Recently a friend of mine (Hi Kim! <waving wildly!>) asked me what the big deal is about prenatal care. As she said, every month she waited in the waiting room for an hour and then got weighed, measured, and was out the door in minutes. The only thing anyone ever told her was that everything looked healthy. End of story. She said all she heard before she got pregnant was how important prenatal care was and she didn't really understand what the big deal was having experienced it. Of course, we both also discussed the fact that she had healthy and normal pregnancies but...wasn't there supposed to be more to it than, "Everything's healthy. See ya next month."
 
YES! There is absolutely supposed to be more to it than that. If you've ever been pregnant before, you can probably attest to the fact that there's a lot of physical changes but there are just as many emotional ones! Prenatal care needs to be wholistic care that considers the whole woman, physical, emotional, and spirtual. Reducing the whole process down to a couple of measurements is degrading and insulting to what women are actually doing, growing a baby, making a whole other human being, and becoming mothers all at once. 

Prenatal visits are billed to insurance companies as being 15 minutes in length. 15 minutes! I find it hard to believe that a woman, the whole woman, could ever be evaluated in 15 minutes. That thought also led me to wonder how many women a typical doctor sees in a day? 20? 30? Does he or she remember their patients or do they need to use their chart to remind them?

A large part of what I do depends on what I remember from the last visit. These are not things that can be charted very easily but are subtle differences. I get to know each baby by feel. I talk to them and I tell them what I am doing each step of the exam. It's so hard for me to believe that I could be as good a midwife if I was seeing 20 patients or more a day.

The more time I spend talking to the parents, the more they open up to me. They feel more and more comfortable with me and my presence in their home. And I believe they need to feel comfortable with me because I will be the one at their birth. It won't be, "If you have your baby on Tuesday between the hours of 8pm and 8am then I'll be your midwife!" I'm your midwife no matter what day it is, there's no surprises here. It will be me! Birth is such an intimate experience. I can't imagine going through it with strangers.

Yet it has happened. Most women get a 15 minute visit if they are lucky and their care providers only have time to look at numbers on a chart. That is how women get misdiagnosed or how women slip through the cracks. A client of mine was told by her hospital midwife that she was "overweight when she started pregnancy." I doubt she knew who she was talking to because that woman is a personal trainer and certainly NOT overweight in any sort of unheathy way. She wasn't looking at the woman though, she was looking at the numbers. This happens all the time with pre-eclampsia diagnosises. Women are told they have pre-eclampsia or are sent for further testing before anyone asks them what they ate last and how long ago that was. Guess what? She's been sitting in your waiting room for the last hour, starving!
 
It's called prenatal CARE for a reason. Women need to be cared for, nurtured, listened to, and supported. They need to be able to ask all of their questions, without feeling like they are keeping you from another appointment. They need to be able to voice their fears and concerns without judgment. They need to have a place to come with their partner to devote just to talking about this baby and this birth. They need to have a place to let out their frustrations about what their mother said, or that stranger said, or how everyone is asking why she hasn't had the baby yet. These things are all part of prenatal care. And I bet you dollars to donuts this kind of wholistic care leads to better birth outcomes.   

I've been attending births for about 13 years now and over that time I've been to around 450 births. They've been all different kinds of births. I've seen homebirths, hospltal births, birth center births, births in a hospital in Jamaica that had little equipment or medications, births that were triumphant, and births that were traumatic. I've seen and experienced a lot!

I've been asked to share my experiences and knowledge by many people over the years. So what kind of information do I usually share with people who ask? It depends on who they are. I understand I can't sell homebirth to everyone and I don't try to. For those who choose to birth in the hospital, I encourage them to do the following things:

~Educate yourself: You wouldn't even walk out on a showroom floor at a car dealership without researching it first. Knowledge it power!
~Ask questions before each and every test or procedure is suggested. (BRAIN: Benefits?: What are they? Risks? What are they and how likely are they to happen? Alternatives? Is there anything we can try first? Instinct? What is my instinct telling me I should do? Nothing? What if we do nothing?)
~Hire a doula: A doula is like a guide in uncharted waters. No matter how many books you read or how many classes you take, you can still feel unprepared for labor. Your doula is like the cliffnotes version of your childbirth class right there in the labor room with you! She provides comfort and information to both of you and you should not birth without one! Why? You will be treated differently with a doula by your side. They know they can't just do whatever they want, you have a witness. 
~ Question whether your provider is the one for you: Don't just keep going back to someone you aren't 100% comfortable with. There are lots of options. Again, it's just like buying a car. You'll feel better about your choice if you researched your options and then made your choice.

For people who are interested in birth center or homebirth, I like to share the following things:
~ For most out-of-hospital births the same midwife who you saw for prenatals will be there at your birth. No strangers, no surprises.
~ Prenatals with an out-of-hospital midwife are more family-centered and encompass both your physical and emotional development throughout the pregnancy. Doctor or hospital-based midwife = 1 hour in waiting room, 7 minutes with your provider, MAX. Out-of-hospital midwife = 1 hour actual face-to-face time, MINIMUM, no waiting.
~ Birth feels different when you are in the comfort of your home, able to do whatever you want to do, eat whatever you want to eat, and are attended by people you know and trust. In this situation, it feels managable and you feel in control.
~ Birth is safe at home: My joke is that we don't just show up with a birth drum and a feather, though we bring those too! We bring equipment that any small hospital might have. We're also specially trained to be able to detect potential problems ahead of time and handle any emergency that arises. Emergencies rarely if ever happen without warning. Reputable studies show that homebirth is just as safe or safer as hospital birth and involve significantly less interventions.
~Your baby will be treated with respect and will not be taken from you...EVER!
~Postpartum visits take place in your home because...you just had a baby!

It all sounds incredibly reasonable to me! And let me tell you, this knowledge doesn't come from books. It comes from experience! I'm not a zealot. I don't have these ideas for no reason. They are based on my experiences and I tell you, if you had my experiences, you would feel the same way I do. I've often thought if people could see what I've seen, they would see the problem! So I thought I would write about some of the things I have seen. Each and every one of these things actually happened. Don't worry, I'm not telling horror stories! I'm also not being selective about my experiences to try to paint a certain picture. The specific situations I am discussing are the most typical births I have attended, not exceptions to the rule.

Some people ask me why I'm such a huge proponent of homebirth and I like to say, "Because I've seen birth in the hospital!" The response is the same for countless others that have been where I have.  I've seen birth after birth in the hospital where women are treated routinely. This is a once in a lifetime event in their life but to that nurse or that doctor, it's Tuesday, just one more day until my day off.

I've seen what happens when women don't question their doctor as to WHY they are being induced. When they ended up with a cesarean for "failure to progress" the nurse said it was because the mom's body "wasn't ready yet. Why did you come in for an induction anyway?"

 I've seen what happens when a couple gleefully tells me about how their doctor or hospital-based midwife is going to be on-call "just for us!" Uh...no, sadly they are not!

 I've seen what happens when a woman specifically asks for no male providers and is greeted upon admission with a male doctor as he proceeds to do a vaginal exam without permission, before he's introduced himself.
 
I've seen what happens when a couple decides it's not necessary to go to a childbirth class and then has no idea what the doctor is talking about. "What's a cervix?"

I've seen what happens when a woman feels like birthing at home is "wierd" and "people might think I'm wierd if I do it"...and then she doesn't feel comfortable at all in the hospital environment.

I've seen what happens when a dad thinks he can definitely handle doing all of the labor support for his wife without a doula...and 42 hours later is he exhausted and regretful.

I've seen what happens when a woman doesn't really like her doctor but she's afraid his feelings will be hurt if she changes providers. Guess what? He's 100x as bad in labor as he is in the office. 

I've seen couples be terrified into doing something they know in their heart they don't want to do because someone finds it necessary to "pull the dead baby card" as I call it. You should never have to threaten a patient into doing what you want them to do by telling them their baby could die if they don't.

I've seen women have 20 or more vaginal exams during the course of her labor, by many different people. Her vagina is supposed to be a sacred place at any other time of her life but this is BIRTH! Put your feet up in the stirups and let everyone in the hospital in there!

I've seen women be forced to lie down when it is excruciating for them to do so for.no.reason. I've seen those same women finally submit to an epidural because they can't take it any more.

I've seen nurses act more like drug pushers than nurses. "Are you sure you don't want an epidural now? How about now? Come on, everyone's doing it."

I've seen endless parades of staff coming through a room to examine the woman with the wierd whatever. Yes it's a teaching hospital but this woman is trying to give birth!

I've seen women yelled at and told they don't know what they are doing. "You'll never figure out how to push if you don't listen to us!"

Nearly every birth I've seen at the hospital ended with the entire room yelling "Push!!! 1,2,3,4,5,6,7,8,9,10 Now PUSH AGAIN!!!" Next time you're doing something difficult, see if that helps.

I've seen a doctor say if he doesn't cut her, her baby will never come out and will die in the birth canal. The baby was born 1 minute later without assistance.

I've seen a doctor who refused to deliver a woman unless she was on the bed. Thankfully the father caught the baby before he hit the floor as she was walking to the bed with her baby crowning.

I've heard the cries of a woman begging to be given her baby and then heard the nurse say "It'll be just a few minutes. I have to weigh him, give him his shot, give him his eye ointment, diaper him, and swaddle him. THEN you can have him." She just birthed a baby after losing her first one and you are going to deny her the first 30 minutes of that baby's life for WHAT?
 
I've seen babies go to the Neonatal Intensive Care Unit (NICU) for silly hospital policies such as: The baby is under 5lb, albeit 1 oz under, and the parents are VERY short, small people. The baby is under 37 weeks, albeit 36 weeks and 6 days...The baby's temperature is .1 degrees too cold, we have to take her to NICU. Believe me, if you are a baby, you want to do everything you can to avoid NICU!

I've seen NICU staff tell parents that they can only hold their fullterm newborns 1 out of every 3 hours, not because it is for their baby's health but because it's NICU policy. I've come to understand that NICU's "Hands On" policy actually means hands OFF.

I've seen moms forcibly stretched by doctors doing "perineal massage" (not the real perineal massage, this is no massage!) who then tell the woman that pain she's feeling is from the baby's head. 

I've seen women talked into scheduled cesareans rather than being given the support they need.

I've seen women be talked into repeat cesareans because of the risk of uterine rupture. That same doctor then induces a mom with a previous cesarean, upping the chances of rupture from .5% to 3%. I guess the doctor doesn't care about that .5% as much as she emphatically stated.

I've seen a woman at 10cm be forced to under-go a repeat cesarean because she didn't follow hospital protocol in coming to the hospital at the first sign of labor.

I've seen the nurse turn on pitocin when a woman was 9cm, calm, and relaxed. As the nurse said, "She's not hurting enough to be 9cm."

I've seen an entire staff of a hospital not provide any assistance when the mom threw up on herself after they forced her to chug 2 liters of water. Not a towel, not a mop, not a napkin.

I've seen a couple be pressured into amniotomy at 5 cm (manual rupture of the baby's protective amniotic sac) to screw an internal monitor into their baby's scalp because the baby forcibly kicked the belts of the external monitor every time they put them on. Smart baby I say!

I've seen a woman be given an epidural when she was 10cm and pushing just because the anesthesiologist hadn't been able to get to her until then. She then spent 2 1/2 hours trying to push her baby out who was in distress and needed to be born. She had absolutely no feeling except that helpless feeling of knowing her baby is in trouble and she couldn't help him.

I've seen a woman arrive at the hospital at 10cm with the baby's butt crowning, then rushed back for an "emergency" cesarean where the baby had to be pushed back up to be delivered. All of this despite her protests "I don't want a cesarean! If the baby is coming, can't I just push and give birth vaginally? Please let me birth my baby! I don't want a cesarean!"

To be honest, this list is but the tip of the iceberg of the things I have seen in my 13 years as a doula and midwife.   

I've seen some nice births in the hospital too but those only happened when people did those things I mentioned before. They educated themselves, hired a doula, chose the best provider for them, and asked questions before deciding on any test or procedure.

In those situations, I've seen a woman say things like "Oh you need to assess my baby? Well you can do that while I am holding her, thank you!"  

I've seen a woman who slapped the midwive's hands away when she went to do a vaginal exam without permission and declared "Don't touch me! I'll let you know when and if it's ok."
 
I've seen a dad get angry at the nurse for forcing his wife to lie down, despite the midwife's written orders that she could be off the monitors. He yanked the belts off of her and threw them at the nurse when he (yes the nurse on L&D was a man) refused to take them off. (I always tell parents that you catch more bees with honey but in this situation, it was very effective!)

I've seen a dad who openly questioned the lab results of his newborn girl who was in the NICU and then told the doctor that if she tried to lie to him again, he was moving his daughter to a different NICU.

I've seen a mom refuse to go home when she was discharged and her baby wasn't. She spent the next 7 days and nights in NICU with her baby, happily and cheerfully going against the policies that would prevent her from holding or breastfeeding her baby on-demand, the policies that had NOTHING to do with her baby's health.

I've seen parents who asked questions every step of the way on their birth journey and made every decision that led up to their cesarean. They never felt out of control or forced to do anything because they had educated themselves and made decisions based on the information and their own instincts. They never questioned the outcome, ever.

I've seen women birth their own babies, even in the hospital.

I've seen a dad crawl right into bed with the mom and tell the nurse (jokingly but also serious) "I guess I'm your patient too. If she wants to be cuddled, I'm going to do that for her no matter what anyone else says."

I've seen a couple patiently wait 48 hours after her water broke at home and then announce to the doctor that yes, it had been 48 hours but they had been monitoring for infection and were not going to come in for an automatic induction. She birthed 3 hours later.
 
I've seen a woman who had to be induced at 37 weeks be offered a cesarean because an induction would be likely that fail and would probably take at least 3 days. With the power of her mind, she willed herself into labor and gave birth painlessly 5 hours later, much to the shock of the doctors!

The commonality with all of these births is that the couple knew what they wanted and they were insistant that they were going to get that. They expected and demanded integrity of the staff. Most of them were extremely nice about it but left absolutely no question as to their own intentions. I like to remind people that these people work for YOU, not the other way around!

Homebirths are a stark contrast. Rather than good birth outcomes being few and far between, they are the norm. The majority of births at home are quick, involve very little if any pain, and result in a securely attached mom, dad, and baby. The difficult ones are the ones that are few and far between. When a woman births at home, she is in her own space and she feels she can do whatever she needs to do, without having to ask permission.

At home I've seen a woman smiling, joking, and happy at 10cm. As in, you could barely tell she was in labor.

I've seen a woman silently breathe her baby out and then announce to everyone, "The baby's out now."

I've seen a young dad bond instantly to his baby as he helped bring her into this world.

I've seen a mom say after every surge "That one felt sooooo good."

I've seen a mom bring her baby to the surface of the water and say "Hi Baby! I love you so much that I'll never let anyone take you away from me! EVER!"

I've seen babies who never cry the whole 4 or 5 hours I am there after the birth. Why cry? They have everything they need!

I've seen babies make their journey completely on their own to the breast and latch on, without assistance from mom.

I've seen a baby completely birth himself, without mom's assistance. As mom said "He's coming! But I'm not pushing, HE is!" Babies are smart and they are strong!

Every time I am at a homebirth, I think to myself that this is how birth is supposed to be! Women birthing without fear, surrounded by loving support. Babies coming into their parents arms, feeling love and peace as their first emotions, instead of fear and pain. Families supported in their home environment and encouraged to make their own decisions, rather than listening to the decisions of their provider. Families supported through their transition, creating strong, emotionally stable, loving bonds. This is how birth is supposed to be! I'm not biased, I'm RIGHT!!!

I'll admit it. I'm a 16 and Pregnant addict! Of course, anyone that knows me knows that I'm into just about anything with pregnancy or birth in the title. After watching one recently I was struck at how roughly the baby was handled right after the birth (which is very routine from the hospital births I've seen) and how completely unbothered the parents and grandparents were about this treatment. I've seen it at least 100 times. The baby's emerges, he is roughly rotated (a job he can do on his own by the way!), extracted from his mother's body, flipped over on the doctor's forearm, bulb syringe roughly inserted up his nose and in his mouth, and then flopped over into a waiting nurses arms. The nurse proceeds to take him over to the "baby station" where he is placed under the brightest of bright lights and his skin is roughly scrubbed until no trace of vernix remains on his skin. A tube is inserted up his nose and then down his throat to suck out any remaining mucus. A shot is given in his thigh and antibiotic eye ointment is rubbed into his eyes, blurring his vision. Through all of this, he screams in fear, pain, calling for his mother. She's the only things he's ever known. Where is she? Unfortunately, she is watching helplessly from her hospital bed. As was the case in this 16 and Pregnant, too blissfully unaware that this is NOT ok. She looks on lovingly, in awe, and seemingly doesn't notice her baby's anguish. 

I don't blame the mom or the father or the grandparents who all witnessed this post-birth treatment and did nothing. I think we've become desensitized to this kind of treatment. Just turn on any Baby Story or Birth Day. Walk into any birth room at most hospitals in the US and you see it. You'll see the blissful, loving look the moms have on their faces while their baby screams. It's part of our culture. The baby comes out and they SCREAM right? How many times have you heard "We were really holding our breath there, waiting to hear the baby cry. Then we knew everything was ok!" 

After I saw that show, I thought to myself that outside of birth, that kind of treatment would be unacceptable. If someone roughly grabbed a mom's baby out of her arms and proceeded to change the baby's diaper in the same manner, you better believe a Mama Bear will come out! Why is birth so different? Is it because she's in a birth haze? Is it because she feels she has no power? Or is it because every show she's ever seen has shown newborns being treated that way and therefore it must be NORMAL. Or worse yet, NECESSARY. It's not!

Do babies need to cry? Actually no. Many of them do not or only cry for a short period of time. Some of them do come out "telling their birth story" as I say and bless us with their cries for some time after the birth. They aren't crying because they are in pain though and there's a big difference.   

This baby was born in a home waterbirth. She never cried though her heartrate and resperatory rate were even and normal. Her lungs quickly cleared of fluid. She connected with her parents for a few minutes, reaching for them silently and calmly. After a few minutes, she simply snuggled in and went to sleep next to her mother's breast. Our little joke was that she didn't cry at all until about 2 hours after the birth when her older brother bothered her and then she let us know that she DID know how to cry! I believe this is the hallmark of a baby who is respected during birth.

During my prenatals, I talk to the babies. I let them know who I am and what my intentions are. It might sound silly but I just narrate to them what I am doing. "Oh hi Baby! How are you today? I'm just going to feel around to see what position you are in. This is exactly the right position Baby! Good for you!" Remember that fetal hearing begins as early as 10 weeks. Sure, maybe they can't understand the words that I am saying but they hear my intentions to treat them as an individual, capable of feeling emotions. They understand that I have no intention to hurt them. I also encourage both parents to talk to their baby regularly. I have found that women tend to have shorter labors if they explain the birth process to their baby.  

During the birth, I imagine that there could be no better experience for the baby then being received by his parents. Philosophically, I've always liked the idea that the parents were the ones who created the baby and they should be the first ones to touch him.

In homebirths, we have a baby station too. It keeps the newborn warm and fed and loved. It's his Mother! I rarely use a bulb syringe because babies are very, very good at clearing up their own mucus. Try sticking one of those up your nose and see how it feels! I've done that so I only use a bulb syringe if it will truly be helpful and only after telling the baby what I am doing and why. 

As long as the baby is transitioning normally (as nearly all of them do), I would never even consider doing a newborn exam for at least an hour after the birth. During that hour, he needs to be with mom and dad, skin to skin, being fawned over and stroked. Mom needs to do that too! It regulates her blood pressure and releases huge amounts of the bonding hormone oxytocin. 

If a baby isn't transitioning very well, he still needs to be with his mom. It goes against every rational argument that a baby who isn't oxygenated properly should be removed from his oxygen supply (his umbilical cord) and taken away from his mom, the very person who has sustained him thus far and who can actually stabilize him herself. If I need to intervene, I do it right on the mother, with the mother and father talking to their baby. 

This is homebirth. Mothers, fathers, and babies treated with respect. My deepest wish is that this respect becomes part of our culture. That when you see a baby treated with respect, THAT seems normal. I want parents to see that rough treatment of their newborn for exactly what it is...ABUSE! Every baby deserves to be treated with respect and dignity. Every parent needs to demand it. Every careprovider needs to ask themself if they inflict pain and suffering on newborns. Even if it is unintentional, that treatment is the baby's first experience with life on Earth. Respect and dignity. Every birth. Every baby. Every time! 

There's a certain look people give me when I mention Ecstatic Birth. You know the "You are talkin' crazy talk now!" look. A couple of months ago a male friend of mine who has 2 young kids called and left a message with me after he had heard my voicemail message which mentions Ecstatic Birth classes. He was like "And yeah...I'd kinda like to talk to you about this ecstatic birth thing and like how...that would be...possible." It was a laugh out loud moment!

So what do I mean when I say that a birth was ecstatic? I think of the hormonal blueprint that nature intends to be in place during birth. When birth is undisturbed and the mother is not fearful, birth is ecstatic. When birth is disturbed and/or the mother is fearful, birth is less than ecstatic!

Let's talk about what happens during labor. Contrary to popular belief, the uterus does not "squeeze" the baby out. That's not how it works. A contraction, or surge as I prefer to call them because let's face it, it just sounds better, is the action and relaxation of 2 muscles. For the next couple of moments, bend and straighten your arm. When you bend your arm, your bicep contracts and your tricep relaxes. Does it hurt to do this? A uterus contracts the exact same way.

The uterus is made up of vertical muscle fibers and horizontal muscle fibers. The vertical muscles are meant to contract and draw up the bottom of the uterus to open the cervix. The horizontal muscles are meant to relax around the cervix. Their job of holding the cervix shut for 9 months is done! During a surge, the horizontal muscles relax and the vertical muscles pull the uterus up and the cervix open.

Now let's look at how hormones affect this action during labor. There are basically 2 ways labor can go hormonally. There's the fearful, adrenaline filled way and the calm, relaxed, feeling good endorphin way. We'll start with the fearful way.

Let's say that a woman grew up hearing birth stories that scared her. She had never heard of a birth being anything but excruciatingly painful. Then, she gets pregnant and goes to the doctor. There are all these tests and procedures that imply that pregnancy isn't safe. Worry sets in. Labor starts and she is scared for the baby's life, afterall, everything that has led up to this point has told her that pregnancy and birth are not safe. She goes to the hospital early in labor, the transportation of herself during labor being the first disruption in the birth process. She arrives at the hospital and is asked to fill out paperwork, answer a bunch of questions, and pee in a cup to ensure that she is healthy. "Do you have a living will?" the nurse asks. This is a routine question that they must ask. She's thinking, "Am I going to need one?" "What's your pain level on a scale of 1-10, 10 being the worst pain you've ever felt in your life?" "I guess...a 5," she says as she thinks about what it will be like to get to 10. She is strapped onto the fetal monitor and an IV is started "just in case." In case of what? is the lingering question in her mind. Now, left alone with her partner in a brightly lit room, surrounded by equipment that implies that birth is dangerous, unable to move around freely, now is where labor gets painful.

What has happened is that her body has dumped adrenaline into her system. Adrenaline sounds at first like it might be a good hormone for labor but the opposite is true. Adrenaline intensifies feelings of pain. Physically, when adrenaline is released it tells the body that this is not a safe place to let the baby out. The horizontal muscles around the cervix contract instead of relax so the vertical muscles press ever harder onto a cervix that refuses to open. The body begins to use the baby's head as a sort of battering ram to try to pry the cervix open. Ouch for both parties! The woman's body goes into preservation mode and much of the oxygenated blood is shunted away from the uterus to all of the vital organs in the mother's body. Less oxygen means 2 things. 1.) The baby has less oxygen and is much more likely to go into distress. and 2.) The uterus has less oxygen to work therefore it hurts more and works less effectively.

Hormonally, having adrenaline coursing through the body inhibits the release of 2 hormones, oxytocin and endorphins. Oxytocin is the hormone of labor and is necessary to produce effective surges. Endorphins counteract feelings of pain and help women cope with labor effectively. Basically her body has been given the message that it is not safe to birth here. Back when we lived in the wild, this response was incredibly necessary because a woman might need to stop labor in the presence of a predator. In this modern birth situation, one of 2 things will happen. If her body feels she is past the point of no return, the baby will be born quickly but not without a lot of pain and a feeling of loss of control by the mother. She will birth without the benefit of her body's feel good morphine-like drug, endorphins. The most likely situation that will arise though is that oxytocin is inhibited and labor ceases. It will begin again when she feels calm and safe again. My record for this happening was 5 times over a 5 day period. Every day the woman would labor at home beautifully only to have labor stop when she arrived at the hospital. She would go home, labor beautifully some more until it seemed progress had been made and then return to the hospital a centimeter or so more dilated. But labor always stopped at the hospital. Finally on the 5th day of her labor she arrived at 5cm and her body took off in labor as if it had tried waiting her out as long as possible but now it made the decision to just birth the baby as quickly as possible.

Fortunately for the hospital, they don't have to wait around for women to release oxytocin. If they did we might see a lot more doulas comforting laboring women, coaxing them to relax. There's this little drug called Pitocin which is synthetic oxytocin. Sounds great right? It's *just* like what your body releases...not quite! Normally oxytocin and endorphins go hand in hand. When oxytocin is released, it amps up the surges but endorphins are released to counteract any pain sensations. But, when pitocin is given through an IV, endorphins are not released. The woman is left with ever increasing surges, stronger and closer together than her body would ever give them to her, and she has none of her natural pain-killers on board.

Now you see why birth is portrayed as the "I HATE YOU! YOU DID THIS TO ME!! GIVE ME DRUGS NOOOWWWW!" fiasco that the media so loves. How many of you have even lived it? I hear these stories all the time and when I used to do hospital births, it was how I saw birth most of the time. Now let's look at the other calmer, gentler way that Mother Nature intends for birth.

Let's take the same woman who has grown up hearing scary birth stories. But somehow in there some where she decides that homebirth is for her. Maybe she heard just one homebirth story or read just one thing about it but she knows it is how she wants to birth. Throughout pregnancy she sees her midwife for at least an hour every prenatal and is able to discuss her hopes and fears. Her fears are neither discarded and shunned nor nurtured and given fuel. They are discussed, information is given, and plans are made. Every appointment the woman hears about another woman who had a triumphant birth. Information is given about every test and procedure. Her and her partner discuss and decide upon each test, procedure, and treatment. The decisions are theirs alone and they are respected. She and her partner take a childbirth class, read,  watch videos, and learn together how to be calm and relaxed when the big day comes. When labor arrives, they tune into each other. They keep the lights dim, they cuddle and sway, her partner whispers words of encouragement. The surges are each stronger than the last and labor progresses quickly but they are never stronger than the mom can handle. The midwife arrives quietly and integrates herself respectfully into the woman's birth space. After looking deeply into her midwife's eyes for reassurance, the woman feels that all is well (because it is!). Soon she feels her body change rhythms and powerfully turn to pushing her baby out. It is strong and powerful but the woman feels that she is too. She births her baby gently, quickly, efficiently and the biggest flood of hormones in her entire life begins.

Physically what happen when a woman feels safe and secure during labor is the uterus floods with oxygen. The baby is supplied with plentiful oxygen-rich blood and the uterus is able to work effectively with minimal effort. The horizontal muscles around the cervix relax perfectly so the vertical muscles merely need to gather the uterus upwards to gently open the cervix. When this happens, labor need not be painful at all. In fact, you'd be surprised how many women tell me that it wasn't painful at all, hard work but not painful.

Hormonally, the two buddies oxytocin and endorphins walk hand in hand, each feeding off the other. More oxytocin = more endorphins = more oxytocin = more endorphins. Can you imagine a birth in which a woman coped better and better as labor progressed? I see it all the time. Most notably I had this homebirth client who was a first time mama. She was really needy and whiny in the beginning of labor. "Oh my back! It hurts so much" etc. I started to worry about how she would cope as labor progressed. Much to my surprise, the woman who needed constant reassurance during early labor had progressed into a stronger and stronger woman as her labor progressed. By the time she was pushing, she was completely silent and within herself. Most first time mamas look for reassurance when their body starts pushing but not her! I knew she had been pushing the past few surges but imagine my surprise when she suddenly said out of the silence "He's out. The baby's out." and she calmly reached in the water and brought her baby to the surface. Afterwards she said the beginning was hard but after that it felt like she was "on a high" and like she "could do anything." She said she felt completely in tune, instinctive, yet in control. This is what Mother Nature intended! 

Mother Nature's next secret is the true secret to ecstatic birthing. When mom has birthed this way and remains for the most part undisturbed postpartum AND she has her baby with her at all times, her body begins the biggest hormone dump of her life. She is flooded, literally flooded with oxytocin. Here's something I didn't mention before: Oxytocin, while being the hormone of labor, is mostly the hormone of LOVE. Think back to a time you fell in love. What did you feel in your body? That was oxytocin! It is also the hormone of bonding and guess what? It is the hormone is orgasm! That's right, your body releases oxytocin to bring on orgasm. So now, a few minutes postpartum, the woman's body is flooded with this lovey-dovey hormone. Suddenly, and it is quite sudden sometimes, the mom is gushing about her baby, exploring every inch of him. "I love him SO MUCH!" she says over and over. And thus she and her baby are bonded for life, her milk comes in sooner, she feels that all is well in the world. In short, she is ECSTATIC! 

My grandmother shared with me a glimpse into the past when she told me about her mother's homebirths. The thing that stuck out to me was her detailing of this woman, Miss Katie I believe it was, who came to the house a week or 2 before each birth. Miss Katie stayed in the house with them, cared for the children, cooked dinners, and generally kept the house running smoothly during the end of the pregnancy. She helped her mother birth the baby and then stayed an additional 2 weeks or so to continue to care for everyone after the birth and ensure that mother and baby were healthy. Who among you reading this isn't saying "I want a Miss Katie!!"?

I tell my clients that they need at least 2 weeks rest after birth. This is the bare minimum, assuming that the birth was vaginal and normal. One week of that needs to be in bed, mostly lying down. The second week needs to be in bed or around the house but not doing any of the usual household activities. "No vacuuming the ceiling" I am often overheard saying! I say two weeks because I know from experience, that is all I'm getting out of modern women. I recommend a month but tell them the 2 weeks is an absolute bare minimum. In cultures across the world, women often do a "lying in" period or a "babymoon" for 30 days or longer. During this time, they are cared for hand and foot. The belief across cultures is that if you take care of mom, she will care for and nurture the baby to the best of her ability.

So why do women need this kind of recovery time? After the baby is born, the placenta detaches from the wall of the uterus. Think of the placenta as being like an orange and the uterus is the peel. When the placenta peels off and is born, it leaves a wound which is where the postpartum bleeding comes from. Common advice for postpartum women is to monitor their bleeding. If the bleeding picks up noticeably after some activity, it is a sign from the body that you have done too much and you need to rest more. Why? Because the wound in the uterus has been disturbed.

It's interesting how hard of a time I have convincing women that they really need and DESERVE to have 2 weeks off. Dads are always right there on board with the idea of waiting on mom yet mom doesn't want to be waited on. I think this idea has become woven into our culture that being "down" makes you weak. It's like we want to be that woman that people talk about who took her 2 day old baby on a 10 mile hike. Or better yet, the woman one of my clients told me about who brought her 2 day old baby to a really nice restaurant. I'm all for fine dining but is it really necessary to do when your baby was just born 2 days ago?

Babymoons are for dads too. Take at least a week, preferably 2 weeks, off from work. With a little planning you can probably plan 2 weeks worth of food and additional help to allow the new family to bond together. Dads job is to take care of mom and mom's job is to take care of the baby. If you can have people bring you meals and plan for some close family or friends to drop by to help with dishes and other household tasks, then you can be truly free to bond as a family. Plan on spending the first week in bed with mom and the baby. Mom will feel better about being in bed for a week if you are there with her. Imagine how bonded you will be with your amazing newborn after a week of skin-to-skin contact! 

One of the most common questions I get about babymooning is "What am I supposed to do in the house for 2 whole weeks?" The answer: You are supposed to be present with your baby. You will never ever get those first 2 weeks back. I've heard plenty of people say they wished they had babymooned and I have never heard even one person say they wished they hadn't! Just plan on using that time to get to know your baby, really get to know them. The busyness and craziness will return soon enough! It won't be long before you'll be looking back on that time wishing you had it again!

If it is your first baby, the babymoon is of utmost importance. Why? Because it is the best babymoon you will ever get! This is the only babymoon you will have without an older child running around that you both have to care for. When it's your first baby, you can truly just lie around revelling in the wonderfulness that is your baby. Often first-time mamas are the ones who want to be out and about as soon as possible. Ask and mom who's had a couple of kids and she'll tell you, babymooning is where it's at!

I often tell women to receive visitors the first week in their bedroom. People treat the visit differently when they have to come into your room. They usually stay for a shorter period (which many postpartum families appreciate!), are more respectful of the mother and baby pair, and are more helpful to the parents.

One thing that can help in the visitors department is to talk to everyone ahead and time and let them know what to expect. If you plan on spending the first day alone with the baby, say so. Explain to those close to you that you will be doing a babymoon and tell them why. It's also a lot easier to ask for help before you actually need it so consider asking certain people for the specific help you will need before the baby comes. An easy way to do this is to pass around a sign up sheet at your MotherBlessing or baby shower. That way you know who is coming and when.

So what kind of benefits will all this lying in get you? The babymoon supports the complete mother/baby dyad both physically and emotionally. The physical benefits for the mother are decreased postpartum bleeding, decreased healing time from vaginal tears, the uterus involutes (or returns to it's normal size and pre-pregnant place in the body) sooner, and mom is less likely to have any serious complications like blood clots and infection. Emotionally, the babymoon supports a healthy transition to breastfeeding hormones. Having the baby in close contact for the first 2 weeks keeps the mother's hormones balanced and makes it much less likely that she will experience postpartum depression. Studies show that moms are less likely to experience postpartum depression when they do a babymoon.

For the baby, the babymoon focuses all of the attention on him or her. The breastfeeding relationship is supported and mothers are more likely to feed the baby on request, rather than on a schedule which means the baby is more likely to thrive. Babies also have a high need for skin-to-skin contact that few people seem to know about it. Skin-to-skin contact helps the baby develop their brain and connect synapses within the brain. Many mammals with actually die without this skin-to-skin contact. We aren't one of those but that does illustrate how important it must be. The baby also is prevented from overstimulation when the mom is babymooning. Imagine life as a newborn. Everything you see is new! I imagine it being like going to Disney World and at the end of the day you have a headache from all the bells and whistles! Now imagine being a newborn baby being carted around to Walmart and the grocery store and the peditrician's office and you can quickly see why babies often dissolve into screams at the end of the day. Limiting the baby's contact with the outside world for the first 2 weeks or so helps alleviate this tendency.

In a homebirth, the babymoon is naturally supported. After the birth, the new mom (and dad too!) are tucked into bed for true rest. Her midwife returns 24 hours later, then again at 3 days, 5 days, 2 weeks, 4 weeks, and 6 weeks. All without the new mama ever having to leave her home. A babymoon can be enjoyed by anyone though, no matter how or where you birth. Just a little planning and your new family will be enjoying each other in babymoon bliss! 

I have to admit. I'm on a jag. Ever since my second daughter was born, I've been all about my parents catching their own babies. When she was born, even being in the birth and midwifery community, I rarely heard about people wanting to catch their own babies or midwives that encouraged it. Maybe it was because of my own midwifery experience but I decided I was absolutely catching her myself and I asked my midwife to sit in the corner. I wanted her there in case I needed her but I wanted to be my own midwife. My husband and I both caught our daughter as she was birthed into warm water in one of those infamous fishy pools. It was a feeling that can't be easily explained but the best way I've thought of to describe it is that it just felt "right".

When I started in my path to becoming a midwife, I remember being told and reading in several places that women needed the help of a midwife or else they would tear horribly. Women need perineal support and they weren't particularly good at doing it themselves. If you let a woman push without your help, she would surely rip. That was the feel I got about it. As with anything you are told with authority, it's something that I never questioned, I just assumed it was true. 

Then I went to Jamaica to midwife women in an under-served area. To say the nurses were generally hands off was an understatement! They wore the most beautiful white uniforms and I remember thinking when I first got there "How on earth do they keep those so clean?" Turns out it's because they midwife from a distance! Not that it was a bad thing. I saw woman after woman walk into the "delivery" room, announce calmly that the baby was coming, lie down, push 3 times and easily birth a baby with no tears. The midwives merely caught the baby as they actually came out. No perineal support...Hmmmm. 

After I returned to the states, I noticed a common stage during pushing that nearly every woman displayed. There was this point that I knew was the push or 2 or 3 before crowning that the woman would become discouraged. Often they would exclaim "Nothing is happening!" or "He's never coming out!" I would ask if it felt like the baby was moving lower and the woman would usually say "I have no idea. I don't know. I can't tell." I would respond "Why don't you feel with the next push and see what you can feel." With the next push nearly everyone woman would light up with recognition. She would often exclaim something like "Ooooh! The head is right there! No wonder this feels so hard!" Or something to that affect. Then within 2 or 3 pushes, the baby would be born.

The best way I've thought of to describe this is that we just aren't as used to feeling things with our vagina! Our hands tell us so much more! I've found that several things happen when a woman births her own baby into her own hands:

~She's less likely to tear or to need stitches. Why? Because she knows exactly how hard to push. Her hands tell her when she gets to that point of burning and she pulls back. She knows where the baby's head is and how fast she is birthing it. She knows where to provide support based on where she is feeling needs more support.

~ Pushing takes less time because mom knows exactly where the head is and is able to feel a sense of control. She isn't afraid.

~ Moms seem much more ecstatic about their birth. They feel completely empowered, like they can do anything. I call it Superwoman Syndrome!

Catching his own baby is every bit as transformative for dads. What I usually recommend is that the mom birth the head and the dad help her to bring the baby to the surface. This seems to work the best since moms don't usually want to be touched during crowning and dads often feel like they're not sure what they are supposed to be doing then. In almost all physiological births (meaning the process was not interupted), the head is birthed on one surge and the rest of the baby comes on the next one. This allows dads ample opportunity to get into position and see and feel the baby's head. I've seen fathers instantly transformed into daddies when they gently bring their new baby to the surface and into mama's arms. Often times the first thought dads have when this idea is introduced is "no way" but I will say I've never once heard a dad say they regreted doing it.  Quite the opposite! I once overheard a dad after the birth calling the office to say he couldn't come to work that day. "Bill! Hey, I can't make it to work today. S finally had the baby!...Yeah we're great!! I delivered her!...Yeah ME! I was the first one to touch her!! She came out right into my arms!!!...Yeah, I really did!...Ok, thanks! See you Monday." I always wondered what his boss thought!  

Symbolically speaking, the parents were the ones to make their baby and they are the ones who are there immediately after birth. Imagine that you are a baby about to be born. Would you prefer being birthed gently into your parents waiting arms with a midwife waiting watchfully beside them or would you rather be pushed into the hands of a stranger who immediately severe your attachment to your mother, suction your nose and mouth, roughly rub you with scratchy towels, diaper you, wrap you up tightly in 3 blankets and then give you to your parents? Not many people would choose the latter!

I think it is important that midwives do recognize their role. As a midwife, your job is most certainly not to catch the baby. That might be part of what you do in certain situations but that is not your job. Your job is sit beside the parents, allowing birth to unfold as it is supposed to, watchfully waiting. If your assistance is needed, then you help. But ask yourself if it is really needed. I've heard it said before that midwives should be like lifeguards. A lifeguard doesn't jump in and try to save someone who is swimming. They are there IF you need them and the assumption is that you WON'T need them. Think about it, when was the last time you went to the pool and thought "I'm probably going to need that lifeguard today!" But if you do need a lifeguard, aren't you glad they are there, watching, ready to jump in and save you if you're drowning?

Something is changing in the breastfeeding world. Have you noticed? Breastfeeding books and pamphlets everywhere have always emphasized what I call the "mom and baby have no idea what they are doing" philosophy. Basically, you as a mother have no instinct or ability to breastfeed until we teach you how to breastfeed. Your baby? Well, of course your baby has no idea how to breastfeed either. I mean, he or she was just born an hour ago! So books were filled with every minute little detail that us birthworkers were supposed to arm new moms with. Hold here, flip this, check the chin, are the ears moving? Does the baby have a "good" latch or a "bad" latch? What shape is your nipple when you pull it out of the baby's mouth? Where is the baby's tongue? I know you can't actually see inside the mouth but could you make a guesstimate? You have to TEACH your baby how to breastfeed. You are both learning, neither one of you yet knows how to do it. With all this information, it certainly seems like if you plan on breastfeeding, you might as well go get a PhD in it because you are going to need some technical information! 
 
Thankfully a lot of research has recently brought to light the fact that babies DO know how to breastfeed and moms DO know how to help them. Instead of what we've been doing with only poor to moderate success that could best be described as "mother-led breastfeeding" is giving way to "baby-led breastfeeding." If you've never heard of this, you are in for a treat! 

Did you know that a newborn baby when placed low on his or her mother's abdomen can actually crawl up the belly, over to a breast, and achieve a perfect latch-on? It is really quite amazing but true. After a couple of minutes (or sometimes after a nap!) the baby will begin stepping motions that actually press on the mother's uterus which helps to deliver the placenta, and reduces her postpartum bleeding. The mother instinctively uses her hands as a push off point for the baby to assist the baby is getting to the breast. The baby visualizes the target which is the by now very dark areola (area around the nipple) and moves towards that point. This is actually the reason behind the "linea negra" or the black line of hair that grows up the belly during pregnancy for some women. It's a long black line pointing the way to the food! Along the way, the baby often stops and sucks on their hand for a bit before crawling again. The baby's hand tastes and smells like amniotic fluid which also smells like the mother's nipple. As the baby gets closer, he or she makes eye contact with the mother and the mother instinctly opens her mouth wide when cooing to show the baby what to do next. "Ooooooo, hi Baaaaaaaaby!!" she says with an open mouth in the perfect nursing position, unknowingly demonstrating the perfect latch on! The baby reaches out to the nipple in a massaging movement. This not only protracts the nipple and makes it more prominent, but also floods your body with the bonding love hormone, oxytocin. The baby then simply imitates mom's open mouth and latches to the breast. I've noticed that this first feeding is longer when babies breast crawl, usually 45 minutes to an hour. In traditional breastfeeding, babies often latch and re-latch several times before losing interest.

Another huge change I've noticed since I started having babies do the breast crawl is the way mothers react and relate to breastfeeding. I always felt so helpless before, even though I was armed with an arsenal of information on helping a mother get her baby latched. Inevitably, the mom would feel as though she couldn't get comfortable, couldn't get the baby in the right position, couldn't figure out how to manuver the baby's head, etc, etc. It always bothered me that women who 30 minutes before had been glorious and empowered as they pushed their babies out were suddenly completely without confidence in their own ability to feed their baby. Birth after birth I remember the mother looking at me with pleading eyes saying "I'm not doing it right. I can't seem to get it. Can you help me please?" With the breast crawl, women feel empowered by their babies. How awesome is it to realize that your baby is strong enough right after birth to crawl to your breast and attach the proper way? Thankfully, that "good" latch on that babies achieve by breast crawling also significantly reduces or eliminates nipple soreness.

I know the first question I had when I first heard about this amazing ability is why would you want to make a newborn baby work so hard? The truth is, it is innate and necessary. Your baby is literally mapping your body and your breast and connections are being made beyond what we can even comprehend. Doing the breast crawl provides optimal natural stimulation to the various sensory organs and the brain. In short, babies have better sensory-neural development. If you've ever seen kittens born, you've likely seen the breast crawl at work. Even with fused eyelids, the newborn kittens crawl along the mother's abdomen and root around looking for a nipple. The breast crawl is a natural part of our instinctive selves and interupting a natural process is rarely, if ever, beneficial. Aside from all of that, babies seem to love being on their mama's belly working towards a goal. I've never seen one cry and become frustrated. At most they stop and take a short nap before resuming their journey. 

The breast crawl is so important that UNICEF is getting into the game. They are using the breast crawl as a way to initiate breastfeeding because it works and it keeps moms breatfeeding for longer. As they themselves say, the breast crawl saves lives. That's a pretty strong endorsement! Here are some other advantages of the breast crawl from UNICEF:

• Helps to keep the baby warm
• Leads to faster and effective achievement of feeding skills by the baby
• The baby starts getting colostrum as the first feed. Colostrum has high concentration of antibodies (immunity). Baby starts getting colonized by safe germs (bacterial flora) from the mother. Both these offer protection against infections and hence are important for the baby's survival.
• Helps uterine contraction, faster expulsion of the placenta, reduces maternal blood loss and prevents anaemia.
• Leads to better sugar levels and other biochemical parameters in the first few hours of birth.
• Earlier passage of meconium (first blackish-green stool) and hence decreased intensity of normal (physiological) newborn jaundice.
• Early and long term breastfeeding success.
• Better mother-infant bonding.
• May have a role in boosting development of baby's nervous system.

Here is the video UNICEF has on their website to demonstrate all that you have read about. I have a video of a breast crawl after a homebirth that I did coming soon.