I am honored, humbled, and excited to report that just a few days ago my blog had over 1,500 hits in just one day. I was floored when I saw the number and almost choked on my Cheerios J! When I started this blog in February I was feeling lost, frustrated, burnt out, defeated, and disempowered regarding my role in the current maternity care system in America. The day I wrote my very first post, NursingBirth is BORN!, was only one week after I almost up and quit my job after I had witnessed a very traumatic assault and battery against a woman I was caring for as her obstetrician performed a pudendal block against her will as she and her husband were screaming for him to stop.
(Side Note: This is one situation that I still have not been able to bring myself to write about. The fact is that assault & battery on patients in health care happen DOES happen and it was the first time I had ever witnessed such an event. I cried for days, ran the story over and over and over again in my head, wondering what I could have done differently, wishing I had the courage to throw myself over her to physically prevent him from violating her, instead of just saying “Stop!”. I am getting pretty choked up even thinking about it so for now, I will have to continue to process that event and hopefully one day, I will be able to write about it.)
My intention for this blog was simple…if I could reach one mother, just one, who might stumble upon my blog and be inspired to learn more about labor, childbirth, and birth options, to realize that she has options and rights regarding her experiences and her body, I would then feel triumphant. I had convinced myself that for months or maybe even years the readers of my blog would probably only be my husband and sister-in-law J. I conceded to using this blog as just catharsis and a way to process my experiences. What I never imagined was that more than just a few people would ever read, never mind enjoy and keep reading, this blog!
So MANY THANKS are owed to all of my readers, who have turned out to not only be moms, but grandmothers, nurses, doctors, doulas, childbirth educators, midwives, and other people in the birth advocacy community. THANK YOU, for reading! Thank you to those who find themselves sharing many of my interests and beliefs!! I love networking with all of you and learning more every day about how to better serve childbearing families. And thank you to those of you who not only disagree with me but tell me about it too!! You keep me thinking and on my toes. Great things come out of great discussions and a discussion isn’t quite as interesting if everyone has the same opinion.
THANK YOU! THANK YOU! THANK YOU!
With all of that being said I feel that it is time to share a bit more about my personal philosophy regarding birth, breastfeeding, and advocacy. Of course my opinions do shine through in my writing (after all, it is my blog J) but with all of this “success” (haha, take that with a grain of salt please J) I have found that many people are beginning to label me with thoughts, feelings, and beliefs that I do not hold. Contrary to what some readers have implied, my goal in writing this blog was not to push my own agenda or to bully women into believing everything I do. (For example, one mom linked to a lighthearted post on my blog entitled Top Ten Things Women Say/Do During Labor on a popular baby website and wrote something to the effect of “Beware of the rest of her posts because she is pretty hippy-crunchy.” Another person commented that my blog was something to avoid because I was a “crunchier than thou/more natural than thou natural birth Nazi.”) Please note that I am NOT writing about these comments to start a flame war, nor did they hurt my feelings (I work in L&D after all, I have a pretty tough skin! Haha!)
However, I did feel compelled to outline what my personal philosophy is so my intentions are clearer in future posts and since it is my blog that is exactly what I am going to do! I feel that it is better for me to “fill in the holes” rather than have readers “guess” at where I am coming from. That being said, I DO NOT expect everyone in the world to share the same philosophy. The beliefs I have written below are meant to be provocative, that is, I am not trying to hide or sugar coat anything to make it have universal appeal. Also, although I strongly believe in these statements, I can also understand the other side of the story. For example, although I am a supporter and advocate of spontaneous, un-medicated labor and birth as well as VBACs, I do not condemn any woman for getting an epidural, taking pain medication, or scheduling a repeat cesarean. I know there are some people out there that would, but I do not feel that way. In reality more so than anything else, it’s not the epidural, pain medication, or repeat cesarean that bothers me; instead, it’s the women who request these things but have never even researched their safety or risks. Like author Henci Goer, one of my goals in writing this blog is to never hear another women ever say, “But I didn’t know that was an option” or “I never would have agreed if I had known that could happen.” You wouldn’t believe me if I told you how often I actually hear women speak these exact words because I hear it ALL THE TIME. Also, I would like to point out that this is not a completely exhaustive list. Regardless, here it is!!
(Note: Many of these statements are taken or adapted from the following resources)
v Childbirth Connection’s Rights of Childbearing Women
v BirthNetwork National’s Mission & Philosophy
v Coalition for Improving Maternity Services’ Mother-Friendly Childbirth Initiative (MFCI)
My Personal and Professional Birth, Breastfeeding, and Advocacy Philosophy
Pregnancy, Birth, & Breastfeeding
1) I believe that pregnancy and birth are normal, healthy processes and should not be treated as illness or disease.
2) I believe women and babies have the inherent wisdom necessary for birth.
3) I believe that pregnancy, birth, and the postpartum period are milestone events in the continuum of life that profoundly affect women, babies, fathers, and families, and have important and long-lasting effects on society.
4) I believe that breastfeeding provides the optimum nourishment for newborns and infants which does NOT mean that I am not grateful for the advancements in artificial milk for those mothers and infants who truly require it.
5) I believe that every woman has the right to virtually uninterrupted contact with her newborn from the moment of birth, as long as she and her baby are healthy and do not need care that requires separation.
6) I believe that for the majority of women, VBAC (or vaginal birth after cesarean) is a safe option that should be available to all women in all birth settings who safely qualify.
The Obstetric vs. Midwifery Model of Care
7) I believe that uncomplicated, healthy pregnancies far outnumber pregnancies that have complications and hence, the technology and techniques utilized to maintain the safety of mother and baby in high risk pregnancies should not be automatically or routinely applied to low risk pregnancies.
8.) I believe that the current maternity and newborn practices in the United States that contribute to high costs and inferior outcomes include the inappropriate application of technology and routine procedures that are not based on scientific evidence.
9) I believe that although you cannot make blanket generalizations about the model of care that a birth attendant follows just by their credentials, typically speaking I believe OBGYNs tend to follow an obstetrics model of care while midwives tend to follow a midwifery model of care based on the very nature of their education. After all, obstetricians are surgical specialists trained in the pathology of pregnancy and women’s reproductive organs.
10) I believe that per the very nature, philosophy, and experiences of medical education/obstetrical residency and midwifery education/apprenticeship, midwives should be the only health care providers attending normal, healthy, uncomplicated labors & births while obstetricians should be called to consult or transfer care to if and only if a problem or complication out of the scope of midwifery practice arises.
11) I believe that women need access to professional midwives whose educational and credentialing process provides them with expertise in out-of-hospital birth as well as hospital-based and clinical care that extends beyond the childbearing cycle.
12) I believe that midwives can obtain quality education and experience in a variety of ways and programs, including certified nurse midwifery and direct-entry midwifery.
13) I believe that integrity of the mother-child relationship as well as the safety of our mothers and babies is compromised by the pervasive over-medicalized, obstetrics model of maternity care in this country.
Interventions & Natural Birth
14) I believe that research supports the reality that both a mother’s body as well as her baby will initiate the beginning of labor when the baby is ready to be born and that women should not have their labor induced for any elective reason unless the health of the woman or baby is found to be in immediate danger if the pregnancy is allowed to continue.
15) I believe that empowering and safe births can and do take place in a variety of settings including birth centers, hospitals, and homes.
16) I believe that every woman should have the opportunity to give birth as she wishes in an environment in which she feels nurtured and secure and her emotional well-being, privacy, and personal preferences are respected, whether that be in a hospital, birthing center, or at home.
17) I believe the research supports that a minimal to no intervention, medication free, spontaneous vaginal delivery is the safest birthing option for the vast majority of both mothers and babies.
18) I believe that the obstetrical model of maternity care plus a pervasive American cultural phenomenon that teaches women to fear childbirth, doubt their innate ability and power to give birth, and be ashamed of their bodies and their sexuality is responsible for many women opting relinquish all control over their birth experiences to others and consent to unnecessary interventions that seem to provide a way to escape.
19) I believe that every woman has the right to create her own birth plan and that her birth attendants and labor companions have the responsibility to assist her in making it a reality as best and safely as they can. I also understand that for some women, their birth plan does not include a medication or intervention free labor and childbirth and I support this as long as the women has been provided with informed consent, including all the risks and benefits of her requests.
Autonomy & Empowerment
20) I believe women are entitled to complete, accurate, and up-to-date information that is supported by evidenced based research on their full range of options, including all procedures, drugs, and tests suggested for use during for pregnancy, birth, post-partum and breastfeeding.
21) I believe that women have a right to make health care decisions for themselves and their babies and that this right includes informed consent as well as informed refusal.
22) I believe that interventions (i.e. many standard medical tests, procedures, technologies, and drugs including narcotic medications for pain relief in labor, epidurals, labor inductions, primary & repeat cesarean sections) should not be applied routinely during pregnancy, birth, or the postpartum period and in my opinion should be avoided in the absence of specific indications and true necessity for their use.
23) I believe that said interventions have life saving potential and are necessary in certain circumstances (which I am entirely grateful for) but are often abused and misused.
24) I believe that maternity care practice should not be based on the needs of the caregiver or provider, but solely on the needs of the mother and child.
25) I believe that every woman has the right to health care before, during and after pregnancy and childbirth.
26) I can admit that (probably related to my educational background, experiences, and values) I am not entirely comfortable with the “free-birth” or “unassisted childbirth” movement but I can also admit that I know little to nothing about the movement and I am open-minded to learning more.
27) I believe that every woman has the right to receive continuous social, emotional and physical support during labor and birth from a caregiver who has been trained in labor support and I believe that the current obstetrical education in this country does not train physicians to provide labor support.
28) I believe that every women has the right to have how ever many supportive labor companions and birth attendants of her choice (as she deems necessary) attend her labor and birth, has the right to change her mind at any time, and has the right to decline the care or presence of any unnecessary personnel during her labor and birth.
In closing, I am NOT anti-obstetrician, anti-hospital, anti-intervention, anti-induction, anti-epidural, anti-pain medication, or anti-cesarean. Quite the contrary I am PRO the appropriate use of such interventions when they are necessary to support the health and safety of the mother-baby unit and facilitate a safe and empowering (hopefully vaginal) birth. I have found my passion in assisting women and families during the intrapartum period and my number one goal in my job is to support, facilitate, and encourage a natural-as-possible, empowering, and safe birth experience, however that may be, for all those involved.
Thanks for reading.
Super Comment! Re: The Deal with Delayed Cord Cutting May 19, 2009
Tags: cord blood, delayed umbilical cord clamping, fetal circulation, home birth, hospital birth, midwife, natural birth, OBGYN, placenta
Many of you might not realize that I personally read every comment that is posted to my blog. Why you ask? Because I love reading what the people following my blog have to say! I love when people engage in great discussions that have been stimulated by something I have written. I love when women post comments seeking advice, information, or camaraderie and other readers respond! And I love reading about other women’s birth experiences that they share via this forum. Often, a reader will post a question to me under the comments section, a question so great that I take hours or days to research and write a response. And I am such an information/research junkie that if I don’t know the answer, I’ve got to find out!! Other times a reader will post a comment with some really great information or resources to share with other readers. Unfortunately, many of these “super comments” often go unnoticed by readers who only read the posts and not each “comments” section. So I have been inspired to create a new category for my blog entitled “Super Comments” to pay homage to all of the great super comments and questions that my readers post!
Today’s Super Comment is in response to May 17th’s post entitled The Deal with Delayed Cord Cutting or “Hey! Doctor! Leave that Cord Alone!”
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Dear Nursing Birth,
I have a student nurse question. In nursing school we were taught that clamping/cutting the cord stimulates respirations. This comes from our textbook, Maternity, Newborn, and Women’s Health Nursing by Susan Orshan, specifically this quote “…clamping of the umbilical cord affects chemoreceptors sensitive to changes in arterial oxygen and carbon dioxide content, contributing to the onset of respirations.” This sentiment was echoed by our faculty to the tone of *this is why cords are clamped and cut immediately after the birth*.
I guess my question is this: Is the above quote enough to justify swift cord-clamping? Or not?
Thanks so much for this post. I’m enjoying the research you’ve done!
Sincerely,
BCB
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Dear BCB,
That is a really great question! What you (and I) both learned in nursing school is right on one hand, but wrong on another. Let me explain a bit further. I would like to first address the statement you found in your textbook.
Your textbook reads “…clamping of the umbilical cord affects chemoreceptors sensitive to changes in arterial oxygen and carbon dioxide content, contributing to the onset of respirations.” This is true in the fact that clamping the umbilical does stimulate the baby to breathe…BUT the act of clamping the umbilical cord is NOT necessary for the baby to take his first breath! Clamping of the umbilical cord in a way actually forces the baby to take his first breath! In the textbook Respiratory Physiology author John B. West writes:
“The emergency of a baby into the outside world is perhaps the most cataclysmic event of his or her life. The baby is suddenly bombarded with a variety of external stimuli. In addition, the process of birth interferes with placental gas exchange, with resulting hypoxemia and hypercapnia. Finally, the sensitivity of the chemoreceptors apparently increases dramatically at birth, although the mechanism is unknown. As a consequence of all these changes, the baby makes the first gasp.
The fetal lung is not collapsed but is inflated with liquid to about 40% of total lung capacity. This fluid is continuously secreted by alveolar cells during fetal life and has a low pH. Some of it is squeezed out as the infant moves through the birth canal, but the remainder has an important role in the subsequent inflation of the lung. As air enters the lung, large surface tension forces have to be overcome. Because the larger the radius of curvature, the lower the pressures, this pre-inflation reduces the pressures required.” (page 152, chapter 9)
Also (and this is a bit technical so bear with me!) an excerpt from the article “Cord Closure: Can Hasty Clamping Injure the Newborn?” by George M. Morley, MB published in OBG Management in July 1998 tell us:
“Very early clamping results in less than physiologic blood volume. The normal, term child routinely survives, but clamping the cord of a compromised child before ventilation is riskier. Initial aeration of the lungs causes reflex dilatation of pulmonary arterioles and a massive increase in pulmonary blood flow. Placental transfusion normally supplies this volume. Clamping the cord before the infant’s first breath results in blood being sacrificed from other organs to establish pulmonary perfusion. Fatality may result if the child is already hypovolemic.” (Thanks to gentlebirth.org for the reference!)
And to answer your second question…
Homebirth midwife from Mountain View, CA and author of the website http://www.gentlebirth.org/ Ronnie Falcao, LM MS writes in a post entitled “Some comments about ‘Anatomy of A Fetus: Circulation and Breathing’” :
“It is not air hunger that causes the newborn to take a first breath, and it is certainly not necessary for the cord to be cut in order for the baby to start breathing. …I am quite certain that nature didn’t assume that a birth attendant would be standing nearby, scissors in hand. In reality, babies start to breathe right away even if the cord is left untouched. It is not air hunger that stimulates a baby to take its first breath. It is likely the stimulation that comes from the shock of cold air and the sudden exposure to light and noise. Even dim lights and low noises seem very startling to a baby who’s only used to life in the womb.
Both Williams Obstetrics and Varney’s Nurse-Midwifery concur: ‘The phenomenon that occurs to stimulate the neonate to take the first breath is still unknown. It is believed to be a combination of biochemical changes and a number of physical stimuli to which the neonate is subjected, such as cold, gravity, pain, light and noise, which cause excitation of the respiratory center.’
Beyond the question of what stimulates the baby to take a first breath, we can look further at the triggers for the changes in the foramen ovale and ductus arteriosus. The delicate process of rerouting the circulatory system depends on the intricate interplay of blood gas levels that occurs naturally as there is a gradual shift from reliance on umbilical cord oxygen to reliance on air breathed into the lungs. Sudden severing of the umbilical cord is an unnecessary and dangerous meddling with this process. Some people refer to this as premature amputation of the placenta because the baby is still using oxygen carried through the cord from the placenta.”
As an L&D nurse, I have witnessed births where the birth attendant practiced early cord clamping and some where the birth attendant practiced delayed cord clamping. And guess what!? These normal, healthy, uncompromised babies took their first breath and started to cry whether the cord was clamped early or late! (When I first personally witnessed a few of the delayed cord clamped babies breathing just fine I started to wonder if the impression that I was given in nursing school (i.e. that babies needed their cord to be clamped to take their first breath) was really totally true. Both experience and research have shown me otherwise! Pretty cool huh!
Thanks for your great question!
Best,
NursingBirth