Taking charge of your fertility, part 2

So why bother with natural fertility methods? You might be concerned with putting hormones into your system. You might not want to go through surgery to tie your tubes as an alternative to the pill. If you’ve rejected both those things, and you don’t want any more pregnancies, you might not want to use condoms or a diaphragm for the rest of your life.

Whatever your reasoning, you might just be a big geek like me and think it’s cool to see how your body naturally regulates itself. I love the big surge of energy I get when I ovulate, when I feel like a sexy creative goddess. It’s a pretty cool feeling, one that I never had when using chemical methods of contraception.

So here is a bit of info, but it is by no means the full picture for you to know how to prevent pregnancy with this method. Don’t come to me in 9 months and blame me if you get pregnant and you haven’t educated yourself, okay?

The biggest downside to using fertility awareness is that you must be patient, and take the time to get to know your body. That in itself can be an incredible experience. Some people are squirmy about their bodies and this method isn’t for them. If you are on the pill you need to stop taking it and use barrier methods or abstain to prevent pregnancy until your body sets its own cycle and you are in tune with it. If you are breastfeeding this method won’t work for you as your hormones will be influenced by the nursing and it will be difficult to pinpoint when you ovulate. While opinions vary, I personally would plan on at least 6 months of charting your cycles to let your body get back to normal. You will be using several “markers” to know when you are ovulating, including basal body temperature (you take your temp first thing every morning before you get out of bed), the consistency of your vaginal discharge, and other physical symptoms.

Once you determine when you ovulate each month, most people who use this method to avoid pregnancy add days on either side of the big “O” day as their “be careful” days, when they either need to abstain from having sex or use barrier methods to prevent getting pregnant.

Another great thing about this method is that women can use it to help achieve pregnancy, by knowing when they are most fertile.

Something to think about and educate yourself about. Your fertility is a precious gift, and one you can understand and use to your advantage.

In sisterhood,

Amy

Taking charge of your fertility...part 1

I love babies. And love being pregnant….but all women need to have the knowledge to take charge of their fertility. We need options, to be able to have our babies on our schedules. As a midwife-in-training, I think it's important to serve women throughout their life cycles, including when they aren't or don't want to be pregnant.

We are all pretty much acquainted with the pill. The birth control pill was introduced to the public in the 1950’s in the US and became it became legal to prescribe it as a contraceptive in Canada in 1969 (before this point it could be prescribed to “regulate menstrual cycles”). It is generally accepted to have about a 99% effectiveness rate, as long as you don’t miss a dose and you take it at the same time every day. You can go online and look at all the wonderful benefits of the pill and the side effects and decide for yourself if it’s a good choice.

We all SHOULD be acquainted with condoms. If ya ain’t using them for contraception, you sure as heck should be using them if you aren’t in a monogamous relationship. Condoms are 97% effective when used properly. That includes using latex friendly lubrication to help avoid breakage. A point to note is the thinking in the late 1990’s was that spermicides like nonoxynol-9 were good to boost the effectiveness of the condom and to help prevent STDs. Several studies over the past decade have shown that spermicides actually irritate the vaginal wall and INCREASE chance of STD infection. I would suggest using the condom properly J

Most women don’t know that the morning after pill or “emergency contraception” as it’s also known, is available without a prescription at most local pharmacies. So you’ve made a mistake, missed some pills or the condom broke? Go see your pharmacist within 24-48 hours after having sex. One questionnaire (to ensure that you understand how the drug works and if it will be effective or not) and $40 later, you’ll walk out the door with two tiny pills. I bring this up here because while it’s more desirable to use an effective form of contraception ALL the time, there is a reason it’s called “emergency contraception” and in my mind it is important to have the option.

Ok….so what’s all this discussion leading up to? True, natural birth control, also known as fertility awareness. It is more in depth than the good ol’ “rhythm method”, and 99% effective when used correctly. Yep…you heard me right. 99% effective. And to me, every woman has the right to get to know her body in a drug-free, hormone-additive-free state. She can know when she’s fertile, so she can plan when to have her babies instead of going on the assumption that she “can get pregnant at any time”. She can stop dumping money into the drug companies’ pockets. She can get in touch with her inner goddess J

Tomorrow, I’ll go thru the basics of fertility awareness, who it is most effective for, and some things to start thinking about. An excellent resource is the book “Taking Charge of Your Fertility” by Toni Weschler, MPH.

In sisterhood,
Amy

Baby wearing: benefits for mother and baby!

I first became interested in baby wearing with my first little one. She was happier in my arms, and I was happier with her there too. I could stare at her sleeping so peacefully, or take advantage of the nap and sleep with her! She wasn’t a big fan of being in a sling, but my arms got a workout and so did my back. Who knew that having children can improve your muscles!!

With my son, the sling was used extensively. He was a bit bigger than his sister, and I had figured out what to do with the darned thing. When he was still small, I could even get away with nursing hands free with the sling. The only downside to the sling was that it hung on one shoulder, and as he got older I found it just caused back pain and an overall “unbalanced” feeling.

Well, if slings were the “carrier du jour” of 10 years ago, wraps are where it’s at today! With a little practice, your newborn can sit snuggled against you, listening to your heartbeat and have easy access to either breast *BONUS*!!! I also love that many of the wraps have little bulk, so you can throw a poncho over them to stay warm as the fall days get chillier.

So why wear your baby, besides having a happier baby? Turns out that babies need to be able to block out stimulation. In a wrap, once they are an older baby, they can turn their head in toward mom to block out the world as they need to so they don't get overstimulated. Another positive benefit is that moms who carry their babies have better core body strength and get good aerobic benefits from carrying the extra weight. These gains in personal fitness can result in long term health like lowered rates of osteoporosis and heart disease.

I had the pleasure of looking at all the beautiful wraps Saint John’s own Sue Appleton sells while at the baby fair last Sunday. I wanted to buy them just for the colours! You can find these wraps at: http://azurewraps.com/index.php?main_page=index&cPath=14_45_46. There were a number of moms and babies walking around using them, all looking comfy and happy. Sue also offers many other quality products, like cloth diapers and non-leaching stainless steel sports bottles. Definitely worth a look, and if you are expecting, a gentle nudge to grammies, friends and family for some ways to spoil you and baby!

Daydreaming....

So let's play a game for a moment. Let's pretend that today in New Brunswick, you are free to give birth in the way you want to. Let's pretend that our c-section rate could be lowered to 5% or at worst 10%. Let's pretend that moms will be able to breastfeed their babies and receive prompt help when they encounter a problem.

Ok, so giving birth the way you want to. You want a birth pool? No problem. A great resource for info is http://www.midwifemama.com/. Your pool can be set up for you to use as you see fit, whether it will be for simple pain relief, easing your joints and resting, or actually delivering your baby.

You want to avoid tears? Ok...you pick the position you will give birth in. Will you be standing? On your hands and knees? Reclining in your bed? Who knows? You'll probably find a position that will feel better than others as your baby starts to emerge. Oh, and you won't be coached to push, ok? Read this article: http://www.midwiferytoday.com/articles/pushing.asp. Want to see a baby emerging with little effort on mom's part? Watch this cool video: http://www.themidwife.net/index_files/Page340.htm.

You want good postpartum care, with your caregiver coming to your home several times over the weeks following your baby's birth? Ok, sounds like a good plan for a healthy baby and healthy mom.

In our imagined world, homebirth is as safe as hospital birth. You have fewer problems with your birth because it starts on its own schedule, and noone is giving you drugs to make it go faster. You are in great shape physically and nutritionally, and you've been nourishing your body to prevent complications by following the Brewer diet: http://www.blueribbonbaby.org/.

Does all of this sound too good to be true? Most mothers tell me it is too good to be true. And yet it's not. There are women in New Brunswick who are choosing these alternatives for their births. They aren't all crazy hippies, they aren't all raging feminists, they aren't all women disillusioned by a previous hospital birth. They are women who are taking the time to educate themselves about birth options, who are more scared of unnecessary interventions than they are of birth.

Grab yourself a cup of tea (nettle/red raspberry leaf is a combo your body will appreciate!) and start educating yourself. You just might help yourself to have a better birth, or be able to support a friend or family member to do the same. Some resources to start with are:

http://www.midwiferytoday.com/articles/index.asp
http://www.gentlebirth.org/archives/
http://www.radmid.demon.co.uk/archive.htm

Some of the information may seem technical, but you will learn! If you aren't choosing homebirth, these resources can be used to demand the care you deserve from your obstetrician and hospital.

Gentle, low- or no-intervention births ARE possible, and they ARE happening in our province. Let's turn the tables so they become the majority, instead of the minority of births!

Baby fairs and New Year's resolutions

I attended the baby fair at Lily Lake Pavilion on Saturday. There was a good turnout with lots of bellies and babies. Women in Saint John are blessed with a multitude of places to buy good quality toys and gear for their babies. There are great photographers, spas and boutiques that offer maternity wear.

And then it struck me….what the fair was missing. There was no breastfeeding support information, nor a spot for a tired mom to sit. There were no healthcare providers…they are all too busy and overworked at the hospital. There was no information on birth options.

I was walking around, informally interacting with presenters and moms, wondering if I too should have booked a booth. I thought back to a few years ago, at a baby fair in Fredericton. Moms were happily looking through booths of baby clothes and bottles. At the time I wondered if I had something on my face as moms streamed past the table that I shared with the local La Leche League group. We were not as colorful as the other booths, but we had also relied on our “excellent” information, and our feeling that if we could only educate women, they would flock to our doors. That simply isn’t the case.

As birth professionals we need to realize that we are countering mainstream images of birth and parenting. We need to make sure that we are accessible to women and that our attitudes are ones of acceptance and support. We need to show pride in the work we do, politely correcting misinformation while at the same time refraining from being “defensive”. We need to take advantage of opportunities like the birth fair and shamelessly market activities like breastfeeding challenges and International Midwifery Day. We need to understand that our support of our clients is worthy of a paycheck!

And so I make my New Year’s resolution early this year: PROMOTE PROMOTE PROMOTE! It’s a win-win situation….I do my heart’s work, women learn about options, and slowly we will have more peaceful fulfilling births in Saint John and beyond.

Competition forces midwives out of business

This is a very interesting case study, bringing up points about the economic incentives of hospital birth, and the fact that the public doesn't question statements from institutions like hospitals, which they trust.

Even though this is an American case study, don't ever think that economics don't have an impact on birth in the Canadian public system. In New Brunswick, each time a woman has an epidural, the anaesthetist is paid a fee. Each time a woman has an assisted delivery using either forceps or a vacuum extractor, her attending physician is paid a higher rate. Performing a caesarian section puts an extra $500 in a physician's pocket, and is more time efficient than a long drawn out birth. Just having the epidural puts the woman at higher risk for an assisted delivery or a c-section.We need to educate ourselves and delve into the reasons why we treat birth the way they do. Fear and ignorance go a long way to keep women from having peaceful, healthy birth experiences.

http://www.lamaze.org/Portals/0/Research%20and%20Advocacy/Research%20Summaries/2007-9.htm#A4

Case Study Reveals Economic and Political Forces that Hinder Access to Midwifery CareGoodman, S. (2007). Piercing the veil: The marginalization of midwives in the United States. Social Science & Medicine, 65(3), 610-621. [Abstract]

Summary: This qualitative case study analysis illuminates the forces behind the underutilization of midwives in the U.S. maternity care system and the process of their professional marginalization. The researcher identified two prominent midwifery services that had good outcomes and were connected with prestigious and influential institutions. One was a university-affiliated hospital practice that had provided uninterrupted midwifery service to the community for nearly five decades. The other was a birth center in continuous operation for nearly 30 years and hospital-owned for the final seven. Both practices were threatened with closure in 2003. In the case of the university-affiliated practice, the midwives ultimately maintained their ability to practice but the hospital imposed restricted clinical practice guidelines resulting in an 84% decrease in the number of midwife-attended births and a number of midwives leaving the service. The birth center practice closed abruptly in a decision handed down by the hospital without the involvement of the center's Board of Directors. In order to understand the circumstances behind the closures, the researcher conducted 52 in-depth interviews with midwives, nurses, service administrators, childbirth educators, policymakers, and physicians and reviewed archival data such as email correspondence, policy statements and memos.

In both cases, the publicly articulated reason for the attempted or actual closure of the midwifery services appeared to be reasonable. In the university-affiliated practice, the hospital claimed that too many of the women in the neighborhoods served by the hospital were high-risk and midwifery care was therefore unsafe. In the case of the birth center, the hospital reported that the decision to close was prompted by a 400% increase in malpractice insurance premiums. In neither case did the hospital provide any documentation or other evidence to support these rationales for closure. Interviews and analysis of archival data revealed that the midwifery services represented competition to the hospital, local physicians, or both. The case of the university-affiliated midwifery practice was particularly overt: the hospital had recently paid a multi-million dollar fine for double-billing the Medicaid program for births attended by midwives - once for the midwife and again for the consulting physician. When this fraudulent practice was discovered and the hospital was censured, midwives became a source of competition rather than income. In the case of the birth center, five-fold growth in the number of birth center births over the time the hospital had ownership may have appeared to be siphoning business away from the hospital's labor and delivery unit. Despite these potentially powerful economic and political motives for closing the midwifery services, the public were led to believe that the decisions were driven by rational concerns about safety and liability. The author concluded, "In the cases studied, institutions successfully altered maternity care and diminished midwifery services without accountability for their actions. In fact, the elimination of midwives seemed to be a rational decision when framed in the context of patient safety and the rising cost of medical malpractice" (p. 9).

The author explored aspects of the U.S. health care system that facilitate professional marginalization of midwives. The most problematic is the way the U.S. medical education system is funded. Hospitals essentially get paid twice for care provided by medical residents because they can bill directly for the care and also receive large subsidies from the federal Medicare program in exchange for providing residency opportunities. The more residents a hospital employs, the more federal money they get, so there is a government-imposed disincentive for hospitals to employ midwives. Furthermore, in many states midwives must have formal practice agreements with physicians in order to obtain licenses, liability insurance, reimbursement, or hospital privileges. This requirement makes midwives dependent on their competition in order to gain access to employment. Finally, midwives' reliance on low-tech care practices result in lower utilization of medical devices and services that may be separately billable.

Significance for Normal Birth: Advocates for improvements in maternity care are often at a loss to explain why childbearing women cannot access care providers who support normal birth. Normal, physiologic birth, it would seem, must be less costly than technology-intensive birth. Solving this paradox requires an understanding of the political and economic forces that foster dependency on high-cost obstetrics to the detriment of women and babies. While this study is small and focused on two specific examples of midwifery service closures, it provides important insight into the systemic forces that hinder women's access to midwifery care despite a large body of evidence that midwives provide equal or better care than physicians with lower reliance on costly technical interventions. The study documents how our market-based health care system safeguards the interests of the medical profession which can often be at odds with those of women, babies, and society.

Radical, systemic reforms are needed if the United States hopes to achieve a high-functioning maternity care system, characterized by effective, high-quality care, universal access, and cost containment. Evidence from countries with excellent maternity care outcomes suggest that eliminating barriers to midwifery care must be a priority. Birth advocates can begin by calling for accountability and transparency from hospitals and maternity care providers.

Confessions of a homebirth supporter

As an avid supporter of homebirth, I rarely speak of it in negative terms. I fear that I am adding to the already powerful cult of misinformation that portrays hospital birth as a life-saving, absolutely necessary occurance in our every day lives. And yet I have a dirty little secret: my homebirth sucked. Not all of it. But much of it.

I had my first child in the hospital 8 years ago. There were some things that I didn't like about the birth: my daughter's cord was cut quickly, and I had a managed 3rd stage. She was taken to the cart to be suctioned and dried off, and I never got to hold her all slimey and wet against my skin. My doctor had broken my water at 8 cm, telling me it might shorten my labour. My nurse kept offering me gas. She also coached me into pushing when I really had no urge whatsoever. At the time, though, these were minor occurances, and I honestly didn't really know anything about active vs. expectant management of 3rd stage, or that I could have waited to push. But my first birth left me feeling powerful and strong. No continuous fetal monitoring, no episiotomy, no drugs. I had waited to go to the hospital, labouring at home overnight and arriving at my doctor's office to find that I was 7 cm dilated and he would follow me to the hospital. I had discussed my wishes, and I trusted that my GP would honour them. He listened, took me seriously, and consistently devoted 30 or more minutes of his time to me at each prenatal appointment. To this day I think that if I saw him in the street I would want to go up and hug him!

For my second birth, I chose to be assisted by a midwife. Things were rocky with my then husband, and we spent the duration of my pregnancy fighting over where the birth would take place. By this time, my GP was no longer practicing family medicine; he had taken a position in our local emergency department. Choosing hospital birth would mean going to several obstetricians, having 10 minute prenatal appointments, and having no idea which doctor would be present for my baby's birth. I had by this time decided that I would practice as a midwife at some time in the future. Despite the fighting, despite the naysayers, I wanted my homebirth, unless something serious came up that I felt warranted intervention.

And so I discussed my opinions, my beliefs, my wishes for my birth with my midwife, who was also a friend of mine. We had met shortly before I became pregnant, united by our wishes for universal midwifery care for women in New Brunswick. In theory we agreed that vaginal exams are rarely necessary, that induction of labour is risky and that the risk of going postdates is often not valid, that cervical "lips" may just be an "old doctor's tale" (as opposed to "an old wives' tale"). We talked and ranted and seemed to agree on all points.

Then my due date came. And went. I was getting anxious, and, thinking I was in labour, called in my birth team, who were driving from 2 hours away....and....contractions stopped. I feared going into labour and having a baby without them around, because I knew I would be promptly encouraged to get in the car and taken to the hospital. I daydreamed about going into labour and having my baby all on my own, and surprising my husband when he got home from work. I fretted and waited, then, thinking all was good to go, called my birth team in again late on a Sunday evening in June. Contractions stopped, and we called a meeting at 2 am, after a walk through the darkened neighbourhood had failed to encourage stronger contractions. I was informed that if I didn't have my baby within the next two days, my midwifery care would be terminated and I would be advised to transfer to obstetric care as I would then be at 42 weeks gestation. I could feel my options slipping through my fingers, and, as I always do when faced with a stressful situation, I became ultra calm.

I agreed to be induced at home. Castor oil and orange juice and baking soda, chugged along with a prayer "Please God let this work". An hour later, an enema gets labour on the fast track. I have pictures of me at 5 and 6 am, sitting through active labour contractions in my grey nightgown, my Siamese cat coming for a cuddle and helping me through another contraction. My house is full of people: a midwife, a friend, a journalist from the local paper, my husband. And I wish that I was alone, in a dark, safe space as the sun comes up and takes away the last feelings of intimacy that I had so looked forward to for my homebirth.

I decide to get into the whirl pool tub. I don't realize it, but I am working through transition, having contractions that I can only deal with one at a time as I descend into a black hole of emptiness. The tub is in a secluded corner, giving me some sense of privacy. My husband presses his forehead to mine, we are both crying quietly, and he is whispering words of encouragement.

Then it happens....I think I need to use the bathroom. All my studying, all my knowledge of birth and I don't recognize this urge to push. It is a huge struggle to get out of the tub, and then I am sitting on the toilet, shivering and bellowing, the pain is killing me as the pressure increases and all I can do is push through it. The atmosphere in the room changes. I am disoriented as I am led to the edge of my bed for a vaginal exam. WHAT?!? WHY DO I NEED THIS? I hear that I have a bit of a lip, and that I need to be kept from pushing. I can't talk, but I am thinking, "FUCK YOU I NEED TO PUSH" and proceed to anyway. The doppler is applied to my stomach, and I can hear it, my baby's heartbeat, marching along at 150 beats a minute. I don't need to see the little screen or use a watch, my music training over the years lets me know the speed instinctively, a little march plays in my head. Then another contraction hits....and the heartrate goes to 30. Something is wrong.

The contraction is done, heartrate jumps right back up to 150, and internally, I am sighing a huge sigh of relief. I am thinking, "My baby will be ok, but he needs to be born NOW!!!" Instead, I am shoved on my side, an oxygen mask put on my face, presumeably to see if that will help my baby's heartrate. I stay there for 3 contractions, feeling like I will die from the pain that this position is causing me. My midwife is holding her hands to her head, saying, "What the fuck am I going to do?" and my husband sends the journalist to call 9-1-1. Crazy words ensue, with the journalist relaying questions from the dispatch center.

Somehow in the middle of all this I have pulled the mask off my face, and I think I have said, in no uncertain terms, that I want OFF the bed. I am standing, pushing...and as three ambulance attendants walk into my bedroom, my son's head is out. Another look of panic, and I am on my back in the bed with my knees to my chest. My midwife's hands are inside me, on either side of my son, maneuvering him out of me. And he is on my stomach, warm towels are on top of us, he is pink and gorgeous and there is a collective sigh of relief. We are healthy, and safe. A knot in his cord is deemed to be the cause of the low heartrate. The youngest ambulance attendant, a trainee, informs us that the time of birth was 9:12 am. I sign some papers to send the ambulance back out to help truly sick people, and the cleanup starts around me.

Today, my son is 4, happy and healthy. I wonder if I had this birth experience so that I could better understand the atmosphere of fear surrounding birth. I used to scoff at women's birth stories that said, "I had no choice...they just did it to me." And now I understand that feeling of powerlessness, when you feel your choices are nonexistent, when your body is working so hard that there is no energy left to formulate arguments.

My son's birth did NOT have to happen the way it did. The induction aside, if I had been able to push the way I wanted to, as soon as I wanted to, I would have felt better about it. If cooler heads had prevailed, then his decelerating heartbeat would have been seen as a possible problem, but the room needed to be filled with support to get him out of me, and a midwife working through in her head what she might need to do to resuscitate a baby if it came down to it, all things she was trained to do. Fear needed to be pushed aside for a moment in order to give us the best care possible.

Two weeks later, my midwife cut off all correspondence. Calls went unanswered, emails weren't returned. It would be over a year until I spoke with her again. We have never processed this birth, and so I am left to wonder about how it affected her, and her perception of birth, and her perception of herself as a midwife. I feel like she abandoned me at a very difficult time in my life, and I can still think back to the emptiness and pain I was feeling, trying to deal with a newborn, a four year old, and a difficult marriage.

I am ready for the barrage of emails I will get about this post. Homebirth supporters, either in sympathy or outrage or just simply defending homebirth and citing my experience as an exception. Hospital birth supporters, chastising me for taking the "risks" that I did, or defending my midwife (a US-trained CPM). This story is an incredibly difficult one to tell, but I have been silent too long. Today I was telling my story to a midwife in California, and realized that I don't want to keep it hidden any more.

I trust birth, totally. I feel that sometimes we need interventions for the safety of both mother and baby, but we need to remove fear from the equation. Until that happens, interventions will be used and abused, women will be left feeling disenchanted and assaulted, and true, loving birth won't happen. We need love to give us courage, and to clarify our decision making. And I join the ranks of women who admit their need for healing and closure, and face mothers with more compassion and understanding than I had just 4 short years ago.