An absolutely stunning birth slideshow

This is absolutely beautiful. I love how it captures the work and anguish of birthing a baby and then the ecstasy of holding that live, healthy baby--the delicious fruit of all that labor. It's extremely well done. Makes me wish I'd had a professional photographer at my babies' birth to capture such extraordinary moments!

"Staying Home: Why and What If?"

I found this great post on another birth blog that answers the questions of "Why homebirth?" and "What if something happens? " She articulates so well the very same reasons I chose homebirth and how I dealt with my questions and fears of "what if something goes wrong?"

"I’ve been planning a few Q&A posts to answer questions I am frequently asked. This first post will examine two questions that tend to come together. How did you decide to have your babies at home? What if something happens?

The answer to the first is fairly short, but needs some explaining. I decided to have my babies at home because statistically, it is the safest place to give birth. Though I enjoy stories, opinions and philosophies of childbirth, I’m more of a numbers person when it comes to making decisions that impact my health or that of my children. I’ve spent a fair amount of time looking at research on childbirth statistics and outcomes. Interestingly, every study out there shows that midwife-attended homebirths have better outcomes compared to hospital births.
Better outcomes outside of the hospital? How could that be? What if something goes wrong? It is true, there are risks involved with homebirth, but there are also risks involved with hospital birth. The most recent and largest (to date) study examining the two was published by the British Medical Journal (BMJ) in 2005. The conclusion? Planned home birth for low risk women using Certified Professional Midwives was associated with lower rates of medical intervention and no higher likelihood of death than that of low risk hospital births in the United States." This was an important piece of research because it is the largest homebirth study that also matched women for risk (meaning the hospital births were of low-risk women who would have qualified for birth at home).
This may not make sense at first, especially with all of those emergency cesarean stories we've all heard. With so many emergencies, how could it be safer to birth outside of a hospital? Pay attention, the next time you hear one of those stories, chances are, the emergency was preceded by an intervention of some sort. Common examples: Labor wasn't going quickly enough so we started pitocin and then the baby crashed and we needed and emergency cesarean. After they did several internal exams and broke my water (both increase the likelihood of infection), the mother got a fever and the baby's heart rate sky-rocketed so we needed an emergency cesarean. She got an epidural and the baby’s heart rate dropped. They put on an oxygen mask, gave her a shot of something and had her rolling from side to side, but the baby didn't recover and we needed an emergency cesarean. Hearing story after story like that, hospital birth does sound dangerous.
But sudden reactions to medications and invasive procedures don't exist at home because the medication and procedures that cause them are not used in the first place. In the absence of medical intervention, the majority of complications in childbirth arise slowly with plenty of time to notice them and seek medical care, if necessary. Common examples: The baby gradually becomes less tolerant of labor. Labor is prolonged and the mother begins to wear out. When non-emergent complications do arise at a homebirth, a skilled midwife can help resolve them through a variety of non-medical techniques; she can also provide some medical treatments like, oxygen for neo-natal resuscitation or drugs to manage hemorrhage. In the rare event that a complication cannot be handled at home, she has a transport plan and will recommend transfer to a hospital (in the BMJ study 12.1% of the homebirth group transferred to the hospital, but less than half of a percentage of women had urgent transfers).
Looking at the BMJ study, the effectiveness of this gentle approach to complications was clear:Induction or Augmentation of labor (with pitocin or prostaglandins) 4.8% vs. 39.9%Episiotomy 2.1% vs. 33.0%Cesarean Section 3.7% vs. 19.0% (it is worth mentioning that the national cesarean rate is now over 30%)
With so many risky interventions at hospitals and no improvement in outcomes, many women planning hospital births also like to "stay home as long as possible" to reduce the likelihood of unnecessary intervention. I guess my preference is to stay home as long as possible too. I just prefer to do it with a skilled attendant present to catch any signs of trouble. If my midwife recommends transferring or I just feel I would rather be at a hospital, I can always go. But if not, staying home as long as possible turns into just staying home.
As I ponder homebirth, privacy, comfort, support, convenience and a positive birth experience have been nice perks, but they are not the reason I stay home. I stay home because I know the risk of death is the same in or out of the hospital, but the risk of injury, infection and intervention are significantly lower at home. I prefer my body and my baby to be uninjured, uninfected and left alone and that is why Johannes and Willem were born at home.
You can learn more about midwives and homebirth here. Full results of the BMJ study."

Another Reason to Avoid an Epidural

I was reading a post on Optimal Fetal Positioning on a blog called "Doula momma." Because of her own baby's malpresentation that resulted in an emergency c-section, this woman subsequently did lots of research on fetal malpresentation with the intention of avoiding such a situation again. She learned many things she could have done differently such as better nutrition, regular exercise and proper posture. These things I already knew about, but what was most interesting to me was a research study that a reader sent her that found that epidurals significantly increased the rate of malpresentation.

Here's the conclusion of the study: "Significance for Normal Birth: Epidural use increases the risk of instrumental (forceps or vacuum) delivery in first-time mothers. Experts have proposed various reasons for this association, including diminished urge to push and changes in the tone of the pelvic floor muscles that inhibit proper rotation of the fetal head. Letting the epidural "wear off" has been thought to increase the likelihood of unassisted vaginal birth, however, this systematic review calls into question that common practice.

In normal birth, there are complex hormonal shifts that help labor progress and facilitate delivery. The laboring woman produces natural endorphins that help her manage the pain of labor. Her ability to move freely and assume a variety of positions while pushing work in concert with these hormonal changes. Epidural analgesia numbs the sensations of birth, and the production of natural endorphins ceases as a result of the disruption of the hormonal feedback system. When the epidural is discontinued, the woman's pain returns but her natural endorphins may remain diminished and therefore her pain may be greater than if the epidural had not been given in the first place. Furthermore, when an epidural is administered, the woman is usually confined to bed and attached to fetal monitors and an intravenous line. The woman and provider may become accustomed to laboring in the bed attached to machines. When the epidural is discontinued the restrictions! on her movement may persist. Under these conditions, it is likely that the impact of an epidural on normal birth may outlast the epidural itself."

Two of my own conclusions: First, given that most women giving birth in the hospital receive epidural anesthesia, it makes sense to me that this could be one very common reason so many women are having malpositioned babies that result in "failure to progress" and the subsequent c-section.

Second, every pregnant woman needs to learn during her pregnancy how to encourage her baby to be in the optimal position through proper nutrition, exercise, and posture. It's really sad that not only do most OB's never discuss this with their patients, they probably wouldn't even know what to tell their patients if they wanted to, as this woman learned when she researched what OB's learn at medical school in relation to OFP. (Another plug for Hypnobabies: the classses and the homestudy manual go in depth on how to encourage OFP. ) Check out Doula Mamma's post to learn more. It's very informative.

Make a Smilebox slideshow

OK, so this is kind of a repeat, but the first one came out pixelated, so I just had to improve upon it. =)

Another Blog Discovery

I've come across a very interesting blog called Man-Nurse Diaries. He's a student neuro-trauma nurse in Chicago and a father of four children, all born at home. He recently posted an eye-opening account of a woman who almost bled to death from a cesarean. He points out how today's medical community seriously downplay the risks of this major abdominal surgery while overplaying the risks of VBAC and vaginal breech delivery. It's a must-read.

In another recent post he writes about the homebirth debate. My favorite part is where he discusses the ridiculousness of the current obstetric system in the US where healthy, low-risk women see specialists (obstetricians) for pregnancy and birth. Here's a great quote:

" It seems inefficient to train physicians for years to achieve a high level of emergency obstetric skill, in order to attend births which generally don't require any of those skills. I think this artificially raises the intervention rate on normal births (as a doc said the other day at work, when all you have is a hammer, everything looks like a nail), as well as ill side effects of those interventions. Not only would it lower the intervention rate and probably make birth safer if we handed normal births over to midwives, but it would be a better division of labor and resources. Critical care physicians don't spent 95% of their time seeing healthy adult patients in a family practice clinic. Medicine has already divided critical care from family practice in order to become more efficient and provide more appropriate care. So I don't see why critically-skilled obstetricians devote their time to the 95% of births which are normal and uncomplicated. And no insurance company would pay for you to go see an intensivist if you're healthy and just have the common cold. If insurance companies weren't paying all women to get high-tech obstetric care, my insurance premiums would probably be lower.

Dividing labor (pun intended) between emergency/high-risk obstetrics and midwifery would also produce a better integration between the two, which would be better for those of us (like my wife) who do home birth. There's no reason on earth why most women can't birth at home. There's also no reason why women who choose to birth at home should be treated like second-class patients if they do require emergency obstetric skill. I'm sure if I ever have to transport my wife, even if it's to a hospital I work at, we'll be treated like we have three heads. It's a shame. But I don't think good, patient-friendly integration will ever happen if obstetricians (and their hospitals) are fighting with midwives for the same market. "

Very good points indeed!