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Category: Post Partum

My Healing Hospital VBAC

My Healing Hospital VBAC

To tell Mel’s birth story, I have to say a few words about Katherine’s and Laeney’s birth stories.

Laeney’s birth was a hospital induction. At my final ultrasound, my doctor told me my placenta was failing and she was losing weight in the womb. They told me she would only be 4 lbs and might have to be transferred to a NICU 40 miles away. She was born, healthy, weighing 6 lbs 3 oz and although I didn’t suffer any adverse effects, I felt cheated. I didn’t even get to go into labor on my own and desperately wanted something different for my next baby.

Nearly 4 years later, during my pregnancy with Katherine, I knew I wanted a homebirth. I dreamed of bringing our baby earthside, surrounded by my friends and family, in the peace and love of our own home. Unfortunately, I ended up with a nightmare instead. My water broke at 25 weeks and we had a traumatic emergency c-section at 30 weeks due to an amniotic infection, followed by a 46 day NICU stay. My c-section was brutal. The spinal block was only effective on one side of my body and my daughter’s heart rate was dropping, so they cut me anyway, even though I could feel it. Once she was delivered into the hands of the NICU team, I completely lost my composure and started screaming uncontrollably and flailing on the operating table trying to escape from the pain. The anesthesiologist put me under and I woke up in recovery terrified for my baby. When I was finally able to see her, I could only hold her for a few minutes. I’ve never cried so much.

I grieved for my pregnancy. I grieved over my birth. I grieved for my child’s start in this life. I grieved over leaving her in the NICU and having to go home, 40 miles away. I hated my body for doing this to my child. For doing this to me. I agonized over what I could have done differently that would have kept her inside me even one day longer. I would break down sobbing when I saw other pregnant women in public. I felt jealous and cheated and angry.I suffered through PPD and PTSD and remember very little of my daughter’s first year on this earth.

Fast forward three years and we found out we were pregnant with our third child. In my heart, I was terrified of going back to the hospital and desperately wanted a healing homebirth. But my husband was so traumatized by Katherine’s birth, he didn’t want to take the risk of staying home. So I found a midwife group that supported my decisions about my care and forged ahead, planning a hospital VBAC.

It was a terrifying, nerve wracking, healthy pregnancy. I had nightmares from the day I got that positive test result. PTSD is rough, and the triggers never really go away. We had lost two babies between Katherine and Mel, so I breathed a little easier at 12 weeks. We were out of the worst danger zone and baby was still hanging in there. When we passed 24 weeks (the age of viability), my fears eased even more. 25 weeks, 2 days, the day my water broke with Katherine,it seemed like I held my breath all day. Then 30 weeks came and went without a hiccup. (Well, with lots of in-utero, tickly baby hiccups, but you know what I mean.)

My husband and I both slept a little better once we passed that milestone. At that point, we were finally able to really embrace our pregnancy. We were having another little girl and it looked like she was going to go all the way and be big and healthy!!

I was beside myself when we made it to 36 weeks. I couldn’t believe my body was doing it! I was growing a big healthy baby and nothing was going to stop me from bringing this baby earthside, peacefully and naturally, with my husband and midwife. Yeah!

Until my 36 week appointment. I found out my insurance had dropped my coverage. So, at less than a month til my EDD and 3 days after Christmas, I was on the phone every day trying to get things straightened around. And every person that I talked to had a different reason to NOT put me back on my insurance. Without coverage, my midwife group dropped my care. I was terrified. What would happen when I showed up to the hospital in labor, with no midwife and no insurance? Would they force me into another c-section? Would they call child protective services on me for not having prenatal care for the last month? I decided to just show up at the hospital, basically ready to push this baby out. I would rather have her in the car on the way there, than be faced with another c-section.

Feeling pretty empowered, my pregnancy progressed past 39 weeks (woo hoo, FULL TERM!!!) I had gained 40 lbs and was so big, people (including my mother) insisted every single day that there must be twins, and one was just hiding on the ultrasound. The Saturday and Sunday after I hit 39 weeks just felt different. I was even more tired than usual. Having a lot of gross discharge. Only sleeping a couple hours at a time because my hips hurt so badly. Just being generally miserable. It was January and we had a winter weather warning, it was supposed to be -40 degrees F with the wind chill. My husband worked outside and requested that I have the baby on Monday so he wouldn’t have to go to work. He even talked to my belly and asked the baby to please come on Sunday night. HA! Ask and you shall receive, husband!

Saturday and Sunday I was having weak, lame-o contractions 10 minutes apart all day and all night. They were annoying, but not painful, but they were making my back really hurt. I bounced on the birth ball and walked around as much as I could in the house, but nothing really happened yet. So around 7 o’clock Sunday night, I broke out my breast pump and I power pumped for 40 minutes. I got 4 oz of colostrum (seriously, 4 oz before the baby is even born?! Who does that?), but no stronger contractions. They did pick up a little, going from 10 minutes apart to seven minutes apart. After the pumping, contractions spaced back out to 10 minutes again and I got discouraged, told my husband it wasn’t happening that night, and we went to sleep around 11.

3:34 am,WHOA! Umm, ouch! Calm down in there, baby. I thought you weren’t coming tonight? Since I felt like my bladder was about to burst, I got up, peed, and climbed back in bed. I had a mild contraction while I was up. As soon as I laid back down, another crazy one ripped through my body. Holy crap! This might be it! I started timing them. Two minutes later, another one hit and lasted a whole minute! 2 minutes later, another one! And another one after that! WOO! I woke my husband to tell him that I was in labor and he freaked out.

“What?! Is it time?! Are we going to the hospital now?!” I told him to calm down, that I wanted to labor at home until I felt it was time to go, and to go back to sleep. Honestly, I just wanted to be alone with my baby to center myself and power through those awesome contractions. I was beyond excited. I had never gone into labor on my own and I was really curious what it would be like.

I walked back and forth in the living room and swayed over a side table and hummed through each contraction. I got on Facebook and updated my private mom groups and I texted my best friend. I felt amazing and powerful and beautiful. I imagined my baby inside me, poised, ready to meet the world. In my mind’s eye, I saw my cervix glowing bright and hot as each contraction pulled it open a little more.

An hour passed like that. I called my sister down to make me a snack but couldn’t eat more than a couple bites. I ran a warm bath to try to take the edge off the intense back pain that was coming with each contraction. But I couldn’t stay in the tub longer than about 10 minutes. My body wanted me up and moving! Around 5:30 I woke my husband up and told him it was time. He ran around like a crazy person, grabbing all of our things I wanted to take with us. He went out to start the car since it was so cold and my mother called and wanted to talk to me. A contraction hit and I just yelled at the phone and threw it back at my sister. “She doesn’t really want to talk right now.” I heard her say. Then we got in the car.

That was the most painful drive ever. I couldn’t move through the contractions. I was vocalizing loudly and started to feel out of control. I felt pinned to the seat by the pain. And they were coming hard and fast, only a minute apart and a minute long. I wanted to climb out of the car and run away. We had just had an ice storm and the roads were AWFUL. The 15 minute drive to the hospital took 40 minutes and we arrived somewhere around 6:30. We parked in the garage and headed up to labor and delivery. My husband grabbed a wheelchair and wheeled me through the hospital between contractions. It was too painful to stay seated the entire time, so I got down on my hands and knees when each one hit. We checked into labor and delivery and they started monitoring me.

When the nurse checked me, I was 4 cm. My brain came out of my labor haze. “Only four?!”

“Four is great!” she said. “You’re doing amazing!”

A young doctor came in and told me that he would have to perform an ultrasound to make sure baby was head down. She was and he estimated her at 8 and a half pounds. He checked my chart. By some miracle, my surgical records had finally come through and I was cleared for my VBAC!!

The nurse came back, “We have to move to a delivery room, now. Here if you want to put this gown–“

“NO!! I don’t want to wear that!”

“Ok, well can we just wrap it around you?”

I guess the rest of the hospital didn’t appreciate a full term pregnant woman walking the halls naked. I made it to the delivery room with only a couple stops in the hall. A nurse came in and asked if I wanted the epidural. No, I can do this. My husband was my rock. He kept telling me how wonderful I was doing and how powerful I was. They checked me again. 6 cm. Okay, making progress.

My brain totally disengaged at this point. My nurse kept trying to talk to me, asking me questions, but I was just sitting on the edge of the bed, utterly focused on the contractions and my baby. It was like she was speaking another language.

I was hooked up the the monitor, trapped on the bed, and the pain was inescapable. I couldn’t even get down on all fours to get through the contractions. At this point, I was no longer vocalizing, I was screaming as each contraction peaked and felt totally out of control.

Another nurse came in right when a contraction hit and asked if I wanted the epidural again. “YES! Give me the epidural!!”

My husband rubbed my back. “No, honey, you don’t want it, remember? You can do this. You’re strong. You’re doing amazing. You can do this.”

“I can’t do it.”

“You can. I know you can.”

I started crying, “I can’t. Please. It hurts too much. I can’t do it. Please.”

He buckled under the tears. “Get her the epidural!”

A million years later, the anesthesiologist came in to do the epidural. He was great and it was very light. It only took the edge off the contractions and brought them down to a level that was bearable. I could still feel them all and even stand up. It was perfect. I relaxed and we waited.

As soon as the epidural took effect, the nurse checked me again and my husband walked down the hall to grab a snack (and try to sneak me something to eat as well). I was at 8 cm with a bulging bag. I couldn’t believe I made it to 8 cm on my own! I kind of felt like a wimp for caving in when I was so close. The doctor wanted to break my water but I asked her not to and she didn’t press the point. My baby was so close. I called my husband and he ran back upstairs without the food (sadly).

A little while later I felt something warm and wet on my thighs and reached down. My hand came back up covered in blood. I called my nurse and she brought in the doctor. I was 9 1/2 cm with an anterior lip. She asked again about breaking my water saying that the baby’s head against my cervix would help it finish opening and get rid of that lip. I agreed and she ruptured it. There was a little meconium in the water, but baby still looked good on the monitor. They left us alone so I could finish dilating.

A few more contractions and I started to feel pushy. I could feel her head descending through the birth canal and knew it was time. I called the nurse to “check me” and told her I was feeling pushy. She tried to check and only felt baby’s head. “OH! Baby!!” she said.

We were at a learning hospital so within seconds there were four OBs between my legs, four pediatricians by the warmer, about eight nurses scattered around, and three anesthesiologists in the back of the room. PUSH!

I pushed. And I pushed. And I pushed again. She crowned. One of the OBs said “Look at all that hair!”Really? Try to focus, Doctor. PUSH! Man, her head was so big!PUSH!Too big! PUSH! I can’t! She won’t fit! PUSH! NO, ouch!! PUSH! Just take her out! I can’t do it! PUSH!

“Her head is out! One more big push!” Her shoulders were born and then the rest of her.

And there she was. After nine months. Perfect, beautiful, healthy. And fat!! Whoah, fat, rolly baby! She was 8 lbs 10 oz (which is almost as much as my other two daughters’ birth weights combined). They put her on my chest and she just laid there. She never cried, she just snuggled on me and looked at my face. We hadn’t decided on a name yet and my husband looked at her and looked at me. “She’s definitely a Melanie.” After seeing her, he picked the name I had wanted. We just laid there skin to skin for what seemed like hours. She didn’t show any signs of wanting to nurse for quite awhile, so we just snuggled.

It was a perfect birth. Even though I had planned a natural birth, I don’t feel guilty about the epidural. It allowed me to relax and truly enjoy the perfect birth of my daughter. I was glowing with happiness. I did it. I grew a full term, healthy baby. I went into labor on my own and I pushed that baby out! But taking her home after only 24 hours in the hospital, only having left my side for 10 minutes to have her hearing test, was the truly healing part.

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A Breastfeeding Mother’s Will Knows No Bounds {I Am Strong; Anxiety, SNS, Donor Milk}

A Breastfeeding Mother’s Will Knows No Bounds {I Am Strong; Anxiety, SNS, Donor Milk}

I am strong because after 5 hours of intense labor I gave birth to my beautiful 7lb 13oz baby girl without any pain medication. My daughter had difficulty latching but was able to with a nipple shield.

I am strong because I suffered from severe postpartum anxiety and didn’t feel connected to my daughter.

I am strong because after a week of breastfeeding I got mastitis. I was running a fever of 103.8 and attempting to take care of my newborn. The antibiotics I was given weren’t working and I needed stronger medication. This new medication made both me and my little one sick but we kept breastfeeding.

I am strong because I continued to nurse through excruciating pain.

I am strong because when my daughter was 2 weeks old she and I both got thrush. My nipples were cracked and bruised. It felt like sharp daggers were going through my breast. I cried every time I nursed her. I begged my husband to let me give up but he continued to encourage me.

I am strong because at 3 weeks old my little one still had not gained back her birth weight. She was nursing every hour for 45 mins around the clock. I only had 15 mins in between each session. I was exhausted. I wanted to give up. I felt like I couldn’t do this anymore. All she did was cry all day long.

I am strong because I reached out for help and saw a lactation consultant. At 3 1/2 weeks old my daughter was diagnosed with a posterior tongue tie. I needed to start supplementing so she could gain weight. I tried pumping but wasn’t able to get enough to feed my daughter.

I am strong because I battled low supply issues related to her tongue tie for weeks. I used donor milk to supplement until my supply came back.

I am strong because on Christmas Eve I took my daughter to have a tongue tie revision done. I returned to the lactation consultant 5 more times to help get her to latch. For three weeks I did tongue exercises and continued to supplement using an SNS.

I am strong because I nursed with a nipple shield for 6 months until she finally learned how to latch on her own.

I am strong because at 8 months postpartum we are still breastfeeding. I have never fought so hard for something I felt so strongly about ever in my life. I would rather give birth a hundred times over than go through that again. And yet I’m thankful for the struggles I had, because without them, I wouldn’t have stumbled across my strength.

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Breastfeeding and the Workplace

Breastfeeding and the Workplace

***When I wrote my piece on community support and its effect on breastfeeding, we had a huge request for a follow up piece about breastfeeding and the workplace. So mamas – here it is!***

Breastfeeding in today’s social climate is sometimes an uphill battle. Not only do we encounter booby traps from the media and cultural cues but we also have to avoid traps set by our care providers and hospitals and even from our loved ones and friends. Now, if we avoid all those negative influences, have proper educational sources, and hopefully some positive social support we have a decent chance of reaching our breastfeeding goals. But then the majority of us need to return to work. What is a mom to do? What are our rights?

Simply put, breastfeeding works easiest (usually) when the baby can be at the breast on demand and without interruption. That is how nature designed the system to work. Nature never expected us to live in a society where it takes two people working 40+ hours a week just to make a decent living. Our breasts simply don’t have that sort of knowledge, expectation, or wiring. Luckily the invention of the breast pump came into our lives.

pump

Mothers who work and continue to breastfeed, be it directly (baby comes to work or comes to visit) or through pumping, deserve major respect and kudos. I know as a stay-at-home-mom that I have it easier in many respects when it comes to maintaining my breastfeeding relationship. A working mother has to figure out not only the logistics of making sure her supply is maintained, but also the logistics of making sure her rights as a breastfeeding mother are respected.

Because of the many changes to the law, varying laws in some states, and the newest changes to insurance and breastfeeding coverage, I wanted to create one easy resource with all the information in one place. After all, you are a new mom and you have a baby on your breast (a lot) and you only have two hands and so many hours in the day. So let me do the leg (or rather mouse) work for you.

Starting at the federal level, I am going to look at the United States Department of Labor and what they say about nursing/pumping and the workplace. The basis of the federal law has to do with changes from the Affordable Care Act:

The Patient Protection and Affordable Care Act (“Affordable Care Act”) amended section 7 of the Fair Labor Standards Act (“FLSA”) to require employers to provide reasonable break time for an employee to express breast milk for her nursing child for one year after the child’s birth each time such employee has need to express the milk. Employers are also required to provide a place, other than a bathroom, that is shielded from view and free from intrusion from coworkers and the public, which may be used by an employee to express breast milk. The break time requirement became effective when the Affordable Care Act was signed into law on March 23, 2010.

To break this down a bit further, there is a specific fact sheet HERE. Some highlights include a note that the number of breaks, duration, and frequency will likely vary from mother to mother. The location made available to the mother must NOT be a bathroom and must be private with some security from coworkers walking in. It does not have to be a dedicated space just for pumping, but needs to be available to the mother when she needs to pump. [As an example, some businesses will offer an office to use that has a lock.]

Now the cravat (and where many businesses fall through the loophole) is that if a business has less than 50 employees they are not required to provide pumping time or space if it would cause “undue hardship” to the employer. [Never mind undue hardship to the mother and baby I suppose.] They do have to demonstrate to the Labor Department that it would cause the hardship to the business. You are also not covered by this if you are exempt from Section 7 protection (however, State laws could cover you). The break time also does not have to compensated (unpaid breaks). These federal standards do not override any higher protection given by states in which the woman lives.

They provide a PDF of a handy card to carry with your rights on it HERE, and if you need a file a complaint you can do so HERE.

Looking at the state level, additional rights vary. An overview of state laws and links can be found HERE at the National Conference of State Legislators. While 45 states have laws ensuring mothers can breastfeed in public and 28 further protect that public feeding from indecency laws, only 24 states have laws related to breastfeeding and the workplace (along with D.C and Puerto Rico). Those states are Arkansas, California, Colorado, Connecticut, Georgia, Hawaii, Illinois, Indiana, Maine, Minnesota, Mississippi, Montana, New Mexico, New York, North Dakota, Oklahoma, Oregon, Rhode Island, Tennessee, Texas, Vermont, Virginia, Washington and Wyoming, [As an authors note: I am happy to say that my states protects breastfeeding mothers in public, from indecency laws, and at work!]

I wanted to see which states go above and beyond the current federal protections, since some of the states listed above simply reiterate the federal standards. Those states include:

  • Colorado: the federal standards are extended to TWO years after the birth of the child, and the Department of Labor in that state provides a list of ways for employers to accommodate nursing mothers.
  • Hawaii: specifically prohibits an employer from denying employment, withholding pay, demoting, or in any other way discriminating against a lactating employee. Another plus for Hawaii: they also give any mother who is discriminated against at work or in any public place the right to a private cause of action against the person or business who infringes on her rights. This actually gives the public breastfeeding law there some “teeth” to protect the mother with more than words.
  • Indiana: any state or political places of employment must provide PAID breaks for the expression of milk. Any employer with more than 25 employees must make every effort of accommodate a mother to federal standards and also to provide a refrigerator for storage of milk.
  • Louisiana: state-owned buildings, educational institutions, and certain office buildings must all provide suitable areas for breastfeeding and lactation. (While not specific, this seems to imply that a lactation room is needed in these locations)
  • Maine: provides for a mother to provide milk for her child at work for THREE years after the birth of her child. They also specify they the mother cannot be discriminated against in the workplace for her choice to pump milk.
  • Montana: specifies that a storage location (fridge) must be available to mothers who express milk.
  • North Dakota: creates the term “infant friendly” that can be used on employment information if an employer complies with certain policies such as adequate break times and work patterns for expression of milk, safe and convenient space to express milk, and a fridge to store milk in within the work place.
  • Oregon: allows for a 30 minute break every 4 hour shift for the expression of milk (though some businesses can be exempt).
  • Puerto Rico: allows for women to have the opportunity to nurse their baby directly for 30 minutes during each full-time work day for up to one year.
  • Texas: creates the designation of “mother friendly” for businesses to use if they make efforts to accommodate working nursing mothers.
  • Vermont: provides protection of pumping right for up to THREE years after the birth of the child and creates a task force to encourage and improve workplace pumping policies.
  • Washington: also uses the designation “infant friendly” for employers, similar to North Dakota (above).

Any states not listed above all must still follow the federal guidelines. These above states simply have specific laws giving extra protections.

Now this next bit is where I will admit, I get confused. You might too. Insurance issues are swampy in this country (well, for American readers) due to the massive variety of coverage levels, copays, etc, etc, etc. Health insurance is enough to give me a headache. However, I am going to try to pry what I can from the changes at the federal level (though from what I have heard from mothers, some insurance plans or providers can still wiggle around; for instance plans that were “grandfathered” in).

On this fact sheet we see that breastfeeding and lactation services and products are mentioned. It states that pregnant and postpartum women be given access to coverage for lactation consultants and counselors from trained providers and have coverage for breast pumps and related supplies. They state that non-grandfathered plans must do this, but that they still have the freedom to decide at what level they will provide coverage and what they will cover. This leaves things very murky.

The HealthCare.gov page doesn’t really clear things up much either. The pump can be covered before or after baby gets here, at the insurance companies discretion. The pump covered can be rented (for a certain period) or yours to keep. It can cover a manual or electric pump, single or double. Again, this is all up to the insurance, not on you and your needs. Sometimes a recommendation from your doctor can override the basic coverage of a policy. For instance, many women report that a “prescription” from their doctor for a pump or pump rental allowed the insurance company to cover what they needed. Medela*** provides a helpful little list of list for figuring out your coverage. One thing that does seem to be clear is that for non-grandfathered plans, a lactation consultant should be covered with no co-pay.

The bottom line with insurance coverage for pumps and lactation help is to be proactive and get on the phone with your insurance company. Don’t take “no” for an answer – talk to as many people as you need to. Sometimes the person you first connect with won’t know the answers but might not admit that – they may just give a generic answer and hope to satisfy you enough to get you off the phone. One thing I have learned from my mom (an insurance-company-phone-talking whiz) is to write down each call you make. Write down the person’s name and extension, what you ask and what they say. That way if you call back you know everything you were told and don’t get flustered. It is also a good idea to write down your questions before hand.

The bottom line for navigating the workplace and breastfeeding and pumping rights is to know your rights and be prepared. Your employer may not have dealt with this before, so you don’t necessarily have to go in with guns blazing. But be ready to stand up and help educate them not only on the law, but also on the benefits for the workplace that come with your baby getting breastmilk. Working on preparing both your workplace for postpartum and pumping and navigating your insurance before the birth of your baby will make the start of your breastfeeding relationship smooth and less stressful.

Breastfeeding and Benefits for the Employer (further reading):

 Pumping Tips from the Pros (aka, other mamas!):

  • Having a picture or video of baby is helpful for letdown. You can focus on your little one and let the oxytocin flow.
  • Get a good pump. This will vary from mom to mom, but generally a double electric pump is the fastest way to get the most milk. However, some moms have better luck with single pumps, manual pumps, or hand expression.
  • Consider two pumps – one for work and one for home, that way you don’t ever forget your pump.
  • If your job means you are mobile, keep a manual pump with you in your purse or consider a battery operated pump or car adapter.
  • Relax for a minute or two before pumping. Take that time to have a drink of water, think about baby, and just unwind. Tension makes letdown harder.
  • A hands-free pumping bra can be a life saver. You can also “diy” one, just check out pinterest/google for ideas.
  • Try to pump at the same times each day if you can, it will help your body regulate and prepare for a good letdown.
  • Know what your employers breastfeeding/pumping set up and rules are before you have baby. You want time to negotiate for what you need.
  • Nursing at night can help bolster supply. Night feedings give the strongest cue to make more milk and provide the most fatty milk of the day.
  • Never hesitate to seek help or guidance if you feel supply is low or you need help with your pump.
  • Pay attention to flange size – if the flange is too large or too small it will not get milk out as well.
  • A little olive or coconut oil around the inside of the flange can help with soreness.
  • Be sure your child’s care provider is not over-feeding. This is a common problem for breastfed babies who also take bottles and will kill your freezer stash. Kellymom has a great guide HERE. (there is a PDF link as well)
  • There is a handy milk calculator to see how much your baby should need while you are gone HERE.

950 oz

***Birth Without Fear is not affiliated with Medela or any breastpump/breastfeeding supply company, nor do we promote any one company. This list was just a helpful source found for this article.

Maternal Death and the United States {Birth Without Fear}

Maternal Death and the United States {Birth Without Fear}

Maternal Death – the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes. (WHO)

This is a subject no one really wants to talk about. Mothers die. Mothers die in pregnancy and childbirth and just after birth. The weight of that reality is just so heavy and heart breaking. In our current birth culture, fear reigns. However, fear reigns without reason or knowledge of what really needs fear. And of course – all of us hope to Birth Without Fear. And so, I approach this subject with a heavy heart but hope as well.

Samantha's Birth

Where Does It Happen?

In short, it happens everywhere. However, some areas are more prone than others. This can be due to lack of care – think of sub-Saharan Africa or rural villages in some undeveloped countries. Maternal death in those areas is an unfortunate fact of life (though organizations are striving to change this).

But apart from the “obvious” places, where do you suppose it happens? Perhaps war-stricken places, or those places without advanced medical facilities? Would it surprise you to know that the United States has one of the highest maternal mortality rates in the developed world?

Yes – you read that right. Our current maternal mortality rate is 21 deaths per 100,000 live births as of 2010 (WHO). This rate went up from 2005 (18/100,000). The 2010 “Healthy People” Goal for the United States was set at 4.3/100,000 – we grievously missed that by a large margin. The 2020 goal is 11.4/100,000, which would only be a 10% decrease from what the US considers to be its current statistic (the 12.7/100,000). I find it interesting that the government decided after they missed the 2010 goal that maybe they should try less to save mothers, since their efforts before had no effect and saw a rise in deaths.

The WHO number is adjusted from the number reported by the CDC (12.7/100,000) – this is because the United States does not have a universal system of reporting maternal deaths and the CDC admits that our numbers are drastically under reported due to this lack of uniformity in reporting (See this CDC publication, specifically page 20). Currently, only 25 states make it mandatory to state that a death was pregnancy related on the death certificate – and even this method is questionable due to lack of doctor training in filling out certificates and the great fear of litigation in the medical system. Ina May Gaskin writes about the lack of reporting here.

Other countries have much better standards of reporting. The “gold standard” is considered to the be reporting system in place in the United Kingdom. The UK ensures that not only is every death reported, but they also compile the deaths and reasons for them in a report every three years. This report is available to the public and the locations and names of the deaths remain confidential. This allows the nation and the nation’s health workers to look at the issues without fear of litigation – meaning they have no reason to hide maternal deaths.

To provide some perspective, here are the rates of some other countries:

  • Australia: 7/100,000
  • Brazil: 56/100,000
  • Denmark: 12/100,000
  • Germany: 7/100,000
  • Israel: 7/100,000
  • Japan: 5/100,000
  • Netherlands: 6/100,000 – note that about 30% of all births here are at home.
  • United Kingdom: 12/100,000

As you can see, we are rather behind many other countries – and don’t worry, I am going to come back to Brazil and why I included that statistic which is very high for an industrialized country (as is the USA’s number).

Why Are Mothers Dying?

This question is hard to answer since as mentioned above the reporting methods are varied and not always followed. We do know that some deaths are simply not preventable, this is just a fact of life. However, looking at the much lower numbers in other comparable nations we know that unpreventable deaths are not the reason for the very high numbers in the United States.

We know that it is not from lack of care in general – reports show that over 99% of all women in the United States receive prenatal care. However, we have to look at the level of care women are receiving. We have to ask, does a 5 minute rushed visit with your actual doctor count as adequate care? Does more diagnostic testing equal better care? Does spending more money equal quality care? (The numbers say no – we spend more than any other country in the world on birth).

We see a HUGE disparity in death rates in regards to ethnicity. An African-American woman is 3.3 times more likely to die in childbirth than a white woman. This is simply not acceptable in a country as advanced as ours, and one that is supposedly equal. Midwives such as Jennie Joseph are helping to implement ways to combat this disparity – her creation of The JJ Way is an example of how we can work to correct this travesty.

A big question that needs to be asked in the United States has to do with who is providing this care – care that is obviously not saving as many mothers as it should. In the United States women overwhelmingly see Obstetricians. While Obstetricians are amazing for complicated and high-risk pregnancies, they don’t have much training in plain old boring pregnancy and birth.

A majority of the time pregnancy will proceed in a normal fashion, and birth will follow in the normal fashion. When we use care providers who are trained to search for problems there tends to be a trend of finding problems whether they exist or not, or whether they are actually emergencies or not. As the saying goes, “Give a boy a hammer and he will find something which needs to be hammered.”

We can see that in countries were the majority of care is given by midwives (or that country’s equivalent care provider) the maternal mortality rate is lower (and the infant mortality rate is lower as well). The United Kingdom is a great example of this. They are comparable to us in many ways (general health and population structure), and yet consistently have better maternal outcomes. And they use the midwife model of care in which all women start with midwives and only transfer if problems arise. (Note that a woman can opt for an OB to start with, however most do not).

Now for the elephant in the room: the United States cesarean rate. Our current cesarean rate is 32.8% (CDC). Yes – basically 1/3 of all babies in the US are born through cesarean. So are 1/3 of all US women somehow “broken”? Unable to birth? Producing massive or stubborn babies? NO – of course not. If 1/3 of all women in the US were “broken” then those numbers would be reflected all over the world, and the statistics show this is not the case. In the same vein, we are not producing massive babies either – in fact the average birth weight has gone down as the cesarean rates have gone up (and is independent of that rise or that of induction).

Remember when I said I would come back to why I included Brazil? Brazil has a rather good medical system and is considered a developed country, so why the massive maternal death rate (56/100,000)? Take a look at their cesarean rate – 52.3%. Yes – over 50%. Brazil is an interesting case since most of these surgeries are elective, even for the first time mothers. The fear of childbirth is so deeply engrained in Brazilian culture that women jump at the opportunity to have a cesarean and avoid labor totally. A vaginal birth is seen, culturally, as something only poor women do because they can not afford a cesarean.

That mortality rate could be the United States’ future. We see a fear of birth in the US, and a huge cultural love of telling horror stories about labor and birth. We see more interest in elective cesareans (though elective first time cesareans are not significantly altering the rates). As VBACs are “allowed” in fewer and fewer places and malpractice issues continue to rise we see more and more women forced into surgeries they do not want or need. Our rates are heading right up to that of Brazil’s, and our maternal mortality rates will be sure to follow. A Cesarean increases the risk of death significantly in comparison to vaginal birth.

In comparison, the rate of cesarean in the UK is 25%, the Netherlands has a rate of 14%. As I stated before, the UK has 12/100,000 rate and the Netherlands 6/100,000 – rather interesting that as the rate of cesarean is almost half in the Netherlands and their rate of maternal death is also half that of the UK. While in some countries a higher cesarean rate does not correlate to a significantly higher mortality rate, those countries with very high rates of cesarean typically have higher (or rising) mortality rates.

We also cannot forget postnatal care. The postpartum period is one that needs care just as much as the prenatal time period. In the US, typically a woman is seen in the day or two after birth, at two weeks or so, and then at six weeks…and that is about it. This is simply not enough during this time of life when hormones are changing, the body is attempting to heal from creating another life, and things like retained placenta or clots can cause major issues. A much better plan of postpartum care must be put in place.

What Can We Do?

Be Educated. That is the number one thing you can do to not only help yourself have a safe pregnancy and birth, but also to help the women around you as well. When you learn, share the information. Break down the myths that pervade this culture – break down the assumption that VBACs are dangerous, or that “big babies” need surgical birth. Share the studies and articles you read.

Be Fearless. Help to eradicate fear of birth. Can birth end in tragedy? Yes. Unfortunately is does happen. But with proper and evidence-based care we give ourselves and our babies the best chance. Share the positive birth stories you hear. Share your positive birth. How does this help? It helps women to not fall into a fear based decision that increases her risks of complications – namely induction and cesarean. When a woman can start her pregnancy and birth journey from a positive place it gives her more space for growth and research. Absence of fear is not ignorance of risks – it is not being beholden to the fear of risk.

Those two things hand-in-hand – education and fearlessness – can go a long way towards helping this mortality rate go down. An educated woman is better able to avoid situations or care providers that increase her risks, and a fearless woman is better able to stand up for herself and decipher what is really in need of intervention and what is not without cultural fears clouding her view. Lets do our part to save mothers.

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Grief And Guilt {The Birth Trauma Experience}

Grief And Guilt {The Birth Trauma Experience}

Trauma after the birth of a baby is a ‘special’ kind of trauma.

It’s a bittersweet kind of trauma. It’s a silent kind of trauma. It’s an invisible kind of trauma.

And if your baby is healthy, it is usually considered an unjustified kind of trauma.

I suffered from birth trauma. It was agonising, painful, and heartbreaking. I was alone, and misunderstood. It began the first night, a few short hours after the birth of my first daughter, from the moment my partner went home for the night. I was alone in the dark in my single room with this tiny little newborn. I held this chubby baby girl in my arms, and felt nothing but sadness at the experience we had gone through together to bring her into this world. I’d feel a stab of shame every now and then, and scold myself for being so ungrateful – my baby was here, wriggling in my arms, and I had the nerve to even consider mourning the experience that brought her to me. I would quickly go back to the sadness, mourning the loss of a dream – a beautiful and empowering birth experience. That night was the beginning of a four year battle with birth trauma.

My grief was deep, and some days I felt I was drowning in it. I floundered, being hit by waves of sadness, disappointment, and anger. I replayed the labour over and over in my head. I beat myself up with ‘what if’ and ‘if only’. I felt responsible; I blamed myself. I felt cheated, let down; I blamed my partner, I blamed the midwife, I blamed everyone. I tried to pinpoint where it went ‘wrong’, where I  went wrong. News about new babies had me sobbing, even watching birth scenes in movies was painful. A phone call from my sister, hours after the birth of her son, left me feeling like I’d been hit by a truck, and I hid behind shelves in the department store I was in and I just cried and cried. I bitterly wished for every woman to have a horrifying experience, and I felt an unimaginable hurt when I saw women emerging from birth empowered and ecstatic. It wasn’t that I wanted every woman to experience the pain of birth trauma, but I just wanted to them to know my pain.

 

I suffered terrible postnatal depression and post-traumatic stress disorder, even though my trauma largely went unacknowledged. Where it was acknowledged, it was usually deemed unwarranted. My experienced was pushed away and minimised by well-meaning but hurtful comments from others…

 “Years ago, you both would have died. Thank goodness for modern medicine.”

“It’s just one day in your life.”

“You were probably never going to give birth naturally anyway.”

“It’s probably because of your birth plan. You can’t control birth, you know. If you didn’t have such high expectations, you wouldn’t be so disappointed.”

“At least you are both alive and healthy, that’s what really matters.”

The comments were so hurtful. I felt like very few people understood. What about me? I would think. How can you say I am healthy? I feel like I am falling apart. Does my mental health not matter? I should have been overwhelmed with love for this tiny little bundle of joy, but instead I would hold her, look at her, and wish that I felt something. I was numb.

Sometimes I retold my birth story. I rarely came across anyone who had a story like mine, and people would cringe and exclaim “oh my goodness that’s terrible”, and then tell me their story. Sometimes they would have their own war story to tell, and I would listen and we would joke about never doing that again… But that wasn’t what I wanted.

I craved validation. I craved acknowledgement. I just wanted to tell someone my story, have them hold me as I cry, and look me in the eye and say: “I’m so sorry. You were cheated. You deserved better. You should have been able to birth the way you wanted. Your pain is justified. You have every right to grieve, without guilt.”

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Maybe your birth trauma hit you straight away, or maybe it slowly grew, beginning as a nagging feeling you didn’t quite understand and growing into a deeper pain. Maybe your plan for birth went way off course, or maybe you didn’t have a birth plan but you wished that you had. Maybe you sometimes think that you weren’t informed about your choices, or maybe you think your pain could have been eased if you knew, and expected, less.

Maybe you had a caesarean. Maybe you had an instrumental vaginal birth. Maybe you had an unmedicated birth. Maybe you birthed in a hospital. Maybe you didn’t make it to hospital. Maybe you birthed in a birth centre. Maybe you had a planned homebirth. Maybe you asked for pain medication, and didn’t get any. Maybe you asked for support in a drug-free birth but was pressured into using medication. Maybe you had an unexpectedly fast labour, or an unexpectedly slow labour. Maybe you refused a procedure, but it happened anyway. Maybe you wanted a certain procedure, but no one listened…

Or maybe, none of this happened. Maybe it’s not about how you birthed. Maybe you birthed exactly as planned – but your trauma relates to how the nurse spoke to you or looked at you or ignored you…

Maybe you feel unsupported, alone, unjustified, silly, or even selfish. Maybe you’re sad. Disappointed. Angry. Hurt. Jealous. Afraid. Ashamed. Guilty. Responsible. Maybe you don’t feel any of those things…

Birth trauma can happen to anyone, in any situation. Birth trauma can happen to you, and even to your partner. Your experience is totally unique, and it doesn’t matter how anyone else feels about their birth or what anyone else would have done. Birth trauma is about how YOU feel about YOUR birth. Birth trauma is about YOU and YOU alone.

But make no mistake, you aren’t alone. Right now, thousands are alongside you, silent in their trauma and suffering.

Birth trauma is real. And needs real support.

To the mothers out there, dealing with birth trauma, I want to offer you my empathy, and my deepest condolences. Birth trauma is real. Your pain is real. Your pain is justified. You deserved a wonderful birth experience, and it is unfair that you didn’t get that. You deserve support. You have the right to grieve without guilt.

To the partners, friends, family, midwives, doulas, doctors, nurses, acquaintances… offer your empathy, and your deepest condolences. Birth trauma is real. Their pain is real. Their pain is justified. They deserved a wonderful birth experience, and it is unfair that they didn’t get that. They deserve support. They have the right to grieve without guilt.

 

A Home Water Birth Based on Faith and Evidence Based Care

A Home Water Birth Based on Faith and Evidence Based Care

Around my daughter’s first birthday in December, it was placed heavily my heart to have another child. I had just graduated college, and the timing seemed perfect. My husband agreed and we found out we were expecting in January with an estimated due date of around September 17! I immediately started researching home birth midwifery options. I had an all natural, un-medicated hospital birth attended by a midwife with my daughter. I was at the hospital less than an hour before she was born, because I knew I needed to wait as long as possible before going in to be able to stick to the birth plan. It felt weird to not have a care provider with me while I was laboring. The post partum care was disappointing with my hospital midwives. So I knew I wanted to give myself something more with this baby. We deserved the best care possible. I found a homebirth Certified Nurse Midwife in my state, and she took me on as a client.

I was incredibly blessed with an easy pregnancy. I didn’t have HG this time; in fact, I never even threw up once. I was able to work out until the middle of the third trimester as well. This was such a difference than my pregnancy with my daughter, which was great because having a 1 year old and being pregnant at the same time is quite challenging! We had an anatomy scan with the maternal fetal medicine doctor that does the ultrasounds at the birth center and found out we were having a healthy son. I still tear up thinking about that day. I knew God had a plan for us to have a son, and to keep him whole and intact. He was created perfectly, and I would not change that by circumcising him! I felt instantly connected to him the moment I saw him on the screen. I knew at that moment I would do anything to protect him!

maternity shot for birth story

Having my midwife come to my house for all my appointments was so nice. I never had to make childcare arrangements for our daughter, and it was simply convenient! I also had regular chiropractic care during this pregnancy, which alleviated a lot of aches and pains. Also, I treated myself to pedicures with my girlfriends which was fun!

Once September came I had some episodes of prodromal labor. I knew my baby was getting ready to enter the world, but each time the prodromal labor would end without me actually going into labor, it was disappointing. He had been posterior most of the pregnancy, so I figured it was him trying to get into the best position.

The early morning hours of my due date, I started having contractions that I knew weren’t Braxton hicks. I knew Berkley was coming to meet us. I was timing them and getting so excited. I cleaned and lit candles, prayed and told my husband. He needed some convincing that it was time, but once he realized it was, he started blowing up the birth pool. It was around 3:30AM at this point. We called our midwife and told her we believed I was in labor. We also sent text messages to the doula and photographer. We were so excited!

birth pool for story

My midwife called around 6:00AM to let us know she was on her way. She told me my labor may stall a bit once my toddler woke up, and recommended sending her to Grandma and Grandpa’s so I could get on with my labor. In her experience, mothers of small toddlers can get out of the labor when they mother their toddler. And I was so ready, so off she went to Grandma and Grandpa’s. I remember sitting with her on the rocking chair, where I nursed her for her first year of life, telling her mommy loves her so much, and she will always be my baby girl. It was such an intense moment knowing when she would arrive back home she would be a big sister.

My midwife was right. My labor slowed way down once Faith woke up. I went almost 2 hours with no contractions. My midwife still set up all her equipment though. She suggested I take a walk, use the breast pump, take a shower, all to get things moving again. I asked for a cervical check and I was 4 centimeters dilated and 80% effaced and baby was at minus 2 station.

Hours passed with pretty minimal contractions. My midwife went to go eat some lunch around 11:00AM to give us some space. It was so weird having such irregular contractions, yet they were so intense. I was pretty confused about the situation. When my midwife arrived back, I told her I would like an intervention of some sort to get labor moving. Once my doula arrived, I consented to a stripping of the membranes. Literally, once that happened, things picked up so fast. The contractions were coming so quickly. I could barely breathe and talk through them. I noticed all my hypnobirthing techniques weren’t helping to cope. I told my husband to call the photographer, I knew it would be soon that we would be meeting our baby boy!

My midwife didn’t want me getting into the birth pool prematurely. So when I asked her if I could get in and she said yes, I knew it would be close. This was around 2:45PM. I already felt so tired from being up all night with contractions. The pool was very relaxing, I am so glad I got that thing! It was nice being able to stretch out in it. The contractions were coming so quickly. I didn’t know how much more I could handle. I felt like I was loosing it. We put on my hypnobirthing tracks which helped a little. I even said I wanted to transfer to the hospital. Looking back, I know this is a “sign post” that means that the baby is coming soon, but I couldn’t think at that point. I just didn’t know how I could handle any more labor. The photographer walked in and I couldn’t even say hi. I felt so rude! I was sobbing. I was a mess. I felt like I was failing at my peaceful birth.

janet hugging me

labor in pool 3

birth story photo 1

 

labor in pool 2

I felt nauseated (which again, usually means baby is coming SOON) so my doula did some aromatherapy which did help.  I asked to get out of the pool. I went into my room and was crying some more. My midwife came and gave me a big hug and told me I just needed a little more courage and the baby would be here. I told her she was right, that I was scared. Looking back at my photos of that moment, I realize I definitely picked the right care provider. She hugged me and told me everything I needed to hear.

laboring on ball

Right at that moment, my water broke. My midwife called her assistant in to chart the time. It was clear fluid. I felt so much better once my water broke, but then the contractions kept coming even more frequently. I started having bright red blood drip down my leg. My midwife immediately (yet calmly) figured out I was involuntarily pushing against a cervical lip. I asked if it were too late to get back in the pool. Of course not! So I ran back into the pool. The bleeding stopped just as soon as it started. Everyone was right there with me. I told my midwife I felt like I had to have a bowel movement. Again, a sign the baby is right there. She just told me “poop the baby out”, “it’s okay!”, “you can do this”.

labor in pool 4

labor in the pool 3

The pushing was an experience I had not really had before. With my daughter, she came very quickly with no pushing stage, and I had 3 first degree tears. I wanted to be in the water to minimalize tearing. It is amazing how natural it is to push. I didn’t need any directed coaching about how long to push or how to push. If given the opportunity, it comes naturally!

pushing

Within just a few minutes, he was born! I did it! I leaned against the back of the birth pool and he was right on my chest. He had vernix! He was so cute and tiny! It’s amazing how quickly you forget how tiny they are! He got a 9 and a 10 on his APGARs. He was so beautiful and calm. My photographer said when he was born, I was saying “We wanted you so much, We wanted you!”.

group shot at birth

birth of c 2

birth of C

 

after birth of c 2

I felt like I didn’t have a lot of traction sitting in the birth pool with him, so I asked to move to my bed. We went to the bed and just cuddled, hugged, breastfed, everything that should be done in that golden hour. When we were ready, my midwife checked me and I didn’t tear! She weighed our boy and he was 7 pounds 12.5 ounces and 20.5 inches long. There were no hands on him other than mine and my husbands until we consented to his exam. She didn’t even have to draw blood to test his blood type, she collected a sample from his umbilical cord! It was such a private birth, this was the experience I wanted, the experience we deserved. I know God designed me to be able to give birth, and having a midwife with so much experience and evidence-based practices made the home birth decision even more excellent. I know my fast recovery and lack of PPD can be attributed to such a peaceful birth and loving care from my midwife and family.

we did it

kale at birth

Maternity Photo by Brink Street Photography

Birth Photography by Aperture Grrl

A Healing Hospital Birth {After a Delivery that Resulted in PTSD and Birth Trauma}

A Healing Hospital Birth {After a Delivery that Resulted in PTSD and Birth Trauma}

This birth story of my daughter Kayla was my healing birth after having suffered a traumatic birth experience with my son Alex in December of 2011. When I gave birth to Alex, it was a traumatic, intense birth to say the least. I struggled with PPD and PTSD as a result of his birth.  I wanted Kayla’s birth to be different and healing.

I had hoped and planned for a homebirth. I suffered HG my entire pregnancy and because of that my hemoglobin was dangerously low, too low in the state of Wyoming to be “allowed” to birth at home.  Because my labors and births with Blake and Alex were so fast we still prepared and educated ourselves to have this baby unassisted. To be completely honest, I wanted nothing more than my husband to catch Kayla.

I had been contracting every 4 to 6 minutes from 6:00PM or 7:00PM the night before.   As morning approached they were becoming much more intense and harder to work through.  When my husband woke up at 6:30AM I informed him of this and we both made the decision that we would pack and drop off our boys and make the 45 minute drive to our midwife.  I had an appointment with her at 2:00PM that day but didn’t think I could make it that long and didn’t want to give birth on the interstate.

I was checked in to triage.  I knew that on the drive over my contractions had gotten much worse but was shocked to see on the monitor they were every 2-3 minutes lasting 30 seconds to a minute. I felt as though I was leaking amniotic fluid so made sure to tell the OB but the two tests they did right there were negative and they also sent a third to the lab. I was dilated 3cm which was an improvement from 2cm but still only 50% thin and minus one station.  I was told to walk the halls and come back to be re-checked.

Jimmy and I walked and walked and walked. I was very disappointed but not shocked that my contractions were slowing down and becoming much less intense. This always seems to happen to me when I arrive at the hospital.  We eventually made our way back to triage and just knew there would be no change but I also knew that just because there was no change now doesn’t mean that I may not be in full blown labor later that day or night.  I was re-checked and sure enough still 3cm and -1 station and I was 60% thinned out.

I was getting ready to be released when Kayla’s heart rate jumped to the low 170’s. Her normal heart rate is usually late 140’s to low 150’s and I know this because I checked it often at home on my Doppler. Many of the labor and delivery nurses had commented on how beautiful her heart rate usually was and joked that she was just showing off. They opted to keep me in triage for a while to monitor her and see what would happen.  I had texted my doulas earlier that morning to let them know what was going on and kept giving them updates.  They were trying to decide at this point if they should make the hour drive to join me.  I told them not quite yet, I would let them know if and when I needed them so they were on stand by.  Jimmy was updating my mom and sister who were watching Blake and Alex.

The doctor ordered a bio-physical profile to be done.  The tech didn’t give us any clue as to what was happening but she made a comment to the effect of “they will take good care of you here” as she was leaving.  After that comment was made I just had that “feeling” she had found something on the BPP.   We waited a bit and then my nurse came in and said,  “Do you want to have your baby today?”.

She walked me to a labor and delivery suite and started an IV.  I agreed to this because I knew with my hemoglobin and hematocrit level being so low I was in danger of bleeding out after birth.  The doctor came in and informed me that I had no fluid.  My heart immediately sank because I knew that I was at risk for the cascade of interventions being started. The doctor said that her recommendation would be to start Pitocin but I stood my ground and said no, especially with Kayla’s heart rate being so high and the fact that I had no fluid. She agreed to try and stretch my cervix as much as she could.  She was able to get it to 4-5cm and at this point I was 90% effaced.  I let my doulas know that I needed them as well as my mom and sister.

My mom and sister arrived with my boys around noon, about 15 minutes before my doulas did.  Once they arrived the doctor came back in and asked how much time I felt like I needed to get things moving and we said two hours.  I don’t think she was happy about it but she agreed and she also agreed to “let” me get out of bed as long as I stayed on the monitor.  This meant I could only go as far as the cords let me.

As soon as they left the room my doulas had me get up and start moving.  I was doing squats, figure 8’s, lunges, bouncing on the ball and all fours in my bed.  I knew as long as I kept moving and upright there was a very good chance that I would get things going on my own without the Pitocin. I had an amazing nurse that day and I do think God was looking out for me.  She came in countless times to re-adjust the monitor and never once complained or ordered me back to bed.

Two hours later the doctor came back and I was so scared but almost positive I had made a change.  I was approximately 5 to 6 centimeters dilated at this point and 100% effaced.  We were all elated.  I continued to do what I had been doing and my doulas made sure I stayed hydrated and nourished at all times.

The doctor continued to come back every two hours to check me and every check there was change.  At some point in time I made the very difficult decision to have a fetal scalp monitor placed so I could be a bit more mobile and wouldn’t have to worry about the monitor not staying on.  I must say that this doctor was amazing and truly she restored my faith that there are still “good” doctors out there.  She respected my wishes. She would always tell us what her opinion was but never once pushed anything on me. She never violated me and would always ask before doing a cervical check if it was okay and if I was having a contraction would wait until I told her it was over.

One of my doulas took the clock down so it would not be a distraction to me.  My mom and sister unfortunately had to leave and go home 45 miles away with my kids.  It made me sad they wouldn’t be there for the arrival of the baby.

The atmosphere during my labor was consistently calm and relaxing, the lights were dim and we used candles. It was the kind of atmosphere I needed.  My husband was putting tons of counter pressure on my back and was using cold rags to help with the pain and also because I was hot.  I found the most comfortable position to be on the ball and I stayed there most of my labor.  Things hadn’t got intense yet and I was easily breathing and moaning through the contractions.  I made sure to stay on top of them and really, really focus. I remember thinking at one point “could it really be this easy all the way to the end?”.  There was one point and I think it was around the time I hit transition that the journey become emotional, very emotional.  It caught me off guard.  I was having flashbacks to Alex’s birth and realizing that I was facing this fear head on.

It was when I hit 8 centimeters that things got bad and I really started doubting my ability to do this naturally.  I had made the move from the ball to the bed for that check and was still doing somewhat okay.  The doctor let me know she was slightly concerned because although I was dilating and thinned out Kayla’s head was still -1.   She let me know that if it stayed that high there was nothing she could do to help get her out vaginally and it would have to be a cesarean section.  I remained calm because I trusted my body. I trusted Kayla and I remembered something a different labor and delivery nurse had told me when I was pregnant with Alex. Some babies do not drop until moments before birth.

The doctor brought up the idea of Pitocin and it stirred a lot of fear within me. I was reassured that I would not need much at all.  I agreed to it but was absolutely terrified because I have heard so many stories how unbearable Pitocin makes contractions. I was suddenly hit by the worst contraction ever. I couldn’t get my focus back and I lost control.  I started begging for the epidural, saying I could not do this and yelling at the nurse to stop the Pitocin.  To this day I am not sure if I received it or not, I know the bag was hung but not sure it ever entered my body.  The nurse said she had barely hit the start button when I yelled to stop it.  So, if I got any at all it was a very small amount. I know now this was transition because of the intensity and fear that just took over. What made it worse is I lost my focus. I had been so calm up until that point but the idea of Pitocin and a possible cesarean section sent me over the edge.  Deep down I knew she would drop.

I could feel Kayla’s head getting lower.  I could feel that I was leaking what little fluid I did have left and I knew I was pooping.  I was embarrassed but there was nothing I could do. I started screaming, “She’s coming, she’s coming”. My husband knew from my previous birth that when I start saying that the baby is close very close to being born.  He let them know someone needed to get the doctor right away.

She came in and did a cervical check. I was 10 centimeters, her head had dropped and she was about to crown.  The doctor barely had time to get dressed.  I told her I had to push and I pushed once.  I felt the ring of fire but was so confused why it wouldn’t stop. I know now that it is because she flew out all in that one push and flew out so fast her body hit the bed.  I screamed and the next thing I knew she was on my chest.

I began bawling and couldn’t stop; it was surreal.  I could not believe I had just given birth un-medicated and I survived! Although this was not the birth I envisioned or planned, it was wonderful. It was healing and most of all it was empowering and in that moment my natural birth high began.

Empowering Hospital Birth after birth trauma

 

The Skinny Mom: Does She Think She’s Better Than You?

The Skinny Mom: Does She Think She’s Better Than You?

“When my daughter was about a week old I was at the grocery store and a woman asked how old my baby was, I told her one week with a smile. Her response was “well you don’t look like you f***ing had a baby a week ago.” and turned and walked away from me. It hurts to be ostracized by other mothers in that way.” – Jonelle, of Aware Beginnings Doula Services, commenting on Mothering the Mother Part II: How Postpartum Care Helps Us Love Our Bodies

I’m a skinny mom. Not too skinny. But on the slender side.

I gained about 25 lbs in each of my two pregnancies and shed it within a few weeks of giving birth.

When I’m pregnant, people tell me I don’t look it.

I fit into my pre-pregnancy jeans until seven months in.

I wore a short black dress to a party a few days before our second was born.

party

My K’taan is a size small, I can still squeeze into the back seat between my two babies’ carseats, and I still have no stretch marks.

Do you hate me yet?

What if I told you that I don’t diet and my only exercise is babywearing? Would you hate me then?

My body looks the way it does for a number of reasons (including socio-economic status and access to real food) but mostly because of a genetic lottery. In the eyes of our society, it’s a lottery I’ve won. But ‘winning’ isn’t everything. I have a history of starving, purging, cutting, and risking my body. This history is invisible when you look at me. It can be covered up by a short black dress and gold high heels.

Maybe you assume that I have my shit together, that I am in control; maybe you think I’m happy.
Maybe you assume that I am superficial.
Maybe you assume that I diet constantly.
Maybe you assume that I diet constantly even when I’m pregnant and therefore do not have my baby’s best interest at heart.
Maybe you assume that I’m mean and manipulative.
Maybe you just know that I think I’m better than you. (I don’t. And I don’t think the skinnier mom standing next to me is better than me, either.)

Other people’s ugly assumptions aside, I know and enjoy the advantages of being a skinny mom:

I still get to be seen as cute and slightly sexy (even though I’m a mom, which is, apparently, the least sexy thing in the world).
I don’t have to buy a new wardrobe when I get pregnant.
When I look at pictures of mothers in magazines and advertisements, they look like me (I also happen to be caucasian and able-bodied. Bonus!).
I wasn’t automatically classed as a ‘high risk’ pregnancy due to my weight.
I could satisfy all my pregnancy cravings without feeling guilty.
I receive most of the advantages of being a skinny girl – I get served first at deli counters, customs officers are always nice to me, my in-laws think me an appropriate match – but since I’m a mom, these days I get a lot less harassment from skeezy men.

These are important social advantages. It will be hard for me to lose them as I get older. But they’re all from the outside. Inside is a different landscape.

Some nights I tell my husband I don’t want to have sex because I’m tired and covered in milk and I imagine my body has been taken over by a hungry parasite who just also happens to be a baby I love. It feels there is no more space in my body for receiving or giving anything.
If I do compare myself to the mothers in an advertisement, they are still thinner than me, happier than me, prettier than me, less milk-stained than me. I am still lacking.
I wasn’t classified as ‘high-risk’, but I had to pay three months’ rent for out-of-pocket for decent healthcare during my last pregnancy. It was hard to convince myself that my baby and I were worth it.
I could satisfy all my pregnancy cravings without feeling guilty, but I didn’t (I still satisfied them – I just felt guilty).
I don’t do it anymore, but I have thrown up or skipped more meals than I can count. Other people liking your body doesn’t make you love your body.
I’m a happy person but I still feel out of control sometimes – especially when my toddler is eating spaghetti with a spoon.
I love breastfeeding now, but when I first lactated colostrum, I felt disgusted by my pregnant body.
The flip side of being told I don’t look pregnant is people thinking that I am not my baby’s mom. “Is this your baby?” they ask, and I try to take it as a compliment but I know there’s an edge in my voice when I answer, “Yes, this is my baby. This is my baby.” This is my body that birthed this baby and I hate that you looked at it and thought otherwise.

My body is real and I am learning to love my postpartum pooch (below: a few days PP in ye olde disposable panties).

Postpartum

My claim is not that, “I too, my full-bodied sisters, am a daily victim of unfair physical ideals!” I know that, on the whole, I benefit from them. And I’m not saying that BWF should have a ‘skinny moms’ day for every plus-sized mama day. I know that every day is ‘skinny mom day’ in all the rest of social media. I’m just saying that in a country where at least 80% of women dislike their bodies and Miss America is perpetually malnourished, we are all capable of hating ourselves. You don’t know how someone feels about their body just by looking at them. You only know how you feel about their body. And your own.

In my better days, this is how I like to think of my body: as a powerful vessel. A vessel for my thoughts and actions; a vessel for my creativity; and of course, a vessel for my babies. It is through this body that I show my love for other people. This body lets me laugh. This vessel has (love) handles but it is tall and deep. It will get old and its enamel will crack. Someday it will disintegrate entirely. I can only hope that when it does, I’m not worried about how it looks.

So, do you hate me yet?

Mothering the Mother, Part II: How Postpartum Care Helps Us Love Our Bodies

Mothering the Mother, Part II: How Postpartum Care Helps Us Love Our Bodies

“A safe pregnancy is a human right for every woman regardless of race or income.” – Amnesty International

“I have horrible [postpartum] stretch marks that I feel the need to cover and of course my breasts are nowhere near where I would like them to be.” – Courtney, Beauty Revealed Project.

So here I am, sitting cross-legged with a computer in my lap, typing around the soft belly that still protrudes (that always will protrude), while my seven week-old daughter sleeps in the next room. I’ve got a clean cloth diaper stuffed into my bra and I’m thinking about the talk I will give at the upcoming BWF Conference in October.

(((Registration is open! You should come! I want to meet you!)))

My topic is ‘Mothering the Mother’, an expansion of my most popular blog post ever, decrying the lack of postpartum care provided to American women. And I am being sponsored by the Beauty Revealed Project, a fantastic community and an online collection of photos and stories celebrating women’s real postpartum bodies.

Darien McGuire Photography

To some, this may seem like a strange fit: What, one might ask, does postpartum care have to do with bodily self-acceptance? If I bring a new mother a big pot of soup, is she suddenly going to love her stretch marks?

The answer is no; the answer is yes.

Our society-wide refusal to acknowledge the changes that come with motherhood is one of our greatest acts of misogyny. The bare facts: The United States is one of four countries in the world refusing paid maternity leave to its new mothers (the others are Liberia, Swaziland, and Papua New Guinea). Despite 20 year-old research stating that changes in our healthcare model would soon require in-home postpartum support, American women do not receive postpartum care beyond a six week check-up. And our maternal mortality rate is the highest in the Western world.

These policies and their resulting tragedies perpetuate a widespread distaste for the childbearing process. Somehow, it has become OK to force a woman back to work just a few days after a human being came out of her body. To cut it open (routine episiotomies, routine cesareans) and leave it untended for six weeks or more. To let women – especially poor women, and women of colour – die preventable deaths after they have created life. The birthing woman’s body, not perceived as an economic resource, removed from its dubious status as a sexual object, is just not valued.

Sweet Serenity Photography

This devaluation spreads to other non-essential aspects of women’s postpartum bodies. The postpartum pooch. The stretch marks. The sagging flesh, the milky leakiness, the scars. There is nothing ugly about these body parts. But google any one of them and the instructions you find will be on how to hide it. How to get that ‘pre-baby body back’, terminology which I find so offensive because, really, where did that body ‘go’? It’s still here. Right here. My body did not disappear into some Platonic realm from which it must be reclaimed. No. My body, my (fortunate, privileged) healthy body birthed a baby.

It is so hard to see one’s own culture(s) because these are beliefs we are born into, ideas by which we live and die. So I’d like to try a little experiment. Let’s imagine the cover of a celebrity-ogling magazine. You know, the kind that watches bumps like my toddler watches diggers.

The cover shows a glamorous new mother.

She is lying in bed, her body relaxed and comfortable.

She is not groomed because she does not need to be, it is not expected of her.

She is not lifting weights or on her way to yogafit class; she is nursing her baby.

The headline reads, “K. Kardishian, New Mother! Inside: pics of her beautiful baby and fabulous new stretch marks!”

Yeah. I can’t imagine it either.

But I maintain that the physical manifestations of having birthed a child do not need to be hidden. They could, hypothetically, be celebrated. I swear they could be seen as sexy. I have heard they can be markers of status. Or simply perceived as healthy, normal, even unremarkable.

open book studios

What would it take for any of these to happen? We would have to start with the postpartum period. With gently caring for women who are gently caring for their newborn babies. With giving their bodies space to recuperate. With touch and massage, actions which tell them that their bodies are OK. With giving them nourishment and love. Showing mothers that we care about them will allow them to internalize that care and to care about themselves. Bodily self-acceptance cannot be far behind.

I have been lucky to receive incredible postpartum care over the past two months. I had midwives and friends, community to bring me meals and a partner to look after me. I did not have to get back up on my feet and do the impossible. I could rest. My body and my heart both show the benefits of this care. And as I sit here and feel my milk let down, telling me that my infant daughter will soon wake up and call me in to nurse, I feel grateful that my body birthed a baby. I know deep inside that my body is more than a cog in a machine, or something to be looked at. That it is strong, powerful beyond measure.

The health of our bodies has everything to do with how we feel about them.

KaylaMarie Photography

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The Beauty Revealed Project is on Facebook and online at www.beautyprojectrevealed.com. The staff of this wonderful, encouraging page accept photo and story submissions from postpartum mothers. They also assist in the arrangement of free or low-cost postpartum portraiture sessions with professional photographers. The Beauty Revealed Project is a not-for-profit organization and a labour of love.   

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