C Jane - unassisted homebirth - thoughts?

[ladypuglover]

I wanted a home birth with my first one but was already black listed to perinatalogy. I wanted the warm, fuzzy birth but reality is/was that without doctors I could never make it past the first 6 weeks let alone a whole pregnancy on my own. Back in the "good old days" I would have had more miscarriages under my belt than I do now or had died from one long before I ever had a live birth. I in plain speaking would have bled to death before I would have even known I was pregnant. So hospitals and heavy pre-natal were my only options. Did I want it, no. It isn't fun going to see the doctor several times a week when you have other kids and a home and chores... But I did it as my only goal was to have a happy outcome of a living and healthy mother and baby, in that order. Cruel? Maybe but I had living children who needed me more than another brother and the only way to give them both was to follow my doctor's rules as law.

Childbirth sucks but yes, it is worth it. Nursing sucks (lol) but we did it for as long as baby didn't draw blood with new teeth. Hell every part of childrearing sucks from the moment the stick shows a plus sign but again it is worth it. Talk to others that have been there and got the tee-shirt and always ask for help if it is offered. Raising kids isn't a contest or a race but survival of the fittest. ;) Just kidding, but really there really isn't a right or wrong way because what is wrong for her might be the very best thing for you. The point of it all is to get everyone one out alive at the end of the day.

[Mokek Kwe]

I don't think the problem is just her having UC (unassisted childbirth), for me it's the possibly icky things that go along with her motives, display mode, etc.

I think UC is okay, but only for the right person. Just like I think doctors are right...but only for the right person.

[Cran]

No children here and certainly not planning any, but as I know my nipples are sensitive (Heck, why else do they play an important role during you know what for many women?!) I am not surprised that someone suckling on it with no thought for my own comfort several times a day would need some time to get used to.

[jenny_islander]

Part of the problem for Westerners is that our nipples are extremely sensitive. Going topless as much as possible helps with BFing pain because being out in the air toughens the nipples. This is not a sure-fire preventive, of course. IME, pure liquid lanolin dripped onto sore nipples and followed by gently putting on a soft cotton bra will make beginning breastfeeding pain go away and the lanolin will not be needed after a few weeks at most. If pain persists, of course, see a doctor. And hope it isn't one of those "Oh, you're a woman and you're having pain? Pfff, must be a character issue" jerks. (Five and a half months with thrush?!)

[Funky Chicken]

The biggest advances in medicine that increase the survival rate for women and children during birth are; improved nutrition, handwashing and overall better maternal health. The practice of obstetrics did not make advances in birth outcomes through any sort technological achievement of medicine. Of all the medical fields, it's actually one of the least evidence-based practices. Routine procedures in L&D have less to do with better outcomes than protecting the doctor and hopital, giving at least the appearance that they act in the best interest of the baby (they really don't give a hoot about mothers, *physically*, I'm not talking about lovely birth experience here, she can be hacked to pieces and held together with catgut as long as her heart beats and the child lives she should be greatful @@).

Three procedures specifically have been found to not only NOT improve outcomes but actually increase maternal morbidity (injury); continuous fetal monitoring, manditory IVs and misoprostol as a labour inducing drug. Continous fetal monitoring and manditory IVs only increase the number of c/s, bringing us to the all time high of, what is it now? 35%? Ridiculous. Misoprostol is a medication for stomach ulcers used off label, it's cheaper than the prostaglandins it's replaced. It works great to contract the uterus, wonderful for missed miscarriages, abortions and postpartum hemmorage. For a uterus full of baby at term, it can actually cause over-stimulation and rupture. In healthy non-scarred uteri. Often OBs are saving the day and rescuing babies from problem they themselves caused, looking like heros all the while.

Having said all of that, I'm a huge proponent for assisted homebirth. What makes homebirth so safe is the midwife, it's her training and experience that backs the decision to transfer. The hospital is always there, if necessary, "call to cut" times are actually very similar for emergent c/s from home or in hospital, given the home is within a ~20 minute radius. Midwives are the key. UC is not the same, at all.

Would you care to provide some evidence-based studies for all that you state, please? Also, I don't know in what universe they use misoprostol to initiate labour (or even in terminations or "hemmorage"[sic]), because they sure don't in the hospitals I have worked and studied in (I am a doctor, BTW).

Also, you later, in another post,stated that things don't go wrong in "seconds". Please back that up - specifically with reference to: umbilical cord prolapse, shoulder dystocia, hypoxia in twin delivery/other obstructed delivery (I can provide a copy of a lovely coroner's report of a midwife-attended home birth that went wrong), and the biggie, placenta praevia.

Also, in relation to this CJane person who "felt fine" so never had any more antenatal care, I wonder what would have happened if her baby had been born with the consequences of gestational diabetes, or intrauterine growth retardation, etc, etc, etc? Wonderful role model, I don't think...

[browncoatslytherin]

Yet if you listen to the MDC crowd, you might believe that every single pregnant woman who steps foot in a hospital is tied down, has her water broken and Pitocin administered, is forcibly given an epidural and then gets whisked off for an "unnecessarean" so the doctor can make his tee time, after which her baby is given formula behind the mother's back. While I have no doubt that unwanted interventions sometimes do happen, I think that the overwhelming majority of doctors/nurses/hospitals don't operate like that.

THANK YOU.

lily, just because you go to a hospital doesn't mean you have to have pain meds and all these interventions. i've read quite a few birth stories that took place in a hospital that was completely natural with very, very little interventions.

if you have a doctor that tries to force something on you that is unnecessary - no matter what it is, birth-related or otherwise - then you need to get another doctor.

[eohiken]

Major study showing planned attended home birth as a *safe* alternative to hospital birth for low risk (normal) pregnancies. Mortality same, interventions and morbidity much lower.

http://www.bmj.com/content/330/7505/1416.full

Misoprostol 'safe' for cervical ripening

http://www.medscape.com/viewarticle/410624

A meta-analysis of misoprostol for cervical ripening

"Uterine hyperstimulation with fetal heart rate changes and meconium-stained amniotic fluid were more common with misoprostol. [vs other protaglandins]"

http://apps.who.int/rhl/pregnancy_child ... index.html

Misoprostol causing uterine rupture

This is a Midwifery Today article, but the methodology looks pretty tight. All the other peer reviewed studies looking at misoprostol and rupture admit tothe correlation, but don't go into as much detail.

http://www.birthmarket.com/articles/cytotecwagner71.asp

Contiuous fetal monitoring versus intermittent

"Universal monitoring was associated with a small but significant increase in the incidence of delivery by cesarean section because of fetal distress, but perinatal outcomes as assessed by intrapartum stillbirths, low Apgar scores, a need for assisted ventilation of the newborn, admission to the intensive care nursery, or neonatal seizures were not significantly different."

Continuous fetal monitoring is often vilified for limiting locomotion and reducing ability to deal with labour without drugs. Why use it if it doesn't help?

http://www.nejm.org/doi/full/10.1056/NE ... 9043151004

Evidenced based maternity care

see the section on overused and underused interventions

http://www.milbank.org/reports/0809Mate ... yCare.html

Cord prolapse; midwives do not routinely rupture membranes, and certainly won't at all unless baby is low and well engaged, this reduces the frequency of spontanious cord prolapse to minimal. Still, midwives have been known to hold back heads in back seat of cars on the way to the hospital. There's a good telling of this in Peggy Vincent's book mentioned upthread.

Twin hypoxia; twin birth is not considered low risk and is much more highly monitored. Only a small number of unlicensed lay midwives will attend a known twin birth at home, but then they don't adhere to a standard of practice or monitoring by peer group. IOW, this is not a safe practice.

Placental Praevia; Most midwives I know fell much better attending about home births when at least one u/s has been done to determine placental location. They don't require it, though. Any amount of bright red bleeding during labour is a call to transfer.

C/S; "The World Health Organization recommends that the caesarean section rate should not be higher than 10% to 15%." This is the level that maximizes maternal and fetal outcomes with the least amount of disadvantages to maternal health and continued childbearing.

I've used up all my interwebs time for this morning getting this monster compiled, and I still couldn't find the c/s article I was looking for. Anyhoo,I hope that this shows that routine hospital interventions can and do cause more problems than they are worth, and that low-intervention and midwife attended births are a safe and sane practice, not solely justified by the fluffy butterfly happiness of mothering.com. Many doctors are consummate professionals, treating their patients with care, respect and dignity. Some don't. The use of medical intervention has its function when problems in childbirth happen. More is not better, however, in this case.

[treemom]

[quote="eohiken"

I've used up all my interwebs time for this morning getting this monster compiled, and I still couldn't find the c/s article I was looking for. Anyhoo,I hope that this shows that routine hospital interventions can and do cause more problems than they are worth, and that low-intervention and midwife attended births are a safe and sane practice, not solely justified by the fluffy butterfly happiness of mothering.com. Many doctors are consummate professionals, treating their patients with care, respect and dignity. Some don't. The use of medical intervention has its function when problems in childbirth happen. More is not better, however, in this case.

[eohiken]

Honestly, I wouldn't care about people with low risk pregnancies choosing hospital births if doctors didn't routinely induce/augment labours (without good reason) and have policies (like continuous fetal monitoring) that reduces locomotion and coping techniques. There isn't inherently anything wrong with giving birth in hospital, but current culture and policies make it more risky than it needs to be.

If the barriers to homebirth and midwifery care were removed, and women had greater access to them, I don't think we'd be seeing an interest in UC.

[figgypudding]

So glad y'all are discussing this here, because I read Courtney's post and thought my head would explode. I think she's completely irresponsible not only for doing UC (especially with no prenatal care), but for presenting it as this easy, ethereal, fulfilling experience, because you know there are people who are naive enough to try UC just because C. Jane said it was a good idea. The irony that Courtney seems to miss is that her story is proof that every birth is different, and you really don't know what's going to happen until it happens...and if a life-threatening complication is what happens, the laboring woman and her hero husband are going to be up the proverbial creek.

And FWIW in re: the hospital vs. homebirth debate, I had two deliveries in hospital with absolutely no interventions (no IV, no monitoring beyond the initial reading when we checked in, freedom to labor and deliver however and wherever I wanted) and no pain medications. There's some fearmongering that goes on among proponents of natural birth, but in many hospitals you can have a completely natural experience if you want one.

[browncoatslytherin]

Honestly, I wouldn't care about people with low risk pregnancies choosing hospital births if doctors didn't routinely induce/augment labours (without good reason) and have policies (like continuous fetal monitoring) that reduces locomotion and coping techniques.

the thing is, the doctor can't do any of that without the mother's permission. you might not mean that the docs just do what they want and the mother gets no say in the matter, but that's the way it read to me and i wanted to clarify that.

[Wolfie]

Eohiken, have you had a hospital birth?

[desertvixen]

I am not surprised that someone suckling on it with no thought for my own comfort several times a day would need some time to get used to.

Well, they're not suckling on it in exactly the same manner - ideally, they've got the whole nipple back in their mouth and are actually pressing their jaws against your breast tissue to get the milk out. Most of the breast irritation seems to come from the wetness that can accompany breastfeeding (moisture in the kid's mouth, if they get a thrush infection and give it to you, etc). After you get a good latch-on routine going, breastfeeding itself shouldn't be too uncomfortable unless you've got an issue like cracked nipples, abscess, thrush, mastitis, etc.

Then yes, it can really really suck.

[antifundie]

Can I just say I really appreciate the truthfulness about birth here? I don't have kids (want them)--and it's nice to hear something other than "You can have Orgasms!"I mean, not having been through it, it's nice to know how bad it can be--I like to know the worst, because then I might have a shot at knowing what I'm in for when the time comes.

And breastfeeding is painful??? OMG. I didn't know that. Ugh.

[ilovetchotchkes]

Can I just say I really appreciate the truthfulness about birth here? I don't have kids (want them)--and it's nice to hear something other than "You can have Orgasms!"I mean, not having been through it, it's nice to know how bad it can be--I like to know the worst, because then I might have a shot at knowing what I'm in for when the time comes.

And breastfeeding is painful??? OMG. I didn't know that. Ugh.

I think the "orgasmic birtH" is the biggest lie on the face of the Earth. Unless its you telling me directly, the "it happened to a friend of a friend" I think is BULLSHIT.

Once breastfeeding is going well, it should NOT be painful, but in the beginning, there's a learning curve and some definite soreness. After our initial 2 1/2 weeks of ZOMG OW, relatively pain free. (until he bit me when his teeth were coming in). Now that I'm pregnant again, its another kettle of fish, but we're taking it a day, well one nursing session at a time.

[Austin]

Can I just say I really appreciate the truthfulness about birth here? I don't have kids (want them)--and it's nice to hear something other than "You can have Orgasms!"I mean, not having been through it, it's nice to know how bad it can be--I like to know the worst, because then I might have a shot at knowing what I'm in for when the time comes.

And breastfeeding is painful??? OMG. I didn't know that. Ugh.

I breastfed all of mine and never experienced any nipple pain or any nipple problems at all. So hope is definitely in order on that front.

I did become incredibly engorged to the point where I felt like there were two boulders on my chest. A newborn has a hard time latching on to an hard, engorged breast, so I had to pump some of the milk off in order to nurse. Only problem with that is that the body is all about supply & demand (assuming no issues), so the body will produce the amount of milk pumped off plus the amount the baby took in nursing and fill 'em up again and I'd quickly be back at square one. This issue tends to straighten itself out in a few days as you learn how not to pump too much off so as not to overstimulate production, but still keep production high. Finding the right balance is just trial and error and it works out.

Personal story alert: with the twins, I was hugely engorged. I mean, the "girlz" were right under my chin and as hard as rocks. We had a hand-operated pump and I pumped what I could off of one breast, but I was just so exhausted from the entire twin ordeal. My husband offered to pump off the excess on the other breast and I readily agreed. So I laid back and he started carefully pumping in his usual goal-oriented style and after a minute the hilarity of the situation overcame us. I mean, I did not imagine when dating and falling in love that someday this man was going to be milking me, ffs. Apparently, he had not imagined such a scenario, either and when I started laughing, he started laughing and neither of us could stop. And then I started gasping "moo. . . moo" making us laugh even harder. :lol:

Yeah, it was very romantic :D We still talk about it every now and then. Ah, the beauty of love.

[treemom]

Honestly, I wouldn't care about people with low risk pregnancies choosing hospital births if doctors didn't routinely induce/augment labours (without good reason) and have policies (like continuous fetal monitoring) that reduces locomotion and coping techniques. There isn't inherently anything wrong with giving birth in hospital, but current culture and policies make it more risky than it needs to be.

If the barriers to homebirth and midwifery care were removed, and women had greater access to them, I don't think we'd be seeing an interest in UC.

Oh I think you are wrong about that.

[emmiedahl]

My unassisted homebirthing friends do it because they feel it is this moment of supreme female power and that they don't need anyone there to spoil the moment. So, no, I don't think they would do it if midwives were more available. There *are* homebirthing midwives in my area, and one of the unassisted homebirthers calls a midwife after the baby is born to clean up the mess.

[treemom]

So glad y'all are discussing this here, because I read Courtney's post and thought my head would explode. I think she's completely irresponsible not only for doing UC (especially with no prenatal care), but for presenting it as this easy, ethereal, fulfilling experience, because you know there are people who are naive enough to try UC just because C. Jane said it was a good idea. The irony that Courtney seems to miss is that her story is proof that every birth is different, and you really don't know what's going to happen until it happens...and if a life-threatening complication is what happens, the laboring woman and her hero husband are going to be up the proverbial creek.

And FWIW in re: the hospital vs. homebirth debate, I had two deliveries in hospital with absolutely no interventions (no IV, no monitoring beyond the initial reading when we checked in, freedom to labor and deliver however and wherever I wanted) and no pain medications. There's some fearmongering that goes on among proponents of natural birth, but in many hospitals you can have a completely natural experience if you want one.

Yeah that is the thing. I had interventions...and with my son I actually had a double dead baby history but I it was never a pendulum swinging over my head and I was explained the benefits and risks of the interventions and consented (to some, not others)

[Cran]

I think UC will always attract the crazies, all-natural-I-want-my-birth-experience-for-me types, and not a hundred thousand midwives next door will change that. Bet C Jane could have found a midwife if she wanted to, but she just didn't want.

For example: In Germany, you can birth with a midwife at home or in a birth center and have your prenatal care there, too, covered by health insurance. It has gotten more difficult in the last years, because insurance rates went up and many midwives are struggling to stay in business, but the possibility is there. And our homebirth rates are low, most women have hospital births.

[Clementine]

Personal story alert: with the twins, I was hugely engorged. I mean, the "girlz" were right under my chin and as hard as rocks. We had a hand-operated pump and I pumped what I could off of one breast, but I was just so exhausted from the entire twin ordeal. My husband offered to pump off the excess on the other breast and I readily agreed. So I laid back and he started carefully pumping in his usual goal-oriented style and after a minute the hilarity of the situation overcame us. I mean, I did not imagine when dating and falling in love that someday this man was going to be milking me, ffs. Apparently, he had not imagined such a scenario, either and when I started laughing, he started laughing and neither of us could stop. And then I started gasping "moo. . . moo" making us laugh even harder. :lol:

Yeah, it was very romantic :D We still talk about it every now and then. Ah, the beauty of love.

:lol: :lol: :lol:

[desertvixen]

A newborn has a hard time latching on to an hard, engorged breast, so I had to pump some of the milk off in order to nurse.

I had this problem at first. God bless the lactation consultant at my hospital. (And then we took pictures so I have references for next time...)

It's also cool how your body can adjust the supply - I stopped pumping shortly after I went back to work because it was making me miserable - and I was able to nurse evenings/weekends without having to pump during the day. That was pretty neat (and handy).

[desertvixen]

Austin, your story reminds me of the line from Yours, Mine, and Ours - "It isn't going to a bed with a man that proves you're in love with him; it's getting up in the morning and facing the drab, miserable, wonderful everyday world with him that counts."

[contrary]

i didn't have any trouble nursing either...with the first, it took me awhile to understand what a proper latch should feel like, so she pulled up some doozy owies the first day, while we were trying to get her properly latched, but once we got it right and i knew how it was SUPPOSED to feel, we were clear sailing.

I was worried about it because i have very sensitive nips...like, i shudder sometimes at the thought of them even being touched during certain times of the month. but it's true: nursing is a completely different sensation than you're expecting until you've nursed. it's not the same sort of physical sensation at all.

eta: regarding your body and adjustments in supply....it is remarkable, isn't it? it blows me away sometimes, what the body can do.

my second baby would only nurse on one side, and she would not take a bottle. this body did it...totally fed that baby with one boobie. i looked hilariously lopsided, but i did it!

[Austin]

Austin, your story reminds me of the line from Yours, Mine, and Ours - "It isn't going to a bed with a man that proves you're in love with him; it's getting up in the morning and facing the drab, miserable, wonderful everyday world with him that counts."

Trufax. It was a wonderful, exhausting, magical summer.