I laughed until I cried!

A Man’s Guide to HomeBirth on Dr. Momma [Update: it was removed from Dr. Momma, but here it is in full.]

This is hilarious! Simply hilarious. I’ll give you a taste, but you must read the whole thing:

These are the items that men need to assist in a homebirth (not in order of use by the way): a black-light, princess wand (any type of wand toy will do,) fun-house mirror, catchers mitt/fishing net/soccer gloves, pocket watch, thesaurus, gum, woman who has witnessed a live birth, six pack of beer (or favorite alcohol), shovel, bucket, 1 dozen eggs, shredded mozzarella cheese, shower shoes, swimming shorts, push-up/pull-up bars or a wheelbarrow, old table covers (plastic holiday ones are best,) 1 big steak (or other red meat,) and 1 big cliche. Most of these items are for preparing for the birth, while a few are for the actual birthing….

So when I came down the stairs and was informed that she was in labor at 9am-ish, I felt ready this time since I just slept for 10 friggin hours. Alas, after hanging around downstairs for about ten minutes, my eyes rolled into the back of my head and I went and took a nap. On a side note, this is where the doula’s biggest strength lies – they are highly trained to withstand the Hypno-Fog. It was after that nap during the Hypno-Fog stage that I discovered that women who are about to go into labor cast this area-of-effect spell that can drop a man to the floor in a matter of minutes….

Where to draw the line?

I’ll start off by saying, “I don’t know.” There are now and have been in the past different cases which are thorny issues — both related strictly to birth, and those that are not — which have to deal with parents’ rights to choose for their children (or themselves) vs. “the state’s” or “society’s” right to interfere in such matters. There are some clear-cut issues — when a parent is abusing a child… and yet even in that, some people may consider spanking an abuse while others consider it to be merely one form of correction and discipline which parents have a right to use. Some people are trying to get circumcision made to be illegal; and while I think circumcision is unnecessary and ought not be done, I don’t think that I have the right to forbid others to do it, and think it might be trampling on religious rights a bit much (although I think that Christians should not circumcise their children for religious reasons). Yet I don’t think that parents should be allowed to have their females circumcised no matter what their religion. Call me inconsistent.

But where will this end? That’s what concerns me. Do parents have the right to choose what is in the best interests of their entire family? Yes — within reason. They cannot decide that because their 13 year-old is “eating them out of house and home” that it is in the best interests of the family as a whole that that child no longer live with them, or that the child stop eating, or that the child should die. But certainly many other things are within the purview of the parents. Most if not all states have laws concerning buckling children into seat belts and approved car seats. A three month-old child cannot buckle himself into a car seat, after all. When I was working at the pharmacy, I’d see all sorts of things, including people driving up to the drive-through window with unbuckled children. The most memorable is a baby in a bouncy seat, in the front passenger’s lap — oh, yeah, that’s protection! If parents don’t buckle their kids, and they have a wreck, the children could be killed, and they were unable to protect themselves. Does the state or local government have a right to step into the family and dictate to the parents how to treat their children? Some might argue “no,” but most would say that most certainly the authorities have a right to protect the innocent child.

What about the right of parents to decline medical treatment for their children? What if the medical treatment is “iffy” — what if there is a strong chance that the treatment will not work, but will only make the child sicker? Some years ago, there was a case in which a woman had two children diagnosed with HIV or AIDS (her other two children were healthy). When the first child was diagnosed, she complied with all of the medication and treatments that the doctors ordered or suggested, and watched her child die a horrible and painful death, sickened and made weak and in pain by the medications which were supposed to be saving his life. When her second child was diagnosed, she refused all the treatments and medications, saying that she’d rather the child quickly die and in less pain than with the “life-saving” (but health-taking) drugs her first child took. The state took her to court, wanting to force her to give the child the medicine, or to terminate her parental rights and turn the child over to foster parents who would medicate the child. The judge ruled in her favor, though, saying that she had every reason to believe that the drugs would not actually help, and she was within her rights to refuse. Despite the dire predictions of the doctors, the second child was still living and seeming to be in perfect health, two years after the diagnosis, without taking any anti-AIDS/HIV medications. But what if the treatment options were more clear — if the child gets the treatment, there’s a 99% chance that he will live and be perfectly healthy; and if he doesn’t get the treatment, there’s a 99% chance that he will get terribly sick and/or die — and the parents still refuse?

What if it’s somewhat murky? Is any increased risk worth terminating parental rights, or overstepping the parental bounds of authority? We’d best be careful. There have been cases in which women have been forced to undergo C-sections for less-than-clear-cut “medical” reasons. It’s possible that these were ultimately overturned… after the woman was cut open — but perhaps some have been upheld. One such case I’ve heard about is a woman who wanted a VBAC. That’s all — no medical problems that I know of other than a previously cut-open-and-sewn-shut uterus. The risk of uterine rupture is about 1/200, with the risk of death or serious injury to the baby a much smaller percentage than that. Yet she was denied a chance of a vaginal birth because the judge found that her baby had sufficient rights of his own to force her to have surgery.

Don’t get me wrong — I’m strongly pro-life… but I’m also strongly pro-family and pro-liberty. I think the baby had the right to be born alive, and should not have been allowed to be killed at that or any other point in his life, before or after birth. But is the slightly increased risk of death from uterine rupture (which is not completely eliminated with a C-section) a strong enough argument to force an otherwise autonomous woman into having surgery? Is it strong enough to override her parental authority to choose what is best for her, her baby, and her family? We’re not talking about killing babies deliberately, here — we’re talking about a slight risk, but in the absence of uterine rupture, the outcomes will be better for both mother and baby with a vaginal birth.

What about drug use during pregnancy? — and “drugs” includes tobacco, alcohol, and illegal or illicit drug use. Smoking cigarettes most definitely increases the risks to the baby — of preterm birth and low birthweight (which by themselves carry with them a whole bunch of risks and longterm consequences) and also of stillbirth and neonatal and infant mortality. Illicit drug use ditto; and alcohol probably the same, but “fetal alcohol syndrome” is more particularly associated with it. As long as women have the right to ingest all of that stuff during pregnancy, exposing their “captive prisoner” (the baby) to the toxic chemicals, then surely loving and thoughtful parents can choose between two medical options that have both risks and benefits, picking the course of action they think is best altogether.

However, if the parents (or more particularly, the mother, since she is the one who really calls the shots, since it’s her body carrying the baby) are being grossly negligent, then it’s possible that as the state can step in and remove children who are being subjected to abusive parents, so the state can step in and force a woman to stop prenatally abusing her child. But we must be very, very careful when we do things like this. Horror stories abound in the foster-care system (and all that surrounds it), of children being repeatedly abused but nothing is done about it, while perfectly innocent parents are stringently investigated due to an angry neighbor’s spiteful and false report, and even of children removed from parents (abusive or not) and placed in abusive foster homes. Similar things might exist when tampering with the maternal-fetal relationship. I might liken forcing a woman to undergo a repeat C-section rather than an attempted VBAC as being in the second or third category — the “cure” is worse than the disease; whereas I would have little or no problem with forcing a woman who is pregnant and abusing drugs to enter some sort of treatment, so that her innocent child is not born addicted to crack. But so much of the problem exists not in a particular case, or a case-by-case basis, but rather the precedent that is set when the government starts interfering. What might be perfectly innocent or even laudable interference can become heinous and loathsome, depending on the circumstances. And as this post points out, it is hard to draw the dividing line. When you’re not talking about certainties — such as, “if you do X, then your child WILL die or be harmed,” but just, “if you do X, then your child MIGHT die or be harmed… or might not… and if we do Y instead, your child also might be harmed or killed.” For instance, I think the stillbirth rate is about 1/1000 around 41 weeks and perhaps 2/1000 around 42-43 weeks or above — still pretty darn good odds that any given baby will NOT be born dead if the mother declines an induction or C-section. There is a slightly increased risk of stillbirth, but very, very far from a certainty. And it’s also a possibility that the child will be harmed or killed as a result of an induction or C-section — something like not being able to tolerate an induced labor, or actually being premature so ends up in the NICU for weeks, or with serious asthma or other breathing problems, or something like that.

For me, it seems to come down to the parents’ intentions and desires — if they are good and loving parents, and want what is best for their child, then they have the right to give or withhold treatment as seems best; but if they are selfish or uncaring, then their motives may be suspect. But then the problem becomes, what if the “people in authority” believe that the parents do not have their child’s best interests at heart — such as the woman whose children had AIDS, mentioned above? Whoever took steps and set in motion the process to override her parental decision to withhold the drugs with the horrific side effects was either convinced that the child needed them (and thus that he was acting in the best interests of the child, while the mother was not) or he was some sort of sadist who liked to see children get sick and die horrible and painful deaths. Hindsight proved the mother to be correct; but we don’t always have the luxury of hindsight, nor the luxury of time.

As big as the implications I’ve highlighted are, they are even bigger — this topic is so broad and wide-ranging, covering everything from prenatal care, labor decisions, vaccinations, child care, home school, circumcision, ear-piercing, food choices, etc. If loving and concerned mothers (and fathers) cannot choose what they believe to be in the best interests of their child and/or the whole family, who gets to make that choice? What if society (or science or medicine) decides that eating meat is bad for people, so they take away your child so he can be fed a “proper” vegetarian diet? What if they decide that vegetarianism is bad, so they terminate parental rights so they can feed your child a “proper” omnivorous diet? What if you decide that vaccinations are not in the best interest of your child – that your child’s situation is such that you believe that the risk of vaccinating is higher than the risk of not vaccinating? Should the state overrule you, and decide your child must be vaccinated? What about home birth? or unassisted birth? What if the court system decides that ACOG and the AMA are right and homebirth is unsafe — should they have the right to forbid you to have a home birth, to incarcerate you in a hospital and force you to give birth there?

Does the state have the right to tell you what to do with your child? Why or why not? Tough questions to answer in general, although specific questions may be clearer. I can say, “Absolutely not, because I am a good and loving mother, and I’m doing what I believe to be is best for my child. I am not harming and certainly not killing him, so you have no right nor reason to step into my family and tell me what to do.” And I think that most if not all of you reading this would be able to say the same with a clear conscience. But who decides where the line is drawn between a good parent and a bad one? Ah, now that is a scary thought.

Planned C-section turned unplanned HBA3C (home-birth after 3 Cesareans)

How’s that for a story? Oh, and it happened only about an hour away from where I live! Here’s the article, from the Memphis Commercial Appeal. She was supposed to show up for her fourth C-section on Dec. 6. Instead, she started having contractions on Friday the 13th. (Actually, she says in retrospect, she had started labor in the night, but they were so mild, she didn’t recognize them as true contractions.) Then her water broke, and in a couple of minutes, the baby came out, “caught” by her two-year-old son! [The three-year-old was a little freaked out. {Shrug}]

One odd thing, is that she related that the contractions for this labor were not as strong as those with her other children… but if they were all born by C-section, I’m wondering why. I can see her having a normal labor for the first one (most likely induced and/or augmented with Pitocin), and ending in an unplanned C-section. And I can see them allowing her to attempt a VBAC with the second, but usually not with the third — although it’s possible she showed up in labor and was given a C-section. Oh, the details these stories written for the general public leave out!

Another woman proves her body works, and her vagina is actually useful in birth. 🙂

h/t Birth Activist

Canada to support vaginal breech birth!

Read all about it on Stand and Deliver and The Unnecessarean.

In a nutshell, the Canadian version of ACOG (the SOGC) has reviewed the literature on breech birth and determined that there is insufficient evidence to say that all breeches must be born vaginally. Many vaginal birth and vaginal breech birth advocates have been saying that there were problems with some of the breech trials that seemed to show a problem for years, so it is nice to see that the SOGC seemingly confirms that.

This does not mean that it is 100% safe for all breech babies to be born vaginally — if you do an internet search, I’m sure you’ll find numerous stories in which it did not work out. But I think the worst statistics the pro-C-section people had to offer was 6% of breech babies being serious injured or killed (I don’t remember the study for sure, but it seems like that has been the number bandied about — Pinky, do you have anything more certain on that?). Which means that 94% will do just fine. And trying to figure out which breech babies will be in the “6%” category and which will be in the “94%” category will be the subject of much discussion, I’m sure. There are some definite contraindications, but a whole lot of middle ground to study. [Update — Pinky corrected me to say that it’s 6/1000, so that means it’s 0.6% of breech babies possibly harmed by vaginal birth and 99.4% that will do just fine.]

Apparently, one of the factors in the SOGC’s decision was that some women have chosen out-of-hospital births as an alternative to automatic C-section, since that was their only “choice” in a hospital. Since a lot of U.S. hospitals and/or doctors will no longer allow VBACs, regardless of the reason for the initial C-section, many women have found the “automatic C-section for a breech” to have the unfortunate negative consequences of morphing into “automatic C-sections for all babies.”

Now the question becomes, what will ACOG do?

For more information, check out Science and Sensibility‘s post on this topic.

Happy Birthday, Seth!

Last year on this date, I published Seth’s birth story; now, here are the pictures that were taken right after he was born. Just a very slight recap of the birth story — because I had called the midwife when I had false labor and had her come too soon (from about 90 minutes away), I decided to wait to make sure it really was really for sure really labor before calling her again. So, I called her when my water broke… and Seth was born about an hour later. You do the math. 🙂 Plus, she had to arrange child care, so she got there about an hour after he was born.

Seth's First Picture (I'm talking to my husband, who missed everything!) :-(

Seth's First Picture (I'm talking to my husband, who missed everything!) 😦

Keith meets his little brother for the first time

Keith meets his little brother for the first time

03

I remember thinking that the baby was so small — probably about the same size as Keith was when he was born, which was 7 lb., 5 oz. Wrong!

The midwife looks over the baby

The midwife looks over the baby

Weighing my "itty bitty" -- nine pounds!

Weighing my "itty bitty" -- nine pounds!

The student midwife performs the neonatal assessment

The student midwife performs the neonatal assessment

“Birth Matters Virginia” Video Contest

Previously, I had blogged about the video contest sponsored by Birth Matters Virginia. Now that the deadline for new entries has passed, there are 44 videos in the running. In order to be considered for the contest, entries had to have a YouTube tag of “BirthMattersVirginia,” so it’s easy to find them. Here is the link to all the videos with that tag. I haven’t had a chance to watch them yet, but it promises to be good. Remember to vote for your favorite(s)!

Here is a video that was included in the facebook group’s links, but is not actually entered in the contest (perhaps because Dr. Buckley is one of the judges, and also appears in the video?). Enjoy “We Can Be Much Kinder,” a video about delayed cord clamping:

Same team!… Same team?

A few weeks ago, on someone’s blog, I read a comment which said something along the lines of all women who support home birth need to band together, rather than break up into somewhat antagonistic groups over things like unassisted birth; this commenter said we need to remember that we are all on the “same team.”

I’ve thought about that comment a lot since I read it, and while I agree with it in some ways, I disagree with it in others, and think it doesn’t go far enough in still other ways.

On one hand, I infer (perhaps wrongly) that a lot of people set up some goal or outcome as the paragon everyone should aim at, and those who aim at it and get it are the highest, those who aim and miss are next, and those who don’t even aim are lowest. This isn’t just in birth — you see it in everything, from people who get on the exercising bandwagon to those who go on certain diets, etc. But I get the sense from the UC people I’m exposed to that unassisted childbirth is considered the paragon of birth. This doesn’t mean that UCers look down on women who do not choose UC, necessarily (although I have heard disparaging comments made towards any midwife who does not wholeheartedly support UC as an abstract or who does not support women who wanted to have a UC; and somewhat casual denigration of women who choose hospital birth because they don’t “trust birth” enough, or whatever). Rather, what I remember most strongly is women who have acted apologetic because they just didn’t feel quite comfortable with UC — for whatever reason. Perhaps I was reading into it more than was meant.

But it goes both ways. There are more than enough ways for everyone to look down in some way on everyone else. And it’s destructive. So as far as that goes, we should realize that we are on the “same team.” But it might be impossible to be on the “same team” with some people, because of some basic philosophical differences, or perhaps even antagonistic behavior between some of the sub-groups of people within certain groups. But I think we should try.

And here’s how I think it doesn’t go far enough: the original analogy was that all home-birth people were on the “same team.” This implies that those who do not support or have home births are on a “different team,” and that we struggle against each other. In some ways, we do — specifically when home-birth or CPM advocates have to fight tooth and nail against the intrenched medical establishment for legislation that legalizes CPM-attended home birth. But can we not find some common ground, even in this area?

Here’s the “same team” idea I have — everyone who wants mothers and babies safe are on the same team. We may differ in what “safe” looks like, but we can all at least agree that whatever “safe” is, we want.

Among the blogs I read are those written by L&D nurses, CNMs, CPMs, doulas, childbirth educators, and other “birth junkies”. Some of the hospital-based nurses support home birth, while others think it is unsafe. We can all learn from each other. For my part, I get so into my “healthy, low-risk profile” women that I can easily forget that a lot of women are not healthy and low-risk, and bad stuff can and does happen, and home birth can be dangerous for some mothers and babies. Reading blogs written by nurses who see the not low-risk births is eye-opening for me. Contrariwise, a lot of L&D nurses can get their perspective about birth changed by a “refresher course” in normal low-risk births by reading about out-of-hospital births. Those who cannot understand why women would “take the risk” of having an out-of-hospital birth or a UC can read what these women have to say about the reason behind their choices, and then learn. Same goes for home-birthing women who don’t understand why women would choose to go into the hospital when they don’t have to.

Rather than just disparagingly saying, “I don’t know why they’d do that,” we can atually sit down and find out why and then we will know — and as the saying goes, “knowledge is power.” For instance, take an L&D nurse that can’t figure out why a woman would choose to give birth at home. She can read the stories of women who felt like they were abused (physically, emotionally, mentally) or coerced into unwanted and unnecessary interventions by those who were supposed to be caring for them in the hospital. And then she can learn from that more of the perspective a laboring woman has — of her care givers, her hospital, and herself — and the nurse can work on making her hospital unlike what these other women experienced. If she reads that a woman blames her PPD on her C-section which she believes was unnecessary, she can double her efforts to make sure 1) that the women she cares for do not have unnecessary C-sections or other interventions; and 2) that women fully understand what is happening to them and their babies, and why it is necessary. Because a lot of the thrust behind the home-birth movement is simply anti-doctor and anti-hospital — and this is because a lot of women believe themselves to have been taken advantage of by doctors or hospitals. A lot of the thrust is simply pro-natural, “back to the earth” philosophy, but there is a definite percentage of women who choose home births simply because of how they were treated during a previous labor or birth. The whole “god complex” of some doctors, and the inflexibility of hospital protocols (especially those not rooted in any sort of science or evidence-based medicine) contributes a lot to the home-birth movement. And people who refuse to listen to what home-birthers are saying, simply because they are home-birthers, do themselves a disservice. Also, if you believe home birth to be dangerous (or at least, that hospital birth is safer), then dismissing out-of-hand what home-birth advocates have to say, ignoring the experience of thousands of women who were traumatized by their hospital births, and trying to legislate home birth out of existence, is actually serving to increase the number and rate of women who will choose an out-of-hospital birth. And some of these women will be truly high-risk and will truly be putting themselves or their babies at risk by having a home birth with or without a midwife. Let this sink in — they are willing to take the risks of birthing without medical assistance, than to take the risks of birthing within a hospital — so what does that say about birth in a hospital? If you want these women to give birth in a hospital because it is safer for them or their babies, then change the system to accommodate them. By forcing them to adjust to the hospital, you are keeping them out.

So, let’s get on the same team and be on the same team as much as possible, shall we? Here is an analogy that comes to mind. In this country, we have several branches of military, and sometimes they fight and squabble amongst themselves (jockeying for position, prestige, money — whatever), and they even have football games or other sports matches in which they directly oppose each other. But when an outside enemy comes along, all differences disappear because they all understand that they are truly on the same team. In a similar way, we have several branches of people involved in birth, and sometimes we oppose each other on certain issues; but let’s always remember that we do have one common goal, and that is that we protect mothers and babies from unnecessary harm. We can learn from each other, and support each other in the common goal — even if we don’t always get along in other matters.

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