Unmedicated Childbirth: Why Every Mom Needs a Midwife
April 9, 2016
Childbirth is a special, life-altering process that sets the stage for a child’s development throughout life. Award winning science shows that when done correctly, unmedicated birth encourages health and parental bonds throughout life. It also serves as nature’s way of preserving moms hormone balance, output and sensitivity later in life.
Unfortunately, many misconceptions and fears exist when it comes to pregnancy and birth. In my own experience, many doctors act as if it’s a “high-risk” situation, requiring emergency medicine and medical intervention. Sadly, this aggressive approach is contributing to the growing infant mortality rate in the US, which has one of the highest among industrialized countries.
That’s why you need a midwife. Their vast experience helps moms better understand the dichotomy between a high-risk and low-risk pregnancy. Once done, a birth plan can then be made specific for parents that circumvents the need for unnecessary medications and interventions like c-sections and epidurals.
To help parents learn more about this, I interviewed Elizabeth Bachner. She’s our family’s midwife and the owner of GraceFull (www.gracefull.com), Los Angeles’ first Accredited Birthing Center.
“If more women interact with medical professionals who respect birth, trust the process, and support the physiology of the body, then more women would have unmedicated births without as many interventions — and America would have better birth outcomes,” says Elizabeth.
TPC #1: Please explain what a midwife is, and what they do exactly?
Elizabeth: Hi! I’m excited to be here and answering your questions. The word midwife means “with woman.” Midwives are primary health care professionals who support other women throughout pregnancy, labor, childbirth, and the postpartum period.
Midwifery licensure varies state by state, and there are even some states that consider midwifery illegal! Midwives who practice outside the hospital are considered experts at “low risk” childbirth and work collaboratively with doctors who are experts at “high risk” childbirth.
In California where I practice midwifery, we have two different types of licensed midwives who can support women for ‘out-of-hospital’ births (which includes home births, water births, and birth center births). First are Certified Nurse Midwives (CNM) who have nursing licenses, must be supervised by a doctor, and have had most of their training in a hospital. Next are California Licensed Midwives (LM & CPM) who have medical board licenses, do not need the supervision of a doctor, and are expertly trained in out of hospital births (home births or birthing centers).
TPC #2: What are some of the top misconceptions people have about childbirth?
Elizabeth: I love this question. So many people think every birth is a “high risk” birth and will need emergency interventions. This, unfortunately, is the thinking of uneducated people who don’t know the difference between “high risk” and “low risk” childbirth.
Believe it or not, many doctors fall into this category, as medicine is taught from a place of a “problem” that needs to be fixed.
While this philosophy is important when having surgery or if a mom is in need of interventions to manage her high-risk pregnancy, there’s almost no required training for doctors on how to support mothers who are considered low-risk and who don’t need interventions to birth her baby.
This is part of the problem as to why so many people are anti-hospital. The birthing culture in most hospitals neither educates families nor supports the choice for having safe, evidence-based, unmedicated births where the family is seen and heard, treated respectfully as adults, and the physiology of the body is worked with to ensure a safe birth.
TPC #3: What, exactly, is involved during a home birth?
Elizabeth: Before the birth even happens, we meet with the families the same way doctors do —once a month until 28 weeks, then twice a month until 36 weeks, then once a week until the mother gives birth.
The difference is that our prenatals last for 30 – 60 minutes. In addition to checking mom’s blood pressure and pulse as well as listening to the baby and measuring mom’s belly, we discuss mom’s diet and exercise routine. We help her prepare to give birth outside the hospital by discussing how the body works physiologically and how extra people present at the birth can affect labor. We find out what mom’s fears are and try to come up with a plan before she goes into labor. This way, she’s mentally prepared to surrender and trust.
Birth needs to be respected and the process trusted. At GraceFull we help families prepare for all of this before mom goes into labor.
At the home birth itself, the midwife arrives when mom is in a good active labor pattern (around 6 cm) and is joined by a trained assistant when mom begins pushing. The midwife will bring all the necessary medical equipment (IV fluids, lidocaine — for numbing the perineum if it needs to be stitched — suture equipment, drugs to stop heavy bleeding, antibiotics and oxygen if we need to resuscitate). During the labor we follow evidence-based protocols when it comes to listening to the baby’s heartbeat with our hand-held doppler (which can even listen in the water) and taking mom’s vitals.
The midwife will sit on her hands unless the mom’s body or the baby has communicated through vitals, heart tones or words that some management or intervention is needed. If not, we work with the anatomy and physiology of the body and let it do what it does really well: birth a healthy child!
Once the cord stops pulsing, the placenta is ready to be born. During the immediate post partum, both mom and baby’s vitals are checked to make sure everything is stable.
Then we tend to leave the family alone to integrate this huge event while we fill out the paperwork. About an hour after the baby is born, we cut the cord and start a newborn exam. After we check mom for tearing, we help her get into a shower and then put her back into bed with her baby, encourage breastfeeding and then sleep.
Birthing at home is an easy clean-up for the family, as the birth is contained in one spot. Also, because both mom and baby are considered “low risk,” they can stay at home in the family bed to recover, with a midwife checking in with them by phone daily. There’s usually a home visit from a midwife within 24 hours, then another visit at 1 week, 3 weeks and 6 weeks back in the office.
TPC #4: What’s the difference between a birth center and a hospital?
Elizabeth: Again, this varies not only state by state but also by your local birthing culture. We are an Accredited Birthing Center with https://www.birthcenteraccreditation.org/ which has helped us create a formal structure for protocols and risk assessment and makes sure that we continue to adhere to their standards and are practicing Evidence Based Care.
Culturally we pride ourselves in being a home birth practice within a birthing center. We go slow and honor the natural rhythms of both the body and the baby, practicing what is called bio-dynamic childbirth. This philosophy works with both the anatomy and physiology of the body and goes slow, as to allow for integration of the nervous system, which can minimize emergencies.
In general, birthing centers have queen size beds for the whole family and supportive tools such as birthing chairs, birthing swings, birthing tubs (which many moms report ease the pain of labor), nitrous oxide, as well as one-on-one care with someone you have met before. These tools can all help a mom achieve her goal.
TPC #5: What are some of the top dangers of delivering a baby at a hospital?
Elizabeth: The #1 issue with birthing at a hospital is most hospitals don’t know the difference between low-risk and high-risk childbirth. As a result, they treat everyone as though they were high-risk, which can create problems that are not actually there.
Physicians are not taught about nutrition or exercise, so they’re unable to help you be physically at your healthiest and fittest for the birth. They’re not taught about physiological childbirth, meaning they’re not taught how the body releases the appropriate hormones at the right time to help a mom birth her baby. They’re not taught what is needed for the body to release the appropriate hormones (a dark room, being unobserved, a warm room, feeling safe…).
It’s rare for me to meet a physician who has been taught in school about hands-off childbirth (or how to “not manage” a birth); therefore, they’re not experts at low-risk childbirth. The doctors we consult with are trained to deal with advanced pathology, and we love them for that.
TPC #6: Other than an emergency situation, are there ANY legitimate reasons for a woman to give birth at a hospital?
Elizabeth: There are many legitimate reasons for a woman to give birth at a hospital. If she is considered “high risk,” she should be birthing with a surgical room down the hall and a good NICU (neonatal intensive care unit) nearby. Some reasons that come to mind are high blood pressure, gestational diabetes that can not be controlled via diet and exercise, and a fever during labor. Also, if a mother wants to get pain relief that numbs part of her body so she is unable to move, she will need a surgical room down the hall as there is a higher chance of her having a complication during labor.
[TPC note: During and after all four of our children’s births, my wife used all natural Relief FX, a safe pain relief solution created with ingredients from Mother Nature. Relief FX is non-toxic, works within minutes…and there are ZERO side effects. It’s much safer than using painkilling drugs during childbirth!]
TPC #7: Is it possible to have an unmedicated childbirth at a hospital?
Elizabeth: Yes!! It is! You can have a great unmedicated birth in a hospital, but it is still a hospital birth. A great hospital birth is not a home birth, it’s a great hospital birth complete with florescent lights, small beds, a nurse, and possibly a doctor whom you’ve never met before. In that kind of environment many women have challenges feeling vulnerable, open and safe with someone they’ve met not even once.
I do know I’m making broad generalizations. I’d like to give a shout out to those few doctors and hospitals that support a woman’s choice, honor her body and even offer water births. In Los Angeles we’re fortunate to have quite a few of these practices where you have one-on-one doctor care, can set your hospital room up with battery-operated candles, bring in essential oils, have a photographer and not just labor but also push your baby out in any position you want.
It’s important to remember, doctors and nurses became care providers because they wanted to help people. They’re not bad people. Many have become tired because of the rigorous training they had to endure where they saw one emergency after another (while sleep-deprived from their long shifts), without ever being exposed to a trusting unmedicated birth where a mom gently breathed her baby out on all fours.
On top of that, you have protocols and paperwork that are demanded of them from hospitals to make sure they’re protected in case of a lawsuit (which is sometimes called “Med-legal”). If you do go to a hospital and want a good birth experience, speak to a healer who chose to become a medical professional. Invite that part of the person in front of you to show up in your birth rooms and you might have a really lovely hospital birthing experience.
TPC #8: How do you educate women about a C-section?
A Cesarean section is a surgical birth in which a surgeon makes an incision into the low abdomen through the layers of skin, fat, muscle, and uterus to help the baby come out and into the world.
The most common risks are: infection, heavy blood loss, a blood clot in the legs or lungs, nausea, vomiting, a severe headache after the delivery (related to anesthesia and the abdominal procedure), bowel problems (such as constipation or when the intestines stop moving waste material normally), the injury of another organ (such as the bladder) in mom, or an injury to the baby from the scalpel during surgery.
A C-section is still a birth — a surgical birth that should be respected as a birth. Sometimes it’s a necessary surgery that carries with it big emotions. A woman may be disappointed and need to mourn the loss of her unmedicated birth, while also feeling excited to meet her new child. Both of those experiences can be there at the same time, and both need to be honored.
I’ve heard some birth professionals call this type of birth a “vaginal bypass.” That wording is shaming and degrading. We need to stop judging other women’s choices and start respecting each other and lifting each other up!
We will never be standing in another women’s shoes and will never know why she might need or choose a surgical birth. We don’t know what kind of abuse a woman may have encountered in her life, so the thought of a vaginal birth takes her so far into her PTSD that she will never be present for her child. We don’t know who is being diagnosed with what pregnancy illness that makes a vaginal birth out of the question. Babies ultimately need to come earth-side sooner rather than later, so the body does not terminate the pregnancy.
We don’t have a crystal ball, but current studies are letting us know that in the past we used to think a surgical birth could “save” children because they’ve been dying from the birthing process. Studies around surgical births show we’re not ‘saving’ as many children as we thought, sometimes Mother Nature is cruel, and babies are dying in utero regardless of whether the birth is vaginal or surgical.
Yes, cesarean births are surgeries and do come with surgical risks. But it’s the right of every woman to choose what she wants to have happen to her body. We need to respect her right to choose a Cesarean birth, if that’s what she thinks is best for her family.
TPC #9: What’s the #1 thing you wish people knew about the birthing process?
Elizabeth: This is easy. Moms are strong and babies are smart. They are both really great communicators and let us know when they need extra support or interventions to be born safely.
I also want moms to know that low-risk births are just that: low-risk. Yes, challenges can come out of left field, but if you’re low-risk, talk with your care provider because you have more choices (home, birthing center, or hospital) and should not be treated as high-risk, and exposed to undo medicalization.
TPC #10: Do you believe ALL women should opt to have midwifery support when giving birth? Why or why not?
Elizabeth: Yes. I believe all women deserve someone who will listen to them, hear what they have to say, offer nutrition and exercise information, look at them as an individual and consult with a surgeon when they go from low-risk to high-risk. I think if more women interact with medical professionals who respect birth, trust the process, and support the physiology of the body, then more women would have unmedicated births without as many interventions, and America would have better birth outcomes.
I want to end by saying that we need to start respecting all choices. Pregnancy is a risk. Parenting is a risk. Having your heart outside of your body in the form of another human being is a risk.
What needs to change is that parents need to research and own their choices, because only THEY will be parenting their child — not the obstetrician, the pediatrician, the midwife or the nurse.
Medical professionals need to start implementing education for themselves and their families about how the anatomy and physiology of the body is made to birth babies. Once families are educated with evidence-based care then we need to start trusting that parents are well researched, well meaning, well educated and are making their own choices so that their baby can be safe. Just because a parent makes a choice that you personally don’t agree with does not make the choice wrong.
We as women need to stop tearing each other down and start lifting each other up! Respect birth and trust the process. That is our motto here at GraceFull and I’d like to see more medical professionals and families adopt those words.
Article reposted from: The People's Chemist
Vaccination: A Different Perspective by Dr. Michelle Gerber
April 9, 2016
Vaccination is a subject that provokes heated debate regarding efficacy, necessity, societal obligation, safety and reliability. The debate over vaccination tends to be steeped in rhetoric, dogma and exaggeration. It is undeniable that vaccination can help prevent potentially life threatening illnesses. On the other hand, issues have been linked to the process of vaccination.
Based upon the current body of evidence, neither the extreme pro nor anti-immunization position is completely defensible. Because adequate lifetime research has never been completed, the long term effects and side effects of compulsory childhood vaccination remain relatively unknown. The vaccination decision is difficult and complex. To make an informed decision, you will need a balanced view of the available information. Your local department of health can provide literature in favor of vaccination.
Dr. Michelle Gerber, our in house Naturopathic Doctor, offers a vaccination class that educates families about the nature of immunity in the body and how vaccination decisions might affect your child’s developing immune system. If you are interested in understanding vaccinations and being informed around your choice, go to our classes page to see when the next class is being held. Below is an excerpt from her extensive handout and lecture.
The Naturopathic Perspective
It is obvious that germs contribute to the development of disease, and that vaccines can generate protective levels of immunity to certain diseases. However, the infectious agents are not the only factors to consider. The individual’s health and constitution as well as his/her social and physical environment are also crucial determinants. In other words, a strong and healthy body is not fertile ground for the spread of infection and disease.
The naturopathic community does not have one unified position on the topic of vaccination. The final decision rests with responsible parents. We recognize the complexity of the decision, and encourage parents to carefully consider many factors in the light of existing knowledge. There are several criteria to assess prior to making any decision.
- What is the risk (probability) of this child contacting the causative agent of the disease?
- What are the consequences of the natural infection?
- Is there a safe vaccine available?
- Is the immunity conferred by the vaccine solid and long-lasting?
- Is the route of vaccine administration compatible with the route of natural infection, and are the appropriate elements of the immune system stimulated?
- What is the particular child’s health history?
- What is the child’s current health status?
- Are alternatives available, and if so, are they safe and effective?
It is important to understand the absolute and relative contraindications to vaccination in support of long term heath. Routine vaccinations should be deferred in a child during an acute febrile illness, with signs of eczema or any acute skin rash, or when undergoing immunotherapy. Vaccination should be avoided in a child who is allergic to any vaccine component (note: some vaccines are cultured on chick eggs), with altered immunity or immunodeficiency and/or with a previous history of significant adverse reaction to vaccinations.
There is no doubt that the most currently used vaccines do confer varying degrees of immunity with little acknowledged risk. It is the risk that cannot be assessed which causes concern for physicians who are committed to the first principle of healing, “Do No Harm.” The final decision on vaccination rests with responsible parents and what is right for you and your child at any given point in time. Carefully consider the available literature, and trust your parental intuition. In any case, the decision is difficult, but it does not have to be "all or nothing," and in fact in the vast majority of cases, should fall somewhere in between.
Article reposted from:
Tissue Integrity During Birth
February 29, 2016
When I interview with new clients, possibly the most-asked question with the most furrowed brows is some permutation of, "What about tearing?" While it sounds gruesome and can sometimes be severe, most of the time women will have a moderate - dare I say healthy - tear, and many women will not tear at all. The discussion of tearing involves three parts: Prevention, Repair, and Healing.
There are lots of theories on how to reduce tearing, from the perspective of both the mother and the care provider. In midwifery school, my teacher's take was almost always, "Hands off the perineum!"
But most midwives I know, including myself, do at least some hands-on techniques as the baby crowns to help protect a mama's perineum. I really think that sometimes counter-pressure and perineal support can at least help a mother feel safer about pushing her baby out, which may actually help her relax and let more blood flow to her tissues. Could this actually reduce tearing? Possibly.
Nutrition, general health, and genetics play a role (some of those things you can control, and others you can't). Smoking is definitely contraindicated, and I encourage my clients to eat healthy fats every day - salmon, avocado, walnuts and the like. Some women are just prone to tearing no matter how well they eat.
Here are some things you can ask your midwife or OB to do to prevent tearing:
- Ask your care provider ahead of time to help you slow down your pushing as the baby crowns. You will probably want to push like crazy and get that baby out, but there is some evidence that slowing down at that crucial point can give your perineum more time to stretch instead of tear.
- You can ask your provider to do a little counter-pressure on the baby's to control the descent, or to put some pressure on your perineum, if it's appropriate. Many women will instinctively put their hands on the baby's head to help them ease the baby out. You know your body best, so if that action comes to you easily, go for it.
- Warm compresses. The literature is mixed, but personally I feel that warm compresses can be comforting to mamas while pushing, and may bring more blood flow to the pelvic floor, to help your tissue expand.
- Avoid pushing the baby out while you are in a deep squat or on the birth stool. If squatting feels good when the baby is still high, and it is helping baby to descend, great. But before your baby crowns, consider getting on hands and knees or laying on your side or in semi-sit. Squatting and birth stools can distend your perineum, creating less slack for allowing tissue to stretch. Talk about pushing positions with your provider ahead of time and make sure you are both on the same page.
- I was taught in school that water birth reduces tearing. One of the theories about this is that the water pressure supports the perineum, and that the warmth relaxes the tissues. On the other hand, a new study from Oregon State University of more than 6,500 midwife-attended water births in the United States reports an 11% increase in tearing for women giving birth in the water. (https://www.sciencedaily.
com/releases/2016/01/ 160121190918.htm) It think it's possible to do all of the techniques described above while mama is in the water, if it's welcomed.
And what if you do tear? First of all: It's not your fault! Vaginal tearing is a normal part of the birth experience, and midwives believe that your vagina knows exactly how it is supposed to tear to be able to heal well. As with any injury, there are varying degrees of severity, specifically four degrees that we talk about during vaginal birth. (http://www.mayoclinic.org/
Whether or not your tear will need to be sutured (which means getting stitches) is a conversation you can have with your care provider when she checks out your vagina after you give birth. Suturing can help put tissue back together where it belongs and keep it there for the best healing possible, minimizing scar tissue. Typically midwives will be able to suture a first or second degree tear at home or at a freestanding birth center. Some tears, even second degree, hold together so well on their own that as long as they're not bleeding, they may not need to be sutured at all. Third degree and fourth degree tears - which are rare - will always need repair, and we transport women from a home birth to the hospital for those repairs because a surgeon will usually do the best job for a very severe laceration.
Home birth midwives carry Lidocaine to help numb you if we need to suture. Some freestanding birth centers may even have nitrous oxide to help you relax during suturing. In the hospital, stronger medications may also be available to you if you have a severe tear that needs repair, including an epidural or general anaesthesia.
Healing and Pain Management
- Even if you don't tear, you may have some "papercuts" that sting a lot when you pee. Drink lots of water, which will dilute your urine to reduce the stinging. You can also buy a numbing spray to apply before you use the bathroom. Make sure you use a peribottle with water or brewed sitzbath herbs while you are peeing, which may help dilute your urine. Your midwife or hospital providers will make sure you get a peribottle. Papercuts heal after a couple of days.
- A sitzbath basin (http://www.walgreens.com/
store/c/nova-sitz-bath-8101/ ID=prod6095772-product?ext= gooHome_Health_Care_Solutions_ PLA_Toilet_Accessories_ prod6095772_pla&adtype=pla& kpid=sku6086102&sst=e328681c- 77e4-4415-82a2-5824fc94b925) is available to fill up with warm water or brewed sitz bath. You simply sit in it and pee into the warm water, while the overflow drains out the back into the toilet. So nice.
- Several companies make sitz bath herbs that you can make into a tea to put into your peribottle or sitz bath basin. There are lots of wonderful herbs, but my favorites are comfrey and calendula. You can also soak your bottom in the herbs in your (very clean) bathtub. Most sitz bath herbs are also great for hemorrhoids!
- If you're not into the herbs, simply soaking in alternating warm and cold water is meant to promote healing. This is called "hydrotherapy." (Also great for hemorrhoids!)
- Ice is now contraindicated after 24 hours post-tear, so don't ice for too long.
- Acetaminophen and ibuprofen may help pain and swelling in the short term.
- Squeeze your butt cheeks and your vagina closed before you sit on the toilet, then relax once you're seated. This will help your perineum to not distend into the toilet, and prevent undue pressure on the wound and on your stitches.
- Wound healing requires good nutrition. Ask your care provider if you may be anemic or if you lost a significant amount of blood during birth. If you are anemic, get a good-quality iron supplement on board - one that doesn't constipate you. Anemia reduces oxygen to the tissues, which can impede wound healing.
- Take magnesium or over the counter stool softeners to ease bowel movements. You might even reach down and support your perineum with your hand while you have a bowel movement. This may be ultimately unneeded (having a BM shouldn't pop your stitches) but if it helps you relax, do it.
- If you believe that your tear is taking longer than expected to heal, or you think it might be infected, talk to your care provider right away. My personal first line of defense for a mildly infected perineum or slow-to-heal wound is a sea salt soak in the sitz bath basin a few times a day. In more severe cases, you may need antibiotics or to have your wound cleaned and re-sutured.
- Lots of rest! Avoid climbing the stairs. Please no sex, and no tampons or sex toys.
- Keep the wound very clean. You may need want to hop in the shower after a bowel movement if rinsing with the peribottle isn't enough.