever was “on call” when I went into labor would attend my birth, so I’ve technically had three midwives) said at the first visit how many children they had. In fact, I remember wondering about one or both of my CNMs, since neither seemed to be married, and they didn’t mention children — and then finally one or both said something about their children (who were all adults, I think), because I  remember thinking, “AHA! She has had a baby!” So, I wondered, but I didn’t ask. It seems like later I found out she actually had four children, but I could be misremembering. My second pregnancy, the midwife and her doula/assistant/apprentice had pictures of their children up and talked more freely about them (but they were younger, so she sometimes talked about arranging childcare and such).

Is it sexist to want a woman to attend you in birth, rather than a man? Perhaps. But I don’t care. 🙂 There may be very good male midwives and male doulas; but I think I would choose a female, if all other things were equal. And perhaps even if the male were more qualified. I suppose I would have to meet him and see if he could change my mind. Same for a male nurse. There’s just kind of a “woah!” factor in my mind. So I guess I’m sexist. That doesn’t bother me — I’m pretty traditionalist in a lot of ways, so this is just one more thing.

But I don’t have the same feelings about a male OB. Perhaps it’s simply that I’m very accustomed to the idea of doctors being male and obstetricians being male, although there are quite a few female OBs. But I think there is a bigger difference, and that is, that I expect a different kind of care from midwives, doulas and/or nurses. I expect doctors to have clinical knowledge, to “manage” my care prenatally, to be in touch over the phone (but rarely in the building) while I’m in labor (speaking hypothetically, since I’ve not had a doctor-attended hospital birth), and show up while I’m pushing in order to catch the baby. He — or she — will not be there with me when I go into labor, as I go through labor, when I’m in the middle of most of the contractions, while I’m in transition, when I need counterpressure on my back, when I need someone to hold an emesis basin, when I need someone to get me a blanket (or to keep the blanket from touching me at all — love those feverish feelings!), etc. But I expect those things of midwives, doulas, and nurses. Plus, I expect them to be knowledgeable enough to know what to do, and what to say, as I’m going through labor. If a male birth attendant can do these things — fine. But they seem to be things that are more inherently female, or at least, easier for women to intuit and follow through on. I wouldn’t expect them of a doctor of either sex, because that doesn’t seem to be part of their job description — although it probably ought to be. But there is something so “with-woman” about the concept of midwives (and by extension other female attendants), which is why millenia of women have given birth surrounded by other women. And not by men.

But I will say, that I would rather have a supportive male nurse than an unsupportive female nurse. No question about that. I would expect all midwives and doulas to be supportive; but I’ve heard more negative stories about unsupportive nurses than negative stories about midwives or doulas. [Present company, of course, excluded!]

On to the question of having given birth. I think it’s an added bonus — or at least, it can be an added bonus — for birth attendants to have given birth. But I don’t think it’s any more necessary for them to be qualified to attend a birth, than it is necessary for them to have been a cancer patient in order for them to be a hospice nurse. There is an added dimension of knowledge gained from having experienced it. But there are many very excellent and qualified midwives (and nurses and doulas) who have never been pregnant. As others in the discussion I’ve previously linked to said, if we go on this negating mission very far, we will elimate everyone who has had C-sections, or who has had an epidural, or who has in some way not had “our” birth. Yet, what is it that everyone says, but that “every woman is different, and every labor is different”? I could probably give birth a thousand times, and still meet women who had a different experience. And as another commenter pointed out, if a birth attendant has not given birth, then she will have less baggage to bring into your birth — i.e., trying to make your birth be like hers, whether that’s what you want or not, whether that’s the determined course of your labor or not.

So, I’m a modified sexist, I suppose. What about you? Where do you fit in?

Why I chose midwifery

Rebirth Nurse is going to be doing a “blog carnival”:

When I first started blogging, I really enjoyed reading blog carnivals covering different nursing topics. But with school, and now a “real” job, I’ve gotten away from really reading or contributing to them.

So, I was thinking that I would start up one!

My unofficial blog carnivals will be posted here, twice monthly. The carnival will be called The Rebirth Carnival (how original, I know, I know…). I will announce the carnival topic about two weeks in advance. Submissions can include old posts, or something written specifically for the carnival.

The first carnival will be up on August 9. I’m looking for posts about why you chose midwifery, either for your care or for your career.

Please pass the word!

Submit your post link to my email: knitting-fool AT hotmail DOT com.

This sounds cool. Now, why did I choose midwifery?

It was a long road. As a teenager, I had no particular desire to have a natural birth — in fact, I remember saying at one point that I’d have an epidural, or it was stupid not to have an epidural, or why go through that pain if you didn’t have to? — that sort of thing. Undoubtedly, I was heavily influenced by the current culture (it hasn’t really changed much “out there” in the normal world, which is why I like my little blogging world so much), including a friend who had just become a nurse and gone into L&D, and sang the praises loud and long for epidurals, professing confusion as to why women would not get one if they could.

Then a few years later, I regularly babysat for a woman, and when she became pregnant for the third time, dragged out all her pregnancy, labor, and birth books. Voracious reader that I am, I read through them. Plus, I wanted to make sure that I knew what to do if she had a precipitous labor, and I ended up being her only birth attendant! She wasn’t particularly pro-natural birth (I know she had epidurals with at least three of her births; although the third labor went so fast that the epidural didn’t have a chance to take effect before birth, and the fourth labor was similarly quick, so I’m not sure if she managed to get the ol’ needle-in-the-spine that time either), but she liked Dr. Sears for his baby advice, and had his Birth Book among other books.

It would be several years before I first got pregnant, and I wasn’t particularly interested in birth, but would sometimes make note of birth stories, interventions, complications, etc., and by the time I got pregnant, I had made the switch into planning not just a natural birth but a home birth. Honestly, I can’t remember what clinched it for me — why I changed. Probably, my oldest sister’s first birth had something to do with it, although I was already leaning towards “natural” at that time. Many women in my church and among other friends had home births, which made it seem more normal to me. I knew two midwives, both of whom were CNMs, both of whom attended home births. So, perhaps I was heavily influenced by a pro-home/natural-birth subculture.

When I got pregnant, I already knew I would be having a home birth. There were several factors in it, as listed above, but another factor was the financial one — I didn’t have health insurance, and home birth is a lot cheaper than a hospital birth. That by itself is not a good enough reason to have a home birth; but it is one consideration. Novice that I was, I didn’t realize all the politics surrounding birth — primarily that many states had outlawed midwives except CNMs, and in states that had CNMs, they may be heavily regulated. So, modern, internet-savvy gal that I am, I turned to the web to find a local midwife. I’m not sure what I would have done had I not been able to find one. Living in the suburbs of Chicago at the time, there were several midwives who served the Chicagoland, so I actually had a pick of midwives. However, I didn’t know enough to even know what to ask in an interview, or how to find out if the midwife was a good “fit” for me or not (not all personalities jive, after all). But I liked what she said and how she acted, so I went with the one and only midwife I interviewed. That’s not a course of action I would wholesale recommend, although it worked out for me. It might not work out for everyone.

Why did I choose a midwife? Partly because I assumed that only midwives attended home births. Actually, there is a doctor practice that attends home births in Chicago (Dr. Mayer Eisenstein of HomeFirst), but I didn’t know that at the time. Would I have gone with him had I known? Probably not. Even then, there was just something about a female birth attendant that appealed to me. Not saying that men can’t be a good birth attendant… just that I wanted a woman to attend me in labor. So I’m sexist that way. 🙂 It was more the “doula” aspects of midwifery care that appealed to me than simply giving birth at home, or having a female OB. To me, in general, there’s not a dime’s worth of difference between a male OB and a female OB — I’ve heard so many good and bad birth stories with doctors of both sexes, that I wouldn’t make the doctor’s gender to be a deciding thing. I expect a doctor to be a doctor — reserved, clinical, doing his job, most likely coming in only to catch, and otherwise managing birth over the phone. I expect a midwife to be a midwife — touching, comforting, helping, guiding, aiding, being there — “with woman,” as the original term meant. It’s the difference between choosing a mechanic and a husband — totally different expectations and criteria — not really in the same ballpark. Perhaps that seems nonsensical to you, but that’s a fitting analogy in my mind. (Now, if you can find a husband who is also a mechanic, that might make him a doubly-good choice; likewise, if you can find a doctor with a midwife’s qualities. But from what I’ve seen and heard, those doctors are few and far between.)

Why did I choose a midwife? Because as far as I’m concerned, that’s the only choice to make!

Great post on doulas

Here at Birth at Home in Arizona. Many times women may say, “What do I need a doula for? — my husband will be there.” Sometimes husbands say, “I don’t want a doula there — I want to be there for my wife, not have a doula elbow me out of the way.” This post explores the topic in more detail, so go read it.

While it is possible for men to be such good labor support as to make a doula redundant, or for doulas to make men feel redundant, this is somewhat rare. What is much more typical is for doulas to help the dad help the mom, for example, by suggesting various comfort measures that are just not blatantly obvious to most men. [And if most men are like my husband, it would have to be blatantly obvious! :-)] So, dads and doulas are usually partners in labor support, complementing each other’s skills and abilities (as well as letting each other have periods of rest if need be), combining forces to make a great team to help the laboring woman.