Breastfeeding, Pitocin and Epidurals; a new look

Did you know there are predictable stages babies move through during the first hour after birth? First they rest. This is soon followed by searching for the voice they have been listening to in the womb. As soon as they have identified her voice, from among a myriad of new sounds, they are driven to raise their faces and gaze into their mother’s eyes attaching the familiar voice to the unfamiliar face as they begin bonding outside of the womb. Once satisfied, they move on to innate behaviors meant for finding their food source and receiving immune boosting, brain stimulating colostrum. By pushing with their feet and knees on mom’s tummy they wriggle and squiggle their trunks up to find the swell of her breasts. They head bob or bump on mother’s chest breathing in her smell. Their eyes search for the bull’s eye of her darkened areola. Then they open their mouths or push out their tongues getting ready to taste. They explore her nipple with their hands; squeezing it in their tiny grasp. Giving themselves tactile information. Then they move their fist to their mouth, sucking the flavor of mother off their hands, and filling their intestinal tract with the good bacteria they need to promote internal health. Finally they latch on and taste the colostrum. After several uncertain tastes they get down to business and suck deeply; flooding their bodies with oxytocin; the love and bonding hormone.

These behaviors are repeated whenever a baby is born. Not just a human baby but every mammal baby has a repeatable, quantifiable process. What happens to this process when a mother is given an epidural or Pitocin during labor and should we care? Ethnographic Researcher, Dr. Brimdyr, PhD, CLC, and her team of obstetricians, lactation consultants, nurses, midwives and anesthesiologists wanted to find out. In their newly published study they divided sixty-three low risk mother/baby dyads into two groups; medicated and un-medicated. All the pairs were filmed during the first hour of life. Then the team of researchers did what ethnographers do; they studied the pairs to watch for clues. Ethnographers observe and analyze “symbols” that their target users use. In this case the predictable innate behaviors which initiate bonding and breastfeeding in human babies; a basic survival skill.

So what did they find out? Both IV Pitocin, the most used labor induction or augmentation drug, and Fentanyl, a drug in the typical epidural, significantly impact a baby’s abilities to move successfully through the normal first hour of life behaviors. The amount of medication and the length of time the mother was receiving these drugs were also found to be significant. The more mothers had, the longer they were on them, the greater the impact on the babies’ abilities. The worst case was the typical 2015 birth scenario in U.S. hospitals, long Pitocin induced labors with an epidural for pain management over an extended period. This study shows a direct correlation; a direct impact on skills considered basic survival behaviors.

These mothers were given fentanyl via an epidural which we have been told for many years doesn't reach the baby. Still we can see a correlation between amount fentanyl and poor survival efforts by the babies. 

In my observation as a doula I believe those caring for and about the new baby; mom, nurses, midwives and doulas, also have an internal innate clock ticking from the moment of birth which further complicates matters. I have certainly felt it inside myself. Our intuitive senses are telling us if the baby is struggling to complete the tasks on the normal timeline. Unfortunately what happens next is very damaging to the programming process. Babies who are “helped” through assertive positioning, holding of heads, and nipples being pushed into their mouths, or faces being shoved onto breasts, are not only unable to complete the correct programming but have an incorrect program laid down in their systems. This often takes many tech support trips to a lactation consultant to uninstall.  Meanwhile mothers are in their homes spending many weary hours pumping while quietly shedding lots of tears. They incorrectly assume they are the ones to blame; there must be something wrong with them. It takes a very strong mother not to give up on breastfeeding. Not just for this baby but for any future siblings as well.

So should this be a cause for concern? We know these stages lay down the initial programming for successful breastfeeding. Other studies have observed a connection between moving through these steps in an hour and ultimately being a successful breastfeeding mother/baby dyad for at least 6 months. Exclusive breastmilk for the first 6 months is recognized by the World Health Organization and the American Pediatric Association as providing the best start for babies’ bodies and brains. Studies have now shown that even just one bottle of artificial human milk can alter the microbes reproducing in an infant’s gut. Cutting edge research is showing us our intestinal flora balance is tied to many diseases. Further consider other ways we may be inadvertently installing wrong programs in our children. We know babies are flooded with hormones as they leave the womb. One of these is adrenalin; fueling their drive to survive. It creates a hyper-alert state where sensory information of all kinds is heightened. This is initially needed but adrenalin is very draining to our systems. The system is designed to down regulate within an hour. Oxytocin and endorphins, the hormonal antidote to adrenalin, are released during suckling changing their body and brain chemistry. So what happens to an infant’s brain when it continues to be bathed in fear flight hormones beyond an hour? What happens when our babies’ bodies are wired to assume this level of adrenalin should be their baseline? What programs could we be installing for life?

Although this study was small the results are important and point in the direction for a much larger study to be done and a review of the true risk of these drugs to babies. For many years I have heard doctors, nurse midwives, labor nurses and anesthesiologists telling mothers there is very little risk to their babies. The only risk they perceive is in the here and now. Their responsibility for this new life ends soon after birth. Their risk assessment is grounded in a fear of doing nothing about other known risks, such as, going too long past the due date or a labor lasting too long. But when we consider the now known impacts to breastfeeding and breastfeeding’s impact to life-long health the true risk comes into clearer focus. Projected, possible risk, is like looking into a crystal ball. No one can know the true risk for any individual baby of either saying yes or no to Pitocin and or an epidural but at the very least mothers need to have good quality evidenced based information of the total picture to make their decisions.

"It is crucial for new parents to be aware of the risks of intrapartum drugs, and medical professionals have an ethical obligation to inform parents of such risks, especially when these drugs are so prevalent in Labor & Delivery. The implications of this study are huge."
Dr. Brimdyr, lead researcher

To see the study: http://onlinelibrary.wiley.com/doi/10.1111/birt.12186/full

Listening

All the time we are hearing that good communication is the key to relationships. For many of us this translates to if I can just find a way to tell you what I need you to hear you will grant me what I want. Or perhaps you think of it as speaking your truth and assume that the truth will set you free? What if the key to relationships wasn't in the speaking but in the listening?

Julie Nevison, founder of Aware Parents Aware Kids, recently gifted me with a slim little gem of a book called Listening Partnerships for Parents, by Patty Wipfler targeted at listening skills. I have always thought of myself as a good listener and over the years have actively worked on improving my skills. Recently I am finding that there is WAY more for me to learn and put into practice with those I love, clients I work with, and friendships that lighten my life.

Eons ago my husband and I took a class together taught by Steve and Cathy Brody, a psychologist and therapist husband and wife team. We learned the skill of mirroring what someone said. This was supposed to help them feel heard. Unfortunately we only learned the basic rote skill. In practice we simply fed back the other person's words before rushing forward with our own ideas, complaints, or needs. My husband rightly HATED it. I had to wait for more than twenty years to see the art of mirroring done so gracefully by Christi Silva as she facilitated La Leche League meetings. Not only did she mirror but she organized and sorted the random thoughts, feelings and ideas presented without ever interjecting her own ideas or making the speaker feel judged. She handed this back to the speaker as a gift. I listened. I heard you. Thank you for sharing.

Struggling as a parent and feeling I wished to strengthen my relationship with my son I read, "How to Talk So Your Kids Will Listen and  Listen So Your Kids Will Talk" by Faber and Mazlish. Oh ho! So if I wanted my son to talk I needed to STOP talking! Now there's a concept. I still have a hard time with this at times. Sitting and waiting rather than engaging with questions isn't easy for me. Also this was the first time I heard the idea that as the listener, especially as a parent, it isn't your role to give them solutions or fix things for the speaker. If you just wait attentively, supportively, your child will begin to think of their own solutions. Then you can help them "try their solutions on" to see if they feel right to them or have the chance of actually working.

A few years ago taking Tory Blue's NVC class (non-violent communication) again shifted my whole perception of listening. She opened my eyes to all the critical dialogue going on in my head about myself and the person I was listening to; all the ways I thought I would, could, or should "fix" their problem. I also became aware of the concept of unmet needs creating dis-ease commonly felt by us as anger, frustration, sadness, or tension while met needs create happiness, satisfaction and joy. Communication is simply a way of asking to get unmet needs met. Sometimes others are willing and can meet those needs. Sometimes they can't or do not wish to meet the need. Often because meeting your need is in direct conflict with one of THEIR needs. This isn't wrong or bad. It just is. We may have to meet our own need or seek that need being met by a different person or in a different way. And guess what? That's okay!

La Leche League training puts a lot of emphasis on listening skills. We are taught to help a mother observe, look for clues, and sort through her own situation. We give her pertinent information she may not have which could help her clarify what she desires to do. We express confidence in her and her own abilities to know what to do and to do what needs to be done.  We tell her whatever she decides we know it will be best for her and her family. Or perhaps we are expressing confidence in her baby's abilities to learn or conquer a struggle, tap into their innate wisdom and abilities, or the hard wiring of their genetic coding. In essence we are modeling the behavior of listening to her baby rather than any other voices, especially if listening to those voices shakes her confidence in her mothering abilities.

My CranioSacral and Ortho-Bionomy studies and Feldenkrais explorations deepened my understanding of the many ways to "listen" to myself or someone else through physical touch. Again I saw that no real communication would happen if I was anything but completely accepting of what was, rather than what should be. Only after awareness and acceptance could I begin to explore other possibilities. Doors keep opening and new levels of understanding are revealed. Awareness and intention allow us to blend with another physical being through our hands. Permission has to be asked and granted on many levels before another human being will feel safe enough to reveal themselves to you. This is a sacred trust.

As an Intuitive Doula I listen with my head, heart, and hands. I listen to her hopes, dreams and plans. I listen to her birth struggles. I listen to her joy or sadness when the birth is over. So much of what I bring to a birth is simply my attentive presence. Feeling really listened to and honored through the intensity of birth is what is missing in so many women's birth stories. I listen with my ears, my brain, my hands, my intuition, my intention. Listening brings self-awareness.

Reading Patty Wipfler's little book I realized I STILL have so much to learn about active, caring listening and acceptance. Some of it was simply a good review; helping me brush up on things I already knew. There were also good reminders of things I had learned but still forget to use effectively in every day life. Most importantly it brought me a new layer of understanding about pain, hurts, and healing. Patty says unhealed childhood hurts leave scars that create rigid, irrational behavior. This makes sense to me. In order to heal those hurts we need to be LISTENED to. Feeling truly heard accepted and loved can help us release tears. Tears allow us to rid our bodies of trapped emotions. Emotional tears contain the harmful chemicals that have been trapped in our cells; frozen in rigidity. From my body work studies I know these unhealed hurts also leave physical scars in the form of physical rigidity or dis-ease trapped throughout our bodies; aching to be listened to, released, and healed. When our body feels listened to it finally is able to let go.

I am lucky to have Julie drop into my life at this time. "When the student is ready the teacher will appear." Thank you Julie.

A Feminist Perspective on Breastfeeding

“Breastfeeding and Work; Let’s Make It Work.” What comes to your mind when you hear the 2015 World Breastfeeding Week’s slogan? Most Americans think of women working outside the home who juggle nourishing their babies at their breasts with the demands of a boss. This calls to mind breast pumps, bags of frozen breastmilk, and bottles left for daycare providers; mothers striving to provide the very best both financially and nutritionally for their families. If you are a politically progressive American, “breastfeeding and work” may evoke images of paid maternity leave, perhaps even as long as some European countries, which provide 1 to 3 years! If you are a woman working in an office job perhaps this slogan sets you dreaming about pretty, private, lactation rooms with cozy chairs, baby photos, relaxing music, a clean sink to wash your pump parts, a refrigerator for storing pumped milk, clean counter space and electrical outlets to plug in your double, hospital-grade, hands-free, electric pump. Or you may be one of the many women yearning for a long-enough break from running a cash register, working the sales floor, making motel beds, tending the sick, picking vegetables, or flipping burgers to drain your full breasts often enough during the day to keep your body producing enough of a milk supply to match your hungry baby’s growing needs.

These are all valid dreams and desires, but as a community lactavist and modern feminist I have a broader vision; a vision better for all of humanity.

Who decided what IS work and what ISN’T work? Men did. Our modern chauvinistic culture decided work was what men did away from home. Therefore, women weren’t working when they stayed home and raised children. Anyone who has raised children knows this is ludicrous. Raising babies into well-functioning, happy, healthy adult human beings is incredibly demanding work. The hours are ridiculously long. Your job description changes every few months. Your day is filled with multitasking, negotiating, and strategic planning. Safeguarding the next generation, assuring the continuation of the species, is arguably the MOST important human endeavor. Regardless, men deemed raising children as less important than making money; therefore, what women did was NOT work.

Sadly when the women of the women’s liberation movement fought for the right to work outside the home they adopted the male paradigm for themselves. Imagine all those career-minded women in their pant suits. Secretaries might wear skirts but any woman who hoped to climb the corporate ladder donned the female equivalent of the coat and tie. Even Hillary Clinton perpetuated this stereotype through much of her last campaign. The 1960’s feminist reasoning went like this. We want to compete in the professional world. The professional world was designed by men for men, therefore we will pretend we are men. We will pretend we don’t grow babies, we don’t birth babies, and we don’t make milk to continue to grow babies. Many of the feminists of the time, such as Gloria Steinem, DIDN’T have babies. Others, like Betty Friedan had children who were older by the time they spearheaded a cultural revolution.

The “Mommy Wars” are a direct outgrowth of this acceptance of the male construct of what is and isn’t work. The media plays into big corporations’ hands when they keep the conversation about women judging each other; “working” mothers versus stay-at-home mothers. Giant formula makers are happy the conversation stays away from the damage we are doing to the long-term physical and mental health of human beings by feeding milk proteins designed for baby cows instead of baby humans.

Purely from a science perspective the verdict is in. Breakthroughs in epigenetics, the human microbiome, gut health, and evolutionary biology all point to the same conclusion; formula feeding is a major health risk in our society, but no one is talking about it except people directly involved with lactation education. We desperately need to make a cultural shift if we want to truly deal with the obesity epidemic. Or tackle lowering our rates of heart disease, autoimmune disease, breast and cervical cancer in our country and much, much more. Studies link all of these health issues to artificial human-milk feeding.

That shift starts by valuing women’s abilities to nurture and sustain life. Acknowledge that women have brains, and uteri, and breasts that lactate. We are the crucial link between the generations. This most important ability needs to be supported by every level of society if we want the human race to thrive. We need to support not only the women who are pumping behind closed office doors, but also the women who need to pump during a break from picking strawberries, and the women who are working at home to raise kids, and the women who are nursing their children while they take calls for their in-home business, and the women who are taking their babies to work. We need to tell all mothers through our laws, through our media representation, through changes in our language, through our politics, and through our economics that all women who are providing breastmilk for their children are doing important work for all our futures. I want us to move beyond the Mommy Wars, to move beyond normalizing breastfeeding, into a culture that values and supports the significant contribution every lactating woman is making for our country, our world and our species.   

Jennifer Stover is the education chair of the Central Coast Breastfeeding Coalition, based in San Luis Obispo, CA. She has been a La Leche League leader for 5 years and a certified birth and postpartum doula for over 20 years, and founder of the Birth & Baby Resource Network.

Classic Hospital Bed Meets Ancient Wisdom

So you have read Ina May's Guide to Childbirth and plan to birth in an active, upright position. Bravo! You have taken the first step in reclaiming your birth instincts. As a first time mother you have chosen to do a "homebirth in a hospital." You took classes, hired a doula, and crafted a birth plan. Being well educated when labor began you did not rush to the hospital with the first contraction. Instead you listened to your doulas suggestions of eating, showering, baking, gardening on hands and knees, rocking in a rocking chair, swaying on a birth ball, dancing, cuddling, hanging within your partner's loving embrace, climbing up and down your stairs, and going out for a walk or two or three. 

At last the time has come to drive to the hospital. You climb in the car and instinctively know that leaning back in that bucket seat while you sit to ride to the hospital is NOT going to be fun. Each contraction is intensified without being more productive. You are so glad to be able to get out of the car. You get on your feet and instinctively lean forward, drop your knees a bit and sway gently with the contraction that hit as soon as you stood up. Strong but doable you tell yourself. 

Next stop the emergency room doors and waiting for a wheel chair to take you to your room. Now they want you to sit in a chair and wait for a chair. The idea of not having to walk sounds inviting as your labor hormones are coming on strong and making you feel drifty but the actuality is something very different. Labor sensations while in a wheel chair moving forward causes your head to swim and you grip the arms of the chair causing tension through your neck and back intensifying your pain. The pressure of the seat on your bottom causes you to lift one cheek and list to one side. Too late you realize walking would have been much better than this. You traded in your feelings of competency and confidence in exchange for a quicker way to access the privacy of your birth room because you have a strong desire to be away from the bright lights and staring eyes of strangers. 

You finally arrive at the room where you will meet your baby face-to-face and there it is; the bed. It's presence dominates the room. Next to it stands all the technology money can bring to birth; fetal heart monitor, contraction monitor, computer, read out screens, audio controls, blood pressure reader, oxygen saturation tester, IV pole with computerized medication administration box attached, in other words, all "the machines that go beep". Still it is the bed that seems to suck the life out of your idea of an active birth; an instinctual birth. Your nurse cheerily asks you to pee in a cup and climb into the bed. So after all that walking, and sitting, and rocking, and kneeling what should you say or do?  

U.S. mothers are faced with this dilemma every day or more likely night. How should you handle this moment. It will be the opening moment in the long negotiation of your birth. If you have already had a baby and experienced that moment what DID you do? How do you feel about it now? Would you do it again?

This is the theme for July's Positive Birth Movement; the hospital bed's impact on your birth. PBM started in Great Britain and is spreading around the world. I am proud to be the SLO facilitator. We will be discussing the topic of labor beds from many different angles at my coffee & conversation in July.

It is important for modern American women to fill their mind with images of many possible birthing positions. Positions that can be done in or out of a hospital bed. How many different positions do you see portrayed in this short film? Notice how many different ways one may "squat". How deep the squat is, how far apart her feet are set, whether or not she is rounding or arching her back, pushing her feet against something or someone, or pulling on something all make the physics and body mechanics different.  <iframe width="560" height="315" src="https://www.youtube.com/embed/0J5xlBmJHTI?list=PL197D9817EDD8A137" frameborder="0" allowfullscreen></iframe> 

For anyone to make the general statement that squatting causes babies to descend too rapidly or causes tearing isn't educated enough about squatting to see all the many nuances that can be obtained. <iframe width="560" height="315" src="https://www.youtube.com/embed/Q3wbuDSio74?list=PL197D9817EDD8A137" frameborder="0" allowfullscreen></iframe>

Many of our doctors and nurse midwives are comfortable with mothers moving into a variety of laboring positions but once the mother is in the pushing phase still desire to take over and control the process by moving her into positions they, the care providers, are most comfortable in regardless of the mothers instincts or desires. In which of these birth positions do you think your care provider will be comfortable catching? Which ones will he or she have ever done? <iframe width="560" height="315" src="https://www.youtube.com/embed/HiCgDlxdmPI?list=PL197D9817EDD8A137" frameborder="0" allowfullscreen></iframe>

In many ways I see the pushing phase of labor as the final frontier of the struggle I have been part of for so many years; the struggle to return birth to the birthing woman. As a doula the hospital labor bed represents the Berlin Wall that stands between women and their innate abilities. It is long past time to “Tear down this wall!” 

Looking Deeper into a Negative Birth Story

This blog piece is in direct response to the recent piece in the Huffington Post, “My True Feelings Regarding My Home Birth Experience” by Ashley Martin. Please take the time to read her birth story before you read my response.

This is a sad story. As a doula I have listened to many sad birth stories over the years. Sad stories from home births. Sad stories from hospital births. Unfortunately negative births happen all too often although the vast majority of births in the U.S. have positive outcomes; healthy moms and healthy babies. When I hear a disturbing story I have learned to pause and think. To put it in context with all the birth stories I have heard and all the births I have witnessed. I have learned to dig deeper while at the same time to not judge either the mother, place or care providers. It is important to remember that this is HER story. Her perception of home birth based on her two experiences of home birth. I wish her title had been, "What MY Home Birth Was Like". This birth lives large in her mind and heart; although she had previously birthed at home and I can only assume it went well because she chose to birth this baby at home as well. The trauma of this second home birth has indelibly imprinted its personal message in her psyche. If we were to hear her midwife's or doula’s perception it might be vastly different.

When birth turns high risk it instantly becomes traumatic for mom and dad no matter where it takes place. No matter how blissful the labor. No matter how much they trust those around them or themselves or a higher power. Naturally parents are extremely grateful to the person or people who they perceive as "saving" their baby. I put saving in quotes because I paused and put this birth into context. I used this mom's words about the actual timeline to direct my thinking. I thought about the births I have attended in hospitals that suddenly took a turn into trauma. I thought about what I know about neonatal resuscitation and procedures and time lines.

It is very difficult for parents when they feel let down by ANYONE at their birth. It is even more devastating when it happens in the middle of a high risk situation. When one group of care providers points fingers and lays blame at another during the process, rather than working as a seamless safety net for mom and baby, then things really begin to unravel emotionally for parents. Through this mother’s words I can hear the echoes of the hospital staff blaming the care she was provided, although they were not their to witness it, before she entered their doors. I have walked the halls of our San Luis Obispo hospitals. I have heard these words of blame and yet I only hear words of support for all involved echoing down the hospital halls when one of their births suddenly turns into a dangerous mess. Even when a baby dies. Our culture is always looking for “the other”, the one who is different. The one we can safely blame because they are not like us.

When we add the fact that our culture insists on a perfect baby every time in every birth place AND a perfect experience, AND someone must be to blame when that doesn't happen it often surprises me that anyone is willing to help birthing women at all. When things go bad the people providing care have put their lives, their livelihoods and their families in the line of fire. This has happened in our community. It has happened to both midwives and doctors. Good people providing good care as best they could.

Now we need to look more deeply into this mother’s birth. Here are the facts she presented. She had a very rare presentation. We are not told when during the birth process this was discovered or what steps or actions were done based on this information. It may have been missed until the baby was close to crowning, especially if her pushing phase was rapid or she hired a midwife who believed in a hands out of vagina birth. It is easy to immediately jump to the conclusion that if it was missed it must mean that her midwife was not qualified or was somehow negligent. But consider that I have been at 2 different breech situations where, despite numerous vaginal checks by doctors, midwives and nurses, no one realized that the babies were breech during labor until mom was fully dilated. If they had come rapidly after reaching 10 centimeters we would have had accidental vaginal breech births. Breeches happen much more often than brow presentations so presumably all of these providers had had the opportunity to feel what a breech feels like; whereas very few providers have ever felt a brow presentation.

Her second difficulty was the shoulder dystocia. Now I know from my son's birth that shoulder dystocia is scary even in the hospital. Everyone in the room goes on high alert. I have seen this dealt with quickly, smoothly and successfully both at home and in the hospital. Actually as scary as it was for her it appears since her baby is fine that it was dealt with successfully at her birth too. She mentions receiving fundal pressure to help get her baby out. I too received fundal pressure. Is fundal pressure risky for mom? You betcha. I learned this long after my birth. Have I seen doctors and midwives deal with shoulder dystocia successfully with no further complications for mom and baby? Plenty! Can shoulder dystocia go horribly wrong? Yes. I know of 2 cases in our county where it went horribly wrong. One at a home birth with a qualified midwife and one in a hospital with an extremely qualified and well respected doctor. She says her baby was stuck for 9 minutes. I assume she means head out body trapped inside behind the shoulder trapped behind her pubic bone. What steps can one take at this point in a birth anywhere. You can move mom into different positions. You can reach inside and try to free the trapped shoulder or turn baby into a new position. You can push back on the shoulder to break the clavicle. Were these tried? We don't know. What we do know is you can not get a cesarean in under 9 minutes in a labor bed.

Then she says 911 was called at 1 minute after birth. That is a very quick response from a midwife and right in line with MOST hospitals. Currently our local hospitals have baby respiratory specialists standing by at all births. Don't let this fool you. This has only been the case in our community in the last few years. Before that, like many hospitals around the country, labor nurses would have been taking care of this baby until a specialist could be called in. Normally at a birth, home or hospital, babies are given help if breathing is difficult or heart rate is low. As the baby is worked on it is constantly assessed every 30 seconds to see if it is responding to the intervention. If not, a swift decision is made to continue and/or go the next step. This midwife knew in 1 minute that this baby needed more help than they could offer at home and the call was made. She did the RIGHT thing and called an ambulance to transport. The ambulance arrived, assessed and transferred baby into the ambulance by 6 minutes! Not sure how that is possible but bravo! I have seen respiratory specialist teams struggle much, much longer at the hospital bedside before transferring into the Neonatal Intensive Care Unit.

What happened during the first minute? Was the baby dried and stimulated? This is the first step taken with any baby in trouble. Yes I can see by the photos this was done immediately. I see the assistant about to put the baby stethoscope on and listen to the heart rate. The mother tells us the assistant was warned to listen carefully and be sure of her assessment. Was this baby suctioned? Did they use only a bulb syringe or the DeLee which the hospital would have used? This mom doesn't say. Was the baby given oxygen? Yes. I know this from the photos. I can also see the baby has the slightest bit of pinking up beginning to show which indicates that his system is trying to circulate blood and that blood is oxygenated. They are also in the process of cutting the cord. This might be done if they are about to start CPR and therefore need to move the baby to a firm surface. Did the baby require CPR? Did the baby respond to CPR? The mother doesn’t tell us. Perhaps because she was in too much shock to take it in. She also doesn't tell us how long she pushed or what the baby's heart rate was during labor; especially pushing. Without all of this important information I have no way to assess the quality of the care provided by her midwife or if anything would have been different about her birth if it had taken place in a hospital. This may be an excellent midwife taking exactly the same steps they would have taken at the hospital in the same order and with the same rapidity.

We also don’t know what “life-saving” steps were taken by the traditional medical staff. Did the EMT need to do infant CPR when they arrived? How did the baby respond? What was the baby's condition when it arrived at the hospital? Did they need to intubate this baby so it could breathe? Perhaps, but there is no sign of that in the photos. The baby appears to have a line of fluids going in indicating medication of some type. Could this simply be the antibiotics so often given to home birth transport babies because of the perceived bias of a “dirty” home environment? Perhaps. Perhaps not.

She also feels that she almost died during this process. Women can die during birth. It happens due to hemorrhage. When a woman hemorrhages there is blood. There is LOTS of blood everywhere. This mom mentions no blood. Remember her description of the bathroom floor? She talks about baby poop being everywhere but not blood. Could she have bled too much? Perhaps. I have been with moms who have bled too much. Most of them were in the hospital. They received the same medication and physical manipulation a mom would receive at a home birth. As a birth assistant at a home birth I have held the medication drawn up in a syringe ready to go as the midwife monitored the bleeding and made a careful assessment about how much blood the mom was losing. Did this mom need medication and receive it? Did she need it and not receive it? We don't know. There is so much about this birth that we don't know. Making ANY decisions about the quality of care she received or the safety or risk of home birth is impossible based on the facts she has given us, no matter how compelling her story is. No matter how much it tugs at our hearts or shocks us.

This woman's perception of her son's birth IS important to me. It makes my heart ache but it doesn't cause me to believe more or less in place of birth. It DOES get me thinking more about what a woman needs to feel positively about her experience. The importance of having quality communication before, during and after a birth is very important. When a birth becomes traumatic or suddenly high risk this is a critical component that often gets lost. This is where I know this mother was let down. No woman should feel she was not listened to during her birth or have to "fight" to get her records. No woman should ever feel the need to make the statement, "I was misled, lied too, and manipulated. Informed consent? Hah. I wish. I left my birth feeling broken, beaten down, cheated." Unfortunately I have seen this too often with too many care providers in too many places. It is their fear response. They go on the defensive because they fear for themselves and their families.

To help a mother heal from trauma it is critical to keep blame, of the mother or any of the people who helped her, out of the conversation. Listening to her truth. Helping her sort through and understand the facts. Helping her go beyond her fear and shock and pain. This is important. Unfortunately rather than seeing this birth as unfolding just as it should; a hard labor followed by swift action to turn around a potentially bad situation by her midwife, the EMTs, the doctors and nurses, with a healthy mom and baby in the end, she is stuck in the negative feelings of guilt, blame and shame.

I do not know Ashley Martin. I do not know her midwife. I do not know what happened at her birth. I do know how she feels about it. I also know my own birth experience which took place in a hospital and included a posterior labor and a long pushing phase and a scary shoulder dystocia and in the end a happy healthy mom and baby. It took me 20 years and witnessing 100 births to stop blaming myself and/or my midwife. I can now confidently say we both did everything we could and my birth unfolded just as it should and I am grateful to my midwife and proud of my strength. I can finally claim the words "birth warrior" for myself.

I do believe many women are told, or choose to only hear, the roses and fantasy of fairy tale

birth. Let’s get real ladies. Birth isn't all orgasms and euphoria. Birth may have that, but birth is life and life is messy and risky and that is why it is miraculous. It is time we embraced the miraculous.

For another perspective and some of the missing puzzle pieces of this birth please check out the birth photographer's account. Remember we are not sitting in judgement. We are NOT trying to decide whose account is the "truth". For this mom, in despair over her birth, her truth is ALL that matters to her. I would caution anyone who would judge all of home birth through the lens of this one birth.