The Cesarean Option

If you have considered cesareans as a favorable option to avoid the pain of childbirth, or if you have thought that c-sections are no big deal, or if you think that the recovery from a cesarean is shorter or easier than a vaginal birth...

...or if you simply want to become more educated on cesareans, what they're like, what happens to the woman's body...

...Take 30 minutes and watch the linked webcast. It is a straightforward, uncomplicated c-section performed in Kansas.

The webcast can be viewed here.

For first-time pregnant moms

If you are pregnant for the first time, you are either caught up in the magic of pregnancy, the drudgery of daily queasiness and the consequent change in your eating habits, or both. You know that in a few months you will become a parent. You are likely looking at how your baby is developing; when the heart has started beating, when the fingernails are present, how large your baby is, and so on. You are probably also thinking about the lists of things you will need, like clothing, diapers, cribs, mobiles, other furniture, car seats, strollers...It's an exciting time.

Truly, there is nothing like your first pregnancy.

But don't get complacent.

Here are some things that you don't want to overlook during your journey:


1. Learn about birth. Even if you assume you will have an epidural, or you really like your doctor, educate yourself. Find out what will happen. Have a backup plan (in a startling number of women, epidurals don't work! What will you do if that happens to you?). This won't be just another day in your life; what happens to you on the day you give birth will affect you and your relationship with your baby. And if you don't know your options, then your options are limited.

You may want to hire a doula, to make sure you have the birth you want.

At the very least, take a childbirth education class. When you go into labor, it is too late to prepare for it. All education is valuable, and with birth, there is so much to learn. Find out what kind of birth you want to have and ways you can encourage it to happen.


2. Find out what you want. What works for one person may not be ideal for you. Stop worrying about criticism and take the time to work out what you want and how to go about getting it. There are few things as frequently and openly criticized as pregnancy, birth, and parenting. It requires courage from you to research your preferences, be open to doing things differently, and do what you believe is correct.

The first year, from conception to babyhood, is full of facing your fears. Do you really want to try cloth diapers instead of disposables? Find out about it! Are you nervous about an epidural and are considering an unmedicated birth? Look into it! Are you thinking about having your baby with you in bed instead of in a crib in another room? Read about co-sleeping! In every case, talk to people who have done it. Find out what worked well and what didn't. Remember that you may be different. You may discover that you don't want to pursue something you thought you wanted, and that's good. Now you know for certain.

This process of self-discovery is so important; the alternative is going along with a random opinion you aren't sure you share, one that shapes your relationship with your child and your style of parenting. The truth is that these things are highly individual and varied.


2. Prepare for parenthood. Getting ready for birth is important, but the shock of what taking care of your own baby is actually like, could be detrimental without some real preparation. Don't schedule trips for a long time after the baby is born. Have everything ready in the month before you're due. Stock your freezer with meals you can easily defrost. Get a support network of friends, family, other new moms, and anyone else you can lean on or call if you need help or advice.

Understand that you will need to let go of all ability to schedule your days (and nights) for a time. Your baby will probably not sleep through the night, and you will need your rest; figure out potential sleeping arrangements.

And realize that every mother had to learn this on her own, just as you will. You aren't supposed to know how to do it all; it's a learning process. You, your baby, and your relationship with your baby are all unique. Have the confidence to figure out what works for you.

Article on Fear in Childbirth

Help urged on childbirth fears

Woman wanting Caesareans for no medical reason should be offered counselling to help them overcome their fear of childbirth, experts have said.

A study from the Karolinska Institute in Stockholm, Sweden, found that more than 40% of first-time mothers had a clinical fear of giving birth after hearing stories from family and friends who had bad experiences.

These women were least likely to be happy about the delivery and some were afraid their child would die.

Expectant mothers who opt for a Caesarean without medical justification are often dubbed "too posh to push".

The operation is linked to higher risks for the mother and baby, including increased risk of hysterectomy, death, blood clots and infant breathing problems. Almost one in four babies born in England in 2005/06 was delivered by Caesarean.

The study, published in BJOG: An International Journal of Obstetrics and Gynaecology, followed 496 pregnant women until three months after they gave birth.

Comparisons were made between women actively choosing a Caesarean, Caesarean due to a baby's breech position and women acting as controls who wanted a normal vaginal delivery.

The women were asked for their views before delivery and three months after birth. Mothers requesting a Caesarean section had more negative expectations of how a vaginal delivery would be and 43.4% in this group had a "clinically significant" fear of delivery.

The authors said these women - and those still wanting a Caesarean but without a clinical fear - clearly needed more support.

Meanwhile, mothers who were expecting a normal delivery but who needed an emergency Caesarean (14%) or an assisted vaginal delivery (such as with forceps - 16% of the women) had more negative experiences of childbirth.

Preparing for a VBAC

For women who have had a cesarean and wish to give birth vaginally for subsequent deliveries

1. Your Care Provider

The most important factor in your VBAC journey is the support of your care provider.

No matter how much preparation and determination you otherwise have, if your care provider is not comfortable with VBACs, your chances are diminished.

Whether you choose a doctor or a midwife, you must talk openly and specifically about VBACs. You need to gather information as well as find out what your care provider's attitudes towards VBACs are.

Here are some questions to which you will need direct answers:

How many VBACs have you attended? Keep in mind that the number might not be very high. Many women do not have the support or confidence to achieve a VBAC, and in our current medical climate, the numbers are low. Watch for how enthusiastic your care provider is.

How many women attempting VBACs in your practice were successful? This is to find out who simply says "I will support you" but won't, and who is truly capable of supporting women who want VBACs. Some care providers give lip service to VBACs early on while never intending to allow post-cesarean women a fair chance at a vaginal birth.

Do you think I will be able to have a VBAC? This is your chance to discuss your childbirth history. Your reason for a previous cesarean should not matter, but watch for warning signs, such as "I will consent to a VBAC attempt so long as your baby is less than X pounds" or "You can have a VBAC if you go into labor within seven days of your due date" or "VBACs are much riskier than repeat cesareans" or if they put a time limit on labor or use the phrase "trial of labor." These are red flags indicating a care provider who is unwilling to offer the support you will need.

What do you do about a suspected CPD or past due pregnancy? VBACs should not be induced, if it can be at all avoided. Going past your due date, by itself, is not a reason to induce. Doctors are inducing earlier and earlier, often with the reason of "large baby" (macrosomia), but inducing for suspected large baby will often lead to cesarean section, rather than avoiding complications. If you had one or more cesareans for CPD, there is no reason to believe that you will never have a vaginal birth. Many CPD diagnoses are disproved by subsequent vaginal deliveries of larger babies. CPD, FTP (failure to progress), malposition, and the body's unpreparedness for an induced labor, are often one and the same reason. Your care provider should not assume that a previous diagnosis of CPD is accurate and permanent. Ask specifically how long past your due date your care provider believes it is safe to go. Change providers if your time is limited to one week or less.

Who can be in the room with me during labor and birth? If you can bring one, hire a doula. Doulas with VBAC experience will be able to provide invaluable support to you during labor. VBACs can be difficult. You will need as much encouragement, advocacy, and support as you can get.

What are the medical guidelines for women having a VBAC? Find out if you will be required to have constant external fetal monitoring (EFM). Are you required to have an IV or heplock? How about free movement? Will you need to labor in an operating room? Is pitocin routinely given to all women, including VBACs?

Do you personally attend all your patients' deliveries? Some doctors may not be able to control whether they are the physician present at any delivery, while others make a point of being with all their patients' births. Find out if you will be unexpectedly working with another doctor when you go into labor. Talk to that care provider as well to gauge how supportive they are of VBACs.

2. Your Physical Self

To maximize your ability to birth safely and without complication, take excellent care of your health. Eat well, including lots of fresh fruits and vegetables, and exercise. The better care you take of your body, the better it will function. Also, eating well helps your tissues to stretch farther without injury. Do not drink alcohol, caffeine, or smoke. Cut sugar. Do your Kegels. Yoga is wonderful, too, but make sure you are doing the prenatal kind, since you do not want to harm yourself.

3. Your Psychological Self

Do not underestimate the impact your first cesarean has on your outlook. Many women whose dreams of vaginal birth were undermined by their c-section experiences carry a heavy burden of doubt in their birthing capabilities.

All fears will manifest themselves the most strongly when you are in labor. You are best prepared to face them when you deal with them before labor. And keep in mind that all women who have had VBACs began by thinking they may not be able to accomplish it.

One of the most effective means of facing your fears is through hypnosis. Hypnobabies and HypnoBirthing courses are designed for the express purpose of building your confidence, understanding and handling your fears about labor and birth, and nurturing a positive outlook of birth. It also teaches women how to relax during childbirth, which is a fundamental part of preparation for any birth, but will be especially helpful for VBAC women.

The fear of repeating your previous experience(s) is very real and must be confronted if it is to be overcome. Your mind has a tremendous influence over what happens in your body. If you are scared, your body will respond and hold back; if you are confident and unafraid, your body will work more smoothly. Work with a counselor or hypnosis instructor to sort out your fears. Read everything you can. Take charge of your life, of your body, and begin your preparation for your VBAC.

Many women need a good deal of determination to have their VBACs. With supportive doctors and hospitals lined up, the last and greatest obstacle is the mother's belief in herself to give birth. This may be where your personal support team steps in, but you would be best served by working through as much of your fears and doubts as you can before they seem overwhelming.

4. Your Educated Self

I separate this section from the one above because they are truly distinct. Any facts you learn about VBACs and cesareans are likely to have no bearing on what you believe about yourself. Even if you learn that VBACs are safe, you may still harbor extreme doubt about your own ability to birth vaginally at all. Your self-belief is predominant.

However, education is still valuable, and in the case of VBACs, it is solid and startling.

The only reason VBACs are termed 'risky' is because of the chance of uterine rupture. Scar tissue does not generally have as much flexibility as unscarred tissue, and so the incision line along the uterus has a slightly higher chance of separating. Uterine rupture is a serious and life-threatening medical emergency, for both the mother and the baby.

For a woman with a previous cesarean, the chance of uterine rupture is about 0.5%. The chance of the uterus rupturing along the scar line is increased by the following factors: chemical induction (pitocin, prostaglandin, misoprostol), suturing type (previous cesarean incision closed in single-layer suturing rather than double-layer suturing), timing (previous cesarean less than two years before), age (the numbers rise as the woman ages past 30 years), classical incision in previous cesarean, and frequency (two or more previous cesareans).

If the sole risk for VBACs is uterine rupture, and the chances of it happening are so low, why is there so much controversy? Why is it difficult to find doctors supportive of VBACs? Why is the VBAC rate plummeting?

The answer is not in the increase of risk. It is in the expense.

Most hospitals require more staff for VBAC attempts. This means an anesthesiologist, an obstetrician, and increased nursing staff, just in case there is an emergency (read: rupture) and the woman needs immediate surgical attention.

If all goes smoothly and the woman delivers vaginally, it is possible that this staff would have been on call, at the hospital, paid, and not used. The woman is also not billed for their services.

Many hospitals are understaffed, a fact shown most clearly through the nursing crisis. Hospitals want to either save money or make money. With our national cesarean rate rising to an all-time high of one in three births, the number of VBAC candidates has also risen. Repeat cesarean is currently the number one reason for all c-sections. Obviously most hospitals are attempting to make money rather than cut costs, and VBAC is a primary target.

The other reason for the trend is malpractice costs. As lawsuits continue to be the standard response for anything having gone wrong in a hospital birth, malpractice insurance has risen accordingly. Not offering VBACs to women is a way of cutting the cost of malpractice insurance; if you don't offer it, you don't need to cover it. (Case in point: Last year, a local CNM was forced to stop offering VBACs because malpractice insurance to cover them had increased by over $10,000 in a single year). Another example is this quote from the vice president of a hospital, referring to the risk associated with VBACs: "99 out of 100 times it works, but I'm not willing to play those odds."

The alternative is that you, the taxpayer, the insured, are footing the bill for the increase of cesareans.

Cesareans are not without risk. Terming them a 'safe' alternative is both relative and circumstantial.Cesareans cause much higher incidences of infection, hemorrhage, depression, have far longer recovery times, and the risk of unpredictable complications such as accidental severing of nerves or tissues. Babies born vaginally are generally in better condition, with the benefit of catecholamines released during vaginal birth, healthier lungs, higher Apgar scores, earlier contact with their mothers, and better breastfeeding success.

The bottom line: VBACs are safe. They are safer than repeat cesareans. But they are not inexpensive.

5. Resources

Take advantage of the availability of information on the internet and do your homework.

Here are some very helpful resources:

ICAN (International Cesarean Awareness Network) -- Read The White Papers. Find a local ICAN chapter, if one is available to you, and attend regularly.

Childbirth Connection -- A fantastic site for information. Provides evaluations of current studies and medical research.

Pushed -- Informative blog about our current birth culture and a few sections specifically addressing VBACs.

Henci Goer -- The author of The Thinking Woman's Guide to a Better Birth and Obstetric Myths versus Research Realities has several articles on cesareans and VBACs.

Birthrites -- A site devoted to VBACs and healing after cesarean surgery.

VBAC.com -- A comprehensive resource for women wanting to know more about and prepare themselves for VBACs.

Hypnobabies and HypnoBirthing -- While similar in both philosophy and practice, the main difference is that Hypnobabies classes can be taken independently (a workbook and CDs may be purchased from their site), while HypnoBirthing requires an instructor and in-person classes.

The Myth of CPD

CPD (cephalopelvic disproportion) is a common reason for cesarean section. It means that the pelvis is too small to admit the passage of the baby's head.

It is vastly overdiagnosed. True CPD is a malformation of bones. Unless medical issues such as gestational diabetes exist, babies will not be too large to fit through the mother's pelvis.

Induction for suspected big baby will often lead to cesarean section. The reasons are many: the pelvic bones will not stretch as much when labor is induced, the baby may not be in an ideal birthing position, lying in bed (common when one is receiving pitocin, and often leads to epidurals, which out of necessity restrict movement) does not help but seriously hinders the natural gravitational pull of babies out of the birth canal.

Many women who have been diagnosed with CPD have gone on to vaginally birth much larger babies.

This wonderful clip, put together by ICAN, reveals the myth that is CPD.

Let's get started!

Inducing Labor

Let me begin by assuring that there are some valid reasons for inducing an otherwise healthy pregnancy.

Life-threatening illnesses that will affect the health of mother or baby. These include preeclampsia, severe hypertension, cancer, diabetes, organ disease, or placental age or deterioration.

There are many more reasons women induce their labors to begin:

Suspected large baby. No technology exists to accurately predict the size or weight of an unborn baby. Measurements, ultrasounds, and assessments through other means can be off by several pounds, higher or lower. Even still, women commonly induce out of fear of having a big baby.

Being overdue. Early in pregnancy, women are assured that their due dates are mere estimates; by the end of pregnancy, that has changed, and going past one's due date has become undesirable. I don't think it's a stretch to assume that this is connected with the first. Merely being past the due date, however, is not a medical reason.

Being full-term. This is more common, as women take lightly the act of inducing labor and try to have their babies at an arbitrary time, so long as it's after 36 weeks (and often before 40).

Doctor scheduling. Your doctor has told you that he or she will be out of town at a certain time, and you want to ensure that you are in labor during a time he or she can attend you.

Family scheduling. Many women feel pressured to produce a baby when family will be around. "My mother will only be here for ten days!" "Grandpa will be in town on the 26th, and he'll want to see the baby!" Some women want to give birth so they can attend a family event or go on a scheduled trip.

Discomfort at the end of pregnancy. Your hips hurt. Your belly is huge. You can barely walk or stand up. Sleep is elusive. You're ready to be done. The baby, though, is not.

All of these are inducing for convenience.

Why it matters

Whether or not to induce your labor depends largely on what you want to experience in your labor and what you want to avoid.

As a result of induction you may have:

1. A vacuum or forceps-assisted birth;
2. A baby unable to tolerate contractions.
   

As a result of induction you are likely to have:

1. Increased fetal distress;
2. Pitocin administration, which will make labor contractions stronger and far more painful;
3. Epidural anesthesia to cope with the pain;
   
4. Rupture of your bag of waters, which puts a time limit on how long you will be allowed to labor and increases your baby's and your own chances of infection;
5. Problems with presentation and position of the baby in the womb;
   
6. Increased incidence and severity of jaundice in your baby.
   

As a result of induction you will have:

1. Doubled your chances of delivering by cesarean section;
   
2. A highly-medicalized and regulated birth where you have little or no decision-making power;
   
3. A premature baby. (By premature, I mean a baby born before it is ready; since we do not know when that date would have been, it is safe to assume that all babies born before that point are, to some extent, premature.)
   

The most important part of prenatal care

So, you're pregnant, for the first time -- congratulations!

You go to your prenatal appointments. You're gathering supplies and cute clothing for your little one. Maybe you're picking out the perfect crib, changing table, rocker with matching footstool. You're filled with tender visions of motherhood.

Maybe you can already feel the tiny being moving around inside your abdomen. It's magical.

Your doctor assures you that everything is normal. You continue along in your pregnancy.

As your birth looms closer, your excitement grows. So does the realization that this baby, which seems impossibly huge in late pregnancy, must come out of your body somehow.

You will probably begin to hope that your labor will begin early. This means that not only will the baby be smaller, but you'll spend less time feeling as large (and agile) as a barn. Inductions, stripping the membranes, anything you may be offered at your doctor's office to speed the onset of labor, sound sweet.

What will happen in your labor is an unimportant mystery -- after all, isn't that why you have a doctor? Whatever happens will be fine, because your doctor and nurses will make sure that you come home with a healthy baby, and that is the very most important thing.

..

Except it isn't.

..

You will find that how your baby comes into the world, and how you feel about it, matter tremendously. You might be asked to make decisions you don't understand. You will experience new sensations and emotions and not know if they are normal or aberrant. You might feel afraid, insecure, discouraged, or foolish.

On the contrary, you have the opportunity to experience your birth as a wonderful and normal passage. You can feel comfortable, even in the midst of unfamiliar sensations. You can be confident in your knowledge that you are where you should be, that what you are experiencing is normal and good, and what to expect to come shortly. You can bring your baby into the world, fearless and radiant, with no sense of unease to cloud your joy.

..

Does it depend on whether or not you had an epidural?

Not at all.

All this hinges on your education. Do not miss the opportunity to learn about childbirth. You need to know what will happen, to become very knowledgeable about what is normal and what is outside the range of normal.

Whether or not you choose pain medication does not ultimately matter. You will do what you feel comfortable with, and education may or may not change your course of action in that respect.

But if you arrive at the hospital in labor, are examined and found to be 3 centimeters dilated, and the care practitioner offers to break your waters, what will you choose? There are consequences to early rupture of the waters, not all of which may be disclosed to you in that moment.

If you are told that you need to be induced because of a large baby, what will you say? Do you know how the measurements were made and how accurate they may be? Why does the doctor want to induce for a large baby anyway? Is induction safe?

If the baby's heart rate drops to 100 bpm for a moment, is there something seriously wrong? What will the medical staff do? What does it mean?

Are you prepared to make these decisions?

Do not miss your classes. If you find you still have questions, find out. There are plenty of resources, and for most things, there is reliable, studied information available. Read about birth until you are weary of reading because you know the subject so well.

Prepare yourself.

What happens in your birth, and how you feel about it, matters tremendously.

"I have a doctor; why would I need a doula?"

The roles of doctors and doulas are in different spheres.

Your obstetrician is there to monitor your health and your baby, look for signs of presenting problems or issues, and handle all medical aspects of your care.

When you are in labor, you will typically see your doctor briefly during labor and then when you are pushing out your baby. The doctor is present for a very small percentage of the time you will spend giving birth to your baby.

You will see more of your nurse or nurses (depending on when you are at the hospital, and for how long,, taking shift changes into account). The nurse will come in to check on you, maybe check dilation through a vaginal exam, ask you to rate your pain on a scale of 1-10, take blood pressure, take a lot of notes, and then leave to do it again for however many women are laboring on the same floor as you.

Some nurses are better than others at attending women in labor and giving them help and personalized care. Many have a practical, businesslike approach to caring for laboring women. Some are downright harsh to their patients. Most are too busy.

The hole left between medical visits is what's filled by a doula. Doulas are not medically trained and will not perform vaginal exams to check dilation or blood pressure measurements, but they will remain with you at all times.

Doulas give constant emotional support. They can explain to you what is happening, help you maintain your focus and keep you grounded. They can help with positioning and comfort. They know your intentions and help to communicate them to staff and gently remind you of your goals if needed. They are there to help you have a safe and satisfying birth experience.

This is not the role of the doctor or the nurse. The nurse's priority is the hospital protocol and communicating with the physician. The doctor's priority is the health of the baby and the mother. The doula's concern is your happiness, comfort, and helping you have the birth you want.

No matter what kind of birth you desire, you can benefit from having a doula present. We do not replace the nurse or your partner; we are simply an extra pair of hands and a caring heart to help and encourage you through this amazing rite of passage.

Who is going to give birth to your baby?

What kind of birth experience do you imagine having?

Do you picture your baby coming into the world without your experiencing any sensation of his or her passing through your body?

Will you have a cesarean? Are you expecting twins and therefore (as is standard in many places) have your c-section date scheduled, even if you are newly pregnant?

Do you want to know what birth feels like, even if it is painful and lasts for several hours with increasing intensity?

Are you undecided?

Perhaps you have heard from other women that no one receives a medal for having an unmedicated birth, and you are determined not to exhibit any unnecessary heroics. Maybe you are so scared of birth, having heard too many times that it is the most painful sensation women have ever felt, and you want to avoid the pain. After all, we have medications that make it a pain-free experience, so what excuse do you have to refuse them?

Quite honestly, as a doula, an educator, a woman, and a mother, I don't care what women visualize for their births. What they want does not matter nearly as much as their approach to it.

If a woman is educated about birth, she will know what the benefits and consequences of her decisions are. She will know that:

• There may be unexpected hazards with low-risk, uncomplicated births, but cesareans are always riskier. The recovery after a cesarean is much longer, too, and it will change your body forever.

• Epidurals are relatively safe, but the anesthetic and narcotics used DO pass to and affect the baby.

• Epidurals don't have the same effect on every woman. Sometimes the chemicals have a partial or even NO effect on the physical sensations of labor. If you are one of those women, what will your next course of action be?

• Often, when a medically-trained person claims that a medical procedure has no risk, the meaning is that there are risks but they can be medically treated. An example of this is the use of narcotics as painkillers during labor. The narcotics may cause respiratory problems in the baby, and there is a pharmacological treatment for respiratory distress that usually takes effect swiftly. While that does not truly equal NO RISK, it does for medical purposes.

• Women cannot depend upon the medical personnel to support them during labor. They may have a nurse who completely supports her goals, but that nurse may be attending twenty other women in labor that day, and her good intentions do not count as 'support'. Women need to go into the hospital with their own team.

• Doctors and nurses do not necessarily know more about birth than women do. They know how to treat complications. As a whole, they rarely see the birth process untouched by medical procedure.

I am certain this sounds very anti-hospital, but I assure you I am not. I wish to challenge the notions many women harbor that they do not need to think about their own births, that they can simply give the experience over to the medical staff AND have the births they want. You are not guaranteed anything by going into the hospital to have your baby. The medical personnel will operate by their own protocols, and those may or may not agree with what you have envisioned for yourself. In the absence of an emergency, it is up to YOU.

I want to rally women into education. If you are choosing to have an epidural because you are scared of the pain, then research how women have coped with it and what they have said about their labor experiences. Epidurals may have no effect on you. Have a backup plan. Know how to cope with difficulty, just in case you cannot have the pain meds or they do not work for you. If you have had a cesarean but want to have a VBAC for your subsequent birth(s), you need as much support, knowledge, and strength as you can muster. Go to it.

Find the location and the care providers, the doulas, and every community resource you can, to have the birth you want. Do everything you can.

No one else is going to give birth to this baby. You need to be the woman you envision, not one making choices out of ignorance or even operating on the advice of a few friends or your sisters. Be strong and take the responsibility that is yours.

We are no longer in the age of absolute trust in our doctors. The choices are largely yours. The path you take is one you alone determine. Learn all you can, from all sources. If something sounds too good to be true, do more research to find the truth, because what you have heard is probably misleading. People and doctors pass along bald lies about birth. Find out what they are.

Drop your laziness and apathy. You are becoming a mother, and any bit of knowledge and toughness with benefit you in this capacity. It will help you in labor. It will serve you when you are in the trenches of parenthood. You will not be handed the tools you require; you must seek them out.

Nobody cares about your birth as much as you do. Take up your burden of authority and find out what you will do with it. Bear it well. Educate yourself.

SOOO Big

"We just had our first granddaughter! She was born six weeks early, which is really a blessing for her mom, since the baby already weighed 5 pounds."

"The Porters have just added a small blessing to their family -- actually, a rather large blessing, at 8 pounds 12 ounces."

I don't know where we have learned our fear of delivering a large baby. Sometimes babies can get rather big, and sometimes size is a consideration in determining how a baby is born, vaginally or by cesarean section. But our collective fears are exaggerated. Macrosomia (large baby) is frequently misdiagnosed; ultrasounds are notoriously unreliable for determining a baby's weight before birth.

Here are some common myths about birth weight:

• If the baby grows too much in the womb, the shoulders will become stuck during birth. This is called shoulder dystocia, and while it is a rare and very serious problem, its incidence is not connected absolutely with how much the baby weighs. "It has been established that 48 to 89% of SD occur in non-macrosomic fetuses" (Blickstein). Shoulder dystocia is unpredictable and while its likelihood increases with larger babies, it has also been reliably linked to maternal diabetes, labor induction, and the use of pain medication. Cesareans done for suspected macrosomia have resulted in dismal statistics: 100 unnecessary c-sections for one true case of macrosomia. Plus, since there is no assurance of shoulder dystocia occurring even with a large baby, performing a cesarean for the sole reason of avoiding dystocia is unsupported. Causal relationships have been established between shoulder dystocia and the following: increased maternal age, shortened first stage, prolonged second stage, maternal obesity, gestational diabetes, position of the baby during birth, labor induction, epidural use, and a long time period (8 years or more) since the previous birth.

• A larger baby will result in larger vaginal tears. Not necessarily. While there is a limit to how much tissues can stretch to allow the passage of a baby, the most important rule to avoid tearing is to slow down. Pushing too hard, too fast, and not allowing the tissues to stretch out, will almost certainly result in tears. While there is a place for episiotomies, they absolutely do not help women avoid larger tears; they create a weak spot where stress is centered and can cause more injury rather than preventing worse tearing. The best advice for avoiding tearing during birth is to take your time. My midwife told me that "Your body will not grow a baby you can't birth." I'm not certain that that is entirely and completely true, but I do believe that in the great majority of circumstances, a woman can give birth to the baby she is carrying, without it being "too big" for her. As stated on a childbirth website, "your body is designed to accomodate even a large baby."
  


• Babies gain a pound a week during the last weeks of pregnancy. I have heard this misconception many times, and I don't know where it came from. It is a lie. By the end of pregnancy babies can gain as much as one ounce per day - that equals 7 ounces per week, or less than one pound every 2 weeks. This myth leads to...

• Induction before 40 weeks will avoid the trouble of having to birth a large baby. Inducing labor carries with it so many risks that there is no evidence of improved outcomes for women thought to be carrying large babies. Inducing labor before your body is ready to give birth also increases your chances of having a cesarean.

• A large baby's head will get stuck in the mother's pelvis. True cephalopelvic disproportion (CPD) is very rare. The baby may be too large for vaginal birth in some cases, called absolute disproportion, but this is, again, extremely rare. More common causes of CPD are bad positioning of the baby, inflexible tissues of the cervix or vagina, and impatience. Another very rare cause is an abnormally-shaped pelvis (rickety or trefoil). Many women who deliver a baby by cesarean due to a diagnosed CPD will go on to vaginally birth an even larger baby, disproving the initial diagnosis.

• The average birth weight of babies has increased over time, and soon babies will become too large to birth vaginally. There has been an increase, especially noted around the turn of the century (1900, not 2000). The average birth weight suffered a giant drop leading up to around 1900, and then made steady improvements, up until the modern day, the past twenty years or so, when they seem to have levelled off. Accurate birth weight measurements were not in place until the mid-1900s. So while the first part of the statement may appear technically true, the second part is unfounded. The increase in birth weight can be attributed to better health care and prenatal care, better workforce environment, lower levels of hard physical activity, better nutrition, and education.

I am not pleased when people talk about their "giant 8-pound babies". To me, 12 pounds is large, and 8 is pretty darn close to average.

The current average birth weight for all babies is 7 1/2 pounds.

Some are larger, some are smaller. Either extreme may result from and/or cause complications. But by definition, most babies fall within the average, normal category for birth weight.

Both of the quotes above are things I have overheard in the past few months, and it made me want to jump out of my skin.

8 pounds is not huge. Anecdotally, I know many moms who say that their latest, 10-pound baby was their easiest delivery. It isn't all about weight.

Prematurity is not a good tradeoff for low birth weight.

The optimal goal is a good outcome for both mom and baby. Most of the myths I discussed are based on fact but are not exactly true. Each individual needs to research and weigh her own risks and circumstances. My intention is to clarify the truth and dispel the misleading beliefs where appropriate.

Childbirth-easing drugs may affect breastfeeding

11:32 11 December 2006
NewScientist.com news service
Rachel Nowak

Drugs used to ease the pain of childbirth could interfere with breastfeeding, a new study suggests.

Siranda Torvaldsen of the University of Sydney, Australia, found that 416 women who received the opioid drug fentanyl by epidural injection during delivery were twice as likely to have stopped breastfeeding by the time their baby was six months old compared with 312 women who did not receive the drug.

Torvaldsen does not know whether this is because the drug has a direct effect on babies’ ability to suckle or that women who opt for (or need) epidural painkillers are also more likely to stop breastfeeding sooner.

A previous study found that the babies of women who have fentanyl tend to be drowsier at one-day-old, raising the possibility that the drug affects suckling at the critical time when breastfeeding gets established.

"Adverse reaction"

In Australia and the US only around 40% of babies are still receiving at least some breast milk at six months, although the World Health Organization recommends breast feeding exclusively until that age.

“Now we’re aware that painkillers may affect breastfeeding, we need to be sure that women who take them get adequate help,” says Torvaldsen.

Sue Jordan of Swansea University, UK, who is an expert on the effects of labour drugs and mental health, says the effect of opioids and epidurals on breastfeeding should be seen as an "adverse drug reaction".

In an article accompanying Torvaldsen’s study in International Breastfeeding Journal, Jordan calls for extra support for the most vulnerable women "to ensure that their infants are not disadvantaged by this hidden, but far-reaching, adverse drug reaction".

Journal reference: International Breastfeeding Journal (DOI: 10.1186/1746-4358-1-24)

------------------------------------------------------------

I am not anti-epidural. I'm becoming more anti-hospital, though I still maintain my belief that women need to be where and with whom they feel safe.

But I wonder how much publicity this little bit of information will receive.

People who are already opposed to the routine use of epidurals for all moms will think it's great.

Those who can't imagine why anyone would do anything other than opt for an epidural as soon as it can be given, will dismiss it as unsubstantiated.

The medical community probably won't even blink.

What does it take to cause change? What needs to happen, what needs to be discovered, for real changes to begin happening?

I want to see women seeking education about birth before they seek escape from it. If they ultimately decide that epidurals are definitely for them, at least it will be an educated choice and not a decision made in a vacuum - "I don't know what to expect and I don't wanna know."

I have heard of childbirth educators telling their classes, "Ninety-five percent of you will be getting epidurals anyway, so I won't go over relaxation techniques."

I have heard of nurses begging laboring moms to get pain relief. Even constantly asking the mom, "Do you want your epidural yet?" without knowing what her preferences are, or continually offering "something to take the edge off the pain" without using the word narcotic...these are all actions hostile to unmedicated birth, and apparently to the breastfeeding relationship, too.

So why doesn't this garner more of a reaction? Why don't mothers care more about it? If mothers cared, they would demand change, and the medical community would have to adapt, and men and sons and daughters would learn to act differently towards birth.

Virginia Woolf believed that if libraries were available to women in her time, that the world would split open. She too thought that knowledge would be enough.

I'm dismayed that women don't seek out their own education on certain things, especially childbirth.

It would be nice if every doctor made time to sit down with a pregnant woman and ask, "So what kind of birth do you want?" ...

It would be great if all doctors had a certain reverence for birth, understanding what is inappropriate to do or say when a woman is giving birth, reacting when needed, but showing restraint and respect when needed...

It would be nice if L&D nurses were trained so thoroughly that no laboring mom or doula would ever suspect that she knew more about birth than the nurse(s)...and if nurses all knew how important it is to support and nurture the connection between mom and baby...

It would be great if all childbirth educators were trained to help women find what kind of birth they want, how to increase their chances of having that experience, what to do if it doesn't happen, and how to recognize if something is going wrong, either during the birth or during the initial postpartum time...

But the reality is that none of these things are common or guaranteed.

So it's up to women, it's up to each woman to educate herself and learn to stand up for herself.

No more assuming that because someone went to nursing or medical school, they must therefore know what they're doing and would NEVER do anything destructive to the health and well-being of mom and baby. No more thinking that taking a single childbirth class covers all the bases and prepares you for anything, especially childbirth.

No more denying responsibility.

There is so much to learn. Do your research. Ask questions. Change care providers. Read everything you can.

It's all up to you.

More on Prodromal Labor

My previous writings on prodromal labor were strictly theoretical. I have never experienced it, and I had never before attended someone who was in prodromal labor. This past weekend, I did. I have much more to say about it now.

Prodromal labor is a term for early labor that lasts for a long while without progressing into active labor. It is a nightmare. This is the labor pattern that lasts for days, causing the mother to lose sleep, disrupt her appetite, and causes exhaustion. It will probably eventually change into an active labor pattern, but even if this happens, the biggest danger is depletion of emotional and physical resources: the mother may not be able to continue with the labor and may need pain relief or even a cesarean. This is not the kind of labor that any woman wants to experience.

The article I wrote before stands out to me now as something written by a person who has read about a topic and knows nothing of it. It strikes me now as profoundly unhelpful.

When a woman is in prodromal labor, also called arrest of the first stage of labor, one of two options should be considered: should active labor be encouraged, or should attempts be made to slow or stop the contractions?

For either option, there are universal precautions: save your energy (no marathon shopping trips), eat as much as you can (even if it's only smoothies and toast - you will need the energy), and sleep if possible.

To encourage labor to progress, stay upright and walking if you can. Sway your hips - sitting on a birth ball or slow-dancing with your sweetie are great ideas. You may want to consider using nipple stimulation.

If you wish to try to halt the contractions, you need to relax. Sleep as much as you can. Take lots of baths or showers. Get a massage. You may not be able to stop the labor from progressing into active labor, but you will increase your chances of being a little more rested, and it will make a difference.

Prodromal labor can last for days. Its cause can be a complex combination of physical and emotional reasons. To avoid physical causes, do not be induced without a medical indication. Emotional work may be needed. Are you afraid of having your baby? Are you scared of what changes it will bring to your life, especially to your relationship? Are you afraid that your partner might leave you? Are you a single mom without a partner? It is time to work through these fears. It may help your labor to do so.

Sometimes new mothers will focus too much on early labor. This is not necessarily the same thing as real prodromal labor, which takes longer than usual to progress - though the same principle applies: the excitement of steady contractions can cause women to become exhausted, if they are focusing on the contractions and spending too much energy when labor is easy. If the contractions are not stopping you in your tracks or preventing you from speaking, you're very likely in early, early labor, and need to conserve your energy. Do not spend too much effort on these contractions.

If you gained nothing else from reading this, I hope that the main point that stands out is this: if you are in prodromal labor, you need to rest.

Going Overdue

By the end of pregnancy, you're probably ready to be done. You're huge, your belly is pendulous, you can barely sleep, and you have to pee every ten - no wait, every seven - minutes. Most women hope to deliver early, and these hopes soar in the last weeks.

Your due date arrives! And...it passes. No changes in your body, or your dilation, but your mood plummets.

Going overdue often makes pregnant women depressed. You are ready to be finished, prepared for labor, perhaps have family arriving to help with the transition, yet you are still pregnant. You might feel like a failure - after all, you aren't doing your job. No baby to show for your forty weeks of effort. If it goes on, you might feel that you will never go into labor.

If this is where you are, take heart. Forty weeks is an estimate, and your actual due date is an estimate too. Your baby will be born soon. Relax, do something fun, like go see a movie. Try to forget that you're pregnant (it doesn't help to dwell on it - thinking about labor will not cause it to occur any sooner - sometimes trying to forget that you're past your due date is good therapy). Your life will change dramatically very soon.

Avoid induction for arbitrary reasons. If you are more than a week overdue, you will need to be monitored by your OB to make sure that the placenta is functioning and the baby is doing fine. As long as everything is going well, do not be induced. There are complications associated with induction, especially in first-time moms, and you and your baby will be better off if you allow labor to start on its own. Your body will be better able to respond to labor, and you will know that your baby is full-term and ready to be born.

If you have family arriving and feel pressured to have a baby while they're in town, please readjust your priorities. Your baby has one chance to be born, and it should be as free from risk and complications as possible.

One word on how labor begins: The baby's lungs are the last organs to complete their development. Once they are mature, they release a protein, and that protein causes the release of other hormones that initiate labor. If you haven't gone into labor yet, it may be because your baby's lungs are not yet entirely ready. Hang in there. You will go into labor.

If you are concerned about the baby gaining weight, there is usually not cause to worry. Ultrasound weight estimates can be inaccurate by 2 lbs either way, on average. Most methods of estimating fetal weight tend to overdiagnose macrosomia (large babies). Do listen to your doctor, but keep in mind that it is ultimately your decision whether to be induced or not.

If you are overdue and there is no evidence of complications:

• Do not be induced. Labor will begin on its own when both you and your baby are physically ready.
• Do not dwell on your pregnancy. Do something fun. Try to forget you are pregnant.
• It is OK to take yourself off the radar for a while. Do not answer the phone or accept visitors, if you are feeling antisocial. You might want to change your voicemail message to say that you are still pregnant and doing fine. Take care of your emotional needs.
• Use the time to finish up any projects or arrangements you haven't yet completed. Make sure the baby's space is ready. Pack your birth bag. Do some cleaning (getting on your hands and knees to scrub a floor is especially helpful to get the baby in the right position for birth!). Or get some much-needed rest.

You WILL go into labor. This is a tough time for you, but no one is pregnant forever. And you won't be the first, I promise!

Updated to include this press release, dated 21 February 2008:

Lamaze International recommends that a woman allow her body to go into labor on its own, unless there is a true medical reason to induce. Allowing labor to start on its own reduces the possibility of complications, including a vacuum or forceps-assisted birth, fetal heart rate changes, babies with low birth weight or jaundice, and cesarean surgery. Studies consistently show that inducing labor almost doubles a woman's chance of having cesarean surgery.

— Lamaze International Press Release

The State of Birth Around the World

This is by no means a complete list. These are just some of the issues brought up in recent news feeds.

Japan. The current situation is that a low birth rate is driving many obstetricians out of business, leaving many women without needed health care. Maternity wards are closing. This is a sad dilemma. Japanese women have a low fertility rate, which means their needs for obstetrical care are limited. They are also having children later in life, raising the risks for a complicated birth, which has historically produced more lawsuits. Not many obstetricians are willing to work long hours in a highly-litigious career for average pay, and who can blame them?

Asia. The mortality rate for babies is dismal in southeast Asia, where fully one third of all neonatal deaths (that's death occurring within 28 days of birth) occur. "South Asia has the highest rates of newborn deaths in the world, next to Africa. In Afghanistan and Pakistan, for example, up to six percent of infants die in their first month." Probably the most helpful thing for these areas would be government emphasis on and funding for better health care systems.

India. Here, "a woman dies in childbirth every five minutes." From the UNICEF website: "The reasons for this high mortality are that few women have access to skilled birth attendants and fewer still to quality emergency obstetric care." Infant mortality is as high as 63 per 1000 births (for comparison, in the US, infant mortality is about 7 in 1000).

Scandinavian countries. Sweden and Denmark are the top two countries for maternal and infant health. More on Swedish maternity leave policies here.

Poland. With the high cost of health care in Poland, many pregnant women have been giving birth in border clinics in Germany, citing better health care. And, by the way, under the EU agreement, Germany pays for it. But not anymore.

Ireland. The cesarean rate has climbed drastically over the past 10 years, from 7.5% of c-sections being elective, to 45% last year.

No Alcohol is Safe During Pregnancy

Pregnant women told no alcohol at all in new guidelines

When I first saw this, I thought it was a new WHO or national guideline. Well, it is a new national policy, but it's new for New Zealand, not the US. Too bad.

I remember being pregnant with my first baby and attending a work function where alcohol was served. I asked for a root beer instead, and someone near me misunderstood me. "You can't drink!" she said, pointing at my swollen belly. I said, "I'm not! I ordered a root beer."

"One drink is ok during pregnancy," another girl said.

"No, it isn't," I said. "I don't think any alcohol is ok during pregnancy."

The first girl suddenly got defensive. "Well, then, you shouldn't be drinking that soda either, for that matter."

Well said, ex-coworker. Sodas should be taboo during pregnancy also, especially caffeinated ones.

I know one pregnant woman who wanted her Pepsi so bad that she changed OBs until she found one who told her that it was ok to drink as much Pepsi as she wanted during pregnancy.

No matter its source, caffeine has been linked to low birth weight, prematurity, and fetal death.

Ingesting high levels of sugar while pregnant may cause gestational diabetes or birth defects.

Pregnant ladies, stick with your vegetables, fruit, and whole grains. Drink only water. Move your body. Take good care of yourself and your growing baby. Everything you do, everything that happens to you, affects your baby, just as everything you do affects you.

What the WHO Thinks of Midwives

Selections from this article:

Evidence shows that midwives are vital to preventing the estimated 529,000 maternal deaths and 8 million illnesses that occur each year during pregnancy and childbirth. In countries as diverse as Malaysia, Sri Lanka, and Tunisia, investments in training, recruiting and retaining midwives, as well as in emergency obstetric care, have reduced maternal death rates. The lives and health of many millions more would be saved with greater investments in midwives.

UNFPA (United Nations Population Fund) and ICM (International Confederation of Midwives) call for urgent action to address the shortage of midwives if the world is to achieve the international development goals of improving maternal health and reducing child death. The World Health Organization estimates that at least 700,000 more midwives are needed to curb maternal death and illness.

"A strong midwifery profession is the key to achieving safer childbirth, and all women should have access to a midwife," said Kathy Herschderfer, the Secretary-General of the ICM.

"Midwives...transcend the levels of care within health systems, and are essential to the continuum of care during the childbearing cycle."

UNFPA and ICM are working together to strengthen midwifery capacity worldwide to reduce the high levels of deaths and disability among mothers and babies. They are cooperating to promote the professionalization of the midwifery practice, to improve national midwifery standards and to help countries scale up community-based midwifery practice.

ICM, the heart and voice of midwives across the world, was founded in 1919. It is a Confederation of 88 midwifery associations from 75 countries. Its mission is to advance worldwide the aims and aspirations of midwives in attaining improved outcomes for women in their childbearing years, their babies and their families, wherever they reside.

UNFPA is an international development agency that promotes the right of every woman, man and child to enjoy a life of health and equal opportunity. UNFPA supports countries in using population data for policies and programmes to reduce poverty and to ensure that every pregnancy is wanted, every birth is safe, every young person is free of HIV/AIDS, and every girl and woman is treated with dignity and respect.

Should men be banned from the delivery room?

This article is from a survey taken by The Royal College of Midwives (love that name!) in the UK. I know, it's trying to be inflammatory. Most of the article ("research") is anecdotal - meaning it's based on a few experiences and not on much actual reliable research - and isn't worth much. But it raises a good question.

I don't think men should be banned from the delivery room. I think, though, that it should be up to the couple to decide, and that men should face no social (or family) stigma if they determine that the man will not attend the birth.

The only problem with my theory: it's anecdotal. It's based on two experiences. OK, maybe three.

The first is my own. My husband, after being by my side throughout twenty hours during my first labor, didn't feel the need to be present for the second one.

I objected to this idea, until I attended a birth as a doula where the husband didn't want to be there at all. It was their third child. He sat in a chair and looked green for most of the labor, and during the delivery he was detached and sickly. I realized that he was not contributing anything, and if anything his reaction detracted from the loveliness of the atmosphere. To me birth is sacred, but if anyone in the room disagrees with that premise, the entire birth team is affected. He wanted to stay at home, and he probably should have.

My husband did attend the birth of our second child, and I am glad he did. Though after that doula experience I didn't think that his presence was required, I felt more supported by him than anyone else, whereas at the first birth I wasn't able to really distinguish one person's support from another's.

But if he truly had not wanted to be there, I would not have demanded it of him.

In another birth situation I witnessed as a doula, the husband watched TV the entire time. His wife, rendered speechless by the strength of her contractions, reached for his hand but he didn't notice. This went on for a few hours.

"Birth is a fundamentally female event." It is difficult to argue with that statement.

If men are required by their women or by society to be there during labor and delivery, well, why should that be the case? What benefit does it give to women if the man is not going to be supportive? Certainly if he's going to turn green and wish the entire time that he didn't have to be there, it would be better to let him be somewhere else.

"A woman who says she prefers not having her partner in the delivery room is doing so to protect him, because she thinks he can't handle it. Why oh why do women keep on treating men like children? And why oh why do men keep on acting as if they were?"

Not all men are the same. Some can handle nearly anything, while others get nauseous by the sounds and smells of childbirth.

"Conception, reception - if you're there for one, you should be there for the other."

Not so! Bad logic! Bad! That's the "you-did-this-to-me-and-you-must-be-made-to-suffer" mindset.

"I think men should be allowed in the delivery room if they want to be - it is an experience not to be missed: very emotional. Unlike watching it on film, you don't tend to notice the blood and mess when it is actually happning before your eyes. However I do think they should stay in a corner out of the way and should not be made to feel guilty if they change their mind and want to go out. The best person to be present is a woman who has been through it.

The best place for a man is actually right outside the door within earshot. That way they don't get in the way but will still know how much the woman has gone through and will be more sympathetic afterwards.

I had my first in hospital and my husband was at home. He expected me to be up and about and cooking the meals immediately afterwards. I had my second at home and he heard everything despite not being in the room and he looked after me better."

First of all, it is a very different experience to watch someone give birth and to give birth yourself. When you are delivering a baby, you don't notice the blood and mess, but when you are watching another person, you certainly do, along with all the smells and unusual sights. That is one of the main objections that the husband of my client had: birth is gross. Sometimes it is. If the man wants to be involved, he should be, and not "put in a corner" to stay out of the way. I doubt there is ever reason to worry about giving too much support to a laboring woman.

"The best person to be present is a woman who has been through it." Amen, amen.

I didn't agree with having men hear the labor so they can understand what their women are going through, but based on her experience, it sounds like it was a good thing. Each man is different. I think that most wouldn't assume that women are exaggerating about the ordeal of birth, but maybe I'm wrong about that. It is work. Sometimes it is very painful. And women tend to want all the sympathy they can get.

And that right there is why men should not ever be banned from the delivery room.

Absence of Tens

...as in ten centimeters

This may be anecdotal, but I have witnessed and heard of a number of women who do not progress beyond nine centimeters. I'm not sure why. I have heard of first-time and experienced moms who stay dilated to 9 for hours. One client of mine was at 9 cm for 10 hours before she ended up having a c-section (there were other complications at this birth).

I have a number of theories, but I'm not sure how to find out if there truly is a common cause:

• lack of movement/activity: too much laying in bed prostrate doesn't help the baby's head apply pressure to the cervix and aid dilation;
• posterior baby: wrong birthing position and the baby is unable to rotate because of mom's failure to be upright and moving around (see above);
• interventions (like epidurals) given too early, interrupting labor's progress, and dilation doesn't occur because of uterine exhaustion.

I don't know what the reason is, but I have heard of more and more moms who don't progress past 9 cm and never feel the urge to push.

...as in TENS unit

In many childbirth books and resources, references to TENS units abound. TENS stands for Transcutaneous Electrical Nerve Stimulation. It is a small machine that delivers electrical currents through wires to specific places on the back, and the sensation tends to block the perception of deeper pain (like a labor contraction) and causes the body to release endorphins (natural painkillers). It does not alleviate all of the discomfort, but usually helps to significantly reduce the sensation of pain.

There is no documentation of side effects, and the machines can be small enough to carry in your palm. As far as I can tell, there is also no restriction of movement, though the unit would of course need to be removed for labor tubs or shower use. They are often used for physical therapy and to alleviate the pain of arthritis and fibromyalgia.

However, I have never heard of a US hospital employing the TENS unit for labor. I have never seen one, nor have I heard of anyone personally who has used this method.

Why not??

No side effects, freedom of movement, pain relief...why not?

Hypnobirthing might be dangerous, but we aren't sure why...

Article here.
The New York Times on Thursday examined hypnobirth, a childbirth technique that does not use drugs to control pain but instead uses a combination of relaxation, breathing and visualization techniques to control pain, according to Linette Landa, a hypnobirth teacher. According to the Times, "hypnobirthing" is meant to relax women through contractions so "that there is no screaming to tire the mother or alarm the baby, and labor is shorter." The American College of Obstetricians and Gynecologists allows physicians to decide whether they will permit hypnobirth, and, although many hospitals permit the technique, some physicians have concerns about the process, the Times reports (Olson, New York Times, 4/27).

Very strange. I wonder what the concerns are? Why not "permit" hypnobirthing? I checked out the New York Times article, and it became stranger, and scarier:

While many hospitals now permit hypnobirth, doctors are wary because they fear litigation. The American College of Obstetricians and Gynecologists leaves it up to the individual doctor's judgment.

Oh, of course. Because they might get sued for something.

Such techniques are not a surefire way to avoid pain, but rather "adjuncts and not the end-all to birth," said Dr. Jeffrey M. Segil, an obstetrician who offers the HypnoBirthing option to every patient in his practice in Dover, N.H.
"Women should not be set up to feel that they've failed if they can't follow through to a totally natural delivery," he said.

Don't even bother to set goals, pregnant ladies, if you aren't completely sure that you can reach them.

It doesn't work for everyone: Jennifer Richards, 29, said she gained self-confidence from hypnobirth methods, but had an epidural because of the intense back pain during her 30-hour labor.

I have said many times before that with back labor, all bets are off. But that might just be me.

I have so many questions about this that I don't know where to begin.

• What's wrong with learning relaxation techniques? Why does that have to be equivalent to setting oneself up for failure? What about women for whom epidurals have no effect - aren't they also in danger of relying on "adjuncts and not the end-all to birth" by planning on using methods that might not work?
• Why isn't this decision left up to the mother instead of the "individual doctor's judgment"?
• What potential litigation are the doctors really worried about?

Seems like we could do more good helping the childbearing women in other countries than worrying about whether or not hypnobirthing is going to mysteriously make something go wrong.

I Swear I Am Not Making This Up

Obstetricians are using a pregnant robot to practice attending births.













Named Noelle, the gestating automaton, hooks up to a laptop and can approximate breech births and failure to progress. It can be given IV fluids. The baby robot can be programmed to be born healthy and pink or blue and not breathing.











With this amazing innovation, doctors can practice cesareans, instrument delivery, suturing...

...and they never have to see the natural pattern of undisturbed birth, progressing on its own.

When I heard about this, my first thought was, Why? Is any obstetrician lacking in human births to attend? Is any OB short of practice regarding medical interventions?

We are getting farther and farther from knowing what normal birth looks like. Whatever situations our plastic-and-metal friend Noelle can imitate, undisturbed childbirth allowed to progress on its own, remains a mystery to those in medical training.

No one is asking me. But I think that obstetrical training should involve rotation through a homebirth practice. Just so they know that birth can be left alone and turn out well, so they know that women can give birth without medical assistance.