A Spectrum of Pregnancy, Birth & Parenting Services to Meet Your Needs

After working with San Luis Obispo families for over 20 years I am more strongly committed than ever to helping families find what feels right to them for pregnancy, birth and parenting. I have a broad perspective and a depth of knowledge which is grounded in the work I have done with families making a wide variety of choices. As a doula I have been blessed to be part of over 100 births. Working beside doctors and midwives I have witnessed inspiring births both in and out of the hospital. As a birth educator I have impacted the births of several hundred babies and through my work with the Birth & Baby Resource Network, La Leche League, and the International Cesarean Awareness Network I have touched the lives of countless families in our community and beyond.

I offer a variety of support/education options to match your unique needs. Our journey together may start at any point along the spectrum. Please feel free to mix and match and make the exact support and education package that meets your needs. All classes are offered both as group or private experiences with flexible schedules.


Before You are Pregnant

Private consultations over tea: learn about options & resources in our community or review and process a past birth and discuss possible effects on future births. We can meet in the privacy of your home or at a coffee shop.                              

 

Early in Your Pregnancy

Classes: learn how to nurture your body, your baby and your relationships in my Healthy Beginnings/Healthy Choices classes.

                                                        

Preparing for Your Birth

Classes: My small group classes held, in the privacy of a home, foster a sense of belonging as we eat, laugh, learn and share together this amazing adventure. My Heart, Mind & Body series empowers and inspires you to create the birth you want.

For each class group I create a private on-line community for extended sharing of ideas, inspiration, connection and support which continues until your baby is sleeping blissfully in your arms.

Labor Land Practice: My Birth Connection Date Nights are serene spaces where all learning is experiential through relaxation, guided imagery and touch. The focus is encouraging oxytocin, the “love hormone”, to flow between you, your partner and your baby, and to teach you how to move through labor land together. These “practice” sessions are ideal for experienced birthers, homebirthers, or as an expansion of more intellectual birth classes.

Private Classes in Your Home: Every family has different needs; bed resting moms, changing schedules, or simply a desire for privacy. I try to be as flexible as possible to let you create your unique education package. Let my Class Outline be your guide. I am happy to create a series just for you!



Doula Service: I am happy to join your birth team no matter where you are planning to birth; home, birth center or hospital. We start building a trust relationship with prenatal visits in your home. Through listening I learn what you need and want to feel confident about your coming birth. I facilitate thinking and dialogue between partners to help clarify and prioritize what is important to them and help craft a birth plan which reflects these values while being well received by your care provider and staff.

I am available via phone, email or Facebook to answer questions and lend support throughout the pregnancy.

                    Once labor begins. . .

 I will stay continuously by your side
 where ever you are laboring until. . .

your baby has arrived. . .

and is blissfully breastfeeding for the first time!

I will visit your home a few days after your birth to ensure breastfeeding is going well, check on your postpartum recovery, and help you process your experience with tears, talking and laughter. I will answer questions, clarify and enlighten you on issues you may not have understood. I want you to have a thorough grasp of what happened, why, and how necessary it was, to empower you for future births.

After Your Birth

Private consultations over tea: When women suffer after a difficult birth experience it is very helpful to share your story to a listening heart who is knowledgeable enough to review your birth, answer your questions, and help you move forward in your process. I can connect you to resources for your recovery and discuss things you will need to think about for future births.

Private Postpartum Visits: I believe new mamas need to rest and adjust to motherhood in the comfort of their home. I am happy to travel to you. The first days and weeks of parenthood many new families need some additional guidance. A little hands-on help from an experienced mother/doula can give a new mama just the boost of confidence she needs.

Welcome to the parenting community!

Classes: My Fourth Trimester Parenting Support group meets every Tuesday from 10:30-12. I provide this free to the community because I believe deeply that women need support during this important transition in their lives to grow fully into confident motherhood.




Support Group: I lead a La Leche League Mothers’ Meeting once a month in the South County which is free and open to all mothers for breastfeeding advice and support.

 

Loving Guidance Workshops: These periodic workshops cover my Five Steps to Creating a Healthy, Happy, Whole Family empowering parents to move through the normal ups and downs of parenthood, take control of their own learning, and make their own decisions on how they wish to parent.

Support Group: I created “Whole”istic Mamas and Papas to provide community for families choosing to parent from an alternative point of view; attachment parenting, co-sleeping, extended nursing, baby wearing, individual vaccination choices, homeschooling, etc. It is a safe space; both in our face-to-face play day meet ups and private on-line group for asking questions, gathering information, sharing and learning from each other.













Parenting is much more fun when we share and play with others!

Let's connect! I am happy to answer questions and get you started on just the right path for you.            Call: 805.459.8145
jenniferstoverdoula@gmail.com

My Heroes

I'm sure you have heard it said that every birth is unique, each its own story. But no one talks about how deeply that story is written into women. Each woman's birth story is carried in their bones and sinews. It has put its stamp on their bodies and breasts and the very energy contained within their cells. This is how they know "birth" to be.

I have been very lucky in my life to able to attend women in birth. I am constantly in awe of womanhood, its power and its grace. Every birth IS a story. I have so many stories jammed in my head and packed into my heart. Some are private stories only shared with a sacred circle. Others are meant to be shared with the world. Some demand to be shared. So it was with my preemie twin vaginal birth. Now I want to speak about cesareans. Next post I'll share a recent positive cesarean birth story.

For many years I struggled with each cesarean birth my clients had. I took it as a personal failure. If I had just been a better doula this wouldn't have happened. I could have, should have, rescued her. Over time I grew to understand that these stories weren't my stories to write. They belonged to the birthing woman. They were her story. I tried to let go of my arrogance in thinking I held the power and turned it back to the mothers. I am there to help a mother find her own path. Success or failure is in her hands not mine. This attitude helped me, but did it help them?

Recently I have begun to question and be more critical of the whole idea of cesareans as being failures. I have never been with a mother who just gave up. Every one struggled mightily; pushed themselves to the edge of their personal precipice and beyond. How can that be labeled a failure? Who is to blame for this stigma?

The ugly truth is the blame lands squarely at the feet of the natural birth movement. A movement which is near and dear to my heart. A movement which sprang up in direct response to the over medicalization of birth. A movement which wanted to give women back their power; their belief in their bodies.We wanted women to be in awe of their own strength and abilities. A movement I signed on to many years ago. It gave me strength to do my work and replenished me when I was tired, weak, or hopeless. A movement which has branded the heart of every woman with a big fat F who began labor with the intention of birthing vaginally and ended up in the operating room . You failed at the very essence of womanhood. Enough.

I want all the mothers who have courageously fought to win that medal of female honor, only to see it fade from their grasp, to know they are heroes. They are the walking wounded who gave it all in battle for their comrades; their partner and child. Many suffer with post traumatic stress disorder. Some face on-going health issues. All of them have had their bodies invaded by friendly fire and have the scars and internal adhesions to prove it. Why do we treat them as shoddily as the returning Vietnam Vets? If you are for the war, people who believe in the medical model, you are numb to their tremendous sacrifice. If you are an anti-war protester, pro-natural birther like me, you actually have the unbelievable gall to question their loyalty to the cause. Enough!






Isn't it enough that she stayed the course for 9 hours at 8 centimeters without ANY pain medication? What about the fact that the last 4 hours were with pitocin to make her contractions even harder? What if you knew she was in active labor for 26 hours with back pain from a posterior baby? Enough?

Isn't it enough to join the club of "successful" birth if you labored with no medication and then pushed with ALL your strength for 3 hours at home AND THEN had to face your fears of transferring to the lion's den? Your midwife, your doula, your husband, your mother, didn't they all do everything they could? Why isn't that enough?


What about the mothers who train for the war but never get to feel their mettle tested? Herpes outbreaks, breech babies, high blood pressure, intrauterine growth retardation, or their baby's size can have them falling on their sword and relinquishing their bodies to be invaded for the sake of their children before a single shot has been fired. Their birth dreams laid waste upon the surgical table as the fog of war descends upon them.

What about this mom so great fully full of life? First she was told she would have to have a cesarean because her baby was breech. Then she went through an external version to turn her baby, only to have her water break with no labor. She did everything she could to make labor start. She and her husband held off the medical staff for hours and hours and finally, with time running out, submitted to one of her biggest fears; pitocin. After many hours on pitocin her baby's heart rate climbed. Could this be from infection? No mother wants to risk her baby. So she said yes to her deepest fear; a surgical birth and was wheeled off to the operating room. Surely she did enough. Would you have had her say no? She allowed them to cut her body open for the sake of her son. Isn't that enough?

                                             It should be enough.

Welcome home to ALL the mothers who began their births with the bright shiny intention of a natural un-medicated vaginal birth. As you marched off to do battle, you hoped against hope you would come home whole. You raised the banner of natural birth high above you. You held tight to your talismans of homebirth, nurse midwives and doulas believing they could bring you home safe from the war. You counted on your training from Bradley, Hypnobirth, or yoga to sustain you in the trenches. Bravo to those of you who made it through; war weary, battle hardened and whole. But let us not forget the walking wounded that sacrificed it all. Our highest motherhood medal of honor should be reserved for them for their bravery and selflessness. My heroes.

Welcome Home

Hayley D.      Annie W.       Kim S.      Laurie E.      Emily P.

Ruth M.      Miriam M.       Rebecca P.       Megan B.       Larissa H.

Yselle L.      Kelly B.          Kristina G.        Suraya S.       Wendy M.

Fara H.      Rochelle W.       Shelly F.          Sarah M.R.         Shannon L.

Katelen F.    Anna R.           Jenna M.          Star A.           Colby L.

Janet M.        Eva N.         Gwendolyn S.     Amy E.         Kambria D.

Stacie S.     Jennifer W.        Bridget B.       Georgie W.       Amy O.

DeAna C.     Amy H.           Jennifer K.         Traci C.        Heather S.

        Kat K.        Michelle L.        Tomi M.            Cindy L.          Linda S.       

                      

   Patti D.         Steph W.        Sarah R.          Kendra W.       Lisa N.
 
Sabrina S.       Anna T.       Glo       Stephanie A.       Annie R.

Kathryn D.       Sara M.      Spencer O.      Katelyn L.      Susan K.

Jessi C.     Beth S.

Do you have a hero that belongs on my memorial wall?

After 20 years of listening to mothers and witnessing births;
I have more names than I can remember.
Each is an important story.

If you or a loved one or friend belong on my wall please let me know and I will include them.

Thank you to the mothers who allowed me to use their stories and photos.

Next post will be a mother facing down her fears 
with a planned cesarean birth!

What's a Mother to Do?

Normally I take photos at births and write notes throughout the process. I think it is important to chronicle this important family event. I give them to my families and hope that they will treasure them forever. After two back-to-back high risk preemie births I felt these special stories needed to be shared. I had never experienced any births quite like these before. I learned an incredible amount and my hope in posting these stories is to educate future parents. Hopefully it will take some of the fear out of an incredibly fearful situation. 

Yesterday Ada Rose came into this world.
All 1 pound 10 ounces of feisty little girl. 

Thank you to Ada's parents for allowing me to share a part of their birth story. 

When babies come unexpectedly in the middle of pregnancy it is quite challenging for everyone involved. Suddenly needing to have a surgery to save your little one's life is scary as hell. Being separated from your new child fills a mother with fear and grief in every fiber of her being. Not being able to put her baby to her breast is an additional sorrow. Keeping it together under these conditions is heroic.

So what's a mother to do? Like every other mother she is going to do the best she can for her baby at that moment on that day. In this situation nothing helps a mother more than getting her colostrum to her baby. And of course the colostrum is VERY helpful to the baby. The colostrum of the mother who just gave birth to a premature baby is designed specifically for them. It has a special balance of nutrients to help their brains and bodies continue to grow outside the womb.

Getting the colostrum out of mom and into a teeny weeny baby who can't suck, swallow and breath yet is quite a trick. So what's a mother to do? Pump! Ada's mama was pumping by the time Ada was 2 hours old. The nurse at Sierra Vista tracked down a hospital grade pump. She brought it to mom's bedside and showed her all about it. I talked to her about tricks to help her let down her breastmilk to a pump.  We had just gotten started when dad got the word he could come be with their daughter in the NICU. I told dad to take photos and send them to mom. 

Poor mom looked devastated after he left the room. Of course she wanted him to go be with Ada. Of course she wanted him to not to leave her yet. After all she just went through major abdominal surgery; a really scary experience. Of course she felt it was totally wrong for him to be the first to touch and see her. Of course she felt horribly guilty for all of these conflicting thoughts. So what's a mother to do? Pump out way more colostrum than anyone expected!

Many mothers of preemies are able to only produce a few drops the first day or so. Vickie, the lactation consultant who came in said, "every flood begins with just a few drops. Don't worry how much you get. Just keep at it and your body will eventually respond." Wise words from a woman who works with breastfeeding moms every day.

While mom was pumping dad sent photos and a video back to the room of precious baby Ada. The photos were hard for mom to see; all the tubes and wires. Seeing her wiggle in protest weighed heavy on a mom's heart. I pointed out her perfection. That her color being so pink was a good sign. It meant she could get the oxygen they were giving her into her lungs, into her blood and circulate it through her body. How much better that she was trying to push them away than lying there limp. What a strong little girl she created. 

So what's a mom to do? Why pump out 3 whole milliliters of colostrum. That's what! It wouldn't all fit into the teeny weeny syringe the nurse had brought. They had to go get a larger one. The nurse exclaimed. The lactation consultant exclaimed. The NICU nurse exclaimed. They said, "Why that's about a week's worth of food for such a tiny little person." Yippee!

Mom sent the milk down the hall to her baby. They carefully put some on a swab and ran it around inside her mouth. Now mom's immune system is protecting her baby even though they are apart. Her colostrum is stuffed full of antibodies which can help give her the best chance on life. Right now she is too young to be able to suck, swallow and digest breastmilk. That day is coming though. It is just around the corner. Not to worry, mom will be ready. At 24 hours from birth she pumped out this much liquid gold. Priceless!

so the flood begins...

Every day in the nicu is a scary, hopeful, exhausting roller coaster ride for a family. Neonatal Intensive Care Units across the country are filled with babies and families every day. Please take a moment to hold them in your heart.

Read Eleanor and Caroline's premature twins story

What a VBAC Calculator Shows

This morning I noticed this intriguing post in our local ICAN group's Facebook page:

I know this isn't an active group, but this is the only one of my groups where it seems appropriate to post this. Does anyone know where I can find info about the VBAC rates for home births and hospital births? I found this cool VBAC calculator, but it doesn't account for birth setting.https://mfmu.bsc.gwu.edu/PublicBSC/MFMU/VGBirthCalc/vagbirth.html

A Vaginal Birth After Cesarean calculator? Really? So I decided to try it.

It is always important to know who you are playing with so I investigated who created this calculator. OK it says it is based on data collected from an article "Development of a nomogram for prediction of vaginal birth after cesarean". A nomogram? Huh? That is just a geometric way of looking at multiple variables. The data set came from the Maternal-Fetal Medicine Unit Network. Here is their mission statement: "The MFMU Network conducts clinical studies to improve maternal, fetal and neonatal health emphasizing randomized-controlled trials. The aims of the Network are to reduce maternal, fetal and infant morbidity related to preterm birth, fetal growth abnormalities and maternal complications and to provide the rationale for evidence-based, cost-effective, obstetric practice." They are a network of university based hospitals. These teaching hospitals are where the births happened that form the statistics to base this calculator upon.

First the questions they ask to help them calculate are telling. They want your age and body mass index. Don't know your BMI? Don't worry they'll calculate it for you. They want to know if you have a "proven pelvis". What's that? It is a woman who has either had a vaginal birth before or after a cesarean. In other words at some point a baby "fit" through. They want to know if your cesarean was for lack of progress dilating, lack of progress moving the baby through your pelvis or some other reason. Other reasons could be twins, breech, high blood pressure, fetal distress, maternal fever, etc. They just lump all the other reasons into one category. Most distressing to me are their questions about race. They break it down by African-American, Hispanic and all others lumped together. What the hell? What on earth should race have to do with it?

So here is what I found when I did some calculations.  I kept all other factors the same except the one I was looking at. Trying to compare apples to apples. Let's look at age first.

Age 
They obviously feel age matters. I changed the age from 18 to 30 to 35. 
I had between 7% to 10% less chance of successfully VBACing at 30 than at 18 years old. The low end reflects women who progressed on their predetermined schedule. The top end reflects women who fell off the time chart plus were heavier. At 35 it drops again. Now I have 10% to 15% less chance depending on the other factors. Ugh! Obviously age is NOT something you can do something about or can you? How many 35 year-olds do you know? I have worked with many and some have the physical health of a 40 year old while others could pass for being in their twenties.

Weight
By adding 70 pounds to a white woman with no previous vaginal births and allowable progress during labor/pushing she has lowered her chances of VBAC success by 12%. If she had a "failed" labor the numbers move down to 16% because of the additional pounds alone. This may make some sense because weight can cause confounding health issues, such as high blood pressure.So if you want to VBAC stack the decks in your favor by starting at a healthy weight. Oh wait! If you want to avoid that first section be a healthy weight before you get pregnant and then work with someone who knows about pregnancy nutrition to stay on track.

Arrest of Labor
This is defined as absence of progress. So of course one must FIRST note that progress is a very subjective animal. The good news is this calculator says if you had a surgical birth for arrest or "failure" either during dilation or pushing your chances are only 9% to 12% less than the woman who didn't. As a doula I know it is critically important to look at WHY you stopped progressing or weren't progressing fast enough. Was the baby in a poor position? Was this a failed induction? Why were you induced? Too long past due date? How far was too long? Baby "suspected" of being too large? How large was he or she really? Induced for other health concerns, blood pressure, diabetes, etc.? Perhaps your water broke and labor didn't start quickly enough so you were given labor initiating drugs. Did you have an epidural? At what point in the labor? I can't stress how important it is to obtain ALL your records and to go over them with an experienced doula or midwife. Perhaps your "failure" to progress was actually THEIR failure. 

Race
Here is where they doubly fail women. Be prepared to get angry.
I went back and changed only race as a factor. So let's look back at the age issue WITH race added in. If I am a 30 year old woman of color I had a 10 to 16% less chance than an 18 year old. While a white 30 year old has a 7% to10% less chance.  And at 35 I as a white woman would have 10% to 15% worse odds but as a woman of color it plummets to a 21% less chance of success. Excuse me? What about race with weight? If I am a 30 year old white woman with healthy weight, no vaginal births and no "failure" the calculator predicts I have a 80% success rate in their hospitals. That same woman of color? 67.2%! That is a difference of about 13%. If  I am 70 pounds heavier I have a 16% worse chance of success than my white sister. 

So now I compared the best case scenario; 18 years old, healthy weight, no arrested labor c-section, vaginal birth before and after surgical birth, White to Black or Hispanic. Shockingly the numbers say a woman of color automatically gets 4% worse chance of birthing vaginally. That my friends is systemic racism in its most insidious form. It is in how they are treated from the moment they are in their doctor's offices until the moment they are discharged from the hospital. I have witnessed this unequal treatment. Every time it has angered me. Usually it appears to anger me more than the woman trapped in it. Perhaps because she has only her own experience to compare, whereas I can compare her to the white women I have supported. But here the numbers are; in black and white for all to see. A disgrace.

I did not intend for this to be a post about race. I started in thinking I was going to check out this calculator and compare hospital stats with homebirth stats. But the numbers took me a different direction. Here are two links for those of you who wish to compare homebirth and hospital birth numbers. They were posted by Terri Woods of SLO Doula Connection  in response to the ICAN query. She rightly warns that homebirth midwives automatically risk out a variety of complications and so it isn't exactly apples to apples. Still it is worth noting that out of 1,354 VBAC women 87% were successful. There is no way for me to do a straight comparison because I don't know anything about age, weight, reasons for prior sections or if they have had a vaginal birth either before or after their surgical birth. 

Science and Sensibility looks at the MANA homebirth study 

Outcomes of Care for 16,924 Planned Home Births in the United States: The Midwives Alliance of North America Statistics Project, 2004 to 2009

Planning to VBAC? Hire a doula. Plan a home birth. Hire a midwife. Get healthy and stay healthy. Finally question, question, question; especially if you are a Black or Hispanic woman. 

Consumer Reports: Cesarean Births

“How you deliver your baby should be determined by the safest delivery method, not which hospital you choose.” 

I couldn't agree more with this statement. Consumer Reports is beginning to tackle the issue of our disproportionate cesarean rate. The World Health Organization has determined that NO region, area or country should have a higher rate than 15% rate. Currently the US has a rate twice that and California's is even higher. The rate is "up 500 percent since 1970. All those C-sections have not translated into substantially better outcomes for mothers and babies. The infant death rate in the U.S. is higher than that of most other industrialized nations. And the maternal death rate actually increased slightly from 1990 to 2013, according to an analysis published May 2, 2014, online in The Lancet medical journal."

So What? 
Why should we be concerned? C-sections are safe right? Usually when they are done it is because they are safer for mom, baby or both, than a vaginal delivery right?
"A C-section—the second most commonly performed surgical procedure in the country, requiring a 6-inch incision in the abdomen and a second through the uterus—is major surgery, and thus takes longer to recover from than a vaginal delivery and also carries additional risks." 

Consumer Reports is also concerned that hospitals within a few miles of each other with similar populations can have such drastically different rates of surgical births. "And unfortunately, it’s usually much easier to find a hospital with a high C-section rate than a low one." 

Our Local Hospitals
To earn top marks a hospital had to have a c-section rate of between 5-9.5%. None of our local hospitals earned this ranking. Twin Cities comes in at the next best level between 9.5 and 11.5%. French is in the average zone at 11.5-15%. Both Marian and Sierra show up in the next to lowest ranking with between 15-21%.

Hey That's Not Fair 
You may be thinking Sierra Vista should have a higher rate because they have the high risk mothers. Consumer Reports tried to correct for this. "To level the playing field, the measure controls for some things that affect C-section rates, such as not including multiple gestations and breech births. However, this measure does not account for all differences in patient characteristics (such as chronic illness) that might affect the C-section rates of an individual hospital." So yes their rate should be higher because the high risk moms with chronic illness appropriately deliver there. The question is how much higher? Both Sierra and Marian are just a few percentage points away from being given the worst rating.

“We think it’s time those hidden numbers are brought to light,” said John Santa, M.D., medical director of Consumer Reports Health. 

Well said! Pregnant consumers and their families deserve this information in order to make true informed choices about their births.

Quotes were taken from the following 3 articles by Consumer Reports.

What Hospitals Don't Want You to Know About C-Sections:
Very good in-depth article with an excellent section on things to do to avoid a surgical birth.

Hospital Ratings; Avoiding C-sections: 
Their statistics

Safety Scores:
Finding your hospital's score.

More Research and Reading

What to Reject When You are Expecting
Good list of prenatal and during labor procedures to avoid

My Birth Statistics
Comparing my stats with our local hospitals

Some Truth about the Strength of Women

I recently ran into the quote on Facebook. I liked it so much I chose to use it as a cover on my Labor of Love Facebook page. Then I went searching to learn about Laura Harm. I immediately ran into this article; "Why Some Birth Quotes May Be Damaging to Women" on the Midwife International web site.  After carefully reading their post and the comments left by others I was drawn to leave this comment.

I have been a doula in San Luis Obispo for many years supporting women in the hospital and at home through medicated, un-medicated and cesarean births. I recently saw this quote and chose to put it on my doula facebook page. For most women birth IS painful. For most women it requires them to surrender in some form. Surrendering to your process where ever that process may lead, even into an operating room, IS the strength I see in this quote. Women ARE strong.The strength it takes to endure a surgery at the end of a long labor, the strength it takes to hold yourself together for the sake of your baby during an emergency cesarean, the strength it takes to surrender to the power of the process of dilation, the strength it takes to push a baby out of our bodies and into the world. This strength inspires me each time I am lucky enough to witness a birth, any birth. I make no distinction in my respect for birthing women, medicated, un-medicated, vaginal or surgical. ALL women are strong and need strength no matter how their baby arrives. I wish women could stop dividing themselves into groups. I wish women could stop feeling they are being judged and stop judging themselves. Filtered through our own souls this quote, like art, will mean something different to each of us. I am sorry it is painful for you. I wish you could see the beauty in this quote that I see. The acknowledgement that ALL women no matter how they birth are strong. You were strong.

I would like to know how YOU feel about this quote. I encourage you to read their article. Look deep into your soul. How does this quote make you feel? Who have you been judging?
Please post your comments here or on my Facebook page.

Listen to National Experts: What the Birthing Women of San Luis Obispo Need to Think About!

These posts originally appeared as my Food for Thought series on Facebook. I wanted to provoke the women of San Luis Obispo county into thinking about their birth and parenting choices. By quoting directly from books I wish to stimulate discussion and encourage women to seek out information and become more educated. My hope is you will empower yourself through this process.

“Our lives begin to end 

the day we become silent about things 

that matter.”

~ Martin Luther King, Jr. 

from his unforgettable

 "I Have a Dream" speech

Doctor or midwife: How to choose which is right for you.

Baby Bonding and Attachment: Getting Parenting off to a good start.

Induction and Due Dates: What you need to know to keep anyone from scaring you into a decision.

Understanding Risks: Learning more so you can choose the risks you are most comfortable taking.

Parenting in Labor: Things to know about the decision to use pain medication.

Labor & Birth: Things to remember about normal labor and birth.

My Birth Statistics: 2010 through 2012

Statistics are an interesting animal. You can shape them or skew them various ways. They are used by many people to prove points or to motivate or even manipulate people into taking an action they desire. When asked about statistics on issues such as risks associated with a possible course of action doctors often answer with non-answers. Many times I have heard doctors say, "if it is your baby that dies the risk was 100% not worth taking" or "I only recommend this or do this procedure when it is necessary." They rarely give couples what percentage of their clients do they deem it necessary to do the procedure on, or how that compares to a local, national or global average. They certainly don't offer the parents what studies have proven the statistic should be based on best outcomes for mothers and babies. Those studies weigh the risks of both doing and not doing any given procedure.

Cesareans

For cesarean section the World Health Organization took a global look. Because they are a world-wide organization they looked at poor countries with low access to cesareans and wealthy countries with lots of access to cesareans. Their studies say a cesarean rate of between 5 to 10% of births is ideal and further when you get beyond 15% you are now doing more harm than good to mothers and babies. My total rate has increased from 15% to 17%. My rate in the last 3 years alone, when calculated as I believe WHO intended: total number of births and number of cesareans for any reason, is a depressing 22%. My numbers prove to me what my gut had been sadly telling me for a while; it has gotten harder to keep women out of the operating room. When looking at my statistics is important to remember how few births I attend; 27 since 2009. An individual birth has the ability to shift my rates wildly. But let's put my numbers into context.

Here is the national trend.

Here is the state trend.

But as I said numbers can be shaped many ways. Let's compare my section rate not using WHO's way of compiling statistics. Instead let's use the way California compiles their stats. They choose to not include breech babies, twins, premies and abnormal presentation. Abnormal presentation seems so vague to me it could include posterior babies (facing the wrong way), babies with a hand coming beside their faces (compound presentation) and babies that don't get their heads lined up just right (acenclytic). I have had all of these over the years and most but not all of them came through their mama's pelvis just fine. Using this system of exclusion my rate for the last 3 years plummets to 7% while California's is shocking.

OK now I'm not feeling so bad and a lot less frustrated. But wait! Maybe this doesn't reflect me at all. Maybe we just have really great providers and hospitals? Using identical parameters of exclusion in the statistics here are our local hospitals 2011 rates:

 French 21%

Sierra Vista 32%

Twin Cities 22%

Marian 30%

Now I'm definitely feeling better about my 7%! Let's not forget that I have done births at all of these hospitals in the last 3 years interacting with the staff and working within their individual medical establishment cultures. Don't forget to factor in that my clients use a variety of care providers, 15 in the last 3 years; from the ones who never saw an intervention they didn't like to the most
hands-off low-tech midwives. I've supported high risk moms and teen moms. I've had women hire me 1 week before their birth, 1 day before their birth and 2 this year during their births! Fifty-six percent of my moms were having their first babies and only one of them ended up having a section because of failure to progress.

Now let's compare my primary (first time) cesarean section rate to our hospitals rates. Using their compilation methods I have a 4% rate. The local hospitals 2011 rates:

French 12% 

Sierra Vista 18%

Twin Cities 10%

Marian 16%

Because I go to whichever hospital my client's choose for a birth place, 41% of my births took place in the 2 hospitals with the highest surgical birth rates.

But numbers are just a snap shot. They certainly don't tell the whole story. Let's look back at my true total of 17%. Ten percent of those aren't included in the numbers above. What are their stories? Some moms had a herpes outbreak and felt it was safest for their baby to be born via surgery. A small number were failed v-bacs. About 1% were failed inductions for one reason or another. In the last 3 years I had 2 un-diagnosed breech babies. Both moms labored great but when their baby's position was discovered a cesarean was performed. I had a high risk mom go into labor with her premie baby the day after we first met. Another was a mom trying for a vaginal birth after her first child was a cesarean baby. After laboring at  home and in the hospital for a long time she ultimately had a second section. This time I was able to explain to her exactly what was going on inside her pelvis which made her babies need to come through an incision in her belly.

This last mom called me because her doctor had said her baby was too large and scheduled her for a section for the next day. She was in a panic. We both worked very hard for a week trying to find a care provider willing to take her and let her try for a vaginal birth whom her insurance would cover. We couldn't find one and after an exhausting week of discussions with her doctor she ultimately chose to have a scheduled cesarean. I was with her as much as Marian Hospital would allow and helped her become one of the first moms to latch her baby on in the recovery room immediately after her surgery. 

But women have lots of worries about more than just cesareans. Here are my statistics which speak to those issues; the dreaded pitocin, its connection with induction and the need for pain medications!

Pitocin

Since 2010 I have had 22% of my mamas use pitocin at some point during their birth process; either to induce labor (7%) or to move a labor along (15%). This represents a significant increase from my past 14% rate. On closer inspection I see the change has come in my use of pitocin to augment or move a labor forward. 

Induction  

My induction rate has held steady since 1993; 7%. The only reason for induction in the last 3 years has been because their water had broken and we couldn't get labor rolling with natural methods. All of these women were able to labor without resorting to pain medication and birthed vaginally. 

Augmentation

Between 1993 and 2009 7% of my clients opted to use pitocin to augment their labors. But in the last 3 years 15% utilized pitocin to try to make progress during a stalled labor. Half of the stalled labors, or 7.4%, were transferred into the hospital after a planned out-of-hospital birth. Fifty percent of those transfers ended with a vaginal birth. 

Pitocin plus Pain Medication

The other 7.4% who augmented their labor with pitocin had chosen to take pain medication and then their labor stalled. Ultimately all of these women birthed vaginally. My hat is off to the 33% of my moms who labored on pitocin without pain medication. I am in awe.

This amazing mama successfully navigated a high risk pregnancy, a pitocin induction for broken waters and a vaginal birth in the operating room; all without pain medication!

Pain Medication 

Speaking of pain medication... let's see what my numbers say about the issue. Since 2010 I have had 19% of my moms choose to use pain medication of some sort during their labor. This is up from my 1993-2009 rate of 11%. Not what I had hoped for but to put it into perspective I looked up the official epidural rate in California in 2012. Turns out it was 42%. It is hard for me to believe this is an accurate number considering how ubiquitous epidural use has become in our culture. Digging into it further I see that in 100% of the cases my moms chose pain meds, pitocin was involved; either before or after. It turns out 10% of my moms opted for pain medication and then ended up on pitocin and 10% of my moms needed pitocin and then chose an epidural to  help them cope or as part of an over-all strategy to make forward progress during their birth. I don't know how that compares with the rates for California or our individual hospitals. They don't break their rates down this way.   

Speaking of progress...as a doula I am always pushing the boundaries of the places and providers that my clients have chosen. This usually involves giving moms the information they need to confidently say no to routine policies that are not based in evidence-based practices, such as the 40 week automatic induction or rigid guidelines on fetal heart monitoring. One of the areas my clients and I have been pushing is gravity enhanced non-traditional pushing positions, i.e. birthing on hands and knees, in a squat and standing. I have felt that I wasn't getting anywhere with this issue but the numbers tell a different story. I am happy to say 15% of my moms in the last 3 years have birthed within a traditional setting using a non-traditional position. This is a testament to the strength of will and confidence of those mamas. If I was at all instrumental in creating that to happen I am satisfied.    

This beautiful 9 pound 4 ounce baby boy was born quickly and easily as his mother stood beside her hospital bed.

By the Numbers
2009-2012
27 births
55% first time mothers 

Total Vaginal Birth Rate: 78%

Adjusted Vaginal Birth Rate: 93%

        (See above story for explanation of adjustment)

Adjusted Vaginal Birth Rate First Babies: 96%

Spontaneous Start of Labor: 93%

Total without Pain Medication: 81%

Pain Medication after Pitocin: 10%

Labor without Pitocin Augmentation: 85%

Labor without any Pitocin: 78%

Successful VBAC Rate: 50%

Looking at it another way...

Total C-section Rate: 22%

Adjusted C-section Rate: 7%

    (See above story for explanation of adjustment)

Adjusted Vaginal Birth Rate First Babies: 4%

Total Pitocin Rate: 22%

Pitocin Induction Rate: 7%

Pitocin Augmentation Rate: 15%

Total Pain Medication Rate: 19%

A Positive Cesarean Birth

Approximately 10% of women will truly need to give birth to their babies via surgery. For most of the women in this country this is far from a positive experience. Their babies are born behind a screen and then are moved to a plastic box, called an isolette, far enough away the mothers can't really see them. Once they are checked over and determined to be breathing ok, they are wrapped up so only their tiny faces are visible and given to their dads sitting next to the mothers' heads. The mothers who are lying flat desperately want to at least see their babies' faces. The dads try to find a way to accomplish this with their floppy newborns. Mothers crane their necks trying to catch a glimpse of their babies' gaze. They are biologically driven to look deep into their babies' eyes and connect. In just a few minutes dads and babies are whisked away to a nursery. All the other normal biologic functions which kick into gear as soon as the mothers have given birth are disrupted. These are called claiming behaviors. We are meant to smell our babies, kiss our babies, touch our babies. We are meant to look them over from head to toe and to count each tiny finger. And of course to put the baby to our breast and begin the breastfeeding relationship. Our senses and our babies are heightened at the moment of birth. We are both exquisitely aware of each other. We are meant to connect on a deep emotional, biological, chemical level; a connection which will last a life time. But for most mothers around the world having cesarean babies they get none of these. By the time they get to really see their babies they have been washed and dressed and are deeply asleep; too sleepy to breastfeed for  hours.

For a different perspective on the cesarean birth experience please watch this video. Then talk to your doctor, your midwife, your doula, your husband, and your hospital. You and your baby have a right to the most natural positive birth possible. You can make this happen!

Get Inspired

"Never doubt that a small group of thoughtful committed citizens can change the world; indeed it is the only thing that ever has." Margaret Mead, woman, daughter, wife, mother and controversial cultural anthropologist.



Inspired? Join the Birth & Baby Resource Network or International Cesarean Awareness Network. You can find the info about meetings in the side bar under Meet Me or go to my Labor of  Love Virtual Rally event page and find out the next step.

Think Twice Before You Say Yes to a C-Section Because Your Baby is Arriving Prematurely

Last week in the New York Times Roni Rabin reported on a new study coming out of John's Hopkins School of Medicine which throws a wrench into the machinery of conventional medical thinking. Until now doctors have believed that it is safer for your premie to be born via surgery. The study included 2,560 babies. When they compared babies born mother nature's way to those born in a surgery suite the babies delivered by C-section were 30 percent more likely to develop respiratory distress syndrome, a serious breathing disorder that can lead to organ damage.

It must be tough to be an Obstetrician. You are constantly practicing medicine on women with the best of intentions only to have studies prove that what you are doing is not only medically unnecessary but harmful. No doctor goes into medicine to harm women, so I have to wonder how they feel about it each time one of these issues comes to light and they have to reverse course. Do they think back over the women they sectioned who had complications? Do they remember the babies who ended up with serious respiratory infections and wonder if their belief in the "preventative" cesarean may have caused that baby to suffer? What about the extra stress on families separated even longer from their babies? What about all the money families spent on additional NICU care for premies with breathing issues? I wonder if someone will try to figure out what that bill was for our nation?

So how did OBs get into such a mess? It is grounded in the systemic belief which underlies much of the medical model thinking about birth that women's bodies are essentially unsafe for babies, especially the vagina. To understand where this bedrock of the medical view of the world came from you have to go back to male dominated religion, Eve, sin and the apple, the Greek belief in the perfection of the male body, and an unwavering belief in man & technology over nature and women's bodies. Time and time again this flawed way of thinking has led them into relying on drugs to fix problems only to learn later that they were harmful to mothers or babies. They rely on machines, tests and statistics to give us flawed due dates which lead to inductions of accidentally premie babies, continuous fetal monitoring which led to many more c-sections for fetal distress with no lowering of the fetal death rate, and windows of normal so narrow that fewer and fewer women can thread the needle of pregnancy & birth without being labeled as high risk. So this line of thinking led them to believe, without any studies being done, that it would be safer for premies to be saved from the rigors of a vaginal birth. It apparently never entered their minds that traveling through the vagina served a purpose in a complex system of birth, growth and life long health. Or that being squeezed would push fluid out of the lungs and that the sides of the vagina would coat the baby with beneficial flora. These two items may be why there are less respiritory infections in vaginal birth babies. Instead as the medical provider they donned their super hero robes and stepped in as saviour. The problem with being a super hero is the responsibility. So now they are left to face their responsibility. Of course I'm not looking for some kind of loud national apology. That never happened in the past and it won't happen now. Read the Times article below and then take Dr. Werner, the lead author of the study's advice and have a frank discussion with your doctor.

New York Times
February 9, 2012, 3:22 pm
C-Sections Pose Respiratory Risks for Some Small Preemies
By RONI CARYN RABIN

Small premature babies born by Caesarean section are at increased risk of respiratory distress syndrome, a new study has found.Very small babies delivered prematurely by Caesarean section because they were not growing properly in the womb developed more respiratory problems than those who had induced vaginal deliveries, a new study found. The study adds to growing concern over the high rate of Caesarean section deliveries in the United States, which reached 32 percent, or nearly one in three deliveries, in 2007.

On Wednesday, the federal secretary of health and human services, Kathleen Sebelius, announced a public health campaign to educate families that it is best for both the mother and the baby to let a problem-free pregnancy go for as long as possible, and to let labor start naturally. The campaign is a partnership that expands on a March of Dimes public awareness drive emphasizing that “healthy babies are worth the wait.”

The latest study looked at babies who were extremely small for their gestational age and not growing properly in utero, so waiting was not a medical option. But the findings raise new questions about the risks of Caesarean section.

For the study, researchers analyzed nine years of data from births in New York City, identifying 2,560 babies who were small for their gestational age and delivered between 25 and 34 weeks of pregnancy. Forty-six percent were delivered vaginally, and 54 percent by Caesarean section.

“The conventional thinking, though nobody really knew, was that maybe it would be less traumatic for this group to have a C-section, and they might benefit,” said Dr. Erika F. Werner, an assistant professor at Johns Hopkins School of Medicine and the study’s lead author. “Our study suggests that may not be true.”

In fact, the babies delivered by C-section were 30 percent more likely to develop respiratory distress syndrome, a serious breathing disorder that can lead to organ damage and that is more common in premature infants, Dr. Werner and colleagues from Brown and Yale Universities found.

The C-section deliveries were not associated with improved outcomes in terms of other complications, including hemorrhages, seizures, low Apgar scores and sepsis, the researchers found. Results were adjusted for differences in the mother’s age, ethnicity, education, health status and weight.

The findings are being presented today at the annual meeting of the Society for Maternal-Fetal Medicine in Dallas.

“The takeaway is that if you’re in this situation, you should have a frank discussion with your doctor that maybe a vaginal delivery is equivalent, or even better,” Dr. Werner said. “We need further research to determine if there is any benefit to C-section” for such infants, she said.

Another consideration is that when a woman has one baby born by Caesarean section, subsequent children are far more likely to be delivered by C-section as well.

As to why vaginal deliveries appear to improve respiratory function, Dr. Werner said, “We don’t have the perfect answer.” Some experts believe that the physical compression the baby experiences during labor helps remove fluid from the lungs and prepares the baby to breathe air.

Dr. Diane M. Ashton, deputy medical director of the March of Dimes, who has been overseeing the organization’s Prematurity Campaign to educate the public, said similarly improved outcomes are seen with infants delivered further along in a pregnancy.

“This is consistent with what is seen in infants even at 37 weeks,” she said. “They, too, have better respiratory outcomes when delivered vaginally versus C-delivery.”

Studies suggest that premature births of single babies have been increasing in recent years and that more are being delivered by Caesarean section, including C-sections that are not medically necessary. At the same time, recent research shows that a baby’s lungs and brain undergo important growth and development during the last few weeks of pregnancy, and that babies born just three to six weeks before their due dates are more likely to suffer disabilities or developmental delays in kindergarten.

Last year, the American College of Obstetricians and Gynecologists issued new medical guidelines meant to lower the rate of repeat Caesareans by making it easier for women to find doctors and hospitals that will let them attempt a vaginal delivery even when a previous baby was delivered by C-section. Although these women are at risk for a serious complication called uterine rupture, ruptures affect fewer than 1 percent of women, while C-sections, which involve major abdominal surgery, carry many other risks both to the mother and to the child.