TThe Importance and Function of Vit C in a Pregnant Woman’s DietVitamin C is a water soluble vitamin, which means we do not store it in our bodies long. Because of this, we must eat sources of vitamin C frequently throughout our day to be well. Also, it is a bit of a “fragile” vitamin, depleted from our bodies by stress, and it is sensitive to air, light and heat. Vitamin C is one of the most important antioxidants found in nature. That means that it fights free radicals in your blood stream, and makes it so that they cannot do damage to your cells. Vitamin C is essential to the health of your body’s cells, as a matter of fact, and in the integrity of the space BETWEEN the cells. It helps your body to produce collagen, which is a protein that your body needs to form connective tissue in ligaments (your uterus is slung by ligaments!), skin, and bones. If you are careful to eat adequate amounts of Vitamin C in your diet during pregnancy, your tissue is less likely to tear when you push your baby out. It also means that you are less likely to hemorrhage AFTER birth. Eating a diet high in sources of vitamin C means that you will build a healthy placenta, have healthier and stronger blood vessel walls (which means that you are likely to have varicosities and hemorrhoids), and it also means that you will have fewer stretch marks at the end of pregnancy as well as having tissue that bounces back and regains its shape more quickly after pregnancy!
One of the benefits of adequate intake of Vitamin C during pregnancy is that your amniotic sac is dependent on it to stay intact during labor. Since your amniotic sac acts as a hydraulic system and protects you and the baby both from contractions, and protects both you and the baby from infection, it is a good thing to avoid being in the 11% of women who begin labor with a spontaneous rupture of membranes. One easy way to do this is to build strong amniotic membranes by feeding your body enough Vitamin C from the beginning of pregnancy on!
Having adequate Vitamin C in your diet also means that your baby’s cells (and the space between them), bones, skin, and blood vessels will be in better shape at birth and in early infancy. After birth, continuing to eat good amounts of Vitamin C will mean that your body has plenty to access to add to your breast milk, ensuring that your baby continues to get adequate Vitamin C to be well, this time in its milk.
Getting more than 2,000mg of Vitamin C in a day can put a pregnant woman at risk of miscarriage or premature birth, and can actually cause a dependency in the newborn baby! That said, eating FOODS rich in Vitamin C, rather than supplementing with a pill, makes it more difficult to overdose on the vitamin, as you tend to feel full well before you reach a dangerous level vitamins! Use Google to find a list of foods rich in Vitamin C. Some of them may surprise you! Try to vary where you get your Vitamin C, as having a varied diet ensures that you get a wide variety of vitamins, minerals, micronutrients, and antioxidants for your body to utilize.
I saw a link to this on Facebook, where a doula friend of mine had posted it. http://pregnancy.about.com/cs/interventions/a/vaginalexam.htmIt got me to thinking about a birth that I attended over the winter at a local very urban teaching hospital, where people who call themselves midwives practice. Like the mother I will tell you about, many of the women who choose to birth with the midwives there are lured in because the hospital offers the option of water BIRTH not just laboring in the water. I have YET to see or hear of the tub actually making it out of the closet, even when plenty of time and healthy babies present themselves. The mother had gone that day for her 37 week visit, and the midwife had asked the nurse to set up for a vaginal exam. This was not the midwife the woman usually saw, so she was less comfortable asking questions before the procedure, and frankly, she was eager to find out (even though she knew that it wasn’t at all indicative of when she’d have the baby) how “far” she was. When she called me later, it was to ask me about bleeding, and to tell me that she had just had the most violent vaginal exam she could remember, ever, I asked her if the midwife told her she was going to, or asked her permission (*gasp*) to “strip her membranes.” She said no, that nothing of the sort had been mentioned. The midwife had only said that she was nearly two centimeters dilated, and that she was soft and getting thin. Let me tell you, Friends: MOST practitioners who routinely do vaginal exams have started to strip membranes at 37 or 38 weeks, routinely, as well. And I have yet to hear of a practitioner who asked permission to do this potentially infection causing and water breaking procedure. They are reaching a finger through the cervix, into the opening to the uterus. When they get there, they are separating the amniotic sac from the uterus as far up as they can reach with their finger, which releases prostiglandins, making it more likely that you will go into labor on average up to ten days sooner than you would otherwise. Why, you might ask, is having a baby ten days sooner than they would otherwise have been born a bad thing? Well, Friends, you may be forgetting that your babies each cook at their own individual rate, so to speak. Every single human in this world is different. We have different eyes, different finger prints, our femurs and our toes are all different lengths. So are the lengths of our gestation. They are individualized to our own specific needs. So, when that is fast forwarded, do you think that it may increase the number of babies in the Special Care nursery because they are not breathing correctly, or are having other issues?Also, there is the danger of infection (germs don’t travel up into the uterus unless they are pushed there, a finger going up there is definitely a risk factor for uterine or blood infections…blood infections because after the placenta is birthed you have a dinner plate sized wound wide open for germs to invade). This can cause bad things to happen, all the way up to still birth. Is that worth having the baby early? Wouldn’t be to me.This particular Mama, who started my story, actually went into labor that night, and had her baby vaginally (she got there pushing—which wasn’t the plan, as she wanted a water birth, and needed time to fill the tub once she got ther—she had a fast birth). She had hoped for a low intervention experience, which is one of the reasons she chose midwives. Apparently that wasn’t the case. Even though she got there pushing, the vaginal exam earlier that day had been the biggest intervention in the whole labor and birth…it started labor before she was ready. I say this because if she had been ready to give birth, she would already have been in labor, and wouldn’t have needed stripped membranes to do it for her.Other risks involved could have been a cesarean section, or an instrumental birth. Why? Because when you try to force your body into labor before it was ready to go into labor, you not have completed the processes you needed to complete to let the baby pass through the pelvis. For instance, you release a HUGE amount of relaxin (the hormone that causes your joints to get all gooey and loose…and your pelvis is full of joints) in your third trimester, but especially at the very end, when you are gearing up to go into labor. If you haven’t released this last big burst of relaxin you may not have left your baby the room it needs to pass through the pelvis. So, you may mostly dilate but the baby truly cannot get through the pelvis. Does this mean that NO baby can ever get through your pelvis? Nope. Not at all. It means that if you (and your care provider) had let the baby come when the BABY and your BODY were ready for labor, as opposed to the care provider’s timeline, the strong likelihood is that you would have had a vaginal birth.Notice I mention that YOU could have let the baby come on it’s own timeline? I am not placing blame, per se. I am, however, positing that you can and SHOULD take active part in the care you receive during your pregnancy, labor, and birth. If there is no real reason (and there hardly ever is) that you need to do a vaginal exam to check your cervix at the end of pregnancy, why let your care provider do it? If it’s cause you’re scared to say “No, thank you, I’ve decided against that.” you need to do some self talk and grow some courage. This isn’t just YOUR birth we’re talking about, it’s your baby’s too. If you and your care provider let your baby come on your baby’s own timeline, especially in a hospital environment, it will mean that they are more likely to stay with you in the immediate post partum period. Because they will be READY for the stresses of labor and birth and life on the outside, they will better be able to respond in an appropriate manner. So…if and when your care provider sends staff in to hand you the dreaded paper drape and tell you to disrobe from the waist down, think before you blindly do so. Consider just saying, “No thank you.” OR at the very least, ask some pointed questions. Ask about the risk, ask for studies to back it up. Make sure to talk to your practitioner before they do the exam and make sure that if you decide to go ahead with the exam but want to refuse to have your membranes stripped, they document that you refused consent to having your membranes stripped in your chart. A gentle vaginal exam should not be tortuous. It should NOT cause you to bleed large amounts. If those things happen, it is very likely that you had your membranes stripped without your permission. Membrane stripping is a procedure, and as such, you should give fully informed consent before having that procedure done. That practitioners are doing so without patient’s knowledge, let alone consent, is really criminal, especially with the possible side effects of ruptured membranes and/or infection and babies being born before they were ready and suffering for it in the post partum period.So, at the end of your pregnancy, please, knowing that having that vaginal exam tells you exactly nothing but where you are at that very moment, please consider whether having your membranes stripped without your knowledge is worth the exam. And act accordingly.
Oh, and another thing. Friday I got home from a full (HOT) day of pre and post natals at about seven pm to find an email in my inbox from a woman who was exclusively pumping and bottle feeding because she was told that there was a transfer issue that just could not be resolved and she could pump or formula feed, but those were her only choices. She contacted me not about that, though, but instead because one of her breasts were FULL of plugs that she could not get out, and she was losing her supply. She was desperate to continue giving her baby breastmilk, and could I help her. A vital piece of information here is that she had continued to put the baby to the breast at least once a day, so that she was still accustomed to the feel of the breast and to latching.
I asked her if there was a reason she couldn’t just have the BABY resolve the plugs, as they are much more efficient than a pump at emptying a breast. She explained about the transfer issue. I asked her whether she had had her latch evaluated lately. She said that she had a month ago by the LC at the hospital, but no, not recently. I asked her if she would mind letting me take a look at her latch, that it was possible that I could help get the baby back to the breast. She said that, yes, she would be willing to do that. I had a family commitment most of the day Saturday, and my family wasn’t home right then, so I asked whether I could come right then, as I’d like to get those plugs resolved right away if we could. She excitedly said yes.
Within about fifteen minutes of being there, the baby was latched well and draining the breast. The mother looked at me in amazement and said, “You know, the LC spent TWO AND A HALF hours with me and didn’t fix anything. When I asked if I should call LLL, she said, ‘Oh, no, they don’t have the TRAINING to handle something as extensive as this.’ It seems that she was wrong. How is it, though, that you know how to fix this and she doesn’t?”
Here’s where the snobbery and politics come in. *sigh* A LC CAN know her stuff. The problem is that they might not. Typically a hospital based LC is a nurse who wanted to make a little more money and so did a correspondence course to earn her credentials. Again, this does not mean that she is bad…just that she may never have breastfed her own baby at all, and if so, was likely to have breastfed for a short time only, as is the case with most women in the US. She may never have had any hands on training.
A La Leche League Leader must have breastfed at least one baby for at least one year. Right there, we have an element of “yes, I’ve been there, I know, it’s really hard, but it can be overcome.” Second a LLL Leader must go through extensive training, which involves hands on training, dialogue with a state level trainer, and weekly meetings with their sponsoring Leader. There is also an extensive list of books they must read and be able to comment on intelligently. The training typically lasts at least a year, and ends with an oral exam face to face with a sponsoring Leader, to be sure that the Applicant can problem solve and support mothers effectively.
The gold standard for breastfeeding support is an IBCLC, or an “Internationally Board Certified Lactation Consultant.” If the LC doesn’t have the “IBC” before the “LC” she is NOT the gold standard in breastfeeding support. An IBCLC must have 4-5000 hours of hands on training before she is allowed to sit for his or her exam. One of the pathways to becoming an IBCLC is to be a LLL Leader for five years, as the International Board considers the work a LLL Leader does to be hands on training. An IBCLC is who I would go to if I could not fix a problem (and couldn’t get in touch with Jack Newman, who tends to be very available by email) and had tried everything I and other Leaders in my network could think of and research to do so.
It makes me sad that there is apparently “class warfare” going on when it comes to breastfeeding support. Why, when the hospital based LC could not fix a problem, did she not think LLL could at least give it a go? Or, why didn’t she seek help from an IBCLC? Is her hubris so great that she cannot ask for help, and the health and well being of a baby is worth her saving face? How sad. L
In the end, it just so happens that a LLL Leader WAS trained (in this case through continuing education with Jack Newman) to deal with the transfer issue. And you know what? This baby is EXCLUSIVELY fed at the breast now, and is continuing to gain weight…after a month of her mother pumping and bottle feeding. And if I couldn’t fix the problem, I care enough about mothers and babies and their breastfeeding relationship to continue to look for an answer for them. Friends, if you cannot find a LC who can help you, please, PLEASE do keep looking. Call LLL first (they are free), and then if they can’t help seek an IBCLC. It is likely that you CAN find a fix for your problem.
I attended a birth this past week. It ended with a vaginal birth, despite many attempts by the caregivers to derail it…to the point where we arrived at the hospital with the mother +2 and pushing, and an hour and a half later the OB (who was only supposed to be there to literally catch, as the midwife has been injured, but was the practitioner on the case) walked in, put her finger TIPS on the woman’s belly, and said, “Well, you have a big baby, you have been here for an hour and a half. I really don’t think you can have this baby vaginally. You’ll have to have a cesarean. I mean, I only want to have a good outcome and in this case a good outcome is a healthy baby.” The midwife took her out in the hallway and gave her what for, and in the end the mother birthed vaginally.
Let’s look at this more closely, though. Why, when we arrived at the hospital at +2, was the baby still inside of Mama an hour and a half later? I had a “Cave Birther” on my hands. Many women, when getting to the hospital in early labor, will stall out with the bright lights, the blood draws, and the list of questions. But this particular Mama was PUSHING when she got there, and typically that doesn’t stop for God or Anybody. What gives? Cave Birthers are the most sensitive of all the birthers I attend. They are bothered in all stages of labor by change, conversation, the presence of strangers, the presence of “new energy” in the room, by lights being turned on…anything that is not their safe, warm, close, familiar birthing environment. We got to the hospital and she had been actively pushing in the car, with contractions that were perhaps three minutes apart. By the time we got out of triage, they were more like 7-8 minutes apart, and really quite short. By the time the midwife called the doc in to catch, it had been an hour and a half of very few contractions. The woman said no thank you to the cesarean, and the doc left for a while, to “see what progress she could make, if any.”
I got the mama up out of the bed, turned off the lights, and had her start walking and doing lunges, and after a few lunges, she got into a good pattern again. She immediately dropped herself into a squat and roared like nobody’s business. After ten minutes of this, she started to crown up. Wonderous, for a woman who “couldn’t have a vaginal birth because the baby was so big,” don’t you think? An hour later, her baby in arms, she looked at me and said, “When the doctor came in, I really didn’t think I’d be having a vaginal birth.” I looked back at her and said, “I knew you could do it all along. We don’t grow babies we can’t birth.” The doctor looked at me with a very puzzled look on her face and said, as she walked out the door, “I didn’t think you could do it, either. I’m really surprised.” Really? I wouldn’t have guessed.
Again, this goes to believing in the intrinsic ability of a woman’s body to work the way it is supposed to work. It has done so for millennia, why, all of a sudden, can American women not have their babies vaginally? So much of it has to do with the practitioners and their belief in the wisdom of women’s bodies. Or their lack thereof. Please, do have a conversation with your care providers. If they are saying they’ll let you “try,” or that you can “certainly” have a vaginal birth…”as long as you meet the criteria.” Hmmmm. Does the criteria involve being induced, which dramatically reduces your likelihood of having a vaginal birth? Does it involve non stress tests? Or ultrasounds to determine weight (so grossly inaccurate at the end of pregnancy that it can be laughable) or fluid levels (same story)? Good things to ask, before you decide to but your trust in a care provider. Take a good OUT of hospital childbirth ed class. Trust your body. Trust your body. Trust your baby to be a team member. Trust your body. It has a wisdom, you just have to listen to it.
Oh, and in any case, make sure you have read as much as your brain will hold, and get a doula. In this birth climate, it’s just that much more insurance that you will have a birth that is more like the one you hope to have.
Sorry, friends. J I try to make this a weekly thing. It turns out that when one is too busy to boot up the computer, it’s hard to write more than quarterly!! On to the topic. VBAC and the support of women in hospital. I returned from a VBAC birth last night. I was exhausted…I was there for 29 hours, supporting the couple and particularly Mama while she labored. She actually had the “stereotypical VBAC labor” for the VBAC labors I have seen in the last few years. She presented upon my arrival as if she was deep into active labor. The sounds she was making, the way her contractions were behaving (long, strong, and CLOSE together), the way she was moving, the words she was saying… finally she was burping, she was saying she didn’t want to do this anymore, and she was feeling rectal pressure…so we left for the hospital. To find that she was two centimeters. Now, commonly in this area, this would be the point at which the typical OB would say, “Oh, well, your body must just not know how to do this right. We’ll fix you up in a jiffy--how about just a “whiff” of pitocin?!” Instead, her doc offered her the opportunity to go home, and finish her early labor in a more comfortable environment. She chose to stay and walk in the nice atrium with fountains and plants everywhere, and labor near by for a while, hoping that she would change quickly. Turns out that we were there, at the hospital, for 26 hours before the baby was born. At no point (especially when the woman was “stuck” at the same six she was “stuck” at with her first--induced--labor) did the doctor say, “Well, your body is staying at the same place it was before…it must just not know how to get past this point.” In fact, he kept saying, “You can do this. I believe in you. I trust your body to have this baby. I have seen this before. I wish more women would make the choices you are making, and do such a beautiful job with their birth choices.”
I attended a labor early this spring that was a VBAC. When the OB walked in for the first time, laying eyes on the woman for the first time in that labor, her first words? “Well, I see that you’re at a six! I have to say, looking at your records from your last birth…I highly doubt you’ll get past this six. It’s where you got stuck last time.” Seriously?! Yes, that is what she said. Oh, that and (repeatedly) that she LOVED to be proved wrong. At the end of the birth, when the woman DID get her VBAC, with the baby on her chest nursing away, the mother looked up at me and with a twinkle in her eye, said, “Huh. She didn’t thank me for proving her wrong…” Isn’t it sad that she had to have her baby in that environment?!
I thought of her often, actually, during this birth that I attended yesterday and the day before. The doctor who attended this woman butted heads with staff, bucked protocol, and overall supported this woman in every single way possible. For instance, with the epidural recently turned off and one leg not quite working perfectly yet, the doctor helped me get mom onto her hands and knees, draped over a birth ball, to push her baby out. The nurse in attendance was flabbergasted. The doc encouraged the nursing staff to write a form to sign for the couple to refuse Vit K and eye goop…because it is, after all, their right to do so. He gave her options every single step of the way. He stayed at the hospital and would leave to go home for an hour or two to be with his family, but hurry back, because there were staff there who were trying to make him or the nurses “mess” with this woman and force her to have a more “typical” constantly monitored VBAC that had a great deal more interventions that this birth had. He became not only her OB, but her support and her guardian.
There are two or three docs in our metro area whom I have seen act this way…but one of them is the partner of the woman who walked in and said, “Well you’re at a six, I don’t expect you to get much farther because that’s where you got stuck last time…I love to be proved wrong, but I just don’t see it happening…” How can I expect to send women to HIM to be supported and have their bodies trusted during a VBAC, when he has a partner, who is just as likely to catch, who has completely opposite views!? This doctor, who caught the baby born yesterday, to a mother who fought tooth and nail for this VBAC, and as a care provider, who fought WITH her…he is a Godsend. I look forward to working with him again and again…and to seeing more and more women have a REAL chance at a vaginal birth after cesarean because they are trusted, supported, and given true options when it comes to the birth of their child.
So many docs pay lip service to women who plan VBAC. They say, “Sure you can TRY a VBAC…as long as you meet the criteria when the time comes. I won’t let you go to your due date. I won’t let you move around. I won’t let you have external monitoring (*gasp* intermittent monitoring?! That’s a bad word for VBAC nowadays!). I make the rules, and if you don’t make the requirements, you’ll get cut.” So women expect that their bodies won’t work and that they will have to be cut open again. Why fight and try, when they can schedule it?… and have to recover from major abdominal surgery while caring for their newborn and probably a toddler or preschooler as well. *sigh*
So, Ladies, this is a testament to LOOKING for a TRULY supportive care provider when you are faced with planning a VBAC. It is not only possible, but it is the smart thing to do. You are much more likely to actually have that vaginal birth this time around if you are surrounding yourself with people who care a whole bunch about your getting the birth you want. It might be a hike for you, but I’d be happy to give you this guy’s name. He’s probably the most midwife-y man I’ve ever met. That’s a compliment, by the way. ;) Of course, I’d also be happy to give you the name of a midwife who can catch at home…but if you are planning a hospital birth, he’s the guy to see. Hands down.
So…what’s the difference your spouse or friends might ask? Both of the women I mentioned planned a VBAC, hired a doula, took childbirth ed classes, ate well, exercised, and lo--both got their VBAC. One of them, however, had to fight tooth and nail and be barraged with distrust, a lack of information, a bunch of rules that were useless and non-evidence based, and a doctor who did everything in her power to undermine the woman’s ability to have her vaginal birth…so she could do her fourth cesarean of the day and go HOME, already. The other one fought, too. She worked just as hard physically…but all the other things were a non-issue. Her doula, her doctor, and her nursing staff worked seamlessly together to support her, to make sure that she had all the information she needed, and to be absolutely certain that she had all the faith in her body and her baby to give birth the way God intended. We need more of those care providers out there. The only way we will get them is by customer demand. STOP accepting the Litigator’s rules over your body. Look at the medical evidence and expect that your care provider will follow it too. Your money talks! Go to the providers who don’t have meaningless criteria such as “you can only go to 40 weeks, but if you go before that you are WELCOME to TRY a VBAC…” Every penny that they lose, and I would tell them why you are moving on, makes an impression. Especially if they repeatedly have patients leave for the same reason.
Expect support. Surround yourself with support. PLAN a VBAC, don’t just “try” for one.
Are you pregnant? Do you have a husband or partner who will be attending your birth? Have you talked to him about the birth? REALLY talked? Have you discussed WHY you don’t want an episiotomy, or why it is MUCH safer for the baby and for you to allow the placenta to be birthed before you cut the cord?
Oh? You hadn’t heard that? Well there are a few very good reasons to make VERY SURE that you have a discussion like that with your birth partner. It is very hard to look at somebody you love, who is in pain, and have coherent thought about medical procedures. So, knowing all the good reasons, knowing exactly why you feel the way you feel about things that will take place at your birth, knowing them so that they can recite them front, back, and sideways? It’s a really great idea.
So, back to the placenta thing (and you’ll see how this ties in to the whole of the post in a minute). Did you know that your lungs have little finger like thingies (like the scientific talk there?) in them that increase the surface area and allow you to absorb a greater amount of oxygen on the intake of a breath? Well they do. AND, did you know that, if you don’t have your full blood volume, they don’t stand up, and so they don’t work to increase your blood oxygen levels? That’s true too. So…when the baby is born, they do not have their entire blood supply in their body. Some of that blood is still pumping to it from the placenta. IF, as most hospital practitioners do, your birth attendant cuts the cord at what THEY consider to be “delayed” timing, around 2-3 minutes, it is entirely possible that your baby could go into respiratory distress, or like a former client of mine, actually have collapsed lungs, because the lungs cannot inflate properly without the full blood volume.
So, it used to be routine that doulas and others suggested that women put “please delay cord clamping/cutting until the cord has finished pulsing” in their birth plan. How well do you think THAT worked? Let me tell you. Okay, instead I’ll ask another question. If you are not a birth professional, have you ever seen a cord pulsing? Probably not. I’ll tell you what it looks like. It is thick. It’s a blue/grey color, and you can see the cords of the vessels in many cases, wrapped like rope around the outside of the cord. If you have seen a cord pulsing, have you ever seen a cord that was DONE pulsing? The chances of that outside of a homebirth are so slim that I can count on one hand how many hospital clients of MINE saw a cord that was done pulsing until we changed the wording in their birth plans around a bit (but I’ll get to that in a minute, I’m getting ahead of myself). Again, I’ll tell you what to look for. Imagine one of those long balloons that clowns make balloon animals out of. Imagine a white one, that somebody put air into, and then let the air out of. You know how it sort of gets floppy, and collapses into itself? That’s what a cord looks like when it’s done pulsing. WHITE, no longer blue/grey, and floppy, like a balloon with the air let out of it.
Okay, so when your baby is born, who is watching that cord?! Are YOU? Nope. You’re falling in love with the beautiful baby on your chest. Your husband/partner. NOPE. He is watching YOU watch the BABY. Soooooo…that leaves…the doctor, right? Riiiiiight. And how many hospital birth attendants can you imagine waiting up to 20 minutes for a cord to stop pulsing. Let me tell you, there are very, very few.
Next, did you know that it is VERY common, in fact, it is unlikely that protocols are different in many hospitals in the United States (okay, except in Baby Friendly hospitals, but they are few and far between, and there are NONE here in Michigan), for the baby nurse to take the baby from mom as soon as the cord is cut, to weigh, measure, do the Newborn Exam, wash, wrap, poke, prod, eye goop, and warm baby…to the tune of a minimum of sometimes 45 minutes? And you remember, right, that the first two hours are crucial for mom and baby insofar as bonding?
Hmmmmmmmm… how can we keep the staff from taking the baby away? Bingo. Don’t cut the cord till the placenta comes. INSTANT leash, really, that ties mom and baby together. And lets them bond, all the while, causing the staff to NOT have to give the baby oxygen or formula or do any of the other “necessary” procedures that they might “have” to do because mom and baby are separated at a time when mom and baby should ONLY be together. So now we're getting to the new wording on the birth plan. It should go something like, "We are choosing to wait to cut the cord until the placenta has been birthed."
And then, you should STILL have that conversation with your partner. Because in the end, even if you DO wait till the placenta is birthed, but the baby has yet to nurse, dad will have to look whomever has laid hands on his child FIRMLY In the eye, and tell them, “NO. They will stay together until the baby has nursed and has come of on their own.” No, “If that’s okay with you.” No, “I hope you don’t mind, but…” Simply, “We are choosing to breastfeed, and we are choosing to have mom and baby bond before procedures are done." If the staff comes back with "But that's not protocol, sir." He could say something like, " I am sorry if that is not protocol, but protocol is NOT the law, and this is what we have chosen for our care.” It all goes back to remembering that you are the consumer, that you are paying the bill (and trust me there WILL be a bill at the end of all this!), and that you DO have choices, even if the choices are not presented to you.
Did you know that you can do everything, to the benefit of the baby, but use PADDLES to restart the baby’s heart, while baby is on or very near (I’m talking touching, like between Mom’s legs) mom? And the benefits are great, too. Better oxygen saturation, better respirations, better blood sugar. Better outcomes. No, it’s not what they are accustomed to. But baby and mom are always better off, in normal healthy births, near each other.
Did you know that those little blue bulbs that they use to suck gunk out of your baby’s nose and mouth are AGAINST THE GUIDELINES set by the American Academy of Pediatrics for their NNR guidelines? You are NOT to suction, EVEN IN THE PRESENCE of MECONIUM, unless baby is not making attempts to breathe on their own. Using suction on a vigorous baby can actually cause baby to INHALE meconium because they gasp when the tube or bulb is shoved down their throat.
All you have to do is say “No thank you. We are choosing not to suction if the baby is making attempts to breathe well on their own.” Of COURSE you can tell if the baby is not vigorous. You have eyes. Talk to the baby, welcome them to the world. Oftentimes, it’s all it takes to bring a baby around when they are transitioning from inside the womb to outside the womb. Ask for a piece of gauze or use the corner of a sheet, and wipe the snot away that the baby brings up. Sometimes you can put the baby’s head “downhill” which will help the snot to run out. This is easily done on mom’s chest…put the little toes by Mom’s belly button, and the head by her ribs. Turn baby on it’s side so you can still look in it’s eyes and talk some more and fall in love.
In all, protecting baby and mom can be a scary job. It can seem like you are encroaching into a place where you don’t belong. That is often taken advantage of. I have heard medical staff say to fathers, “Do YOU have a medical degree?! What’s YOUR specialty!? NONE? Oh, okay, then let me do my job.” While doing completely non-evidence based procedures on a child. Luckily for that particular baby, the Dad looked at the doctor and said, “I don’t need a medical degree to use the words, I DO NOT CONSENT to the care you are giving my child. Stop now.” Many fathers, though, have been taught as they grow up to believe that the medical establishment is the be-all and end-all…that you must never question them, even if you feel strongly that what they are doing is not appropriate. And so they feel helpless as they watch their baby be unnecessarily poked and prodded, separated from it’s mother (who is often crying for the baby, and asking for them over and over again), for sometimes an hour or more.
It is such a good idea to talk a lot about what you want out of your birth, what the medical evidence is to support those preferences, and that you are the consumers, and in normal healthy births, there is no reason other than protocol NOT to have your baby with you until you are comfortable handing them over for the weigh and measure. Find your voice. If you are afraid that you might not remember to use your voice, consider hiring a doula, who can remind you of your birth plan, and what your preferences are before they take that baby out of your arms needlessly, causing a whole lot more trouble (oral aversions, trouble latching, trouble breathing, low blood sugar, the list goes on) than you bargained for.
Keep an eye out for a video for dads called, “The Other Side of the Glass” (you can watch the first ten minutes here on their blog: http://theothersideoftheglassthefilm.blogspot.com/2009/01/prenatal-human-rights.html
) It’s made for dads, but really is for anybody who plans to have a baby, or loves somebody who is having a baby.
Did you know that it is statistically more difficult to break up with your OB than it is your first high school sweetheart? It is. More and more women are being faced with that choice, though. In our area, we have three major hospitals whose cesarean rates are nearing 50%. Yup. Really. Is there something wrong with our bodies, all of a sudden, that we “need” to have our babies surgically removed from our bodies?! No way, Ladies. We happen to live in Michigan, which has the fifth highest cost for medical malpractice insurance. This means that if a doctor even gets a LETTER that indicates that they might be sued, their insurance will go from a burden to making it so that they just can no longer afford to practice. And it means that they will therefore “practice defensive driving” or in this case, defensive medicine.
Are you, a normal healthy woman, suffering from an illness when you are pregnant? Unfortunately, when going to a surgeon, Ladies, that is the kind of treatment we will get. It’s not their fault, entirely. Royal Oak Beaumont, which is a teaching hospital, had 492 births this past January. Guess how many of those women labored without an epidural? Just a wild guess?
One. One woman in the month of January labored without an epidural. What does that mean for the interns and residents on rotation that month? And the student nurses? It means that they will have abso-freaking-lutely NO idea what a normal, physiological birth sounds like, looks like, SMELLS like. They will not have a chance to experience birth that does not include a woman on her back or tailbone, purple pushing…after watching CNN until she is checked, told she is complete (or worse yet, told that her “body just doesn’t know how to have this baby,” and that she “NEEDS a cesarean.”), and that it’s time to push, and then after pushing for two hours, told that she’s just not moving the baby properly, and then they’ll “have” to pull the baby out with a vaccuum.
This is the experience of the doctors and nurses who are “learning” about “birth.” It is now ALSO the experience of women, who are in the most psychologically suggestible points in their lives because of the hormonal state their minds are in. They are now SURE that their bodies are broken. And they are spreading that news…if our FRIENDS are getting cesareans nearly 50% of the time…why should OUR bodies be any less broken?
But in the end, it’s not our bodies which are broken. It is the medical system in the United States, and the lack of understanding of the mechanisms of birth in the culture we live in. Our sisters don’t typically see our babies born. We don’t see our cousins or siblings born. Birth is something that many of our mothers and even grandmothers were afraid of, and have spread that fear to us.
So, what is the fix? Education, of course. Primarily, moving the system from mostly Obstetricians (surgeons, taught to look for pathology, and then cut it out) caring for normal healthy women during pregnancy, to mostly midwives (trained to know what normal healthy pregnancy includes, and, UNLIKE OBs, trained to COUNSEL women to keep them healthy--did you know that Obs aren’t required to have even one class in nutrition?) caring for the women who need only somebody who is willing to walk with them through pregnancy and birth, not test them and use technology on them where it is not warranted.
Speaking of technology. Did you know that we spend four times as much as any other country on the cost of each birth that takes place here? And to what end, you might ask? You might, as do MOST Americans, assume that that technology makes us safer. You might assume that it improves the outcomes for pregnancy, labor, and childbirth. You might assume that we get more healthy, ALIVE babies, more healthy MOTHERS. Um. Well, that would be an incorrect assumption.
In actuality, we are 128th in the WORLD for the safety of mothers and babies in childbirth. There are only two or three countries with worst records than we have. Croatia is one of them.
WHY?! In the end, the very technology we have come to depend on in the birth culture of America actually CAUSES more cesareans. We know with no uncertainty that cesareans make sicker babies and babies who die more often. We KNOW that it makes mothers more susceptible to infection, to hemorrhage, to injuries like perforated bowels and bladders…
So…how do WE keep ourselves from being part of that statistic, that 50% of women who end up with a cesarean in our town’s major hospitals?!
Be well. Eat well, exercise to your body’s capacity. FIND A PRACTITIONER WHO TRUSTS BIRTH. Make sure that that practitioner has every confidence in your body and your baby and their ability to work together to end in a healthy birth. Not many of them exist any more, in the hospital setting. There are a few…but the protocols they have to follow in order to keep their jobs often tie their hands in many cases where they would otherwise prefer to just let a woman labor. If you are financially able, find an out of hospital practitioner. Yes, study after study shows that birthing out of the hospital is not only as safe, but because of the very technology that you WON’T have there, it is actually in many cases SAFER than hospital birth. That’s a blog for another time, though.
If you DON’T think that you are financially able, ask around. I bet you that you’ll be able to find an option, a SAFE option, that you are able to afford. Most midwives believe so strongly in allowing women a safe birthing environment that they are willing to work with them on cost.
Be well. Don’t be a statistic! Don’t be like that 16 year old who refuses to break up with her first boyfriend. You only get to birth this child one time. Practitioners attend LOTS of births every year. Ask questions. How many cesareans does your doctor do? How about your hospital. And, and this is a big one, how many VBACS do they do? What are their protocols about fetal monitoring? GBS testing? Glucose testing? What percentage of the pregnant women in their practice are induced? Do they like doulas in the birthing room? Why or why not? Do they sit down and ask you what you want to talk about, and talk till you are done, or do they stand, look mostly at the chart, measure your belly if they have time or feel like it, and then rush out? Are they WITH you in the pregnancy, or are they directing you in this pregnancy…or letting you drift on until--BAM! You’re 40 weeks, and don’t you know that there is a timer in that baby and you HAVE to be induced to keep that baby from certain death?! Not that they mention the method of induction and it’s safety to the baby, or frankly, to you…
Again. Be well, that’s the best way to avoid a cesarean. But equally as important, know and TRUST your practitioner--and know and trust your body’s ability to give birth. And, if you get a red flag, if you at any point feel uncomfortable with your practitioner...find a new one. There are so many from whom you can choose!! And you are the consumer. You won't be penalized for doing so. I had a client hire me because she had literally fired her OB while she was pushing. It's never too late to feel comfortable, or to be safe while giving birth.
I recently read a woman's writing, wondering why her milk had taken so long to come in after a medicated hospital birth. It took about a week for her milk to come in, and she had a vaginal birth. So, so, SO many women hear that their body just can't make milk. This is not the case in LITERALLY all but a half percent of the human population (and those women are GENERALLY people with thyroid issues, those who have "low glandular tissue," or women who have had breast surgery in the past). Here is what I wrote in response to her questioning:
As far as your milk coming in, many factors can cause it to come in later than "normal."
First, was the baby birthed directly to your chest and left there until it nursed, and then left there longer, at least the first hour, optimally the first two hours? Studies have shown that this has a strong effect on your milk, both in the overall supply, and in how quickly it comes in, as well as in the efficiency the baby has in nursing. Your body is tossing hormones out like GANGBUSTERS when your baby is born and put on your chest. There, where humans are meant to be warmed, the baby soaks those bonding and nursing hormones in like a sponge. They teach the baby what you smell like, that you are the food source, and encourage the baby to ask to nurse often (some babies in the first days of life nurse as often as every 20 minutes, others as often as every two hours). It also, for some reason, effects the baby's ability to latch well.
Were you encouraged to be skin to skin with your baby (rather than having the baby swaddled) while you were in the hospital? The more you have the baby skin to skin, the better the baby gets those hormones that you are(still) tossing out (though not as potently in the general post partum period as in the first two hours after birth, it is still crucial that you bond skin to skin with your baby after birth)! The more hormones the baby soaks in during your post partum period, the more the baby wants to nurse and the better the liklihood that you will get a good latch down.
Was the baby taken to the nursery at any point? If so, this separation, and the STRONG probability (especially in our area) that the baby was given a bottle. This can lead the baby down a confusing path of nipple confusion, full belly, and difficulty nursing.
When you nursed, were you encouraged to watch the clock and take the baby off of the breast at a given TIME, or were you instead encouraged to let the baby nurse until it was done, latching off on it's own? I often hear from mothers that their baby was "using them as a PACIFIER." My response is that a baby is physiologically designed to ask to nurse often, and to stay on the breast to be near the mother. Anthropologically, if the baby was separated from the mother out in the "wild," how long would the baby really survive? A baby's need to nurse is programmed into them for many reasons. Manipulation is not one of those reasons. A newborn does not have the cognitive ability to manipulate it's mother to be near it. Babies have a neurological need for skin to skin contact with their mothers, and nursing is the perfect way to get that contact. Many mothers find that a sling or baby wrap lets the baby nurse/be near Mama, and still gives them the arms and ability to continue to fill other needs in the household or on a personal level (you have to pee sometime, and Mamas with babies who have a great need for contact learn early on to pee with a baby in a sling!).
Were you encouraged to do breast compressions while the baby was nursing? Doing so properly helps the baby get more colostrum, which is "viscous"--thick and harder to draw out than breastmilk. Doing so also helps to better drain the breast, thus helping the milk supply to come in more quickly and more fully. Lastly, breast compressions are WONDERFUL at getting a sleepy baby interested again in the job at hand--EATING!!
Was the baby a "sleepy baby?" Babies whose mothers have had narcotics and often epidurals tend to be sleepier. The narcotics hit the baby's drug stream at EXACTLY the same dose it hits YOUR bloodstream (so, if you got 100cc's of stadol, the BABY got 100cc's of stadol...your body does not dilute it at all, and it can be tens of times more than is considered "safe" to give to a neonate--THEN they have what is called an "immature" liver--it is not fully developed--, which can therefore take up to six to eight weeks for the liver to clear all of the drugs from the baby's system). This can cause the baby to sleep more than naturally birthed newborns will, and nurse less, and nurse for shorter periods of time, not fully draining the breast before they fall asleep while feeding.
When you brought the baby home, was the baby in your room, or in another room to sleep at night. We know that your prolactin levels (prolactin is the hormone that causes us to make milk) are highest at night. SO, if the baby is away from you, it is physiologically more likely to sleep longer periods. That causes the prolactin, when it is at it's highest levels, to not be stimulated as often, and therefore it can deeply effect your milk supply.
When you had your baby, were other people holding it a lot, or did other people take care of YOU, and have YOU hold the baby (preferably skin to skin) while they took care of YOU and the house? The second scenario is ideal.
Breastfeeding works on supply and demand. The more frequently the baby eats, the more fully the baby drains the breast, and the more the baby eats at NIGHT and drains the breast at THAT point (see, babies DON'T have their "days and nights mixed up," really...they are designed to nurse often when the milk hormones are at their hightest, which causes you to make more milk overall!), the more milk you make, the more quickly your milk comes in. Again the more you hold your baby, especially skin to skin, the more often they are likely to want to nurse as a newborn. The more a newborn nurses, the more the milk supply increases. It's a wonderful cycle!!
If you lost a lot of blood with that fourth degree tear, and your hemoglobin levels were low, that could also have an effect on how quickly your milk came in. A post partum hemorrhage can also cause a low milk supply.
If you were not paying close attention to staying hydrated, if you were not eating very well, or very often, those things, too, could effect how your milk came in and when. I often suggest to families when they are preparing for a birth that they invest in a crockpot. It is very easy to make a pot of soup and leave it on the counter, so that the new mother can fly by and grab a cup or bowl of it when she gets the chance. It will be hot and ready to go all day, whenever she has time, and the smell of it might entice her to MAKE time more often. It is also a WONDERFUL idea to have things like cubed cheese and whole grain crackers at hand. Baby carrots and hummus. Yogurt and granola. Smoothies already made and in the fridge. Sandwhiches made and bagged and in the fridge ready to go. Boxed organic salad greens from costco. Apples, pears, and oranges, sliced and ready to go. Grapes rinsed and ready to grab and eat... If the food is THERE, even if the mother's support system is gone at work for the day, she is MUCH more likely to be well nourished and able to supply her baby the milk it needs to thrive.
Much of milk supply issues in our culture DOES have to do with how you birthed, not necessarily JUST the drugs, but also how the care providers cared for the baby immediately after birth, and how they supported you with information and breastfeeding help...and THEN how your support was at home.
Milk supply is a finicky thing and can be affected by several factors. However, it definately DOES give an advantage to babies who are not recovering from the effects of narcotics in their blood stream as WELL as birth!
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