Maybe in reading about my Tale of Two OC Moms you got a little mad about your own births.  Or maybe you are happy you made the choices you did.

I read a great article in the Huffington Post where the author compared 2 births and how it effected the breastfeeding outcomes for these moms.

She talks about how some moms feel guilty if breastfeeding doesn’t work out for them, but how a lot of if a mom is successful with breastfeeding goes back to their birth experience and the hours right after birth.  It has a huge impact.  Hospitals often have policies in place that hurt the chances of breastfeeding being successful.

So I say the same thing about your birth, if you had a negative birth experience, don’t feel guilty, get angry and take action!  Help make changes in the system.

One easy way to do this is to fill out The Birth Survey about your experience so other moms know about the care providers they are choosing.

Another easy thing to do, if you are a cesarean mom, or just a mom worried about the rise in cesareans:  join ICAN.  This is a great organization fighting the rise in cesareans and offering support to cesarean moms.

I want to point out that as I compare these two births right now, I am not judging these moms choices.  They each made the best choices for them and their babies along the way.  I am just looking at how different hospitals policies and care providers attitudes can have a big affect on the choices a mom makes.

When to admit a mom to the hospital:

Some hospitals have policies that a mom has to be 3-4 cm dilated before admitting them to the hospital.  This helps prevent un-neccsareay interventions such as pitocin and cesareans.

Addison was sent home 2 times because she wasn’t 3-4cm.

Cara was admitted at 2.5 cm. Had she been sent home until she was really in her active birthing time, it wouldn’t have been a big deal when her birthing time slowed down.  She may have gotten some rest and then birthing time may have started in the morning again.

Maybe having her walk the halls for an hour and then checking her to see if she made progress would have helped confirm if she was in her active birthing time?

Offering Epidural:

Addison:  Nurse let her know if she wanted it, she could ask.  Addison asked when SHE wanted to.

Cara:  Nurse tempted her with “best anesthesiologist” This is a hard offer to refuse.  The nurse might know the next anesthesiologist sucks.  Cara took the offer.  If she had waited until SHE wanted an epidural she probably would have gone a few more hours using upright positions and that may have helped her progress more.

Maybe this nurse wasn’t comfortable with Cara being un-medicated?  Maybe the anesthesiologist was bored and wanted to do another epidural?   Who knows why she presented her choice like that?  But you can see how her offer of the “best anesthesiologist” is different then saying, “let me know if you need any pain relief.”

Time Line for interventions:

This may be more care provider specific then location but I am not sure.

Addison went 8.5 hours with no change before pitocin was offered.

Cara was on pitocin 4 hours after getting to the hospital. This could be because her pw slowed down, because she wasn’t really in her active birthing time when they admitted her.

Suggesting a cesarean:

(Remember, in both cases mom and baby were doing fine.)

Addision:  A cesarean was never suggested, even with 10.5 hours with no change!

Cara:  A cesarean was suggested quite a few times. Starting even before her birthing time even started.   This creates a mind game for the mom and I think is manipulative.

Cara was told she wasn’t progressing, but this isn’t quite true effacing more and having her baby moving down IS progress.

The nurse said,

“If you haven’t progressed in the next hour you are having a cesarean.”

What if the nurse had said instead,

“You are making progress, you are effacing and the baby is moving down slowly.   With more time you will dilate as well.  We’ll check again in a few hours as long as you and baby are ok.”

The first way Cara was getting set up for a cesarean.

I can only guess that her OB had somewhere he wanted to be that early evening. He didn’t even give her until 5 like I thought he would.  (You think I am cynical.  But I just talked to another mom whose OB pressured her into a cesarean and she didn’t know why, until she found out the OB had a concert that night.)

Cara’s OB said to her during the cesarean,

“I thought we would end up here.”

Even if a mom has a great attitude and positive expectations

and plans well for her birth, she can be affected by others attitudes and expectations. Birthing moms are very suggestible.  Care providers and birth partners should take great care in what they say to them!

I share these Two Moms Tales to encourage moms everywhere to Choose Carefully! Your care provider AND your birth location together can have a huge impact on your birth.  Choose Carefully!

It is never too late to change.

• In the last 2 months, I have seen 3 moms change birth locations and birth providers at 40 weeks.
• It is easier to change earlier, so talk NOW with your care provider, but it is possible, even at 40 weeks.
• Talk to your local doulas and childbirth educators for recommendations of good care providers and birth locations!

I have to admit I felt a bit guilty after I found out Cara ended up with a cesarean.

When she talked about changing care providers, I certainly said she should change if she felt like it.   I even shared ideas of good care providers.

But I also nodded my head when she said something along the lines of , “but they are usually only there to catch, so they can’t matter that much.”

It is this delicate balance I walk as a childbirth educator, moms have to make their own choices.  But I learned from this that if a mom has a gut feeling her care provider isn’t a good fit, I need to really reinforce that idea.  If you don’t feel it is a good fit, you SHOULD change!

A mom’s intuition is powerful, listen!

I also felt a little guilty, because when I called at 9AM, I felt I should offer to come to the hospital to be with them. Because of that impression that if she hadn’t had her baby by 5, I knew that it was possible a cesarean would be pressured on them, I wanted to be there to help prevent that.  But I didn’t offer and I feel bad about that.

So, there is my guilt.  I have learned from it and really stress the power of intuition to moms.  I will be better are following my intuition as well!

I was thrilled to find out that Cara is happy with how her birth turned out.  It wasn’t a traumatic experience for her.  She didn’t feel pressured into any choices, and she has had a good recovery.  She was able to breastfeed and it was a positive birth overall (she really feels being able to see him be born, is a huge part of that.)

Knowing that she was ok, helped me to let go of my guilt.  But I did learn from the experience!

In Honor of Cesarean Awareness Month: a continuation of a Tale of Two OC Hospitals.

I had 2 first time moms in one of my Hypnobabies Classes.  Their births were similar in many ways – but had different outcomes.  In a large part due to the choice of their care providers and birth locations.

Mom 1 – Addison was birthing at hospital A, my favorite hospital (lowest cesarean rate, high VBAC rate, low episiotomy rate, no inductions before 40 week rule) with a care provider who has low intervention rates.  This mom was tiny and I was glad she was with this care provider.  Many others would have tried to scare her into a cesarean.

Mom 2 – Cara was birthing at hospital B, (higher cesarean rate, low VBAC rate, elective cesareans “encouraged” by many OBs)  She had a care provider I didn’t know.  But Cara was nervous about the care provider and asked my opinion a few times about changing.  I encouraged her to interview other care providers and gave her some options of those who are supportive of NCB.  But in the end she chose to stay with him.

If you were to guess right now, which one ended up with a cesarean, you would probably be right.  I asked these moms if they were willing for me to share their birth experiences so that other moms can learn how choosing your care provider and your birth location can have a big effect on if you end up with a cesarean or not.

Here are their experiences.  Tomorrow I will compare the two and look at what may have made the biggest differences.

Mom 1 – Addison

Early in her pregnancy she asked about their induction policies and about her cesarean rate.

The OB told her that they “only induce when it is medically necessary.”  She also said, “We only do cesareans when mom or baby are at risk.  C-sections are harder for baby and mom to recover from.  This makes it harder for me, because I am worried about mom and baby!” 

This helped Addison feel confident that her care provider was the right one for her.

39.5 weeks: Addison’s birthing time starts on it’s own.

Saturday night 8 PM her pressure waves (pw) were 5 min apart she went to the hospital.   She got sent home because she was 1cm.

Sunday morning at 9AM, her pw were 3 min apart lasting up to 90 seconds, she went to the hospital again, but was sent home again because she was still 1cm.

3:30 Sunday afternoon she went back to the hospital – She was 3cm!  Yay! She gets checked in and settled in her room.

The nurse did say, “If you want an epidural let us know.”

It was not mentioned again until Addison brought it up.

5 PM Sunday Addison gets an epidural so she could get some much needed rest.  (She was still 3cm)

Midnight (7 hours later), she is still 3cm.  Her care provider brings up trying pitocin.  Addison asks to wait another hour to see what happens and says, if there is still no progress, then I am willing to try it.  The care provider was fine with that.

An hour later, still no progress.  So they start the pitocin at 1ml.  The baby heart rate drops so they stop the pitocin.  This little bit was enough to get things started and she starts to progress.

In all this time a cesarean was never mentioned.

5 AM Addison started to push.

Her baby girl was born vaginally at 6:10 Monday morning.

Mom 2 – Cara

EDD from known date of conception is Dec. 1^st.  When change to new OB midway through pregnancy he changed due date to Nov 27^th based on 18 week ultrasound.  Mom still considers Dec 1^st as EDD

Monday, Nov 30^th Cara has an appointment.

Her OB does a vaginal exam and finds she is 0 cm 0 effaced.  OB says we need to do cesarean. This baby is not coming out on own.

She says “I’m not even due yet.”

OB’s response is  “I know you think your EDD is Dec 1^st, but in the chart it is written down as 11/27.”  Her OB did mention induction, but because her Bishops score was so low it was unlikely to work and she would end up with a cesarean anyway.

Cara had been concerned about the baby’s activity level, so she schedules a cesarean for Thursday and her OB sends her to hospital for monitoring.   The baby is doing great, so Cara calls to cancel the cesarean.

That evening she loses her mucus plug.  While out to dinner with her DH her pressure waves (pw) start and they get more intense as the night progresses.

2AM Tuesday morning they head to the hospital, because the pw are 5 min apart.

She gets to the hospital and she is 2.5 cm dilated.  They admit her to the hospital.  Cara’s nurse is excited and says she has a good chance for a vaginal delivery.

Once she is checked into her room, her pw space out and don’t have a normal pattern.

6AM pitocin started to help get pw regulated.

Nurse comes in soon after the pitocin gets started and announces, “The best anesthesiologist is about to go off shift.  Do you want an epidural?”

Cara was managing her pw ok, but she was nervous that with the pitocin they were going to get harder to handle and who wouldn’t want the “best anesthesiologist”?  Cara says yes to the epidural.

7 AM epidural is placed and she is 3.5cm dilated.

With the epidural Cara found that she couldn’t really rest.  She felt shaky, her legs felt tingly and time seemed to pass so slowly.  She felt disconnected from her body and wasn’t sure it was doing anything.

(At some point maybe around 9AM, I called.  Cara had called the day before when her OB said she needed a cesarean.  I had left a message the day before reassuring her that her body knew how to birth a baby, but didn’t hear back, so I called again.  I was thrilled to hear her birthing time had started on its own.  I was a little nervous, because of her OBs comments the day before.  I thought, “If she hasn’t had this baby by 5, he is going to want to do a cesarean.”)

1PM she is 100% effaced and baby has dropped more into her pelvis.  But she hasn’t dilated any more.  The pitocin was upped to the max, and they had to turn it down a bit because she was having too many pressure waves.

The nurse told her “If you haven’t progressed anymore in an hour we will do a cesarean.”

2PM she is checked again, “no progress” had been made.  Cara had mentally prepared herself for this reality and because she isn’t really comfortable, even with the epidural and she is ready to meet her baby, she is ok with moving forward with the cesarean.

2:30PM her baby boy is born via cesarean! Cara said the best part is that the anesthesiologist really encouraged her to watch while they took the baby out.  She wasn’t sure about that, she was scared to see herself cut open.  But he reassured she would see the baby, not herself.  So she did watch and thought it was awesome.  That experience of seeing her baby come out helped it to be a positive birth experience.  She felt connected to him and the birth experience. 

She tells moms all the time now, to take that opportunity if they need a cesarean.

(Looking back Cara says she wishes she had waited longer to go to the hospital and also that she had waited to get an epidural.)

Can you see how hospital policies and staff attitudes can effect the outcome of a moms birth? What are your thoughts?  I will share my insights tomorrow.

In honor of Cesarean Awareness Month.  I would like to highlight the importance of choosing your birth location carefully.

In this specific case I am talking about choosing between two hospitals.  There are differences in hospitals and their policies and it can have a big impact on avoiding a cesarean!

I actually have quite a few hospitals that moms can birth at in my area.

But to simplify things, I am going to look at just 2: Hoag and Saddleback.

I would say they service the same type of women.  Middle – Upper Class Orange County Moms.

They are both nice/comparable facilities.  Here are the most obvious differences a mom would notice on the tour.

Hoag might “look prettier” and they get a steak dinner the night after the birth.

Saddleback has Telemetric monitoring, so a mom can walk the halls and get in the tub and still be monitored.

But the biggest differences lie in their cesarean rates from 2008.

Hoag’s cesarean rate is 37% and Saddleback’s cesarean rate is 30%

Interesting enough I just got something in the mail from Hoag about the courses they offer.

What Women Should Know About Elective C-Sections

Saddleback not surprisingly has a

Vaginal Birth After Cesarean Class

Their VBAC rates from 2007 is not surprising.

Hoag’s VBAC rate is 3.7%   Saddleback’s VBAC rate is 15.9%

Needless to say, when a mom asks me where the best place to birth is, I recommend Saddleback.  I share the statistics and the experiences I have had as a doula and from the birth stories I have heard my students share.

Tomorrow I will share the Tale of Two Moms.  1 birthed at Saddleback and 1 birthed at Hoag.

I LOVE this article from the New York Times which compares 2 hospitals and their birthing outcomes.

In Effort to Limit C-Sections, Two Methods Yield Different Results on Staten Island

I am going to post my own article tomorrow  comparing 2 Orange County Hospitals and their C-section stats.

Stay tuned!

Tired of being pregnant?

Worried your baby will never be born?

Here is a great letter to read, by a great doula I met at the Trust Birth Conference.

Dear I-feel-like-I’ve-been-pregnant-forever,

Also you may want to check out my Induction Video to learn more about the pros and cons and alternatives too!  It is free until the end of the month.

with a mom living in Korea who wants to create a Childbirth Education program for other expats there.

Mama Seoul

This came out last month, but I just saw it.

A Change of Delivery

I went to Vanderbilt for my undergraduate degree.  I loved it there.

I was interested to see that the Fall 2009 Vanderbilt Magazine had an article on the Midwives there!

Rebirth of the Midwife:  Attracted by hands-on care and lower costs, more expectant parents turn to certified nurse-midwives.

It was a really great article and highlighted a VBAC mom, who used the midwives.

Enjoy!