Link Round-up

Ok, for lack of spare time, in conjunction with internet connection issues [long story, but my husband’s LAN port shorted out or something so we can’t both be on the computer at the same time], I have a whole bunch of interesting posts I’d like to share, and no time to discuss them. But I’m not going to be getting any more time in the future — I’m pretty sure we’re stuck at 24 hours per day for a while, anyway! — so, I’m just going to post the links with a little commentary, so I can clear out both my mental space and my computer browser.

Mom has a successful birth after eighteen miscarriages.

Ms Baker had high levels of a subtype of white blood cell, known as Natural Killer (NK) cells.The cells would normally protect the body against foreign viruses, but in Ms Baker’s case they mistook the foetus for a foreign body and attacked it.

Dr Shehata’s treatment is pioneering because it starts before conception and uses higher than normal doses of steroids.

Natural vs. artificial oxytocin [Pitocin, Syntocinon] in birth.

Oxytocin administered as an i.v. bolus of 10 IU induces chest pain, transient profound tachycardia, hypotension, and concomitant signs of myocardial ischaemia according to marked ECG and STC-VM changes. The effects are related to oxytocin administration and not to pregnancy, surgical procedure, delivery, or sympathetic block from spinal anaesthesia.

Think your doctor knows about breastfeeding because s/he graduated from med school? Think again!

One of the speakers, ABM member Dr. Nancy Wight, spoke on breastfeeding. Almost every word was news to me. Medical school, residency, chief residency and part of a neonatology fellowship and I did not know about any of the content she was presenting. One of the other speakers lectured on lice- that I knew something about. But breastfeeding? Nope. How did Dr. Wight know this stuff when I didn’t? Who taught her yet set me loose on an unsuspecting patient population armed only with my personal 7-week breastfeeding experience? [….]

You really need to read the whole article — I want to cut and paste the whole thing because every part of it is worth reading. But that would be plagiarism, so just go read it.

While on the subject of breastfeeding, a nurse writes about a conversation she overheard between a breastfeeding mother and a mother planning on formula-feeding, occurring a few hours after birth. Very good article!

And “The Language of Breastfeeding” — highlighting the importance of noting that breastfeeding is not “superior” but is “normal,” while formula feeding is “inferior.”

When we (and the artificial milk manufacturers) say that breastfeeding is the best possible way to feed babies because it provides their ideal food, perfectly balanced for optimal infant nutrition, the logical response is, “So what?” Our own experience tells us that optimal is not necessary. Normal is fine, and implied in this language is the absolute normalcy–and thus safety and adequacy–of artificial feeding. The truth is, breastfeeding is nothing more than normal. Artificial feeding, which is neither the same nor superior, is therefore deficient, incomplete, and inferior. Those are difficult words, but they have an appropriate place in our vocabulary.

I may at some point write a whole post on guilt and breastfeeding, but this isn’t it. However, formula is inferior to breastmilk, and everyone should know it. A recent study showed that over 900 babies’ lives could be saved every year here in the United States, not just in some third-world country with nasty water, if 90% of women breastfed. So, yeah, I think if you could have breastfed and chose not to, you ought to feel guilty about it, just as you should feel guilty for blowing smoke into your baby’s face or getting drunk while pregnant or having an elective induction at 35 weeks gestation just because you’re tired of being pregnant. HOWEVER, many mothers who end up using formula are not choosing to use it, they’re making an “un-choice.” Their choice would be to breastfeed, but because of one or another of the “Booby Traps” (TM), end up not being able to. My intent is not to make these mothers feel bad. There are many women who would love to breastfeed, but must work in order to feed, clothe, and house themselves and their babies. Formula is inferior to breastmilk, but starving your baby all day doesn’t work either! And there are many, many more women who wanted to breastfeed or tried to breastfeed, but for one reason or another — perhaps bad advice or hearing too many horror stories — ended up falling back on formula. I know at least two different women — both stay-at-home moms — whose mom or dad died when their baby was young, and the stress of the situation caused their already-shaky milk supply to dry up completely. It wasn’t their fault that their parents died; and such a situation is certainly stressful, either due to a sudden death or due to a lingering hospital stay. They did not choose to stop breastfeeding — that was just life circumstances forcing them into an “un-choice.” In these instances, formula was necessary, and though inferior to breastmilk, was superior to starvation. But this article is about changing one aspect of the culture to truly promote and enhance breastfeeding, by slightly changing the wording to give breastfeeding more force and highlighting not just the superior nature of breastmilk but the inferior nature of formula.

And if you think that this is causing unnecessary guilt because “everybody knows” that breastmilk is superior… you’re missing the point of the whole “mental shift” in breastfeeding language that this article is talking about, and you need to read the “overheard conversation” in the link above, in which the mother who had decided to feed her baby formula had been told that formula was “just as good” as breastmilk.

Nowhere is the comfortable illusion of bottlefed normalcy more carefully preserved than in discussions of cognitive development. When I ask groups of health professionals if they are familiar with the study on parental smoking and IQ (1), someone always tells me that the children of smoking mothers had “lower IQs.” When I ask about the study of premature infants fed either human milk or artificial milk (2), someone always knows that the breastmilk-fed babies were “smarter.” I have never seen either study presented any other way by the media–or even by the authors themselves. Even health professionals are shocked when I rephrase the results using breastfeeding as the norm: the artificially-fed children, like children of smokers, had lower IQs.

Inverting reality becomes even more misleading when we use percentages, because the numbers change depending on what we choose as our standard. If B is 3/4 of A, then A is 4/3 of B. Choose A as the standard, and B is 25% less. Choose B as the standard, and A is 33 1/3% more. Thus, if an item costing 100 units is put on sale for “25% less,”the price becomes 75. When the sale is over, and the item is marked back up, it must be marked up 33 1/3% to get the price up to 100. Those same figures appear in a recent study (3), which found a “25% decrease” in breast cancer rates among women who were breastfed as infants. Restated using breastfed health as the norm, there was a 33-1/3% increase in breast cancer rates among women who were artificially fed. Imagine the different impact those two statements would have on the public.

Yes, imagine the paradigm shift that would occur if people — particularly mothers — were told that infants fed formula had lower IQs and higher rates of breast cancer as women. I think there would be a stronger push from mothers to promote breastfeeding, if the conversation proceeded along those lines — making breastfed babies the standard against which formula-fed babies were measured, rather than the other way ’round.

What is said, vs. what is heard” — if you’ve ever been in one of “those conversations” when you react not only to what someone has actually said but what you thing s/he meant, you’ll enjoy this. Here’s a taste:

She said, “Are all those kids yours?”

I heard, “Is that impossibly large number of children yours? Have you ever heard of birth control?”

I said, “Yes. They are all mine.”

She heard, “They are all mine. I am a saint.”

Whose responsibility is it? — when a woman ends up with an unnecessary intervention during birth, is it her responsibility or is it the doctor’s? This says a lot of what I’ve said before and/or wanted to say on the topic, although I don’t necessarily agree with 100% of it. In short, there is a balance between women’s responsibility in choosing the right care-giver and between the doctor’s responsibility in not intervening unnecessarily. If a woman knowingly chooses a doctor who has a high C-section rate, she shouldn’t be too surprised if she ends up “needing” a C-section too; on the other hand, if the woman believes the doctor (or hospital) to have a low rate of unnecessary interventions and then ends up with an unnecessary episiotomy or C-section, then she should rightfully be upset if she finds out that she was lied to or misled. Women should be conscientious consumers of health care, and not just blindly follow their doctors; but doctors should be conscientious providers of health care, and should be able to be blindly followed. They both have responsibilities; but I would put the emphasis more heavily on the side of doctors, because they have an implicit office of trust, in that they are “the medical professionals who have gone through years and years of study of medicine,” so often their opinion has more weight (and rightly so) than the average person. Since they speak with more authority, they have the greater responsibility not to abuse that authority. And doctors who have a 70% C-section rate for low-risk moms would have a hard time convincing me that even most of them were the responsibility of the mother.

“Safety net” or trampoline?

What if there were no C-sections? What if that simply wasn’t an option? Do you think doctors would practice differently? I do.

No one discounts that C-sections can be beneficial, saving the lives of mothers and/or babies. However, our country is currently experiencing its highest C-section rate, with maternal mortality increasing right alongside the C-section rate (not saying necessarily that it’s causative; however, if these C-sections were life-saving to the mother, one would expect the maternal mortality rate to be decreasing or at least staying the same), and perinatal mortality not doing that much better either. [If you want some state-by-state breakdowns, Jill at the Unnecesarean has compiled several, with the most recent one being California.] Most people agree that the C-section rate is too high, and could safely be brought down. There are many factors going into the increase incidence — some of which may be valid and beneficial reasons, but others that are not.

Carla Hartley recently wrote a note in which she cleared up some misconceptions that have apparently been told about her and “what she believes.” Among other things, it appears that some have said that she thinks midwives ought not take Pitocin with them to home births (for postpartum hemorrhage). She said (paraphrasing), “But what if you as a midwife had no Pitocin in your bag? Would that change your practice style? Knowing that you didn’t have that as a backup, would you be less tempted to act in a way that might cause a postpartum hemorrhage?” That’s food for thought.

Taking this out of the birth realm, we see that when there is a safety net, it changes people’s behavior — how many of you would walk across a tightrope without a safety net below? Some do; but far fewer people would risk crossing if they knew that there was a real risk of death, as opposed to a slight risk of death and a real likelihood of safely bouncing on a net if they fell. There are always adventurous people, daredevils, pushing the envelope — doing things that are dangerous or downright deadly, just because they can. But most people only do something if they think or know that there is a reasonable chance for them to succeed and come back alive.

In another, much more mundane vein, we see banks and other companies loaning people money for various reasons, including education, buying a house, buying a car, etc. The more collateral you put up, the more they’ll lend you; the more you earn, the more they’ll give you; or if the government guarantees that they’ll pay the loan should you default or die, they’ll gladly loan you the money you ask. Why? There really isn’t that much risk involved, if the government is the guarantor; and the risk to the lender is dramatically lowered if you have something valuable that they can take if you can’t pay your bills. It’s a safety net for them.

Back to birth — I wonder how it would affect doctors’ practice style if they knew that there was no “safety net” of a quick, easy, safe Cesarean. I’m reminded of something one of my email doula friends said — she’s attended hundreds of births, many of which became necessary C-sections, but none of which were necessary at the outset of labor. This is not to say that the only time C-sections become necessary during labor is if they were interfered with — sometimes the most natural labors end up requiring C-sections, and sometimes interventions can help preserve a vaginal birth when otherwise a C-section might be necessary; but frequently, it is the interventions which lead to a C-section then becoming necessary. We all have heard of “Pit to Distress” — the practice of increasing the dosage of Pitocin until the baby is born, or becomes so distressed by the unnatural labor that the doctor then has a reason to call for a “necessary” C-section. What if doctors didn’t have easy access to surgery, in the event the baby was distressed? Do you think they’d be so quick to give Pitocin to a baby that is tolerating labor, just to speed things up? I don’t. It’s relatively easy to say that it’s no big deal if the baby becomes distressed due to X, Y, or Z, because “she can always be given a C-section.” But what if she can’t? Then, if the baby becomes distressed because of something the doctor did, it’s all on him if the baby is injured or dies.

If there were no C-sections, doctors would still be taught how to best manage vaginal breech births and vaginal twin births. I think of one snippet of media coverage I saw in the aftermath of the Haiti earthquake. An American woman (probably an OB, maybe not), was attending births in the street “hospital,” and a Haitian woman was in labor. Probably the baby began “crowning,” except that it wasn’t the head, but the rump that was presenting. The American wailed, “It’s breech! I don’t know what to do!!” She had probably never seen a vaginal breech birth before — even assuming she was a trained and practicing obstetrician, she likely was trained in100% C-section for breech, rather than how to safely assist a vaginal breech birth. All well and good for America, with plenty of hospitals and operating rooms, technology and antibiotics — but when the OB is removed from all of that, what skills does she really have to help make birth safe?

If there were no fetal monitors, doctors would not feel safe with administering Pitocin, particularly in high doses, because they would have no way of knowing how the baby was tolerating it. If there were no C-sections available should the baby become distressed, doctors would be more cautious to keep the baby from distress, don’t you think?

I’m afraid that our safety net of technology and interventions has become more of a “trampoline” — rather than being used only to save someone’s life or health in rare events, it is being used on a regular basis, as if it’s meant to be bounced on. And, no, I’m not calling for a complete ban on the use of Pitocin, C-sections, or any other intervention — they have their place. However, if they were reduced only to what was necessary (which we as fallible humans cannot know with 100% certainty which are truly necessary and which are not, so we could not truly reduce the rate of unnecessary intervention to zero; but looking at some things like mortality and morbidity with and without C-sections, and retrospective studies showing that most inductions were not medically necessary [and failed inductions certainly increase the rate of C-sections], we can see that it certainly can be reduced), we would see a very different (and, I think, better) picture in labor and birth, compared to what it is now.

One time my sister was talking to a police friend of ours, and sort of complaining about getting pulled over for speeding tickets. [At the time, she did have a “cop magnet” — a sweet little black T-top Thunderbird.] And our friend said, “Always drive like there’s a cop behind you.” That’s good advice, isn’t it? We often don’t — relying on radar detectors just to keep from getting caught; but if we drove safely and cautiously, within the speed limit, and obeying all laws, we’d likely never get a traffic ticket, and we’d reduce the likelihood that we’d end up in an accident. Maybe if doctors, midwives, and nurses would “practice like there are no C-sections,” we’d be able to safely reduce the C-section rate much closer to the minimum necessary.

Not that we didn’t know this already…

…but reducing the rate of Pitocin reduced the rate of emergency C-sections and vacuum or forceps deliveries. Click here to read the whole article. One thing that was (negatively) intriguing to me, is that the hospital’s Pitocin rate prior to the change was 93.3% — almost every woman planning a vaginal birth (at least, I assume the numbers would exclude planned C-sections; and didn’t include postpartum Pitocin use) got Pitocin either to augment or induce her labor. Even after the protocol change, over 3/4 of the women still received Pitocin.

h/t to Empowering Birth for the link

Also, in light of the whole “Pit to Distress” conversation, the above article had a link to a AJOG paper, which it cited as evidence for suggesting that pitocin not be increased more frequently than every 30 minutes (although many hospitals currently increase it every 20 minutes). The paper had the following abstract:

Oxytocin is the drug most commonly associated with preventable adverse perinatal outcomes and was recently added by the Institute for Safe Medication Practices to a small list of medications “bearing a heightened risk of harm,” which may “require special safeguards to reduce the risk of error.” Current recommendations for the administration of this drug are vague with respect to indications, timing, dosage, and monitoring of maternal and fetal effects. A review of available clinical and pharmacologic data suggests that specific, evidence-based guidelines for the intrapartum administration of oxytocin may be derived from available data. If implemented, such practices may reduce the likelihood of patient harm. These suggested guidelines focus on limited elective administration of oxytocin, consideration of strategies that have been shown to decrease the need for indicated oxytocin use, reliance on low-dose oxytocin regimens, adherence to specific semiquantitative definitions of adequate and inadequate labor, and an acceptance that once adequate uterine activity has been achieved, more time rather than more oxytocin is generally preferable. The use of conservative, specific protocols for monitoring the effects of oxytocin on mother and fetus is likely not only to improve outcomes but also reduce conflict between members of the obstetric team. Implementation of these guidelines would seem appropriate in a culture increasingly focused on patient safety.

It’s Distressing

Part of my “summer busy-ness” included going to the backside of nowhere, with no internet for nearly two weeks. You probably didn’t notice it much if at all, because I was able to set up enough posts to keep active (and I could get online at the library… as long as I could get to the library), but I sure noticed! I am so addicted to the internet! 🙂 In addition to a plethora of emails, I had a huge number of posts from blogs I subscribe to, to catch up on, since coming back. It’s really almost insane — I need to cut back… but I don’t want to miss out! 🙂 So, I missed out on the whole “Pit to Distress” viral blog posts.

I did read N is for Nurse‘s original post which seemed to start it all — in fact, her refusal to “pit to distress” was one of the things I was thinking of when I wrote the post about laboring women having and needing a patient advocate. The remainder are in no particular order, except perhaps the order in which I read them. A few of the links will be to blog posts that have multiple links in them, so I may end up linking to a single post more than once, while inadvertently leaving out another post, thinking I’d already linked to it. So, I’m human. If there is a good post you know about that is not included in these links, feel free to post it/them in the comments!

The first one I read was from Jill at The Unnecessarean, followed by part two (which also includes multiple links). Then, Keyboard Revolutionary has another set of links; with Rixa at Stand and Deliver having two posts — the first has an interesting set of comments after it, because Rixa has a graph of fetal heart-rate with a graph of maternal contractions, and asks L&D nurses who read her blog “what should you do in this instance?” — and gets a multitude of answers, which leaves one commenter saying, “Funny thing about the EFM commentary here. It *perfectly* illustrates how constant EFM is total crap–because nobody can agree on what they are seeing!!” [That may be what Pinky was referring to in this post. And fwiw, here is one post and another post on ACOG’s refining fetal heartrate monitoring guidelines.] The second post has multiple links as well. Jenn from Knitted in the Womb weighs in with her tales of being a doula at some Pitocin-induced/augmented births, as does Sheridan at Enjoy Birth. One of the contributors to our Independent Childbirth educators blog posted this.

From the nurse/midwife side of things: Ciarin at a Midwife’s Tale; Reality Rounds (NICU nurse), on nurses declining to follow a doctor’s order that they disagree with; a triad of posts from L&D nurse Melissa at Nursing Birth — Pit to Distress part 1, part 2, and understanding the pitocin dosage; former L&D nurse now new CNM Rebirth Nurse; and finally, Nicole at It’s Your Birth Right weighs in. In addition to the posts, I’ve read most if not all of the comments on them, which are also very interesting.

Then there is this article — not exactly on “Pit to distress,” but it does tangentially discuss the topic.

This is frustrating, because aggressive dosing of Pitocin, even if not given the term “Pit to distress” (even in jest), can harm mothers and babies. Obviously, contractions that are too strong and/or too close together can distress babies, since it reduces their oxygen supply. But it can also cause a mom’s uterus to rupture, even if she has an unscarred uterus — i.e., no history of C-section or other uterine surgery. Of course, this is not typical — but it can sometimes happen. As one of the posts said (I think it was “Nursing Birth”) — Pitocin, like many other drugs, can have different effects on different people — for some, a tiny amount of a drug will be enough to knock ’em out or make him loopy, while another person can take a bottle of it and barely get drowsy. A tiny amount of Pit may put some babies in distress or hyper-stimulate a uterus, while other women and babies will hardly have any effect from a maximum dose.

Does “Pit to distress” happen? Yes. How often? No clue. Anybody’s guess. It probably varies like every other statistic or factor, like epidural rate, induction rate, C-section rate, etc. In other words, some docs are going to be horrible, and others are not. I remember reading something somebody wrote about birth plans — this nurse or midwife basically said that it was nearly embarrassing to read some birth plans that specified “no pubic shave” or “no enema” or such like because these practices were nonexistent any more. Then several readers chimed in with their own personal stories of them being on the receiving end of these practices which were supposedly “not happening any more.” In my area, I could see stuff like this happening because of what I know of the nearest hospitals’ typical practices in certain things. [My mom was given routine general anesthesia, a pubic shave, and episiotomy — without her consent, and even specifically against her will — for all 4 of her births in the 70s, even though the “natural birth” movement really caught on in the middle of the decade, and many hospitals had modernized their services and practices by the time I was born. A friend of mine only barely escaped being given a routine enema when she gave birth at a different area hospital in 1996. The only way she avoided it was that she had an attack of diarrhea [as part of the normal birth process, not from actual illness] when she was being admitted.) So, some things may not happen in most hospitals — but if it’s even 1% of hospitals, that’s probably 30-60 hospitals where X is still occurring on a routine basis, even if the other 3000+ hospitals aren’t doing it any more. If these hospitals have only 1 birth average per day that’s still 11,000-22,000 women annually who are routinely submitted to these antiquated and archaic procedures. Or to overdosing on Pitocin. I’ve never personally known a woman whose uterus ruptured under any circumstances — but that certainly doesn’t mean it can’t and doesn’t happen! So, even if the majority of “birth people” and nurses say that they’ve never seen it happen at their hospital, doesn’t mean it doesn’t happen anywhere.

Of course, Pitocin, like every other drug, should not be used unless necessary or medically beneficial. If a doctor — or midwife! — is using Pitocin to speed up your labor simply so they can get done and get gone, that is *ahem* not a medical reason. Some doctors tend to have the idea that labor should never plateau, go slow, sputter, or even stop. That tends to be not allowed. “The labor curve must be followed, at all costs!” [Only slightly tongue-in-cheek.] Some doctors use Pitocin on all women — a few of the stories in either the blog posts themselves or the ensuing comments mentioned this — one doula said that her client was told sometime towards the end of her pregnancy, before labor even began, that she would be started on Pit when she got to the hospital; another L&D nurse expressed frustration that Pit orders were written up for a woman before she was even admitted and assessed (the doctor did it when s/he called to tell them the patient was on her way).

What can you do about it? First — trust your doctor. Seriously — pick a doctor or midwife you can trust. This will entail more than just picking a name out of the yellow pages, or from your insurance company’s “preferred provider” list, or asking your friends who they went with. You wouldn’t have agreed to marry your husband based solely on someone else’s recommendation, nor picking a name at random from a list of “available men”; you probably wouldn’t buy a car just from a description, without even test-driving it, so why on earth would you choose the birth attendant based on such little information? Ask questions, and look for red-flag answers, including such nebulous answers as “only when necessary.” As some of the posts have showed, some doctors apparently consider a 100% Pitocin rate to be “necessary.” Unfortunately, some care providers merely provide a bait-and-switch — appearing to be one thing during prenatal visits, and morphing into somebody completely unrecognizable during labor and birth. Not much you can do about that, except being aware that it can happen, and trying to make sure it doesn’t happen to you. Of course, another possibility is that your favorite care provider will be unable to attend your birth, leaving you with someone else who may not share his/her philosophy.

Second, make nice with your nurse. She will be the one actually managing your labor (or being hands-off), so having her on your side can make the difference between having your wishes followed and having them brushed aside as unimportant. You don’t have to call it “bribery,” but you’ll catch more flies with honey than with vinegar. Something like candy bars (perhaps Snickers, “packed with peanuts” or some other thing that has protein in it) is quick and easy for you to have in your room, to give to your nurse when she first meets you in your room — greasing the wheels and all that. Of course, if she’s on a diet, that might not be the best; but you could think of something else that might go over well that’s not just a carby, starchy, sweet thing to eat (mixed nuts? shrimp tray? — a little difficult to get if rushing to the hospital, but if you’ve got the time, you’ve got more options). If she’s going to advocate for you, you don’t want her weakening due to an empty stomach! 🙂 [Also, if you’ve got food in your room, it’s easier for you to eat it without appearing obvious, in case your hospital has rules against moms eating while in labor. Just note, that may be their rules, but not necessarily your rules.]

Third, educate yourself — know how Pitocin is administered and what you should be looking for when having it — not just the negative side effects like contractions too close together, but also the desired effect of contraction strength and/or pattern. Ideally, you shouldn’t have to do this, but it wouldn’t hurt to know. Know also that you can ask that Pitocin be stopped and/or turned down — it is not at all unusual for labor to continue on its own and in a good pattern after having been jump-started by Pitocin. If you are contracting at an adequate pace, and/or are dilating sufficiently (although I will stress that dilation is not the only way for labor to progress), but a nurse is continuing to up the Pit, you can ask why and/or request that she stop increasing the Pit and perhaps even reduce it or turn it off. Certainly you should know the symptoms of your uterus being overstimulated, so you can be more effective when requesting or demanding that the Pit be turned down. I’ve read several stories (including some comments on these posts I’ve linked to) of women who were hyperstimming, but didn’t know they could ask that the Pit be turned down — some even thought that their level of pain and/or contractions was normal, since “labor is supposed to hurt.” If your nurse won’t turn it down even though you are clinically contracting too frequently, request a new nurse or to speak to the nurse in charge. Of course, if you’re in labor and particularly if you’re having back-to-back contractions, this won’t be easy for you to do, so this is where a doula or other labor attendant (husband, etc.) comes in.

Hopefully, you will never need this information. But if you do, I want you to know it.

Contrasting birth stories

I recently came across this disturbing story — a birth story written by a woman who was coerced through frequent and repeated offers of an epidural or other pain medication to take drugs she neither wanted nor needed during labor. Both her mother and the labor nurse encouraged her to take it, which brings up the point that whoever attends you during labor need to be on board with your desires. Even when she consistently said “no,” the nurse kept offering drugs. But the woman’s mother was the one who finally coerced her into agreeing to them.

You can’t any more.  You can do this anymore.  You’re too tired.  You’re in too much pain.  You will be too tired to push.  To be fair, the nurse had brought up the suggestion of the Fentanyl, but my mother was the cheerleader determined to bring the suggestion home.  The nurse watched as my mother continued to harangue me into submission.I remember her screaming in my face, and I interrupted her by saying, “I DON’T WANT IT –” and she interrupted me again.  “– BUT!  But, I’ll DO IT.  Just stop screaming!  I’ll take it!”

I gave in.

Having your loved ones with you during labor can be wonderful; but sometimes their love for you can cause them to ride roughshod over your plans. The mother couldn’t bear to watch her daughter in the pain of Pitocin-induced contractions; sometimes husbands can’t bear to see their beloved wives in pain — and may even feel responsible, since they, after all, got them pregnant. But who does it help, when women are coerced into taking drugs they want not to take? In some instances, it only helps the labor attendants. I’m reminded of the first birth of one of my sisters-in-law: she “wanted a natural birth” (but did no real preparation), and eventually willingly chose drugs. But it didn’t work for her — it dulled her enough that she couldn’t speak or scream or do anything but lie there as the contractions washed over her, but she felt every one just as bad, and remembered every one just as bad, as if she had had no drugs at all. But, since she was lying there in an apparent calm, the husband and nurse congratulated each other that they had helped her and taken away her pain.

Definitely go read the post because it is insightful and shows all too clearly what can happen when your birth “support” people do not truly support you. So, if your mom really agrees with your plans and desires, by all means, invite her to your birth if you wish; but if she’s going to start coercing you into an unwanted something, then maybe it’s best if she stays away. I don’t want my mom to attend me in labor. On one hand, it could be beneficial and helpful for her, since she never got to experience birth (all four of her births were with general anesthesia, without her consent and against her wishes — she begged them not to with me, her last, because she wanted to experience birth and was planning on having her tubes tied after having me; they did it anyway); but I am frankly too concerned that she would be too nervous to be a good labor attendant, and her nervousness would rub off on me. Perhaps if she could be a fly on the wall — unnoticeable and unnoticed by me — and just be there and watch and learn and get rid of her birth anxiety that way, then maybe I would want her there. But I don’t think she’d be that way, so I think she would be an interference and a distraction, and I just don’t want to go there. Ditto husbands — if he’s going to try to protect you from labor and birth to the point that he doesn’t let you have your labor and birth on your terms, or even worse, actively try to discourage your wishes [and this can include that you want drugs and he wants you to go natural — it works both ways], then maybe you should send him fishing or something. Maybe our greatgrandmothers knew a thing or two about men and birth, which is why men usually were sent packing during labor. 🙂

It’s very nice if you want to avoid hurting anyone’s feelings, but you also have to protect your birth space, because you’re the one going through labor and birth, not them; and if they can’t support you, then they shouldn’t be in the room, because if they’re not with you, they may very well work against you. They may not mean it; they may even think they’re helping you, but the wrong kind of support people may actually rob you of your strength, rather than giving you strength.

And now, for the contrasting birth story, posted on Birth at Home in Arizona, told from the doula’s perspective. It’s lengthy, but, oh, so worth it! The doula was concerned that the hospital would be highly interventive, but instead found the CNM and L&D nurse to be wonderful labor support people who respected the mother’s space and needs.

I wonder how often pitocin is really necessary

One of the blogs I keep up with is a new L&D nurse. She worked over the Christmas and New Year’s holidays, and blogged about it. One of the stories she told was that of a first-time mom who came into the hospital in labor on the holiday, when her doctor was off and didn’t want to disrupt his holiday to come in to catch the baby, so he didn’t want to do anything to speed her labor up, so didn’t order Pitocin. The nurse sounded like this woman was one of the few women if not the only woman she had ever attended who did not have Pitocin to induce or augment labor.

But this mom — a first-time mom, you will remember! — actually managed to dilate without any Pitocin! At all! Can you believe it? (Yes, I’m being sarcastic.) Wow — her body actually was able to contract the uterus and open the cervix without any help from artificial substances. Incredible.

When the nurse got off of her shift, the mom was almost fully dilated — stll without a drop of Pitocin, because it was still before office hours and the doc hadn’t showed up yet.

Judging by the tone of the post, most if not all of the women this nurse attends in labor get Pitocin — or at least the first-time moms who tend to have slower labors. Probably these women think that it is necessary. Somehow, I doubt that it is “necessary” for any reason other than speeding up a normal labor so that it is more convenient for the doctor.

Industrial Childbirth

“My experience of childbirth was not an unusually traumatic one. In medical parlance I had an NVD: a Normal Vaginal Delivery. The midwives were pleasant. I was given an epidural. I was admitted to hospital at 2pm and delivered a healthy baby boy ( 8lb 7oz ) eleven hours later. This is the essential information, is it not? This is the only kind of information that we ever really hear about other women’s experiences with childbirth.

“But there is more to it than that. It took me a while to sort out my feelings after the birth – the elation you feel at the presence of a new life combined with your physical exhaustion leave room for little else. And I never really experienced the hopeless grief of the flippantly named “baby blues” in the weeks or months that followed. What I felt – when I was finally able to identify the reasons for my confusion – was anger.

Click here to read the rest of this…