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

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.

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!

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.

Finding Your Path; two women's stories

A former doula & class client sent me a link to a blog piece by Cherylyn, a doula in Utah. Natalie knew I would be interested in this woman's journey of recovery from her first birth which was traumatic and left her feeling victimized and angry. Each of her next four births led her down a new path toward healing. On her journey she made many different choices for where, with whom and how to birth. Each birth was a necessary step in her process. In my classes and through my doula support I honor each woman's choice because I can't judge where she is on her path. It is my responsibility to give information and it is her responsibility to listen with an open heart for what resonates with her. Only she has the answers. Only she can access her intuition. It is my hope to support her in this process through my own intuitive listening so I can respond to her needs along the way. This is why I support women in all birth settings. This is why my classes are designed to teach couples no matter where, with whom or how they are planning to birth. My hope is to give them the tools to have a positive birth where ever they birth. Please read this article if you are preparing to birth or if you are in the process of physical and emotional recovery from a less than positive birth. Then sit quietly for a moment and take her message into your heart. Let it carry any feelings of guilt, doubt, or mistrust in yourself away.

Now let me tell you about Natalie. I met her and her husband, Tobin, at a Birth & Baby Resource Network event. When it came time in the circle for sharing their tears as they shared spoke volumes to me about the depth of their birth trauma. As the event broke up I approached them and encouraged Natalie to visit our SLO chapter of the International Cesarean Awareness Network, even though hers was not a cesarean birth. I knew that the circle of supportive women at their gatherings could help her heal her wounds. Unfortunately there is no local support group for women with negative birth stories except ICAN which is labeled a cesarean support network. Women with birth experiences like Natalie's aren't sure they would belong at an ICAN meeting. The women of ICAN would want me to stop here and say that these women absolutely are welcome and that supporting them is also part of their mission. Unfortunately the general public doesn't know that.

As Natalie's second pregnancy progressed we came to understand that not only had her birth left her with many emotional scars it had also left her with many physical ones. Like her emotional ones, these scars were hidden deep within her and they had the potential to threaten this new pregnancy. Bottom line; she was no longer the same inside and this pregnancy was therefore risky for Natalie and her baby. She was advised that the least dangerous route for her baby's birth was a cesarean. She listened to this advice. She listened to her intuition. She listened to her husband's fears. She listened to her desires. She listened to her body and she waited.

Natalie experienced an incredibly healthy pregnancy. She worked and mommied right through it. She blossomed and so did her baby; growing right on schedule, moving vigorously and letting her mom know she was doing fine. Natalie did a lot of talking, to Tobin, to me and to her doctor. She weighed all the different risks of having or not having a surgical birth; risks to her and risks to her baby. She knew what she wanted but was also willing to make needed changes or compromises. We brainstormed all kinds of possible scenarios for her birth. Then she wrote her birth plan. This plan was unique to her; not something you can download from the Internet with check off boxes. It encompassed many possible avenues for her birth to go. It was detailed. It was flexible. It was respectful and grateful to the people she knew she was going to need to rely on to see her safely through. Then she listened to her body and she waited.

When her water broke I believe all three of us held our breath and made a silent prayer that all would be well. Then Natalie and I released our breath and went to work creating as much normalcy to this labor as possible. But I don't believe Tobin let go of his breath until both mom and baby had come safely through. Natalie carried herself in labor as she does in life, with quiet unassuming strength and graciousness. You would never guess at the depth of her determination, or physical and emotional strength. Tobin told me she can be stubborn but he forgot to also tell me how courageous she is. Immediately after the vaginal birth of her beautiful baby girl she began to have an issue which required her doctor to step in and Tobin, the baby and I to step out. Natalie kept her composure throughout while Tobin died a thousand deaths holding his baby and waiting for news about his wife. For him life stood still and minutes felt like an eternity. All I could do was reassure him that she was in good hands. Dr. Yin and the French hospital staff knew how to take care of her; that's why she had chosen to birth here. In what was actually a very short time he received the news he was longing for; Natalie was fine and would be reunited with him soon. But I don't think Tobin breathed until he saw Natalie's pretty face again; all smiles and wanting to put her new baby girl to breast.

So why did I decide to tell you about Natalie? Because she knows a thing or two about healing, about listening to your intuition, about creating the birth that is just right for you and your baby. Your choices may be different than hers. You may listen to her story and think, "I would never put my baby at risk like that." That's fine. You are entitled to your feelings and if your heart had told you to make a different choice than Natalie's I would support you in that choice. But this was Natalie's choice and it brought her very far along her path as she journey's toward complete healing. So I understand why Cherylyn's story resonated with Natalie. I get it. Do you?

           Thank you to Natalie and Tobin for inviting me to accompany them on their journey!

To Read Cherylyn's piece about her choices as she journeyed toward healing visit her blog: Mamas and Babies

The Seamstress

My doula journey takes me into people's homes and hearts. I am sometimes a receptacle for their smoldering anger or deep despair. I am always honored to help a woman along her path to peace and understanding. Birth trauma occurs when our hopes and dreams go awry. The wounds are deep if we felt unsupported at the moment our plans splintered into a million pieces of sharp glass raining down on us, and the grief process long. This poem is for all the seamstresses out there. The cesarean epidemic has infected our hospitals like a disease causing a disproportionate number of our mothers to begin motherhood disheartened, disillusioned and disattached from their selves. They are all seamstresses.

The Seamstress

We sat amongst her disillusionment and despair
piecing together the scattered remnants of her destroyed dreams.
The disarray of her disappointment spread around us
disconnecting her from the fabric of her life.

We sat disentangling the threads of her distrust and disbelief
from the dishonesty of those she thought had cared;
vainly trying to dispel her disenchantment.

The disjointed story spilled from her wounded heart
discouraged tears distorting the lines of her face.
The silver needle plunging in and out
as she desperately tried to repair the damage.

Together we examined the jagged edges of their handiwork
searching for patterns and matching the pieces.
How had this disaster happened;
this horrendous disruption to her plans?
Had she lost all of her abilities of discernment?

__ __ __ __ __ __

Carefully they stitched the edges of her womb together.
Her birth desires disintegrating around her
she lay in disembodied disgrace upon the cold metal of the steel table
discarded, dismissed and dispossessed.

Disheveled and disoriented she lay upon the gurney.
Could they not see the gaping wound they left upon her heart
her life blood disgorging onto the sterile white sheets?

Gathering together the fraying edges of her heart
she pressed discomfort, anger and disloyalty to her breast
bravely trying to staunch the unending flow.

__ __ __ __ __ __

Dislodged from all her instincts
her disordered mind distorting her visions for those first precious days of life.
Distraught she began incessantly working
the needle flashing in and out
feverishly sewing together the crazy quilt of her life.

Would she forever be at a disadvantage
disqualified for motherhood by her disfigurement?
Was there no way to close this wound that would not stop leaking
to rid herself of this terrible disease?

__ __ __ __ __ __

We sat discussing, sharing and disclosing
patching over the disharmony of her soul.
Disengaging from blame or guilt
we discovered a mother willing to sacrifice her body and her dreams.

# # # # # # # # # #

I became fascinated with the word and syllable 'dis' as I thought about this piece. First because of the dis-ease women feel with their bodies and their mothering abilities after a traumatic birth. Secondly because feeling they were dissed during the process is a large component of their grief. Third the syllable 'dis' turns a positive into a negative which is what they feel happened to their birth experience.

When I researched the meaning of dis this is what I discovered:

The Many Meanings of Dis

Pronunciation: dēs,
1. lady; woman.
2. Female deity; especially one promoting fertility.

Pronunciation: dis, Slang
1. To show disrespect for; affront.
2. To disparage; belittle.

Pronunciation: dis, Classic Myth
1. A god of the underworld.

As a Latin prefix
1. meaning “apart,” “asunder,” “away,” “utterly,”
2. having a negative, or reversing force when used as an English formative
Example: to change ability to disability; or affirming to disaffirming

I was stunned to learn Dis was both a female fertility deity and a god of the underworld. Now I see my seamstress as wrestling with these opposing gods; trapped in the depths of the underworld; struggling to sew her way back up to the light.

A Woman’s Guide to VBAC

Wow!!! Great new site full of just the right info for women considering trying to go for a vaginal birth after a cesarean! Thanks to Megan Bochum, a local student midwife and member of our local ICAN, for posting this link on facebook.

A Woman’s Guide to VBAC

Weighing the Pros and Cons of Planned Vaginal Birth after Cesarean and Repeat Cesarean Section

VBAC Success Rates and Prediction Models: Understanding Your Chances of Important Outcomes

Putting Uterine Rupture into Perspective

Are You an “Ideal” Candidate for VBAC? What Are Your Choices If Not?

The “Immediately Available” Standard: Where It Came from, What It Means, and How to Move Forward with New Evidence and Guidelines

What We Don’t Know: Critical Gaps in Evidence and How to Make Informed Choices In Spite of Them

Discussing Your Options with Your Care Provider

Legal Rights and Protections for VBAC: Issues from the NIH Consensus Conference

Take Action!

New Guidelines Aim to Reduce Repeated C-Sections

Great reporting on an important birth issue by someone in the mainstream media! This reporter does an excellent job of thoroughly explaining the complexities of the issues surrounding giving women back the right to make their own choice to try for a vaginal birth after a previous cesarean or to go with a repeat surgical birth.

But before you read it let's put it into historical, local, political, and a doula's context.

When I was in my twenties the cesarean rate was rising. Like my sister-in-law most of these women were being sectioned the first time for something called cephalopelvic disproportion. This means the baby's head (cephalo) is too big (disproportion) to fit through mom's passageway (pelvic). How did they figure this out? Two ways. One was a labor that wasn't progressing at the rate of speed the medical community agreed was normal at that time. I say "at that time" because I have worked with plenty of local doctors who no longer practice with this older time frame model in mind. Or before she ever began labor they might xray the mom , take measurements and make a determination without even a trial of labor. Of course this practice has now been abandoned. Xraying moms; it sounds crazy doesn't it? Guess what! We still routinely ultrasound moms who have gone past their due date and one of the things the doctor does is make a recommendation to your OB or midwife about the possible size of your baby and whether you should be sectioned for...wait for it...here it comes...cephalopelvic disproportion or possible shoulder dystocia (shoulders to big to fit) before you even try!

The second reason women were being operated on to give birth was the fact that they had been operated on to give birth. This was the era of "once a cesarean, always a cesarean". The surgical technique of the time was to cut the mom vertically from below the ribs to the pubic bone. This classical cut was associated with a high rate of rupture during future labors. The ghost of this fear based on the rupture rate of classical incisions is still with us today in the doctor's office when women discuss their "options" for future births. It is still in women's hearts too, passed down to them from their mother's birth era.

When I was in my thirties things were changing. The medical community had realized the cesarean rate was sky rocketing and they needed to do something about it. Surgical technique for incisions and suturing had changed; the "bikini cut" had come into vogue, and the risk of rupture had been significantly reduced. Also consumers had put pressure on the medical establishment by taking matters into their own hands; either birthing out of hospitals all together to achieve their V-BAC, or going into the hospital late in labor and refusing to undergo a repeat surgery. Doulas were being asked to labor sit at home with these moms and try to bring them to the hospital at the last moment. These brave pioneers proved women could safely and successfully labor and birth vaginally after a previous surgical birth. They proved V-BAC was a viable option for many women. I remember Dr. Clutter and Dr. Lickness being our first local doctors to support women in this choice.

When I was in my late thirties it was the norm to at least go through a "trial of labor" before deciding to section a woman again. Some of our doctors were much more liberal in their "trials" than other local doctors. As a doula I often felt I had to match wits with some of our more scalpel ready doctors to keep my clients out of the operating room. Another positive change was our local certified nurse midwives being allowed by their supervising doctors to V-BAC women in all our hospitals. Sandy Rodriguez and JoAnne Tarkington caught many, many a successful V-BAC baby.

By my forties the pendulum was swinging back. The fear of uterine rupture was again haunting doctors' offices and labor rooms. A study came out showing that V-BAC women had a greater chance of rupturing than nonV-BAC women. This study lumped all women together without taking into account if the mom went into labor on her own or if she was induced. It also didn't make any distinction as to the method used for induction. (Remember that wonderful induction drug Cytotec? This is the era it is becoming more popular among the medical community. Don't know about Cytotec? Read my piece, Let's Talk about Off Label Use, Cytotec and You.) In reponse to the study the American College of Obstetricians and Gynecologists (ACOG) came out with guidelines requiring hospitals to have anesthesiologists waiting in the hospital the entire time a V-BAC mom labored. Most hospitals found this a financial, practical, legal and bureaucratic impossibility. For a brief time all V-BACs were shut down at our hospitals. Luckily for us Sierra Vista took the bold step of contracting with our local anesthesiologists for enough coverage to allow Sierra Vista to offer the V-BAC option to women in our community. But it is the only hospital within hundreds of miles to do so! I recently had a client who moved back from Santa Barbara to Atascadero just so she could successfully V-BAC at Sierra. ACOGs guidelines also required OBs to be standing by throughout potentially long labors. For many doctors' practices this was a practical, geographic, and financial impossibility. So if your OB's office was located physically close enough to Sierra Vista you could V-BAC, if not you could not. And of course our wonderful nurse midwives were no longer "skilled" enough to catch V-BAC babies. I will never forget the last V-BAC I was at with Sandy and JoAnn. My client had been told she could V-BAC with them but when she was in labor in the hospital she was told the supervising doctors could no longer advise she go for a vaginal birth because she was past her due date. My client decided to refuse to say yes to another surgery. Sandy supported her decision and JoAnn did a great job catching a beautiful healthy baby girl. I have never been more proud of three women in my life. Meanwhile women continue to safely V-BAC with our licensed midwives at home and with doctors at Sierra Vista every day.

When I was fifty I was hired as a doula by a woman who was trying to find some way to not end up with a second operative birth. She was caught in a terrible bind. Her due date fell at a time when one of our homebirth midwives was not practicing and the other was already over committed trying to service all the local women who wanted to birth at home. Her MediCal doctor had deemed her too great a risk for V-BAC and wanted her to have a repeat operation. He put her under extreme pressure to agree to a surgical birth, even sending her a certified letter saying he had explained the risks to her of not agreeing to a surgical birth and requiring her to get a notarized signature. Although the nurse midwives wer supportive of her desire they could not help her. It was suggested to her that she labor at home with me for as long as possible, then come to the hospital and refuse the surgery. You tell me how it can possibly be a good choice to labor at home without a skilled medical attendant, with a woman who has more risk of things going wrong, without anyone who can take the baby's heart tones or has any emergency equipment or training? This is an impossible position to put doulas in. My client called me late into her labor and when I arrived at her home it was quickly obvious to me she would be pushing soon. I told her we needed to go to the hospital and she begged me to stay with her at home and catch her baby. She told me she trusted me. I told her I couldn't do it, I had no equipment and no experience. I convinced her to go to the hospital and she ended up with another c-section. An outcome that will weigh on both our hearts forever.

In the last few months I have seen another change on the horizon. I believe we are witnessing a new V-BAC era being born. There have been a flurry of studies, articles and announcements about the concern over the rise in our national cesarean rate, balancing risks of repeat c-sections versus v-bac and a woman's right to choose. The National Institute of Health came out with their finding which has pushed ACOG to review it's guidelines and make their own announcement. Read Neergaard's great article to see where we are headed.

By LAURAN NEERGAARD
AP Medical Writer

Most women who've had a C-section, and many who've had two, should be allowed to try labor with their next baby, say new guidelines - a step toward reversing the "once a cesarean, always a cesarean" policies taking root in many hospitals.

Wednesday's announcement by the American College of Obstetricians and Gynecologists eases restrictions on who might avoid a repeat C-section, rewriting an old policy that critics have said is partly to blame for many pregnant women being denied the chance.
Fifteen years ago, nearly 3 in 10 women who'd had a prior C-section gave birth vaginally the next time. Today, fewer than 1 in 10 do.

Last spring, a National Institutes of Health panel strongly urged steps to reverse that trend, saying a third of hospitals and half of doctors ban women from attempting what's called VBAC, for "vaginal birth after cesarean."

The new guidelines declare VBAC a safe and appropriate option for most women - now including those carrying twins or who've had two C-sections - and urge that they be given an unbiased look at the pros and cons so they can decide whether to try.

Women's choice is "what we want to come through loud and clear," said Dr. William Grobman of Northwestern University, co-author of the guidelines. "There are few times where there is an absolute wrong or an absolute right, but there is the importance of shared decision-making."

Overall, nearly a third of U.S. births are by cesarean, an all-time high. Cesareans can be lifesaving but they come with certain risks - and the more C-sections a woman has, the greater the risk in a next pregnancy of problems, some of them life-threatening, like placenta abnormalities or hemorrhage.

The main debate with VBAC: That the rigors of labor could cause the scar from the earlier surgery to rupture. There's less than a 1 percent chance of that happening, the ACOG guidelines say. Also, with most recently performed C-sections, that scar is located on a lower part of the uterus that's less stressed by contractions.

Of those who attempt VBAC, between 60 percent and 80 percent will deliver vaginally, the guidelines note. The rest will need a C-section after all, because of stalled labor or other factors. Success if more likely in women who go into labor naturally - although induction doesn't rule out an attempt - and less likely in women who are obese or are carrying large babies, they say.
Thus the balancing act that women and their doctors weigh: A successful VBAC is safer than a planned repeat C-section, especially for women who want additional children - but an emergency C-section can be riskier than a planned one.

Because of those rare uterine ruptures, the obstetricians' group has long recommended that only hospitals equipped for immediate emergency C-sections attempt VBACs. Many smaller or rural hospitals can't do that, and that recommendation plus high-dollar lawsuits have been blamed for some hospital VBAC bans.

"Restricting access was not the intention," the new guidelines say. They say hospitals ill-equipped for immediate surgery should help women find care elsewhere, have a plan to manage uterine ruptures anyway, and not coerce a woman into a repeat C-section.

Educating women about their options early enough in pregnancy for them to make an informed choice is key, said Dr. F. Gary Cunningham of the University of Texas Southwestern Medical Center, who chaired the NIH panel on repeat C-sections.

It requires a fair portrayal of risks and benefits that can differ by patient, added Dr. Howard Minkoff of Maimonides Medical Center in Brooklyn, N.Y., which has women sign a special VBAC consent after counseling yet has a higher-than-average VBAC rate of 30 percent.

"There's no doubt that how things get framed influences how people act," he said.

While the guidelines cannot force hospital policy changes, some women's groups welcomed them.
"I feel like ACOG has really listened to how their previous policies have impacted women," said Barbara Stratton of the International Cesarean Awareness Network's Baltimore chapter, adding that she'll advise women seeking a VBAC to hand a copy of the guidelines to caregivers who balk.
But she called for reducing overuse of first-time C-sections, too, so that repeats become less of an issue.
Read more: http://www.sanluisobispo.com/2010/07/21/1223164/new-guidelines-aim-to-reduce-repeated.html#ixzz0uQm4tHXf

Good News about V-BACS!

Women need to think twice before they put their lives at risk by saying yes to a repeat elective cesarean! This was just forwarded to me from our local ICAN chapter leader about a new VBAC safety study:

Vaginal Birth After Cesarean Found to be Safer for Moms than an Elective Repeat Cesarean

A study appearing in the June edition of the journal Obstetrics andGynecology reviews evidence about maternal and neonatal outcomes relating to vaginal birth after cesarean (VBAC). The study authors identified relevant studies from multiple searches of MEDLINE, DARE and the Cochrane data bases(1980 to September 2009) and from recent systematic reviews, reference lists, editorials, Web sites and experts. Overall, there were low rates of maternal harm for both trial of labor and elective repeat cesarean delivery. Maternal mortality rates were higher for elective repeat cesarean delivery at 0.013% compared with 0.004% for trial of labor. Rates of maternal hysterectomy, hemorrhage and transfusions were similar for both trial of labor and elective repeat cesarean delivery. Perinatal mortality was increased for trial of labor (0.13% compared with 0.05% for elective repeat cesarean delivery. The study authors concluded that VBAC is a reasonable choice for the majority of women, since adverse outcomes were rare.

To access the full study online, go to: http://journals.%20lww.com/greenjou%20rnal/Fulltext/%202010/06000/%20Vaginal_Birth_%20After_Cesarean_%20_New_Insights_%20on.25.aspx

ICAN of SLO: icanslo@yahoo.com

Good Newsweek Article on V-BACS

Why don't more doctors support a woman's desire to birth naturally after a previous c-section? This is the question posed in a recent Newsweek article. Claudia Kalb does a good job explaining the relationship between the ACOG guidlines for V-BAC, hospital & doctor liability, the latest research put forward by the National Intstitute of Health, and where a woman's choice fits into it all.

http://www.newsweek.com/id/235317.

Thanks to our local chapter leader of International Cesarean Awareness Network for bringing this article to my attention.

Shocking Article in Huffington Post

As is often the case things are not as simple as they may at first appear. I posted the article below immediately after reading an article from the Huffington Post. I have since done some more research of my own and although this case is still shocking it is about as clear as mud.

The hospital, St. Barnabas, in New Jersey has a 49.3% cesarean section rate and wanted the laboring mom to sign a consent to a cesarean surgery as soon as she arrived! The also wanted a consent for an epidural, fetal scalp monitoring, an episiotomy and other procedures. This in and of itself is shocking to me and sends up many red flags.

On the other hand it is possible this women is suffering from mental health issues. Having been with many women in labor, which most psychiatrists or psychologists have not, I do not feel a woman's mental health should ever be assessed during labor. However this woman suffers from a diagnosed pre-existing condition: post traumatic stress disorder. The feelings of labor paired with the actions of the hospital may very well have provoked an episode of some sort. I have witnessed this myself with women who have suffered a trauma in the past. Labor opens many doors into the heart of a woman and sometimes her demons come out. Labor is an extremely vulnerable time. A woman with a history of trauma must be supported with understanding for her unique situation. On top of this I feel that how many hospitals treat women can bring on post traumatic stress disorder. We don't call it that; we call it post partum depression or an inability to reconcile with their cesarean experience.

Here is a link if you want to read further into this sad story after reading my original piece below.

http://www.theunnecesarean.com/blog/2009/7/21/refusal-of-unnecesarean-leads-to-loss-of-custody-vs-story.html

OMG!!! I just read a stunning article about a woman who refused a c-section and although she gave birth vaginally to a healthy baby she had that baby forcibly taken from her afterwards and placed into state foster care. This is so wrong on so many levels that I am having trouble collecting my thoughts enough to write anything coherent. Tragedy; a tragedy for women's civil rights, a tragedy for this child, a tragedy for this family, a tragedy for all the women out there who may want to take a stand against their OB's "advice" but will now have this fear in the back of their minds. I am telling you the push back from the entrenched medical community against the rising tide of natural birth is very ugly indeed. It is coming at us on all levels; through the media (a ridiculous piece on the Today show against homebirth), through individual hospitals (telling women they can't give birth there if they use a doula or write a birth plan) and through individual birth practitioners (steering women into hospital based birth preparation classes and away from educators who advocate for natural birth).


Please educate yourself by reading this important article by Louise Marie Roth on Huffington Post "Is a Woman in Labor a 'Person'? New Assaults on Pregnant Women's Civil Rights in a NJ Case". Prepare yourself because this article is shocking and disturbing. Click on the Link in my Great Resources section. Continue further by reading "Controversy Sparked by a Sign on a Door", also on my Resources Links. Add that to the situation that I wrote about in my Informed Consent article. Then think about a Certified Nurse Midwife in our community, whom I respect, telling a Bradley educator during a public forum that Bradley teaches women to not "trust" their care providers. I believe this is because Bradley teaches women to be good birth "consumers"; to question, choose what they think is right for them and their baby, and to be prepared to stand up for their choice against opposition.

So why is this happening now? Money, power and fear come to mind. Could the current political climate come into play here as well? Is the right to life movement, which is something completely different, be spilling into other issues surrounding a woman's right to choose what is best for her body in other ways? For the first time women in the 'alternative' birth community are speaking up on the national stage, whether it is Ricki Lake's video The Business of Being Born or The Big Push for Midwives Campaign rallying women to speak to their legislators on Capitol Hill to be sure to include Certified Professional Midwives in the current national health care bill. The Internet is connecting women in a way never seen before and the younger women in the birth community are taking full advantage of it. Remember ordinary obstetrics is a huge money maker for the medical community but if you add in the money for inductions, epidurals, c-sections and extra days in the hospitals for moms and babies in neonatal intensive care units the fees skyrocket. On top of that birth is considered a gateway procedure. Women tend to return to the same hospital for additional births and other health issues as well as bringing their husband and kids when they have problems. That adds up to lots of money over lots of years! So what happens if women start saying no to their doctors "advice" to be induced simply because they are at 40 weeks, or work hard to not choose an epidural, or say no to having major abdominal surgery? There is so much to be lost or gained on both sides.

Please read the complete Huffington Post article then send my link on to family or friends you think would benefit. I really want to hear your thoughts on this issue after you have read the linked articles. Post a comment here.

Thanks goes out to the women at ICAN who told me about the Roth article!