Epidural Epidemic - Drugs in Labor: Are They Really Necessary. . . or Even Safe?

Epidural Epidemic - Drugs in Labor: Are They Really Necessary. . . or Even Safe?
By Joanne Dozer and Shannon Baruth
Issue 95, July/August 1999

The use of epidurals is so common today that many perinatal professionals are calling the 1990s the age of the epidural epidemic. Believed by many in the medical profession to be safe and effective, the epidural seems now to be regarded as a veritable panacea for dealing with the pain of childbirth.

It is true that most women experience pain during the course of labor. This pain can be intense and very real, even for those who have prepared for it. But pain is only one of many possible sensations and experiences that characterize the experience of giving birth. Barbara Katz Rothman, a sociologist who studies birth in America, writes that in the medical management of childbirth, the experience of the mother is viewed by physicians as pain: pain experienced and pain to be avoided.1 Having experienced childbirth ourselves, we have great compassion for women in painful labors. However, we also feel a responsibility to mothers and their babies to explore issues concerning the use of epidural anesthesia in labor issues that are seldom discussed prenatally.

Several factors make the use of epidurals potentially hazardous. The Physician’s Desk Reference cautions that local anesthetics - the type used in epidurals - rapidly cross the placenta. When used for epidural blocks, anesthesia can cause varying degrees of maternal, fetal, and neonatal toxicity which can result in the following side effects: hypotension, urinary retention, fecal and urinary incontinence, paralysis of lower extremities, loss of feeling in the limbs, headache, backache, septic meningitis, slowing of labor, increased need for forceps and vacuum deliveries, cranial nerve palsies, allergic reactions, respiratory depression, nausea, vomiting, and seizures.2 In addition, a piece of the catheter that delivers the drug into the duraregion of the back may break off and be left in the woman, a dangerous risk that necessitates surgical removal. One of the most well-known side effects of spinal anesthesia is a spinal headache. Depending on the amount of anesthetic used and how the catheter was placed, the headache can be mild or severe, lasting between one and ten days after the birth. This is not how any of us wants to feel in our first days and hours with our newborn.

Epidurals also have been linked to an overall increase in operative deliveries: cesareans, forceps deliveries, and vacuum extractions. A meta-analysis of the effects of epidural anesthesia on the rate of cesarean deliveries was undertaken by a group of physicians who examined, categorized, and analyzed all available literature. Eight primary studies revealed that the rate of cesarean section was 10 percentage points higher in the women who had received epidural anesthesia. One study actually found that the cesarean rate increased to 50 percent when the epidural was given at 2 cm dilation, 33 percent at 3 cm, and 26 percent at 4 cm.3 What caused this increase? In the first stage of labor, the muscles of the pelvic floor may become slack from the numbing effects of the epidural, causing the baby to change an otherwise ideal position or fail to descend into the pelvic cavity. In the second stage of labor, the anesthetized woman often is unable to push effectively since she cannot feel her muscles. When the baby does not descend properly or is malpositioned, progress can slow or stop, resulting in a longer labor and the increased possibility of a cesarean section, vacuum extraction, or forceps delivery.

In addition, epidurals usually slow contractions, which prompts medical personnel to administer intravenous Pitocin in order to strengthen them and increase their frequency. Even with Pitocin, which carries its own set of risks, an anesthetized labor may remain prolonged, risking a difficult labor with lack of progress. Prolonged labors put both mother and baby at greater risk of infection, necessitating the use of antibiotics. The longer a labor and slower the progress, the more likely it will end in a forceps, vacuum, or cesarean delivery. Since cesarean section is a major surgery, it strongly influences a woman’s recovery and the initiation of breastfeeding. Of course, the rate of postpartum infection is much higher with cesarean births. All vacuum extraction and forceps deliveries increase the risk of morbidity and birth injuries.

Another effect of epidurals during labor is the creation of hypotension in the mother, which can lead to bradycardia (a decrease in the heart rate) in the fetus. All types of anesthesia, including epidurals, can negatively affect the baby’s heart rate, possibly leading to fetal distress and necessitating an operative delivery. The newborn can continue to have breathing difficulties after birth, requiring supplemental oxygen or even resuscitation. While these problems may be resolved immediately following the birth, they often require the mother to be separated from her baby for neonatal nursery observation. This separation delays bonding and initial feeding. In addition, poor muscle tone and increased acidity in the baby’s blood due to bradycardia and oxygen deprivation may affect her ability to suck effectively, hampering initial attempts at early breastfeeding.

A mother’s temperature may become elevated with the use of epidural anesthesia, resulting in the infant being taken to the nursery and given a full work-up for possible infection. This may include extensive blood work and a spinal tap.4, 5

Furthermore, though epidurals usually remove all sensation in the lower body, "windows" can occur which leave the woman experiencing the intensity of her labor (perhaps on one side of her body) but with extremely limited mobility - obviously hindering her ability to cope with her contractions.6 The idea that pain medication can play a role in "natural childbirth" is deceptive, despite the assurance of the authors of What to Expect When You’re Expecting that "...wanting relief from excruciating pain is natural...therefore pain relief medication can play a role in natural childbirth."7 This is rather twisted logic, since the concept of natural childbirth depends on the mother experiencing both mental and physical sensations of labor. The epidural may allow a woman to be awake and aware of what is happening, but she will not be experiencing a natural labor as she will be numb to any physical sensations below the waist. A split between the mind and the body is effectively created with this anesthetic, disengaging her mind from her physical feelings. Could such disconnection be natural childbirth? Robbie Davis-Floyd, an anthropologist who studies birth in America, argues that the woman in labor with an epidural "...is separated as a person as effectively as she can be from the part of her that is giving birth."8 There is an eerie quality to this kind of birth; the mother is robbed of her own connection to her power and life-creative force. She loses the opportunity to experience the inherent wisdom of the body and its ability to birth without interference. Indeed, most women who have felt childbirth agree that it was a deep, enriching, and positive experience.

What alternatives do women have for the relief of pain in labor? Unfortunately, many women enter the birth experience with a strong belief that birth is something horrible and nightmarish. They are already filled with fear, not only for their own and their baby’s safety but also about what they have heard is the unbearable pain of childbirth. Another important fear is that of "losing control" during labor and delivery. A mother often is labeled out of control if she expresses the natural, primal sounds of labor. Technologically oriented medical practitioners who are sure that childbirth is something to be wrestled into submission feel that the sound of a mother wailing in pain is a sign that she is "losing it" and ought to be medicated. In hospitals, mothers are often told by well-meaning nurses to be quiet so as not to disturb the other "patients." But release of sound is a natural way to express and release painful - and intense - sensations. Suppressing a mother’s natural instincts to move around freely and make noise in labor will increase her actual pain. The prepared childbirth movement - in particular the Lamaze technique - has been successful for some women by helping them remain "in control" by training for structured labor breathing. However, some women actually do connect to their body rhythms and natural breathing patterns in labor, and if they are more loyal to themselves than to their training, they may be seen as wild, out-of-control "Lamaze failures." This failure is defined as their inability in labor to be mannerly and controlled. In fact, one of the primary psychological reasons for lack of progress and cesareans is a fearful mother’s unconscious attempts to control the intensity of her labor. Her lack of progress is due to her inability to let go and surrender. Mothers are told they must be in control when actually they need to let go.

So how does a mother let go and find her way through the pain of labor? First, she needs to give birth where she feels safe. For some women this may mean a medicalized hospital birth; others may feel safest at home or in an alternative birthing center. Most women find that they feel safest in the loving hands of a practitioner with whom they have developed a supportive and loving relationship. This person may be a special kind of doctor or it may be a midwife. Midwives specialize in personalized, supportive perinatal care. Support is the best form and prime source of non-pharmacological pain relief. Support can also come from the love and care of a partner. If you are having your baby in a hospital, it may be worthwhile to secure the help of a knowledgeable friend or a doula. Support can be active: massage, breathing together, encouraging words and attentiveness, and reassurance that what it happening is normal and that you are handling it well. Other support can be more passive: a midwife’s calm demeanor, a gentle nurse’s presence, the peaceful attentions of loved ones. A laboring mother needs to feel safe, loved, and accepted. And when she is, whether she screams, hollers, whines, moans, bargains, begs, or just plain doesn’t act "civilized," giving birth vaginally without medication is a triumph in itself.

One of the ways to endure labor is to recognize (ideally, during one’s prenatal education) the connection between fear, tension, and pain - the "fear-tension-pain syndrome." Basically, when a mother feels fear, she will be tense and experience more pain. Relaxation relieves the tension that helps create the sensation of intense pain. The notion of a relaxing labor might seem crazy, but it is possible, and we have seen it many times. Of course, a mother will feel more relaxed and safer in the birth environment of her choice and with her chosen caregivers. Perhaps the more the mother chooses about her birth environment, the more fully she can relax.

Childbirth education classes that focus on birth as natural and normal encourage women to trust the birthing process. Birthing is full of new sensations which can be frightening and difficult to integrate; some women tell us that they felt they might split in two! Understanding the reasons behind the sensations can make them more manageable, since we fear most that which we do not understand. Another key concept in prenatal education is truly believing we can birth our babies, just as women have done for ages. The world was well-populated long before modern obstetrics, and today the lowest maternal and infant mortality and morbidity rates are in the countries where natural, midwife-assisted births are the norm.

Not only can we birth our babies naturally, we can birth in our own style. Birth doesn’t need to be performed in any specific way. It is a woman’s right to create her labor her way, and she needs to be accepted for her way of doing it. She may find help in deep breathing, light breathing, dancing, singing, yelling, screaming, moaning, crying, walking, or bathing. She needs support for whatever works to assist her to birth her baby. Soaking in water can also help tremendously in reducing pain in labor. Prenatal yoga can be extremely helpful since it teaches women to relax by using deep breathing techniques and imagery. Both of these methods help her to connect more profoundly to her body and baby.

No woman should feel like a failure for having used pain relief medication during labor. There is a time and place for it in specific circumstances, and epidurals may be very effective. However, the decision to use an epidural should be an educated one, made only after all other options have been exhausted. Birthing is hard work. It is sweaty, noisy, and emotional, and it always requires our full attention. If we accept this, and stop trying to make birthing "civilized," we can help mothers to endure and cope.

Assisting a woman who is giving birth also is hard work, requiring education, love, and our full attention. Supporting birthing women in this way results in less fear, less pain, and a decrease in the need and desire for epidural anesthesia. The satisfaction of a natural birth - including the sheer endurance of pain and sometimes overwhelming sensations - is accompanied by great joy, even ecstasy. The realization of all these complex emotions is experienced not only by the mother but also by her partner and those who assist, attend, and support her in labor. The sense of joy and accomplishment from a natural birth is the right of every woman - and a wonderful gift to any newborn in those very special, first moments of life. NOTES
1. Barbara Katz Rothman, In Labor: Women and Power in the Birthplace, (New York: W.W. Norton & Company, 1991), 80
2. Sifton, David W. Ed., The Physician’s Desk Reference (Montvale, NJ: Medical Economics Company, 1996), 2318.
3. Joseph Gambone, D.O., and Katherine Kahn, M.D., "The Effect of Epidural Analgesia for Labor on the Cesarean Delivery Rate," Obstetrics and Gynecology 83, No. 6 (June 1994):1045-1052; Thorp, M.D., et. al., "Epidural Anesthesia and Cesarean Section for Dystocia: Risk Factors in Multiparas," American Journal of Perinatology 8, No. 6: 402-410; Thorp, M.D., et. al., "The Effect of Intrapartum Epidural Analgesia on Nulliparous Labor: A Randomized, Controlled, Prospective Trial," American Journal of Obstetrics and Gynecology 169, No. 4: 851-858.
4. Author’s name, "The Bad News About Epidurals," Time, March 24, 1997, page 40.
5. Fusi, et al., "Maternal Pyrexia Associated with the Use of Epidural Analgesia in Labour," Lancet 8649 (3 June 1989): 1250.
6. B.M. Morgan, S. Rehor, and P.J. Lewis, "Epidural Anesthesia for Uneventful Labor," Anesthesia 35 (1980): 57-60.
7. Arlene Eisenberg, Heidi Murkhoff, and Sandee Hathaway, What to Expect When You’re Expecting (New York: Workman Publishing, 1984), 227.
8 Robbie E. Davis-Floyd, Birth as an American Rite of Passage (Los Angeles: University of California Press, 1992), 115. OTHER REFERENCES
Griffin, Nancy. "The Epidural Express: Real Reasons Not to Jump On Board," Mothering , Spring, 1997.
Mitford, Jessica. The American Way of Birth. Dutton, New York, 1992.
Morton, Sally, Ph.D.; Williams, Mark, M.D.; Keller, Emmett, PhD.; Peaceman, M.D., et. al., "Factors that influence route of delivery - active vs. traditional labor management," American Journal of Obstetrics and Gynecology, Vol. 169, No. 4, 940-944.
Sepkowski, Lester, Ostheimer and Brazelton. "The effects of maternal epidural anesthesia on neonatal behavior during the first month," Development of Medicine and Child Neurology, 1992, 34, 1072-1080. This article was originally edited by Leslie Hauslein. Shannon Baruth is a birth assistant, apprenticing midwife, mother to Cassidy Rose (2 1/2) and Sage (14 months), and partner to Michael. She graduated from Bryn Mawr College in 1997 with a bachelor’s degree in anthropology. She resides in rural Wisconsin. Joann Dozer is a registered nurse and CPM who has been delivering babies at home for more than 20 years. A trained Gestalt therapist, she provides counseling and workshops for women and couples. Joanne is the mother of Scott, born in 1968 in a hospital delivery that included the use of Demerol and spinal anesthesia; Lianna, born in 1973 in the birthing room of an Amish midwife’s home; and Emily, born in 1976 at home with a midwife and doctor.

Homebirth Babble

Most recentlyGisele Bundchen's home birth of her son in December has been a topic of discussion. But there have been many other celebrities who've birthed at home. This is of course good for the homebirth awareness cause, but myself and some others wonder if this makes the anti-homebirth group cry "Trend!" in regards to women choosing to birth at home. Obviously, there's hardly anything trendy about the way women have been birthing since the dawn of time. However, since the big push to move birth from home to hospital and replace midwives with OBs it seems that anyone who has a natural birth even in the hospital is "primal and crazy".

If you've ever been around a group of women discussing birth, you've probably noticed a similar trend. Stories told with a life threatening complication and drama, how they had to endure this and the doctor had to do that and it was an awful horrible experience...but it was all worth it to have a healthy baby. You may have been one of these women, I know I was. I told my first birth story with excitement and enthusiasm but it wasn't that of a happy or calm birth, it was that of peril and fear; of internal monitoring and the "need" for an episiotomy that's left me forever scarred (literally and figuratively).

Now, if you've been lucky enough to talk to a group of homebirth (or even natural birthing) women, the stories are much different. They have that same excited tone and dramatic arm movements, but yet, there's a calm and tranquil quality to the woman who experienced birth in her own home. Even if a "complication" arose, they usually include how their midwife simply did X, Y or Z and the rest went smoothly.

I would love to hear these celebrity accounts of homebirth, straight from their mouths. After all, drama is their JOB, so I can only imagine how intriguing these stories are. I do hope to continue to see many more celebrities choose homebirth, and I'd love to hear more public speeches on their experiences. I also hope that the anti-homebirth movement stops claiming that homebirthing is a "trendy, new-age" idea simply because in the last CENTURY birth was taken from home.

I'd also love to hear YOUR thoughts on celebrities, homebirth and the idea of the supposed trend. What are your thoughts on it all?

The Importance of Nutrition in Pregnancy

I wanted to share an article on Nutrition in Pregnancy. We all have cravings during pregnancy and it's certainly not harmful to indulge occasionally, but it seems many care providers really aren't giving women the real deal on just how important eating healthy in pregnancy is. Enjoy the article below from an older issue of Midwifery Today.

Nutrition during Pregnancy
by Amy V. Haas

© 1995 Midwifery Today, Inc. All rights reserved.

[Editor's Note: This article first appeared in Having a Baby Today Issue 5, Spring 1995.]
Photos by Jennifer Rosenberg

The single most important thing that you can do for your baby is to eat a healthy, well-balanced diet. A well-balanced diet is one that includes foods from all food groups in appropriate amounts, so as to ensure proper nutrition. Proper nutrition ensures that all essential nutrients (carbohydrates, fats, protein, vitamins, minerals and water) are supplied to the body to maintain optimal health and well-being. Good nutrition is essential for normal organ development and functioning; normal reproduction, growth and maintenance; for optimum activity level and working efficiency; for resistance to infection and disease; and for the ability to repair bodily damage or injury. While pregnancy is a normal alternative condition for the female body, it is stressful, and all nutritional needs are increased in order to meet the needs of the pregnancy.

Dr. Tom Brewer found through more than 30 years of research that each day, pregnant women need a well-balanced, high-quality diet that includes 80 to 100 grams of protein, adequate salt (to taste), and water (to thirst), as well as calories from all of the food groups. The World Health Organization recommends that a pregnant woman eat a minimum of 75 grams of protein per day, but protein is just a marker for a nutritious diet. It must be obtained from a wide variety of whole food sources in order to get all of the important nutrients a woman needs during pregnancy. While the government's food pyramid is a good example of a well-balanced diet, pregnant women need more protein and calories in general.

This means including:

• 2 to 3 servings of meat, fish, nuts or legumes, and tofu
• 2 to 3 servings of dairy (milk, eggs, yogurt, cheese)
• 2 servings of green vegetables; 1 serving of a yellow vegetable
• 3 servings of fruit
• 3 servings of whole grain breads, cereals, or other high-complex carbohydrates
• salt to taste
• 6 to 8 glasses of clean, filtered water each day.

While this may seem like a lot of food, it will supply the 2000 to 3000 calories needed per day to make a healthy baby.

A study conducted at Harvard University found that by eating at least 75 grams of protein per day, pregnant women could prevent diseases of pregnancy such as preeclampsia (metabolic toxemia of late pregnancy). During pregnancy a woman's blood volume increases as much as 40 to 60 percent, and in order to reach this necessary level and maintain it, a woman's body needs adequate protein, salt, calcium, potassium and water from her diet. In April of 1996 the Journal of the American Medical Association published an article indicating that calcium may also help reduce the incidence of preeclampsia. Other recent research indicates that pregnant women need adequate folic acid (a B vitamin) to prevent neural tube birth defects such as spina bifida. The Food and Drug Administration now recommends that breads and pastas be fortified with folic acid to ensure that all women of childbearing age get enough of it. Four hundred micrograms of folic acid a day is recommended. This can be obtained by eating whole grain breads, citrus fruits and dark green leafy vegetables.

As long as junk food and excessive sweets (sugar) are avoided, or kept to a minimum, weight gain should not be an issue. The diet listed above (or something similar) should provide all of the necessary nutrients, and a woman should have little problem obtaining everything she needs. A "whole food" is one that is unprocessed and is as close to its natural state as possible. While vitamin supplements are very popular these days, there are risks to taking supplements of certain vitamins while pregnant (i.e., vitamin A), and others are simply poorly assimilated (i.e., calcium or iron). The B vitamins, for example, must be taken in congress (B complex supplement), as absences, insufficiencies or excesses of one or another can cause problems. Check with your care provider before taking anything while pregnant. Vitamins and minerals should be obtained from natural, whole sources whenever possible, to ensure quality and proper assimilation by the body. A qualified nutritional expert should assess special dietary needs.

Cravings for foods are common in pregnancy and, in theory, can indicate a need or deficit in a diet. Cravings for healthy foods can be indulged, but cravings for non-food substances such as clay or laundry starch, a condition known as "pica," can be harmful and should be reported to your care provider.

Milk, eggs and other dairy products are inexpensive sources of calcium and protein. For those who are vegetarian, or simply to provide variety in an omnivorous diet, soy products, beans and nuts can be substituted. Dark green vegetables provide carbohydrates, water, bulk fiber, vitamins A, C, and B, calcium, iron, and magnesium; the darker green, the better. It is best to eat these vegetables raw whenever possible, but steaming or baking will also retain most of the nutrients. Citrus and berry fruits provide a great deal of vitamin C, and yellow fruits and vegetables such as cantaloupe, sweet potato, carrots and mango are good sources of vitamin A. Both of these vitamins are important for fighting infection, boosting the immune system, cell structure development and preventing placental detachment (abruption). Zinc is another important mineral for pregnant women, as it aids in supporting the immune system. According to the Journal of the American Medical Association, zinc also helps to improve birth weight and certain aspects of fetal development.

While a vegetarian diet is a good, healthy choice when well balanced, vegetarians do have to work harder to obtain all the protein needed to increase their blood supply. If a woman follows a strict vegan diet, it may be even more difficult to get the necessary protein, but it is possible with diligence. See the supplemental reading list for sources of information on this subject.

Good Sources

Protein: chicken, fish, beef, pork, turkey, tofu, nuts, legumes (beans), milk, eggs, cottage cheese, whole grains, wheat gluten, soy cheese

Whole grains: brown rice, kasha (buckwheat groats), whole oats, whole wheat bread, whole grain cereals, quinoa, wild rice, wheat gluten, wheat germ, whole wheat pastas

Fruits: strawberries, kiwi fruit, apples, oranges, bananas, mangos, cantaloupe, pears, grapefruit, plums, nectarines, and peaches

Green vegetables: spinach, broccoli, zucchini, dark green lettuces, kale, Swiss chard, green beans, asparagus, arugula, lambs lettuce

Dairy: milk, yogurt, hard cheese, cottage cheese, egg

Other good whole foods: baked potatoes, sweet potatoes, carrots, squash, green peas, soy products, corn

Iron: red meats, organ meats, eggs, fish poultry, blackstrap molasses, cherry juice, green leafy vegetables, dried fruits (raisins, apricots, etc.)

Zinc: pumpkin seeds, squash seeds, sunflower seeds, seafood, organ meats, mushrooms, brewer's yeast, soybeans, eggs, wheat germ, meats, turkey

Folic acid: spinach, asparagus, turnip greens, Brussels sprouts, lima beans, soybeans, organ meats, brewer's yeast, root vegetables, whole grains, wheat germ, bulger wheat, kidney beans, white beans, salmon, orange juice, avocado, milk

Trained and certified as a Bradley® Method Childbirth Educator in 1995, Amy Haas' educational history includes a Bachelor of Arts in Sociology from Plattsburgh State University of New York. For the past six years she has taught Bradley® classes to pregnant families, empowering them to make healthful decisions. Amy's article, "How to Stay Healthy and Low Risk during Pregnancy and Birth" appeared in the Winter 2001 issue of Having a Baby Today. The original version of this article was shared through The Rochester Birth Network.

Sources:

• Dunne, Lavon J., ed. 1990. The Nutrition Almanac. 3rd ed. New York: Nutrition Search, Inc., McGraw-Hill Publishing.
• Brewer, Gail Sforza and Tom Brewer. 1985. What Every Pregnant Woman Should Know: The Truth about Diet and Drugs in Pregnancy. New York: Penguin Books.
• Frye, Anne. 1993. Understanding Diagnostic Testing in the Childbearing Year. 5th ed. Portland, OR: Labrys Press.
• Frye, Anne. 1995 Summer. Unraveling Toxemia. Midwifery Today 34: 22–24.
• Frye, Anne. 1995. Holistic Midwifery, Vol. 1. Portland, OR: Labrys Press.
• American Medical Association. 1996 Apr 10. JAMA. 275(14).
• American Medical Association. 1995 Aug 9. JAMA. 274(6).

Other Recommended Reading:

• The Brewer Pregnancy Hotline by Gail Sforza Krebs and Dr. Tom Brewer (http://ebooks.kalico.net/)
• Pregnancy, Children, and the Vegan Diet, by Michael Klaper, MD
• Diet for a Small Planet, by Frances Moore Lappé
• The Birth Book, by William Sears, MD, and Martha Sears, RN
• The Pregnancy Book, by William Sears, MD, Martha Sears, RN, and Linda Holt, MD

http://www.midwiferytoday.com/articles/nutritionpreg.asp

ttp://www.blueribbonbaby.org/

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2 pending homebirths

I haven't posted in a log time and I was planning, at one point, to blog about why but I've decided to just let it go.

So to bring everyone up to speed I have recently started a new adventure in the world of pregnancy and post birth working at a very popular Maternity clothing store part time. It's been very fun and fulfilling to help these women, some only weeks along in their first pregnancy.

Some clients are such regulars that I know them on a first name basis, others are one time shoppers getting a few basic things but I try to make the most out of each interaction. I've shared much breastfeeding advice and had to bite my tongue other times at things I've heard (or seen!). But all in all, I am so happy to work there, it's very good for me.

In other news, my best friend is pregnant with a baby boy and planning a homebirth. She had twin girls her first pregnancy 4 and a half years ago and had the typical hospital experience: helped along with pit, epidural, purple pushing, etc. She *did* have them vaginally which I think she's always felt was a blessing. So obviously, this is a whole new territory for her and I get to be there with her to experience it. I have yet to meet her midwife but she seems like a very sweet and smart woman. I cannot wait for this birth sometime between mid march and mid april.

There's another woman I know planning a homebirth with her second baby, a surprise package due at the end of February. She was looking for birth support through an online forum we both frequent and after meeting, we both clicked. I plan on photographing her birth as well as offering any support she may need. She's also in the care of an excellent and kind midwife.

I'm so looking forward to these experiences and feel giddy as a school girl! It seems like it's been so long since I've been around fresh new babies and even longer since I've gotten to experience this miracle with another mother.

I will continue to update on the these two births as time draws near!

Going Cloth?

So, it's been a long time coming, but we're finally converting to cloth diapers. We have a stash of about 32 prefolds and I have 2 covers in the mail on their way to me due to arrive tomorrow!! I am very excited for a few reasons.

1. We will save a TON of money by not having to buy sposies.

2. The cloth is much softer and breathable. It also doesn't contain nasty chemicals like disposables, therefore, Alexander will have a nice rash-free bum!!

3. I can reuse them. Though it will be harder for me than another mommy as I will wash by hand, you just throw them in the wash, and you're done.

4. They are good for the environment (Earth day is April 22nd!!)

5. They are CUTE!! BumGenius, Swaddlebees, Bummis Wraps...the list goes on!! Such CUTE diapers!! And, I've been finding GREAT deals at www.diaperswappers.com!! Check it out and let the addiction take over!

Those are just a FEW reasons to CD. It's not like it was 20 years ago. It isn't the hassle or the mess that people assume it to be. Sometimes, the net can give you so much info, that it makes it confusing! Why not read about going cloth is one place.

For anyone looking for more info, a cafemom wrote a WONDERFUL journal with easy to read information, including pics, on the different diapers and methods of CDing!! Find it here.

So, when you're deciding which paths to follow in parenting (breast vs. bottle, natural vs. medical birth, circumcising or not) add cloth vs. sposies to your list!! If you want to do best by your baby and best by the environment, it's really something to look in to, you may be surprised!

Why SHOULD you breast-feed?

We often hear from women how hard it is/was to breast-feed. Some of these well-meaning women may have been there themselves, but many never gave it a go OR approached it with little to no knowledge or desire. You can look up the benefits of breast-feeding and any medically based site will tout it's benefits. We all KNOW that breast-feeding your child is the best thing you can do for them, but here's some reasons why you should straight from the mouth of a mother.

Why do I think you might care what I have to say? Well, I've been on BOTH sides of the fence. Actually, I've been on both sides as well as balancing ON the fence. I have only recently been able to come to terms with some of the guilt I feel over my past choices, and I would HATE for any other woman to have to struggle with the guilt I did simply because you, like I, were uninformed.

So, here are my personal reasons on why *I* think *you* should breast-feed your baby(ies).

1. It is the biological norm- your baby's tummy is designed for consumption of breast-milk. A baby's digestive tract is sensitive and it is susceptible to bacteria. The phrase "breast is best" isn't really the best term, it should be "breast is normal", because it's the STANDARD for optimum infant health.
2. It's FREE!- When I informed my husband that I would be breast-feeding our son come hell or high water, his reaction was simple "Cool, because formula's freakin' expensive!". It wasn't until I educated him more, during my pregnancy, on the benefits of breast-feeding, and even after watching his son thrive on my milk, that he looked at it for it's many other benefits. To him, in the beginning, it was simply enough that we would save, literally, THOUSANDS of dollars by breast-feeding.
3. It's easy- it might not always be easy in the beginning, and yes, many mom's DO face hardships with nursing (though many can be avoided with good education on nursing and/or professional help from an LC) but once you've established your nursing relationship, NOTHING is easier than expose breast and attach baby. That's it, you're done! No lugging around powder, sterile water, clean bottles AND a baby! Boobs are attached, portable, and always ready to go!
4. It's soothing- and not just for baby! Yes, it's true, breast-feeding will calm a fussy baby or whiney toddler like nothing else can, but it is also quite comforting and soothing for mom, both metaphorically as well as literally. When you nurse, you release oxytocin (the feel-good bonding hormone) and seratonin (the sleepy one!) which puts you (and baby) in a state of goo-goo-ga-ga lovey bliss!
   
5. It HELPS PPD- Breast-feeding can help keep PPD (Post Partum Depression) away as well as help it to be less severe. In the event that you still experience PPD to the point of needing medication, there are medications you can take while nursing that will not hurt the baby.
6. It's educational- What? How is breast-feeding educational? Well, let me tell you! When yo breast-feed, other people will inevitably see you doing it! If you have older children, they will undoubtedly be around as you feed the baby, and if they are anything like mine, they will ask questions! This is the PERFECT time to share the beauty of breast-feeding with your children. Remember, they are the future! You can also educate OTHERS by breast-feeding. If you are breast-feeding in public, there may likely come a time when someone confronts you about it (either positively or negatively) and BOTH circumstances can prove benefitial to their breast-feeding education! If it's a negative reaction (usually pertaining to whether you are in the right for breast-feeding in public) you can give them a legal education, as almost every state has a law for breast-feeding mothers, and to my knowledge, NONE have a law AGAINST it! I carry a copy of my state's legislation in my wallet. If it is a POSITIVE encounter, you can perhaps tell an inquisitive person WHY you breast-feed, encourage them to keep going (if THEY are breast-feeding) and all in all, give them exposure to breast-feeding which is helping to remind people it's NORMAL.
7. It's fun- it really is! Especially as your child grows, breast-feeding can become acrobatic and humorous! As you gaze down at your little one suckling away at your breast, you get smiles, giggles, and even the occasional game of peek-a-boo as your baby hides in your breast. Sometimes, the world just melts away as you enter your own little world.
8. It eases baby to sleep- Instead of resorting to possibly damaging methods like CIO (Cry It Out) or having to spend hours rocking, singing or DRIVING to get your baby to go to sleep, you can simply lay with and nurse your child into a peaceful state of slumber. Granted, all babies are different, and what works for one might not work for all, but I have yet to meet a breast-feeding mother who couldn't simply lay with and nurse her little one to sleep, even into the difficult i'llkickandscreamtogetmywayandavoidbedtime toddler years.
9. It's bonding- You hear it all the time, and if you are or have been a formula/bottle feeder, it may jab you the wrong way, putting you on the defense to say "I'm BONDED with my baby! You can bottle-feed and bond ALSO!". Well, no one said you CAN'T bond with a baby despite bottle-feeding. The difference is HOW you bond and how WELL you bond. Breast-feeding gives you skin-to-skin contact, something very essential to newborn bonding. There is no other choice, if you breast-feed, you WILL be skin-to-skin with baby. Also, your breasts are attached to you, meaning there is NO option for NOT holding your baby when you feed them. Even when laying down, you are in contact with your baby. I know many bottle-feeding mothers that SWEAR they have never bottle propped, but truth be told, you WILL do it at some point, it's undeniable. It doesn't mean you ALWAYS bottle prop, but you will be much more inclined to do so, especially when you're trying to get things done and the darn baby just doesn't understand you can't drop everything for them right now! And let's not forget, baby's do learn how to hold bottles, and while they can also hold breasts, they can't exactly do it ALL on their own! Feeding is a very important time for baby, it is important that they are held, so even if you aren't nursing, please, hold your baby.
10. Your child will thank you- I have actually thanked my mother for breast-feeding me. I think it is so wonderful that she made the little sacrifices in order to provide me with the best start in life. She breast-fed me EXCLUSIVELY for my first year of life. I am so happy to know that my mom held me and cuddled me and comforted me, just like I do my son, while also providing me with the most nutritious food for me! I just recently spoke with my friend who discovered she was bottle-fed and when she asked her mom why, she said she just "wasn't comfortable doing that." My friend's response was "Gee, THANKS, mom!" (obviously she was being sarcastic). If your child is still young, they will thank you each time they nurse, just by gazing at you with that intensity, rubbing your breast as they fall to sleep. If your child is a toddler nursing, they may thank you verbally, with something like "Thanks for giving me your yummy milk, mommy!". Even if you're never given a verbal thanks, the appreciation will be there, at some point. You will know, just watching your child thrive off the milk you provide for them, that they are thankful. They are thankful they have a mommy who cares, a mommy who loves them, a mommy who sacrifices to give them the norm, the standard, the best.

If you choose not to breast-feed, I hope that you (and your child) never suffer any guilt from the decision. I say that from the bottom of my heart, having been in a position of regret. If you choose to breast-feed, make sure you have a system of support. Educate yourself in pregnancy by reading books like "The Womanly Art of Breastfeeding" (put out by LLL) or "So That's What They're For", join a group like La Leche League (membership is not required to attend meetings or even borrow from the library) and make sure if birthing in the hospital you have in your birth plan that you wish to see an LC immediately following birth. Arming yourself with knowledge PRIOR to having your baby will help you feel more confident and will also help you counter any difficulties that may arise early. It is a selfless act to breast-feed, and your baby will benefit greatly from your choice to do so!

Baby Thoughts

I've been thinking a lot lately about having a fourth child. No, no, no, I don't plan on doing it now, but I like to think about things and plan, daydream, etc.

One thing that amazes me is how far I've come from my first child, my first birth experience. I've done a complete 180. Would I even recognize that young girl in the delivery room? Legs in stirrups, flat on her back, monitor screwed into baby's scalp, doctor cutting away at her numb genitals? What would I say to that girl, if I could go back? Would I congratulate her on a beautiful baby? Would I tell her it was "Ok" to make those choices based absolutely on complete and utter naivety?

To tell you the truth, if I saw that girl, I don't think I could say a darn thing to her. I think I would sob, hang my head, and walk away. The good news is, it's impossible to ever be in that scenario (time travel not existing and all), but also because that same young girl who was so vulnerable to being taken advantage of (and basically asking for it) has changed so much since then. The dilemma that I REALLY face is telling OTHER women BEFORE they are that girl.

I've seen many women go through something like I did with baby number one, but come out of the OR after it all. Even if they escaped surgery, the wounds are still there. You can see it. Women who praise epidurals do it because they fear their own ability and they also feel as if they failed themselves. They KNOW that they are upset they couldn't birth their baby naturally (or rather, THOUGHT they couldn't). After all, how many natural birthers have heard from someone how "strong" they are, how "amazing" or that they are "a hero"? I've even been told this.

I am no super woman!!! I am simply A WOMAN. I went the route of trusting the doctor and yea, I survived and, at the time, I enjoyed my experience (for the most part), but I have since learned that trust in the doctor is trust misplaced. We need to trust in OURSELVES. We need to take responsibility for our labors, for how we will get through the pain because YES, there will be pain! You can either run from it, risking yourself and your baby, or you could embrace it, EMPOWERING yourself and sparing your baby!

The choice is yours. You can numb yourself from the beauty of childbirth or you could enjoy the amazing experience for what it is.