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.

I created a survey to look at if and how someone’s faith could effect their birth.  Please take a few minutes to fill it out!  It should only take about 5 minutes. 

 Click Here to take survey

If you took a Hypnosis for Childbirth course and want to do a survey regarding your experiences with that, I made a survey for that too.

http://www.surveymonkey.com/s.aspx?sm=smexlaSoppQdfs0441CXBA_3d_3d

Thanks!  I will share the results in May.

The Trust Birth Conference was very interesting.  It was fun talking with other doulas there.  We had one group discussion and someone talked about how our work as Doula’s can be effected by our births. 

It made me think of my 2 cesareans I have attended as a doula. 

I always was nervous how supporting a mom with a cesarean would effect me, because of my first birth.   I had an emergency cesarean at 34 weeks.  It was scary, my baby was in the NICU, I didn’t get to hold him for 24 hours.  It was medically necessary, but still not anything I would want any mom to experience. 

So I was talking to this doula about this and came to realize how God had really helped me deal with the ability to suport moms during cesareans, while not letting my emotions from my birth get in the way.  He did this in an interesting way. 

My first cesarean was Mom B and it was not an emergency situation.   It unraveled over 24 hours.  A long induction for a first time mom.  Exhaustion was the real reason for the cesarean.  She was well supported and respected and made the best choice for the situation she was in.  It was still hard for me to accept in some ways.  It was still quite devastating, because I knew what she was losing and gaining in her choice. 

Since it happened slowly, I had time to come to grips with the situation and help support her through that.  It wasn’t really until afterwards that I broke down.  (There were many facets to that, it was the end of being away from my house for pretty much 57 hours for 2 long inductions.) But driving home I called Jenn, my good friend and all I could say was, “She got a cesarean.” and then started crying and couldn’t really stop.  Jenn is a cesarean mom too, so she understood.   I still tear up thinking about it and it was 5 months ago. 

Fast forward to 2 months ago and I am at another birth.  Mom K is on pitocin after supposed PROM.  OB checks her and she has bulging forewaters, so she goes to break that, without even planning on telling mom.  I jump in to say, “Looks like OB is going to break your water!”   

Baby doesn’t tolerate it well at all, they try changing positions, then try amnioinfusion.  I can tell things are getting dicey.  Suddenly OB is in there and without telling K anything, putting in an internal monitor.  I am calmly telling mom what is going on.  Then OB goes for second Internal Monitor, I say to K, “It looks like you might be going for a cesarean.”  OB calls Code Green, room fills with people.  No one is talking to K at all.  The room is in chaos.  I feel totally calm.  I say to K, “Go to your special place.  You and your baby will be fine.”  Mom and Dad are gone within minutes. 

I am left alone in the room.   I still feel calm.  This was the situation I was most afraid of.  Being in a situations close to Devon’s birth.  But in reality I think that first birth with B, helped prepare me for this cesarean.  It helped me deal with a lot of my emotions regarding Devon’s birth, so that I could be present and calm for K when I needed to be. 

K and baby were fine.  I loved that she was able to recover back in her room with baby in the room with her.  She was holding him skin to skin within an hour after he was born. 

It was a much easier birth for me to deal with as a doula.  It was medically necessary (though I see very clearly different interventions may have caused that necessity).   I was able to provide support before and after.  I didn’t shed any tears, though I do feel sorry for K that she joined the sisterhood of the scar.  It is something I do not wish for anyone. 

The end of  2007 I attended two very long births back to back.  Out of 63 hours I was gone 57.  I was home for a few hours of sleep between them.  I missed my 2 year olds birthday and honestly I don’t know where my boys were during that whole time.  I wasn’t worried, I knew that they were with friends and DH and they were fine. 

Both births were for first time moms who were induced, hence the longness.  (I am not sure if that is a word, but it seems right for this post!)

Here is the short version. 

Tuesday night go to hospital to support my single mom client, A.  She was on pitocin by 5am.  She started having back labor and when she discovered she was still 1.5 cm. she wanted an epidural.  Her OB said Ok.  She did progress and had baby vaginally around 6:30 pm.   Got her settled in postpartum and headed home by 9pm Wed.  

In bed at 10 pm and up at 3am Thursday off to another birth.  Mom B, was induced with pitocin at 5am on Thursday. (had been in hospital since 3 pm Wed. afternoon because of low amniotic fluid) She handled things well throughout the day.  She chose to get water broken at 6pm when she still hadn’t progressed.  Things got very intense and she chose an epidural at 8:15 pm.  She rested, but was quickly getting exhausted and by 4 am was so discouraged and back pain started coming through the epi.  Baby was posterior and at 5am mom chose elective cesarean.  I was going to be able to go in with Dad and Mom, but her sister got there just in time so she got to go in and I got to go rest.   I was able to see mom after recovery.  She was just exhausted.   Didn’t even hold the baby yet when I saw her at 10 am.   It was so sad for me to see.   Baby was fine, mom was past exhausted, but ok physically… I was exhausted too.

My reflections on these births. 

Interestingly enough, I felt like A, while she had a better outcome (vaginal birth), was not treated with the same respect as B.  The nurse for A caught her eating and read her the riot act.  Then after she accepted the epidural, there was a time when the baby’s heart rate was looking fishy, so she ended up with an internal monitor.  The nurse said, in a snotty voice, “That’s what you get for having a 2 page birth plan!”  I was shocked and saddened by her unkindness.  

 Mom B on the other hand was treated very respectfully by everyone.   They respected her choices.  While it ended in a cesarean, I was happy to see how she was not coerced into it.  This is from my birth story I wrote for mom. 

OB comes in at 5 am, she talks to B.  “How are you doing?” 

B. says, “Horrible, I just can’t do this anymore.  I am nauseous.

OB, “Let’s check to see how you are progressing, baby looks good and you are ok, so there is no emergency.”   B is 7cm.  OB checks baby’s position, baby is positioned a little funny.  OB goes over options.  “We can wait and keep on going, baby is doing well, but it may continue to be slow progress because of babies position.  Or we can do a cesarean now.”

B. quickly responds she wants the cesarean.  He DH agrees and in many ways I do too.  She is SO exhausted I really don’t know if she could push a baby out even at this point if it was time to push.   

I was still heartbroken about it, because I knew it wasn’t a medically necessary cesarean and I hated to see her get cut, to join the sisterhood of the scar.  I cried for a few days because of it.  But she was informed and she made the choice.  I think it was the best one for her at the time.  I went through a lot of second guessing, what else could I have done as her doula to help prevent this?  Did I fail her somehow?   B and I have talked a few times about it.   Her saddest part is she doesn’t remember the first time she held her baby. 

It was interesting, I went to visit her after she got out of recovery.  But I didn’t want to see her baby in the NICU, because I did not want to see her baby before she did.  That seemed to wrong to me.  I remember that empty feeling, when my Devon was in the NICU and I was in a room alone.  So empty.  I think this birth was an interesting step for me in regards to emotionally dealing with some issues from my birth.  But that is a whole other post! 

I have had a cesarean with my first baby.  It was a medical emergency and I feel that it saved my baby’s life.  Baby was not OK and needed to be born NOW.  I am grateful for living today when this medical intervention is possible. 

 I have had 2 VBACs.  They were normal births, baby was ok and mommy was ok, so I didn’t need medical intervention. 

Too many moms today are getting cesareans.  They are not all needed.  Too many moms are getting scared into cesareans or repeat cesareans by their care providers before their birthing time even begins.  This is not really about a mom choosing a cesarean, this is about a mom being railroaded into one.  This is not empowering to a mother. 

Women deserve to know all their options.  Women deserve to know the risks of VBAC and the risks of repeat cesarean, so they can choose what is best for them! 

For those who are planning on having more than 1 or 2 children this post at Rixa’s blog, is very important for you to read! 

 This post is NOT about medically necessary cesareans, there are certainly times when choosing a cesarean is obviously the best choice, when the life of mom or baby is at stake.  This is also is a total of 4 posts that go together, scroll down my blog for the rest!

It is sometimes frustrating to see moms choose to schedule a cesarean without what we (people who trust birth) see as a true medical need.   It is easy to blame the moms, why don’t they know better? 

Well, I think the problem is not with the moms, it is with the birthing community leading them to that choice in many different ways…  The moms are often scared into a cesarean or don’t realize they have other options.

Here are some ways moms are led to cesareans before their birthing time even begins. 

Some are gently led there, by little lies given along the way by their care providers.  The big baby card is a prevalent way care providers do this today.  (Your baby looks like it is going to be big… your pelvis is small… this baby is too big for you to birth, you had better have a cesarean) 

Some are scared into it, VBAC moms are told it isn’t safe, or they can never have a vaginal birth, it didn’t work last time, it won’t this time either. 

Some are told vaginal birth isn’t even an option… your baby is breech; you HAVE to have a cesarean.  Moms don’t even know they have a choice, they can try to turn the baby or they can find a care provider who supports vaginal breech birth.  (It is hard to find these care providers, because many are not being trained to do so.)

Twin moms are also often talked into cesareans.  I am not so familiar with the reasons they are given for this, but I know that many moms with twins assume they have to have a cesarean.  So if you know some of the reasoning, feel free to add to my comments.

Scroll down to read the following posts…

So what can we do to help an individual mom?

What if she doesn’t listen?

What can we do to help change the system?

 When I find out someone is planning a cesarean, I start by asking, “Why?”  It helps that I can say, “I had a cesarean with my first baby.  Why are you having one?” 

Then I listen to their reasons.  I ask how they feel about having a cesarean.  Some moms feel really good about it, they have already done their research and know it is the best choice for them.   Most are more on the fence and seem to want more information. 

Making choices with limited information or out of fear is not empowering.  If a Mom is open, I share information of what her choices really are and places she can go to do some research.  I offer support and help if she wants it.

There are a lot of great resources for moms to go to.  For instance moms who have already had cesareans can go to ICAN to find a lot of great information about VBACs.  I also have gathered some resources here. For moms given the big baby card, I send them to this page I wrote about it, after having SO many moms say their OBs were feeding them this line.  Here is a great post with information for moms with Breech Babies. 

I think that the moms who take time to question what they are being told and do research will be able to make the choice that is really best for them!  They also will feel better about their decision, because it is theirs!  They are making an informed decision, rather than a coerced decision.   Many upon doing some research will realize that a vaginal birth is a good option for them.  They may need to change care providers in order to have support in getting one.    

Some moms may still choose to have a cesarean.  They have taken all the information and combined it with their intuition to make the best choice for them.  This should be respected and supported.  Moms know what is best for them (when they have all the information).   At this point as a friend or CBE, I would fully support them in their decision and help them prepare to have the best possible cesarean birth.  

I will admit, it is sometimes a struggle, if I don’t completely understand their choice.  But I think it is important for me to support them, regardless of what I think.  It is their body and baby and their choice!

Here are the related posts…

What if she doesn’t listen?

What can we do to help change the system?