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November 01, 2004

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Oh my heavens, YES YES YES!!!!! You have said it so well. And it is so true. I have one medicated, two unmedicated. It was the difference between night and day.

I screamed once -- once! -- during the birth of my son, as I was pushing out his head. Up until that moment, I hadn't done more than mutter "oh my God" during even the most powerful contractions. And yet, as you described, a nurse took it upon herself to tell me I'd frightened the woman in the next room, and that she'd told that frightened woman that it was ok, that I was pushing without drugs.

I screamed for just a few seconds. It seems like 30 seconds or more in my mind, but I know that it was really quite momentary. And I screamed not just from pain, but for power. Just as a black-belt shouts "hai!" as he punches through bricks, my scream built my energy as I did the seemingly impossible.

In the nearly two years since Dorian was born, I've thought a lot about his birth, about the hypnosis practice I did, and how everything worked out. The hypnosis didn't eliminate the pain or sensation, but the practice I'd done over the past months left me calm and confident that my body would know what to do. I think those two things were the reasons I was able to have a safe, (relatively) easy, intervention-free birth in a hospital.

So many women are afraid of pain, and when I say "it's really not that bad", women don't believe me. They think I'm crazy, or a superwoman, and I'm neither. We all have it in us to survive pain, because what's the alternative? Pain alone won't kill you. (Besides, the dirty secret of birth is that the slow recovery as the uterus shrinks and damaged tissues heal is more of a bitch than the actual birth, and what drugs do you get for that? Stinking Motrin.) I find myself thinking that women go in for medical interventions because they're afraid of the unknown, that they don't know what to do, so let's put the doctor in charge. I can't, for example, imagine being coached on how to push. How would anyone else know what's going on inside my body? Our culture has lost faith in the wisdom of our bodies, lost faith in the ability to understand what our bodies tell us.

Sorry for the babble, but this is a subject I feel strongly about, too. But I also want to state that I'm not against medical intervention, per se -- just the fact that we barely even register the possibility of maternal death from childbirth shows that the medical profession has done real good -- but I think that too often, healthy women are beguiled into accepting help they don't need.

Beautiful
Thoughtful
Insightful
Reassuring
I remember with my first telling my grandmother I didn't want an epidural. She offered to pay for it. I laughed and told her thank you and went on. I read and read and read with my first one.
From one extreme to the other, from LLL to Ezzo. From "ask for the epidural the minute you get to the hospital" to "have it home with you hubby catching" I remember thinking about both birth and breastfeeding - "this is the way God intended it -I WILL DO IT" I remember buying a breastpump online without ever having seen one in person. I remember knowing that I would have my child without drugs and would breastfeed because she would have the BEST. So what if hurt for 20 hours - an epidural crosses the placenta - I read that an my decision was made.
And I've been very lucky with "easy" deliveries and babies that took right to the breast. But I am convinced they nursed so well from the start because they weren't drugged up. Everyone from nurses to family have commented on how "alert" my children were shortly after birth.
I always try to tell first time moms to be that a non medicated delivery IS possible and its not some horrible thing to be suffered through.
It a relief to hear someone else thinks like I do.
I know I'm kinda rambling - but like you said this is not a popular opinion here in the States. Its just nice to know that I'm not nuts.

Thanks for posting the link to Lisa Marasco's article. She and I have corresponded many times on the topic (PCOS is one of my specialties, did you know?). I am trying to get my PCO patients with breast problems to use progesterone before trying to conceive in the hopes that we can get some mammary development. One thing that may be an additional problem is that so many of them are being put on oral contraceptives to regulate their cycles, and I wonder if the synthetic hormones there are contributing further to the infantile breast development.
Oh, and don't you just love it when so many PP women are being put on Depo or OC pills because "Breastfeeding doesn't effectively prevent pregnancy"?
Now - I need to go back and read the rest of your post.

OK - about birth and breastfeeding.
In my hospital practice in Oregon, the breastfeeding rate was over 90% and we had no LC available - just me, the nurses, and the FP docs. We didn't have premies - anything less than 36 weeks we shipped out to the big hospital 65 miles away. We didn't do epidurals - sometimes we would do an intrathecal (narcotics in the spinal fluid - blocks pain but not motor ability) or IV narcotics - but most labors were spontaneous and natural and we had moms up and walking. One thing that made a BIG difference was that there was NO NEWBORN NURSERY!!! Another was that there were NO pediatricians. If I delivered a baby, I was that baby's care provider in the hospital, I wrote the orders, I admitted and discharged the baby and if the baby got sick I consulted and managed the transfer. Our standing orders were that no breast baby was to be supplemented without first calling the provider for an order. I wouldn't supplement without actually going to the hospital and evaluating the situation myself (and yes, sometimes it was at 0200 - that's what one should do).
I had a baby born to one of my moms at 36 weeks. The baby was only 4lb 12 oz at birth. We discharged the mom (on paper) but kept the baby and the mom stayed and kangaroo cared for the baby. At one time, the baby's sugar dropped below optimal, so I went to the hospital and gavaged fed the baby just enough to bring his sugar back up, and we put baby back on the breast. Baby was back up past birth weight at 6 days of age, and went home and never looked back. Breast fed for 2 years. I saw that as an expected triumph. No breast pumps, no gadgets, the only real intervention was a one time supplement via orogastric gavage.
There were days when I wished that I did have an LC available - I had one patient trying to BFAR - she was able to get a reasonable supply up with an SNS and eventually went to 70% breast 30% formula feeding. I had her coming in to the office every day for a couple of weeks to weigh the baby and assess the situation. A good LC might have been able to help me a lot there.
Another factor - Peds docs.
I wish the peds were on our side, but they usually aren't - at least not on the East Coast. They want the babies to be in the nursery for morning rounds, they don't care if it interrupts a nursing for them to do their routines.
OH, I could rant for ages. I think I'll shut up for a few here.

My first birth was a medical nightmare. I think I wasn't sectioned only because it was the middle of the night and they didn't feel like it. If it had been 5pm, they'd have been sharpening their knives. My son was very groggy for the first two weeks after the birth and refused to open his mouth to breastfeed. Add in the L&D nurses who routinely took three quarters of an hour to answer any call for help, and you get a rotten experience.

I've had three non-drugged births since then, and it's lovely. It's lovely to know I did it rather than the doctor, and it's lovely to be able to bond with a clear-headed baby while I'm a clear-headed mommy. Babies #3 and #4 immediately latched onto the breast and stayed there for two hours. With this last one, a nurse came in, saw him still latched on, and said, "You're going to get sore nipples that way!" and I shot back, "I am not!" I didn't. My milk came in with a "boom" about 26 hours after birth, and the baby only ended up losing maybe three ounces from his birth weight. They were stunned that I kept him with me all the time and called him "our prodigal." Sorry for wanting to mother my baby. Play with all these other babies in the nursery instead.

Thanks for a very insightful entry.

Thanks to all of you for sharing your ideas and your birth stories. (And also thanks so much for the encouraging comments after my last post.)

Summer, I wondered specifically about your reaction to the groaning thing because I knew you had done hypnobirthing, which I thought emphasized a quiet calm state. I can see the merits of that idea, but for me pushing is noisy work. I was curious about your experience.

Alicia, keep ranting! -- always interesting to hear about the other side of the birth experience. Have you seen Lisa Marasco speak? She was part of last year's LLL Lactation Specialist Workshops, which are well worth checking out if Boston is close enough to you. I had no idea that PCOS was a specialty of yours. Grrr to the peds who don't care if nursing gets interrupted as long as they don't have to walk down the hall!

I love to hear birth stories so keep talking. I'm curious also about whether there are mothers who have done it both ways and feel the unmedicated route is not for them.

Thank you for writing such interesting, thought-provoking posts on your blog, Jamie.

My perspective on this is that the whole deal depends upon (a) the woman and (b) the baby and (c) the birth process. My view is based on going through childbirth three times, each time being totally different and the experiences being: first time, intervention and full complement of drugs; second time, natural birth; third time, complications, some drugs and intervention. So here's some more detail to explain why I don't think there is a "one size fits all approach":

Molly: 42 weeks, and the obstetrician advised an induction in the interests of mother and baby. He applied prostaglandin (spelling?) gel to my cervix and I went into full labour immediately: from no pain to complete pain. It was a posterior labour so there were no contractions to speak of, just pain, and it didn't matter what position I adopted, it was relentless. I took pethidine. After 12 hours and only 3 cm dilated, I took the epidural and could relax and sleep for the next 8 hours before my daughter was born. No episiotomy, no tearing, no stitches, no forceps (and lots of people think these things are a fait acompli with an epidural).

I was interested to read Summer's comment that she found the pain of slow healing to be worse than labour pain. I didn't experience much pain in recovery at all. I did have mastitis three times in the first eight weeks post-partum, including a bout requiring hospitalisation. Mastitis was worse than labour: no pain relief, sleep deprivation and I had to keep looking after my baby.

Sally: spontaneous labour at 41 weeks. One of the most romantic experiences of my life and also the most empowering. Beautiful. Breathtaking. Perfect.

Different birth story, no intervention and no drugs, but I still got mastitis very badly within one week of Sally's birth.

Harry: After my experience with Sally, I thought the third time would go like clockwork. My body knows what to do now, doesn't it? No. Induced at 42 weeks. After 10 hours, it became apparent there was a problem. I was told that a caesarian was on the cards because my cervix was in danger of tearing; I was warned that it was going to get much worse. My midwife had assisted in all 3 of my labours and she suggested pethidine. I took it, thank goodness. The baby was stuck and my cervix was stuck at 8 cm. One minute before the caesar, my cervix dilated fully, the baby decended and the baby's head was delivered. Then the baby got stuck again. It's called shoulder dystocia and I'm told it is a very very serious complication. We stayed like that for a long time; baby's head between my legs as the contractions rolled on. I can't begin to explain the difference between this situation and a birth without complications. I'm very grateful for the drugs. And I'm lucky that eventually 2 midwives were able to force my knees up onto my chest in the middle of a contraction, and the obstetrician reached both hands up inside me and delivered our 10 pound son as though I was a cow birthing a calf. If the baby had been 1 ounce heavier, he would not have made it through.

To complete the breastfeeding story: Harry birth involved intervention and drugs, but I did not get mastitis.

I successfully breastfed all 3 children for at least 12 months.

I know of women whose first birth has been a wonderous, drug free, empowering experience, and whose second birth has been a nightmare of complications and medical intervention.

In my view, birth is the big unknown. You have no way of predicting what will happen. I don't believe in birth plans; I believe in open minds. And I'm grateful for the choices that are available to us that were not available 50 or 100 years ago.

Jamie, I hope you don't mind such a lengthy comment!

PS. I should add that I'm Australian.

Beautifully written. Captures so many ideas that I think accurately reflect reality (though, as Lucinda pointed out, mothers may experience things differently.)

This is one I'd love to see in something like Brain. Child. Have you thought of submitting it somewhere?

Lucinda, thanks for sharing your story. I appreciate the detail so no need whatsoever to apologize. You are so right that birth is unpredictable. I hope it's clear that I'm not opposed to intervention per se -- just to an environment that makes it difficult to avoid unnecessary intervention.

TulipGirl, thank you for the compliment!

birth is unpredictable, so the best thing that a mom can bring with her is an attitude that will work with whatever God sends her. Much of the grief we experience in labor comes from the attempts to control the uncontrollable.
I love a mom who trusts me to help her the best I can - who realizes that I am not her enemy and that labor is not her enemy either. I am equally disgusted at those who overmanage and those who neglect labor. It's natural but so are hailstorms.

In my view, birth is the big unknown. You have no way of predicting what will happen. I don't believe in birth plans; I believe in open minds. And I'm grateful for the choices that are available to us that were not available 50 or 100 years ago.

Thank you Lucinda for expressing my views so succinctly. I'm not PG, nor have I ever been (although we are TTC). I'd like to try a so called 'natural' birth, but I am smart enough to realize that not every birth goes that way, and I could be one who needs intervention. The importnat thing to me is a healthy baby and mother, and if it takes an induction, epidural or a sectiobn to get there so be it.
What I am learning to despise is the practice of women who induce for 'convienience' . One of my coworkers was induced 2 weeks before her due date because her doctor was going on vacation. WTH? Why force a baby who is not ready? There are valid reasons for induction, but not wanting the on-call doctor is NOT one of them IMO.

I love the comment about how the pains after labor are so inconvenient and all we get is motrin! Here in England, the midwives can administer gas and air (laughing gas) during labor. I've never had it and would'nt want it *during* labor, but I'd like to try it out after labor, just to see what it's like! Would that get into the colostrum or affect the baby at all???

Alicia, the best part of midwives, for me, is that I trust their judgement and view of birth. I'd be more than happy to get a c-section if I *truly* needed one...and I don't trust a regular doctor's opinion on that one.

Some people (many?) think that natural birth proponents are that way for the ego trip or the empowerment. The more I've thought about it, the more I realize that that stuff is just the gravy. The meat of natural childbirth is that it's the best, safest thing for both mother and child.

Thanks for the thoughts, Gladly!
Sandy

Thanks again for another fabulous entry! You are helping me get up the inspiration to write my sons' stories. :)

"Few of today's grandmas breastfed for very long; a mother who did not watch babies being breastfed when she was a child has missed something that should be a part of American girlhood. No LC can infuse her with the inner understanding of how you hold a hungry baby and guide him to the breast that little girls acquire when they watch their younger siblings nurse."

I don't want to be a troll, but I have to take issue with this. I doubt that you meant to criticize only children or youngest siblings, but it came across that way to me. I was the last born child in my family and therefore I never saw my siblings nurse. Your comment made me feel like that is something I (or my mother) should apologize for.

But maybe I'm just too sensitive to perceived criticisms. Probably comes from being the youngest child. :)

Karen, that never crossed my mind and I'm sorry it sounded critical to you. (Maybe my firstborn bias was showing when I wrote this!) In my ideal world girls would see their aunts and neighbors and older sisters nursing, too -- on the living room couch and at the kitchen table, not just hiding out in the bedroom.

Also -- I don't think it's even remotely troll-y to say, "Hey, that didn't sit quite right with me." I'm glad you mentioned it.

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