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VBAC: What ACOG Really Says {Birth Without Fear}

VBAC: What ACOG Really Says {Birth Without Fear}

VBAC – Vaginal Birth After Cesarean.

The term and action is wrought with political and emotional meaning in the birth world. Can  you have a VBAC? Does your doctor or hospital “allow” a VBAC? Under what conditions can you have a VBAC? Should it be called a TOLAC (trial of labor after cesarean)? What sort of prior birth history is preferred? Once I have one successful VBAC, will I still have to jump through hoops in subsequent pregnancies?

All these questions and more come up when we start to discuss the mine field that is VBAC in today’s world. But I wanted to know what ACOG really says. I am not talking about the public statements – which you can read HERE. I want to know what ACOG is saying to the doctors, what they put out in their practice guidelines.


The document I found is HERE. I encourage you to not only look at the document for yourself, but to also follow the many links I have scattered throughout this article.

At the opening of the document, ACOG has this to say:

Trial of labor after previous cesarean delivery (TOLAC)* provides women who desire a vaginal delivery with the possibility of achieving that goal––a vaginal birth after cesarean delivery (VBAC). In addition to fulfilling a patient’s preference for vaginal delivery, at an individual level VBAC is associated with decreased maternal morbidity and a decreased risk of complications in future pregnancies. At a population level, VBAC also is associated with a decrease in the overall cesarean delivery rate (1, 2). Although TOLAC is appropriate for many women with a history of a cesarean delivery, several factors increase the likelihood of a failed trial of labor, which compared with VBAC, is associated with increased maternal and perinatal morbidity (3–5). Assessment of individual risks and the likelihood of VBAC is, therefore, important in determining who are appropriate candidates for TOLAC. The purpose of this document is to review the risks and benefits of TOLAC in various clinical situations and provide practical guidelines for managing and counseling patients who will give birth after a previous cesarean delivery.

Lets start with noticing that ACOG automatically terms all VBACs as TOLACs first. If you complete the trial with a vaginal birth, then it is a VBAC. The issue with this sort of wording (and thought process) is that it sets women up with doubt and it sets the doctor on the defense against the failure of the trial. I will use the term interchangeably only because the document that I am citing uses the term so often. But moving past this unfortunate wording we do see that they know VBACs are beneficial. They state that VBACs lower the maternal morbidity rate and risk of complications in future pregnancies and that as a whole they lower the cesarean rate. They do also point out that there are certain factors that make a TOLAC less likely to succeed, and that when they do “fail” you are more likely to have morbidity (which makes sense, as a major surgery is considered a morbidity to begin with).

In the “Background” section at the start of the Practice Bulletin we see several points that seem to be denied in the general obstetric community. First they state that the cesarean rate has increased rapidly since the 1970s, from 5% to more than 31% in 2007. They blame this increase on the introduction of electronic fetal monitoring, and the decrease in breech births and forceps births. I put emphasis on the EFM use, since we are often told that it is needed for a safe birth, even though research proves that it does not lower fetal morbidity or mortality. Again and again, research also shows that it increases the chances of a cesarean, which in turn increases the risks to mother and baby. Yet, ACOG still insists on the use of EFM as standard care.

They also state in this section that after the 1970’s VBACs gained popularity. By the mid 1990’s the rates of VBAC (28.3%) were such that it was actually reversing the cesarean rates. However, this increase in VBACs seemed to come with an increase in uterine rupture – though the literature does not state what sort of uterine scars were common (since certain types are known to have more risk, such as classical), whether induction was used, or what type of rupture occurred (most ruptures are not catastrophic but are instead considered a “dehiscence”). Due to this increase in ruptures, the case for VBACs was again set back to “once a cesarean, always a cesarean” in many practices. They finish this section by stating that it is known that liability is a large part of why VBAC is not offered to many women who are actually good candidates.

Now we get into the nitty-gritty of what they say about VBAC. I am going to take questions and statements from the document to break this down. All noted pages are from the Practice Bulletin unless otherwise stated or linked.

  • What are the risks and benefits associated with TOLAC? (p2)
    • Neither an Elective Repeat Cesarean (ERC) or a TOLAC are without risks.
    • Most maternal morbidity that occurs during TOLAC is related to a failed attempt when a cesarean becomes necessary.
    • VBAC is associated with fewer complications than an ERC.
    • Thus, the risk of a VBAC really comes down to whether it is achieved. If it is a “failed” TOLAC it has more risk than an ERC, but if it succeeds, it has lower risk than a ERC.
    • The main risk of TOLAC/VBAC is a uterine rupture. However, as stated in the background, some studies do not give background information about what type of ruptures are occurring nor on what type of prior incision or induction methods.
    • They include a chart of maternal risk in this section and it is interesting to note that maternal death risk can be almost double (0.2%-0.4%) with a ERC compared to a TOLAC after one prior cesarean (0.2%), and that TOLAC with more than one prior cesarean had no death risk within those studies. It is also noted that a ERC also comes with the risk of uterine rupture (0.4%-0.5%).
    • It is noted that for families wanting several children a successful VBAC takes away the risks of multiple surgeries which includes hysterectomy, bowel or bladder injury, transfusion, infection, and abnormal placentation such as previa and accreta.
    • They include a chart of neonatal risk factors when comparing ERC to TOLAC. It should be noted that there is no significant increase in neonatal death or neonatal admission (NICU admission). We see a much higher rate of respiratory distress (1%-5% vs. 0.1%-1.8%), transient tachypnea (too much fluid in the lungs which causes breathing issues) (6.2% vs. 3.5%) and hyperbillirubinemia (jaundice) (5.8% vs. 2.2%) in babies who go through an ERC.
  • What is the vaginal delivery rate of women who have a TOLAC? (p3)
    • Most studies show a 60-80% success rate.
    • Studies show a decrease in success if the same circumstances happen again, such as stalled labor, which lead to the first cesarean  (however, I will note that the definition of “stalled labor” is more likely the issue than anything else).
    • The chances of success are increased if the mother has spontaneous labor with no augmentation.
    • One VERY interesting note is that being “non-white ethnicity” lowers your chances of success. This speaks to the huge disparity in maternity care in ethnic groups in this country. Simply taking one look at the maternal mortality rate in non-whites gives a clear and horrible picture of this undercurrent in our maternity care system.
  • Who is a candidate for VBAC? (p4)
    • The best candidate is one in whom the risks and benefits balance out in a way acceptable to the client and care provider, this may be different for each woman and there is no specific “formula” to come to this answer.
    • Decisions about the first VBAC should be considered with future pregnancies in mind. This is due to each subsequent cesarean increasing the risk for future pregnancies, and the inability in some areas to find care providers to attend a VBAC after multiple cesareans.
    • For most women with one prior cesarean and a low transverse incision VBAC is a good option and they should be counseled and offered a TOLAC. Women with other incisions (T-incision or classical) or with prior ruptures and surgeries of other sorts to the uterus should be evaluated more.
    • Individual factors should be considered in all cases (i.e. – no hard and fast decisions to ruling mothers out of VBAC), and in the case of women presenting in labor, VBAC should be strongly considered as spontaneous labor increases the success rate of a TOLAC.
    • More than One Prior Cesarean:
      • Studies addressing TOLAC in women with more than one prior cesarean find rupture rates ranging from o.9% to 3.7% – again, without specifying the type of prior incision or level of rupture. They also have not consistently compared these findings directly to women with only one prior cesarean.
      • One large study in particular found no significant increase in rupture between VBAC and VBAMC (vaginal birth after multiple cesarean) – o.7% vs. 0.9%. A second large study only found a slight increase – 0.9% vs. 1.8%. They also found no significant increase in morbidity.
      • The chances of success are similar to that of a VBAC after only one cesarean.
    • Macrosomia (Big Baby):
      • Some studies show a decreased chance of success with a baby larger than 4,000g, and posibily higher rupture rates. However, these studies are based on actual birth weights, and not the estimates given before birth. This is significant given the inability to accurately predict birth weight before the birth.
      • Suspected macrosomia alone should not rule out TOLAC.
    • Gestation of more than 40 weeks, according to the largest study done which looked at this factor, does not increase risk. There is evidence that after 40 weeks chances of success decrease but we must consider that induction of some sort may be common at that point (given current practice trends) and that lowers the chance of VBAC in general. Gestation of more than 40 weeks should not rule out TOLAC.
    • Previous Low Vertical Incision:
      • Studies show similar rates of success compared to low transverse incisions (the most common).
      • Studies do not show increased risk of rupture or morbidity for mother or baby.
      • Studies are limited, but a low vertical incision should not rule out VBAC given the current information.
    • “Unknown” previous uterine incision should not rule out VBAC. The two large studies done at large tertiary hospitals show that there is no increase in rupture rates or morbidity, and success rates are similar. Unless there is a high clinical suspicion of a complicated previous uterine incision TOLAC should not be ruled out.
    • Twins Gestation:
      • In all studies available it is shown that in women with a previous low transverse incision there is no increase in risk to VBAC a twin gestation.
      • Success rates are similar to those of singleton mothers. Twin gestation should not rule out TOLAC.
  • How does management of labor differ in a VBAC? (p5)
    • Induction of labor for maternal or fetal factors remains an option for TOLAC. However, the increased risk of rupture that comes with any induction and the decrease in success rates should be discussed.
    • One large study of over 20,000 women found that rupture rates increased slightly with induction. Spontaneous labor had a 0.52% rupture rate, non-prostaglandins induction with a 0.77% rate, and with prostaglandins a rate of 2.24%. However, again the types of rupture were not specified and the context of the inductions are not known (unfavorable cervix, need for multiple induction methods, etc).
    • Another study of over 33,000 women found a slight increase in rupture (o.4% for spontaneous labor, 0.9% for augmented labor, 1.1% for oxytocin alone, and 1.4% with the use of prostaglandins). An analysis of this same study noted an increase in rupture rates when the highest levels of pitocin were reached, however no upper level of dosing has been decided for VBACs.
    • Studies done on the risks of misoprostol (cytotec) show an increase risk of rupture and should not be used for TOLAC. (Actually, it increases risk of rupture in ANY mother so it should not be used for induction, period.)
    • Due to the small absolute risk found in several studies, ACOG notes that use of pitocin for labor augmentation is not ruled out for VBAC.
    • Mechanical cervical ripening (such as the foley bulb) are also considered acceptable for labor augmentation/induction in VBAC.
    • ECV (External Cephalic Version), such as to turn a breech baby, are not contraindicated in a woman who wishes to VBAC.
    • Epidural/Analgesia use is not contraindicated and studies show it does not effect success rates. However, epidural use in general is shown to increase the chances of cesarean in all mothers. (to view that study, right click and select “copy link location” and input into google)
    • Electronic Fetal Monitoring is suggested since the main sign of uterine rupture is abnormal fetal heart rate (up to 70% of cases). It is noted that internal monitoring does not help in diagnosing ruptures.
  • How should future pregnancies be managed after uterine ruptures? (p7)
    • If the rupture is in the lower segment of the uterus, the chance of another rupture is 6%. In the upper sections of the uterus it is around 32%.
    • ACOG suggests an elective cesarean for births after a rupture.
  • How should women be counseled about TOLAC/VBAC?
    • Each woman will weight the risks and benefits differently. Therefore, the options should be discussed at length and documented.
    • Counseling should always consider the future plans for more children and discuss the risks of multiple uterine surgeries. Women should also consider that family plans can change or there may be unexpected pregnancies.
    • After counseling the ultimate decision should be made by the client. Global mandates (aka – hospital wide) should not be made as they do not consider the individual factors and wishes of each client.
  • What resources should be available at a facility where a woman will VBAC?
    • The previous suggestion of ACOG was that VBAC should only be offered in facilities with “immediate” access to surgical facilities and staff. However, this severely limits the locations where women could VBAC.
    • ACOG now suggests that care providers and clients consider the facilities available, their individual risk factors, and the availability of other locations where more resources are available.
    • Health care providers and insurance companies should do all they can to facilitate women in achieving VBAC through transfer of care or co-management of care.
    • If there is no way to transfer care, a woman’s autonomy should be respected. If a woman wishes to VBAC in a hospital without immediate access to surgical facilities steps should be taken early in care to develop a plan of action in case of rupture.
    • It should be noted that coercion into a repeat cesarean is not appropriate. A policy of not allowing TOLAC at a facility should not be used to deny care or force a woman into a repeat cesarean. If appropriate, transfer of care should be arranged to a facility and care provider who is better able to support TOLAC.

Now I would like to take a moment to talk about the notion of only “allowing” VBACs in facilities with immediate access to surgical teams and facilities. Lets compare the risk of rupture, 0.7% in most studies, which is not always catastrophic, to the risk of other obstetric emergencies. Cord prolapse, a very dangerous situation in which the cord proceeds the baby down the birth canal and gets pinched, occurs in about 0.28% of births. This situation requires immediate access to a cesarean in most cases. Placental abruption, another very serious complication, occurs in about 0.7% of pregnancies. This also requires immediate access to cesarean in almost all cases. Notice that the risk of abruption and the risk of rupture are the same. The rate of shoulder dystocia, which is considered an emergency that may necessitate a cesarean (or an instrumental birth) is around 1.29% though some studies report it at higher rates in the current birth climate.

Now looking at the rates of these complications, which are on par with the risk level of rupture, we have to wonder why ALL hospitals offering birth services are not required to have immediate access to a cesarean. After all, placental abruption happens with the same frequency and can happen in any pregnancy and ACOG does not seem to be concerned that EVERY pregnant mother does not have access to immediate surgical care. At the end of the day, the risk/benefit analysis needs to be decided by the mother and what she feels comfortable with since the rate of rupture is comparable to the risks of any pregnancy and birth.

The point of this article is not to suggest any particular course of action for every mother. This is about giving you the facts to make your own decision. This is about looking at what ACOG really says about VBAC/TOLAC and not just what your doctor tells you they suggest. Arm yourself with information and consider your own personal factors and Birth Without Fear, no matter how you choose to birth.

Why Don’t You Write Your Birth Story? (Follow-up to Why Should I Write My Birth Story?)

Why Don’t You Write Your Birth Story? (Follow-up to Why Should I Write My Birth Story?)

About a month ago, I wrote a post about a topic near and dear to me: birth stories and the women who write them. I shared the words of BWF mamas who had written to me about some of the benefits of and their motivations for writing their stories. All so beautiful and insightful. These were women who had reached deep inside themselves to put into words one of the most intense and personal of human experiences. Many had already submitted their stories to Birth Without Fear. I couldn’t really share my own wisdom on this topic because, you see, I had nothing to share. Apparently, I’m the kind of person who would rather write about women writing their birth stories than actually, um, write my birth story.

Young writers are forever being told to ‘write what they know’ so here I am, doing just that. From the emails and Facebook comments of BWF mamas, from my own experience, and the words of Shani Raviv, writing coach (full disclosure: I just finished Shani’s awesome birth story writing workshop and am now convinced that I should spend the rest of my life in a Berkeley yurt), here are some of the reasons women don’t write their birth stories. And, at the end, a few tips and tricks for making the process just a little bit easier.


When it comes to writing birth stories, what holds us back is…

1. Time – or a lack thereof.

“…[N]ew mothers get sucked up by the busy-ness of mamahood, of pacifiers and poop, sleep deprivation and breastfeeding, time management and care-taking and we all too easily dismiss or forget the life-changing, life-giving experience of birth … In my first few weeks postpartum I felt bruised and battered like my belly was disconnected from the rest of my body, like I had been hacked in half and there was a space where my belly used to be and I was wrapped in a halo, an aura of peace, of love, of endorphins, of fight or flight, of protecting my new cub while needing to be mothered myself by my doting husband. It was so full-on that I had to set an intention to create time to sit down and write my birth story.” Shani Raviv

“Ohhh I should write mine…if I ever get time.” – Laura P.

The post partum period. That time of new babies and new bodies (including your own), of steep learning curves and getting to know this little one you brought into the world. If you’ve been following my writing on Birth Without Fear, you’ll know that the post partum period is particularly hot topic for me (see Mothering the Mother: 40 Days of Rest) and I think women should get all the support they need throughout it. And, in fact, up through raising their children. It’s hard to find a moment to yourself when you’ve had a baby in the last ten years, and I think this was the biggest factor in my own avoidance. It seemed like a big task; I wanted to do it ‘right’; I wanted more than five minutes here or there to really sort through my feelings about the birth.

2. PPD.

“I don’t even remember writing mine. I was so deep in PPD. It sounds like a happy mommy sharing her birth story but at the time I wanted nothing more than to hide from motherhood.” – Brit M.

If you’re suffering from Post Partum Depression, it’s difficult to think about, express and relate any experience at all – never mind one that is so deeply connected to your depression. Sometimes women need time to recover from a stressful birth, or find that their memories have been intruded upon by other factors, such as medical interventions or pre-existing illness.

“I didn’t write my first birth story because it was a negative uneducated experience. I forgot many details of it because of not writing it and being on pain medications.” – Melanie W.

3. Trauma.

“I wrote my daughter’s but still can’t bring myself to talk much or write about my son’s.” – Nichole F.

“I still haven’t been able to. I break down every time and I’m a sobbing mess… Still just too much. One day soon I hope!!” – Jennifer K.P.

In ‘Why Should I Write My Birth Story?‘ I wrote about the value of narrating a traumatic experience. Doing so helps us to gain control of the events in our minds, to order them and to see them as they were. But it’s not easy. Remembering the details of a traumatic birth and re-experiencing it can be terrifying and sometimes even damaging. For many women, the very thing that helps is also the last thing they want to do; if this is your situation, please know that it’s OK. You don’t have to write your birth story right now. Wait until you feel safe. Wait until you have found someone you trust to talk to while the memories resurface. Be as gentle with yourself as you are with your little one.

“It took me over five years to be able to write my first birth story without bursting into tears. My midwife for my second pregnancy helped me move past it, I knew I’d never birth the way I wanted to with my second if I didn’t.” – Jennifer B.

4. Reckoning.

“Writing mine was kind of disappointing, and reminded me of what I would like to be different next time around (which is pretty much everything).” – Mellysa N.

On  a similar note, the act of writing down one’s experience is tantamount to admitting that the experience happened. Even if the birth was not traumatic, writing it out can be discouraging if a mother hasn’t been honest with herself, or had expectations that were not met. For me this has most definitely been the case. Before giving birth to my son, I would get a little mad at people who talked about birth as a sacred experience. I thought things like, it’s just a thing you do, and women have been doing it forever, and stop making it something it’s not. While I was in labour, I worried about staining the sheets of the Birth Centre bed; in between pushes, I made jokes with my mom. It wasn’t until after the birth that I started to see how deeply I had been affected by it. I now believe that birth is a spiritual, sacred event. I’m all about it and – wowza! – I’m pregnant again. This time, I’m having a Mother’s Blessing, I do birth meditations, I have a birth altar, and all that jazz. Looking back at my first, almost mundane birth experience and putting it into words has been difficult. It’s like I’m writing the experience of another person. Because, in that time, I was.

5. Feeling the story is not important or valuable.

“I had an epidural, so it was nothing spectacular.” – Britany S.

“My son’s was a great experience… but there’s a lot I wish I’d have done differently, and more people are interested in a natural birth anyway.” – Briana G.

There is a persistent misconception about birth communities. This is that women interested in natural birth are only interested in natural birth. That they look down upon women who choose or accept medical interventions for themselves and their babies. I am sure that those jerks do exist. But I (practically an expert on jerks) am happy to say that although I am immersed in natural birth communities, I have never met one. Instead, I have met women with a range of experiences, all with these three things in common: they love babies, they love women, and they love birth.

Many women feel that because their birth was not what they expected, or not natural, or not vaginal, that it is not worth narrating or sharing. Nothing could be further from the truth. At Birth Without Fear, we believe that every woman’s birth story is valuable. Yes, you, the one reading this who thinks that her birth was kind of ‘meh’ and what would people say if they knew I wrote it all out, your birth experience is important! You can write it down! We want to read it!

6. Fear of others’ criticism:

“I was nervous how some would react to me posting my story for everyone to see, especially family. Birth is not something we talk about freely enough…Surprisingly, I’ve received nothing but positive feedback for posting my story. Friends (and strangers) have emailed me and told me what a blessing my story was to them.  What an encourragement it was to them to know that you can have peace with a labor gone awry.” – Kim G. (read more here)

“I worry that people will judge me for using natural induction methods at only 38 weeks, even though I had my reasons and in the end my water broke before labor started anyways. In my actual birth story, I forgot to include how far along I was, but since I’m worried what people will think of me I’m glad I left it out.” – Breanna

Birth is a deeply personal, emotionally intense experience. It remains a taboo topic for discussion in our society. And the internet is full of haters. So it is no wonder that women shy from writing and sharing their stories, anticipating the negative response that, unfortunately, some do receive. If this is a fear that’s stopping you, know that you do have some control of the path your story takes out into the world. In fact, you don’t have to share your story with anyone. Perhaps you’re writing it for your child – in that case, he/she is the only person who really needs to read it (and you can bet they’re not going to be too critical).

But if you want to share it online, consider what forum would feel the best for you. Anonymously, on your own blog? Privately, with only a few Facebook friends given permissions to read it? Or on a large-scale, by submitting it to a birth blog? Consider the atmosphere in which you are releasing your story. Some blogs and FB pages allow all comments to be posted, even those which are cruel and abusive. Others take a more moderate approach; Birth Without Fear lies on the other end of the spectrum. We only allow supportive comments and this, to me, is a kick-ass use of the delete button.

7. Fear that sharing one’s own story will shame or intimidate other women.

“The really crazy thing is I am beyond proud of my birth. I am extremely happy with it…and I think that is the big problem. For you see, I am not afraid of scaring other women with a horror story of a birth, but instead somehow shaming them or worse, giving them false hope with a story of what was in my mind a perfect birth. I know, I know it’s ridiculous.” – Patrice N.B. (read more here)

Some women feel that if they delve into the depths of their story and acknowledge how powerful or transformative it was, they might offend or inhibit other women from sharing their own. In the insecure and judgmental world that American motherhood has become (are you mom enough? or are you just, like, a regular mom?) this fear is understandable. But the truth is, there is room for all of us. And all of our stories.

Of the 352, 500 babies are born around the world each day (that’s one every eight seconds!), only a small fraction of births will be recorded and shared. By sharing your own you are not taking up space from someone else to share theirs. And as Ina May Gaskin has reportedly said, birth horror stories spread like wildfire; we should not be afraid to allow positive birth stories to spread like wildfire, too (from a comment on Patrice N.B.’s blog).


As I read over this blog post, I realize that I have become ever more preachy while writing it. If that bothers you, stop reading because this next section is all advice. But, to be fair, some of it comes from you.

Here are some tips on how to write a birth story you love.

1. Don’t worry about getting it technically accurate. Write what matters to you.

“The details that women often don’t mention are those personal, colorful, emotional descriptions that make their birth story unique, personal and non-generic. It’s the same details that you would utilize for any creative writing: the five senses, metaphors, rhythm, color, description, detail, pace, show don’t tell etc. It’s these techniques that make writing come alive. And because one’s birth story really is such a deeply personal narrative it needs to be written in the teller’s authentic voice, to convey the emotions of the experience––the joy, pain, fear, elation––and be honest, vulnerable and real.” – Shani Raviv

Birth has been removed from its sacred, personal context and placed into the realm of science. As some believe, “Birth is a medical event”. Even if your birth experience was framed in this way, the way you write about it doesn’t have to be. Include your feelings. How you really felt. Birth is an intense experience whether it’s full of excitement and magic or pain and distress; don’t focus too much on the technical jargon or numbers, unless they are what is personally most meaningful to you. As Shani says, “Most people don’t even know what a contraction or dilation is. I had no clue what it was before I birthed or before my midwife educated me about my own body.” And I can tell you from my experience, a birth story that relates your own unique experience will definitely be more fun to write.

2. Don’t feel you need to tell everything in order.

“Everything was so intense and magnified in my mind, it was hard to put down!” – Martha F.

While a linear progression through time is the most obvious way to relate your birth story, it’s likely that you don’t remember it in that way at all. Time changes for women in birth as we go deep inside ourselves, the divine, or simply la-la-labourland. Your writing can reflect that.
3. Feel free to write about events other than the birth.
“Writing my birth story was a life-changing event, but it all started even before by birth.” – Anna Sawon (Editor of this Polish birth blog)

You can include things that happened outside of the birth in your birth story. If you start thinking about some other important event (say, how you met the baby’s father, or the things your mother said about her birth), consider including them. If they’re important to you, they will probably be interesting and valuable to the people who read your story. This is especially true for mothers whose babies had to spend time in the hospital, and who often feel that the birth story is incomplete without a recollection of those events as well. Birth does not take place in a vacuum.

4. Know that you have time.

“I was in such a rush to get it in writing afterwards, I’m now kind of embarrassed when I read it because it just doesn’t flow well. I’m usually a really good writer (IMHO) and my birth story just seems rushed and jumpy to me.” – Breanna.

You don’t have to write your whole birth story the day after it happens. After all, you probably have other things to worry about. Write down the small details you want to remember about the birth as soon as you can. Don’t worry so much about the biggest events because those you are more likely to remember. The little moments – the way your partner rubbed your back, the strange thought you had as they wheeled you off to the operating room – may disappear with time.

“It took me almost a year to write it!” – Amanda S. (read her story here)

5. Know that it doesn’t have to be perfect, in its first draft or ever.

“I actually wrote it 3 different times because I’d forget the little things that seemed so important that day and I just had to add them when I would remember.” – Jennifer C.

Don’t be afraid to write a little, leave it, and come back. This is how most writers work. And it’s also pretty much a necessity if you’re the primary caretaker of your little one.

“It took me about 2 months to write my birth story.  I exclusively breastfed my daughter, so feeding her was a very demanding part of my life.  Not to mention sleeping, diapers, showering, etc.  I took every chance I could to type, doing most of it one-handed!” – Debbie W.

6. Consider who you are writing the story for.

Is it for your child? Your partner? Other women? Or for yourself? This is an easy way to narrow down the focus of this unwieldy task, as it guides the language you use and the details you include.

7. Aak others what they remember.

“…[W]hat I love most is hearing of my births from someone else’s POV… it’s so strange to hear things you don’t remember, but awesome, too.” – Rachel H.

“…[A]s a birth doula I often write up a story for the couples I work with. I note times and major events in the birth, to give the mom a framework to insert her own memories and experiences… I also write down funny moments, jokes, or things that make their birth unique. And I describe from my perspective [the] moments of beauty or tenderness that stick out to me.” – Michelle H.L.

It can be interesting and valuable to hear what other people experienced while you were giving birth. You may want to ask your midwife, OB, or doula. Your partner themselves may want to write or contribute to the story of their child’s birth.

8. Let it go.

“I even printed it out and placed it in my daughter’s baby book so she can look back and read about the day she was born.” – Jennifer C. (read her birth story here)

When you have finished writing and editing your story, consider doing something to bring conclusion to the process. If your birth was traumatic, the concluding element is an important one. Burning, burying, and casting out into the sea are all ways to allow the story to leave your body. On a less cathartic note, some mothers find resolution through publishing their stories online; for others, printing and having it bound is a way to finish the task and preserve the story for future generations.


So, in the end, did I write my son’s birth story? Yes. Is it finished, perfected, in more than a piece-meal draft phase? No. But when it is, I’ll let you know.


The Truth About Gestational Diabetes {And Why It’s Not Your Fault!}

The Truth About Gestational Diabetes {And Why It’s Not Your Fault!}

So you’ve had the Glucose Tolerance Test, or maybe you’ve been monitoring you’re blood sugar levels at home, and your blood sugar readings were high. You have been given a diagnosis of Gestational Diabetes. If your experience was anything like mine, an Obstetrician or midwife gave you a pamphlet on ‘Diabetes and Pregnancy’, referred you to a dietician and endocrinologist for management, and then sent on your way. And now you’re at home, and all the questions you didn’t think to ask are flooding in…  What the heck is it? And what does it mean? Will my baby be alright? Do I need a caesarean? Will I need to be on insulin? What can I eat? Do I have to stop eating CHOCOLATE?!?!?!

There is some debate against the use of routine testing to diagnose Gestational Diabetes, and also questioning about giving the diagnosis of Gestational Diabetes as a label on pregnant women. Dr. Sarah Buckley recommends avoiding routine testing for Gestational Diabetes for most women. Henci Goer and Dr Michael Odent are among many pregnancy and childbirth professionals who argue against diagnosing women with gestational diabetes, citing unnecessary stress and interventions as one of the risks of the Gestational Diabetes diagnosis. Nevertheless, whether you want to call it Gestational Diabetes or Pregnancy-Induced Insulin Resistance, or just high blood sugar levels in pregnancy, some women do have elevated blood sugar levels and need some extra help.

Gestational Diabetes Mellitus (GDM or GD) is described as a form of diabetes that develops during pregnancy, and usually goes away 4-6 weeks postpartum. In a pregnant woman without Gestational Diabetes, the body works ‘as usual’. You eat, your stomach breaks down your food, you start to digest it, and the glucose from the carbohydrates in your food enters the blood stream. The pancreas gets the signal to secrete more insulin into the blood stream to help the cells absorb the glucose and convert the glucose into energy. The blood glucose level increases straight after a meal but as the glucose is absorbed from the blood and into the cells, the blood glucose levels decrease. The blood glucose readings fluctuate as normal, but remain within the ‘prescribed levels’.

In a pregnant woman with Gestational Diabetes, the cells become ‘insulin resistant’. The pancreas makes ‘the usual’ amount of insulin to enable the cells to absorb the glucose, but because the cells have become ‘resistant’ to the insulin, the amount of insulin needed increases. When the pancreas makes as much insulin as it can, and the cells continue to struggle to absorb the glucose, this is Gestational Diabetes. The blood glucose levels in a woman with GDM rise as normal after a meal, but stay elevated due to the cell’s inability to absorb the glucose.

diabetes blood sugar test

So what can you do to prevent or stop insulin resistance and GDM from developing? There seems to be this myth floating around that fit and healthy women don’t get GDM, and unfit or unhealthy women are probably going to have GDM. It’s false. In pregnancy, insulin resistance is mostly caused by an increase in pregnancy hormones (hormones produced by the placenta). The hormones are thought to reduce the effect of insulin on the cell, as well as reducing the response of the cell to insulin. While keeping yourself healthy can reduce your risk, there is nothing that can stop your cells developing insulin resistance from the hormones made by the placenta. Although there appear to be some risk factors which could increase the chance developing Gestational Diabetes (for example, age, ethnicity, weight, personal or family history of diabetes,  or some hormone-related conditions such as PCOS), there are many women who develop insulin resistance and GDM who do not show any risk factors. In short, you just can’t control how your cells respond to your pregnancy hormones. There is a lot of research to suggest the most pregnant women will develop some insulin resistance during the pregnancy because of the increase in pregnancy hormones, but for many women the pancreas is able to produce enough insulin to maintain stable blood sugar levels and so it does not develop into diabetes.

There is also this idea that women with GDM can control it. Women are told “You just need to keep your diabetes under control.”, like it’s just that easy. Unfortunately, no one can explain how to control a cells response to the pregnancy hormones. You can’t control Gestational Diabetes. It happens sometimes. But telling a women that she should be able to control it really put unnecessary shame and blame on mothers who are frustrated and disappointed enough as it is. So if you’ve ever said this then, please, never say it again!

You can’t control Gestational Diabetes. It happens sometimes. But there are ways to help your body deal with it. Monitoring diet and engaging in regular exercise really can be the key for women who have low-to-medium level insulin resistance. The aim of monitoring your diet is to balance the amount of carbohydrate in your meals. The general consensus from dietitians and endocrinologists seems to be that having 3 meals and 2-3 snacks per day (but please follow the advice of your personal care provider). It does make sense that it’s easier on your body if you spread out the carbohydrates into 3 balanced meals and 2-3 snacks instead of packing them into three carb-heavy meals per day. Another way to manage high blood sugar levels can be regular exercise, like walking. Going for a walk 30 and 90 minutes after eating to can help lower blood sugar levels by using up the excess glucose in the blood stream. Every person responds differently though, so if you do have Gestational Diabetes, please work with your care provider in finding the management plan right for you.

Some women develop a high level of insulin resistance, despite eating balanced and spaced out meals and snacks, and exercising regularly. These women continue to have consistently elevated blood glucose levels. I was one of those women.

When my hormones peaked at 32 weeks, I would not be able to eat a chicken and salad sandwich of barely 30g of carbohydrates without my blood sugar spiking well above the ‘allowed’ limits. People kept telling me to “control” my diabetes. I thought I was doing something wrong because my blood sugar levels were so high, so I reduced my carbohydrate intake drastically. The dietician put me on insulin when I started losing weight (and I was only 140lbs at 32 weeks, so didn’t have much to lose!), I had no energy and I was and spilling ketones into my urine.

If, like me, you are doing all you can and you still need insulin, please be kind of yourself – it’s not your fault. Remember, you can’t control this. You have a medical condition. You are insulin resistant. Your body just needs some help. Injecting insulin is very easy (I found it virtually painless, and nowhere near as unpleasant as the finger-prick tests!). It helps your body by giving it the extra insulin it needs when your pancreas is producing as much insulin as possible but your body is still unable to lower your blood sugar level.

Despite the myths floating around, a diagnosis of Gestational Diabetes does NOT mean you will automatically have a big baby. It does NOT mean you automatically need to have a cesarean. It does NOT mean you cannot VBAC. It does not mean your baby will definitely need to go to the Special Care Nursery… You have options, and a gentle, calm and intervention-free vaginal birth with gestational diabetes is possible for most women.

diabetes insulin pen


Australian Diabetes Council. (2013). What is Gestational Diabetes. Retrieved on February 28, 2013, from

Buckley, S. J. (2008). ‘Gestational Diabetes Testing’. In Gentle Birth, Gentle Mothering: A Doctor’s Guide to Natural Childbirth and Gentle Early Parenting Choices. Retrieved on March 31, 2013, from

Goer, H. (1996). Gestational Diabetes: The Emperor Has No Clothes. The Birth Gazette, 12(2). Retrieved on April 1, 2013, from

National Diabetes Service Scheme. (2013). Gestational Diabetes. Retrieved on February 20, 2013, from

National Diabetes Information Clearinghouse. (2013). What I need to know about Gestational Diabetes. Retrieved on March 1, 2013, from

National Institute for Health and Clinical Excellence [NICE]. (2008). Diabetes in pregnancy: Management of diabetes and its complications from pre-conception to the postnatal period. Clinical Guideline 63. Retrieved on April 1, 2013, from

Odent, M. (2004). Gestational Diabetes: A Diagnosis Still Looking For a Disease? Primal Health Research: A New Era in Health Research, 12(1). Retrieved on April 1, 2013, from

Gestational Diabetes: To Test Or Not To Test

Gestational Diabetes: To Test Or Not To Test

If you’ve been pregnant, chances are you’ve had to decide whether or not to take a ‘Gestational Diabetes’ test. You’ll usually be given a form to go have one of two ‘routine’ tests, the Glucose Challenge Test or the Glucose Tolerance Test, and that’s that. When I was pregnant I wasn’t really given any explanation about the test except that I would have a drink that was “like sweet, flat lemonade” (which it kind of is). I had no idea what Gestational Diabetes was. I didn’t think I had the option not to take the test, and I had no idea what ‘failing’ the test would mean. Unfortunately, it was only after I had ‘failed’ the test and was diagnosed with Gestational Diabetes that I researched more about the unreliability of the formal tests and the impact the diagnosis would have on my prenatal care.

The Glucose Challenge Test (GCT) is a relatively simple test: at 24-28 weeks gestation you drink a sweet drink with a high glucose load, usually around 50g of carbohydrate, and a blood sample is taken one hour later. Your blood glucose or blood sugar levels are tested and then compared to the ‘average’ levels. If your blood sugar levels are over the ‘average’, you are considered ‘at risk’ of Gestational Diabetes Mellitus (GDM), and will be sent for the Glucose Tolerance Test (GTT). This is a more involved test. You may be sent straight to this test if you are considered high risk of developing GDM. You must fast for approximately 10 hours, and then attend the pathology clinic for around 2 ½ hours. You will need to drink another sweet glucose drink – this one usually has around 75g of carbohydrate (the equivalent to eating 5 tablespoons of sugar or 3-4 pieces of white bread). A series of three blood tests will be taken – one before you have the glucose drink, another test one hour after you’ve had the drink, and another one hour after that. This series of blood tests are graphed and compared to the average levels. What the doctors are looking for is a normal fasting blood sugar level, a blood sugar peak at one hour, and then back within ‘normal’ range two hours after the drink.

gestational diabetes blood glucose meter

The ‘average’ and ‘cut-off’ levels seem to vary depending on where you live, however generally in the USA, UK, Australia  and New Zealand, women who have blood sugar levels above 8-9mmol/L (140-160 mg/dl) at two hours after drinking the 75g-glucose drink get the diagnosis of GDM.

Recommendations from some of the prominent College’s of Obstetrics and Gynaecology (ACOG, RAZNCOG and RCOG), state that every pregnant woman, regardless of risk or medical history, should be screened because the rate of GDM among expectant mothers is rising – although, that statement itself is ironic! They also claim that the GCT/GTT is essential: the potential ‘risks’ of GDM mean that women need to be under strict management during pregnant, labour and birth for optimal maternal and fetal outcomes. However, there are many medical and birth professionals who, after reviewing the data themselves, have decided to do away with routine testing for GDM.

When you think about the test, it’s not surprising that many women ‘fail’ or are considered ‘borderline’ or ‘pre-diabetes’. Most women are also asked to sit and not engage in any sort of activity for the entire two hour test, which is a factor that can lead to higher blood glucose levels. Pregnant women also naturally have some form of insulin resistance thanks to the pregnancy hormones. You drink the sweet glucose drink (a fast-release carbohydrate load that is larger than someone would have in an average meal) without any form of protein to slow the release of glucose. It’s easy to see why many have decided that the formal tests are not an accurate representation of the mothers ability to tolerate carbohydrates in everyday meals. Dr. Sarah Buckley, GP and obstetric professional, recommends against routine testing for GDM for most women. Ina May Gaskin, a Certified Professional Midwife and founder of The Farm Midwifery Center, also reports that up to seventy percent of women who repeat the test get a different result than on their initial test.

But… what are the options?

Well, a lot doctors and midwives won’t give you any. At a hospital appointment I once had, my partner and I sat and listened to a midwife argue for 15 minutes with a woman who refused the routine GDM test. Over the course of the conversation, the woman asserted herself, telling them she was 34 weeks pregnant, she checked her blood sugar at home periodically, she’d had a scan, everything was fine, and she didn’t want the test. The midwife belittled her, bringing her weight into the conversation. Tried to scare her by predicting the size of the baby. Insinuate that she was uneducated and naive and she didn’t understand the risks. She even tried to pull the “You’re jeopardising the safety of your baby, it’ll be on your head if something happens” card. I’m not sure what became of the woman, but she was just one woman in what I imagine is a sea of pregnant women trying to assert themselves in this medicalised and interventionist culture of birth at the moment.

gestational diabetes glucose meter and strips

The mother in my story knew a great option. One that WAS reflective of real life – periodic home blood sugar tests. If you are comfortable with refusing the GCT/GTT, but still feel the need to have some kind monitoring, then this is one of your options. It is logical and obvious that testing two hours at home after eating your lunch and doing whatever you normally do afterwards, would give you a good idea about whether or not your body is having trouble. These results are usually compared to the ‘average’ results – usually aiming for less than 5.5mmol/L (100mg/dl) while fasting, and less than 6.7mmol/L (120mg/dl) two hours after meals. This could give you an idea of whether you need to readjust your diet or consider medical management.  And, going by the stories I have read and the women I have talked to, this seems to be the option many homebirth midwives give their clients. However, it can be a hassle if you forget, or if you’re in the habit of frequent eating, because for accurate results you need to eat your meal and then nothing but water for two hours. This is because other food or drink could raise your blood sugar levels and give an inaccurate reading of your body’s ability to handle the carbohydrate load of your meal.

Another option some professionals give is to keep the formal test, but swap the drink for something else with an equivalent carbohydrate load. This attempts to mimic a real-life situation, and is thought to be more accurate than a test based on the glucose in the sweet drink. However, this is not recommended by some medical professionals because eating a meal takes more time than the 5-10 minute limit you are given when drinking the glucose drink. Also, different types of foods have slower or faster releasing glucose, so the results can’t really be compared to the ‘average’ results after the glucose drink.

If you choose to forgo the routine testing for less invasive tests or none at all, educating yourself is important. Be aware of the quality of your carbohydrates and how to eat well-balanced meals that include low-GI (glycemic index) carbohydrates. This is a good way to keep your body healthy, diabetes or not. Dr Michael Odent explains this practice quite well in his article ‘Gestational Diabetes: A Diagnosis Still Looking For a Disease?’ (linked below). Alongside a balanced diet, Buckley, Gaskin and Odent all recommend regular low impact exercise throughout pregnancy to help the body lower blood glucose levels naturally.

Keep reading: The Truth About Gestational Diabetes {And Why It’s Not Your Fault}



American College of Obstetricians and Gynaecology, The [ACOG]. (2011). Screening and diagnosis of gestational diabetes mellitus. Committee Opinion No. 504. 751–3. Retrieved on March 31, 2013, from

Australasian Diabetes in Pregnancy Society, The [ADPS]. (2002). Gestational Diabetes Mellitus – management guidelines. Retrieved on March 31, 2013, from

Buckley, S. J. (2008). ‘Gestational Diabetes Testing’. In Gentle Birth, Gentle Mothering: A Doctor’s Guide to Natural Childbirth and Gentle Early Parenting Choices. Retrieved on March 31, 2013, from

Goer, H. (1996). Gestational Diabetes: The Emperor Has No Clothes. The Birth Gazette, 12(2). Retrieved on April 1, 2013, from

Gaskin, I. M. (2003). Ina May’s Guide to Childbirth. United States: Bantam.

National Institute for Health and Clinical Excellence [NICE]. (2008). Diabetes in pregnancy: Management of diabetes and its complications from pre-conception to the postnatal period. Clinical Guideline 63. Retrieved on April 1, 2013, from

Odent, M. (2004). Gestational Diabetes: A Diagnosis Still Looking For a Disease? Primal Health Research: A New Era in Health Research, 12(1). Retrieved on April 1, 2013, from

Royal Australian and New Zealand College of Obstetricians and Gynaecologists, The [RANZCOG]. (2011). Diagnosis of Gestational Diabetes Mellitus. Retrieved on March 31, 2013, from

Royal College of Obstetricians and Gynaecologists, The [RCOG]. (2011.) Diagnosis and Treatment of Gestational Diabetes. Scientific Impact Paper 23. Retrieved April 1, 2013, from

Alternative Methods of Checking Dilation {The Purple Line and More}

Alternative Methods of Checking Dilation {The Purple Line and More}

Through several years of being a part of the birth world I have noticed a trend. Dilation is *the* birth topic. No matter how a mother plans to birth, when the time draws near, dilation is the one thing on her mind. Why? Cervical dilation tells us one thing and one thing only – where you are right that second. It tells you nothing about what came before that check (when you compare to other labors or women) and it tells you nothing about what is to come. It only tells you about the here and now.

cervical check

The news of little or a lot of dilation can either help or hurt a mother’s mental state in labor. If the mother has been in early labor for days (which is normal), the news of a only 1 or 2cm of “progress” can completely take her out of a peaceful state of mind. If the mother has only been in labor for a few hours and finds out she is already at say, 7cm, she may think her time is nigh…only to find out that she has many more hours of work ahead. Basically – the information can back fire on you.

But there are times when the information can be of use. For instance, a mother may plan to wait to get an epidural until “x” dilation. Or she may be waiting to call her family until she is sure things are really cooking. So what are the ways of getting this information? The first thought that comes to mind (and the only thought usually) is that you must have a vaginal exam.

Guess what? You don’t! That’s right – no one has to put their hands in your vagina to give you this information. Vaginal checks come with their own set of risks, from accidental rupture of membranes (or not so accidental – some care providers have used it as a good time to break mother’s water without asking) to increased risk of infection.

Studies also show that vaginal exams are not really accurate. When checking for exact dilation, studies show the accuracy to be around 48-56%. When allowing a margin of 1cm (which is a large margin of error when this information is used to time interventions or labor “cut-offs”) the accuracy is around 89-91%. [One such study abstract from real women in labor. And another study abstract which was done on models.] When you add in multiple people checking, the accuracy gets even worse. Yet, vaginal exams are considered the “gold standard” of assessing labor progress. And lets not forget that vaginal exams are just plain uncomfortable at the best of times – in labor they can be downright hellish.

So what are some ways of figuring out your dilation without actually touching the cervix?

The Purple Line or Bottom Line

This is a purple/dark line that shows up and extends well, to put it delicately, along your natal cleft. Or rather – your butt crack. The line starts at the anus and moves up the cleft. When it is all the way to the top, you are 10cm. Normally – you do have a bit of a line there. But this Purple Line or Bottom Line is not he line that is normally there (which is usually pink). This is a dark purple line. My suggestion is to check out your bum in early pregnancy so that you know the difference.

A study was done in 2010, and published by BMC Pregnancy & Childbirth, that proves the existence and accuracy of the purple line for many women. In this study, the line itself was present at some point in labor for 76% of women. The line was more apt to show in women with spontaneous labor than in those with induced labor (80% vs. 59%). The further dilated a woman was, the more likely she was to have the line show up. The line showed up most when women were around 7-8cm dilated, and seemed to fade in some women at almost complete dilation. And according to this study sample, the line seems to first show for most women around 3-4cm.

An earlier study was done in 1990 and published in the Lancet which also proved the existence and accuracy of the line, though the sample size was smaller. In this study, the line was seen about 89% of the time and was only completely absent in 10% of women. They noticed a significant correlation between the station of the baby’s head and the length of the line.

The reason for the Purple Line is believed to be due to the increased pressure on the veins around the sacrum. This pressure on the veins creates the dark line where the thin skin of the cleft can show it. This pressure from the head creating the line also means that you can reasonably assess the station of the baby’s head as it moves down. Lower head = more pressure = higher line.

Here is a great example of the Purple Line from a wonderful mother in our support group. Obviously – she is complete in this photo, and baby is on its way out! But you can see the Purple Line so clearly (though I did take the liberty of highlighting it for you). Thank you Sara for sharing this moment with us!

purple line

With the relative accuracy of this method, and especially considering the inaccuracy of vaginal checks, this is a great way for women to check themselves without “checking”. This would also be a pretty accurate way of judging when to head to the hospital (if that is your plan) if you are one of the 76% of women this line shows up for.

The photo below is from Jackie, who was so excited when her purple line showed up around 8cm she actually asked her photographer to snap a photo!

Purple LIne

Sounds of Birth

The sounds a woman makes in labor can tell a care provider (or partner) much about where the woman is in labor. Obviously, this will not work the same for all women. Some women are noisy all the way through – which is fine. Some women are quiet until the very end – also fine and normal. However, there does seem to be a pattern for most women in the way they vocalize in labor.

In early labor (0 to 4cm) a women can normally converse easily or with little effort during contractions. She does not feel the need to rest between them very much, and will most likely continue or pick the conversation right back up after each contraction. In active labor (4 – 6 or 7 cm) the woman usually has to do some breathing or vocalizing during contractions, and normally stops speaking during them. She may have to rest more between them.

In transition (7 – 9cm) the woman tends to really need labor noises – groaning, moaning, and sometimes repetitive mantras or noises. At full dilation the women may really retreat within and become quiet. She may not want to speak at all, even between contractions. Pushing of course has its own set of noises. And just a note on noises – low and open noises seem to help women dilate. Keeping the jaw slack and not clenching helps the pelvic area to open and not clench as well.


This is something that birth workers will talk about and recognize. Just before the start of transition, the woman emits an earthy and very “birthy” smell. Musky and deep, it speaks to some inner part of our being and psyche.

Fundal Height

This is a documented way of measuring dilation externally. When not in labor and full term the fundal height is normally 5 finger-breadths between the fundus (top of the uterus) to the bottom of the breast bone. As labor progresses, the uterus pulls up on the bottom of the uterus (which is the cervical opening) and this is what creates dilation. Think of it as the uterus “bunching up” at the top in order to pull the bottom up and open.

As dilation progresses, the finger-breadths between the fundus and the breast bone becomes smaller and smaller – at full dilation, you can normally no longer find the gap between the two. This measurement must be done at the height of the contraction, and while mother is on her back. This means it will not be the most comfortable way of assessing progress – but it does work.


Basically – as a mother gets more serious, her dilation is increasing. Naturally (like with noise/vocalizations) this is not true for all women. However, in reading birth story after birth story (and watching video after video) I do see this trend. Mothers start out chatty and light hearted. As the harder work sets in, mothers retreat inside and tend to ignore those around them or get serious in other ways.

This seems to be a very accurate sign of transition for most women. Transition is typically the last stage of dilation and is normally the most intense. It is during this stage that mom may get irrational or scared. Usually this is when women feel the “I can’t do this” emotions and may express sudden fear or want of pain medication. When women are prepared for this stage they can be reassured that this means labor is almost over and baby is near.

Bloody Show

Many women hear about the bloody show at the start of labor. Not all women have this, but it is the “mucus plug”…basically, it looks like a large wad (or wads) of well – snot. I know, not the nicest way of saying it, but it is true. The mucus plug is probably one of the weirdest looking parts of labor and birth. However, around 6cm or so, most women get another (or first) bloody show. This usually comes out during contractions, and may be a gush of fluids and mucus and blood. If a woman’s membranes were broken before this point, she may have another gush of fluid at this point.

Estimate Without Fear

All of these methods can be used to assess progress in laboring women. Some may be more accurate than others, but perhaps we should ask ourselves about why we want to know dilation in general. In some situations the information can be very useful, for instance if a mother does not want to head to the hospital too early or if she is negotiating for more time in labor but does not want a vaginal exam at the moment (or at all).

However, my suggestion is that for the average laboring woman we learn to not equate cervical dilation with progress or lack of progress. As I stated at the start, dilation is only a snapshot of where you are right now and tells you nothing about where you will be an hour from now or even 30 minutes from now. Long labors with slow dilation can suddenly speed up and reach full dilation (and baby in arms) in mere minutes or hours compared to the slow dilation of the previous hours or days. Women who are not dilated or effaced at all during a prenatal appointment can suddenly have a baby in arms an hour later. [Though, prenatal dilation checks are another subject that will need a separate post.] Dilation is simply not a crystal ball.

If you are a mother who wants to avoid cervical checks completely, or wants to know how to assess dilation before your care provider comes (or you go to them), then these methods can serve you well. As always, continue your own research and talk to other supportive women.

Further Reading

Bellies and Babies Blog on Dilation

Science and Sensibility post on the Purple Line

A Midwife’s Perspective on Cervical Exams

The Magical Menstrual Cycle

The Magical Menstrual Cycle

{guest post by Samantha Bice}

When did you first hear an explanation of your menstrual cycle? Apart from asking my mom or step mom what pads or tampons were upon seeing them in the cabinet, I don’t have a memory of an explanation until third grade. We all had to get a permission slip signed so that we could learn about our “bodily changes”. Boys and girls were sent to separate rooms in the school…I remember the girls were sent to the computer lab.

We were given small booklets that talked about breasts growing, “periods”, and feminine products and hygiene. We were told that a confusing time in our lives was fast approaching and that we would start to bleed, once every 28 days, and that it was okay. We could use pads or tampons, and as long as we were careful to be ready and if we washed ourselves, no one would ever know that we were “on our period.” Most of the talk was focused on the products we would use to take care of this issue. [And they didn’t even teach about the good ones!]

Fast forward to middle school. I had started my “period” and managed to avoid getting blood on my pants or “smelling.” I still really had no idea what a period was for other than to tell me I was not pregnant. At that point in my life that seemed like a useless thing to do since I was not having sex.  Same story in high school, only add in a small amount of knowledge of an egg dropping and that my period was to get rid of the unused egg each month.

It was not until I was a married woman and thinking about babies that I stumbled upon the book Taking Charge of Your Fertility by Toni Weschler in the book store. I picked it up, thinking that since I was a take charge kinda girl with everything else that I should add my fertility to the list too. This was also after many unsuccessful attempts at finding the right birth control for me (come to find out, my body hates all chemical birth control), so that was in the front of my mind as well.

That book changed my life.

Imagine my surprise when I read that my “irregular periods” were actually pretty normal, and that I was not broken. Every cycle (not month – we work in cycles, not on a calendar) my body was performing a magical and specific dance of hormones. Eggs matured, temperatures changed, ovulation occurred, hormones shifted, my body prepared. I was amazed. I suddenly had respect for my body and did not find my cycles annoying anymore.

WHY had no one explained all this to me? Why was the focus on managing the bleeding and not on the reasons why it even happened? Beyond knowing “period=not pregnant; no period=pregnant” we were told nothing. We were told that we should perform this task like clockwork, every 28 days. No room for error or we were “irregular”, like a badly cut puzzle piece. The focus was on all the things we needed to buy and do in order to cover up the fact that our body performed as expected.

Now, I want to share some knowledge with all of you. I can not cover everything – hence why the book Taking Charge of Your Fertility (TCOYF) is large. But I can give you the basics on how things work and the basics of keeping track of all this.

The Menstrual Cycle: A Carefully Choreographed Dance

I think most of us have the basic knowledge of what the cycle does (generally speaking) – it is the preparation and “dropping” of an egg that then awaits fertilization. If that fertilization does not happen (or if implantation does not happen), you have menstrual bleeding – your period – and a new cycle starts. But lets talk about specifics.

The first hormone that causes things to happen each cycle is the Follicle Stimulating Hormone (FSH). This hormone does just what the same suggests – it stimulated follicles. These follicles are on your ovaries, and each one contains an egg. Generally about 15-20 follicles start to mature each cycle.

During this time period (anywhere from about 8 days into your cycle to more than a month) your estrogen is rising. Shortly after you reach your estrogen threshold (one or two days after), one of the eggs bursts through the ovary and starts the journey down the fallopian tube. Sometimes more than one egg makes it out (fraternal twins or higher multiples – if all are fertilized). The eggs that didn’t “make the cut” dissolve.

This high level of estrogen (which drops off after this peak at ovulation) triggers a surge of Luteinizing Hormone (LH). This surge of LH is what ovulation tests detect and occurs just before the release of the egg during ovulation. [Please note – an LH surge does not mean you *did* ovulate, but rather that your body is preparing to.]

After the egg is released, that follicle that it came from turns into the Corpus Luteum. This will release progesterone for about 12 to 16 days. Normally a woman’s luteal phase (the time from ovulation to the start of a new cycle) does not vary much within that woman by more than a day or two during each cycle. The luteal phase is the one part of our cycles that is locked in for most people and they will have their own “normal” they can depend on.

The progesterone released by the Corpus Luteum is very important. It causes the lining of the uterus to thicken (for implantation) and prevents further egg release that cycle. It also causes a change in your fertility signs (more on that later).

After this 12-16 day period of the luteal phase, if the egg has not been fertilized and implanted, the Corpus Luteum dissolves and a new cycle starts (your “period” comes). The first day of bleeding is the first day of your new cycle.

A Quick Word on Averages

Please note that during this entire post I am going to be speaking in terms of the average cycle. There is a large amount of normal variation within these numbers – and outside them. The 28 day cycle is not a golden rule or number. Each woman has a cycle unique to her – just like the particular color of her eyes or her love of a certain food. Please do not take these average numbers to be the only “normal” and count yourself as abnormal. They are simply for simplification purposes.


Conception is the process of fertilization – sperm meeting egg. When and where does this take place? Once the egg is released by the ovary, it is sucked up into the fallopian tubes quickly – normally within 20 seconds. The ovary is not actually attached to the tubes by the way – they sort of barely meet at the end of the tubes where the “fingers” of the tube stick out to catch the egg. These fingers are called fimbria.

Fertilization has about 24 hours in which to occur. The egg does not sit around waiting for sperm for the entire luteal phase. Around 24 hours is all the chance we get. The egg is fertilized in the lower third of the fallopian tubes, not in the uterus as is commonly thought. The egg will continue its way down the tubes and burrow into the lining about a week after ovulation, on average. If the egg is not fertilized, it dissolves and is absorbed, or it comes out with the menstrual flow.

In order to stop the process of the shedding of the uterine lining, as soon as the egg implants your body starts to make a hormone – I know, another hormone! This hormone is called Human Chorionic Gonadotropin (HCG) and is the hormone that pregnancy tests detect. This hormone not only stops the lining from shedding as normal, but it signals the Corpus Luteum to stick around and keep making progesterone to sustain the lining (which feeds the fetus). This progesterone is important as it sustains the pregnancy until the placenta takes over after several months. [This is why low progesterone causes miscarriage.]

As you can see – this dance of hormones and processes is complex. Complicated steps, but seems effortless and fluid when observed. Our bodies do all this without prompting in most cases, and is just as miraculous as the actual process of growing a baby. Our bodies do a lot of work just to get the egg ready to create the baby, and to maintain the system for many years “just in case”.

Charting: Your View of the Dance

Charting with the Fertility Awareness Method (which is taught in TCOYF) is based on three basic fertility signs. These signs, when charted together, give you a view of what your body is doing and where you are in your cycle.

Waking Temperature (Basal Body Temperature)

This is the fertility sign that gives you a view of what hormones are acting at the moment, and when you have ovulated. It is the “graphic” portion of the fertility chart. To get this information you need to take your temp first thing in the morning before you get out of bed. You need to use a Basal Thermometer for the best results, as they are more accurate than a fever thermometer. They are usually available in the fertility section of your local drug store or WalMart/Target. That would be the aisle with the pregnancy tests and contraceptive devices.

Before ovulation your temperature is lower (between 97.0 and 97.7 on average) due to the temperature suppressing effects of the rising estrogen at the start of the cycle. After ovulation, within a day or so, your temperature will rise due to the heat producing hormone progesterone. If you conceived, the progesterone stays around and your temp stays higher. If you did not conceive, the progesterone stops and your temperature drops as well – a sign that says your menstrual flow will start soon.

A few notes about your waking temperature. 1) You need to take it at the same time each day, trying not to vary it by more than 30 minutes or so. When you first start to chart, try to be as precise as possible in order to get your “normal” readings for a few cycles before messing with anything. 2) You need to take it after at least 3 hours of sleep (this gives your body time to regulate and get to the basal state) and before you get out of bed. Keep it on your bedside table. 3) Your readings may be off if you have a fever, have drank more than a drink or two of alcohol (or if you rarely have alcohol), or are using more warming devices to sleep than you normally do. Illness can also effect the temp in other ways – think about if you normally sleep with your mouth closed, but then sleep with it open because you are congested. This would cause your mouth temperature to be lower in the morning.

There are two ways to get your temperature. Orally – the way you do for a fever, or vaginally. Vaginal temps tend to be more precise for many women and you do not have to worry about the effects of occasional mouth breathing either.

Cervical Fluid

Cervical Fluid, or cervical discharge, is an important fertility sign. In my opinion this is the sign that we should absolutely be taught about from day one of becoming a woman. The normal fluid our body makes – which changes throughout the cycle – is not dirty. It is not defective. It is a sign of where our fertility is at that point. I suggest you begin to think of it as awesome and not dirty (in other words – not “discharge”) because this stuff is cool.

You have several types of fluid. I will work from least fertile to most fertile. First is the lack of fluid – this is called a dry day. This generally means you are not currently fertile. This normally occurs right after menstruation ends, and after your fertile period (ovulation). Then there is sticky fluid. This is the dry feeling fluid that clumps and looks almost like rubber cement (a type of glue). This is also considered not fertile. It usually occurs after menstruation but before ovulation – and sometimes for a few days after ovulation. The next type is creamy – this is usually thick and white or yellowish, and feels and looks like lotion. This is not a fertile fluid, and normally occurs before ovulation, and occasionally after ovulation. All of these types leave no mark in your underwear, or they leave a streak or line.

The first type of fertile fluid is called watery. This is just the way it sounds – like water. Usually clear or only slightly colored, it leaves a round wet mark on your underwear due to the high water content. This is a fertile fluid. Fertile fluid is one in which sperm can survive. You must have a fertile fluid present for sperm to live and move in. This fluid usually shows up around ovulation. If you see this, assume you are fertile. The other fertile fluid is egg white. This is the most fertile fluid and is what you want to look for if you are hoping to conceive. It looks just uncooked egg whites, sometime streaked with pink or yellow but is mostly clear. Sperm love to live in this and can swim well in it. This will also leave a round wet mark in your underwear due to moisture content. It is also stretchy between the fingers – stretching up to a couple inches or more.

A typical pattern of fluid would go like this: Menstrual blood, dry, sticky, creamy, wet/egg white, dry or sticky, menstrual blood. Again – this is just an example and each woman will have her own pattern. After a cycle or two of charting, you will see your personal patterns. Occasionally a woman gets a last surge of fertile fluid just before menstruation. This is not another ovulation but rather a reaction to the drop in progesterone.

Cervical Position

This is the one sign of the three that is considered optional when charting. However, I would encourage you to try it. It really does help with charting (especially when your other signs do not seem to match up) and teaches you a lot about your body. It does take practice. My “favorite” way to check my cervix (in other words, the easiest) is to squat down all the way – bum on my ankles – and feel for the cervix. Your cervix is a small “bump” at the end of your vaginal canal or rather at the bottom of your uterus – it feels much like the end of your nose for most of your cycle, only with a dimple in the middle (the cervical os).

When you are not fertile, your cervix is low and firm and closed (keep in mind, those who have birthed children have a slightly open cervix for ever after in most cases). When you are fertile, the cervix moves up higher and becomes soft (like your lips) and opens a bit. It is also very wet when fertile as it puts out a lot of good fertile cervical fluid. To notice these changes, you need to check yourself each day in the same position. You will start to notice after a cycle or two what your normal fertile and infertile patterns are for your cervix.

An amazing site to look at is The Beautiful Cervix Project. This site has collections of photos of real cervices in all stages and ages. Being familiar – and comfortable – with what all portions of our body look like is an important part of embracing the whole woman, our whole self. This project is dedicated to helping with that.

Other Signs

Not every woman has these signs but they are worth charting if you have them. Midcycle spotting, pain or aches around the ovary area (note the side), increased libido, full or swollen vulva, bloating, increased energy, breast tenderness – all are rather common signs during the cycle. If you chart them, you may see a pattern. For instance, women who get midcycle spotting tend to find through charting that it occurs around ovulation. The pain in the ovary area has a name – mittelschmerz – and typically indicates the release of an egg.


I think the easiest way to explain charting as a whole is to show you a chart. I will add one of mine to illustrate.


This is one of my older charts. You can see the lower temperatures before ovulation. The “cross” is the day of ovulation. You see that my temp rose after ovulation and stayed above the “cover line” (the horizontal line) until shortly before the new cycle started. This cycle was 32 days with ovulation on day 2o and a 12 day luteal phase. The blue days are infertile days, the green days represent likely fertile days, and the orange/tan days are the luteal phase.

As you can see on my chart I have a few things that are not typical. First, I tend to have a few random days of fertile fluid before ovulation. I also have what is called a “slow rise” in my basal/waking temperatures. These are both a variation of normal and are normal for me. I am able to line up my typical cues of ovulation to know when I have ovulated – for instance I always get ovulation pain and chart it. This is (for me) a very reliable sign.

Sometimes you might not ovulate. This is called an annovulatory cycle. Most women have these from time to time for various reasons. Stress and illness are two big reasons. I once had a cycle that lasted 147 days – during which my husband and I were apart for my job. After we were under the same roof again, a new cycle started the same week and things went back to normal. Here is an example of an annovulatory cycle for me:

Annov. chart

As you can see, the signs are all over the place, and my temperatures never really get a pattern. I may have ovulated around day 34 or so, but no other signs confirmed that other than a slight rise in temperature.

Getting Started

For more information I highly suggest the book Taking Charge of Your Fertility. It really is an amazing resource and goes into full detail of how to chart and how your body works. I have simply given you the starting building blocks. There are several methods of charting fertility, but FAM (Fertility Awareness Method) as taught by TCOYF is my favorite. You can find classes in most major cities about fertility charting as well.

Fertility charting can be used both to help conceive, and to avoid conception. I have used it for both purposes.

When using to avoid pregnancy, and you understand it thoroughly and use it correctly every day, you have only a 2% chance of conceiving within a year. That is if you use condoms during the fertile phase (correctly) or abstain while fertile. [Condoms have a failure rate of around 2%.] If you use other barrier methods during your fertile time then your chances would be close to that of whatever barrier method you choose. Keep in mind that the failure rate and user failure rate are different, and you should research any barrier method you decide to use with FAM. Also, the user failure rate of NFP (Natural Family Planning – which includes multiple types of charting or fertility tracking) is anywhere from 2% to 20% depending on the study you look at. This is not the fault of the method, but rather the user. “Cheating” (not following the rules) is much less forgiving with NFP than it is with other types of birth control.

When using this method to achieve pregnancy it can be very helpful. First and foremost – you learn about your normal. The 28 day cycle and day 14 ovulation is probably the biggest myth of womanhood. That is a “clockwork” example and is simply not true for all women. In fact, you can have a 28 day cycle and still not ovulate on day 14. And as we learned – the egg is only viable for about 24 hours. If you miss the egg, you miss it – and thinking you ovulate on day 14 when you ovulate earlier or later can mean that you miss the egg again and again.

You also start to see your patterns. You notice when your cervical fluid changes and what the fertile period looks like for you. Past cycles do not dictate future cycles – BUT they can help you to get a good guess going of when to time intercourse to catch the egg. Another thing it does is alert you to issues. You would be able to see if you do not ovulate, or if you do not have fertile fluid when you need it. You can catch a short luteal phase (which means the fertilized egg may not have time to implant) and possible issues with progesterone. In other words – you can arm yourself with information and avoid some expensive and time consuming testing.

Please keep in mind that I have only given you the basics here – the building blocks. Now it is up to you to research and read or take a class. Please do not run with this small amount of information and use it to avoid pregnancy, and on the same hand – please don’t chart for fertility just based on what I have written here. My hope is to clear some myths, help you learn, and help you appreciate your body a bit more. Please feel free to post questions below and I will try to answer them as best I can. I am not an expert or teacher, but I have read and researched the subject extensively and used the method in both ways for several years.

“Pulled Apart And Put Back Together” {A Cesarean Section Procedure}

“Pulled Apart And Put Back Together” {A Cesarean Section Procedure}

[Warning: This post describes and illustrates Cesareans sections with graphic detail.]

The Cesarean section is often described as simply “an incision in the abdomen”, or variations to that effect. Usually you’re told it’s “straightforward” or “simple” or “virtually risk-free” or even “the easy option”. But what is it, really? I’ve heard stories where the muscles are cut, and stories where the muscles are pulled apart from the middle, and stories where the uterus is taken out of the body… So what do they do and how do they do it?


The anaesthesia:

Many women are given regional anesthetic: an epidural or spinal anaesthesia for a Cesarean section. And yes, there is a difference between them.

And epidural procedure involves inserting a needle into the epidural space of the spine. First, a local anesthetic injection is given to numb the area and minimise discomfort of the large epidural needle. The epidural needle is inserted into the epidural space, and a catheter is threaded through the needle and into the space. The catheter is taped into place on the skin, and an anesthetic liquid is pumped through the catheter and into the epidural space. The anesthetic can be continuously pumped through the catheter (known as Continuous Infusion), or can be administered periodically as needed (known as Patient Controlled).

Spinal anesthetic is a similar procedure, but the needle is inserted beyond the epidural space and into the spinal cord. Anaesthesia in injected into the spinal cord, and a catheter is not placed. At any time, you may be put under general anesthetic if an emergency situation arises.

For detailed (and graphic) images of an epidural being performed, visit Patti Ramos Photography | Epidural Procedure

A general anaesthesia is not often the first choice for Cesarean sections, for medical and emotional reasons, but is sometimes necessary. During this procedure, anaesthsia is injected into a vein, and you might also be asked to breathe in gas – these will stop you from feeling pain or being conscious during the procedure. You will be intubated – a tube is put down your throat and into your windpipe – because you cannot breathe on your own.

Once you have been given the epidural, spinal or general anesthetic, you will have (if you don’t already have the following in place): a cannula inserted into a vein, catheter in your bladder, a cuff around your arm to continuously monitor your blood pressure, an oximetre clip will be placed on your finger to measure your blood oxygen levels, an electrocardiograph will be connected to patches stuck onto your skin to monitor your heart while under anesthetic, a possibly an oxygen mask if your oxygen levels indicate that you need it.

Once you are lying on the table in the operating theatre, the nurses will usually hang a sterile blue drape above your neck/chest area. This is done primarily to keep the abdomen and incision sterile, although some people also appreciate not being able to see the details of the operation. Nurses will often wrap your neck and chest area in a blanket or warm you with a heater/fan, as operating rooms are kept very cool, around 20 degrees Celcuis (68 degrees Fahrenheit).

The cesarean section procedure:

A Cesarean section is not ‘a simple cut’. It is an extremely involved major abdominal surgery.

The first incision is made with a scalpel into the skin. The cesarean scar used to span from ‘hip to hip’, however these days the incisions are smaller for aesthetic reasons. This limits the amount of space the surgeons have to work in, and recovery can be more painful because the limted space means there is more stretching, pulling and bruising.

This incision can be in a number of places, however the most common incision, the one that leaves a scar across your ‘bikini line’, is called a Pfannenstiel incision. Other less common incisions are horizontal Maylard and Supraumbilical incisions, and the vertical Midline incision. It’s important to note here that the placement of this incision (and the subsequent scar left on the skin) does not necessarily indicate the placement of the uterine incision.

Surgeons must then navigate through the skin and fatty tissue, being careful to avoid the major superficial arteries present in the area. The skin and tissue are held apart with clamps or the hands of surgical assistants.

The connective tissue (known as the fascia) that surrounds the rectus abdominis muscle is cut down the middle with scissors and pulled towards the respective side of the body. The rectus abdominis muscles (your ‘abs’) are not cut, instead they but pulled apart from the middle outward towards the sides with the fingers.

The peritoneum, which is the connective tissue that encases the internal organs, is then cut with scissors and lifted and pulled aside.

A layer of tissue, known as the Vesicoperitoneum pouch, encases the bladder, uterus and some of the intestine, and a loose portion of the pouch needs to be pulled upwards, cut with scissors, and pulled aside.

A retractor is placed along the lower edge of the incisions, and pulls the opening down (in the direction of the feet). Clamps or surgical assistants hold the skin, muscle and tissues aside, allowing a large opening. At last, the uterus is visible! A baby (or babies!) will soon be born!

The incision made now determines the ‘type’ of Cesarean you are having. The most common type of incision is a transverse lower uterine segment (LUS) incision – an incision going from one side of the abdomen to the other, of a lower section of the uterus. Depending on the circumstances of the surgery, the surgeon might choose to perform a classical incision (up and down), an ‘inverted J’ or ‘inverted T’ incision. After a small initial cut is made, the uterus is then either cut with scissors or pulled apart with the fingers.

The surgeon inserts a hand and/or forceps into the uterus, and carefully manoeuvres the baby out and into the world, usually with some pushing or force placed on the fundus of the uterus while also attempting not to rip the uterine incision further. In a mother-assisted Cesarean, the mother may reach down and assist in birthing by helping to lift her baby from the uterus.

Hooray! A baby!

cesarean post

The baby’s umbilical cord will be cut, and then the baby will moved away from the abdomen. In many cesarean births, the baby is taken to a warmed bassinet to be checked and wrapped, and then brought over to meet their mama. Some mothers ask for immediate skin-to-skin contact once the baby has been birthed, but unfortunately this practice is not standard, and needs to be negotiated with the surgeon.

But it’s not over yet.

At this time, the uterus may be left ‘in situ’ (in situation, or within the abdomen) or ‘exteriorised’ (removed from the abdomen). The placenta is removed, and the surgeon begins the task of ‘putting it all back together’.

The area is washed, and the uterus is stitched closed. Many birth plan examples suggest asking for a ‘double-layered suture closure’ rather than a ‘single-layered suture closure’, and this just means that the uterus is closed with two layers of stitches rather than one. Some studies suggest that this decreases the risk of uterine rupture and increases the chance of a successful VBAC, which may be because doctors are more open to allowing mothers a TOLAC if the uterus has been closed with a double-layer suture.

Surgical retractors and clamps are removed and depending on the surgeon, the peritoneal may or may not be sutured closed – it was once standard to close to however some recent research suggests that it can be left open without adverse effect so some surgeons are trialing or have adopted this technique.

The skin is closed with stitches and/or staples. The area is washed, and occasionally the vagina may be irrigated. And yes, you will bleed after a Cesarean section. Most of the bleeding after any form of birth is from the ‘open wound’ that is created when the placenta detaches or is removed from the uterine wall and slowly heals.

 The mother is moved from the operating theatre to the recovery room, and depending on hospital policy, her baby may or may not be allowed in with her. Depending on her response to the surgery, she will be taken back up to her room quickly, often within an hour of the surgery ending.

cesarean group pics

[Warning: These clips include extremely graphic video footage of a cesarean section birth. It is a real cesarean. It is really graphic. And before anyone asks, the baby is alright, you do hear crying in the background further on in the surgery.]

Cesarean Section Video: Part 1 | Cesarean Section Video: Part 2

After my cesarean birth, I felt the best way to describe the feeling was that I was ‘pulled apart and put back together’ and it’s no wonder. Cesareans are not a walk in the park, and are hardly the easy way out. The body has so much healing to do – it has been cut, moved, pulled, pushed and ripped apart. But we are strong. We have not failed.

For Cesarean section procedure pictures, visit  Cesarean Section


Hema, K. R., & Johanson, R. (2001). Techniques for performing caesarean section. Best Practice & Research Clinical Obstetrics & Gynaecology, 15(1), 17-47.

Lanneau, G. S., Muffley, P., & Magann, E. F. (2004). Gynecology and Obstetrics, Chapter 74: Cesarea Birth: Surgical Techniques. Retrieved on April 4, 2013, from

Morgan, P. J., Halpern, S., Lam-McCulloch, J. (2000). Comparison of maternal satisfaction between epidural and spinal anaesthesia for elective Cesarean section. Canadian Journal of Anaesthesia, 47(10), 956-961.

Ng K. W., Parsons J., Cyna A. M., Middleton P. (2012).Spinal versus epidural anaesthesia for Cesarean section. The Cochrane Collaboration, 4.

Tabasi, Z., Mahdian, M., & Abedzadeh, M. (2013). Closure or Non-Closure of Peritoneum in Cesarean Section: Outcomes of Short-Term Complications. Archives of Trauma Research, 1(4), 176-179.

Tully, L., Gates, S., Brocklehurst, P., McKenzie-McHarg, K., & Ayers, S. (2002). Surgical Techniques Used During Caesarean Section Operations: Results of a National Survey of Practice in the UK. Obstetrical & Gynecological Survey, 57(11), 725-726.

University of Maryland Medical Center. (2011). Epidural Series. Retrieved on April 4, 2013, from

University of Maryland Medical Center. (2011). Spinal and Epidural Anaesthesia. Retrieved April 4, 2013, from

University of Washington, Department of Medicine. (2013). Cesarean Section. Retrieved on April 4, 2013, from

World Health Organisation. (2013). Alternative techniques and materials for Cesarean section. Retrieved on April 3, 2013, from

And a big thank you to Australian midwives Harmony, Manda and Fiona for ‘fact checking’ my information! 

Why Should I Write My Birth Story?

Why Should I Write My Birth Story?

I am daily compelled by the siren call of birth stories. I read them late at night when I can’t sleep because I’m pregnant. I read them early in the morning when I need inspiration because I’m pregnant and my toddler’s favourite co-sleeping position is ‘H is for Hell’. I recount them to my husband, my friends, my colleagues, and my neighbours, just for fun. Why? What is it about birth stories?

Their narrative structure is not that complex (baby…comes out…of woman!) and there’s rarely much character development or plot twisting. They contain typos and grammatical errors, and sometimes leave out the most relevant details. They’re not ‘literature’.

But I always feel a little pique of joy when January forwards me a birth story to edit and format. As a mother, a birth activist, and a writer, editing birth stories fulfills me. Deeply. Perhaps it’s because no two stories are the same or because they narrate one of the most powerful human experiences. Maybe I like to siphon endorphins off the ecstasy and intensity they describe. Certainly, they are all glimpses into other people’s most secret, sacred lives.

But I haven’t written my own, and it’s kind of embarrassing. I keep deciding to do other important things like nap with my toddler instead. It just… hasn’t happened yet. And I’m not sure why.

One evening, while  chastising myself for slacking off on this important parenting/birth activist/blogger task, I got to wondering about birth stories as a social phenomenon: Why do (some) women write their birth stories? Why do others not? What can I do to light a fire under my behind to get my son’s written before May 22nd, which is when our daughter might arrive?*

*Exactly nine months from the sultry summer evening on which I received an email from Mrs. BWF, inviting me to start blogging for her. Beware, O Reader! Birth stories can actually get you pregnant. True story.

To answer these questions, I turned to my friend Shani Raviv. Shani is a professional writer, a yoga practitioner, and mother to an absurdly adorable toddler. She also leads birth story writing workshops in a Berkeley yurt. I asked her to tell me about her work and what she has noticed about women’s efforts to write their birth stories. And I turned to you, the BWF readership. I asked what made you write your birth story and how it affected you. You also shared some seriously awesome pictures.

mama writing 2

This is what I learned.

Women write (and share) their birth stories because they wish…

1. To educate and support other women. 

“It was a true fight to keep my home birth and I want to be able to encourage women when they don’t have the support they may need.” – Tammie H.

“Writing mine… helped many of my peers see that birth is not something to be afraid of.” – Kim G (read more here).

Stories have been used to transmit knowledge since time immemorial. Narrative is a great way to make information – whether about cultural heritage or about the time it took for your cervix to dilate – interesting and memorable. Education and narrative go hand in hand. Shani says that, “…It is unfortunate that we don’t live in a culture where women gather post birth, removed from the drudgery of chores and routine, to sit around the fire under the stars with our feminine clan (including the elders and the young) and share our birth stories … Instead, too many of our stories get lost in our hearts.” BWF mamas describe the desire to share their stories to support and educate other women – not unlike the moonlit knowledge circles Shani describes.

“I wrote it for another mom who was nervous about a VBAC. It was nice knowing my story [helped] another mom to fight for what she wanted.” – Ashlee B.

“I want to [write my birth story] so that other women might find the strength to say no to things.” – Jennifer K P

2. To commemorate the experience. 

“I wrote mine a few days after because I wanted to remember every last detail, every feeling and emotion…” – Sara N G

“…As a birth doula I often write up stories for the couples I work with. I note times and major events in the birth, to give the mom a framework to insert her own memories and experiences since time gets distorted for her during birth.” – Michelle H L

Oxytocin, the ‘love hormone’ which initiates both labour contractions and bonding, has been shown to have significant impacts on memory. Mothers often remember their births differently from other people, and details that are significant to others (such as for how long the mother pushed, or the timing of her contractions) are vague to the mother herself. Some say that memory deficits caused by oxytocin are nature’s way of ‘making sure we have more babies’, believing we must forget the pain of childbirth in order to go through it again. Whether or not this is the case, many mothers are cognizant of the factor of forgetting. They write their birth stories as soon after the birth as possible in order to remember everything as it happened.

“I’m glad I [wrote] it today when our daughter is five days old… I found that details were already fuzzy.” – Martha F

3. To reflect.

“At first, I wanted to be disappointed that I didn’t get the fully natural birth I wanted. I wanted to be angry. But, as I wrote my birth story, I was able to lose that anger, and instead, speak hope for other moms who might not have the perfect birth they planned. … It helped me to celebrate the birth I had. I was able to remember the words spoken to me by my midwife and know that I am capable of an unmedicated birth, even though that couldn’t happen this time.” – Kim G (read more here).

Giving birth is a major life event. Stories used to describe and remember these events have been called “self-defining narratives” (McLean, Paspupathi, & Pals, 2007) in reference to the ways they form our basic perceptions of who we are. These stories evolve with time and re-telling. Sharing them helps us to bond with other people.

“It is very personal to me and I want to share it with anyone who would benefit from it.” – Melanie W.

“I caught myself writing a sentence like, ‘I wanted to go as long as possible before getting the epidural.’ Like I had no choice but to get one. After reading that part over and over, I knew my views had to change. They have 100% changed and have given me more empowerment/encouragement with just being a woman.” – Britany S.

mama writing 3

4. To preserve beauty


“I’ve talked to others about my daughter’s birth many times and have found it hard not to cry just because of how empowering and beautiful it was.” – Briana G

“For both my girls, I wrote their stories so I could share with the world the wonder of their births.” – Sarah Jamison (read more here)

All births are sacred. Some women write or talk about their birth stories simply to capture a bit of that beauty. Shani and I discussed the courage it takes to do this. She says that many of the birth stories she has heard, “…omitted all the excitement, the emotions, the color, the magic [of the birth]… [Women need to] gather to share and write their stories in a creative way and bring magic to an already magical experience no matter where the birth happened or how the baby was born.” In a culture that derides the importance of birth as a spiritual experience, being honest about the transformative qualities of your birth can be a profound gift to others. For some women, it is an early step in the long journey of giving that is motherhood.

“…while my baby nursed, fussed or was just otherwise awake,… [I would recall] every detail of his birth so that I c
ould commit it to memory…Then I started writing it down during those hours-long midnight visits, typing one-handed on my now ancient Blackberry in a memo folder. That old Blackberry had the tiniest screen and no dimmer app. By the time I was done… and exported it to a word file on my computer, it was ten pages long… After I finished writing it, the long nights didn’t end, the sleep deprivation was high and patience was getting even lower, so I would read his birth story over and over again on my Black

berry at night. It really kept me kind and sane for him.” – Debbie R.

5. To change the world.

“Our daughter was born this January, and I was immediately compelled to write her birth story. I spent so much of my pregnancy reading others’ birth stories and finding them so beautiful, different, and empowering. I wanted to be a part of that.” – Kim G. (read more here)

Given the hysteria and prejudice surrounding birth in the West, sharing your birth story can be a political act. Birth was a taboo subject for a number of years – the same years during which twilight sleep ensured that many women never consciously experienced it. No matter how you felt about your birth, sharing your experience of it is another drop in the changing of that tide. Talking about an ‘unspeakable’ topic is a revolutionary act for some BWF readers.

“I will share it because I was inspired by others stories and I want to do the same. I will share it because I want to make my mark in the world of home birth advocacy. I will share it because I am proud. I will share in hopes that other ladies will also share their experiences as well. Good or bad. It’s how we learn. It’s how we grow!” – Patrice NB (read more here

6. To give to the child.

“I wrote my birth stories as I love being able to relive the experiences, and have something to read to my children as they get older.”

 – Tess A.

Shani says, “We… honor our stories as something that came through us, as did our children, but are now bigger than us, our personal journeys. Our stories become part of our family’s legacy or our child’s birthright that can last for generations.” Children love to hear the story of how they were born, and the ritual of its recounting can be so sweet. Writing down your child’s birth story can be a way of ensuring that they will one day know how they entered the world. When the child is a girl, the wish to support and educate her as a future mother also comes into play.

“I…printed it out and placed it in my daughter’s baby book so she can look back and read about the day she was born. I can only hope that it will inspire her to have a birth without fear when she is ready to give birth to her own child.” – Jennifer C.

7. To heal trauma.

“I wrote mine because of its healing factors. I had an induced labour then ended up with an emergency C-section and had severe postpartum anxiety because of it. Writing my birth story helped me be at peace with the fact I couldn’t change what happened and that I am lucky I ended up with my beautiful, now three year-old boy.” – Fiona W.

If a woman’s body or wishes were violated while she was giving birth, this trauma can pop up in other areas of her life. She may re-live her experience of it over and over again. Narrative is a time-honoured method of healing after trauma; it can provide a path through the chaos of an emergency C-section or other crises. For many BWF readers, getting their complete stories out of their minds and onto paper (or a screen) has helped them to understand, organize, and gain perspective on the things that happened to them. As I will discuss in my next post on this topic, writing birth stories for this purpose can be challenging and downright scary. But for those who do it, the results are worthwhile.

“My second daughter’s birth was a little non-standard… and so writing it down helped me process it and really get a handle on what had happened.” – Sarah Jamison (read more here)

 “…to heal regarding the things that didn’t go my way… to appreciate all the things that DID go my way.”

 – D LB

There are many, many reasons to write a birth story – more than I could ever mention here. It’s a great thing to do. But it’s not easy. Almost half of the BWF readers who contacted me also wrote about the struggles they faced in writing their birth stories, and as some mothers have asked, “Why would you want to write about that? You just get over it and move on with your life.” We will discuss some of these challenges, and a few ways of overcoming them, in my next post. I’ll be working on it over the course of this week – by the end of it, I might even have a story of my own to share.

Then again, I might be napping.


Hello Aunt Flo {And Toxins?}

Hello Aunt Flo {And Toxins?}

aunt flo

Lets talk about PERIODS. Cycles. The Curse. Aunt Flo. Your Monthly Visitor. You know…that thing. The thing you were most likely taught to hide at all costs and were so afraid to be shamed about, be it from a stain on your pants to an “odor”, to hell…just being a woman.

Now readers – this is going to get personal. You are about to know a lot more about me. In turn, I would like you to keep gagging to a minimum. Okay? Alright. Here we go.

I come from a long line of bad periods. My mother, bless her, had a hysterectomy before she was 40 due in large part to her horrible, heavy monthly blood. I was told I was doomed to the same fate. From day 1 of my first cycle, which came ON my 11th birthday, it was heavy and annoying and painful. For years I had irregular, long, horrible cycles. Clotting. Cramping. Staying home from school and work. Nightmares basically.

I was told birth control was the answer. So I was on it for several years. Yes, the periods were shorter, but they were just as heavy. Just as painful. I still missed school and work for the first couple days so that I could lay on my heating pad and moan. Lets not even mention the many side effects of the artificial hormones on my body (that would be a whole post in itself).

I had my son and hoped that would kick my body into gear and force it to be “normal”. Not so much. I escaped cycles for 18 months total (pregnancy and then breastfeeding exclusively), but when they came back they were just as bad. What is a woman to do?

Then one of my friends online mentioned menstrual cups. What on earth was that? A cup in your underwear? She said it solved her cramps and heavy bleeding and get this – it saved her MONEY. Let me tell you – I am pretty cheap. Money saving gadgets draw me like a moth to flame. So I started my research.

Come to find out, they are not cups in your underwear. Lets liken them to flexible shot glasses in your vagina. Which sounds weird – but stick with me here ladies. Lets first look at the reasons WHY we should look at alternatives to conventional feminine products (disposable pads and tampons).

Dioxins, Toxins, and TSS

Since 1980 there have been concerns about tampons and TSS (toxic shock syndrome). That year, many women died from TSS. My aunt got horribly sick during that scare with TSS but thankfully recovered. Now we hear about Dioxin (a carcinogen) and other toxins in disposable tampons and pads. So what is all this about?

Dioxin, in simple terms, is the byproduct of wood pulp (rayon) or cotton bleaching methods when we are talking about tampons or pads. Supposedly, the new bleaching methods are dioxin free…and yet there are still detectable levels of dioxin in the products. This is due in part to the fact that dioxin is entrenched deeply in our environment due to pollution. Therefore, it is a part of the cotton or wood before the bleaching is even an issue.

The FDA states that very low levels of dioxin in tampons and pads are acceptable, though the FDA and the EPA both admit that dioxin is a powerful carcinogen. They state that the load is only 0.2% of the “acceptable monthly load” of dioxin each month. They do not include the fact that dioxin is long lived in the human body and builds up over time. They also forget to mention this is only one source of dioxin – our environmental load is large through our air, food, and water (in other words, we are adding MORE to our body through a product we don’t have to use, unlike air or water).

The EPA has done a recent study stating that dioxin is much more toxic than they previously realized. You can read the full 344 page report here (you know, light reading). They do point out, right at the start of the study, that the way they test can not take into account the ways we are exposed. They are simply injecting it and recording. They even specifically state that we don’t know how it changes when it targets a specific organ.

The targeting of of a specific organ is of special significance here since the pads and tampons are in contact with a very vulnerable part of our body – our labia, vagina, cervix, and through that – the uterus.

The list of non-cancer “endpoints” (risks) in animal trials include infertility in males and females, thyroid issues, birth defects and loss, diabetes, dental issues in both the receiving adult and in offspring, over-active thyroid, and several others. The human trials (which were done when there was a large exposure in a population in 1976) were all on children, newborns (who were exposed in utero) through the age of 10. Low sperm count/motility and over-active thyroid were both obvious results in those groups.

There is also a casual link to the increased use of disposable products over the last 50 or so years and a sharp increase in endometriosis, but further study is needed. Endometriosis is a common reason for infertility and hysterectomy. This link from the EPA talks about the casual link (pages 7-9).

There was also a survey done by a manufacture of medical-grade tampons (dioxin free) that suggests a link between one main brand of tampons and several female “issues” from genital warts to abnormal pap smears. The link is here as I don’t want to call out the brand. But this particular brand is designed to enlarge lengthwise in most types of their product and this creates more rubbing on the sensitive cervix, which can cause abrasions, which they speculate can cause more open paths for HPV and other viruses to enter.

Another (unproven) additive which may or may not be in these products is asbestos. Now, the FDA states that this is not in our tampons or pads. After all, they tell them it’s not allowed in there. However, the FDA does not have agents in each factory and rarely inspect them, and the manufacturer does not have to state any of the ingredients on the box. Hence why you rarely know if you are using an all cotton product or one which also includes rayon (which has a larger toxic load). *If* asbestos is in tampons and pads, it would create more bleeding and cramping. More bleeding equals more sales of the product. I leave it up to you, dear reader, to form your own conclusions on this particular additive.

And lastly – TSS. This is something you most likely know about. TSS symptoms are varied and the risks include death. The CDC states that rates are well down from the scare in the 1980’s – but admit that the rates are most likely under reported. Over a thousand cases are reported each year, half from tampon use, and about 5% die. The reason TSS and tampons are so linked is that the absorbent environment creates a breeding ground for the bacteria responsible for TSS. Tampons containing rayon are more likely to create this toxin overload and breed more bacteria.

Please take note that while much of this research has to do with tampons, your pads are created using the same cotton and rayon, and therefore carry much of the same risks (especially in regards to dioxin).

So now you know the truth about what is in your pads and tampons…so what do you do?

Your Alternatives

Now for the fun part! Your alternatives to those conventional products.

The main product I am going to talk about is menstrual cups since they hold the most mystery. You know, the flexible shot glass I mentioned back at the beginning.

Menstrual cups are pretty common place all over the world except in America. One brand, The Keeper Cup is approved by the FDA here, and one other brand, the DivaCup is now available in some Wal-Marts. A few brands (including DivaCup) are available in places like Whole Foods. But still, to the majority of the United States, these little cups are unknown.

There are many, many brands. Some are more popular than others, some are only available in a few countries. To name a few: DivaCup, Keeper, Keeper Moon Cup, Moon Cup UK (different from the Keeper Moon Cup), Ladycup, Lunette….I could go on and on. Really, there is a whole smorgasbord of cups out there. Which means you have to choose one that is best for you.


Each vagina is a bit different. That is the fun part about the human body – we are not all alike. Therefore, cups come in different shapes and sizes and with different features. The cup that fits me like a glove may not work for you. A cup for a teenager is going to be smaller than a cup for a mother who has had a vaginal birth (this is why cups come in two sizes – before and after birth). I will post LOTS of links to help you figure this out at the end of the article. Don’t worry. The opinions vary but you can piece together which will be right for you with a little thought.

  1. Have you had a baby? Think about this one…did another person emerge from your vagina lately? Ever? Keep in mind that for some women a Cesarian birth also changes the size of the vagina. Don’t ask me why…no idea. After childbirth = the larger size cup. No children = the smaller cup of your chosen brand. You may also need the larger size if you are over the age of 30/35 even if you have never had a child.
  2. How long is your vagina? (I told you we would get to know each other well). Squat down on your ankles and figure this out. When you reach in with a couple fingers, do you hit cervix easily (it feels like the end of your nose if you are not fertile right now, or more like a squishy bump if you are)? Congratulations, you have a “shorter” vagina. If you reach back and feel nothing…and more nothing…you most likely have a longer vaginal canal or a very posterior cervix. Please check this a few times over the course of your cycle since your cervix does move around depending on if you are in your fertile phase or not. Short vagina = shorter cup (not cup and stem, just cup).
  3. How sensitive do you feel your vagina is? Also think about the connection between your bowels and your vaginal canal. If you push on the canal from the inside back towards your bum, does it get rather uncomfortable? (Please, do not do this too hard – just gentle nudges). If it bothers you a good bit, you may want to consider a cup with a softer rim.
  4. Do you have a very heavy flow? Now this is tricky. I would have told you before the cup that my flow was very heavy. I would not give that answer now. But just think on it. If you use pads, or if you did, how often would you change them? If you use tampons, are you needing to change them all the time due to leaks? You may want to avoid the few cups who have smaller capacity unless you want to empty it more.

There are a few common questions that I always get when I talk about cups. If yours is not here, please feel free to comment below and I will try to answer them for you or find information.

  • Does it hurt? Let me be honest. The first clumsy attempts are a bit uncomfortable. Not horribly painful, and I did not injure myself. Once you get the hang of it, it is no more uncomfortable than a tampon going in.
  • Do you get leaks? Honestly I never had a leak. Not even the first time wearing it during my period. However, I practicing inserting it before my bleeding began (use a tiny bit of lube as the vagina is more dry most of the time than it is during menstruation). I also researched as much as I could to get the cup I thought would fit me best. If you are worried about leaks the first few times you use it, wear a cloth pad as well.
  • How do you put it in there? This boggles the mind when you first see one. It is round…like a cup. So how do you put it in? You fold it and once it is inside you let go and it opens up. A firmer cup is better at the “popping open” then softer cups. My cup (the Keeper Moon Cup) is considered to be a cup with a firmer rim. The DivaCup is considered by many to be a softer rimmed cup. (Just as an example)
  • Isn’t it gross? Not really. Once you know how to take it out, you don’t even have to look. You just take it out, tip it into the toilet and walk to the sink and rinse. No matter what, we see blood during our cycle at some point. And let me tell you, the blood in a cup looks way better than the brown weird blood that was always on my tampons.
  • How often do you empty the cup? Most people empty twice a day and that is with a regular to heavy flow. I empty morning (when I wake up) and night time before bed. I have never needed to empty it while out and about. However, if you did do that, you can simply wipe it out with a tiny bit of toilet paper or use the handicap stall which usually has a sink. Or you can carry some of the wipes that are made to clean cups!
  • Is it sanitary? Yes. If you follow directions and you know, clean it, then of course it is! Most (except the original Keeper Cup which is latex) are made of medical grade silicone and very easy to keep clean. You simply rinse it out with warm water. At the end of your cycle you can give it a quick dip in boiling water to really be sure – but be aware with some cups that can discolor them a little. Harmless, but worth knowing. The original (brown) latex Keeper cup is even approved by the FDA for safety. Also – there has never been a case of TSS from cup use.

Now, there are other things to think about too. The fun stuff. Some cups come in COLORS! Yes, I know – exciting! Your vagina and cervix can be treated to a pretty color during this process. For some people the reason for a color is practical – you don’t see the blood as much as you would in a totally clear cup. It also hides the slight discoloration that can happen over time (which is harmless). The Lunette is a popular brand that comes in several colors.

Some cups come with goodies. The new DivaCup package comes with a swag pin for your purse…or shirt…or to never see the light of day. Your choice. Some come with very pretty storage bags or with wet wipes or specially made washes for your cup. As a side note – never store your cup in an air tight container. Please store it in the fabric bag it comes with. If you cut off the air, the product can degrade.

Some simple “trouble shooting” tips include cutting the stem (shortening it or cutting it off totally), turning your cup inside out (helps with some brands – cut off the stem first), learning to bare down for easy removal, adding a small “twist” after insertion to seal your cup, and learning new folding techniques if you have a hard time inserting the cup.

Cups normally last about 10 years. So for your $20-$40 investment, you get 10 years of not paying for disposable products.

So…enough about cups right? I will include lots of links at the end – I promise!

Alright Lady…what are my OTHER Alternatives?

Cloth Pads are a great option. I think they are pretty easy to understand. Most are designed with the same shape and style of disposable pads, but you wash them. For those who cloth diaper, this is not a foreign idea. A popular company is Gladrags, but there are many brands – just do a search on Etsy and you will be amazed.

These are really fun. You get the basics of absorbancy levels and lengths/widths. But you also get to look at all types of fabrics, pretty colors, organic or conventional fabrics, things that sound exotic like sherpa or minky. The options are endless. And if you are crafty you can make them yourself. These are reusable for several years with proper care and they save money and the environment.

The range of prices with these is pretty large but affordable – especially considering you use them many, many times. You will need 4-6 heavy pads (for overnight and heavy days), 10 or so regular pads, and 6 or so light pads/liners. Or – just keep track of how many disposable pads you are using right now.

Expect to do laundry with these every other day (much like cloth diapers). You can wash them with your cloth diapers by the way, but I would suggest keeping the wet bags seperate so you do not stain your diapers before you wash. Many women just hang a wet bag in their bathroom for “disposing” of cloth pads until wash day. Some women prefer to get enough for their whole cycle and wash one load at the end.

You can pre-rinse the pads to help keep away staining (keep in mind some fabrics stain more than others), or simply buy a color or pattern dark enough to cover stains if you think it will bother you.

Organic Disposable Pads and Tampons are available. Seventh Generation, Organyc and Natracare are three popular brands. These are all cotton and organic. They give you a bit more piece of mind about toxins and fragrances and all that. However, you still have the cost, the pollution aspect, and the chance of TSS (with the tampons).

Another option is Sea Sponges – I will not pretend to be an expert on these. But basically, it is a natural sea sponge that is trimmed to fit inside the vagina (think, smoosh and push up there). You then rinse them and reuse them. You can use them for about 3-6 cycles. They contain no toxins and should be sustainably harvested. This is actually an ancient method of both menstrual bleeding control and contraception. Make sure you get yours for a reputable source of sponges for menstrual use and not Bath and Body Works.

My Testimony

You know all about my horrible pre-cup periods. But how are they now? Since my switch to the Keeper Moon Cup my periods went from 6 or more heavy days to about 4 regular/light days. They no longer cause me to double over in pain or run to my heating pad. I have maybe a small back ache the first day. That’s it. Truly, it has been life changing for me. I no longer spend a crazy amount of money on disposable products every year. I spent $20 and I am done buying for about 10 years. I don’t have to keep up with tampons in my purse or send out my husband in the middle of the night.

I cannot stress enough how much I want women to try something different. Apart from the fact that tampon and pad manufacturers have taught us that our periods are weird, smelly, to be hidden, or shameful (or the opposite spectrum of fit athletes running around with no bloating and sexy ladies in lab coats), I really do feel that this can improve our health.

The FDA and EPA seem to think that there is an acceptable level of toxins we should snuggle up by our cervix every month. But really – do we want to risk that? Knowing that we already have a toxic load just from the air we breath and the food we eat, do we want to add to that? I hope that this has given you some insight into a different way of embracing your cycle and protecting your health. Again, comment below with questions!

Now….all those links I promised! Please note that the brands/shops linked are not endorsed by BWF, but are simply helpful tools. Feel free to buy from where you wish.

Brand Comparison Photos (this also has many helpful links to the right of the page)

Helpful WikiHow Article

Cup Comparisons (also with lots of links to more posts on the right)

Videos on YouTube (comparisons)

Videos on YouTube (folding your cup)


The photo of the cups if from this lovely website which has more comparison information as well.

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