Monday, October 4, 2010

An Overdue Explanation

So, it has been a while! Guess I haven’t had anything clever, groundbreaking or insightful to blog about lately! (Like any of my posts ever have those characteristics anyways!)

Here’s a post I’ve been pondering on for a while now. No really, a long while; about 8 months to be exact! A little disclaimer up front's LONG!

Throughout this pregnancy, Neal and I have done things a little “out of the ordinary” for mainstream health and infant care these days. Here’s just a little explanation as to why this works for us. I’m not saying it is for everyone nor that we have it all figured out, it just works for us at this point in time!

Midwife vs. OB-GYN

I was shocked to find out that not many people realize the difference between a midwife and an OB-GYN. The Dr. (ob-gyn) is a medical school SURGICAL specialty. They like to cut! It’s no wonder that the C-section rate in the US is one of the highest in the entire developed world. Nearly 33% of women who have babies in the US are getting C-sections, and most of those are not medically necessary. Even the World Health Organization says that the shift towards modernization (C-sections) isn’t necessarily a good thing, and that the C-section rate has hit “epidemic proportions”. To go even a step further, the WHO found that many, not all, but many hospitals were financially motivated to encourage patients to undergo C-sections as opposed to vaginal deliveries. The American Journal of Obstetrics & Gynecology conducted a 6 year study in which they reviewed 228,668 births and concluded that 33% of them were done by C-section. Although they couldn’t put a definitely number on how many were unnecessary, they did conclude that more could have been done to avoid a first time mom having a C-section and more could be done to avoid a C-section an another go-around.

There is definitely a time and a place for C-sections though. Don’t get me wrong! When one is necessary for the safety and well-being of both mom and baby, then by all means, it must be done! After all, the goal of labor and delivery is a healthy baby and a healthy mom. My argument is with unnecessary C-sections due to convenience, “lack of progress”, or any other non-medically founded reasoning.

That brings me to the midwives. Midwives overall should have a different philosophy than a Dr. as they practice their medical vocation. The term itself means “with a woman” and that is their main role…to support labor and delivery, educate women about the pregnancy and labor process, as well as supervise the general care of the mother and children directly after birth. Because their focus should be on reducing the risk of complications during pregnancy and delivery, communication with a midwife is critical. Midwives typically have a stronger commitment to nonintervention and encourage the mom to actively participate in the processes of bringing their child into the world. It has been shown that the birth attended by a midwife as opposed to a Dr. can reduce the length of labor, reduce the need for medication, reduce the likelihood of a forceps or vacuum delivery, and reduce the possibility of a c-section delivery. Midwives do of course work directly with an OB-GYN, so if anything ever should require a higher level of medical intervention, the Dr. is nearby.

At 35 weeks into our pregnancy, we made the decision to switch medical practices. The practice we were with was a large group of about 5 OB-GYN’s and 8 midwives. During the first 35 weeks of the pregnancy, all I saw were the midwives; a different one each appointment. I don’t believe that the midwives at that practice had the philosophy of educating expectant parents, giving personalized attention and care, nor had a great commitment to nonintervention and natural birth. The lack of support that we received when a natural birth was brought up in our 3 minute interactions was astonishing. All they wanted to do was educate us on the different pain medications that were available, and would not mention any alternatives. Also, they were constantly pushing for unnecessary ultrasounds and blood tests and tests done on the baby and amniotic fluid and so on and so on and so on. We always told them we needed to go home and think about each test before we would schedule it. This really was just to buy us time to do our own research! Come to find out, everything they wanted to do was for high-risk patients and was optional even then! Seemed like someone wanted to just bill insurance! Unfortunately, throughout our researching of these optional tests, that was one point that kept coming back up…monetary incentives. Sorry, but I want my primary caregiver to be more interested in giving me care than in the monetary benefits of a test that they didn’t really discern I needed, but just wanted to order it for liability reasons.

So, those are the main reasons we decided to explore our options! Once I got over the hurdle of “I’m committed to this doctor for life and can’t ever switch” fear, the research for a more suitable midwife began. I was recommended to a lady out of North Fulton hospital by both my midwife and doula. Unfortunately, she wasn’t going to be able to see me until the 3rd week in October. Well, that’s just really not going to work for me, so I was back to square one, and panicking! I was about a month and a half from having a baby, didn’t have a birth attendant, my before-baby-to-do-list was just as long as it had ever been, the crib wasn’t finished, I didn’t have a take-home outfit, nor did I even know what hospital I was going to deliver at! Needless to say, it was a stressful few days there! Fortunately though, my plans didn’t work out! The Lord had a plan all along, and I am very grateful He did! I got another recommendation to go and see a midwife who started her own practice called Gifts from Grace. Ok, I like this already! I did some research on her directly and was really impressed by what I was reading. So, I called, and they were able to get me in right away! Neal and I went and met with her last week, week 36 of pregnancy, and we were armed with about 10 questions we needed her to answer…correctly! She came into the room and just sat down and said, “ok, let’s get to know each other”. From there, we just chatted on and on for about half an hour. We only had to ask one of our 10 questions, because she volunteered the answers to the other 9 without us having to pointedly ask! We were sold! My doula told me at the beginning of the switching process that it was better I do this 2 months before the birth and not be looking back 2 months after the birth with regrets on how it went. I am so glad that we switched, as emotionally challenging as it was! Now we have a supportive, nonintervention-minded midwife, and that makes the hour drive completely worth it!

Convenient Hospital vs. Better Hospital

So, why are we giving birth at a hospital that is an hour drive from our house when we will pass 2 on our way there, and there are a handful of others within a closer range? A few simple reasons: first, our new midwife has privileges at the hour-away hospital. Second, the hour-away hospital is only 3 years old, and has state of the art technology, is really clean, has an excellent nursing staff with a 2-1 patient-nurse ratio, and they are very supportive and encourage natural childbirth. The hour-away hospital is a much smaller facility than say the baby-factory also known as Northside. The personalized attention that we will receive from the nursing staff is sure to ensure a birth experience like we expect. Also, the general atmosphere of the hour-away hospital is not one of your typical sterile hospitals. To me, walking into the hospital feels more like a hotel lobby. I mean, they have a concierge and everything! To us, it is worth the drive to have this type of atmosphere to become parents in!

Epidural vs. Nonintervention

I’m sure you can already tell from the previous section, that we are planning as natural of a birth as possible. Again, this decision came after doing some research about what exactly an epidural is, what complications it has to mother and baby, and for what reasons would it be necessary to get one. Well, I’m not going to lie, I really don’t like needles! So, when I started reading about just the mechanics of inserting the epidural, I was quickly grossed out. But, I kept reading. I think what really convinced me that we didn’t want to go the epidural route was something called the “Cycle of Intervention”. Simply meaning, once you start with pain medicine, it can easily and quickly accelerate the need for other forms of intervention. For example, if the mom goes in to be induced with Pitocin, the most common induction drug, that will cause her contracts to be so strong and long that she just literally can’t physically stand it. Because the contracts are so strong, it will also put unnecessary stress on the baby. So, you have to get an epidural to make it through. The epidural comes with risks of a sudden risk in the mother’s blood pressure dropping, which in turn puts the baby into fetal distress. Then, when the baby’s heart rate doesn’t recover, because it has so many drugs in its little system, I mean what do you expect, then doctors start to talk c-section to save the baby. Of course, not all epidurals go this way, but the majority of them do. Also, the epidural will interfere with the naturally occurring hormones during labor. The oxytocin levels, which help to relax the mother, are dramatically changed when there is Pitocin, the synthetic oxytocin in the blood. The beta-endorphins, which are a natural pain relief, are also highly affected when synthetic oxytocin is present.

On top of all this, everything that the mother receives, epidural or narcotic, will pass into the baby’s system, just like everything else you have been taking in during pregnancy. Studies have shown that babies born without any drugs in their system are more alert and begin breastfeeding easier than babies who were born with means of interventions. At this point, so close to labor, I continually remind myself that God designed my body to give birth! I can do this, and by His grace, we will have a healthy baby at the end of the process. We want our child to experience their first moments of life outside the womb without artificial sensory inhibitions!

Birth Positions

So you might think this topic is a bit strange, and I would have said the same thing 9 months ago! Every birth I had ever seen, albeit through the media, the mother was laying or reclining on her back with her legs pulled up. You know exactly what I’m talking about! Come to find out, this is the WORST position to give birth in! The ONLY reason women give birth like this, is for the convenience of the doctor. Seriously! The pelvic is at its smallest when the mother is reclining, and then, when her legs are pulled back, it tilts the pelvic upward, so the baby now has to go through a smaller opening, against gravity! What are these doctors thinking!?! The most ideal position to give birth in is squatting. The pelvic is at its widest, and of course, gravity works best like this as well. The risk for tearing is lessened as the perineum is not stretched as tight as it would be in the “traditional” on-your-back position. There are other upright positions that encourage the baby to move downward and are suppose to encourage labor to progress quickly. Walking, standing, sitting, leaning forward, using a birth ball, are all things that the mother can do during the early stages of labor to encourage progress. Once labor progresses, more gravity neutral positions might be more comfortable as they will have less pressure on the cervix. But for the pushing stage, a simple squat has been shown to be the most effective means of birthing. Most hospitals do provide a bar that will go across the hospital bed called a “squat bar” for the mother to hold onto during pushing. Just ask for it!

Breastfeeding vs. Formula

Of course, most people recognize that breast milk is the best thing for not only the baby’s nutrition, but also for the mother as her body returns to a non-pregnancy state. I’m not really going to go much into the reading I’ve done on this one, because it’s pretty self-evident! As with everything else though, formula has a time and a place, if deemed necessary.

Cloth Diapering vs. Disposable Diapering

So, we’ve done our research on this one too, and although we haven’t had to put it into practice yet, we believe that cloth diapering is going to suit or family and our families needs precisely. Long gone are the days of rectangular cloths with safety pins that hopefully you don’t pierce the baby with! Cloth diapers are designed with convenience in mind nowadays. Our plan is to use, if necessary, a mixture of both. For example, if we are going to be out and about all day, maybe we’ll throw on a disposable diaper so we don’t have to keep up with dirty cloth diapers all day. We’ll see what works for us though! There are definitely many options for cloth diapers, so if you are thinking of exploring this cost-saving option, although the initial investment can be quite steep, I’ve got a whole other blog post I could write on the details of cloth diaper options!

Co-Sleeping vs. Bed-sharing v. Independent Sleeping

First off, simple definitions:

Co-sleeping- mom, dad and baby sleep in the same room
Bed-sharing- mom, dad and baby sleep in the same bed
Independent sleeping- mom and dad sleep in one room, baby sleeps in another

The American Academy of Pediatric Research suggests co-sleeping is the best option for babies and parents. It helps to regulate the babies breathing and reduces the risk of SIDS. It also aids the nursing mothers in getting better rest as they do not have to go all the way to another room to feed or tend to the baby.

The U.S. Consumer Product Safety Commission and the American Academy of Pediatric Research both state that parents should not share a bed with their baby because of the risks of suffocation and strangulation. Also, bed-sharing can lead to babies that associate sleep with being close to the parents and that can make naptimes or moving to their own bed traumatic experiences.

Ok, ok enough! Even though there are many more topics to consider, these are just the few that we have been asked about by various people. I like it when people ask “So what are you doing about…”. It gives me the opportunity to talk about what I’ve read, and to hopefully give people an understanding that there are options out there. That sometimes you need to questions your doctors, and that what works for one person isn’t going to be a one-size-fits-all. I want people to be motivated to educate themselves on what is happening in their lives and to their spouses instead of blindly following the cultural “norms”. I want people to trust that God designed their bodies for this process and that intervention isn’t always necessary!