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Posts Tagged ‘Pregnancy’

Women experience birth. Every life experience leaves an imprint. It’s really that simple.

The experience of birthing a new life (vaginal or c-section) can have a profound impact on the woman. It can be as much of a life-changing event as parenting a new baby. For some, birth results in a new awareness, confidence and purpose. And for some, it can mean insecurity, depression, and fear.

Giving birth- especially the first time- is a pivotal point in a woman’s life. She is transforming from woman to mother. She is often confronted during pregnancy with fears and insecurities about being a good mom, knowing how to respond to her baby’s cues, and wondering how life will change.

And anyone with children knows that life will most certainly change, in many wonderful ways.

The process of giving birth- the birth experience- can impact women positively or negatively based on the woman’s perception of what happened. What many care providers see as routine, women are experiencing for the first time. Because labor and birth is largely hidden from our modern society, women have their own expectations as they approach motherhood. And many expectations are based on individual factors like self-image, education, self-confidence, and the experience of autonomy women enjoy in our contemporary culture.

I have heard first-hand from women who were so traumatized by the birth of their first child that they are purposely preventing pregnancy, even though they once dreamed of many children. I read online the blogs and stories of women coerced into submitting to interventions they initially refused, trying to figure out how to advocate for their children, when they were not able to stand up for themselves.

So what happened?

In a nutshell (and in my opinion, of course) women don’t expect the world to be turned upside down because they are pregnant. If a woman generally makes her own decisions in her life, she expects to continue making her own decisions during pregnancy and labor.

Women expect, and rightly so, that being intelligent, autonomous persons, they will be permitted (and expected) to make their own healthcare decisions, even during labor. They believe that trusting their care provider equates to being cared for. Why would a doctor or midwife attempt to manipulate or rush labor? Certainly these professionals have enough experience to understand labor can occur any time of day (or night) and last as long as it will?

The relationships women form with their providers are often based on assumption, because communication is often difficult during 5 minute appointments. But women have reason to feel confident about asserting their right to informed refusal. They are often educating themselves during pregnancy, reading books that help prepare them, mind and body, for birth. Armed with information about possible complications and procedures, they expect to discuss benefits and risks with their provider if circumstances warrant.

And when situations arise, in the office or in the hospital, where the woman’s voice is ignored, where she is discouraged from asking questions, where she is told she is endangering her baby (selfish, bad mother!), where she is manipulated or coerced in submitting to procedures or tests… then she is upside-down.

The world has suddenly shifted and she’s lost the ground. All her life, she’s been told to speak up, ask questions, try harder, think smarter. Now she’s been told she’s a bad mother for expecting to have a say about her own body.

When women with stories like these speak up, they are often told to get over it; that they are making a big deal over nothing; that they are scare-mongering other women; that they are selfish for wanting to feel whole AND have a healthy baby. (And this time, it’s usually other women/mothers calling her selfish!)

Every pregnant woman wants a healthy baby. And it’s ok to want that.

But when you say a healthy baby is ALL that matters, you disregard the mother. Mothers matter too.

Mothers want to feel cared for during pregnancy AND BIRTH.

Mothers deserve to make their own healthcare decisions- even during labor.  (Are other patients also treated with disrespect when they decline routine, but often unnecessary, tests and procedures?) Mothers deserve clear communication and to be approached with respect, as living, thinking, feeling human beings. Women are trusting midwives and doctors (and L&D nurses too) to provide safe care- to hold this trust, and help us be active participants in our care so we are making informed choices for ourselves (powerful, not powerless!)

And when women are offered a relationship of trust and care, when they are afforded the respect to make choices, when they are encouraged to trust themselves during birth, often they learn they are capable of amazing things- including mothering.

Mothering relies heavily on following your instincts. Babies don’t come with instructions and we all worry about knowing what to do. Having a birth experience where you trust yourself can give you confidence to trust yourself to meet your baby’s needs when s/he is born.

If you have experienced birth trauma, you are welcome to comment here about your experience. Also be sure to check out today’s episode of A Labor of Love for more information.

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If you heard my recent interview with Henci Goer, you know I’m really interested in women having the information they need to make decisions for their care, especially during pregnancy. I also think women have the right to choose the care they feel most comfortable with, no matter how certain data is interpreted, or by whom, or if there is no data at all. For example, choosing midwifery vs OB care can be based on statistical data of outcomes for certain providers, or it can be based solely on how a woman feels about a particular individual.

When it comes to risks and benefits, it’s up to individual women to discern their own comfort levels, especially about safety, weighing the benefits and the risks based on her individual perspective.

Similar decisions are made by individuals all the time. For example- the option to drive or walk to the store:

I live less than 2 miles from my local grocery store. A sidewalk exists on one of the 3 roads that I need to travel. The speed limit on the roads without sidewalk is 30 mph, but enforcement is nil and generally cars travel about 40 mph. Because I live in Florida, the weather is generally nice enough to walk 90% (or more) of the time.

Benefits to Walking:

  • Walking is great cardio exercise.
  • Carrying my groceries will help me save money b/c I may not be able to carry “extras”
  • Ecological benefit- less pollution
  • Save money on gas
  • Fewer miles on car/less maintenance needed
  • Safer than driving

Risks to Walking:

  • Possibility of getting hit by car where there is no sidewalk
  • I could trip/fall
  • May take time away from other necessary activities

Benefits to Driving:

  • Faster
  • Can carry as much as I want/need to buy
  • Safer than walking

Risks to Driving:

  • Possibility of car accident (3 left turns to get to store)
  • Danger of navigating the cars backing out of parking spots
  • May spend too much money due to no limits on carry weight

If you read closely, you’ll notice each option is “safer” than the other, as listed under benefits. That’s because there is a risk of injury in both cases, and ways to be safer in both cases. I could walk on the grass shoulder; wear a seat belt; wear reflectors; drive defensively. I’m sure somewhere I could find statistics that define the probability of accidents for walking vs. driving this distance under various conditions and make a statistical comparison.

But even with a thorough review of the statistics, I get to choose which feels safer to me. Even if the data “clearly show” a greater chance of injury for one option, the benefit of speed (or a smaller carbon footprint) might outweigh the risk.

Choices should be offered to women for childbirth with the full understanding that women are ultimately responsible to choose, and that women have the right to choose for themselves, no matter how others interpret the benefits and risks involved.

After all, risks and benefits cannot always be measured and statistically defined. In birth, it’s more personal than that.

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I was thinking about Rev. Dr. Martin Luther King Jr and his most famous speech- how one man articulated the dream of so many. It wasn’t his dream alone and he didn’t want it only for himself. The dream was so big & amazing and became possible only because so many were willing to speak out, be present and stand strong together for a common goal- real freedom & equality for all people regardless of their color.

My dream doesn’t make headlines. No one is marching – yet.

I have a dream that women (and men) might see more clearly that how women are treated during labor matters. That honoring the wisdom of the body, allowing labor to wind its way to birth, holding a sacred space for birth, and keeping intervention to a minimum matters- for both mother and baby (and for generations to come.)

I have a dream that women won’t have to struggle for informed consent and refusal and that the courts stop ordering medical management of pregnancy, labor and birth against any woman’s decisions. I dream that women have the resources they need to be educated about their body and the community support they need to remember their innate strength, and to find confidence from the experience of birth.

I dream that the hostility and judgment of women by women ends; that women unify to leverage their majority to create real solutions that support women and validate and honor individual choice.

I dream that women might not have to choose between caring for their children at home and earning a living apart from their families- that working together solutions can be found that allow babies to accompany their mothers if they choose to engage in professional work.

I dream women will no longer need to act like men to belong in the world. I dream that being feminine and female is honored- that the role of mother and nurture-giver is respected as valuable work; that women and men will each be respected for their differences- in perspective, in approach to problem-solving, in simply be-ing.

I dream that all women have the opportunity to understand and embrace conscious conception, bonding before birth, gentle pregnancy, and trusting birth; that women have empowered choices for labor; that they are recognized as the experts of their bodies.

I dream that my daughters grow up valuing their femaleness; and that being female is synonymous with wisdom and respect – and the right to bodily integrity.

What are you dreaming?

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Where does a woman’s right to make personal healthcare decisions begin? Does it have a finite existence? Does it continue into pregnancy? Does the right to choose to terminate a pregnancy jeopardize her right to continue the pregnancy on her own terms?

Do women deserve support during pregnancy- do they have the right to medical care, even without insurance? Do pregnant women have the right to informed consent/refusal and bodily integrity even at the expense of the baby?

Do women have the right to be respected and honored for the role we play as mothers? Do we have the right to financial support and the opportunity to choose to raise our children personally- even single moms? even young moms? even disabled moms?

Is it a reflection of our society’s views on mothering that there is no guaranteed paid maternity leave in the U.S.? Is it possible that the reason so many college-age women choose abortion when faced with unplanned pregnancy because they know “just being a mom” is not valued as important in our society (women aged 20-24 account for 33% of abortions)? Because they understand they are making not just a financial choice – to become an under-educated mother or continue with education and career goals and create financial stability, but also a choice about their status within society?

Women don’t live in a vacuum. We live together- where every opinion, every soundbite, every prejudice can barricade a woman to “sleep in the bed she made” without tangible support from any part of the equation.

In rhetoric, a woman facing an unplanned pregnancy has 3 options: Abortion, adoption, and motherhood. In a culture that doesn’t value mothers, these options can be depressing.

I know (and love) women who have chosen abortion. None of them felt excited (or even especially peaceful) at the prospect of ending the life of the baby growing inside them.

I remember one friend crying, guilt-ridden, ashamed, heartbroken and completely convinced that it was the only option she had. She described her vision of the future with a new baby and the preschooler she already had. At this time she wasn’t receiving any child support from her ex-husband, and was working 2 jobs just to make ends meet. She didn’t want to live in complete poverty, on welfare, with 2 kids. (Daycare costs for two children was more than she earned- she looked into it before making her decision.) She felt an obligation to the child already born- that child shouldn’t have to grow up living in a dangerous and violent, poor neighborhood.

Could she have chosen adoption? Yes. Did she consider it? Yes. Her conclusion at the time was that there were already too many minority children in foster care needing homes. At one time, she had been one of those children. She didn’t want to bring a baby into this world and then not know if he or she would be loved and truly cared for. In her opinion at the time, it was better for her baby to not be born, than to be born and possibly suffer its entire life with not being wanted or loved. (And having some experience with this in her own life, she felt qualified to have an opinion on which was worse.) Her abortion added to the statistic.

If she had chosen to birth and raise her baby, she would have become a different statistic: an under-educated minority woman on welfare; 2 kids; divorced; living in a public housing project.

I’m not implying one choice is better than another. But one is certainly more private than another.

She doesn’t wear a sign that says “I had an abortion.” But the women who choose to birth their children and raise them, whose choice is supported by welfare dollars and food stamps, most certainly live under the scrutiny of their decision. They are a different type of statistic. They are judged harshly for choosing to raise their children despite their poverty.

These mothers are judged as lazy (because everyone knows raising children isn’t real work). We’ve all heard stories of the “welfare queen” living large while hard-working taxpayers foot the bill. And I’m not saying welfare fraud doesn’t exist. What I am saying is that you can’t decide abortion isn’t ok, and also believe living on welfare isn’t ok either. These are the options many women face.

This is one story of one woman. How might it have been different?

To honor the lives of yet unborn babies, we also have to honor their mothers. As a society, we have to rearrange our thinking, our values, and how we see mothers. Until we really value the work of mothering, we can’t expect much to change.

Edited to add:

I want to be clear- I personally believe every woman has (and should continue to have) the right to choose what happens to her body all the time- even when she is pregnant. What I want is for women to recognize that we can stand together to foster the value of mothering- validating and honoring the rights of women during birth (bodily integrity, VBAC, refusing medical intervention), and after birth (paid leave, breastfeeding resources & support, financial means to stay home with kids). And that when society really values the nurture of the next generations, it will make it possible for more women to choose life.

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I have a theory. You are the expert when it comes to your own body.

I’m not saying doctors (or midwives, nurses, etc.) are unimportant- in reality, the knowledge they wield is incredible. But their specialty is THE body, not YOUR body. And what they learn and study is great because there are things that every body has in common. Biology has made us each unique and yet the same. (It’s pretty incredible when you think about it.)

People who study THE body understand that normal is not exact- it’s a range. And sometimes even the range of normal can vary by individual. For example, blood pressure is considered normal generally when the systolic pressure (the first number- when the heart contracts) is between 140-90 and the diastolic pressure (when heart is relaxed) is between 90-60. So average normal readings would fall between 130/85 to 90/60. The upper ranges of each number are generally considered borderline for hypertension.

I’ve always had a generally lower average. I’ve had healthy readings as low as 70/35 with no signs of illness, dizziness, etc. Is it outside of normal? Yes, absolutely. Did my doctor want to review some other factors to make sure I was ok? Yes. But at the end of the day, she said it didn’t appear to be a problem and we left it alone. My readings are always at the low end of normal or just below. And this is why watching the other signs my body provides, and talking with my care provider about them is so important.

I’m the only one who knows if I feel dizzy (assuming I didn’t just fall down on the floor). I’m the only one who knows if I’ve suffered blurry vision, weakness, sleepiness- all signs of blood not getting to where it needs to go. So if I am paying attention, I can relay the additional information needed to fully understand the significance of test results. Without my input, my doctor might have unnecessarily prescribed medication.

On the other hand, people may experience the symptoms of hypotension and be within the low normal range. Knowing what feels right in your body is a big part of partnering with your care provider to receive the best care.

When you’re pregnant, there are some changes to your body you can’t miss. Who could NOT notice the belly that makes it impossible to button your favorite jeans? Paying attention to other aspects is just as important.

You are the expert of your specific body. Your midwife or doctor knows what is normal for the average body, and your individual input can have a significant impact on the care you receive. Be sure that you choose a care provider who is open to hearing what you have to say about any symptoms you are experiencing. (S)he should also ask you questions that might lead to this type of conversation to give you an opportunity to discuss anything unusual.

One last thing: Many first-timers might be thinking “How do I know what’s unusual? I’ve never been pregnant before.” And because this is true, you may find you have even more to talk about. Don’t be afraid to ask questions about what you’re experiencing. The books written about pregnancy are not meant to substitute for the personal care of your midwife or doctor.

If the book says it’s normal, but you feel abnormal, bring it up. This is what you’re paying for!

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I’m excited to announce the launch of A Labor of Love radio show on the VoiceAmerica Health and Wellness Channel.

A Labor of Love

Please join me at 1pm ET / 10am PT every Monday for the show.

On this week’s show- The Amazing Placenta with my guest Jodi Selander, we’ll discuss the potential benefits of your placenta on your postpartum health. Join us LIVE for an opportunity to ask your questions on the air, or email them during the show to intentionalbirth at yahoo dot com.

Here are some of the guests you can look forward to hearing on future shows: Henci Goer, author of The Thinking Woman’s Guide to Better Birth, Laurie Boucke, author of Infant Potty Training: A Gentle and Primeval Method Adapted to Modern Living, Bettina Forbes from Best for Babes, and Amy Romano, a practicing midwife, author, and advocate. And this is just the first few weeks!

If you have an idea for a guest or topic you’d like to hear, please email me with your ideas: intentionalbirth at yahoo dot com.

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I’m going to get a bit political today. If you’re not into that, skip this post. There is so much going on about healthcare reform in the media and I can’t help but notice there isn’t much mention of improving the sorry state of pregnancy-related care and maternal/fetal outcomes. No one is talking about the continued restriction of valid childbirth options for women with a history of c-section. Yes, I’m talking about VBAC.

VBAC, short for vaginal birth after cesarean, is a valid healthcare option for pregnant women in low risk categories. According to Childbirth Connection.org:

If you do not have a clear and compelling need for a cesarean in the present pregnancy, having a VBAC rather than a repeat c-section is likely to be:

  • safer for you in this pregnancy
  • far safer for you and your babies in any future pregnancies”

Most OB’s and hospitals that refuse to support VBAC do so citing concerns about uterine rupture. And while this is a possibility, educating women about risks and benefits is vital to informed consent of patients. To be vital, informed consent requires patients (in this case women) the option of informed refusal. It is the right of every person to make healthcare decisions personally. Each pregnant woman, therefore, should also have the same right to choose what she will and will not accept as part of her individualized care. She can choose to accept or refuse induction, epidural, ultrasound, fetal monitoring, IV. She has the right to change her mind, even during labor.

Let’s look at the risks associated with uterine rupture during VBAC (from this article at ChildbirthConnection.org):

“What is the added likelihood that the scar will give way (uterine rupture) during a VBAC labor?
Best research suggests that an extra 27 women experience a ruptured uterus in every 10,000 VBAC labors, compared with planned c-section deliveries. Thus, nearly 400 women would need to experience surgical birth to prevent one instance of uterine rupture during VBAC labors. While the scar giving way usually requires an urgent cesarean, loss of the baby is much less common (see next paragraph).
Added likelihood for a woman with a known low-transverse (horizontal) scar: MODERATE for scar rupture compared with planned repeat c-section.”

“What is the added likelihood that the baby will die as a result of the scar giving way (uterine rupture) during a VBAC labor?

Best research suggests that about 1.4 extra babies die due to problems with the scar in every 10,000 VBAC labors, compared with planned c-section deliveries. Thus, over 7,000 women would need to experience risks of surgical birth to prevent the death of 1 baby from scar problems during VBAC.
Added likelihood for a woman with a known low-transverse (horizontal) scar: LOW for death of the baby around the time of birth compared with repeat c-section.”

To fully understand the risks associated with VBAC and make an informed decision women must also comprehend the risks to mother and baby for repeat cesarean birth. (From this article at ChildbirthConnection.org)

“Extra risks associated with cesarean section: Current research suggests that cesarean section has the following disadvantages in comparison with vaginal birth:

Physical problems in mothers: Compared with vaginal birth, cesarean section increases a woman’s risk for a number of physical problems. These range from less common but potentially life-threatening problems, including hemorrhage (severe bleeding), blood clots, and bowel obstruction, to much more common concerns such as longer-lasting and more severe pain and infection. Even after recovery from surgery, scarring and adhesion tissue increase risk for ongoing pelvic pain and for twisted bowel.

Hospitalization of mothers: If a woman has a cesarean, she is more likely to stay in the hospital longer and is at greater risk of being re-hospitalized.

Emotional well-being of mothers: A woman who has a cesarean section may be at greater risk for poorer overall mental health and some emotional problems. She is also more likely to rate her birth experience poorer than a woman who has had a vaginal birth. {Note: This risk is reduced somewhat for planned cesarean birth.}

Early contact with, feelings toward babies: A woman who has a cesarean usually has less early contact with her baby and is more likely to have initial negative feelings about her baby.

Breastfeeding: Recovery from surgery poses challenges for getting breastfeeding under way, and a baby who was born by cesarean is less likely to be breastfed and get the benefits of breastfeeding.

Health of babies: Babies born by cesarean are more likely to:

  • be cut during the surgery (usually minor)
  • have breathing difficulties around the time of birth
  • experience asthma in childhood and in adulthood.

Future reproductive problems for mothers: A cesarean section in this pregnancy puts a woman at risk for future reproductive problems in comparison with a woman who has a vaginal birth. These problems may involve serious complications and medical emergencies. The likelihood of experiencing some of these conditions goes up sharply as the number of previous cesareans increases. These problems include:

  • ectopic pregnancy: pregnancies that develop outside her uterus or within the scar
  • reduced fertility, due to either less ability to become pregnant again or less desire to do so
  • placenta previa: the placenta attaches near or over the opening to her cervix
  • placenta accreta: the placenta grows through the lining of the uterus and into or through the muscle of the uterus
  • placental abruption: the placenta detaches from the uterus before the baby is born
  • rupture of the uterus: the uterine scar gives way during pregnancy or labor.

Concerns about babies in future pregnancies: A cesarean section in this pregnancy can affect the babies of future pregnancies. Studies have found that they are more likely to:

  • be born too early (preterm)
  • weigh less than they should (low birthweight)
  • have a physical abnormality or injury to their brain or spinal cord
  • die before or shortly after the birth”

When women are fully informed of the risks associated with repeat cesarean and VBAC, they should each have the opportunity to choose which risks they are willing to take. When a doctor refuses to “allow” his patients to attempt VBAC, s/he is taking away a fundamental right of women to determine the direction of their healthcare.

According to ACOG’s Committee Opinion #321 from November 2005, respecting patient’s autonomous decision making is a fundamental ethical obligation:

“Requiring informed consent is an expression of respect for the patient as a person; it particularly respects a patient’s moral right to bodily integrity, to self-determination regarding sexuality and reproductive capacities, and to the support of the patient’s freedom within caring relationships.”

“The ethical requirement for informed consent need not conflict with physicians’ overall ethical obligation to a principle of beneficence; that is, every effort should be made to incorporate a commitment to informed consent within a commitment to provide medical benefit to patients and thus respect them as whole and embodied persons.”

“[Even if] a woman’s autonomous decision [seems] not to promote beneficence-based obligations (of the woman or the physician) to the fetus, … the obstetrician must respect the patient’s autonomy, continue to care for the pregnant woman, and not intervene against the atient’s wishes, regardless of the consequences.“(emphasis mine)

“The obstetrician must keep in mind that medical knowledge has limitations and medical judgment is fallible” and should therefore take great care “to present a balanced evaluation of the expected outcomes for both [the woman and the fetus].”

So how can it be true that women have the right to make autonomous choices regarding their healthcare, including care during pregnancy and childbirth, yet doctors choose to ignore and even ban valid healthcare options for these same women?

This is about women’s rights. A woman doesn’t stop having the right to bodily integrity because she is pregnant. She maintains the right to independent thinking, personal preference, and choice throughout the 40+ weeks gestation. Choosing to bring a child into the world doesn’t limit my right to individualized care or informed consent. In fact, choosing to bring a life through my body has made me more focused on what is appropriate and acceptable risk to me and my baby- and this is a very personal choice.

I should always have the final say about what is ok and not ok for my body, and any baby residing within it. And that’s what I teach my girls.

Who does your body belong to?

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