If you follow my facebook, either personal or professional, you’ve probably noticed that April is Cesarean Awareness Month (CAM). I’m pretty sure there are some of you out there, thinking things like “What’s the big deal? People have cesareans all the time. They’re safe.” Or “A healthy baby is what matters, not the way in which the baby arrived.” Or “So-and-so had a cesarean and it saved her/her baby’s life!”
I want to start out by being clear about one thing. I am thankful for cesareans. They can save lives. They are needed and I am glad we have them. But, and this is a big but….we are doing far too many of them. Ever hear the saying that there can be too much of a good thing? That holds true for cesareans, and all birth interventions. For example: we can all agree that drinking water is good for you. It keeps you hydrated and your body working as it should. Have you heard of water poisoning? It’s a thing. You can actually get really sick or even die from drinking too much water. America’s cesarean rate has risen 500% since 1970. And our maternal and infant mortality rates have been rising right along with it. Today, 32% of babies are born by cesarean. Are we slowly giving ourselves cesarean poison? Hmmmm…..I think we are definitely giving ourselves birth intervention poison.
Interfering with the process of pregnancy and birth has consequences. The medical model of maternity care, although well-intentioned, is slowly poisoning and killing normal, physiological birth. And our high cesarean rate is a symptom of that. The term “cascade of interventions” is something well known among birth workers. Once you introduce one intervention, often another is “needed” and maybe another and another and so-on, often until the point of needing a cesarean has been reached. What would have happened if that first intervention was never introduced?
Birth is a complicated, intricate process with an incredible cocktail of hormones, and body changes (for both mother and baby) that all work together. Every hormone and change in this process has a very specific purpose. And many of those have several purposes, not just for the event of giving birth, but also for the days and weeks, even months after baby is born. They are responsible for mother:baby bonding, for feelings of love, protection, and attachment. They are necessary for the production of breastmilk. They also play a role in whether or not mom will suffer with postpartum depression. They will ultimately affect how mom will parent her baby. If we alter one of those hormones by introducing an intervention, it changes the process, no matter how slightly we alter it. If we do things like bypass the process altogether and cut babies from their mother’s wombs before the process of birth has begun or any of the birth hormones have been released, it drastically changes things. So when doing so, we better be sure it’s for a good reason. When moms labor for a while and then baby is born by cesarean, it also changes the process as mom and baby both are then not exposed to as much of the birth hormones. When we force the process to begin before mother and baby are fully ready by introducing synthetic forms of our hormones, it drastically changes the process. When we use these same synthetic hormones to “speed up” labor, it changes the process. If we use medications for pain, it changes the hormones, thus changing the process. And we are interfering with normal, physiological birth so often now that we are forgetting what normal birth looks like. We are becoming fearful and defensive. We are misinformed about how our bodies work and what is involved in the birth process. We are no longer trusting birth, but trusting the medical maternity system. Fear affects our hormones, including and especially those involved in the birth process.
The way in which we meet our babies matters in so many ways. Mothers and babies feel the consequences of our birth intervention poison when these necessary and purposeful hormones are interfered with. And there are many out there that don’t even realize it because our poisoned state is what is becoming accepted as normal. They don’t realize the potential that is there. They have no idea how amazingly beautiful it can all be because so few (if any) around them have experienced it. The medical maternity system doesn’t realize that it’s poisoning us, it’s just doing its job…methodically, systematically, poking, prodding, testing, monitoring, and delivering “healthy” moms and babies over and over and over again, trusting it’s interventions much more than the birth process, forgetting what is normal, natural, and truly healthy. Like an axe, clearing a piece of land for a beautiful, new neighborhood, full of gorgeous homes and a pretty park with freshly planted trees and flowers. The neighborhood is not bad. The axe is not inherently bad, it is doing its job. But what about the old trees and plants and animals that lived there before? New trees and flowers and bushes will be planted, new animals will move in eventually. The axe will continue doing its job, unchanged, unaffected. But we cannot ignore the fact that that piece of land will never be the same again.
The axe forgets. The tree remembers.
Unless we start speaking out and changing how we currently do birth, birth will never be the same again; we will never be the same again.
Since April is cesarean awareness month, I’ve decided to share with you the birth story of my oldest son, Nehemiah. He was born by cesarean a little more than 7 years ago. I often say that birth is transformative. And that holds very true for me. His birth made me who I am. His birth made me a mom. And the experience I had with his birth was the gateway through which I developed such a passion to support pregnant and birthing women and then ultimately became a doula.
I feel very strongly about helping women avoid unnecessary cesareans and encouraging providers to lower the cesarean rates because when too many are done (our cesarean rate is double that which the World Health Organization has stated to bring the best outcomes for both mothers and babies), more harm than good is done. And for many years after Nehemiah was born, I grieved. I grieved the birth I had wanted. I grieved the birth that was stolen away from me. And while I still sometimes get sad and even angry about his birth, I am thankful for it. Thankful because it made me who I am today. It is my desire to help moms avoid that first cesarean and support moms who have already had a cesarean to achieve a successful VBAC.
I wrote Nehemiah’s birth story while pregnant with my daughter, Roselynn. I knew it would be helpful to write it all out in processing my feelings. And I knew the importance of that processing to my success in having a VBAC. I did have that VBAC. It was very long and hard and full of emotional roadblocks. And I had a second VBAC with my youngest son, Abraham, which ended up being much shorter and easier. I’d love to share those stories sometime, too. I didn’t do any editing to his birth story. I’m sharing it with you exactly as I wrote it a little over 5 years ago.
On May 8, 2007, after 3 years of suffering through the heartache of infertility and losing our first child to a miscarriage, I stared at two lines on a pregnancy test and tried to catch my breath. I was convinced that my body was broken, but these two lines were going to prove me wrong. We were very cautious in the beginning. I was terrified of losing this baby, too. As we reached the end of the first trimester, we breathed a big sigh of relief and happily shared our news with all of our friends, family, and co-workers.
I cherished every moment of pregnancy. I never felt more beautiful and feminine and alive. Feeling our tiny miracle dancing about in my belly was the most amazing thing I have ever, ever felt. Josh and I could sit for hours watching and feeling my stomach move and shift as our son moved, imagining what he may look like and eager to meet and hold him. Josh pampered and doted over me.
On Thursday December 13, 2007 I was headed to my OB’s office for my 37 week check-up. I was actually 36 weeks and 5 days into my pregnancy. I was feeling pretty good. The discomfort and pressure I had been feeling in my hips, pelvis and lower back for several weeks had lessened in the last couple days. I wondered if maybe the baby had moved further down into my pelvis. That morning, I had a pretty serious craving for a Burger King Croissan’wich. Josh and I were driving separately so that he could go straight to work after my appointment. He was running late, so I left with the intention of going through the drive-through and eating the sandwich while I drove. However, I missed my turn and didn’t have time to turn around. So, I went on to the doctor’s office. I was a little disappointed and pretty hungry, but my appointments were usually pretty short so I planned on getting my sandwich right afterwards. My OB checked me and said I was dilated to three. I was feeling so good. I adored being pregnant and was just so excited about the labor and birth, and finally looking into the eyes of the miracle growing within me. I told my doctor about the pressure and discomfort going away. She didn’t seem concerned, she reassured me saying that she had felt his head when she checked me. She was about to say “See ya next week” when I mentioned that my mother had had three breech babies. That caught her attention. She left the room and came back a few seconds later with a little ultrasound machine. “Breech babies aren’t hereditary, but I just want to be sure,” she told us as she squeezed some cold goo onto my belly. Our son, who had been hanging out so low in my abdomen for the last several weeks had flipped. Our doctor exclaimed, “That’s his butt I felt!” He was now breech. The next half an hour or so was a whirlwind of confusion. She worriedly explained to us that since I was dilated to three, she was afraid my water could break anytime. And if my water broke, the cord could prolapse. And if the cord prolapsed, we would have a “dead baby.” I felt sick to my stomach. She told us her plan, but I didn’t understand any of it. I just knew that I was supposed to go home, get my bag and go straight to the hospital without eating anything and that my precious son could die. I called my mom as we were leaving. Josh called his. My mom laughed and said “welcome to the breech baby curse.” I didn’t think it was funny. I was in a weird state of shock and denial. I called my boss as I was driving and told her that my maternity leave was starting that day. “Oh god, I’m having a baby…probably today,” I thought to myself. “But this isn’t right. What is going on?” Fear and desperation had a tight grip on my heart.
Finally, after a couple hours, a nurse came in to escort us down to have another ultrasound. I shuffled down the hall in my standard issue green hospital gown and the pink slippers I had purchased just a few weeks before specifically for our hospital stay. I had envisioned slipping them on in the middle of the night while I happily floated about our hospital room tending to our little blue bundle. Or perhaps as we walked a few laps around the mother-baby floor, proudly displaying our special delivery.
The perinatologist confirmed that the baby was breech. He was a complete breech. He explained to me that our son was sitting sort of cross-legged on my cervix. He estimated him to be 6 lbs. 9 oz. Next thing I knew, they were preparing for an amniocentesis to check his lung maturity. The thing I remember most about the amniocentesis was that there were three staff there: the perinatologist who was a man, another man who was either a medical student or an assistant of some sort, and a nurse. The three of them were trying very hard to joke and put on a sort of comedy routine for us. I’m sure they were trying to keep me relaxed. I imagine it wouldn’t be good to insert a big needle into a uterus that is tense and hard with fear and anxiety. When my husband tells the story of the amniocentesis, he recalls feeling sick to his stomach as he watched the needle move onto the ultrasound screen next to our son. Afterwards, I had a hard time sitting up as my stomach felt hard and sort woozy. Once back in our room and strapped back down the bed with monitors, I felt a tight sensation run through my abdomen. The monitor showed that it was a contraction. The nurse then told me that it was normal after having an amniocentesis performed. Sure enough, there were only three of them over the next hour then they were gone. We were told that we would have the results from the amniocentesis in two hours…4:00. We waited and waited and waited. As it approached 5:00, I was tired, bored, worried, scared, and starving. A nurse came in to check my IV and I asked about the results of the amniocentesis. She responded with “Nobody’s told you yet?” That scared me. She said that someone was supposed to have told us that our doctor was coming in to speak to us personally.
A little after 5:00, our obstetrician appeared in the door of our room. She explained to us that the results of the amniocentesis were good…that our son’s lungs were mature enough to be born. She then told us our options from there. Our first option was to take me over to a delivery room and attempt an external version to move the baby into a head down position. Once the version was complete, labor would be induced to insure that he would not flip again before he was born. I didn’t love that option as I was firm about my decision to not allow my labor to be induced as I knew it could lead to more interventions which could lead to a cesarean. The second option was to just have a cesarean. I was feeling as though a rug had been yanked out from under my feet. “Those are our choices?” I thought to myself. “But, he’s premature. How did we end up here, in this moment with these two crappy options about how our son will be born today…prematurely? Is there really no other option?” I desperately searched my scared, vulnerable mind for something….a question to ask, a tidbit of information about our situation I may have read during the last several months, a knowledgeable friend to call who could provide some guidance…anything. I came up empty-handed. With my doctor hovering over me awaiting an answer, I made the decision. I wanted to avoid a cesarean at all cost. We were going to do the version. There were a few risks involved with the version. They all would require an emergency c-section, so I was moved into a delivery room next door to the operating room. After I signed the consent form for the version and while Josh was gathering our belongings to be moved into the delivery room, I asked the doctor if the external version would be painful, stating that I would not change my mind about it no matter what the answer was. She told me it would be painful. It didn’t matter to me. I wanted our son to be born healthy, vaginally, and as naturally as possible. Josh hurriedly made several phone calls to update our friends and family on the outside.
I noticed right away that the delivery room we were moved into didn’t have a Jacuzzi tub, which we specifically asked for in our pre-admittance paperwork as we were still pushing for a natural, medication free delivery. I asked about it and was told that we could use the “community one” down the hall later if I wanted. Then they began talking about the anesthesiologist coming in to give me an epidural. Wait a minute! Stop! “I don’t want an epidural.” I told them, while thinking to myself “Did you even read our birth plan?” They tried to talk me into it, but I was determined to have as natural of a birth as possible. They put something in my IV which I was told would relax my uterus. The external version was performed by three people: my female obstetrician, the male perinatologist, and his male student/assistant. There were also two labor and delivery nurses present….one of which I think was either a student or in training of some kind. As my OB emptied two entire bottles of ultrasound jelly onto my belly, she grinned down at me and said she preferred to use olive oil for versions.
If it is possible to have an out-of-body experience, I had one during that version. The doctors briefly discussed their plan of action…which way they were going to “roll” the baby. Then, they braced themselves against the tables, and counters around them, looked at me and said “ready?” As I nodded, they began pushing, pulling, and twisting on my abdomen with all their might. My dear husband was by my side, holding my hand and one of the nurses was by his side encouraging me to breath. That’s all I could do. I stared into the light above me and breathed. Every second was excruciating. They stopped, but I could tell that the news wasn’t good. My OB turned to me and said, “Amber we’re going to try and roll him the other direction now. He didn’t want to go that way.” My head and body screamed, “No!” But I was holding on to my hope of a natural birth and nodded. Again, I looked into the light and breathed. They were able to turn the baby transverse, but he would not roll all the way. A cramp formed in my right hand as a result of the tension I felt during version. My fingers were twisted and curved in odd directions, unable to move. My sweet husband massaged my hand for what seemed like hours. I was told it was time for the c-section.
The devastation I felt at that point is beyond words. I felt such a loss of control…control over my body, my life, my family. With warm tears running down my face, the nurses began to “prep” me for surgery. I was exposed and shaved while the room was bustling with people. Nobody seemed to be concerned for my privacy. Although the nurse was gentle, I was humiliated. A cover was placed over my hair and my legs were put into some sort of inflatable blue bags. Josh was handed a set of scrubs and told to quickly change his clothes. I didn’t want him to leave me, even for a second. I was scared and so sad. I asked my obstetrician before she left to get herself ready for surgery if I would be able to have a VBAC in the future. Her response was “Well, we can try if you really want. But, you’ll probably find it easier just to schedule another section.” My heart crumbled.
It was time. The nurses escorted me down the short, cold, sterile hallway to the operating room….the back of my gown open, exposing me. Again, there was no concern for my privacy. I felt defeated as I was assisted onto the table. There were so many people. The anesthesiologist was there, getting ready to play his part. I saw through a window into another little room that the perinatologist, his assistant/student, my obstetrician, and a couple nurses were scrubbing their hands. The anesthesiologist was rude to the nurses and made me feel very uncomfortable. I was terrified of the receiving a spinal block for the surgery. I did not want a needle in my back. What if they did it wrong and I ended up paralyzed? Once the spinal block was in place, I was told to very quickly lie down. Once lying down, my arms were pulled out from my sides and strapped to boards so that my upper half created a T. A large sterile drape was placed just under my bustline, blocking my view of the majority of the room and the people that it contained. The anesthesiologist who placed the spinal block was replaced by another one. This man was much nicer and he took his position at my head…slightly to my right side.
They were about to cut me open and I began to panic. What if the spinal block wasn’t working properly and I felt the scalpel slicing into me? What if they cut into one of my organs? What if they accidentally cut my baby? What if I lost too much blood? I was terrified. I fought with everything in me not to have an anxiety attack on the table. Josh was my rock. He sat on my left side, very close to me and sweetly whispered into my ear. He was such a proud daddy and so excited to see his son. He tried to keep me focused on the fact that I would soon meet our little boy. I was told that I could look into the reflective light thing above me to watch my son being born. The thought of doing that made me sick. I couldn’t look at the bloody, gaping hole my stomach as they were pulling my premature son from my womb. I remember my OB asking me if I “felt that” as she made sure the spinal block was working before beginning. My mind was screaming “they’re cutting me open! My insides and blood are spilling all over this room!” The next thing I know, the anesthesiologist told me that now was the time to look if I wanted to see my son being born. I said “no.” He gently said, “Are you sure?” And I realized that I needed to be as involved in this as possible and that I should look. I didn’t want to regret it later. I looked. My son was being pulled out of me, butt first. There was so much blood. Nehemiah Mark was born at 6:40 p.m. Josh left my side to see our baby. After several seconds, it occurred to me that I hadn’t heard a cry yet. My obstetrician said from the other side of the drape that he was doing OK. Finally, I heard a cry. But, I felt nothing. It was just a baby crying. They do the initial assessment and weigh and measure newborns in the O.R., claiming that they can then stay close the mother and the mother can still be involved. However, I had no idea what was going on. I couldn’t see him or hear him and nobody was telling me anything. Josh came back to me, smiling ear to ear and exclaimed that he was beautiful and he weighed 6 lbs. 1 oz. I tried hard to feel excitement, but I just felt a pounding head and a heavy heart. Josh left my side again and came back several minutes later with a little bundle cradled in his arms. My hands were strapped down. I couldn’t touch him and all I remember seeing of him was his eyes and the tops of his cheeks. I was instructed by the nurse to kiss him and Josh held him close to my face so I could. They told me they were taking him to the nursery now which was on the floor below. I told Josh to go with him.
I was alone in the operating room. There were no friends and family cooing over our new arrival. I wasn’t able to count all his little fingers and toes or kiss his little cheeks. I was lying on a cold table under bright lights with my arms strapped down, and most private places exposed, unable to feel anything below my chest. I was surrounded by strangers wearing scrubs covered in my blood, hovering over the gaping wound in my stomach that they had just pulled my precious baby from and gossiping about their co-workers. I was mad and shocked at their total disregard to the major event that just took place for my family. But, I was too tired and sad to say anything. My husband and baby were gone. I closed my eyes and willed the throbbing in my head to go away. Now I had a terrible taste in my mouth, too. I told the anesthesiologist who was still at his station by my head. He gave an explanation, but I don’t remember what it was.
Finally, I was wheeled into a recovery room. I chatted with the nurse almost non-stop as I was desperately trying to make the time move quickly so I could see my baby. I told her about my throbbing head and she told me it was because of the pitocin that was given to me to make my uterus shrink back down. She said I was given an unusually large amount for some reason…she didn’t know why. Josh came in and I began to feel some excitement. He informed me that our son was 18.5 inches long. He played me a video of my son in the nursery. As I watched the baby on the screen being handled by strangers, I felt no connection to him. He was cute. I sent Josh back to the nursery. Once he left, I desperately tried to muster up some sort of motherly feelings for the baby I had just watched a video of. I knew in my mind it was my son, but my heart was confused. I felt a deep love for the baby growing within my womb. I was having a very hard time forming the connection that the baby I was being shown was the same one that I had so lovingly carried within me and prepared for the arrival of for the last 36 weeks.
At last, I was taken to our post-partum room on the “mother-baby floor” below and was told the baby would be brought right to me. It was approaching 8:00 and I was concerned about initiating breastfeeding as I knew the importance of beginning as soon after birth as possible. I lied alone in that room for 15 minutes before my husband finally came in, pushing a plastic box on a cart which contained a tiny baby boy swaddled in several blankets. Josh placed him in my arms as I was still unable to move my legs. Tears filled my eyes as I looked into his tiny face. Where were the fireworks? I felt very little for this child and was trying so hard to. He was beautiful and perfect, but was he mine? I was split in two as part of me still felt pregnant and the other part of me knew this was my baby I was holding. I was almost frantic about needing to nurse him. It had been two hours since he was born and I desperately hoped that nursing would help me feel connected to him. I had no idea what to do. I had read about it, watched videos, and received some instruction from our “Prepared Childbirth” instructor. But, I could hardly move and was lost. Josh paged the nurses’ station. When they answered, he told them I needed help breastfeeding for the first time. It was at least 10 minutes before a nurse came in to help. By this time, my son was almost two hours old. As she helped me try to get him to latch on, I began to feel sick. The nurse saw it and asked if I was going to throw up. I told her, “no.” I was really good at not throwing up and I was not about to do it while nursing my first child for the first time. I was wrong. In one smooth motion, the nurse handed the baby to Josh, and caught my vomit in a pink plastic tub. While I was being sick, there was a knock on our door. Our pastor and his wife had come to visit. Josh had asked them not to, but they were about to leave town for the weekend and came anyway. I don’t remember their visit.
Finally holding my son for the first time, a little over two hours after he was born. I was in such shock over what had just happened to us. I couldn't understand why the baby in my arms didn't spark any of the love that I had felt during my pregnancy and expected to feel once I saw his little face. Now I know that that's because I didn't labor at all. There was no oxytocin released, which is the "love hormone" and causes feelings of love and nurturing.
I don’t remember much else of that night. It breaks my heart looking back now and realizing what I missed. I missed most of the first 12 hours of my son’s life. Josh took a video of his first bath for me. I was very sick all night. My poor husband held that pink tub for me over and over and over again. I hadn’t eaten in over 24 hours and was vomiting all night. I have no idea how many times I nursed the baby or even if he nursed well. He lay in the plastic bassinet next to me and we all tried to sleep. When he cried, I couldn’t get up to get him and I could hardly sit up in the bed to hold him when my husband handed him to me. Josh realized that I needed to sleep off the effects of the drugs and that I just couldn’t take care of our baby. He took him to the family lounge down the hall and stayed up with him all night, bringing him to me to nurse every couple hours. He remembers that night fondly. He spent all night cuddling with our tiny bundle in a reclining chair while I was in a deep drugged-out sleep down the hall. I remember the nurses waking me up in the middle of the night and making me get out of bed so they could clean me up some. They asked me if I’d like to walk the couple feet to the sink so I could brush my teeth. I wanted to, but only took one step before having to stop.
I am so very thankful that my son had no major complications from being a “late pre-term baby.” We did suffer complications, however. He was small, and had a very hard time breastfeeding. He lost so much weight in the first three days after he was born that we were kept in the hospital an extra day so we could receive more help from the lactation consultants on staff there. Breastfeeding my son ended up being something I had to fight hard for.
The number one reason I hear from parents for not hiring a doula is the cost. I hear and read things such as, “a doula isn't in our budget” and “a doula is a luxury we just can't afford” or “I'd love a doula, but they're too expensive.”
Bologna. If you see something as valuable, you will find a way to pay for it. I'm going to inform of you why a doula is not a luxury, but in fact a necessity.
Let's start by just addressing the financial side of this. Bear with me as I go through some sorta dry statistics. I promise you these numbers are super mega important, though. You need to know them.
In the Omaha area, the average doula costs $450 (price varies a bit by experience...$450 is the average and is my current fee, so we'll go with that.)
According to a Cochrane review published in 2012 by Hodnett and Colleagues, women who receive continuous labor support provided by a doula experience:
28% decrease in cesarean
*The average out-of-pocket cost of a cesarean in America is $15,000
31% decrease in the use of pitocin
*I'm not sure of the average cost of pitocin, but considering that hospitals are notorious for charging a half a day's pay for an aspirin, I'm certain it costs more to have it than not to. Pitocin is administered by IV, so there will be costs associated with having the IV placed, as well as just the medication itself.
12% increase in the likelihood of spontaneous vaginal delivery
*I'm also not sure of the cost of either vacuum or forceps assisted births (despite my amazing google skills) but would imagine it costs more to use them than not to.
9% decrease in the use of pain relief medication
*The price of an epidural is in the neighborhood of $1,000-$2,000.
14% decrease in the risk of her newborn being admitted to a special care nursery
*There are a lot of variances to this one. It depends on whether it is a level II special care nursery or a level III NICU, how long the stay is, and the reason for admittance. Have you ever heard of a $450 NICU stay? Me either.
34% decrease in the risk of feeling dissatisfied with the birth experience
*The ability to be an active participant in my birth while feeling loved and supported by everyone around me coupled with the feeling of intense joy and empowerment after my two VBACs attended by a doula is priceless. Priceless.
Doula care has also been shown to:
Improve breastfeeding success
*The average price of one can of infant formula is $25. One can per week for 52 weeks (one year) comes out to be $ 1,300.
Decrease the risk of postpartum depression
*We can't put a price on mental health. We could put a price on antidepressants and counseling services, though. Let's say you spend $10 a month on prescription antidepressants and see a counselor twice a month at a cost of $40 per visit (after insurance, of course) for six months. That comes out to a total of $540 for six months.
My $450 fee can potentially save you tens of thousands of dollars.
Now, let's look beyond the financial side of a few of these areas.
Nebraska's current cesarean rate is 32%. I said above that the evidence shows that doula support decreases a woman's risk of cesarean by 28%. That is a pretty big number. I also said above that a cesarean costs around $15,000 out of pocket. That's for an “uncomplicated” cesarean. A cesarean is major abdominal surgery, folks. So, of course it comes with risks. Things like infection, blood loss and damage to other internal organs like your bladder. It also increases your risk of placental abnormalities in future pregnancies like placenta acreta or placenta previa. Some of those abnormalities can be deadly to either mom or baby. Take a minute to let all of that sink in...the financial cost, the emotional cost, the health cost of a cesarean can be astronomical for some, especially those that experience some of the complications that I mentioned.
As I said above, doula support decreases the risk of mom receiving pitocin by 31%. Pitocin is a drug used to either induce or augment (speed up) labor. It is a synthetic form of oxytocin which is a hormone mom releases during labor. Oxytocin is referred to as the “love hormone” as it is the hormone released (in different levels) during hugging, kissing, orgasm, labor/birth, and breastfeeding. It is the hormone responsible for mother-infant bonding and those overwhelming warm, fuzzy nurturing feelings moms have towards their children. Pitocin effectively causes contractions, but does not have the same emotional effect that oxytocin does. A mother who receives pitocin does not make as much of her natural oxytocin as she would have otherwise. A price can not be put on all of this. But, think about the possibility of not reaching the full potential of bonding with your new baby. Pitocin also carries with it risks such as hyper-stimulation of the uterus. And moms receiving pitocin are required to undergo continuous fetal monitoring. No walking the halls. No baths or showers (which have shown to decrease mom's discomfort by up to 60%). Mom is now on a leash.
Spontaneous Vaginal Delivery
As I mentioned above, I'm not certain of the cost of births assisted with vacuum or forceps, but I would imagine it costs more than a birth without. And it certainly has more risks than birth without. There's increased risk of tearing for mom and increased risk of injury to baby, including some pretty serious things like bleeding on the brain. Doula support increases the likelihood of spontaneous vaginal delivery by 12%.
Any intervention given during birth messes up the natural physiologic process. Birth was designed with an incredible cocktail of hormones flooding the mother's body as she works to birth her baby. Adding any kind of artificial drugs, whether it be pitocin or some kind of pain medication changes that cocktail. IV pain medications are narcotics. They do affect the baby which can cause difficulties with breastfeeding. They can make mom feel sleepy or loopy or even sick. I know that I'd much rather be fully present for such a milestone moment, not only in my life but in my husband's and baby's lives as well. Epidurals don't affect moms or babies the same as the IV pain medications. But, they severely limit mom's mobility. A glimpse at pelvic anatomy will confirm that women were not meant to give birth on their backs in bed. And of course, epidurals don't come without risk. There is a possibility of nerve damage and spinal headaches, which are awful. Imagine spending the first week of your baby's life with the worse headache of your life. And if you buy the epidural package, there are other things that come with it, of course. Things such as an IV, continuous fetal monitoring, a pulsox clippy thing, and a catheter. Mom will be stuck in bed, tangled up in all sorts of wires, belts, straps, lines, cords and machines, with no control over her bladder, needing someone else to empty it for her. And sometimes no control at all of her legs, requiring help to even roll over.
AND, it has been shown that once mom receives an epidural, her partner and other support people sort of check out. Mom doesn't need help focusing or breathing any longer. Mom doesn't need counter-pressure or the physical support of certain labor positions any more. Plus, it's now hard to even get to mom through all of the straps, wires and belts to do just offer a hand to hold. Mom is often now laboring alone while dad gets a nap, facebooks from his phone or watches TV.
Feeling Dissatisfied With the Birth Experience
No monetary value can be placed on this, but let me assure you, it is of paramount importance. The birth experience will impact you more ways than you realize and for the rest of your life. Birth is the beginning of the mother-baby relationship. The way in which you birth your baby and the circumstances under which you first meet your baby set the tone for your postpartum period, and really your entire parenting journey. Imagine beginning that journey feeling as if you failed. You may be set up for failure. What impact would beginning that journey feeling as though you were trapped, cornered and had no options or as though nobody listened to you or took you seriously have on your parenting? Beginning that journey feeling as though the baby being healthy is all that matters can potentially set a new mother up for an incredibly emotionally hard postpartum period. That mama matters, too. This issue can piggyback off of the decreased risk of postpartum depression that mothers who receive doula support during their births experience. Birth matters.
In my experience, dads have been particularly grateful for my doula services. It helps take the pressure off of them to do all and be all. Even the most prepared dad will forget some (or most) of what he learned in childbirth class once contractions start. Even the most calm, even-keel guy can panic once he sees his lady in discomfort. A laboring woman isn't always able to verbalize what she needs/wants. I've been trained in that area. I've given birth before. I've doula'd for many other mamas. I have been blessed with a motherly instinct and a servant's heart towards birthing women that I tend to follow more often than not.
Mamas, you deserve the love, undivided attention, education, encouragement and support of a doula.
Daddies, you deserve the help that a doula can give you so that you can be all you can be for the woman you love.
Families, you deserve to have the best chance possible of starting your new relationship, your new family off on the right foot in a loving, gentle, educated, and supported way.
You get one shot at this one birth. There are no do-overs.
How can you afford NOT have a doula?
This is Part 1 in a 3-part blog series about the cost of a doula. In Part 2, I will discuss a thorough breakdown of my fee and explain how I came that amount. In Part 3, I will discuss ways in which you can afford a doula for your birth.
Thank you for reading!
The birth world has been a buzz about the newly released consensus statement on preventing primary cesareans from ACOG (American College of Obstetricians and Gynecologists) this week. And rightfully so. This statement includes things that the scientific evidence has been supporting for some time now, but that have not been widely practiced by maternity care providers. Some of the new recommended guidelines in the Safe Prevention of Primary Cesarean Delivery statement, and what I believe are the biggest game changers include:
These new guidelines offer great hope for lower cesarean rates and safer births for both mother and baby. But, it will be a big challenge to change the culture surrounding birth and obstetrician's attitudes about labor management. History has shown us that once new guidelines have been posted, it takes anywhere from 10-20 years before they are widely practiced. I don't want to wait that long. I'm afraid to wait that long. Our cesarean rate has been increasing steadily. Our maternal mortality rate has doubled in the last 25 years. We are ranked very low among developed nations in infant mortality and morbidity, yet we spend an obscene amount of money on maternity care...the most in the world.
We need these changes to happen soon. How can maternity care consumers facilitate these changes?
Amber Piller - Professional Birth Doula and owner of Agape Birth Services. Serving Northwest Houston including Jersey Village, Cypress, Tomball, Spring, and Katy Texas.