Using Your B.R.A.I.N.

B.R.A.I.N. is an acronym that can help parents to gather information from a care provider or birth attendant when a procedure or intervention has been proposed.

First, ask the What & Why questions: What is it you are offering? Why is this being offered now? What is the expected effect/impact on my labor? What is the hoped-for outcome?

Now, dig deeper: What risks are there to this procedure? What does the procedure involve? Does it lead to or require other procedures? What are the side effects?

Next, explore other options: What are some other things we can try first? What have other people tried that might work? Is there any medical reason we couldn’t try X first? Is there any medical reason we can’t wait another (time period)?
Don’t say: “Could we…?”, that allows them to give you a yes/no answer.

Take time to go over what you now know: “We need to have some time privately to discuss what you’re telling us and make a decision, thank you.” Check in with your three ways of knowing! What is the practical information telling you? What is your self-knowing telling you? What is your gut telling you? Are you making a decision in awareness, or from fear, confusion or mistrust?

We are consenting to/declining the procedure.
We are going to wait for (time period), then revisit your recommendation.
We are going to try X for(time period), then we’ll move to your option.
We would like a second opinion.

The Dec. 2015 Home Birth Study & Understanding Risk

Many of you have seen the NYT article about the new home birth study. And, if you were a brave soul, you read through the comments, wherein a large number of people did the predictable anti-home birth flailing, this time carrying a red flag reading “This shows babies are 250% more likely to die! Make it illegal! Selfish mothers!”

Except that’s not what the math shows, at all.

First of all, lets look at the numbers the article gives- for hospital births, 1.8 deaths per 1000. For home births, 3.9 per 1000.

Now we look at what is called “Relative Risk”: The number that tells you how much something you do, such as having a home birth, can change your risk compared to your risk if you have a hospital birth. Relative risk can be expressed as a percentage decrease or a percentage increase. If something you do doesn’t change your risk, then the relative risk reduction is 0% (no difference). If something you do lowers your risk by 30% compared to someone who doesn’t take the same step, then that action reduces your relative risk by 30%. If something you do triples your risk, then your relative risk increases 300%.

3.9/1000 is a roughly 117% relative increase from 1.8/1000. Not 250%. (a 217% relative increase would be 5.9)

That means the actual relative risk is 117%.

That still sounds like a scary number, right? If you have a home birth there’s a 117% greater chance of infant death, oh no!.

Except now we look at “Absolute Risk”: The number of percentage points your own risk changes if you do an action.

1.8/1000 is .18% and 3.9/1000 is .39%, that means that there were .18% deaths in hospitals, and .39% deaths at home.  the absolute increase is .21%.    Put in layman’s terms:

The absolute increased risk of infant death in home vs hospital shown by this study is less than 1/4 of 1%. The risk of infant death in both cases is less than 1%

No matter where you give birth, there is a less than 1% chance your baby will die- and the risk in a home birth is a whopping .21% higher than in a hospital.  Not as scary as the detractors would have you believe.


Use your HSA/FSA to take childbirth classes!

Did you know that Childbirth Education is covered under most Health Spending Account or Flexible Spending Account plans? This means you can take a class, and have it paid for! The easiest way to do this is to ask your teacher for a detailed receipt for your registration fees that you can then submit to your plan for reimbursement.

Some teachers may be able to process your card on site, but you will still want a detailed receipt, in case your plan asks for documentation.

Check with your plan, or talk to your educator to find out if this is an option for you!

Breastfeeding is not Pooping

Dear clueless people responding to breastfeeding articles with “Pooping is natural too, but we don’t do it in public!” or “I don’t whip my d**k out in a restaurant, why should you get to whip out your boobs?”,

You people are kinda scary. I can’t quite wrap my brain around how you think these are equivalent, but I’ll try…

Firstly, pooping is the end result of eating, and our society rightly expects bodily waste elimination to occur in bathrooms. That’s why there’s changing tables in many bathrooms, so babies can have their butts changed in private.

Breastfeeding is not ‘naturally’ eliminating waste, breastfeeding is eating, just like every human being eats.

We watch people eating all the time. We see people shoveling food into their mouths, with sauce dribbling down their chins. We see people talking with their mouth full of half chewed food and belching. We see people laugh so hard at something their dinner companion said, wine spurts out their nose. This sort of thing happens in public every single day. Sometimes seeing people eat exposes us to things we’d rather not observe.

Last time I checked, most of us will avert our eyes when we see eating habits we consider uncouth. We’ll just ignore it, because our boundaries are our responsibility. If someone is being really gross with their belching, we might (if we’re mature adult human beings) politely ask them to stop, or ask that we be moved to another table. We take control of our actions, so that we don’t see what we don’t want to.

I’m pretty sure no one has gone to a gross eater and said “OH MY GOD, we shouldn’t have to look at that! Why can’t you go eat in the bathroom!” or “That’s just disgusting, put a blanket over your head or something!” or “Can’t you wait until you’re somewhere private to eat? Why do you have to force that on the rest of us?”. In fact, if we said those things to someone, we’d have them and the rest of the diners looking at us like we were nuts.

So why is it ok to say those things to a breastfeeding mom, just because someone is freaked out by part of a boob?

Go eat in the bathroom? Sit on the floor of (or in a chair in the corner of) a public restroom where waste germs are actively everywhere and have a meal? How many of us would actually, legitimately think that was an appropriate place for someone to consume food? “But, but…” There are no buts, you are not a motorboat. If you would be grossed out by eating a meal in a bathroom or janitors closet or stairwell, you can’t expect a mom to go feed their baby there. ESPECIALLY given that babies have weaker immune systems than adults. Would you ask someone undergoing chemo to eat in a bathroom? No? So don’t have a baby eat there.

And, lest you think that covering up is the reasonable thing to demand, go eat a whole meal with a blankie over your whole head. Go for it, I dare you. Get through a whole nourishing meal until you are full with a blanket over your head. Even better- make it a blanket you can’t control; so if it starts getting too hot, getting in your mouth or blocking your nose you have to stop eating and cry until someone fixes it for you. Oh and you can;’t tell them exactly what was wrong.

Secondly… Well, honestly, if you can’t tell the difference between displaying your primary private sexual organ in public and breastfeeding, there’s really no help for you. But I’ll try and break it down.

Newsflash: Most women aren’t “whipping it out” and letting it all hang free in the breeze for all to see when they breastfeed.

No, they aren’t. Even if you saw this one lady this one time at the mall who toootally had her whole boob hanging out, ZOMG.

For most women, nothing but the nipple and areola (the darker area around the nipple) needs to be uncovered for a baby to latch on properly, and once baby latches, you can’t see those. Babies provide better coverage than burlesque pasties.

How much of the rest of the breast shows often depends on the nursing bra being worn, the clothing being worn over the nursing bra, her breast size, how much futzing is needed to get the baby latched on, and how much skin to skin contact happens between baby and breast. 99.9% of the time, a woman breastfeeding in public will show less skin than a Victoria’s Secret ad or a Kardashian selfie. Oh, how scandalous!

The bottom line is public breastfeeding is neither shocking, tittilating or immoral.

It just isn’t. It’s how babies get fed. And if you look it closely, no one in our culture had an issue with that, up until the time formula feeding became a heavily marketed and advertised commodity in the mid 1930s. So it really has only been the last 80-85 years that breastfeeding became something weird or offensive.

So the next time you see a woman breastfeeding in public, and you think “Oh, ick!”, stop and realize that your mindset has been deeply inflenced by decades of marketing execs telling you that bottles are the normal way to feed babies.

And if you really can’t handle that part of her breast is showing while she provides nourishment and comfort to another human being, then maybe go grab the latest issue of Cosmo or something, where you can look at breasts that are actually on display for your amusement.


The Reality of Obstetric Violence

Increasingly, we are hearing more and more women speak out about abuse and violence that have happened to them at the hands of their childbirth care provider. The video of a woman having a forced episiotomy reached far beyond the usual ‘birth junkie’ circles. Another woman’s experience of being physically wrestled onto her back causing long-term pelvic injury made the local papers. These voices have become loud enough that the term ‘obstetric violence’ has entered our vocabulary.

What Does Obstetric Violence Look Like?
Obstetric violence or abuse can take on many aspects, but the core element is a blatant disrespect for, and abusive treatment of, a woman during labor, birth and/or postpartum. Looking at the general categories of abusive tactics (as articulated by domestic & relationship abuse prevention) we have- Emotional Abuse, Verbal Abuse, Physical Abuse, Economic Abuse & Sexual Abuse. Here’s how those manifest in an childbirth setting:

Emotional Abuse
Emotional abuse manifests as bullying and using scare tactics towards the mother- often with the implication that, being pregnant, she is not entirely mentally competent to make decisions, and cares more about herself than for the baby. Phrases like “I’m the doctor here, where did you get your medical degree?”, “I won’t be held responsible if something happens.”, “If your baby dies, it’ll upset the staff.” “You must not want a healthy baby.” These fear based proclamations and undermining of the mother’s wants & needs are common enough that labor support people often call it playing the dead baby card.

Verbal Abuse
Verbal abuse is found in demeaning, aggressive language towards the mother, often targeting her choices, actions and behavior during labor. “Stop yelling, you’ll upset the other moms.”, “Just get the epidural, stop trying to be a hero.” “Quit making those noises, you sound stupid.” “You’re embarrassing”. “Just do what the doctor tells you, why do you have to be so difficult?” “If you don’t hurry it up, we’re going to have to do a cesarean”. “You can’t be pregnant forever, so schedule your induction.”

Note that this language is not at all limited to the care providers, other people present at the birth may use demeaning language, especially when confronted with a laboring woman that does not meet their expected standards of behavior.

Physical Abuse
We find physical abuse when women are:

  • Denied freedom of movement during labor & birth- attached to monitors & machines confining them to bed, confined to small rooms for safety/convenience, denied access to labor/birth support tools (birth balls, birth stools, squat bars, hydrotherapy, etc), restricted to birthing in provider-approved position.
  • Denied access to nutrition & hydration- iv ‘just in case’, no food allowed, ice chips only, long hours without being able to intake any ‘fuel’.
  • Subjected to physical procedures without fully informed consent- monitoring, episiotomies, vaginal exams, amniotomy, stripped membranes, etc.
  • Denied access to their healthy newborn immediately following birth- lack of skin/skin contact, delayed breastfeeding, etc.
  • Economic Abuse
    Economic abuse exists through the systemic limitations of the US healthcare system. Women are regularly constrained in their choice of care provider and birth location to that which is approved by her insurance company. Even if she desires a different provider, or a different location, those options are denied to her unless she has the financial resources to pay out of pocket. If a woman finds herself actively in conflict with, or uncomfortable with her care provider, changing to another may be economically difficult.

    Comprehensive childbirth education and trained labor support (doulas) are likewise considered luxuries (instead of the money saving, outcome improving tools they are), and are primarily accessible only to those families in economically advantaged populations with financial resources.

    Sexual Abuse
    Discussing obstetric sexual abuse or ‘birth rape’ is often where people are the most uncomfortable. The idea that a woman’s body can be sexually violated while giving birth does not fit what most people think of as ‘rape’. However, childbirth is absolutely a sexual act that involves all of a woman’s primary sexual organs & hormones. Violation of those areas during birth will have a profound impact on a woman’s sexuality postpartum and beyond, especially if the woman (like so many) has been the victim of sexual assault previously.

    Examples of sexually violating behavior can include:

  • Exposure of genitals & body to unknown/unfamiliar people.
  • Repeated exams & touching of genitals by multiple providers.
  • Unexpected and/or ungentle touch around genitals.
  • Alteration of genital area without consent (episiotomy).
  • Comments and/or commentary about genitals, sexual acts, sexual performance/ability (“We’ll just stitch you up nice and tight for your hubby, hmm?” “Looks like you’ve got plenty of room for breastmilk in there, your husband/partner will have to share those, now!”).
  • Responding To Obstetric Violence

    Although it is not a new phenomenon, the increased voices means that the reality that obstetric violence happens, and that women legitimately can experience PTSD symptoms postpartum (and beyond) because of their birth experiences is coming out of the hush-hush shadows where “You have a healthy baby!” was a valid reason to ignore what had happened to the mother. Sadly, this has not meant (yet!) that providers are ebing held legally accountable. The woman with the pelvic injury is in litigation with the hospital, but the woman who’s assault was caught on video is representing herself in court, after being told by hundreds of lawyers she didn’t have a case- “The problem is, you don’t have any damages. Your baby is fine and you are alive.”

    It is important to acknowledge that the vast majority of providers, from OBGYNs, to Family Practitioners, to Midwives of all types, are thoughtful, respectful people who have a positive intention of supporting & serving women during birth. We must not, in pursuing a culture of openness and raw honesty about obstetric violence paint anyone, or any profession with broad brushes- even while we acknowledge the systemic issues of training, environment and mindset that can lead to condoning obstetric violence. AKA, it isn’t just “those” providers, or “that” location where obstetric violence happens.

    But, unlike domestic abuse, there’s no roadmap for helping women recognize when abuse is happening to them, or how to know that they are ‘at risk’ for obstetric violence. Because the abuse often happens in a contained time period of a few hours, even the women who are abused may brush off their experience as unimportant, or even tell themselves it didn’t really happen that way, that she’s misremembering.

    A study in 2005 found that oxytocin, the hormone in full swing during labor, increases trust levels in humans. A laboring woman flooded with oxytocin is vunerable in a way she never is anywhere else, and she may belive that what’s being done to her is correct, or in her best interests, or not abusive, because she is chemically encouraged to be trusting. Once that oxytocin glow wears off, she may feel confused and even betrayed by herself and her response to what was happening. It is vitally important that we give women a way to tell the deep, heart-true stories of their birth, not just the social contract birth story she’ll tell family and playgroup moms, but the core essence of her birth story, and have it be truly listened to. Birthing From Within offers this through their Birth Story Listening– but that’s a whole blog entry of its own!

    For Labor Day 2014, the consumer group Improving Birth created the hashtag #breakthesilence, that made a safe space for people to begin speaking out about their experiences, things they’ve witnessed, how they’ve stepped up to being working against obstetric violence. I have no doubt it’ll happen again for 2015, 2016 and further, until the cycle of obstetric violence, and societal acceptance of such as a ‘normal’ part of birth, ends.

    For more information:

    Caught on Video: Improving Birth Breaks the Silence on Abuse of Women in Maternity Care

    Forced Episiotomy: Kelly’s Story

    Telling the Truth About Childbirth

    Pain Happens, Suffering Doesn’t Need To

    There’s a lovely article out right now: “Denying the Pain of Labour Is Like Denying the Pain of Life”. In it she talks about how “pain-free birth” has become a holy grail, even among people going for a ‘natural’ birth. If you just do XYZ, your birth will be painless, or orgasmic, or some other enlightened, empowering phrase. And for the women who don’t find that enlightenment, even if they do XYZ, there’s feelings of disappointment or failure.

    The flip side of this is the people who look at the suggestion that pain is inevitable in labor, and think how HORRIBLE and CRUEL it is to make a woman go through such misery. This viewpoint is especially prevalent in some feminist circles, who find the idea of experiencing pain in childbirth as a barbaric throwback to the days when easing pain in childbirth was actually illegal because of the “punishment of Eve”. It also occurs in traditional care provider circles because they have been taught that pain is the enemy, something to be defeated.

    But what they are talking about, what they and every single birth professional, be they in home, hospital or birth center, is rightly against is not pain, but suffering.

    Suffering is when the experience of pain overwhelms us, when we start telling ourselves negative stories about what the experience is, when our coping skills are overwhelmed.
    We have, all of us, experienced pain without suffering. How many of us have cut ourselves shaving, and it didn’t start hurting until we saw the blood? Or the bruise on some body part that you discover later, but you have no idea when or how it happened? It’s a bruise, pain signals from the damaged area had to go from there to the brain, but you weren’t aware of them. What about smacking your thumb with a hammer? The ‘coping skills’ people use for that (yelling swearing, hopping up and down, grabbing the affected hand) are so common, they’re used in cartoon and comedy. We’ve gotten through broken bones, bruised shins, cuts, bumps, scrapes, scraps and other painful mayhem by drawing on our own, inborn coping skills, and our body’s natural response to pain.

    Take, for example, getting a tattoo. It hurts, right? Getting little needles poked into your skin at high speed is not going to be without pain. And yet people do it all the time, sometimes in amazingly intense hours-long sessions. How? If you watch someone getting a tattoo, you often see the same coping skills that women use in labor; deep or naturally patterned breathing, eyes closed inward focus or eyes focused on a specific point, external distractions. And if you talk to someone after a tattoo, they may describe feeling “euphoric” or “floaty” or even “orgasmic”. That’s because they were able to use their body’s natural response to pain,endorphins, to get through.

    Or what about a marathon runner? Labor is often compared to marathon running- lots of hard physical work, ups and downs and breaks, and an exhausting but exhilarating finish. No one denies that marathon runners go through physical pain when running, and yet, no one suggest that they should take medication at the soonest opportunity, or that they are suffering for ‘no reason’ or are ‘trying to be a hero” or just out to ‘win a medal’. In fact, their perseverance, focus and drive are often lauded and celebrated.

    So how do those runners get through their marathons without suffering? Training and education. They’ve done things to help their body prepare physically for the marathon, they know how their body is going to respond to the challenges of the event, and they’ve learned skills that will help them meet each challenge as it comes. And they, too, rely on endorphins to get up and over the pain.

    Fear leads to Suffering

    Quotes from Master Yoda aside, one thing both the tattooee and the marathoner have been able to do is overcome fear. Remember when we talked about all the things that have caused pain, but we’ve not noticed them or ignored them or powered through? Part of the reason we coped with those experiences is because we were not afraid.

    When we experience fear (even when we know we are ‘safe’, like watching a horror movie), our body floods us with hormones that get is ready to either run like heck, or put up a fight. And those hormones override endorphins, because if we’re going to be running or fighting, we need to not be loopy on natural painkillers.

    In labor, that Fight or Flight response directly interferes with the birth process (In a whole lot of complex ways, that’s a complete blog post of its own!) and increases pain. Increased pain when someone is experiencing fear, increases the fear, increasing the pain, until the coping skills are overwhelmed, and suffering sets in.

    So a key element to childbirth preparation is learning how to recognize and face potential fear triggers in labor, learning what your own reflexive, already existing coping skills and resources are, and learning to draw on those coping skills at any point during labor.

    By educating women about labor and birth, by validating their concerns and helping them recognize their coping skills and resources, by giving them tools to respond to the pain of labor without fear, by giving them skilled support in labor (and not expecting partners to be professional Coaches, and allowing partners to be supported in what is their birth, too!), we set women up for experiencing labor and birth without suffering.

    Through giving all birthing women these resources we make it so that, if or when medical supports become a part of birth, or a woman reaches a point where she feels she’s tapped out her coping skills and requests medication, she’s done so in complete awareness of her body and her choices, and she can make decisions without doubt or fear of ‘failure’.

    Actually, It’s About Ethics In Placenta Encapsulation

    Controversy skittered through my world recently, when some birth work organizations started using statements and advertising that implied theirs was the One Right And True Way to do placenta encapsulation- and everyone else was dangerous and unsafe.

    A quick lesson- placenta encapsulation is the act of taking the human placenta, and preparing it so that it can be put into gelatin capsules and taken postnatally like a vitamin. It is, (According to the proponents, because it hasn’t had enough money thrown at it to warrant hard science studies. However, the circumstantial evidence supports the practice, and early studies are starting to happen.) a way to get the nutrient benefit of the placenta, without needing to eat it like an organ meat- which seriously hits most people’s squick factor.

    Anyhow, encapsulation is a growing practice, with the attendant range of provider skill level that happens when a practice is ‘new’. Everyone in the birth community knows this, and discussions about ensuring health, safety, proper procedure and such happen regularly. Where I am, people have stepped up to make sure that birth workers who want to offer encapsulation can learn how to do so in a way that would make anyone with OSHA proud.

    So when these new peeps came along, using words like “transparency” and “clear boundaries” to describe their service, with other language that implied that using Other Services might do things like give you someone else’s dried up placenta, or something that isn’t really placenta…people generally reacted with a resounding “Buh?”

    It really is one thing to say “We offer placenta encapsulation (or any other birth service!), and here’s the standard of practice we use in that service”, and another thing entirely to say “If you don’t use our service, here’s all the Horrible Things that might happen to you!!”

    That is a strong example of fear-based language, so much like what we ‘birth junkies’ rail at coming out of some obstetric staff: “Well, you could give birth standing up, but I won’t be held responsible if something goes wrong!” “You don’t want something to happen to the baby, do you?!?”

    It also deliberately tries to throw doubt on the practices and integrity of anyone doing a birth service that didn’t go through them- and that’s just a smarmy business practice, especially since there’s never been any indication of unsafe, unethical or shady actions by placenta encapsulators, no hint that people are hoarding or mass processing placentas, no sign of being given fake placenta pills.

    It is mud flinging, pure and simple, and that’s sad to see happening in the birth world. Supporting physiologic birth is about uplifting the community, not ‘throwing shade’ at people who took a different route than you. This isn’t political campaigning, we don’t need to act like it.

    Given all this, if you decide you want your placenta encapsulated, how do you do about finding the right person?

    • Research who’s in your area, look for testimonials
    • Ask other women who they’ve used
    • Ask about procedure- How do they get the placenta from your birth place (some birth places have rules about this!)? Where do they prepare it? What’s the ‘turn around time’? How do they follow safe handling practices?
    • Decide what you want out of the service
    • Hire someone!

    Remember, there’s a big difference between “Use our service, we do things this way, and here’s why we think that is good!” and “Use our service, because the other guys are doing it wrong!” 

    What the *Bleep* is “Natural Childbirth” Anyhow?

    Title of this post shamelessly stolen from a comment by another local birth professional.

    You hear this quite often in the childbirth world. “I want a ‘natural childbirth'”, “She’s trying for a ‘natural childbirth’. In general, they mean that a woman wants to give birth without pain medication, especially an epidural. They are laying a claim to “Birth the way nature intended!”.

    But is supported birth, that is: Birth where outside interventions are used to support & influence the health and well-being of the mother and/or baby really “unnatural”? I don’t think so, at all.

    To be clear, I am talking here about needed and necessary interventions. Certainly there’s much to be said about the over use of interventions, and the increased pressure women feel to utilize interventions when in a hospital setting; that is a major issue that needs addressed, but not here and now.

    When an intervention is used thoughtfully, with clear intention, to address a particular need happening in a woman’s labor, then that intervention is an asset that shouldn’t be discounted. Nor are interventions limited to the hospital or birth center setting- midwives also have interventions they use regularly during labor. Some count those as less ‘invasive’ or ‘unnatural’ because many are not Western Medicine based- that doesn’t make them any less of an introduced intervention. They are still an outside influence on the physiologic process of birth.

    Natural Birth as this mythic ideal of the perfect birth is a dangerous precedent. Do hands off, unmedicated, perfect births happen? Absolutely, they can and do happen. But by promoting an idealized image as natural, we default label women who don’t meet that ideal as unnatural. We set them up for feeling shame, guilt and failure over not being able to “go natural”. We open up the door for them to doubt their own feelings, choices and experiences.

    Imagine a woman having a ‘natural’ childbirth- she’s labored without significant medical supports (aside from intermittent EFM, and a vaginal exam or two) for hours, and has just reached Transition. The intensity and pain is overwhelming for her, and for her partner and they find that the comfort measures they know aren’t effective anymore. The nurse offers a dose of IV narcotic and she accepts, feeling this is the best next step for her to take. The relaxing impact of the narcotic is so effective, she births a 8+lb baby less than an hour later, with only a small episiotomy.

    Did taking that narcotic (and having a small episiotomy on a primapara with an 8lb baby) magically cause her childbirth to become unnatural? Baby still came out, her body was still working hard for hours, the physiologic process of birth still occured- Nature still Happened. But some around her console her for not “being able to go natural”, as if, by her choice, she’d done something wrong, and failed at having a natural birth. She’s led to doubt herself, and her birth experience. Should she have toughed it out? Was she a wimp? Did the nurse pressure her into drugs she didn’t really want? Where did she go wrong?

    There’s a dozen “But ifs…”, that could have happend: But if she’d had more support in transition. But if she’d changed positions. But if she’d had more childbirth preparation so she knew Transition was coming…butifbutifbutif… she may not have felt she needed a medical-based intervention. Speculation doesn’t help us, and it certainly doesn’t help her. Coping and responding to a need is using the resources available too you in that moment.

    The focus then, shouldn’t be on promoting a Natural Childbirth ideal, but on what I call “Baby Steps” childbirth:

    When a need arises in childbirth, apply the appropriate resources; starting with the least invasive possible, and then working up from there.

    The idea is to fuss with the physiological process of birth as little as possible, and take baby steps when increasing the amount of fussing being done.

    Care providers & support people who utilize & encourage the use of smaller tools before getting out the big guns, send a message to the laboring woman that they believe in physiologic birth as a functioning, well-designed process, and that supporting that process doesn’t automatically require lots of bells and whistles and medications and monitors, but they are willing to draw on their tools as appropriate. Women who are given supportive access to a wide range of tools, can be more confident and secure in the choices they make during labor and birth, because they know they are making appropriate decisions in each moment.

    By going for the least-interventive tools in the birth toolbag first, we can know that everything has been tried if and when the big tools need to be used. A woman who has been supported in non-pharmocological means of pain-coping, can know that she is making a compassionate and appropriate choice for herself if she moves to an epidural, or other medical means of pain reduction. When her care provider has been supportive, and has been noticeably using the least-invasive tools through labor, then if they do recommend something more invasive, there’s a sense of trust that it is the most appropriate step to take.

    It’s like if you know your IT person has done everything possible to pull a virus from your computer, and then tells you they’re going to have to reformat the hard drive- you’re still going to be upset that the drive needs formatting, but you’ll likely be less angry and upset over it than if the IT whiz had just waltzed in and said “Oh, that’ll need formatted”, without ever trying anything else.

    The bottom line is that the path of labor and birth is going to be different for every single woman, and every single woman is going to need something different- we shouldn’t be setting up any type of birth as the ideal.

    We can still make the effort to improve maternity care, and push for changes where interventions and invasive procedures have become routine and the norm, rather than applied appropriately to individual cases, but that is very different from setting a birth up on a pedestal and calling it perfect.

    But what about induction? Induction is a very specific intervention, that is ideally only used when nature isn’t working- it artificially kickstarts the physiologic process, and sometimes artificial oxytocin flow is needed to maintain the entire process until birth. Like other interventions, the over-use of induction is an entirely different discussion.

    Isn’t Cesarean Section unnatural? Technically, yes, a surgical birth is ‘unnatural’, because the physiologic process of birth is bypassed to bring the baby out of the uterus directly through the abdominal wall. However, it is still a birth, and the whole motivation behind this post was that I find the implication of labeling someone’s birth as ‘unnatural’ to be pretty darn offensive.

    Vaccination Information

    While I’m sticking my neck out elsewhere, I might as well do it here. This was in response to the question “So just to be clear, you think it is unethical or dangerous to ask parents to research or question vaccines?”

    Since most anti-vaccine sites provide dangerous, unscientific and ethically questionable information it isn’t really ‘research’. I think that professionals directing parents to these sites– who overtly or outwardly suggest that there is anything dangerous or controversial about vaccines that parents need to ‘research’ or ‘learn the truth’ about, who imply that vaccines are something to be afraid of– are misguided, and are contributing to the decline of the public health safety net.

    If that’s what you mean by ‘dangerous and unethical’ then yes. If you mean showing parents where they can get scientifically accurate, myth-dispelling information that isn’t full of fear mongoring and conspiracy theories, then no.

    As an adjunct, since many of the professionals who provide these questionable sites to women, are also members of the natural/low intervention/out of hospital birth community, I think they are contributing to the damaging image of that community as unsafe, dangerous and full of unqualified practitioners.

    I think it is time for midwives, doulas, CBE’s etc who are pro-vaccination to start speaking out because it is unfair that we are being tarred with the same brush.

    A very well done breakdown of some of the anti-vaccination myths & fears is found HERE

    You wanna steam your what??

    The latest thing skittering across my feeds is the idea of vaginal steaming. In this, a woman sits over a hot herbal infusion, letting the steam rise up and, supposedly, enter the vagina, traveling up to the uterus, and carrying the beneficial, relaxing, cleansing properties of those herbs into your ladybits.

    On the surface, this sounds like a Good Idea- we use steam for all sorts of cleansing & soothing purposes all over our bodies. So steaming your vagina must be ok, right?

    Thing is, the labia and vagina are really good at Keeping Things Out.

    We talk about it all the time in relationship to birth- sitting in a bath after your water breaks is ok, because the water isn’t going to travel up your vagina, putting things in your vagina can introduce bacteria, which is why you should limit exams in labor, but just having the area uncovered doesn’t suddenly make things ‘unsterile’, cautions against douching because it mucks with your natural vaginal biome, and how it is difficult for things to accidentally go up the vagina, when the design is made for things to come out.

    So how would the steam get up in there, anyhow? Even with the legs spread, the labia will act as a barrier (so, arguably, you’d have to sit there holding the labia open… kinda uncomfortable after a while?), and the vagina itself isn’t just an open-wide tube, even for women who have given birth previously. There’s folds and folds of tissue that only become open when something is actively moving that tissue aside. (Gently poke around sometime… you can feel the tissues moving out of the way. This is why doctors use speculums. So, I suppose you could use one of those to hold things open, but it that really going to be soothing and relaxing?)

    So, sitting over a pot of herbal steam, you would get the labia, perenium and anus nice and warm, you might get the first bit of vagina steamy, but it would be really really hard for normally rising steam to make its way past the labia and deep into the vagina, let alone all the way up into your uterus.

    It just doesn’t make any sense. Sitz baths, those are different because they are being applied to external, easily accessed tissues. But unless you’re doing something like forcing the steam up the vagina (bad idea!) the mechanics of it just don’t fly. It will increase blood flow to the genital area, which is not bad for relaxation in general, but if you’re not watching the temp of the steam you could end up with burns, which would oh so defeat the purpose.

    The only thing designed to travel up the vagina to the uterus are sperm, and even after billions of years of perfecting their travel plans, most of them still die before getting anywhere- I don’t think steam is going to do any better.

    If you really want your vagina to be relaxed, take a nice warm bath (you can even toss some of those herbs in there), and then have an orgasm or two. The muscle spasms, plus the release of fluid will help clean the vaginal tissue, and the oxytocin and endorphins will make you feel nice and floaty.