Archive for June, 2009

Book Review/Commentary: Homebirth in the Hospital (Kerr, 2008)

Homebirth in the Hospital: Integrating Natural Childbirth with Modern Medicine, by Stacey Marie Kerr (Sentient Publications, 2008)

I just got my hands on this book last week–the BPL took awhile to get a copy in, apparently–and I’d had very high hopes for it. It’s a great title, first of all–I think something about that concept (comforts of home, plus the just-in-case feel of a hospital) appeals to a wide range of women who would not consider a homebirth. I had also read a little about the author’s background, and I was eager to read anything by a woman who had lived at The Farm for years, had a baby there, worked under Ina May, and then became a family-practice physician who delivers babies in standard hospital settings. Unfortunately, the book doesn’t quite live up to these expectations; it generally presents a watered-down view of the standard medical party line on childbirth, with a few bones thrown out for women along the way.

Kerr’s whole point here is that she–and other doctors inspired by her–can provide care for a woman, her child, and indeed her whole family in what Kerr calls an “integrative model” (15) of care:

I resolved to provide hospital care that was as close to midwifery as possible. I vowed to trust Mother Nature, watch with vigilance for signs of distress, and respect each mother who honored me with her trust. I worked to integrate the midwifery model and the medical model into each birth I attended. (13)

The problem here, of course, is that if Kerr sets out to combine the midwifery model of care with something else, she is implying that it is insufficient on its own, and I wager most (all?) practicing midwives would disagree here. There is no midwife on the planet, after all, who will tell you that there is absolutely no place for a c-section: midwives acknowledge that medical technology has life-saving benefits to offer, when truly needed. Kerr therefore seems to overly simplify the midwifery model and depict midwives (even though she apprenticed with them) as Luddites. 

The book is set up with an introduction by Kerr explaining her philosophy, a first chapter aimed at expecting parents to convince them of the value of integrative childbirth, a final chapter aimed at OBs and family doctors to convince them of the value of integrative childbirth, and fifteen chapters in the middle containing women’s birth stories (most in the words of the women themselves). All of the births profiled here (except Kerr’s own) are indeed hospital births, some with absolutely no interventions and some with quite a few. The birth stories are not nearly as spiritual or inspiring or positive as many of those featured in Ina May’s books, however, and plowing through all fifteen of these stories became slow-going indeed. I can see how a woman who is absolutely set on a hospital birth might like to read more hospital birth stories rather than homebirth stories, but there have to be more inspiring hospital birth stories out there than this set Kerr has chosen.

Kerr herself offers side-notes to the birth stories, clarifying some points and offering “tips”: “Looking forward to pushing your baby with excited anticipation makes it easier to accept and push through the pain” (61); “Allowing the provider to rupture the membranes is a relatively natural way of inducing labor without the side effects of medication. But . . . once the membranes are ruptured, the baby must be born within twenty-four hours” (66). Probably because these sidebars need to be quite so condensed (they look like those mini-blurbs magazines pull out from the main article and reprint in larger font), they alternate between pleasant, empty drivel and aggravatingly medically-minded statements with no elaboration.

Furthermore, the birth stories themselves tend to be upsetting on an emotional level, since many of the women profiled here display a passivity and lack of agency about their own care and their own births:

When I arrived at the hospital, I kept thinking, “Well, soon we’ll have a baby.” Whatever that means. During the whole birth process I just kind of disconnected myself from the whole thing. I just kept thinking of the following day. (66)

I wasn’t afraid of childbirth at all. And that doesn’t make an ounce of sense at all. It’s just something that you have to tough out. . . I’d just think of the horizon and what lay ahead, and I didn’t dwell on what was going on at the moment. I wasn’t excited about it. I was just really indifferent to the whole experience. (71)

Typically the midwifery model of care values the process of childbirth (the experience for the mother) as well as the product (a healthy baby), so I’m unclear why Kerr presents a woman’s dismal views of childbirth above without commentary on them.

Elsewhere in the book, there are frequent derisive references to birth plans, as though women are not capable of making informed decisions about their birth preferences; birth plans are trivialized, and both Kerr herself and some of the women she quotes suggest throwing them away:

We have a saying in my practice: “Burn the birth plan!” My patients were the one who coined this phrase. . . (29)

The quote above is from Kerr, and while she may have a point about women who attempt to rigidly adhere to birth plans, the quote below–from one of the women she profiles–is more troubling:

I had already learned from my first pregnancy that birth plans don’t work because everything you write down that you don’t want in your birth plan is pretty much what you will end up needing. So in my second birth plan, I didn’t write things like “I don’t want a C-section.” (80).

Of course I understand that birth is a natural process and as such doesn’t necessarily run according to “plan”; it would clearly be absurd to write in a birth plan, for example, that you want to be in labor no longer than X number of hours, etc. But the derision shown to birth plans–and the suggestion that there’s no point in listing the interventions you don’t want because “you will end up needing” them anyway suggests that this supposedly integrative model of birth is far more on the medical side of the spectrum than I had anticipated. Unfortunately, I think it’s too far toward the medical side to truly be of value to women who value the process of birth, desire a low-intervention birth, and trust themselves and their bodies to birth their babies.

–Christina

29 June 2009 at 5:15 pm 3 comments

Reducing Infant Mortality: a free film

Free for download later this summer, this film discusses the normalization of birth and how advanced technology has not improved infant mortality rates or overall birth outcomes.  Once released, birth advocates are are encouraged to share this film with all of their colleagues and clients  to spread the word!

maria

26 June 2009 at 8:38 am 1 comment

Who’s Birth Is It, Anyway?

My customary closing, when I respond to an initial email from a woman looking for a birth doula, is “Enjoy the rest of your 40 or so weeks, and best wishes for a wonderful birth-day.”

When we meet in person, I will start the conversation by asking “What are some of the ways you envision your birth?”

But who’s birth is it, really? Isn’t it the baby that is being born?

I admit I never gave much thought to this use of language until a friend was critical of someone else’s homebirth. The woman blogged about her birth in heroic, Herculean terms, and my friend found it boastful. “It’s just a notch in her belt,” he argued. “And it shouldn’t be about her. It should be about a healthy baby.” His assumptions about the healthiness of homebirth aside, his feelings are only a reflection of the way birth is typically viewed: a medical event meant to be just barely endured. And if the birth is traumatic, the disappointment with the experience gets swept aside by saying “In the end, all that matters is a healthy baby.”

Of course we all want a healthy baby. A healthy mother, too. But there are women who envision something different than a delivery that is done to them, under a cloud of fear and suffering. They want to experience the physiological process of birth: the wonder, the fear, the ecstacy, the pain, the awesome strength of her body’s own power to thrust another human being into the world. Their babies will be born, and these mothers want to birth them.

To my clients, I wish them all a wonderful birth-day.

maria

25 June 2009 at 11:31 pm Leave a comment

Quick link: Homebirth-friendly article from Indiana

This is a surprisingly homebirth-friendly article (though it features CNMs attending, rather than CPMs) from the mainstream press in Indiana–just a nice read!

–Christina

23 June 2009 at 8:29 am 1 comment

How to talk to pregnant friends (and relatives): Part 3 of an occasional series

So, I just found out that one of my cousins is pregnant. She’s 30 years old, healthy, normal weight. Nine months ago, she had an early miscarriage (5-6 weeks or so) which was allowed to resolve naturally, and now for this pregnancy, she’s seen her OB twice already (she’s now 7 weeks along).

At her most recent visit the OB took blood “to see if [she's] high-risk.”

Sigh.

What does one say in a situation like this? I’m the older cousin, and I’ve always been a bit of an obnoxious know-it-all to her (about, you know, all the things older cousins/sisters get to be–everything from school to boys on up), so I’m concerned that anything I say will sound that way again. . . on the other hand, I’m really concerned about my cousin! One previous miscarriage at six weeks DOES NOT make you “high-risk”–if this assessment is representative of the care she’s getting from her OB, then she’s going to have quite the unsafe, unsatisfying, intervention-filled birth.

–Christina

22 June 2009 at 8:00 pm Leave a comment

The Big Push for Midwives on YouTube

Here is the latest from The Big Push’s BigPush Tube Channel! The statistics are clear, the sentiments sweet — an all around good video to share for people who don’t yet know about the wonder of Certified Professional Midwives.

maria

22 June 2009 at 7:59 pm Leave a comment

Nursing in Public: Chinatown, the Subway, the Vatican, and More

Welcome, Carnival of Breastfeeding readers!

The June 2009 Carnival of Breastfeeding is about nursing in public; read my account, then click through to read those of the other contributors!

CIMG4173I’d always been scornful of the nursing covers sold with cutesy, punning names; why would a woman want to use them? What baby would want to be covered up under one? I couldn’t understand it. While pregnant, I joked to my husband that—so much for “inconspicuous nursing”—when a friend of ours draped her Hooter Hider around her neck and nursed, she might as well have a giant bulls-eye painted on the cover, or a sign that said “NAKED BREAST UNDER HERE NOW!” Interestingly, my husband, apparently more oblivious than I’d thought possible, said, “Wait, that’s what your friend is doing under there? Really? Huh, I’d never known.” Still, I was unswayed. Breastfeeding is completely normal, and there is no reason a woman shouldn’t do it absolutely anywhere, without the need to hide her baby and her breast under a colorful flowered cloth.

When my baby Marcus was born I discovered that latching was a little hard for him (“Ah, I see the problem,” a lactation consultant said, a day or two after my milk came in, “you have very full breasts with very flat nipples.”), so I breastfed with a silicone nipple shield at first. The nipple shield, however much it helped my baby latch on, made nursing in public such a logistical nightmare (find shield, attach it, attach baby, detach baby, take off dripping shield, dry off, store somewhere clean) that I couldn’t even think about doing it at first.

Still, when Marcus was two weeks old, we went out to lunch at a little family-run restaurant in Chinatown with my parents—who were staying with us to help out—and some of my husband’s co-workers. There were eleven or so of us squeezed around a round table meant to fit perhaps eight, and we were all the way in the back of the crowded restaurant, between another full round table, a wall, and a refrigerator, with no elbow room whatsoever. Inevitably, as soon as we had ordered, Marcus got hungry and started to cry. My husband tried to soothe him; my mother tried to soothe him; my baby still screamed in hunger. I tried to plan out my movements, as though in a cautious military attack, but the nipple shield was in a plastic baggie in the diaper bag underneath my seat, impossible to reach without making at least three people push back their chairs and move. I couldn’t see a viable strategy at all, and hearing my baby’s cries was making me so upset I almost started to cry.

In desperation I grabbed Marcus from my husband or whoever was holding him and just cradled him against me. He calmed down immediately, opened his little mouth, and latched onto my right breast over my shirt. This maneuver bought me a few minutes, but I realized he wasn’t going to be content with cotton-covered breast for long. Still, since I already had a wet mouth-shaped spot on my shirt, I figured I didn’t have anything to lose by trying to latch my baby on without the shield (even though he had never once nursed without it so far). I was wearing a nursing tank at the time and no bra, so I just nudged the upper layer of the tank aside and Marcus seamlessly latched onto my naked breast instead. He nursed hungrily, of course—silently, seriously, and happily.

The food arrived just then: my baby was nursing from the right breast, in a cross-cradle hold supported by my left arm, so my right hand was free to hold the chopsticks and eat. I remember the peculiar combination of sensations: the tingly let-down of my milk—so much stronger when my baby was a newborn than now, nine months later, that I miss it; the rush of relaxed elation as all my anxiety disappeared; and the first bite of juicy dumpling. When Marcus fell asleep at the breast and his mouth went slack, I detached him, nudged my tank back in place, and kept cradling him until it was time to leave. First experience nursing in public? Success! (And, incidentally, we never went back to the nipple shield after that.)

Since that day in September, I’ve breastfed my baby all over. Sometimes Marcus wants a full meal, and sometimes just a few sips—at those moments, he’ll sit up from the breast, his mouth full of milk, and raise himself up on my chest and grin at people walking by. Sans cover, my baby has nursed in all sorts of malls, supermarkets, restaurants, and playgrounds—the basic places of daily life, after all—as well as in a planetarium during a show, in a rush-hour subway car, in airplane seats next to strangers, in a gallery of seventeenth-century maps at the Vatican Museums in Rome, in an adult Sunday School class in a church basement, in a mei tai while I stood on line at an airport, and in the halls of a convention center between sessions at an academic conference.

Since that day in September, I’ve become somewhat rabid about nursing in public. After all, I had never seen anyone breastfeed—other than my one friend under her Hooter Hider—before I had my baby. Now I want people—family, friends, and total strangers—to see me breastfeed, to know that it is normal, healthy, convenient, and fulfilling.

Sometimes people notice when I nurse in public, and sometimes they don’t. Sometimes they smile down at what they think is a sweetly sleeping baby, and then get nervous when they catch a glimpse of breast. Sometimes men stare at me, sometimes they look away; sometimes women meet my smile and give me encouraging looks—and, in one case, even a couple of thumbs-up and a motion to her own breasts in apparent solidarity.

I hate it when women say that breastfeeding keeps them “stuck at home,” unable to get out of the house: know that you can nurse your baby anywhere. There might be some logistical hurdles to overcome—nipple shields, close quarters that prevent you from using your baby’s favorite position—but you’ll figure those out as you go along. So yes, I learned to avoid booths at restaurants (not enough room), and I found the football hold, for example—one of Marcus’s favorite positions early-on—nearly impossible to accomplish on a bench at a mall or other unsupported spot. But what I also learned is that when you’re nursing (in private or in public), you’re never in it alone: it’s you and your baby, together. You both have a shared desire that only nursing can meet—your breasts need emptying, while your baby needs filling and comforting, so you work together: you both make do in the occasionally awkward positions, you both are thrilled when your milk ends up in his mouth, and you both smile up at people. What’s more, by nursing in public you both normalize the act of breastfeeding for everyone else.

(pictured above, me nursing Marcus in my Storch wrap on Fisherman’s Wharf in San Francisco, when he was seven months old)

–Christina

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19 June 2009 at 7:34 pm 11 comments

Things people say when you’re planning a homebirth

At the slightest provocation–the mere hint of an opportunity–I tell people I had a homebirth (now ten months ago!). When I was pregnant, I told everyone and anyone that I was planning one. People’s reactions fell into a few main catagories:

1) “You’re crazy–you’ll be begging to go to the hospital and get that epidural!”

2) “You’re crazy–what if something goes wrong and it’s an emergency?”

3) “Really? A homebirth? What’s that?”

4) “That’s great! I [or my mother, my sister, my wife, my daughter, etc.] had a homebirth and it was the best experience!”

Obviously, #4 was the most gratifying, but I also found #3–a genuine plea for information–really fun to respond to. I wasn’t even unhappy about getting responses like the first two, though, because while part of the reason I told people about my birth plan was that I was excited about it and wanted to talk more about it, another part of the reason was my desire to educate people. Basically, I was thrilled to talk statistics, to explain my research, and to try to convince people of the safety of homebirth.

All too often, though, I hear people who had a homebirth say things like, “Well, we didn’t tell anyone we were planning a homebirth because we knew they’d freak out,” or “We didn’t want people to look at us funny, and we didn’t want to have to explain ourselves.” But, really, why be silent? Talking about your birth is free publicity for homebirth and midwives! So be brave, homebirthers–get out there and talk about your births!

–Christina

19 June 2009 at 7:19 pm 1 comment

Speak of the. . . yup, that’s what it has to be!

The news that the AMA will be voting on whether or not to create a code to label patients as non-compliant (also referred to as “ungrateful” in the proposal) has hit the birth world hard. ICAN has issued a statement decrying this move, in particular. So yeah, last week when I advised my pregnant friend that she could decline unnecessary exams and interventions? Apparently she could be on the road toward getting a big red letter (I think “T” for “troublemaker” fits nicely) if she follows my advice and this resolution passes.

–Christina

15 June 2009 at 8:38 am Leave a comment

How to talk to pregnant friends (part 2 of an occasional series)

Here’s a conversation I had recently with a pregnant friend (37 weeks at the time). She’s doing the standard OB-hospital route, although she has hired a doula and is planning a natural birth, and she knows I had a homebirth with a midwife. We were sitting on the T when she brought this up.

Friend (casually): So, when you saw your midwife, did she, like, do exams and stuff?

Me: Sure, yeah, she examined me–she’d palpate my belly, listen to the heartbeat, all that stuff.

Friend: But did she do pelvic exams?

Me: Oh. Uh, no. I think like way into labor she checked my cervix once, but she asked first, and then it was only about five hours before I had the baby. Why? Are you getting pelvic exams?

Friend: Oh yeah, and yesterday the doctor couldn’t even find my cervix–which is fine. But it hurt!

Me (thinking very very fast): Wow, well, that’s no fun.

Friend: No, it was awful! I was like, gee, if there’s this much pain just from her fingers, then. . . 

Me: So wait, what was her reasoning about why she needed to give you the exam?

Friend: Well, you know, she was doing the Strep B test and I guess she figured she might as well check my cervix while she was down there. . . 

Me: Huh. Well, you know these exams really don’t tell you anything right now. 

Friend: Oh, right, I know–I could be walking around at 3 cm for three weeks.

Me: Or you could be completely closed at your last exam and start labor that night.

Friend: Right, sure. But I’m going back on Friday and I just know they’re going to do another one.

Me: So, you don’t have to agree to these exams, you know, since they don’t really tell you anything, and since they’re so uncomfortable.

Friend (uncertainly): Yeah. . . 

Me: I mean, you could just say, “No thanks, I’ll skip the pelvic for now, I’m good,” or something like that.

Friend (even less certainly): Uh huh. . . 

At that point we had to get off the T, and we never really picked the conversation back up.

This was a really hard conversation for me, though, and it represents on a small scale my problem with the medical approach to birth (vs. the midwifery approach). First of all, there’s the issue of trying to justify an invasive, physically uncomfortable procedure which has no clear benefits. Then, there’s the psychological impact of these cervical checks–right away they put the woman in the passive role of patient and the doctor in the more powerful (and clothed!) position, and then beyond that, if a woman hears that her cervix is completely closed, she may start to doubt that her body will ever begin labor naturally.

Furthermore–not to be too cynical here–after reading hundreds of Internet birth stories, I can say that many women who have become accustomed to routine cervical checks at their 37-, 38-, and 39-week appointments report that at the 39-week or 40-week appointment, the cervical check is suddenly, sharply, much more painful than before. When they question their doctor, he/she typically says something like, “Oh yeah, you were at a 3 but I stretched you out to a 4 so don’t worry, we can get you admitted to the hospital and induce labor now,” or “Oh, don’t worry, I just swept your membranes so we can hustle this baby along.” These procedures are now even more invasive, and are often performed without a woman’s knowledge (much less consent!), because the woman has been conditioned to relax passively while the doctor just does his/her thing inside of her.

As you see, I didn’t say all of this to my friend, but her extreme reluctance to even consider declining a procedure–or, for that matter, even just asking the doctor to explain her reasons for the procedure–suggests she would not have been open to this line of thought.

–Christina

12 June 2009 at 9:32 am 1 comment

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