I wanted to share a bit of a story of  a woman’s journey in labor and birth to help you see things from a perspective that is not the norm in our area. A highly interventive hospital does not mean lots of interventions if you make some other choices that help avoid just that!


This is a first time mom who started her labor right around her due date. Her labor started with a bang! Contractions started fairly intensely lasting about 45 seconds and coming every 3 to 4 minutes. She tried laboring in the tub at home for a while, but as they escalated and were timed at 2 to 3 minutes apart lasting a full minute, she went ahead and left to go to the hospital. She had been in labor for about 4 hours at this time.
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I have a client who had an initial early ultrasound and based on that test and her last menstrual period, giving her a due date of the 26th. When she had a second ultrasound a couple of months later, the technician said that the baby was measuring a week older due to length. So, the next person she saw in her care providers’ office changed her due date- decreasing it by 6 days!


I discussed with her how important those six days may really be. In her practice they consider their patients late at 41 weeks and I knew she was shaving almost a week off of missing an induction! So, are six days really a big deal? (more…)

One of my doulas recently had this birth experience. Ironically with the same group of midwives as mine but at a different hospital. Let’s read about the dots she made sure she followed.

Labor began in the early hours of day one. She calls this the start of labor because she could no longer sleep through the contractions. She left for the hospital a little more than 9 hours later. Her contractions were 2.5 minutes apart for just at an hour and she was feeling some pressure in her bottom. (more…)

What does this mean?  The internet offers these definitions:

Definitions of Evidence-based medicine on the Web:

“One of my favorite stories concerns a Buddhist scholar and a Zen Master. The scholar had an extensive background in Buddhist Studies and was an expert on the Nirvana Sutra. He came to study with the master and after making the customary bows, asked her to teach him Zen. Then, he began to talk about his extensive doctrinal background and rambled on and on about the many sutras he had studied.

The master listened patiently and then began to make tea. When it was ready, she poured the tea into the scholar’s cup until it began to overflow and run all over the floor. The scholar saw what was happening and shouted, “Stop, stop! The cup is full; you can’t get anymore in.”

The master stopped pouring and said: “You are like this cup; you are full of ideas about Buddha’s Way. You come and ask for teaching, but your cup is full; I can’t put anything in. Before I can teach you, you’ll have to empty your cup.”

This story is and old one, but it continues to be played out in our lives day-by-day. We are so enamored of our own ideas and opinions and so trapped by our conditioning that we fill ourselves up to the brim and nothing can get in.” http://www.prairiewindzen.org/emptying_your_cup.html (more…)

Imagine you are driving down a road- it is not clear where you are going. The weather outside is beginning to be unpredictable. You turn on the radio and the commentator keeps saying he does not think the road is open ahead. In fact he says multiple times you may be able to drive down the road but that does not mean you will be able to get through this huge roadblock ahead. You may have the gas to get there- you may have a car that works to get you there- but it does not mean you will be able to get through the roadblock.

A passenger in the car may encourage you that you can do it. But all you can see ahead is a red flashing light saying STOP! TURN AROUND!

I want to share with you the language used in two births I attended recently. One was a mom attempting a VBAC (vaginal birth after a previous cesarean) and one was a first time mom having her labor augmented. I want you to consider the mind body connection and how this type of language can interfere with a mom’s ability to believe in her body- her baby- and her birth.

The doctor came into the room and after suggesting that Pitocin was needed commented, “He can get anyone to dilate but that did not mean you could get the baby to be born vaginally.”

Later he came in and said, “He was sure this baby was over 9.5 pounds and the baby’s head was molding a lot. But he was unsure if this baby really was going to fit.” (the baby weighed 8# 14 oz)

He returned an hour later and said, “He hates pushing cause he knows the damage it can do. He has to do so much reconstructive surgery on women due to pushing out big babies.”

After having to stay in the hospital all night since she was a VBAC, he made the comment, “That there was no financial viability in doing VBACs like this. It was not cost effective for him.”

He later came in and shared how awful it was to have to bump a doctor out of the OR for his planned cesarean deliveries when a mom waited til just before 7am to have her cesarean called. He told her he would not impose that schedule change on another doctor as he hated it when it was done to him. He would be calling this before he had to do that.

He was certainly surprised when only an hour or so later when she pushed her daughter our vaginally into the hands of her supportive midwife. He even said, “You certainly surprised me!”

The next mom had a doctor who was very gentle and encouraging for the most part. He would come in and although she was not progressing he would offer that she could do nothing and keep going. But he would offer the caveat that she was an older mom- she was 34 years old. How our uterus was really meant to have babies in our 20’s.

He then would return and say almost identical to the first doc, “I can get you fully dilated, but that does not mean this baby is going to fit out your vagina.”

He would encourage her to keep doing what she was doing but would end each statement with, “I don’t think this baby will fit.”

He would also offer up that in Ireland they are doing active management of labor. “The active management of labor, first introduced by O’Driscoll et al in the 1960s at the National Maternity Hospital in Dublin, Ireland,5 is a group of interventions initially devised to ensure short labors in nulliparous (never having given birth before) women. In addition, active management of labor was noted to be associated with a lower cesarean section rate,6,7 which was thought to be due to a decrease in the number of cesarean deliveries performed for dystocia. Three randomized studies have been done to evaluate the efficacy of active management of labor.8,9,10 These studies have demonstrated significant decreases in the duration of labor and the incidence of infectious morbidity, as well as a trend toward lower cesarean section rates.” What this really means is they gave moms huge amounts of Pitocin after breaking their water and pushed their labors into a short but frenzied labor. There was no discussion of how the Pitocin may effect the baby or mom. Nor was there any consideration for the type of birth experience this left the mom with. But he said it is catching momentum with doctors!

So after not progressing for several hours, this mom had her water broken and then active labor began. She did get fully dilated but after a little more than an hour with constant comments on how this baby, “was not going to fit.” and a declaration that the baby had a capput- the swelling of the soft tissue on his head, a cesarean was strongly encouraged.

I am not sure if this doctor felt the same way as the first about having his surgery schedule messed with- since the call was made just before 6am and the scheduled cesareans begin at 7am. I am unsure if this doctor was just tired of waiting. I am unsure if this mom really could not fit this baby through her pelvis. (The baby was just under 8 pounds.) I am unsure we will ever know.

But what I do know is it is hard to keep driving forward when the red flashing lights are blaring at you. It is hard to keep moving ahead when those you feel are in authority are saying you can get there but you will never make it through the roadblock that they see.

The mind body connection is a strong one. But it is also so hard when you are feeling so vulnerable. When you are second guessing your ability, when the ones you believe can guide you best are not believing the dream you had planned, it is shaky ground. It is a highly emotionally charged time. You do not know the decisions that are right all the time- when you look back later you wonder… but you have to make the decisions that feel right in that instance. It is not black and white. There is no clarity. It is easy for those on the outside to second guess your choices. It is awful when someone says you made the wrong decision. They were not there! They did not feel what you felt!

And what about the baby? What about the mom’s intuitive spirit? One mom hoped she would be able to birth her baby vaginally this time and she did. One mom had no idea she would be having a surgical birth. Some of her friends had opted to do so without labor. She had discussed this early in her labor with me. I thought it a curious conversation at the time. I wonder if her body was letting her know something. I wonder if she needed to know that laboring first before a planned cesarean had its benefits. When later she felt something just was not working, it makes me wonder if that came from her internal spirit or was it a seed this doctor had planted. We won’t ever know for sure.

But when you are driving down a road- it is not always clear where you are going. The weather can be unpredictable. Those in authority may believe you will not be able to get through this huge roadblock ahead. You must believe what you have come to believe as truth. You must shut out the negative voices around you and give it your best try. Then you will either find out they did not speak the truth for you- you either do make it through the road block or indeed it is one that is insurmountable. But what you will know is this- you gave it your best. You did not quit due to non belief.

And with that I pray you will surround yourself with voices of affirmation. I pray you will surround yourself with support along the way so you can get the information you need to make your decisions. I hope you will face your roadblocks with courage.

NEW from CIMS! “The Risks of Cesarean Section” and “A Checklist for Expectant Mothers”
CIMS’ newest fact sheet was released on Feb. 26 at the 2010 CIMS Forum

CIMS proudly announces the availability of a recently updated fact sheet “The Risks of Cesarean Section,” (PDF) which also includes “About the Risks of Cesarean Section: A Checklist for Expectant Mothers to Read During Pregnancy.”

Birth is a normal, natural, process and the vast majority of women can have safe, normal, vaginal births. While there are health conditions where a cesarean birth is necessary for the well-being of the mother or her baby, more and more mothers these days are giving birth by cesarean section for non-medical reasons. CIMS along with 20 endorsing organizations recommend that cesarean surgery be reserved for situations when potential benefits clearly outweigh potential harms. This educational material is provided by CIMS to help healthcare providers and expectant parents learn about the risks of cesarean section.

Take Action:

* Download the new Cesarean Section Fact Sheet & Mother’s Checklist (PDF)
* Purchase CDs of recorded sessions from the 2010 CIMS Forum through our A/V partner Network Communications
* Download slide presentations of select 2010 CIMS Forum sessions

There was recent conversations regarding informed consent. Often times if a mom chooses to get an epidural it will be after she has been in a situation where she is hurting and it is hard to make a decision much less read the form- so here is a form from http://www.gentlebirth.org/archives/epdrlrsk.html for you to read now so you understand the risks involved.

Epidural Consent Form

Here’s the consent form I mentioned a while back. The only thing I’d like to see added is increased c-section rate, which seems to finally be proven.

CONSENT TO EPIDURAL FOR LABOR PAIN CONTROL AND/OR CESAREAN SECTION

1. I authorize the performance upon _________ of the following

procedure ______________ performed under the direction of

______(physician’s name).

2. I consent to the administration of local anesthetics, narcotics,

and/or other medications into the epidural space.

3. I understand that the following, among others, are possible

complications or risks of the procedure and that while they are

uncommon, they have been reported in the medical literature:

-Failure to relieve pain.

-Hypotension (low blood pressure).

-Postdural puncture (spinal) headache which may require

medical therapy.

-Persistent area of numbness and/or weakness of the lower

extremities.

-Temporary nausea and vomiting.

-Breakage of needles, catheters, etc. possibly requiring

surgery.

-Hematoma (blood clot) possibly requiring surgery.

-Infection.

-Rapid absorption of local anesthetics causing dizziness

and seizures.

-Temporary total spinal anesthesia (requiring life

support systems).

-Respiratory and/or cardiac arrest (requiring life

support systems).

-Back pain.

-Fetal distress resulting from one of the above complications.

4. I consent to the performance of procedures in addition to or

different from those now contemplated, whether or not arising from

presently unforeseen conditions, which the above named doctor or his

associates or assistants including residents, may consider necessary or

advisable in the course of the procedure.

5. The nature and purpose of the procedure, possible alternative

methods of treatments, the risks involved and the possibility of

complications have been fully explained to me. I understand that no

guarantee or assurance has been given by anyone as to the results that

may be obtained.

Notes from Midwifery Today tape on epidurals

After 7 hours on an epidural, the woman’s temp is up 2.1 deg. F, which is considered a maternal fever, which requires a neonate septic workup.

Of 96 first-time moms, 0 w/o epidural had a c-sect., 25 w/ had a c-sect. Of those getting epidurals < 3 cm, 33% had c-sects, 3-4 cm, 26%, > 5 cm, 0% MORAL – try to wait until 5 cm before epidural.

Problems with epidurals: 5% got no pain relief; 5% got inadequate pain relief, often had windows of sensation, which are just as annoying as all over pain.

Epidurals require catheters, which can require antibiotics, which may interfere with nursing.

Another study of 11,000 women having epidurals showed that 18% of women had chronic backache within 6 months of birth, lasting > 3 months. Of those with chronic backache, only 10% didn’t have an epidural.

Lactation consultants say that nipples don’t get erect for 24 hours after end of epidural. Newborns can’t get a good latch. (Ref: Dr. Edie? Laurence, “Measuring Effects of Breastfeeding Success and Epidurals”, U. Rochester.)

Rare complications of epidurals: cardiac arrest, respiratory paralysis, convulsions (most often from high spinals or intravascular injection). Other complications, 9 had spinal headache for 6 weeks, 5 for a full year.

Ways to minimize risks: Choose attendant w/low -sect. rate. One study showed that 46% of primips have epidurals. 1% of “clinic” patients have c-sects. 20% or private patients. If you get an epidural, make sure the facility has emergency c-sect. available and full resuscitation team. For a first baby, posterior or VBAC, delay epidural until after active labor is well established.

Robbie Davis-Floyd says “Women’s satisfaction with the birth experience is directly related to her sense of having mastered it.”

You lose endorphins and euphoria.

Recently I gathered some information regarding the costs of an intervention filled birth and received this, “my epidural was $1500 and when it turned c/s there was an additional $600 bill for the anesthesiologist who was present during surgery. between the c/s (which there were bills from 2 different surgeons on top of my $3000 maternity care), the pediatrician bill who was present during the surgery, the 48 hour after birth stay in the hospital, etc, etc, etc….it was about $10,000 in Montana in 2007. i remember looking at the hospital bill (from the stay, not including birth “meds”) and seeing over $200 of “drugs” on the bill…which included a few pain pills, some Colace, and i think a calcium supplement.”

And a midwife in another area sent me this, “Trying to find “proof” but asking my hospital MW and nurse friends around the country, the average vaginal birth looks to be about $10,000 – without an epidural and with a 2 day hospital stay. This does NOT include the doc’s fees. A cesarean seems to be about $18,000 or so, again, not including OB or anesthesiologist’s fees (another $2000-$5000 dollars). Epidurals look to be about $2000, not including the anesthesiologist’s fees. Hope this helps!”

$17,843 was the amount of the bill from one of my students who ended up with an induction- an epidural- a cesarean and a baby who ended up in the NICU for twelve hours since she was having trouble keeping her temperature up…I do not see on the bill that she sent me that this includes the obstetrician or the anesthesiologist either.

This made me think about how when economic times are difficult a few things happen…

Folks decide that childbirth education is optional. They decide they can not afford to do the preparation for their birth experience. Childbirth preparation is not an item I would consider optional unless you are fine with a birth full of interventions. You can not expect to show up for the Olympics to race purely because you were able to obtain a uniform. It take training to get the birth you desire. It takes preparation to know the questions to ask to determine if a procedure is the one you feel informed enough to make. If you do not prepare, be prepared to hand your birth over to the medical team to make the decisions for you. Now some of you may think that is not a bad option. Just remember if your birth turns out differently than you desired- you gave up any ability to shove the blame elsewhere- it is yours to acknowledge. Kinda like complaining about the government if you don’t vote.

Some folks decide that they do not need a doula after all. But the studies show that having a doula not only enhances the mom’s view of her birth experience- but the studies show having a doula
* results in shorter labors with fewer complications
* reduces negative feelings about one’s childbirth experience
* reduces the need for Pitocin (a labor-inducing drug),
* reduces the use of forceps or vacuum extraction
* reduces cesareans
* reduces the mother’s request for pain medication and/or epidurals
* mothers who feel better about their birth experience and therefore have less postpartum depression

A study by Klaus and Kennel showed that using a doula as part of the birth team decreases the overall cesarean rate by 50%, the length of labor by 25%, the use of Oxytocin (Pitocin) by 40% and the request for an epidural by 60%.

So, how does this speak to your wallet during these times of trying to save money? Well due to insurance costs, many folks now have a deductible and then have to pay 20%- 30% of the final costs of their hospitalization. So keep in mind if the average birth in the metro area has an epidural- with the cost of an epidural being around $1500- then the cost to a couple could be $300 to $450. If a cesarean occurs the cost to a couple could be an additional $120 to $180 or more for anesthesiology alone. A complicated birth ending in a cesarean could be as much as $17,000 or more. There is an additional day stay in the hospital if not even two extra days. Now your cost could be $3400 – $5100 or more.

Now a doula can not promise you a natural, easy, non surgical birth- but certainly the studies show if that is what you desire- you have a greater chance of getting it if you hire a doula. Now the cost you saved by having a doula may have saved you a lot of money in comparison to her fee which is usually between $500 and $1000 in most areas. And you also can possibly be more assured that if you ended up with a cesarean you did what you could to avoid it by having a great support system in place.

So whether your insurance plan has a percentage you have to pay or not add the cost of a good childbirth class $250 and a doula for the cost of $600 for a doula- the total is $850 which is a far cry less than the upwards of $5000 you could pay for not having the preparation and support. A great class and a fabulous doula may not keep you out of the OR but again- these two things can certainly help do so!

Remember there are other pieces to the pie- care providers and choice of birth location play into this as well.

Keep in mind more and more insurance companies are trying to decrease costs- so some are actually reimbursing doula costs. Some even reimburse childbirth class costs. And I know that most any pretax plan often times does pay for both of these items. Often times if you ask the insurance plan if they cover doula services prior to having the baby, they will say no. But if you end up saving them money by leaving a day earlier- not having an epidural and such- they will consider paying for your doula. So, can you afford to not hire a doula?