Thursday, September 30, 2010

Experience Watsu

There is nothing more earthbound than a heavily pregnant woman. Waking or sleeping, she feels more and more weighed down as she slowly plods through the last weeks of pregnancy; her belly swollen with baby and amniotic fluid.

Now imagine the same woman stepping into a pool of warm water and floating, weightless. Her eyes are closed as light and shadows play across her eyelids. Her ears are submerged, so only muffled sounds can be heard. She is cradled in the supportive arms of another, who gently rocks her to and fro to the rhythm of her own breathing. The baby floats submerged within her womb in the warm, dark amniotic water, gently cradled within the mother’s pelvic bones. They are one, together, weightless and free. Their energy flows freely and all tension about the impending birth drifts away. The mother-to-be achieves a deep level of peaceful relaxation, entering an altered state; bliss. This is a state through which the journey of natural birth is much more possible. Floating somewhere between dreaming and wakefulness the mother-to-be feels her body gently letting go, stretching, lengthening, opening and releasing.

This is water massage, a unique form of bodywork also known as water shiatsu or Watsu. Invented in 1980 by Harold Dull, it combines elements of massage, joint mobilization, shiatsu, muscle stretching and dance. Its therapeutic benefits are for everyone and can bring new life into long neglected muscles, joints and ligaments.

As a birth professional I have witnessed the amazing benefits specifically for pregnant women. They go beyond relieving the typical aches and pains of carrying a baby to term. Watsu combines the deep breathing of the Bradley method, the trance state of Hybnobirthing and the gentle stretching of prenatal yoga within the weightlessness of water. Requiring no intellectual effort on the mother’s part water massage frees both her body and mind to prepare to birth confidently. As a doula, I have held many women in my arms during labor, so I find Harold Dull’s goal particularly poignant; “a world where everybody holds and floats each other in their arms.”

To experience this amazing technique connect with kinesiotherapist Kay Heaton:

To see prenatal Watsu for yourself visit:

Monday, September 27, 2010

A Cultural Perspective on Mothering

African Mother by Denise Cummings

Below is a beautiful piece on mothering from an African perspective. It is filled with wisdom. The author, a mother from Kenya, reminds American women that we need to slow our lives down when we have a baby and get back to the basics of mothering. How does this woman become so wise? By following the wisdom of her grandmother. Woman to woman; generation to generation women learn everything they need to know from each other. When we go off the path our babies are quick to tell us if we will only use our hearts to listen.

Why African Babies Don't Cry:An African Perspective
by Claire Niala
A mother, osteopath & writer based in Nairobi, Kenya

I was born and grew up in Kenya & Cote d'Ivoire. Then from the age of fifteen I lived in the UK. However, I always knew that I wanted to raise my children (whenever I had them) at home in Kenya. And yes, I assumed I was going to have them. I am a modern African woman with two university degrees and I am a fourth generation working woman - but when it comes to children, I am typically African. The assumption remains that you are not complete without them; children are a blessing it would be crazy to avoid. Actually the question does not even arise.
I started my pregnancy in the UK. The urge to deliver at home was so strong that I sold my practice, setup a new business and moved house / country within five months of finding out I was pregnant. I did what most expectant mothers in the UK do - I read voraciously: Our Babies, Ourselves, Unconditional Parenting, anything by the Searses - the list goes on. (My grandmother later commented that babies don't read books - and really all I needed to do was "read" my baby). Everything I read said that African babies cried less than European babies. I was intrigued as to why.

When I went home I observed. I looked out for mothers and babies and they were everywhere (though not very young African ones - those under six weeks were mainly at home). The first thing I noticed is that despite their ubiquitousness it is actually quite difficult to actually "see" a Kenyan baby. They are usually incredibly well wrapped up before being carried or strapped onto their mother (sometimes father).

Even older babies already strapped onto a back are then further protected from the elements by a large blanket. You would be lucky to catch a limb, never mind an eye or nose. It is almost a womb-like replication in the wrapping. The babies are literally cocooned from the stresses of the outside world into which they are entering.

My second observation was a cultural one. In the UK it was understood that babies cry - in Kenya it was quite the opposite. The understanding is that babies don't cry. If they do - something is horribly wrong and must be done to rectify it immediately. My English sister-in-law summarized it well. "People here" she said "really don't like babies crying, do they?"

It all made much more sense when I finally delivered and my grandmother came from the village to visit. As it happened - my baby did cry a fair amount, and exasperated and tired, I forgot everything I had ever read and sometimes joined in the crying too. Yet for my grandmother it was simple - nyonyo (breastfeed her!). It was her answer to every single peep.
There were times when it was a wet nappy, or the fact that I had put her down, or that she needed burping that was the problem, but mainly she just wanted to be at the breast - it didn't really matter whether she was feeding or just having a comfort moment. I was already wearing her most of the time and co-sleeping with her, so this was a natural extension to what we were doing.

I suddenly learned the not-so-difficult secret as to the joyful silence of African babies. It was a simple needs-met symbiosis that required a total suspension of ideas of "what should be happening" and an embracing of what was actually going on in that moment. The bottom line was that my baby fed a lot - far more than I had ever read about anywhere and at least five times as much as some of the stricter feeding schedules I had heard about.

At about four months, when a lot of urban mothers start to introduce solids as previous guidelines had recommended, my daughter returned to newborn style hourly breastfeeding. She needed hourly feeds and this was a total shock. Over the past four months the time between feeds had slowly started to increase. I had even started to treat the odd patient without my breasts leaking or my daughter's nanny interrupting the session to let me know my daughter needed a feed.

Most of the mothers in my mother and baby group had duly started to introduce baby rice (to stretch the feeds) and all the professionals involved in our children's lives - pediatricians, even doulas, said that this was OK. Mothers needed rest too, we had done amazingly to get to four months exclusive breastfeeding, and they said our babies would be fine. Something didn't ring true for me and even when I tried (half-heartedly) to mix some pawpaw (the traditional weaning food in Kenya) with expressed milk and offered it to my daughter - she was having none of it.

So I called my grandmother. She laughed and asked if I had been reading books again. She carefully explained how breastfeeding was anything but linear. "She'll tell you when she's ready for food - and her body will too." "What will I do until then?" I was eager to know. "You do what you did before, regular nyonyo". So my life slowed down to what felt like a standstill again. While many of my contemporaries marveled at how their children were sleeping longer now that they had introduced the baby rice, and were even venturing to other foods, I was waking hourly or every two hours with my daughter and telling patients that the return to work wasn't panning out quite as I had planned.

I soon found that quite unwittingly I was turning into an informal support service for other urban mothers. My phone number was doing the round and many times while I was feeding my baby I would hear myself uttering the words, "Yes, just keep feeding him/ her." "Yes, even if you have just fed them" "Yes, you might not even manage to get out of your pajamas today" "Yes, you still need to eat and drink like a horse" "No, now might not be the time to consider going back to work if you can afford not to". "It will get easier". I had to just trust this last one as it hadn't gotten easier for me - yet.

A week or so before my daughter turned five months we traveled to the UK for a wedding and for her to meet family and friends. Especially because I had very few other demands, I kept up her feeding schedule easily. Despite the disconcerted looks of many strangers as I fed my daughter in many varied public places (most designated breastfeeding rooms were in rest rooms which I just could not bring myself to use), we carried on.

At the wedding, the people whose table we sat at noted, "She is such an easy baby - though she does feed a lot". I kept my silence, then another lady commented, "Though I did read somewhere that African babies don't cry much." I could not help but laugh.

My grandmother's gentle wisdom:

  • Offer the breast every single moment that your baby is upset - even if you have just fed her.
  • Co-sleep. Many times you can feed your baby before they are fully awake, which will allow them to go back to sleep easier and get you more rest.
  • Always take a flask of warm water with bed to you at night to keep you hydrated and the milk flowing.
  • Make the feeding your priority (especially during growth spurts) and get everyone else around you to do as much as they can for you. There is very little that cannot wait.
  • Read your baby, not the books. Breastfeeding is not linear - it goes up and down (and also in circles). You are the expert on your baby's needs.

Reading this reminded me of something that happened years ago when my son was just a few months old. I was already back to riding and training horses, as well as, teaching lessons. I would take him with me and teach as I carried him around in a Snuggly. I was determined to continue my professional horse life and be a mom, i.e. super woman you can do it all.

One day I was teaching a young girl at her home on the Mesa. Joe began to cry and nothing I did would make him stop. He didn't want to nurse. He didn't need his diaper changed. He didn't need a nap. So I ignored him, raised my voice above his cries and valiantly kept teaching.

After a while my young rider's mother came out of the house carrying a baby blanket. She was a vastly more experienced mother having had many children by then. She calmly said, "I think your baby doesn't like the wind" and began tucking the blanket over his head and stuffing it into the sides of the Snuggly sack creating a warm little cocoon. It was magic. His cries immediately stopped and he opened his eyes and calmly peered up at me. His face quite clearly said, "Thank goodness somebody came along who knows something about babies!" Along the way I learned so much from so many women more experienced in motherhood than I. I am forever in their debt.

Do you have a story of an experienced mom helping a young mom? I would love to post it. E-mail me at

This article appeared on The Natural Child web site. A wonderful on line resource for new parents at:

Wednesday, September 15, 2010

A Chance to Do Something I've Never Done Before or Is this What it is Like to be a Nurse?

One morning recently I was getting ready to go to a La Leche League meeting when the phone rang. It was another doula, a friend, and she needed some help.She was stuck at an airport far away and one of her client's had just called to say her water had broken. Unfortunately her back up doula had been at another birth all night. Would I go to the birth? Of course! My friend said she would connect with her birth client and let them know I would be calling.

So as I pulled my pick up truck onto the freeway in Pismo Beach I answered a call back from the dad. He was fairly calm. We discussed how mom was doing. He said she was in labor but handling contractions well. I asked if he wanted me to come right over to their place? No, he thought I should go on to my LLL meeting as planned. I asked if I could talk to her? When he took the phone to her I could hear the labor sounds she was making; a deep breathy moan. Hmmmm...I'm thinking. Then dad came back on the phone and said she couldn't talk now. Hmmmm...I'm thinking. He said he would see me when the meeting was done. I drove towards SLO I'm thinking that didn't sound like a mom in early labor. Hmmm...My gut said I don't think you're going to League today. So I drove past SLO and on over the grade to their place.

Driving down their windy country road I wondered what this would be like. I had never supported a woman I had never met. Usually I have spent many hours with my moms sitting in their homes, chatting, educating, answering questions, calming fears, instilling confidence and creating relationship. As the birth nears I become a unique blend of confidante, experienced guide, friend and mother hen. So I wondered what would this be like? Could I be effective? Would she respond to me, a total stranger?

When I pulled into their driveway dad came around the corner with a puzzled look. I introduced myself and he visibly relaxed. He took me to the sunny deck where mom sat leaning back in a chaise lounge looking very uncomfortable and obviously contracting. After the contraction subsided I introduced myself and told them their doula was very sorry she couldn't be there with her. Then we got down to business.

I suggested she would be more comfortable in a different position. Could I help her move? After getting her into a leaning forward position I began to gently rub her shoulders as I assessed where she might be in her labor by the rhythm of the contractions, her response to them, her flushed face and unfocused eyes. I thought either this was going to be a long difficult posterior labor or things were moving very quickly.

"When had she last been to the bathroom" I asked? "Could she try to do that with me?" We slowly worked our way through the sliding glass door and into their bedroom. From the deck across their bedroom to the bathroom counter was 3 contractions. We never made it past the bathroom counter. Leaning onto its' smooth surface with me giving sacral counter pressure she swayed and moaned and contractions flowed through her like a torrent.

I turned to dad and calmly asked when he had spoken to their midwife and what she had said. He informed me that she said she would come some time this morning and check how things were progressing. I instructed him to call her again and tell her I said it was time to come. He left the room.

Alone together my hands sent waves of quiet calm into her being. Then I felt her knees begin to buckle with the power of her contractions. Her body was being lead in the primal birth dance, rocking, swaying, head rolling, opening to the flood of sensations that would bring her baby. Having been a birth dance partner for many women I could sense where we were in our journey together, so I was not surprised when I heard her give a soft grunt with the next contraction letting me know her uterus was pushing.

Dad came in and I inquired what the midwife had said. "She's on our road" he announced. "and will be here any minute." I breathed a sigh of relief. I am a doula not a midwife. I am not trained in catching babies. I have non of the necessary equipment. A few contractions later the midwife walked in, assessed what was going on and calmly went into action readying her supplies, talking to the mom and dad and smoothly stepping into the primary support role.

Usually a midwife has a trained assistant but it was clear to us that this baby wasn't going to wait for an assistant to arrive. As best I could I worked with the midwife, getting supplies, holding things, and handing things, while at the same time talking to the mom to give her confidence in her abilities to birth her baby, taking photos, and guiding dad into positions where he could remain a connected part of the process. Very soon a beautiful baby girl emerged into this world and into her moms waiting arms, healthy and happy.

I continued in my new dual role during the mother's repair and clean up, alternately fetching for the midwife, stroking mom's hair, taking more photos, cleaning up their rug, putting their towels in the washing machine. Finally it was time to go. Mom, dad and baby were in bed glowing and in love. Food and drink were at hand, family was arriving. They thanked me once again for being there, for not listening to dad's suggestion to go ahead to the League meeting and for everything I had done. Then I walked out of their door.

It has taken me weeks to process this new experience. I still don't know why she listened to me. Why she willingly followed my every suggestion. Why did she have confidence in me?

Is this what it is like to be a labor & delivery nurse? You walk into a room with people you don't know and yet you need to be able to guide them during one of the most intimate and intense moments of their lives. You have to assess where the laboring woman is in the process in order to call the doctor or midwife to come in time for pushing. When they arrive you have to support the mom at the same time playing step and fetch it for the doctor. When it's all done the family walks back out of your life and the connection is broken.

I can tell you I have worked along side some excellent labor nurses. Women that have known how to seamlessly flow from one role to another. The best ones are able to instill confidence and a sense of caring within minutes of entering the room. They are able to enter a room without disturbing its' energy or the rhythm of the labor. They listen to the mother as she progresses through labor and will try to encourage the doctor or midwife to honor the mother's wishes for her birth. Apparently I have learned a lot from these wonderful nurses.

Of course I have learned just as much from struggling with nurses that do not have an aptitude for being with birthing women. They don't generate the right kind of energy for laboring with a woman.

A good doula or nurse needs to be able to emanate confidant guidance without taking control. Their presence needs to create a sacred space in which the woman feels secure to birth. They become the mother's sanctuary in the storm. Now I know this can happen within minutes of meeting if the labor guide brings an open & intuitive heart to the birth.

Monday, September 13, 2010

A Quick Homebirth

Baby's First Latch
I love catching this precious moment on film. Welcome Desiree!
Born on 8/9/10

We never know how birth will go. At classes we try to prepare first time parents for the idea that things can go very quickly, the 50 yard dash babies, or very slowly, the marathon babies. Accepting whatever you are experiencing and going with the flow is the important thing. If a couple is having a fast birth the dads are often left one step behind because they were mentally preparing for a marathon. When the baby arrives they are astounded! It's done? The babies here? How can that be?

Desiree James was born at home one unassuming Monday morning. Daddy went off to work. I mentioned that I was feeling "A little uncomfortable". Two short hours later my water broke and I called him back. I laboured quickly. Like Superwoman, Jennifer arrived and gave us the leadership and support we needed. I was having surges so closely together that my partner was unsure of how to help me. Jennifer immediately helped us into a more suitable birthing position. She used her calming voice and loving hands to ease our labour and reassure our progress. What a magical day it was. We had our baby girl in our arms, and all in the comfort of our own home. Thank you Jennifer for your professional and loving care!

There is nothing sweeter than being able to tuck a mom, dad and baby into their own bed after the birth is done. Leaving the house cleaned up, food available and supportive family at the ready feels just right. I'm a believer in what Dorothy said, "There's no place like home. There's no place like home. There's no place like home."

Friday, September 10, 2010

The Challenges of Being in Labor While Being a Mommy

I love this humorous account of a local homebirth. The humor comes from her no nonsense down to earth truth telling about the challenges of laboring and mothering at the same time. This is one of the difficult parts of having another baby. Women don't get the luxury of stopping motherhood while pregnant, birthing or recovering. No matter how many times I tell my experienced moms to have things arranged so you can drop everything, including your older child/children and zoom to the hospital I always arrive there before them! And then there is the issue of assuming this birth will be like the last birth; right? Enjoy Kelly's story!

Our little Alubia (bean in Spanish) was born on Aug.27, 2010; weighing 6 lbs 14 oz and measuring only 18 ¾ inches. She’s soooo small, but so cute. She has a full head of black hair and adorable chubby cheeks. We have named her Maui (Maria Luisa) and sometimes manage to NOT call her Alubia. Thanks, Maui, for the name.

Her birth story is very different than I imagined it would be, but it is still perfect (well, mostly). It turns out this labor stuff is complicated and having had a child only makes it more complicated. Who knew? This is the way things are supposed to be with a second birth: 1) The mother should know when labor starts. 2) The mother should remain calm during labor, because after all, she’s done this before and should be able to relax and breathe correctly. 3) The first child is NOT supposed to randomly start vomiting once labor starts and need his daddy. 4) The mother should be able to handle labor just fine if the father is temporarily needed by the older child. You know, the !Kung women only have birth attendants with their first child. After that, they go into nature and give birth alone and walk back to the village. So what’s a few contractions with no hubby, right? Well, none of that worked out well for me. And, I’ve also found out that the fact that everybody says that second labors can progress rapidly once they actually begin actually has a bit of a negative spin. They can take forever to “actually begin” and you should probably simply store your birth personnel (midwives, doulas, babysitters) in the garage or office or something so that everyone is ready to go right when you need them.

So here’s how it started. Wednesday at noon, I went to put Xavi down for his nap, but just couldn’t. I had absolutely no way of keeping my eyes open. So I pulled out a comforter and pillow and lay down on the floor and tried to convince him to nap with me. No such luck. Under those circumstances, he wants to lay on top of you with you on your back and I just couldn’t do it while pregnant. Finally, I texted Eneko to come and put Xavi down for his nap. He did and then returned to work while I went and laid down. And then started vomiting and having very continuous Braxton Hicks contractions and feeling like I was going to die. So he returned home and worked from home, watching Xavi while I made friends with the toilet (like we haven’t spent enough time together during this pregnancy). I felt so icky and wretched, way worse than with any stomach flu I’ve ever had, but a little like I was in labor, but not for any real definable reason. Kristi came over to check me and said not yet and drink the following liquids and we all went to bed (not together, she went home, obviously). A little later that night, the vomiting and ickiness went away and real contractions began. So that happened for most of the night and by morning, I was sure the baby was coming that same day, on Thursday. So when Eneko woke up, I told him the good news and we started getting the house ready for the baby and then I went to lay down to rest between contractions. It was wonderful. I let Laura, our doula, know what was happening and that we would call her when we needed her. Meredith, our babysitter, was able to get her in-laws to come care for her son until when her husband got off work and she kept me company until Megan could come check me and tell me… ehhh, maybe it will turn into active labor, but maybe not today since it was in the early stages. Stay hydrated, well-fed, rested and probably tonight, after Xavi was in bed.

Discouraging, but Eneko, Xavi and I decided to do those final things before the baby arrived. We ate lunch, went to Trader Joe’s to get some stuff, got Alubia’s birthday for Xavi present from Whiz Kids (love that store!!!), went to Doc Burstein’s one last time to get ice cream (I imagine I will be dairy-free with this little girl too so gotta eat the good stuff while I can) and then came home to rest while California Pizza Chicken (according to Eneko) was delivered. All this time, I was having fairly regular contractions that were pretty strong and I was doing a good job of relaxing during them, visualizing progress and all that good stuff. And on Thursday night, NOTHING! No baby snuggling in bed with us when we woke up in the morning on Friday.

So after a contractiony breakfast, the decision was made to send Eneko to work. Who knows when this labor will start so we’re going to have to go on with our lives, just pausing to breathe every little bit. Xavi and I went to gymnastics and the contractions were pretty controllable while we were there and then we came home, prepared dinner and had our naps and our lunch (staying rested and well-fueled like advised). I was pretty miserable by now, but didn’t want to waste my last days of one to one attention with Xavi, so we went to Avila Valley Barn to feed the animals, ride on the tractor and get some "I-sheem." That tractor ride almost killed me. When we got home it was close to five, so we finished dinner and then sat on the sofa to read (Xavi is in the phase where he loves to have marathon reading sessions, having you read a book to him over and over and over and then choosing another and having you read that one over and over and over. Up til now this had been great for pregnancy because how often do you get to sit with a toddler???). By now, I’m moaning through the contractions and trying to read to Xavi. “A cow says Moo, A sheep says Baaa. Three singing pigs say AHHHHHHHHHHHHHHHHHH” and Xavi is getting upset and crying because that isn’t how the book goes and Eneko sends me a message saying he’ll be staying a little late to finish some stuff and I’m about to cry… But we survived that extra half-hour with no daddy and when he got home, he took Xavi on a bike ride and I got to have a few contractions without someone crying through them and flailing on my lap. Things seemed bearable once again. Eneko would be home all weekend and hopefully we would have a baby. Then during dinner, Eneko tells me about all the stuff happening in the office that weekend and I start freaking out. If he needs to work, he needs to work. Life can’t stop because I’m having contractions. But SERIOUSLY, it is sooooo hard caring for a toddler and having contractions. Should I call Sabrina to watch Xavi Saturday? But she needs to move and it’s her day off and she has her own family to take care of. And what if this goes on for days? weeks? It’s getting reaaalllly hard to relax during the contractions since it was getting really hard to relax period! And when you’re tense, they hurt so much more. And I was getting to my mental breaking point.

So my poor husband is trying to help and he offers to call one of the midwives to examine me and I say no, we have to wait until we are actually in labor. He offers to examine me and I say, no. Then I change my mind and decide that once Xavi is in bed, that would be a good idea and then I went to moan my way through the contractions in bed while he put Xavi to bed. By the time Xavi was asleep, I was so restless, moving from the ball, to walking, to laying on my side and just not feeling too great anywhere, knowing it was my fault, if I could just relax I wouldn’t have a hard time. So Eneko, around 8:30, checks and he says, “Not a 2 or a 5. A 3 or 4.” And I almost cried. Or maybe I did. Can’t remember. If it’s a 3, that means NOTHING. But if it’s a 4, then we’re in labor. But what if it’s a 3 and I stay like this for weeks???? He calls Kristi, against my advice, and reports his findings and asks for someone to come. And says he will set up the birth pool. I’m dead set against this, because, what if I’m not in labor? He wants to call Laura and Meredith too and I say no! And then beg for the pool because I can’t take it anymore and I need something to help. So he sets up the pool and it was like heaven getting into the warm water, but I still couldn’t relax because now we had an inflatable pool set up in the dining room in a house with a toddler and a cat (what could possibly go wrong there?) and what if this wasn’t even labor and if you can’t relax the contractions hurt and aren’t as effective which causes you to tense up more, which causes them to hurt more.

Poor Eneko is doing all of the last minute birth preparations for the house and wanting to call in reinforcements and I’m still saying no, not until we know for sure. Around 10, Megan and Edana arrive and begin unloading all the equipment for the birth and I am soooo frustrated because they might just have to pack all that stuff up and take it with them. I had thought one person would just come and do a quick exam. But, it turns out, surprise, it was labor. Finally Eneko gets to start calling help when Xavi wakes up. So Eneko is trying to call people and things aren’t working out. Meredith’s husband is working that night of all nights and Sabrina has to bring her little girl who is throwing up and he didn’t want that because it’s contagious. Turns out, I had understood that incorrectly. The reason Xavi kept waking was because HE was the one who was throwing up (probably what I had on Wednesday). So no babysitter. And I am freaking out again, because I really needed Eneko to help ME but it turns out it is hard to arrange for childcare via telephone while taking care of a vomiting child and massaging your wife’s back in the birthpool at the same time. Why isn’t there an app for that? Everything else seemed to happen in some kind of crazy blur. It seems like Laura, Meredith and Sabrina arrived about the same time, right when they were needed most and Eneko was able to focus on one thing, me, since Xavi was now in good hands :). Things were moving so fast at that time, or at least it seemed like it from my perspective. The contractions got crazy strong very suddenly and for two or three contractions it was really overwhelming and then we adjusted and the birth went on well. But certainly not gracefully. I was never really calm or centered or focused, even having to be reminded to breathe on way more than one occasion. I remember Xavi’s birth as being so peaceful but this one I think I will remember as more chaotic (entirely my own fault though). I think she was born just a little while later, totally covered in vernix, but adorable. And then we got those great moments you dream of in your pregnancy: time has stopped, you’re sitting in the pool, holding each other and your new baby, not feeling like pushing out the placenta, but knowing you will have to. And, yeah, after she was born, I was informed that it had indeed been labor :)

Anyhow, everything ended up perfect and everyone came through and then some, making our night exceptionally special. We got some amazing pictures, though all seem to have some kind of nudity, and it was great to see how my friends who had come to take care of Xavi ended up helping out with everything, as did our doula. It was so wonderful to birth our little Maui among friends.

Now I have a feeling that if we have any more kids, I will not be allowed to participate in any decisions about phone calls. So unfair! I only messed up one time. Like the one time (our first “date”) when the action movie we went to see ended up being a graphic (or pornographic depending on your definition) movie about gay bank robbers. And now I’m not allowed to choose movies for us to go see anymore. People should really get more chances in life.

Sunday, September 5, 2010

If Your Baby's Breech

I have had several couples over the years who were planning natural births only to be told at the end of their pregnancy their baby was breech. This is a very upsetting situation. First the medical establishment doesn't give the parents much options or hope. Second they don't seem to understand why the mother is upset; surgical births are second nature to them. For them it is no big deal. For the moms it is a very big deal. They feel boxed in, frightened of a cesarean, frightened of a vaginal birth, the clock is ticking, they scramble about to educate themselves on ways to get the baby to turn, and they begin the grieving process for their dream birth before the birth has even begun. All of my moms have tried hard to get their babies to turn. So far none of them has been successful. I feel some of this is due to how late in the game they were told about the situation. Some have toyed with going ahead with a vaginal birth and what that would entail; finding a care provider in or out of the hospital willing and qualified to assist the mother, dealing with everyone else's opinions on the subject and facing down their fears. Some were completely demoralized by their cesarean experiences others were not. No matter what you decide here are some things you should know.

All of my moms seemed to intuitively know something wasn't right about what they were feeling in their uterus before anyone confirmed their suspicions. They would say, "this just doesn't feel like a butt to me" or "if this is his bottom why am I getting kicked way over here?" Most of these were first time moms but they just knew. If you think this might be your situation ask for an ultrasound to verify position earlier rather than later. Don't rely on the doctors skill in "feeling" baby positioning because they can be wrong. Don't let your doctor talk you into putting this off until 37 weeks. The best time to start natural turning methods is 35 to 36 weeks. The bigger your baby, the tighter the space, the more difficult she will be to turn!

There are many alternative things to try: acupuncture, homeopathy, slant board, Watsu massage, prenatal massage, chiropractic adjustment, headstands or somersaults in a pool, frozen peas on your belly, and more. Use this link to learn more: One Midwife's Collection of Breech Turning Techniques

If the natural methods don't work you can try an external version where your care provider tries to manipulate the baby into turning by pushing on your abdomen. If this is done by a doctor they will want you in the hospital. They will have an i.v. in place so they will be ready to do an immediate c-section if the process causes the baby fetal distress which can't be resolved any other way. This is one of the reasons they will try to put you off and tell you not to worry until 37 weeks. They have nothing else to offer you and they want the baby to be considered "term" in case it needs to come by emergency c-section. I have watched this done a few times now. For some moms it is quite uncomfortable and for others only mildly uncomfortable. I have to say the doctors all spent quite a bit of time and really tried hard to get the babies to turn. Here is a link to view a version.

If none of these methods turn your baby you will need to say to yourself, "now what?"

Consider going for a vaginal birth anyway. Some of you may think I am being reckless, too "radical", in even suggesting such a thing. But guess what? In Canada, that bastion of radical thinking the Society of Obstetricians and Gynecologists new guidelines say to NOT automatically go for the cesarean with a breech. Here is a study from Canada on which they are basing this new approach. For them the "wisdom" of doing a c-section depends upon what type of breech position the baby is in. Study.

Do your own research! Read the chapter on breech birth in The Thinking Woman's Guide to a Better Birth by Henci Goer. Then go more in depth with Breech Birth by Benna Waites. Watch this video of a breech homebirth: Aurora's beautiful and inspiring frank breech home birth. 

If you are going to go for a vaginal delivery of a breech baby who will be your care provider? Ask your doctor or midwife. Ask them if they know any doctors or midwives in your area who do breeches. It is very hard to find any doctor willing or skilled anymore in breech deliveries because with all breeches being automatic surgeries non of them have had much practice at it. This of course compounds their distrust of a vaginal delivery because they don't have the skill. Talk to the homebirth midwives in your area. Are any of them skilled in breeches? Will any of them do a planned breech baby at home? Ask yourself if you are comfortable with the idea of having a baby at home?

If you find a care provider and a place you will need to prepare yourself and anyone else who will be at your birth with positive images and stories of vaginal breech births. You can find this in the book, Breech Birth-Woman Wise by Maggie Banks. Find a copy of Birth Reborn, the movie, through your birth educator or a midwife. This video has some intense footage of a breech birth which made me hold my breath with fear the first time I watched it because it was so foreign to me. You and your partner need to get beyond that feeling.

So what do you do if you can't find a care provider willing to "let" you birth your baby vaginally? Well you can be really radical and just show up at the hospital in labor and then refuse to go to the operating room. Once they have informed you of the risk you are taking you have the legal right to refuse consent to any procedure. This is not an option I am advocating because for labor to go well the mother needs a peaceful and relaxing environment. This sounds far from peaceful to me. My point is you have this option; it is your right. Some women have chosen this path; it has been done before.

If you are still thinking you want to have a cesarean birth the next decision is whether or not to let labor spontaneously happen or to simply choose a day, book the O.R. and schedule your baby's birthday. Here are some things to think about. We know that labor is physiologically good for babies and for mothers. It stimulates the babies breathing, pumps the baby full of hormones that spring the brain into activity, and prepares the baby for life outside the womb and for bonding. The down side to this approach is not having control of the cesarean itself. If you schedule it you can have a meeting with the head nurse of your hospital's labor and delivery unit and make special requests. The number one thing to ask for is to have mom, dad and baby together continuously. In other words the baby and dad stay with mom in the O.R. throughout her repair and go with her into recovery. At most hospitals this is not the standard procedure. It may require special staffing or shuffling of staff at your hospital. It is much more likely to happen when it is arranged ahead of time. You can also arrange to have a lactation consultant be there to help with latching the baby on in the recovery room or perhaps even in the O.R. Of course your doctor may be concerned about "allowing" you to go into labor at all because your water could break. They have concern about "letting" the water break because of possible cord emergencies with a breech presentation. Again this comes down to presentation. If your baby is presenting their butt firmly down into your pelvis and not a foot or feet than common sense tells us the risk of cord prolapse is about the same as for a head. If not than you need to consider that about 30% of the time a woman's water breaks before any signs of labor and the risk of cord prolapse with a foot presentation is considerably higher.

If you are scheduling a cesarean consider asking your doctor to try to do the external version one more time after you have an epidural. Sometimes with the mother unable to feel anything her muscles will relax enough for a version to be successful. If you are successful you would have to decide to go forward with an immediate induction or risk having the baby slip back into breech position.

So much to do. So much to learn. So much to think about. So many decisions to make. So little time and so little energy for any of it those last few weeks of pregnancy. This is why it feels so overwhelming. Of course the easy choice is to simply abdicate your authority and responsibility for your birth to your doctor and say yes to a cesarean without any further thought. Unfortunately abdicating your responsibility isn't what motherhood is all about. Whatever you decide make it your choice because you will have to live with this birth for the rest of your life. Your heart will heal better if you take the time, think it through and take up the role of mother. Parenting starts now!

Read one of my birth class client's breech birth story.

Thursday, September 2, 2010

The Pendulum Swings

Can you feel it? The pendulum is beginning to swing the other way again. Last February I witnessed a doctor emotionally manipulating a woman, who was courageously working on pushing her baby out, into agreeing to a cesarean. I didn't know then that in that hospital room we were standing at the apogee of the pendulum's arc.

Apogee (Merriam Webster) Definition: 1. Farthest point on an orbit 2. final climactic stage, standing at the culmination

I only knew that in the past few years it had become a greater and greater struggle to keep my hospital doula clients out of the operating room. I didn't know that this was the final climatic stage in a hailstorm of surgeries.

Here is a simple physics lesson:
When a pendulum reaches it's apogee it holds its maximum potential energy. This energy is released as it begins to swing back the other way.

Can you feel it? In the past few months there has been a huge release of energy on a national and international scale against cesarean sections. On Tuesday I opened our local paper and saw more evidence of this phenomena; an article reprinted from the Los Angeles Times titled Study Finds Patience May Lower C-section Rates. That's right patience, not patients.

Here is a simple vocabulary lesson:
**Patient as a noun.
(Merriam Webster) Definition: individual awaiting or under medical care and treatment 2. one that is acted upon
**Patient as an adjective

(Merriam Webster) Definition: Patient 1.manifesting forbearance under provocation or strain 2. not hasty or impetuous 3. steadfast despite opposition, difficulty or adversity
**Patience is a singular noun
(Merriam Webster) Definition: the fact of being patient

Here is what this latest study done by the Eunice Kennedy Shriver National Institute of Child Health and Human Development said:

If doctors and their patients (women under their medical care) would have patience (forbearance under the strain of waiting out those last difficult weeks of pregnancy) and not go with an induction they have a much greater chance of not having a surgical birth. Of course for the woman remaining patient (steadfast) to the idea of waiting for spontaneous labor in spite of her doctors threats of placental disintegration, baby too large or blood pressure rising (opposition) can be a daunting (a great strain). In my experience getting a mom through these last prenatal visits is very difficult but well worth the effort. My own doula statistics bear this out with a 1% section rate for my first time moms who wait for labor to begin on its own.

If doctors would be patient (not hasty or impetuous) about the progress of their patients (women who they are acting upon) labors there could be many fewer c-sections. The authors of the study say doctors aren't acknowledging that labor takes time and doesn't follow a predictable pattern, especially in first time mothers. A high proportion of the surgical births reviewed were done after the patient (one who is acted upon) had been in active labor for only 2 to 3 hours! OMG!!! These women are being labeled as suffering from "failure to progress" which leaves them feeling defective the rest of their lives which leaves them much more open to being manipulated into repeat elective cesareans for all future babies. Most of the women I attend at births are in active labor for waaaaaaayyyy longer than that. I guide them, support them and explain that this is normal, babies take time and they are doing just fine. My cesarean rate even for mom's who agreed to an induction; 1%. The study showed that a major reason for having a cesarean was having had a cesarean. But my total cesarean rate with spontaneous labor, inductions and v-bac attempts is only 7%. There is no great mystery here. I am no wonder woman. Doulas and midwives support women whom they do not see as patients but instaed as healthy people in the process of a healthy physiologic act; like breathing or sex. Doulas and midwives having an abundance of patience is the key to good, safe, healthy births.

One final thought: Years ago I met the women who were spearheading our local International Cesarean Awareness Network at the time. One of them said, "There is no such thing as a 'failure to progress' only a 'failure to wait'. I have been calling it that ever since and now we are beginning to have the studies to prove who failed and what that failure has meant to women in america.

Can you feel it?

National Institute of Health panel strongly urges that steps be taken to reverse repeat cesarean sections.

Study in Journal of Obstetrics and Gynecology says v-bac is a reasonable and safe choice because the outcomes for repeat elective surgery and v-bac were basically the same.

New Guidelines from American College of Obstetricians and Gynecologists on repeat sections.

Study Finds Patience May Lower C-section Rates.