High epidural rates, society vs. reality

Why is it that such a high percentage of women takes an epidural? Many pro-natural birth advocates claim it's because health care providers don't tell women all about the negative side effects, and that women don't educate themselves enough.

I think the problem lies in a much, much earlier stage, long before the woman even becomes pregnant. I think the main problem is not (only) that pregnant women are not informed enough by their caregivers, I think that society as a whole plays a main role.

Let me explain.

When births moved into hospitals, the doctors didn't fail to close the doors behind them. Birth literally happens behind closed doors. In the beginning, the woman wasn't even allowed to have anybody with her, including her husband.
Before that, birth happened at home with a midwife, and was very much part of society. Often, the woman would be assisted by her husband (sometimes), her sister, her mother, her neighbor. Birth was a normal part of daily life.
So when birth moved behind the closed doors of the hospital, the societal familiarity of birth also disappeared.
What remains, is whatever trickles out from behind those hospital doors, and that's mainly horror stories.

I believe that there are 2 reasons for that:

1) I think that birth in a hospital, under hospital circumstances, has not really been an improvement for the circumstances of the mother. It generally did not make her birth experience better, quite the opposite. It has been like this for 3 generations already, since the 1920's approximately. Which means that in most cases, even our grandmothers didn't know anything else. So in a short century time, this has become our knowledge of the birth process.

2) Horror stories make for much juicier stories, so they're more likely to go around.

So this is how our society has gotten to know birth. Hollywood also adds some very unrealistic views, even though they generally leave out the epidural (and every other gory detail).
Society's view of birth has become distorted. One of the clear messages society gives about birth is that it's unmanageable without an epidural, and birth is a medical emergency. And we've been brainwashed with these messages ever since we were little.

As a childbirth educator I try to set the record straight about birth. But when I get a young, newly married 21 year old scared little birdie who is heavily pregnant, and I need to tell her that birth really isn't this big scary monster, it's already too late. It won't be able to take those fears away because they're too deeply instilled.
And that is where my frustration lies.

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New childbirth courses starting!

I'm very excited to announce that I'm opening 2 childbirth preparation courses soon.

The first course will be for couples, held on Sunday evenings. The course will be 6 weeks long.
We will start on Sunday, June 7th.

The second course is for women only. It will also run for 6 weeks. We will be meeting on Wednesday mornings, starting on June 10th.

Contact me for more information and registration, or join me on facebook. Look for the israeldoula page.

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My birth story

It was a Tuesday and I was already 10 days overdue. Until then I was having some Braxton-Hicks contractions in the evening, but nothing serious. But that afternoon I felt that things were different.
Noga and Savion were sick with the chickenpox and were feeling very miserable. They were staying over at my mom’s.
I felt that if I would stay there too for too long, my contractions would not get any stronger. My offspring was sick and it was sending the message to my body that now is not the time to give birth. So I went home in the evening and told my parents that there is a good chance that they’d have to take Eran to day camp in the morning.

When I came home, I made sure that all those last minute little things got done. I arranged the laundry, took a check to the neighbors and more things like that. Then I watched the first episode of the new season of The Apprentice UK. Meanwhile the contractions got stronger and I knew it was the real thing.
I decided to sit down on my birth ball a bit, and that was nice. It was around midnight and I called my doula to tell her what’s up.
I was chatting a bit on the internet, timing the contractions. From the timestamp in the chat I noticed that my contractions were already coming every 2-3 minutes are lasted around 1 minute each! That was very encouraging. They were also definitely gradually getting stronger. I told my doula it was tome for her to come.

She got there a little while later, and I was still in a good and chatty mood. The contractions kept coming every few minutes. It didn’t take long before I decided that it was time to go to the hospital. I felt that things picked up really quickly, and I didn’t want to be stuck in a taxi with very strong contractions.

We got at Hadassah Ein Karem at around 2.30 am. Luckily it was very quiet. I got checked, but I was only 1 cm dilated, 80% effaced. What a disappointment!!!
I got hooked up to the monitor to check the heart beat. Thankfully that was all fine. But the weird thing was that the monitor didn’t pick up my contractions at all. Not that that was a problem, the midwife believed me and the important part was the heart beat, not the contractions. But I still found it weird.

When I was lying on that bed, strapped to the monitor, the contractions became really intense, probably because of my position. And because it was it was the middle of the night, I suddenly got very tired so I dozed off in between contractions. Midwife Yana was very nice, and let me rest on the bed a bit longer. When I went to the bathroom, I noticed that I had lost my mucus plug.
Because I was only 1 cm, she was going to let me walk around for a while. She also needed the bed I was in. So we moved all my stuff to the waiting room. We weren’t the only ones there, and it was actually really annoying not to have privacy. My doula suggested that I walk around, but I was too tired. All I could do was sit quietly on a chair. I would close my eyes and nap in between contractions. I figured that sitting up is also an upright position, and it should be beneficial. I actually wanted to sit on a birth ball, but they wouldn’t let me have one in the waiting area.

After a while, Yana checked me again, and I was still only 1 cm! I didn’t understand how that was possible. The contractions were so strong and getting stronger, and it wasn’t my first birth!
Yana said that we should go home, because there was nothing to stay for at the hospital. We just needed to wait for the doctor to sign the discharge papers.
We decided that we were going to try to get a room in the Hadassah Hotel, because it was too far to go all the way home. My doula decided that she was going home because she felt that she wasn’t very helpful yet and she also needed to arrange a babysitter for her kids.

It took a long, long time for the doctor to come, so we were back in the waiting area. This time I couldn’t sit at all, and I was walking around and swaying my hips during contractions. All of a sudden it was so much easier to deal with contractions! I had an AHA-moment; the baby probably wasn’t in an optimal position which is why I wasn’t dilating, and swaying my hips helped move it into the right position.
I was actually longing for the ball and the shower, but pacing up and down the waiting area was all I had.

At 7 am Ely called my parents to let them know that we’re at the hospital, and that they should take Eran to day camp.
Finally finally the doctor was ready to see me. He said, “It’s your 3rd birth and you’re so much overdue and your contractions are so strong, I want to give you a room because it could go fast.”
That’s what I had been thinking all along! He told the new midwife Michal to check me and strip me, and he went over the admission questionnaire with me.
He said that according to the records, midwife Yana had also stripped me when she first checked me. She didn’t tell me that!! And I didn’t notice. Still very much NOT ok!!!! But at that moment I was so happy that they’d give me a room that I didn’t care.

Midwife Michal checked me again, and I was already 4 cm. No need for stripping! I was totally overjoyed. Ely called my doula to come back, it was now 7.30 am. She said that she would come as soon as she could get hold of a babysitter.

When I got to the room, the new midwife Tali gave me a hep lock and a hospital gown. I immediately sat down on the ball and thought I was in heaven! Unfortunately the ball wasn’t comfortable very long.
Tali wanted to put me on the monitor, and we decided I should lie down again.
The baby wasn’t moving enough, so after half an hour Tali said that I should drink something sweet in order to get a good monitor reading. She asked me if I preferred an IV or some tea with sugar. Well, some tea with sugar of course! She went to get it for me. She also told me that if I’d be interested in an epidural, I should know that it would take some time before I could actually get one because they’d have to give me IV fluids first and do a complete blood count. I told her I’m totally not interested, and that I’m a doula myself.

The sweet tea did the trick, and soon I was released from the monitor. Finally time for the shower! It didn’t come a moment too late, because it was becoming very difficult to deal with the contractions on the bed. I couldn’t stand being touched, and the only way I was getting through them was to tune deep into my own world. I felt the need to describe the force of the contractions, and I kept thinking to myself: “This one is totally mind blowing, I’m being knocked off my socks!”
But once I got into the shower, things got a lot easier. The water actually took the pain away. Partly it was the heat – it was numbing the area, and partly it was the force of the water beam on my skin. I felt my contractions low in my abdomen, with 2 ‘epicenters’, one on each side of my uterus. It would have been more helpful if I had 2 shower heads, 1 for each epicenter. But I had to make do with 1.

Tali told me that I could be in the shower for an hour, after that I’d have to come out for another monitor check. I kept praying that I’d be fully dilated before that, because I knew there was no way that I’d be able to handle the contractions on ‘dry land’.
After a while, midwife Jamilla stuck her head around the corner of the bathroom. She said that I had to come out because the doctor wanted to estimate the weight of the fetus. I didn’t do the Glucose Tolerance Test so they didn’t know if I had diabetes, and my last ultrasound was weeks earlier, so they wanted to make sure that the baby wasn’t too big, since I was already 10 days past my due date.
Ely said that the doctor wasn’t in the room yet, so I decided not to come out of the shower until he was actually there. That took a few more minutes.
So I quickly ran out of the shower, not bothering to cover up more than plainly throwing a sheet around me. Quickly I climbed onto the bed. The doctor felt my belly with his hands and said that it’s around 3500 gr, the average. Not too big and not too small. Then, before the next contraction started, I hopped off the bed again and ran back into the shower.

Now the contractions were getting hard to cope with, even with the hot shower aimed right at my belly. This is when my doula finally returned. She kept me company in the bathroom and we were chatting a bit.
Eventually I had about 2 contractions that were really completely mind blowing, and I didn’t know what to do with myself anymore. I was thinking to myself: “These better be transition contractions!!”
The doula noticed it too, and she commented that it was starting to look serious now. If she only knew!

Then there was a big WHOOSH, and my bag of waters broke. I looked down and the water was clear. I told my doula to go tell the midwife that my membranes had ruptured. I was hoping that this was the 10 cm mark.
Midwife Tali came and asked me to come out of the shower to be checked. She wanted to make sure that there was no prolapsed cord. I climbed onto the bed on all fours, and Tali checked me. She said that I was fully dilated! She told me that I could push if I felt the urge, and I immediately started pushing.
Now here is the weird part: I remembered from my previous birth that the doctor asked me if I felt the urge to push, and my mouth answered yes automatically even though I wasn’t really aware of the urge to push. Now the same thing happened, the midwife said I could push and I did, even though I was not aware of the urge to push. But apparently it was there!

I suddenly remembered that there were things on my wishlist for right after the birth, and now was the time to bring it up. I said: “I want you to wait with cutting the cord” and she said “OK!”
I know that ‘waiting’ of theirs, it usually goes like “1-2-3, I waited, *SNIP*” so I told her: “No I mean REALLY wait, until it’s stopped” and she said: “Yes, I wait until it’s stopped!”
Then I asked her not to give me the Pitocin shot, and again she said: “OK!”
I came into the hospital prepared to give a fight about those things, but I was pleasantly surprised that I didn’t have to.

Pushing wasn’t anything as easy as I thought it would be. Last time, it was incredibly easy and I was done in about 2 pushes, but this time it was different.
I started off on all fours, but soon I noticed that that wasn’t any good at all. It was agony.
Next I tried side lying, which was only slightly better but it would have to do. My doula asked what she could do for me, since I still couldn’t stand being touched. I told her that I just wanted her to be there for me. So she was standing by the bed, encouraging me. After a few pushes I turned to her and said: “you know, these contractions are just a b*tch!” and that was as far as I got with cursing.

So I was in a lot of discomfort, and actively pushing didn’t bring relief. The midwife was encouraging me and telling me how much progress I was making. At a certain point I thought to myself: “I better push hard now, to get this over with!” and that worked. Midwife Tali was giving progress reports, and she announced that the baby was already crowning. I went on pushing, and I was surprised that I didn’t feel that ring of fire that you always read about, and that I also remember from last time.

Then I felt some kind of *pop* and I thought, ‘that must be the head!’ and indeed, midwife Tali announced that the head was born. I gave another good push and was then surprised that it still took some work from my side to let the body be born. It didn’t slither out like the last few times. This baby was considerably bigger than my other 3! I opened my eyes to see my baby come out of me.
The midwife announced: “It’s a girl!”

I got her on my belly right away. She was screaming!!! She sounded incredibly angry. My mother always tells me that I came out screaming like that too.
I kept her on my naked belly and tried to calm her. It didn’t work. I wanted to let her try to crawl to the breast and latch herself on, but I guess she was too upset. Eventually I helped her find the breast and she finally calmed down. She was hungry!
Only after about an hour did the midwife take her to get weighed, with my permission.

My baby girl was not taken away from me at any point during our hospital stay. Of all my birth wishes, that one was the most important to me and I am very happy that it went exactly the way I wanted.

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How to turn a breech head-down.

R. called me with the message that her baby is breech. She was 37 weeks pregnant and about to give birth to her first baby. During our first prenatal meeting, R. had told me that she has a bi-cornuate uterus and that makes her chance on a breech much higher, so I was not very surprised.

R. sees a doctor that I like very much, but is too biased towards the Bikur Cholim hospital in my opinion. No wonder, he's affiliated with them himself. So I was not surprised to hear that he had sent R. to another Bikur Cholim doctor to do an ECV (external cephalic version) to turn the breech head-down.

I told R. to hold her horses and check out her options first. She was 37 weeks which means that there wasn't much time. The fetus is already big at 37 weeks, and the bigger they get, the harder it will be to turn them.
Normally when a lady finds out that her baby is breech, it's a little earlier (around 33-34 weeks) and there is time to try some less invasive techniques first.

A known technique is this one:

Lie on the floor and pace your feet against the wall, pelvis up in the air. Support yourself well with pillows. Do this for about 10-15 minutes, twice a day. Alternatively, you can place an ironing board against the couch or your bed and lie on it head-down. Put some pillows under your head.

Another pose is this one:

Also known as the knee-chest position. Kneel down on the floor (rest your knees and head on a pillow or sit on a yoga mat). Make sure that your pelvis is higher than your chest by placing your chest on the floor as well. Sit like this for 15-20 minutes, a couple of times per day.

Well-known alternative treatments for turning a breech include moxibustion (acupressure/shiatsu) and the Webster technique (chiropractics).

Only when these techniques don't work and the baby is still breech by 37 weeks, I advice my ladies to do an ECV, or external version.
I sent R. to the most experienced ECV doctor in Israel, Dr. Kanetti. He has a very high success rate.
Unfortunately, it didn't work for R. Her baby was still breech.

She went to several doctors and professors in the field to ask their professional opinion on how she could best give birth. On the one hand, outcomes for first babies who are breech who are born by c-section are slightly better than for first babies who are breech who are born vaginally. But a c-section has a lot of implications for subsequent pregnancies and births. Mothers who deliver their first babies by c-section, have a higher chance of ending up with subsequent c-sections than mothers who have already given birth vaginally.
But all the doctors R. turned to said unanimously that in her specific case, because she has a bi-cornuate uterus, a c-section was the only option. A c-section was scheduled.

Technorati Tags: birth, breech, ECV, external version, c-section

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Pregnancy massage using body pillows

My client M. is getting a weekly massage from me. She is 36 weeks pregnant with her first child, and really treats our weekly hour as her pamper moment. Usually when I do pregnancy massage, I put the lady on her side, do my whole massage routine, flip her over to her other side and repeat the whole thing.

Women with a pregnant belly can't lie on their stomachs, and later on in the pregnancy lying on the back also becomes problematic. Many women can't breathe while lying on their backs, because the heavy uterus is pressing on the vena cava and causes dizziness and breathing difficulties.
So I always prop pregnant ladies up on their side, supported by lots of pillows. But this time, M. really wanted to try to lie on her belly. I always use this pillow for massages:



So I propped M. up so that her belly was right in the hole of the pillow, and her chest was leaning on the top. And I put lots of pillows under her head. She was comfortable that way, and I could massage the whole back part of her body like that.
Then I flipped her over for another few minutes of chest- and belly massage.

Another great pillow is this one:



I ordered the bigger one with a special cover which is easy to wipe clean. When I put a lady on her side for a massage, which I usually do, she can hug this pillow and put one knee on it so she'll feel supported and it also keeps her hips level. This pillow is perfect for that.

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Birth ABC explanation part 5

Vaginal birth

Also known as normal birth, when the baby emerges through the birth canal. This is opposed to cesarean sections, which are gaining in popularity.


Water birth

A birth which occurs inside the water; the baby is born into the water. Research has proven that this is not dangerous for the baby, because he only starts breathing as soon as his skin touches air. He is still attached to the umbilical cord and keeps receiving oxygen from his mother. Read more about the water birth research here.

Xxx's for mother and baby

After the mega achievement that birth is, mother and baby deserve lots of kisses!

You can do it!

With this one I actually refer to natural birth, meaning birth without the use of pain relief. I took the quote from Pam England in her book Birthing From Within, where she says: "There are three givens about labor; it is hard work, it hurts and you can do it!".
And I truly believe that this is true.

Zzz's you won't be getting a lot of in the coming weeks

This one is actually not so true. The old cliche holds true for women after birth; sleep when the baby sleeps! Babies sleep in smaller patches than we adults are used to, and they wake up every few hours to feed. Mother will need to adapt her sleeping pattern to that of her baby, which means that she has to sleep when he does (if possible of course), and sleep in close proximity to her baby. Nature will make sure that mother will have the same sleeping cycles as baby, waking up automatically between cycles when he does. Isn't that great?
It just takes some getting used to, and might be draining in the beginning. Especially if you have a baby who is 'jet lagged'; the baby sleeps most of the day and is awake most of the night. But after a while, things will start running like clockwork in most cases.

The end!

For the whole birth ABC, click here.
Birth ABC explanation: part 1. Click here.
Birth ABC explanation: part 2. Click here.
Birth ABC explanation: part 3. Click here.
Birth ABC explanation: part 4. Click here.

Technorati Tags: birth, vaginal birth, water birth, baby, labor

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Birth ABC explanation part 4

Quite an experience

No matter what kind of birth you have, quick or long, natural or with an epidural, vaginal or cesarean, it is always quite an experience. This is not just another day in the life of a woman, but rather an event that will stay with her in memory for the rest of her life. Nobody argues about the fact that the most important thing is a healthy mother and a healthy baby, but having a positive birth experience is just as important for this life changing event. From research we know that it doesn't matter so much how the birth went, if the woman felt respected and supported all throughout, she's much more likely to look back on it in a positive way.

Rupture of membranes

Also known as breaking of waters. This happens when the amniotic sac that surrounds the fetus inside the uterus ruptures. The bag is filled with a liquid called amniotic fluid, which serves as protection for the fetus from the outside world.
The membranes can rupture at any point during labor. Sometimes they rupture before the onset of labor, and usually contractions will start within 24 hours.
When labor stalls, rupturing the membranes artificially (also known as AROM or amniotomy) can help move the labor along. This procedure is used much more often than really necessary, and that also has negative effects. The risk of infection rises, the contractions usually become much stronger and pain medication is needed, and sometimes the baby's head will come down in a weird angle and they have to perform a cesarean. In most cases, it is best to just be patient and let nature and labor run their course.
Also, in a recent study it was discovered that artificially rupturing the membranes does not speed up the labor. Read more about it here.

Shiatsu pressure points

Shiatsu pressure points are points on the body that lie along the meridians that are known in chinese medicine. Every point corresponds with organs inside the body. There are points that are in contact with the uterus and stimulate contractions. Those points are out-of-bounds during the pregnancy because they might trigger premature labor, but during birth itself they can be very useful for making stronger contractions. Read more here.


Tea of nettles and raspberry leaf

The teas of dried nettles and raspberry leaves are known to help tone the uterus and get it into shape for labor and birth. Pregnant women are recommended to drink nettles tea all throughout the pregnancy, and add tea of raspberry leaf during the last few weeks in preparation for the birth.

Uterus

Also known as womb. This is the little house of the fetus during the pregnancy. This is what the uterus looks like when the woman is not pregnant:

It is about as big as an uninflated balloon.

At 40 weeks gestation, this is what it looks like:

The uterus is the pink balloon that surrounds the baby. By now, it has the size of a big watermelon!



To be continued...

For the whole birth ABC, click here.
Birth ABC explanation: part 1. Click here.
Birth ABC explanation: part 2. Click here.
Birth ABC explanation: part 3. Click here.

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Technorati Tags: birth, life changing event, rupture of membranes, AROM, amniotomy, shiatsu, pressure points, labor, nettles tea, raspberry leaf tea, pregnancy, uterus

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