Do Your Own Thinking

Rather than let someone in a white coat and degree on the wall do it for you. 'But what makes you think you know more than a doctor???' I've been asked. Well.....I don't think I know more than a doctor exactly, but I do think I'm intelligent enough to understand the mechanics of birth (um, not rocket science folks) read up on common complications (hooray for the University of Google) and the methods different birth professionals use for responding to them. And sorry but when it comes to my own healthy body I definitely DO think I know more than some random doctor who sees me as a random patient and just another mark on the statistics chart, expecting the worst as fear of liability is her bottom line.

I'm a unique individual!! And so is my baby! The American hospital system and insurance companies may not think so, but we are and for both our sakes I demand to be treated that way. Which is exactly why I chose to birth outside of a hospital, in my own home when I was preparing for the birth of my twins.

A chemically induced forced early exit for my babies at 36 weeks? Really? A forced epidural? Really? Forced to give birth on an operating table? Really? Forced to stay on my back with my legs in stirrups? Really? The 'choice' between allowing a doctor's arm elbow deep into my uterus to grab my baby's feet and pull him out or major abdominal surgery to extract him from my body??? No, thanks. REALLY.

Those are the constraints of maternity care I found offered in local hospitals, simply matters of policy that were non-negotiable. It didn't matter that I was a third-time mother with a history of healthy, full-term, intervention-free vaginal births and was enthusiastic about managing labor without medication. Because I had two babies (perfectly healthy, Baby B a breech position) inside my belly we were labeled and put in the high risk box.

And why do the good doctors believe a twin pregnancy and a breech baby is so risky? Largely, based on the findings from The Term Breech Trial which said that cesarean birth has better outcomes than vaginal birth for breech infants. Never mind the thorough professional criticism of the study and it's own follow-up which negated the original findings, obstetricians continue to perform c-sections as a matter of practice for multiples and breech babies. It's quick, can be easily scheduled, surgeons perform the surgical procedures they are skilled at and most often there are good outcomes. Win-win for everyone right? Oh, except for the mother who was perfectly capable and willing to birth her own baby but is now recovering from surgery, and the baby who most likely needed NICU time as they were born before they were ready and missed out on the important life-supporting events that occur in the process of normal spontaneous birth. Allowing babies to grow to full-term and begin labor naturally with a mother who is an active participant in their birth also usually has good outcomes. But it can take a long time, and is cheap. Where's the efficiency and profits in that?

In many ways, the modern obstetrical birth scene is a machine. One I didn't want to be a cog in. So I *gasp* thought for myself and hired a Certified Nurse Midwife to attend us at home who was comfortable with the very normal scenario of twins and the very normal presentation of a breech. I mean, if I wanted modern decor for my home I wouldn't hire Rachel Ashwell would I? Same principle, if you need help with something in your life find someone to assist you who does what you want and does it WELL.

Midwives do normal vaginal birth VERY well. They can also do multiples and variations on normal birth presentations well. Searching on Gentlebirth.org and Midwifery Today gave me a lot of information and filled my notebook with questions for my own midwife. We talked about her experiences and training, how it compared to what I had read, and what she felt most confident with. She even brought out her midwifery textbooks and dirt-dove options with me. A birth attendant should absolutely be this willing and transparent with you, treating you with respect. If you ask detailed questions and are met with condescension, silence, or get answers that do not satisfy you should think about transferring care. Been there! When expecting my first baby and telling my OB I wanted a natural birth I got a 'Sure, we'll see how things go' said shortly through pursed lips. I should have ran. I didn't, and she wasn't on call the night my daughter was born and while I was thrilled to walk away with my beautiful baby girl I was less than thrilled with my experience with that OBGYN practice.

Expecting my second baby, I still hadn't made the leap of considering birthing outside of a hospital so I made an appointment with an OB who'd been recommended by a friend. A friend who loves her pitocin-induced and epidural-aided births, I should have known I probably wouldn't get support for natural methods but I was completely shocked when after hearing the details of my daughter's birth he replied that he would have c-sectioned her! Why??? 'Because that labor was too long' he said, it had been about 36 hours. It mattered less to him that my daughter had been born perfectly healthy and there were no major complications, he said because I labored so long with her he considered me high-risk. I instantly went cold with his words and from that practice, I did run.

I ran straight to the Austin Area Birthing Center, where I was appropriately assessed as a low-risk mother and went on to enjoy a great pregnancy ending in a productive and completely manageable labor with my son. He was born in less than 18 hours from when contractions began, about 4 hours after checking in.

With my twins, my perinatal doctor (who had previously been a practicing obstetrician) was wonderful in his honesty and forthrightness in discussing delivery technique, I truly did appreciate that. But I also knew those techniques were not right for my babies. Performing a full breech extraction on a second twin may have been his favorite thing to do and while I'm aware I'd lose a contest of education and medical expertise with him I knew enough to know that I did not need anyone to pull my baby out, I have a uterus that can push just perfectly.

I thanked him, said he gave me a lot to think about and focused on the positives from my experience at his practice and went out the door so grateful for my midwife, who was trained in the 'hands off' method for birthing breech babies that I knew was our best bet to have him born safely. Which he was.

Birth is personal, and should be treated that way. Cookie-cutter constraints do not serve mothers and babies best. Find the support you need and deserve, demand evidence based care and don't let anyone else do your thinking for you!

And this is why.....

those first few hours are SO important. In my 'moonshot' hospital birth request list, my desire for my baby to stay in MY ARMS ONLY has good reason behind it.

The Magical Hour

The health benefits from the intense connection of the birth bond between mother and child are far more important than heel pricks, blood tests, vaccines, weight & length measurements, cord cutting and even cleaning. All of that can wait, if it's to be done at all. The healthiest thing for a baby is it's mother. The safest place, it's mother's loving arms. Especially for babies in distress, or fighting death.

Common practice calls for newborn babes to be whisked away, placed under hot lights for warmth when their mother's empty arms could provide that needed heat so much more effectively, held close to her heart.

Why? Ask that question Posh Mama! If the answer is unsatisfactory, demand your baby stay with you!

If I were going to give birth in a hospital

my moonshot list of care to request and decline would look like this....


*minimal u/s scans through pregnancy

*no induction before 42 weeks (unless evidence of fetal distress)

*no epidural

*ability to move freely

*privacy, minimal staff in attendance

*control of room lighting

*no cervical checks

*no heparin lock

*fetal monitoring with doppler only

*wear my own clothes

*have my own food & drinks

*no time constraints

*birthing ball, birthing stool

*room with a bathtub and slower

*allow waters to break naturally

*freedom to choose birthing position

*freedom for my husband or I to catch our own baby if desired

*delayed cord cutting

*keep placenta

*baby in my arms only for first few hours unless I request assistance

*spontaneous birth of placenta

*baby's own clothes and blankets

*lactation consultant, breastpump

*place for father to room in

*baby stays with me, no nursery visits

*no circumcision

*NO BOTTLES

*early discharge


Okay, so I know much of what I listed is totally against most hospital policy and would be impossible to get but like I said it's shooting for the moon. Why not?

The most important thing when negotiating for evidence-based care with an obstetrician and L&D nurses is to be calm, kind and gracious. It is a hard thing to ask people to do their job differently, or to not do it at all. Most doctors and nurses are wonderful people who love mothers and babies and the last thing you want is to create a struggle or be in a place where you feel like you are having to 'fight'. At least for me, birth is all about being soft and open, letting go and trusting. It is not the time to have to direct your energy toward controlling others. This is where having a doula for support, and working with your OB far in advance on your desires for care during birth can be extremely helpful in having everyone in agreement and on the same page.

Taking the hospital tour and hanging back afterward to chat with the nurses and ask questions can be extremely helpful too. You never know who will be on shift when you go into labor, but the chance that you could make a connection is worth it. Getting more familiar with what will be your birthing space will only help your comfort and boost your confidence.

What am I missing from my list Posh Mama's? What made your hospital birth a success, or what did you learn from a frustrating experience you would like to pass on to others? What negotiating tactics worked for you in obtaining a natural birth in a hospital setting?