Babies are Not Pizza
Birth Prep (Book Summary)
From my favorite book: Babies Are Not Pizza, and creator of the Evidence-Based-Birth Class
 This book is not meant to advocate for one way of giving birth. She presents evidence, and defines “evidence-based-care” as having research-based information, being able to interpret that information, and for each mom to be able to make an informed decision on her own birth choices.
Who is she? A woman with PHD doctorate, trained in the western medical world, but quit her job as a nurse to start her own company advocating for evidence-based care for women during pregnancy and birth.
Chapter 1: Naive (the Author’s experience)
I went into my first birth with rose colored glasses. I figured everything would be fine as long as I had a healthy pregnancy, which to me meant exercising and not gaining too much weight. I had seen a few births back in nursing school and I didn't want to be one of those patients they gossiped about at the nurses station.
One of my main goals for this birth was for the nurses to like me, especially because I was giving birth at the hospital I worked at.
It was also the only place my student health insurance would permit me to give birth.
I planned to do as i was told. I did not do much prep. I was a nurse, and I trusted the process. I read several popular pregnancy books, which in retrospect weren't the best choices.
We took a hopital-lead birth class, which essentially told us how to be a good patient. We learned little about the actual biological birth process, and instead took home the message that we should passively accept everything that would be done to us during our hospital stay.
I laughed at birth plans. How can you possibly plan birth? You're supposed to be flexible.
The doctor is the one with the medical degree.
What I didn't know then is that if you give up total control of your decisions and don't do any education or planning, you often end up getting the lowest quality of healthcare at the highest cost to yourself, your health and your wallet.
My younger sister was training to be a doctor at the time, and tried to warn me.
She noticed how many women were receiving totally unnecessary interventions like medications given to speed up labor, even when labor was progressing normally, and for episiotomies or cesareans being done because the physician was tired of waiting for the client to push the baby out.
One time a resident told Shannon, “Well, she's 4 centimeters now, so we are going to go break her water.”
“Why?” Shannon asked.
“Because that's what we do.” Feeling a bit like a 2 year old Shannon again asked, “Why?”
“Because it will make it go faster.”
“Why do we need it to go faster?” The resident grew more annoyed and brushed Shannon off.
A few hours later after finding all the research articles she could on PubMed, Shannon came back to the resident. “So I was looking up this issue of rupturing membranes. It looks like it doesn't really make the first stage of labor go faster. And it can increase the risk of infection.” Safe to say, she was not the favorite student on this rotation. But she did learn a lot about culture and the need for it to change, even inside the birth room.
Finally it was my turn, 11pm one night, i felt a gush of water and told my husband I think my water broke.
One of the instruction sheets we had been given said to go to the hospital if my water broke.
During our quick seven minute drive to the hospital, my contractions started. They were easy to handle, and coming five minutes apart.
Dan dropped me off at the hospital entrance and I made my way to triage alone while he parked the car. Triage is sort of a hospital holding area for patients coming in for birth, to help decide if you are far along enough to stay in the hospital.
THey decided my liquid was amniotic fluid, so they wheeled me to the delivery room. She dropped me off inside the room and said, you should go to the bathroom now because you're not allowed to get out of bed from now on.
I had an IV hooked up to a bag of fluids. A belt fitted tightly around my abdomen to measure my contractions, and another belt placed to measure my baby's heart rate. The belts had these hard, circular shaped discs that pressed firmly and uncomfortably into my very pregnant abdomen.
An hour later, I needed to pee again. And when I pushed the call white button, I was told that I must use a bed pan. As a nurse, I helped others use on ein the past, but never myself. cannot tell you how difficult it was to urinate lying flat on my back on that hard plastic pan while having contractions with two people watching me. I just could not go. So the nurse inserted a painful catheter tube into my urethra to empty my bladder. Instead of letting me walk 10 feet to the bathroom just like that, I had transformed from a healthy pregnant woman to a patient in a hospital gown.
I was offered Pitocin, artificial oxytocin, a medication used to speed up contractions, but I politely declined. My contractions were already coming five minutes apart, so I didn't see the need.
By now, it was the middle of the night and I was left alone. I knew labor might take a while, so I had told Dan to try to sleep while he could. He slept in an armchair and I endured labor in bed on my back in the dark with a random football game replaying on the TV and nobody there to support me through the contractions.
just before sunrise, everything changed. Doctors and nurses started coming in without introducing themselves anymore. I started getting more and more pressure to get Pitocin and an epidural. They told me i was not progressing as they would have liked me to be by 7am (looking back, it was a totally normal timeline, 8 hours before).
I learned later that it's normal for a first time mom to have a long, early phase of labor, especially if water broke before labor began.
I kept saying, no thank you. No thank you. No thank you to almost everyone who entered the room. I was not expecting so much pressure from so many people. I knew I wouldn’t be able to say no forever. I wanted to finally say yes.
Around noon, I begrudgingly agreed to Pitocin. They started with a low dose and my labor picked up almost immediately. I had heard that Pitocin induced contractions were more painful, so I asked for an epidural. I was read some risks aloud, then signed a form between contractions.
However, what happened next was somewhat traumatic. The resident tried once, twice, three times to get the huge needle in my back, but said my bone structure was not ideal, and each attempt was extrememly painful. (a common other problem not mentioned was the that often the doctor misses the nerve and gives the mom an excruciating nerve migraine that lasts for weeks after birth)
Eventually someone was able to get the epidural placed. Afterward, I shivered uncontrollably, dry heaved, and cried. I couldn't stop crying for a while.
Turns out, many women have a reaction after about 7cm, when things really ramp up. This can be expected and tends to move along pretty fast after (think another hour or two usually max). Many women get shivers and it contractions get more intense, but you also know you are in the final stretch, so you kind of mentally prep for that last sprint (after a marathon), and know you will see your baby soon! There is no turning back here, and you are almost done.
After the epidural, the nerve block was so strong that I was completely numb from the waist down. I couldn't move my legs at all. Every time I wanted to shift my position, Dan had to move my body around for me. They didn't feel like my own limbs. It was weird and uncomfortable.
I lay on my back and more time went by until all of a sudden I felt the urge to push. It felt like I had intense pressure in my bottom. By now, it was 7:00 PM I pushed the button on my call light and the nursing assistant poked her head in the door excitedly. I told her, I think I'm ready to push. She said, “I'm so sorry. Everyone is busy. You'll just have to wait. We'll be back in half an hour or so.” Frightened by the overwhelming pushing feelings, not knowing what to do, I pushed my epidural button repeatedly, delivering doses that numbed all sensations. About 30 minutes later, the medical student walked in dressed from head to toe in bodily fluid protection gear, complete with a plastic face shield like she was about to start welding or something.
A half dozen people followed her. The staff coached me to push. They put my feet in stirs and I lay on my back half sitting up. I couldn't feel a single thing in the lower half of my body. The pushy feeling was gone due to my overzealous attempts to medicate it. The nurse said, now hold your breath and push. And again.
An hour of this and zero progress. after an hour, my epidural started to wear off. I started pushing with a renewed zeal, but after another hour, my baby's head still wasn't coming down. Then my OB did an exam and discovered that the baby's position was not optimal.
Later, I found that this was not a surprising finding given that I just spent nearly 24 hours in a backline position that didn't allow the baby's space to move down and rotate the way she needed to. Researchers think that laboring, upright and moving around uses gravity to help the baby's head descend into the pelvis in the optimal position for birth.
(You find out that laying still on your back is the absolute position for getting the baby in the right position. A really great program everyone should learn about (and watch their program is called Spinning Babies. They tell you the science of the rotation of a baby at each stage, and helps provide positions any woman can do, no matter what type of birth she is having. these excercises are great in the months leading up to birth as prep as well!)
My doctor asked my permission to maneuver the baby's head into a more favorable position.
Basically, she inserted her entire hand at my vagina and into my dilated cervix, put her hand on the baby's head, and rotated the baby around. Even though I was still partially numb from the epidural. The pain from this procedure was so intense that I leaned over the side of the bed and vomited. However, after she adjusted my baby's position, I finally started making some progress.
(This was totally unneccessary, and could have been avoided had she just let the mom walk around!)
At the very end, the OB asked my permission to use a vacuum suction cup device on my baby's head to help pull her out, called a vacuum assisted delivery, and again, I consented. Finally, at 10:50 PM my daughter, Clara, was born after 24 hours of labor, including more than three hours of pushing.
Clara was immediately removed from my site so she could be sectioned, swaddled, measured and weighed
I was checked and only needed one stitch (apparently 98% of women tear, (but how much??) but I (victoria) did not on either birth delivering naturally. The doctors were amazed and treated me like an total anomaly).
The birth was done, but my baby was not in the room. Although her Apgar scores were normal. Apgar scores are way of assessing the health of a baby at birth.
(I think these should be made public: all the things leading up to birth and how they affect the birth APGAR scores for the baby, since it is the ONE measuring stick used no matter type of birth).
After they let me take one photo holding her all bundled up, the hospital staff whisked her away to the nursery for observation. Now this did not make sense. I had accepted without question so much of what the hospital told me to do. I'd fasted for 24 hours, used a bed pan, complied with all their requests and recommendations, but I would not, could not accept separation from my baby, my own baby, who I had been growing inside my body for the last nine months and was so eager to meet after a full day and night of labor still paralyzed from the waist down due to my epidural.
I pushed my call white button every 10 or 15 minutes. Where is my baby? When will they bring my baby to me? I need to breastfeed. One hour went by. Two hours went by at two hours. When I checked again to see if she was coming to me, I was told over the intercom, “Oh honey, I'm so sorry. We just gave her a bath, and her hair's all wet.”
Finally, at around 1:30 AM nearly three hours after she'd been born, she was brought to me for the first breastfeed. She was sleepy. We'd missed the magical golden hour when freshly born babies are still wide awake after birth and ready to bond and breastfeed, and she didn't latch well.
The night nurse didn't really know how to help me. She just stood by and watched while I clumsily tried to latch my drowsy baby onto my breast. It hurt. And as a result, these first attempts to breastfeed left my nipples cracked and damaged, which would haunt us in the days and weeks to come the next morning.
Most hospitals have a lactation consultant on staff, but they tend to be VERY over booked. You are lucky to get a single 30 minute session if you are adamant about requesting it ahead of time. I did this, and they still would not schedule me until i said my nipple was bleeding. You can sign up for a home lactation consultant, and I highly recommend this for first time mom’s. We had a lot of feeding issues and needed to pump around the clock every 3 hours, and had I not had this, I could have lost my supply. The first week really is critical, and we saw ours on day 5. She said you can go to day 14, but that is about it before you lose your supply. Had i waited for an opening in the hospital version, who knows if my supply would have survived.
The night nurse offered to take my baby away so I could have some time to sleep. I agreed, but asked her not to give Clara any formula as we were still working hard to establish breastfeeding when the nurse brought her back a few hours later.
I was disheartened to see that Clara was spitting up formula.
Then we were sent home the next afternoon after signing that we recieved a bunch of forms that looked like they were photocopied from the 90’s, as if we would be reading anything in the next few days on zero sleep in 3 days.
Looking back on what happened, some of my story might seem somewhat nightmarish, but part of you might be thinking that what I experienced wasn't that bad.
I had a healthy baby, right? I gave birth vaginally and stayed in one piece. I didn't have major abdominal surgery like one third of American women do when giving birth. I didn't even experience any major tears when the baby came out. Although the staff put pressure on me to follow certain policies and recommendations, they were always friendly and polite.
Many minorities say they feel they were treated even worse.
But if I had to sum it up, I think there were quite a few wrong things that happened at my daughter's birth.
First, my baby and I were treated like we were sick, even though we were healthy all along.
Second, I was coerced to have specific interventions instead of being given true alternatives and then being supported in my choices.
Third, you might have noticed that I was never offered any comfort measures or support from my nurses other than an epidural, no tub, no shower, no positioning, no massage, no ability to walk around, no breastfeeding support. All of these have proven research that they work to make mom more comfortable and help the birth along! Dan and I were left alone for most of our labor. I was in pain in a cold clinical place with no idea of what was going to happen next.
Fourth, I experienced a lot of pressure to receive unnecessary interventions that caused bad things to happen down the line. For example, I was made to lie on my back, which slowed down labor, increased my pain. And may have prevented my baby from getting into an optimal position for birth that led to the use of Pitocin and an epidural. Which led to a long pushing phase and a vacuum assisted birth, and ultimately hours of separation between me and my baby. During the most important bonding time humans experience in their lifetimes.
The domino effect of one intervention leading to another has a professional term: the cascade of interventions.
I tell this story of my first daughter's birth because I'm not alone. When I share the story with others, about half the time the person I'm telling the story to starts crying.
Why are they crying? Because they identify with my story. But why are they crying? Even if it's been years, sometimes decades after giving birth? Because what happens in birth stays with you the rest of your life. So those feelings never leave.
I always knew something was wrong with how tears welded my eyes when I thought about my separation from Clara, but I never knew why. Why on earth would I cry when I remembered her birth the day? That should have been the most joyful of my life.
It wasn't until years later when I met Dr. Cheryl Beck, a world renowned researcher on birth trauma and postpartum disorders, and I shared my birth story with her that I finally received the answer.
Birth trauma is estimated to occur in 33% to 45% of all births in the US and Australia. These numbers are astoundingly high and explain why it's so common to hear horror stories about top birth from family and friends. Women who experience birth trauma often describe cold, unsupportive, or degrading and inhumane care.
Their care providers don't communicate with them. They may talk over them as if they're not there. The woman may fear for their safety or that and their baby, especially if they're told they must comply so we can keep your baby safe. And in the end, their experience is almost never validated. Everyone tells them, but you have a healthy baby.
If you have a history of anxiety, depression, or trauma, or if you experience medical complications such as cesarean or a postpartum hemorrhage.
People who are survivors of sexual assault are at especially high risk for PTSDs after birth trauma. This is because many abuse survivors are exposed to traumatic triggers during labor, such as during vaginal exams.
On the opposite end of the spectrum from birth trauma, I learned that researchers have found that some people feel incredibly satisfied and empowered after giving birth.
(Victoria experienced this. It is a shame that something so beautiful can be turned so ugly, just as sex itself can do the same thing if consensual or not).
Learning this fact that some people felt empowered by giving birth made me curious. What's the difference between a scary traumatic birth and an empowering, satisfying one?
Is it luck? Is it the presence or absence of complications, or is it something else? The answer is surprisingly simple. In one review of 137 studies on birth satisfaction, researchers found that the factors that most influence birth satisfaction include:
whether or not your expectations were met
whether or not you felt involved in decision making
and how you were treated by your care providers.
The decision making part is important, because there is too much to learn about birth when you are IN the hospital giving birth. It requires a bit of prep work so you have some introduction before one of the most intense experiences of your life.
And it is especially hard if you have preconceptions about hospitals and doctors, and even more if your livlihood depends on trusting the medical system as it stands. But many amazing people have been through the experience themselves and are in the best position to help others, and make sublte changes that can help so many women have better birth experiences.
I also have to make an aside not about hiring a doula.
If you have a sister or friend who understands the birth scene, even better. But sometimes it is nice having someone not tied down to some other expectation and can listen to what mom wants without prejudice. A doula is a hired person that preps them on things they can expect, and helps make decisions that align with what mom herself wants from her birth. She works for YOU not the hospital. Nurses and doctors are great, but they have birth after birth and just expect to have problems and treat mom like a number, just running in to deliver the baby and run out. It feels great to have someone on your side helping you through every contraction. And that person also helps DAD so much, too. As a partner, you want to be helpful, and it sucks being in the dark, too, not knowing how to help or what to do. Often times a woman wants touch or doesnt want touch, and it helps having someone else who knows massage techniques, etc. They cost out of pocket, about $1500 or so, but in terms of research on birth outcomes, if they were a pill, it would be considered neglegent to not give it to a person becuase of how much it helps on the mom and baby and reduction in problems in birth. That is because SO much about birth is mental - about mom feeling safe and like she is understanding of what is happening, but also the physical placement and helping the child birth through the canal, which is OPPOSITE to the laying back position strapped to 10 wires that is standard in American hospital scenes.
I didn't have very high expectations for this birth. I wanted to get through it without having surgery, and I did so in that respect. I actually wrote in my journal a few weeks after, I'm so happy with our birth, and I wouldn't have had it go any other way, but I was still so blind. I didn't know how good birth could be.
I didn't know what it was like to have a childbirth care team focused on empowering me while also helping keep me and my baby safe. If I had known in that moment what I was missing out on, I might have been even more traumatized.
I did know, though that my baby and I should have been given time to bond and get to know each other, that it was wrong for the staff to separate us.
Why did they do that? Didn't they realize the harm they could cause? Why weren't they so flippant about keeping Clara away from me during the first hours of her life? Why did they think it wasn't a big deal? I didn't know the answers to all of these why questions? All I knew was that I left birth feeling exhausted and disempowered, and I started parenthood that way as well.
Chapter 2: Evidence
American Statistics
From the NIH: Maternity care in the United States is intervention intensive.
for women who gave birth in 2012
89% of women experienced electronic fetal monitoring
(66% experienced continuously monitoring, meaning 10 cords and no walking)
62% received intravenous fluids
79% experienced restrictions on eating
60% experienced restrictions on drinking in labor (THIS IS NEGLIGENCE!)
67% percent of women who gave birth vaginally had an epidural in labor
31% were given Pitocin to speed up their labors
20% of women had their membranes artificially ruptured
17% of women had an episiotomy
31% had a cesarean
The 2 weeks after giving birth were a blur. I was indescribably tired from labor and birth, and from the sleepless days and nights I spent caring for a newborn. I felt like I'd been run over by a truck from pushing for three hours. Every muscle in my body hurt from the strain.
Also, my legs and ankles that had felt like elephant legs during labor were now elephant legs in real life. That's because they were swollen from the large amount of IV fluids I'd received during my long labor. Breastfeeding was difficult, mainly because I had additional swelling in my breasts.
On the flip side: Victoria’s experience, every time a nurse or doctor came to check in while in the hospital, they almost gasped and kept saying, “you’re not swollen!”. That's amazing. It was because I asked to not have IV’s used. At one point I accepted half a bag because I was super tired and didn’t want to be dehydrated, but I asked how many bags of IV fluid most women get, and they said “MANY”.
The salty IV fluids swell up the mom all over, but also swell the baby too. Many babies have extra weight on them BECAUSE of the IV fluids, and get warnings in the next 10 days that the baby has lost too much weight and needs to start on formula. But in reality, mom SHOULD have everything that baby needs with breast milk, which is protective, adaptive, FREE, and means no dishes. Plus the bonding time and TOUCH has proved to be more important than the nutrients. Skin-on-skin time is so important for a newborn. So take off those clothes and get under a blanket (DAD, you should do this too! Hold that baby in a diaper only and take your shirt off, and put a blanket on top. It feels like heaven).
There was no one to call for help. My mom didn't live nearby and none of my local friends had given birth yet, much less. Knew how to breastfeed, crying and desperate. I searched online for breastfeeding support and found something called La Lech Leauge, a group that has free regular support meetings for new moms.
I dragged myself outta my house. You cannot even imagine what goes into leaving the house with a newborn baby. And sat on the floor next to another mom who was also holding her two old baby. We were both in tears me from the pain and frustration I was experiencing her from her mother-in-law who kept trying to give the baby formula.
But the support we received there was the turning point for me. And as I found out a year later when I ran into that same mom at a local swimming pool, it was a turning point for her as well. I finally had someone show me how to correctly latch my baby, eliminating the pain I'd had for two weeks now.
They also taught me how to handle a problem I've been having with an over abundance of milk. From that point on, I started getting the hang of things and my world changed. Motherhood actually became fun.
One of my friends mentioned that I had a new mom glow. Funny how a little bit of support and teaching tipped me from desperation into bliss.
In the us, women typically don't get checked by any sort of healthcare provider until six weeks postpartum.
(Victoria’s, they didn’t even look at my vagina. They asked how I was feeling and sent me home. Total waste of time. I have had other moms cry about this and say they paid out of pocket for someone else because their doctor was useless and she had so many questions and was pushed aside at this first visit).
In France, insurance pays for repeat visits to a pelvic floor therapist!
Through reading books and watching documentaries, I began to realize that my story was a classic example of the standard or routine care that happens in a lot of hospitals.
I mulled over what I had gone through. The unnecessary pain and frustration, the separation, the pressure and coercion, the nurses refusal to let me walk to the bathroom.
I started questioning everything.
In the 1990s, the founders of Evidence-Based Medicine wrote that evidence-based care is
1. research evidence
2. a provider who is trained in how to help you interpret evidence, and
3. care that is tailored to your own values, goals, and preferences.
Now, I'm sure many people believe this is how healthcare is already delivered, but the truth is, a good portion of healthcare, including (and especially) care during childbirth is still based on:
longstanding tradition
doctor's opinions
fears of liability
financial incentives, and financial disincentives (hospitals have protocol to allow or not allow certain labs, procedures and medications. It tends to not allow you to spend insurance on preventative care like blood tests, but will pay for C-sections because it is a huge money maker for them.
Victoria’s opinion is that the healthcare system is great for getting people from 10% to 50%, but not 80% to 100%. That is what you have to do yourself. It is much more profitable to keep patients as lifetime customers on some kind of pill than help them get lab tests to understand if they have any nutrient deficiencies. WHen I was pregnant, I did lots of research that said to look at nutrient levels to make sure you are getting the baby everything. When I asked my doctor to get the ones suggested, I was told I needed to have 3 miscarriages to get bloodwork on hormone levels and nutrient status beyond the basics they provide. As a doctor, they get written up if they order too many of these labs.
Believe it or not, research is usually more of an afterthought rather than a foundation for current medical practice. Researchers have found that it takes, on average 15 to 20 years after something is proven in medical research before it becomes used routinely in hospitals.
while I waited to get pregnant again, I decided to look up the research and figure out whether or not my care with Clara had been evidence-based.
I started by making a bullet point list of everything that had happened to me during Clara's birth and dug up the research on each topic. As I read the research, I was shocked to find that almost everything that was done to me during my birth had already been proven by research evidence to be either not helpful or actually harmful to healthy people who are giving birth.
Here's what I discovered:
Not allowed to eat or drink fluids during labor.
This practice originated in the 1940’s and continues because many doctors and anesthesiologists believe it is necessary to fast during labor. But research has shown that eating and drinking during labor is safe and makes women much more satisfied with their birth. (Women need energy during this marathon! Same caloric requirement!).
Researchers have concluded that people have the right to decide if they would like to eat or drink during labor. There was no scientific basis for making me fast for a whole day and night while my body was essentially running a marathon. Practitioners in other parts of the world actually encourage women to eat and drink because it's assumed you'll need the energy for birth.
Women were not advised to eat when they were given specific narcotics that knocked them out during labor, called “twilight sleep”. Women would wake up with a baby, and no memory of the birth. And sometimes they would throw up when passed out. This has been all proven highly unacceptable since the early 1900’s.
In the first wave of feminism, women were demanding to have access to the new drugs.
But in the second wave (especially of the 1960’s), women felt empowered and educated to say, actually I don’t need your “medicine”.
Restrictions on eating and drinking in labor were based on the observations of Mendelson in the 1940s. At the time, if a mom was totally knocked out with anesthesia (not a practice today), she has risk of suffocation.
Differences today
rare to use general anesthesia, if used, it would be local
airways are now protected during anesthesia (they were not in the 1940s)
we also have learned the stomach is never empty, so fasting does not give an empty stomach as once thought
we understand fasting is unpleasant and makes it difficult for a woman to meet the demands of labor (we would not tell anyone to fast before/during a marathon).
Since then, Cochrane (ideal of medical studies today, 2013) found there were neither benefits nor harms associated with restricting eating and drinking in labor for woman at low risk for needing anesthesia. There were no studies done on women who were high risk for needing anesthesia. Based on the findings, the Cochrane recommendation is that women should be free to eat or drink what they want in labor, but American College of Obstetricians and Gynecologists (ACOG) has not changed its recommendation yet that restricts low-risk women to clear fluids during labor (12 years behind).
Regarding a marathon: “Is it possible to complete an entire marathon on an empty stomach? Yes, but you will be slow. An empty stomach means you will be very low in glycogen, which is your fuel when you run at a high intensity, like in a marathon.”
You want to eat easily digested foods a couple of hours before the start of the marathon so that most of the contents has left your stomach. Nothing heavy, spicy or greasy. You don’t want to be digesting much during the race because that diverts blood flow to digestion and will slow you down. During the race you want to take in energy, hydration and electrolyte supplements by using gels and fluids. Gels are designed to be assimilated quickly with almost no digestion necessary.
While a full stomach can slow you down, (digestion takes up a LOT of energy!), you do not want to be so hungry during your workout that you begin feeling peckish, or jittery, or even have a growling stomach.
Not allowed out of bed during labor.
Evidence shows that this practice is harmful. Large research trials have found that being restricted to bed leads to longer, more painful labors. It also increase chances of wanting an epidural and C-section.
Women who birth in lying positions are also more likely to be have babies who need to be admitted to the newborn intensive care unit.
The nurses insisted I stay in bed because my water had broken
They said that sitting or standing upright could cause a rare emergency called cord prolapse when the baby's cord could drop down below the baby's head. I looked up the research on that situation as well. Turns out, there is no evidence showing that you're more likely to have cord prolapse just because your water broke at the start of labor. I had been restricted the bed and exposed to the risks of bedrest for no good reason.
Intravenous fluids during labor:
I wasn't allowed to drink liquids, so I was hooked up to fluids from a vein in my arm. But evidence shows that first of all, you shouldn't deny people oral fluids during labor.
Second of all, you get everything you need from drinking water (just ask you partner to bring you water constantly, after every contraction). And have some to go bars handy in your hospital labor bag! Get the kind of snacks that marathon people use, gummies, hydration packs, etc.
Also a few studies have started to look at the effects of IV fluids on breastfeeding found that excess amounts of IV fluids during birth can cause painful breast swelling in the mother, and an artificial weight drop in the baby. The painful tissue swelling in my arms, legs, and breasts was related
A Cochrane review of the effect of intravenous fluids on length of labor (spoiler: no link found on speeding things up) noted they found no risk for eating, so women should be allowed to eat and drink, and abandon the use of IV unless medically necessary.
The study also notes the potential risk for maternal and neonatal morbidity that may be attributable to the unnecessary administration of intravenous fluids, including large weight loss of infants.
Studies also found IV’s can cause fluid overload, which can affect ability to urination ability.
There is also evidence that IV fluids contains glucose, and unless given slowly, can cause hyperglycemia in the mother and baby
The IV tubing use plastics not allowed in food-grade materials for children under 12 years old (while plugged directly into mom’s bloodstream, and subsequently, her infant).
The swelling of tissues from the IV fluids also swelled mom’s breasts signifigantly, leading to increased difficulties breast feeding.
Continuous fetal monitoring
One of the first things the nurse did was hook me up to an electronic monitor to track my baby's heart rate. Amazingly large randomized trials have shown that this type of monitoring is not very good at getting accurate information about what's happening with the baby. Overall, it has not been shown to reduce the rate of stillbirth or newborn death. While it increases the chance that the mother will have a cesarean. Put another way, hooking someone up to an electronic fetal monitor increases risks to the mother without significantly improving safety for the baby other than reducing the risk of rare seizure events.
A more evidence-based option, which is rarely used, is for nurses or providers to hold a small handheld doppler or fetal stethoscope to your abdomen and listen to the baby's heart rate at prescribed intervals. (also called intermittent monitoring).
In contrast, the electronic monitor requires you to stay in bed all or most of the time.
Although there are mobile monitors on the market today, there's very little research on mobile monitors, and women tell me that hospital staff often make them lie still in bed, even with a mobile monitor, so staff can get a better reading on the baby.
Victoria’s experience: In my second birth, the nurse had a really hard time with the belt monitor and getting a reading through my belly unless she was pressing hard on my tummy and me laying completely still. In the most intense contractions, this HURT! I said i don’t want it, and she got a call from the doctor saying, fine, she can go without the monitoring, but we want readings for every contraction- meaning they would have to fumble this thing onto my belly every time i had a contraction (ever few minutes). I asked, “how is that letting me be free to walk around?” She didn’t know how to answer, and I said no again. What could this doctor over the phone do anyways? Nothing. She was barely there to “catch” the baby as the nurse fumbled with her computer mouse.
Electronic fetal monitoring (EFM) was introduced in the 1970s
as a way to decrease cerebral palsy and infant mortality. Although there was no research to support its value, it quickly became a standard of practice. Many studies have been done since, and consistently found no difference in infant outcomes if used or not.
Before that time, the fetal heart rate was assessed using intermittent auscultation with a stethoscope.
The only finding: women who were monitored continuously with EFM were more likely to have a cesarean surgery or instrumental vaginal birth.
in summary, EFM increases interventions without improving neonatal outcomes. EFM disrupts normal physiology of labor by restricting movement and potentially interfering with appropriate labor support as providers and family watch the monitor.
The increased cesarean rate is probably in part because of problems with interpretation. In the two births I experienced, the equipment was archaic, and hard to get a heart beat no matter what position I was in.
V’s story: the nurses were not aware I was at 6 cm, and concluded my contractions were too difficult on the baby, and he was not coping well, but they later told me that had they known i was so far along, that would have been seen as normal.
One mom was woken up by the incessant beeping of the printer being out of paper for several hours, and nurses not knowing how to change it.
Problems
inter-observer/intra-observer reliability is poor;
the false-positive prediction of fetal distress rate is greater than 99%;
substantially increased the cesarean section rate with attendant mortality and morbidity
Optimal care should include:
intermittent auscultation for low-risk women.
Admission test strips should not be done.
If there is a medical indication for EFM, telemetry should be used to permit mobility.
Pitocin to speed up labor
Research has shown that natural labor progresses on average 2 hours FASTER than when given artificial hormones.
And man, in labor, you will do whatever you can to reduce it down 2 hours!!
I learned that had I instead been encouraged to walk around and be upright, it likely would've shortened labor by an average of about one and a half hours and significantly reduced the risk of having a cesarean.
Randomized trials have also demonstrated that if you're a first time mother with a slow labor, getting into a warm tub of water can reduce your need for drugs or breaking waters. It increases satisfaction without increasing the length of labor.
I also learned that Pitocin is considered a high alert drug. Meaning that there's a high risk of harm if a healthcare worker happened to make an error while administering the drug.
Because of this, Pitocin should be used with care only when there's a medical need that outweighs the risks of using it.
I was still in early labor when Pitocin was suggested to me, and I now know that it's normal for early labor to last a long time, as a first time mom whose water broke before the start of regular contractions.
At term, half of people in this situation are in early labor for less than 17 hours, and half are in early labor even longer.
Yet, I was not offered any alternatives to speed up labor. And I was told that I was experiencing something abnormal that needed a medication to fix.
Frequent vaginal exams.
One of the first things done to me when I got to the hospital was checking my cervix to see how far dilated (from 0 to 10 cm).
The more vaginal exams you have directly relates to much higher risk of getting an infection during labor. This sucks because it means mom (and baby) need antibiotics right away. Even though gloved fingers are sterile, bacteria gets pushed from the bottom of the vagina up to the cervix.
Studies
Research has shown that vaginal exams nearly doubled the number of types of bacteria at the cervix.
In a large trial of people whose water had broken, broken into groups of, there was a direct correlation of infection with more exams given.
Those who had whose who had 2 or less,
3 or 4 exams (they had twice the odds of getting an infection)
and 5-6 exams meant 2.6 times the odds of getting the infection.
7 to 8 vaginal exams had 3.8 times the odd
Those who had more than 8 exams had 5x the odds.
I'm not sure how many vaginal exams I had after my water broke at the onset of labor. It was at least five or six.
Victoria: I had 2 and 3 exams with each birth. Upon arrival I was 6 cm with both, then just before pushing to confirm if 10cm. This is one reason to labor at home as much as possible, so you are not getting checked every moment you (or the doctor) is curious- ESPECIALLY if your water has already broken. If your water breaks, the risk of infection goes way up.
Because of the hospital staff's desire to keep close tabs on my dilation, they had more than doubled my risk of developing an infection. Now, if my water hadn't broken at the start of labor, there would be less risk of infection with the vaginal exams because intact membranes help protect you from infection.
I learned later on from clinicians who worked at my university's hospital that the culture there was to check a laboring woman's cervix every 2 hours if their water hadn't broken (less if it had). Clinicians were under a lot of pressure to write those dilation results on a big whiteboard at the nurse's station. (but birth is not linear! we do not progress at the same speed).
Zero research shows benefits to frequent vaginal exams during labor. It turns out that this extremely common practice is based on tradition and routine, not on evidence.
Epidural for pain
Epidurals can help you rest, relax (and even sleep) during labor, but it also, on average, increases the length of labor by an average of 2 hours.
There is some evidence that severe untreated pain when someone is suffering, not coping with labor, can cause major stress and even decreased blood flow to the baby. So if a mom is not coping, it can be a great solution.
However, epidurals do come with potential side effects. This includes:
The risk of a drop in your blood pressure, which can then drop the baby's heart rate, and cause fever.
Some rare but potentially severe side effects include long-lasting headache and nerve damage.
I was informed of the risks, but there are plenty of other less risky comfort measures that I was not offered.
A large survey of mothers rated laboring in water (even just a shower) and with a birth ball as providing even more effective pain relief than opioids.
Research shows just moving around makes the contractions feel better.
One move we learned was just slow dancing with your partner. Let your arms hang over the other person and put most of your weight onto them. It is surprisingly beautiful and helpful.
The use of an exercise birth ball have studies to back their effectiveness.
Research also suggests Accupressure, aromatherapy, massage, and music.
I was not educated about any of these comfort measures in my hospital class, and while I was in Labor, was offered ZERO non-drug suggestions.
In fact, movement was explicitly forbidden for me.
The birth environment was incredibly stressful and unsupportive, which may have increased my discomfort
in one study with 600 mothers, researchers measured pain intensity during labor.
Then interviewed mothers afterward about environmental stressors. The mothers reported increased pain with stressors like:
crowded and noisy birthing rooms
restrictions on movement
restrictions fluid intake (told not to drink water, but given lots of IV salt water in veins)
The researchers concluded that these kinds of environmental stressors can aggravate pain and anxiety levels during labor.
Other researchers have found that loud noises during labor increase fear, and fear can make a person more sensitive to pain.
you could also argue that going into birth without understanding anything increases fear. Add the feeling of relying totally on a doctor you may or may not know, along with feeling abandoned by your doctor as you labor alone for many hours, and feeling totally out of control all increases fear. (which we now know makes you more sensitive to pain!). This is one of the many reasons to learn as much as you can before hand so you do NOT feel out of control. Birth is a lot of things, but all fall within an expected range of outcomes. Familiarize yourself with birth stories from books expecially catered to natural labor because you have the most to learn about natural cycles.
If you want a totally medicated birth, look those up as well, just understand people’s tolerances to drugs and how they were given vary wildly.
The temperature of the room, the brightness of light in the room and the feeling of being observed, can also stimulate the brain to release stress hormones.
(M&V) We brought in a portable speaker, some essential oils, and printed out a sign asking to keep lights dim and voices low. Marcus was a total advocate for this when anyone walked in the room!
It's important for care providers to help women cope with labor by providing privacy.
Needing to constantly say no to unnecessary procedures, or being restricted from walking or drinking all can cause stress and tension
Even mentally, it can be important to identify sources of disturbances and removing them. Talk to the mom and ask her to talk about anything and everything she is feeling. Just saying things outloud alleiviates much of the negative tension. (birth is one of those moments where what mom is thinking about directly affects biology and how her body moves the pregnancy along.
Laughing and crying have both been effective ways to get labor to jump start again. One mom wanted a fake wedding with her husband. Some want to be told “I love you” a million times. Others don’t want to be touched. Just listen and react, and try not to be offended!
Looking back, I would've preferred to have a birth environment in which I felt supported and private. The crowd's lack of privacy and restrictions on my eating, drinking, and movement were unnecessary stressors that increased my anxiety and discomfort. I also would've liked to start out using non-medical comfort measures and then switched to an epidural, only if the non-medical approaches were not helpful enough.
Epidurals can be TOO effective, where the mom has a hard time moving even way after the birth, and increase the risk of needing a vacuum or forceps to literally pull your baby out(and neither of those techniques tend to have great outcomes for the baby… it is just as it sounds… imagine someone using clamps or a vaccum to pull on your head to get your whole body out of a tight hole. It is much better to allow the body to work as it was meant to!).
From victoria: The body was MADE to give birth. The pain is temporary, and the recovery time is way less with less interventions you accept. Just assume it will be hard no matter what, dive right in, and it is over with. Many of my friends had MUCH longer recovery time, sometimes 6 months after still with pain and complications from infections, Epidural spine tap migraines, not able to hold their newborn for weeks after birth, and bad vaginal stitches that caused sex to hurt for almost a year. And I just had a small mom’s group I was working with! I avoided all of that, even though to them I seemed insane ahead of time. Not that it is for everyone, some doctors just say some women have a harder time with pain. But for certain, the number of C-sections should be more like 10%, not 33%, and better education could reduce that number even further.
Side effects
Epidurals relieved labor pain better than other types of pain medication but led to more use of instruments to assist with the birth. (leading to more difficult recovery)
While the number of C-sections remained the same if had epidural or not, more babies went into fetal distress leading to C-section in the epidural group.
Epidurals lead to increased likelihood of fever in mom just after birth
which has both direct and indirect consequences, including separation of mother and baby and baby sent to the NICU for further watch
Epidurals lead to longer second stage of labor
Women with epidurals had more trouble retaining fluid
Epidurals decreased the likelihood of a spontaneous vaginal birth.
Early epidural administration increases the risk of persistent malposition of the baby, (baby in the wrong position PERSISTENTLY), leading to increase liklihood for cesarean and instrumental vaginal birth.
In conclusion, Epidural analgesia provides excellent pain relief, but it disrupts labor physiology in several ways.
Without pain, oxytocin levels drop dramatically, and women require intravenous oxytocin (Pitocin).
Pitocin does not pass the blood–brain barrier; therefore, women with epidurals do not get an endorphin release.
The numbness and relaxation of the pelvic muscles makes rotation and descent of the baby more difficult. As a result, there is increased risk for several unintended complications.
Once an epidural is started, there is a cascade of additional interventions:
intravenous fluids,
continuous EFM, and
restrictions on movement
Need for fake hormones (pitocin) because mom’s body stops producing her natural oxytocin when pain decreases (and her natural pain killers also are blunted)
Recommendations
Delaying the epidural until active labor (6 cm) decreases the risk of both occiput posterior presentations and epidural fever.
If an epidural is required, low-dose anesthetic-only epidurals are recommended.
Side-lying and upright positions are likely to decrease the risk of instrumental birth.
Continuous labor support
Labor support is defined as the therapeutic presence of another person
it includes touch and massage, emotional support, information, and advocacy.
Even though these have proven scientific evidence of reduction in pain, most nurses are never trained in these methods in school or hospital trainings.
these provide the BASIS of midwife programs, which have much better birth outcomes for both mom and baby.
Nurses also have other patients and responsibilities
Hospital cultures sometimes frowns on nurses spending too much time with patients.
For whatever reason, I did not receive labor support from my nurses. It was a major gap in my care.
Doulas
Hired doulas are an option for filling that gap that nurses no longer fill, but doulas are not covered by insurance.
A doula’s essential role is to support you no matter what decisions you make or how you give birth.
In one of the most important studies on doulas,
researchers randomly assigned 42 first time mothers to only receive support from their partner vs care with a professional doula.
The results showed a huge improvement in outcomes for women who had both a partner and a doula compared to having a partner alone.
The C-section rate was 13% in the group with a partner and a doula
25% in the group with just a partner
Fewer women in the doula group required an epidural compared to those without a doula.
100% of people in this study who had a doula rated their experience as positive or very positive.
My obstetrician and the educator in my hospital childbirth class never encouraged me to hire a doula or even told me there was such an expert.
While some think it might feel weird to have a stranger in the room when I was giving birth. Little did we know that our room would be packed to the brim with strangers as the baby was emerging. In retrospect, the doula would've been one of the only people in the room we knew ahead of time. Doctors today cannot guarantee they will be the ones on staff for your birth.
Episiotomy
50 years ago, episiotomy rates in hospitals used to be virtually 100%. The current rate, at 17%, is still higher than it should be.
The World Health Organization set the goal to be 10% in 1996.
Systematic reviews of episiotomy, however, found that doctor cutting of the vagina to enlarge the opening caused only more problems for mom:
episiotomy causes more pain than spontaneous tears,
causes more healing complications than spontaneous tears,
has no effect on neonatal outcomes.
Episiotomy does not preserve pelvic floor functioning, and may instead contribute to urinary and anal incontinence.
Some doctors add an extra “husband stitch” (without consent) to tighten the vagina, which women report to cause pain in sex for a year after giving birth. (does a guy really get more sex when it hurts a woman to have sex?) (V’s friend experienced this, and in her second birth, the doctors mentioned serious scar tissue where the doctor sewed so poorly).
Tear Prevention
Studied suggestions for optimal prevention of vaginal tearing (promoting an intact perineum) include:
Policies that limiting the use of episiotomy
Encouraging mom to labor in positions NOT on her back (encourage non-supine positions in second stage of labor)
changing positions (as mom has more intense contractions, gravity is helping to help stretch and prep her vagina and canal, so we want to help this process along)
discouraging prolonged breath holding,
Allowing mom to push when her body urges her (once she is at 10 cm, fully dilated)
and waiting for a spontaneous urge to push for women with epidurals before actively pushing
Water immersion during birth.
I knew that laboring in water was safe, but what about pushing and delivering a baby in a waterbirth? Is that a safe option?
I found that there had been many observational studies on waterbirth with more than 31,000 water births studied, and a few randomized trials.
Benefits include
lower levels of pain
higher levels of satisfaction
fewer interventions
less use of medication for pain relief
In terms of vaginal tearing, in hospital settings, we see lower rates of severe tears and much lower rates of episiotomy, (the doctor performing a traumatic cut of the skin between the vagina and rectum, which has NOT proven any benefits).
but we see a higher rate of mild tears from waterbirth in homes and birth centers
Large observational studies show same health outcomes for newborns (no real risk or benefit with risks of death, breathing, APGAR scores, infection, breathing difficulty, need for resuscitation).
There have been some case studies of bad outcomes for newborns. There have been several reports of water aspiration when the newborn breathes in water before they were lifted out of the tub, but this side effect has not been observed in observational studies since 1999, and almost all of the infants in the individual case reports made a complete recovery.
Although large studies have not seen any increase in the risk of infection, there have been several individual reports of newborn infection after water birth.
Practice guidelines state that this rare risk can be lowered even further by:
using pools that are easy to disinfect
and filling tubs closer to the time of the birth (not letting the water stand for a long time)
if giving birth in a hospital, performing regular bacterial tests on the water supply hoses and birthing tubs
based on the evidence, it seemed to me that water waterbirth was a reasonable option, provided that I understood the benefits and risks, and made an informed choice.
I know I plan to be staying in a warm tub for the birth of my next baby.
Pushing positions
One of the least effective pushing positions is lying on your back or semi-sitting in bed.
Laying in one position makes the sacrum or tailbone inflexible, which makes it harder for your baby to exit your body, especially with gravity working against both of you.
Would you ever poop laying in this position? No way!
Just use your common sense and let a woman move in ways that make sense to her body.
Research has shown that when people (without epidurals) get in upright birthing positions, they're much more likely to have more streamlined births
including
less likely to get an episiotomy (doctor cutting their vagina open, which is PROVEN cruel and inneffective)
less likely for the doctor to feel the need for vacuum or forceps to pull the baby out
and the pushing phase is shortened (yes please!!)
These positions help a birthing mother (also mentioned in Spinning Babies Class):
squatting
on hands and knees (aka doggy style. Victoria gave birth in this position!)
standing
kneeling
For those women with epidurals (and limited movement), laying on her side (called supported sideline position) has shown to be helpful as a birthing position to reduce the same adverse outcomes above.
I was made to lie on my back the whole time and nobody ever suggested that I push on my side. Instead, I was told with intense yelling to hold my breath and push. (called purple pushing, because mom lacks oxygen and turns purple. This is NOT scientific at all, and one of the most popular forms of American “coaching” methods.
There is no evidence that coached pushing provides any benefits over spontaneous pushing, often called mother directed, pushing for women with or without epidurals.
So in the absence of evidence on the popular doctor’s methods, mothers should be allowed to choose their position and type of pushing based on education, preference, comfort, and unique circumstances.
I was never asked about my preferences for pushing. Large research studies show that for first time mothers, especially those with epidurals, pushing may take hours.
From V: Taking an epidural means the whole process takes longer (no effing way), and makes pushing more complicated (bc mom cannot feel her body or listen to her body), so unless I NEEDED an epidural (which is never the case), I had no interest in it. Plus, getting an epidural also comes jointly with pitocin (fake hormone), which (much like antidepressants), blocks your body from making the real stuff which has proven pain-reducing benefits, and I wanted everything good my body could naturally provide.
In fact, it is an evidence-based option for a first time mother with an epidural to consider pushing for four or more hours as long as mother and baby are doing well in making progress.
Improper Positioning
The fact that my provider diagnosed improper positioning of my baby and used her hands to adjust the baby.
Baby's position has also been shown by evidence to help prevent cesareans.
However, my baby's improper positioning may have been caused by the fact that I was instructed to labor on my back for 24 hours. This could have been a preventable complication and an avoidable procedure that caused me stress and pain.
Early cord clamping.
Something that I didn't notice at the time, they immediately clamped my baby’s umbilical cord after she was born.
Early cord clamping became widespread in the 1960s, defined as clamping the umbilical cord within 1 to 2 minutes of birth.
Many parents don't realize there's a difference between clamping and cutting the cord.
The clamp stops the blood flow from the placenta to the baby and is usually done immediately by hospital staff with a clamp, and the cutting is done later on, often by the partner with scissors.
During labor and birth, 1/3 of the baby's blood is flowing through the placenta at any one time.
When hospital staff immediately clamp the cord, this means that 30% of the baby's blood volume is left behind in the placenta, and the baby only receives 70% of their own blood at birth. (later causing anemia, or low iron in baby’s blood, because they were restricted from absorbing that last 1/3 of their blood! and it just takes 5 minutes!)
In contrast, if you leave the cord unclamped for a longer period of time, the baby will get
80% of their blood within 2 minutes
87% within3 to 5 minutes.
Babies need their blood.
That blood coming from the placenta to the baby is rich in stem cells and iron.
that blood has millions of stem cells, (people pay so much money for this!!)
and iron
iron is used to make hemoglobin, the protein contained in red blood cells that is responsible for delivery of oxygen to the tissues
babies get iron from mom while pregnant. But iron does not pass through mother’s milk. Amazingly, a baby gets to about 6 months before their iron stores from mom at birth are depleted, and that is just about the time most babies start eating SOME solid foods along with mother’s milk. A genious design of our bodies to help make that transition to getting iron naturally.
fun fact: mother’s milk is a direct byproduct of her blood!
Many babies are born with jaundice, that condition of yellow skin meaning low iron. The high prevalence of cord clamping too soon could prevent this!
Randomized trials have found that babies whose cords are unclamped for longer periods of time have higher hemoglobin levels.
No shit: Babies who get to keep more of their blood, they have higher blood cell levels
In the first year of life, researchers have looked at brain scans
MRIs of infants who are randomly assigned various forms of cord clamping at birth, found:
increased brain development among the babies who received delayed clamping (and suspected to have long-term benefits for brain development in your child)
Delaying cord clamping has been shown to be so beneficial in so many studies that some researchers have said that it may be unethical to subject ANY babies to the early clamping methods
But early cord clamping is still the most routine practice in American hospitals.
Victoria’s experience: Our doula helped us to be our advocate here. She mentioned it many times in our pre-visits, and told us to highlight it and remind the nurses, because she knew how common it was to have to fight for this. And we did! One nurse tried to tell me the baby would be at risk of bleeding if we waited, and I was so ready to tell her she was comopletley wrong. I just listened to a scientific podcast a day before, and knew she was wrong, as I held my brand new baby, I told her no, that is wrong. And never saw her again. DO NOT be afraid to tell the nurses no, or that they are wrong. Do not be surprised to see them pushing an idea that is a literal lie, because they have made up an insiuation or heard something without actually verifying it.
Other nurses urged in her place that there was danger here. The doula was VERY adamant about our desire to wait until the cord was white. Several nurses said, it is kind of white now, and our doula basiacllay said, “not white enough”. Several times. The nurses were under the impression that the blood would bleed out, but it has been shown that if the cord is left in place, the blood has valves that make sure the blood flows TO THE BABY from the placenta. The nurses had an outdated, innacurate impression, that the blood could somehow flow BACK into the placenta. This used to be in education text books before it was debunked in the last 100 years, and must still be lingering as a truth in hospitals. This was one very potent example of superstition, and not science, being a guiding practice still in 2023.
Pulling on the placenta: the doctor also wanted to sit there and hold onto my placenta to make sure it came out, maintaining light pressure on it. I was too happy to be holding my baby to argue any more, but I should have told her to back the eff away. The evidence on “pulling” out the placenta shows to cause WAY more chance of bleeding than letting all those blood vessels slowly relax and let go of the placenta naturally. There is worry about the cervix closing with the placenta in place, but this is actually very rare.
If the placenta is still inside mom after 30 minutes of birth, that could be a problem, and could lead to infection and extreme bleeding. But I was only 5 minutes in!
The prevalence of retained placenta in high-resource countries is only 2.7% of vaginal deliveries.
If a mom has a history of retained placenta, recurrence rates are approximately 12.5%
The amount of flutter by the nurses to pull that placenta out and cut the cord was insane. To prevent a risk factor that only had 2% chance of being a problem!
They also really wanted me to take pitocin (more of that artificial hormone) to get the forced contractions for the after birth, to deliver the placenta after birth. Again, this is completely unnecessary, uncomfortable, and I just read research about how it had adverse effects on baby (but I need to find that research now).
Parents may write down delayed cord clamping on their birth plan, but the nurses or doctors may do early cord clamping anyway, just because it's what they're used to doing.
V: I truly believe nurses and doctors have best intentions at heart (while the insurance companies are a whole different story, and force various requirements on doctors for profit). I think modern doctors and nurses are working with an old set of tools and guidelines, and there are no incentives to help them update policy.
I've heard accounts of parents asking for delayed cord clamping and physicians saying things like, I don't delay past one minute because it's dangerous, the baby would receive too much blood. My nurse was saying the baby could bleed BACK into the placenta. Both are untrue.
Hospital staff may also believe that delayed cord clamping increases the risk of jaundice, a yellowing of the baby's skin and eyes from the breakdown of red blood cells. (it is actually the opposite. more blood, means less blood quality problems!)
While it's true that a 2013 Cochran meta analysis found more use of light therapy to treat jaundice with delayed cord clamping, 4.4% versus early cord clamping 2.7%.
This finding is based mostly on one large unpublished dissertation study, and the final conclusion of the Cochrane review was still that delayed cord clamping is beneficial.
A different systematic review published in the Journal of the American Medical Association, JAMA did not include this unpublished study, and they did not find any relationship between jaundice and delayed cord clamping.
None of the published randomized controlled trials on term infants have shown an increase in jaundice with delayed cord clamping
Oxytocin vs Pitocin
Oxytocin and its synthetic form (Pitocin) are identical in chemical structure. However, they don’t act on the body in the same way.
They both cause uterine contractions that help to birth the baby and placenta, the mother’s oxytocin is also released in the brain, where it reduces anxiety, stress, and pain.
This is a major difference between oxytocin and Pitocin.
the birthing person’s own oxytocin levels rise in both blood and brain fluid, but Pitocin does not cross into the brain because of the blood brain barrier (learned in 1983).
Once again, we see how intelligent our bodies are, and how our real hormones do much more than just the mechanical pushing achieved from the man-made version known as Pitocin.
Dosing of Pitocin:
At high doses, Pitocin can cause more frequent, longer, and more painful contractions
Doses up to 9 milliunits (mU) per minute leads to similar levels in the blood as seen with physiologic labor
10-16 mU per minute raise levels to double those of physiological labor
The optimal dosing of Pitocin® in practice is controversial, and guidance simply limits dosages to 40 mU/minute (varying by state). This lack of research in optimal dose does not stop it from being used at
Oxytocin in the body (both natural and synthetic) causes the uterus to contract by binding with oxytocin receptors on the cell surface.
When there is a lot of oxytocin, the body compensates by decreasing the number of oxytocin receptors to maintain body equilibrium (balance).
Prolonged exposure to Pitocin (man made oxytocin) in labor may lead to a reduction in the number of oxytocin receptors (receptor desensitization or down-regulation). This is less likely to happen in physiologic labor and birth (with the body’s own oxytocin) because the oxytocin is released in pulses and then rapidly broken down by an enzyme so that there is very little (if any) oxytocin left in the bloodstream between pulses (known since 1984). Getting that break from oxytocin exposure protects against receptor desensitization, helping to keep contractions effective.
The hormonal dance of labor
The physiologic process of labor and birth is largely driven by hormones, and the hormonal orchestration of the process is easily disrupted. -NIH 2014
In the last weeks of pregnancy, the cervix, under the influences of increasing amounts of oxytocin and prolactin, softens and may begin to efface and dilate. The uterus becomes increasingly sensitive to oxytocin.
During labor, increasing amounts of oxytocin increase both the strength and the efficiency of the contractions. The increasingly strong contractions cause increasingly high levels of pain. As women cope with the increasingly painful contractions, increasing amounts of oxytocin are released. If the pain is taken away (for instance, with an epidural), oxytocin levels drop and contractions become fewer and less effective.
At some point, when oxytocin levels are high, endorphins are released. Endorphins produce an intuitive, dreamlike state and pain perception decreases. This makes coping with the contractions easier. Endorphins in labor are sometimes called “nature’s narcotic.” If the woman requires an epidural and oxytocin augmentation, she does not experience this endorphin release because exogenous oxytocin (Pitocin) does not cross the blood–brain barrier.
Catecholamines, the stress hormones, are released if the mother is fearful or if she does not feel safe and protected. Early in labor, high levels of catecholamines can slow or even stop labor. At the end of labor, however, there is a natural surge of catecholamines that facilitates the quick birth of the baby, even in a tired mother. If the natural, physiologic process of labor and birth has not been disrupted, both mother and baby have large amounts of circulating oxytocin and catecholamines at birth. The effect is an alert, eager mother and baby who are ready to greet each other calmly and begin breastfeeding.
Optimal care in childbirth is care that facilitates rather than disrupts the normal physiology. There is substantial research evidence for five birth practices that facilitate the physiologic process:
letting labor start on its own (so that mother and baby are ready for labor),
freedom of movement (to help women cope with pain and to protect the birth canal and the baby during rotation and descent of the baby),
labor support (to decrease fear, enhance emotional and physical relaxation, and provide for privacy),
spontaneous pushing and birth in upright positions (to facilitate rotation and descent of the baby), and
keeping mother and baby together (to facilitate transition of the baby to extrauterine life, breastfeeding, and placental separation)
Routine interventions have the potential to interfere with the processes at every point in labor and birth, leading to a cascade of other interventions and ultimately increasing risk for mothers and babies. Because of this, optimal care includes avoiding routine interventions unless there is a clear medical indication.
Separation from my baby
Without even looking at the evidence, I was pretty sure there's no way research would support separation of mothers and babies, but I looked it up anyway.
I was right. Separating mothers from newborn babies is extremely harmful.
It's a practice that is unique to the 1900’s and 2000’s, and is a complete break from human history.
Evidence shows that the best care for mothers and babies is to provide them with uninterrupted skin-to-skin contact during the first hour or two of life,
and to intermittently continue that skin to skin contact over the next days and weeks.
Parents (moms AND dads) are encouraged to lay their (unclothed, diaper on) baby on their bare chest while covering the infant with blankets to keep them dry and warm.
Placing a baby on TOP of her clothing or a towel does NOT count as skin-to-skin.
It is the actual skin contact that allows hormones between the mom and baby to communicate with each other.
To this day, it drives me crazy when I see nurses throw a towel on top of the mother's chest before handing the baby over.
The Science:
Babies who are held skin to skin with their mothers have:
lower stress levels
better success with breastfeeding
more stable blood sugar
better breathing
better heart rate
better oxygen levels.
By contrast, when babies are separated from their mothers,
they less able to breastfeed
have more trouble with their vital signs
12 TIMES more likely to cry (obviously something wrong intuitively)
Moms and babies who are separated are
more distressed
more likely to experience anxiety
more likely to experience breast engorgement, (painful, swollen breasts in the days after birth because the baby is not feeding properly).
I also found one randomized trial out of Russia about the long-term effects of temporarily separating mothers and newborns after birth.
In this study, all babies were separated from their mothers for the first 25 minutes of life, for mandatory routine care.
Half the babies were returned to their mother's arms for skin-to-skin care. The other half were tightly swaddled and kept separate from their mothers for two hours. The babies were filmed playing with their mothers one year later, and researchers who were blinded to group assignments analyzed the films.
The results showed that the one year old infants who had been separated from their mothers at birth for two hours were more irritable, impulsive, and had trouble self-regulating. The mothers who were separated were less responsive to their infants and showed less reciprocity and mutuality, meaning they were less enthusiastic and more likely to have a flat affect when interacting with their child.
Tylenol
Many doctors do not see the harm in either of these, however crunchy mama research dives down several steps further than general accepted mainstream knowledge, and several studies have surprising information
Tylenol should also be avoided (unless mega high fever in newborn, above 104 or so, or per doctor suggestions)
Baby versions of ibprofen and tylenol (Acetemenaphen) are sometimes said okay after 6 months, but doctors still allow (nd recommended) their use after vaccines or before circumcision.
However, tylenol prevents toxins from being able to leave a body. When vaccines are tested, they do not test in combination with tylenol use, which would show the retained chemicals held in the body.
Ibuprofen is shown to increase internal bleeding in excess (so in small dosages, can’t be doing anything good).
Another study on the effect of circumcision showed the only negative outcomes were on those babies that had tylenol after circumcision.
Since neither of these provide much pain relief anyways, it is best to just get through it without it.
Sugar
One study showed nurses who did their own study. They administered half the newborns to sugar to help prevent crying, and no sugar to the other half. After 6 months, babies that did NOT get the sugar had much less fussiness. Sugar should not be used as a coping mechanism.
Many doctors will suggest sugar water to cope with the pain of circumcision. Usually this is performed while still in the hospital right after birth, or within 8 days of birth.
Instead of sugar water, it is suggested to provide the doctor with several small vials (1-5 mL of hand pressed breast milk)
See youtube videos on how to hand express. This is useful to learn anyways, while in the hospital bed while your newborn is sleeping, especially if you are having breast feeding difficulties. Try to start stocking up, each drop is pure magic, and can be applied to skin rashes on baby, to help clear up eye gunk (from blocked tear ducts), and even any skin ailments on adults!
But if parents want to circumsize, stocking up on this really helps to keep the baby calm while the procedure is done.
Length of labor
if allowed to get into labor naturally (no drugs), 50% of women go into labor after 41 weeks and 3 days. So that can be used to realize a normal birth could easily be expected to go into 41 weeks.
the hospital system wants to limit the rare case of placenta weakness, which can happen for some women by 40 weeks. But because each women has such a different expectation for full term, (ranging by full months!), we should be looking at individual women to decide what is right for them, or better yet- let that baby decide! Let’s study and look at period length prior to pregnancy and see if that makes a difference.
V has a normal monthly cycle length, for her, of 24 days, (borderline abnormally short) and both of her babies were born a week early. Many women see that birth timing of all her children tend to be around the same time, but this is highly UNDER researched. Women should track these things for herself, (know her avg period length, and recognize when it shifts), and (at best) maybe we have an aggregate of data available to us all.
Some intelligent studies point to a protein released by the baby that causes labor to start naturally, but we still really do not know. (there is a crazy amount we have not studied about birth).
Conclusions
All I can say is I'm glad human beings are resilient.
Clara and I became very bonded despite our separation.
You and your baby will be FINE after an american hospital birth. But it is not as good as it could be. When something can be magical, why settle for FINE bordering on traumatized?
After uncovering all this information, I was beginning to feel a bit betrayed by the system. How could it be that an institution that's so valued and proclaimed support for evidence-based medicine be so archaic?
As I read through the research, I became more and more upset that the care I had received in a modern academic hospital was based more on tradition and routines rather than best evidence.
And all across the world, people copy routines used in the US because they ALSO assume it is the best of care.
Childbirth Education
It is clear that the routine use of these interventions disrupts the normal physiologic process of labor and birth. It is also clear that the number of interventions increase with early admission to the hospital. This is what women need to know:
Eating and drinking in labor is not dangerous and, if desired, is beneficial. There is usually no need for intravenous lines.
EFM does not make labor safer for the baby and increases the mother’s risk of having an unnecessary cesarean.
Epidurals provide excellent pain relief but that relief comes at a cost. Some of the risks of epidural analgesia can be lessened by delaying the epidural.
Augmentation is rarely necessary. Labor can and usually does take a long time. Patience, movement, and position change; excellent labor support; and eating and drinking are all that most women need to keep labor moving. It also helps to stay at home until active labor (6 cm).
Routine episiotomy is harmful and its use should be restricted.
Having a deep understanding and confidence in the normal physiologic process of labor and birth and confidence in her own ability to give birth makes it easier for a woman to let go of the belief that technology and routine interventions make birth safer for mothers and babies. Providing women with “the facts,” including the research, isn’t usually enough to change values and beliefs. Storytelling is a powerful way to make that happen. Just as importantly, the childbirth educator, the nurse, and the midwife and physician need to send a clear, consistent message to women. We can’t tell women that they have all it takes to give birth simply without complications and then tell them that routine interventions “just in case” make birth safer.
