How much worse can they make themselves look?

The AMA is really making themselves look pretty bad here. Open mouth and insert foot. They've joined ACOG's movement with recent resolutions (Resolutions 204 and 205) both to completely BAN all homebirths AND births in freestanding birth centers and criminalize mothers who choose to continue doing this, plus they are going after the entire midwifery model of maternity care by suggesting all non-nurse midwives be OUTLAWED, and nurse midwives come under even greater levels of OB control. Um, what? And, to make it even better, these resolutions are made with absolutely no medical basis. They don't mention a single study, a single statistic, or even a promise that this would be good for mothers and babies. Nope. Their resolutions read more like, "I'm scared for my job and Ricki Lake has made this powerful movie that makes us look really bad so now we better just throw everyone in jail and make it a law that all pregnant women must pay us directly...no other options."

Reaction in the normal birth world is mixed. Some are scared, just because it does suggest there will be a fight ahead and the AMA is waaaaay more powerful than any midwife group (the AMA controls the entire insurance industry, for example). Others think this is good publicity for midwifery and for homebirths. Because their statements are sooo outrageous and have no medical basis, they do seem rather ridiculous. Kinda like shooting guns with no bullets. I have a difficult time seeing how this could ever become a real law...given there is NO medical research supporting the AMA and ACOG's statements (quite the opposite actually).

Well, I'll tell you how much this has changed my mind. I had a very nice talk with my HOMEBIRTH-ONLY, NON-NURSE MIDWIFE yesterday. I'll be seeing her apprentice as my primary midwife, so not only is she NOT a nurse, she isn't even certified OR licensed. HA! And thankfully, my right to do this is completely protected by the fabulous state of Oregon.

PA Court tells State Medical Board to shove it

Big news in the midwifery world on Friday. I know lots of people across the country were tuned in to hear the outcome of this one. Thankfully, the humans came to their senses and an innocent midwife pervailed!

Diane Goslin has been a practicing midwife for like 25 years, and she's attended over 3,000 births. In that time, she has received one (ONE!) complaint against her - and it wasn't even by a parent or family she was serving. It was by a coroner, who examined an infant's body from a birth she had attended. You see, the coroner found the infant's death had nothing to do with the birth or the midwife, but he didn't like that the midwife had attended the birth at all so he complained to the PA Medical Board. What a kind fellow.

So Diane was ordered to cease and desist her midwifery practice and was brought up on numerous charges, including practicing medicine without a license, and given $11,000 in fines. Diane is a Certified Professional Midwife (CPM), an internationally-recognized certification for midwives. But silly Pennsylvania doesn't recognize them and therefore won't give them licenses of any kind. There were a bunch of rulings, and it looked like homebirth midwifery was about to be shutdown in Pennsylvania. But Diane fought hard, and she had thousands of supporters along the way. Save Homebirth joined the fight. The Amish and Mennonite (Diane's primary customers) came out in full force to support her. You can see some amazing pictures here.

Well, it all worked. Diane won. The court decided that practicing midwifery was not the same as practicing medicine, and therefore Diane wasn't guilty of practicing medicine without a license. AND, the court gave the PA Medical Board a slap on the wrist for trying to claim she was practicing as a nurse-midwife, because the Board is only allowed to police women who are trying to do this, and at no time did Diane advertise or call herself a CNM. PLUS, the court decided Diane was denied due process in these charges. Wow. You can read the final ruling here.

This is amazing news for all supporters of midwifery and homebirth. Midwifery is not "practicing medicine" and it should never be judged as such. Midwives should never be prevented from practicing because of misunderstandings about what they do. If states are afraid of midwifery (and that is what it comes down to here - FEAR), they need to take the time to learn what a midwife does and what a midwife doesn't do. If they would open their minds just a little, they would realize that supporting midwifery (and specifically homebirth midwifery) is not only cheaper, but better for the health of mother and baby.

Man, I'm so glad Pennsylvania saw the light. And now onto the local fight - whether or not Oregon will begin mandatory licensure for all practicing midwives (it is currently optional). OMC (Oregon Midwifery Council) is debating how to coordinate a unified front and what they should be arguing for. More to come...

She was meant to be a midwife

SageFemme is definitely in the right profession. Kudos to her for handling a 13 MINUTE shoulder dystocia of a nearly 13 lb baby girl. At home. With no broken bones. And full resuscitation. Oh. My. God.

Baby girl is doing well.

SafeFemme is also an amazing photographer of the births she attends, and has created this gorgeous montage of some of her homebirths. Beware - not for office viewing.

A great response to ACOG's stupidity

This is an awesome, honest, and accurate response to ACOG's statement on homebirths.

I couldn't have said it better. And I agree whole-heartedly with her point that ACOG's statement was defensive, insulting, and paternalistic.

Citizens for Midwivery offers facts as talking points

This is a really nice collection of talking points (in no particular order) from Citizens for Midwifery (CfM):

• Twenty-four states license direct entry midwives, several for more than twenty years. Twenty-two use or recognize the Certified Professional Midwife (CPM) credential administered by the North American Registry of Midwives (NARM) as the basis for licensing, and two states have voluntary licensing. In all theseyears, no state has repealed their midwifery law for any reason. Furthermore, in 9 states licensed midwives receive Medicaid reimbursement for their services. These records demonstrate that CPMs do not pose any threat to the health and safety of pregnant women and newborns.
  
• An economic analysis of the cost benefits of a licensed midwife program (Washington State) indicate that the cost savings to the health care system (public and private) is estimated to be ten times the cost of the program, even with this licensing program being the most expensive in the country. (Midwifery Licensure and Discipline Program in Washington State: Economic Costs and Benefits, (A report to the Washington Department of Health), Health Management Associates, October, 2007)
  
• Contrary to ACOG’s uninformed assertion, many rigorous scientific studies, published in leading medical journals, have found that for a healthy woman having a normal pregnancy, a planned, midwife-attended home birth is as safe as a hospital birth and with far lower rates of medical interventions. The most recent is also the largest study, based on prospective reporting for all the births attended by Certified Professional Midwives in 2000, published in 2005 in the British Medical Journal . ("Outcomes of planned home births with certified professional midwives: large prospective study in North America." Kenneth C Johnson, senior epidemiologist, Betty-Anne Daviss, project manager. BMJ 2005;330:1416 (18 June). Also see CfM’s summary fact sheet.
  
• About 99% of births in the US take place in hospitals. If standard obstetric practice is so good, why does the US rank so abysmally when it comes to maternal mortality and neonatal mortality?
  
• The Complete Mothers’ Index 2007 shows that mothers in the US have a higher lifetime risk of maternal mortality than the mothers in 27 other developed countries.
  
• The World Health Report (from the World Health Organization) indicates that the neonatal death rate (death in the first 28 days of life) is greater in the United States than in 35 other countries.
  
• ACOG claims that "complications can arise with little or no warning even among women with low-risk pregnancies". However, complications seen in low-risk women laboring in hospitals are often related to the many routine practices and interventions that disturb the birth process and cause or lead to complications and more interventions. In fact, most of these practices were adopted without being studied for safety, and many are still routine even after being studied and found to be either worthless or harmful or both. (Enkin et al. A Guide to Effective Care in Pregnancy and Childbirth) Midwives attending home births avoid unnecessary interventions and the use of drugs, allowing normal birth to proceed. They are trained and experienced in noticing any signs of problems and taking appropriate action, including transfer to medical care in a hospital when necessary, which is rarely. (see the BMJ article cited above)
  
• The press release states "ACOG acknowledges a woman’s right to make informed decisions regarding her delivery…" but goes on to say that ACOG does not support any of the alternatives to a doctor-controlled birth in hospital or birth center, or anyone who provide or supports home birth. So how is ACOG supporting informed decisions?
  
• ACOG claims that an "emerging contributor" to the rise in cesarean section rates is "maternal choice." However, there is no evidence for this claim. In fact, recent surveys of mothers found that less than 0.08% of pregnant women request a C-section. Applying these numbers to a recent figure for annual births, a scant 2,600 out of 4.1 million pregnant women actually requested a C-section. (Declercq ER, Sakala C, Corry MP, Applebaum S. Listening to Mothers II: Report of the Second National U.S. Survey of Women’s Childbearing Experiences. New York: Childbirth Connection, October 2006.) Clearly, this number is so small it could not possibly explain the doubling of cesarean section rates in the last decade. Furthermore, when he was President of ACOG, Benjamin Harer publicly promoted maternal choice cesarean sections on popular TV news and talk shows, for reasons for which there was not evidence. (for example: Benjamin Harer on Good Morning America, 2000. Having actively worked to create a market for cesarean sections for no medical reason, based on lies and misinformation, ACOG is now blaming women for the increased cesarean rate??
  
• When attending births outside the hospital, both Certified Nurse Midwives and Certified Professional Midwives referred fewer than 5% of mothers for cesarean sections, while obstetricians were performing cesarean sections on nearly 20% of low risk mothers in hospitals. (see CfM fact sheet with references)
  
• Some women are going to choose to deliver their baby at home, for a variety of very legitimate religious, social, health or economic reasons. These women deserve to have the best care available the care of a well-trained midwife with experience in out-of-hospital settings. (Firefly Mama thinks this is the most important point!)
  
• While ACOG states that childbirth is a normal physiologic process, today’s obstetrical profession performs cesarean sections for nearly one third of births, induces labor in nearly half of births, and administers drugs of one kind or another to more than two thirds drugs that pass through the placenta and harm the baby. In fact, almost the only women who give birth with no interventions are those who give birth at home. (Listening to Mothers: Report of the First National U.S. Survey of Women’s Childbearing Experiences. New York: Maternity Center Association, October 2002.)
  
• Apparently obstetricians are not trained to support normal birth, but oppose the very health care providers who are: midwives who are trained and experienced in attending births outside the hospital. The Certified Professional Midwife credential is the only maternity are credential that requires experience in out-of- hospital settings.

Childbirth Connection addresses ACOG's policy

From Childbirth Connection:

ACOG Place of Birth Policies Limit Women's Choices Without Justification and Contrary to the Evidence

In October 2006, the American College of Obstetricians and Gynecologists (ACOG) released a Statement of Policy on "Out-of-Hospital Births in the United States." Following feedback from ACOG members and from Childbirth Connection and many other concerned organizations, ACOG issued a revised Statement of Policy on "Home Births in the United States" in May 2007. This Alert and Response describes Childbirth Connection's concerns with the statements and their implications for mothers and babies.

What place of birth policy did ACOG set in "Out-of-Hospital Births in the United States" (October 2006)?
The earlier statement asserted that "studies comparing the safety and outcome of U.S. births in the hospital with those occurring in other settings are limited and have not been scientifically rigorous." ACOG also claimed that the hospital "is the safest setting for labor, delivery, and the immediate postpartum period." Consequently, it concluded, ACOG "strongly opposes out-of-hospital births" and "does not support programs or individuals that advocate for or who provide out-of-hospital births." However, the statement failed to cite any evidence to support the assertions and failed to acknowledge impressive existing evidence regarding the safety of planned home birth and out-of-hospital birth center birth.

What place of birth policy did ACOG set in its revised statement, "Home Births in the United States" (May 2007)?
The revised statement was identical to the previous statement with the exception of limiting the focus to home births rather than to all out-of-hospital births and acknowledging the safety of birth in out-of-hospital birth centers that meet standards of relevant accreditation organizations. The revised statement concluded by stating that "ACOG strongly opposes home births" and "does not support programs or individuals that advocate for or who provide home births." Again, no study was cited to support this position, and existing research in support of planned home birth was overlooked.

What was the response to the earlier statement?
Some ACOG members objected to the policy, and numerous organizations submitted letters of concern and posted the letters online. These included American Association of Birth Centers, American College of Nurse-Midwives, Consumers United for Evidence-based Healthcare, Lamaze International, and White Ribbon Alliance for Safe Motherhood. In addition, Childbirth Connection and other consumer advocacy organizations together sent a letter identifying special concerns from a consumer perspective. Joining together with Childbirth Connection were Center for Medical Consumers; National Partnership for Women and Families; National Women's Health Network; and Our Bodies, Ourselves, as well as the Executive Director of Families U.S.A. signing as an individual. In general, the letters asked ACOG leaders to review the policy in light of the plethora of high-quality scientific evidence supporting the safety of planned out-of-hospital birth.

What were the major concerns of the consumer groups?
The joint letter from organizations writing from the perspective of best interests of mothers and babies expressed several concerns. First, the groups were troubled that the policy would undermine women's choices and legal right to informed consent about where to give birth and noted that ACOG's own document, Ethics in Obstetrics and Gynecology (2004), strongly supports women's right to informed consent.

Moreover, the groups were troubled by the complete lack of evidence to support the statement's assertions and its failure to acknowledge impressive existing evidence. With respect to home birth, they noted a large prospective study of 5,418 American women planning home births with Certified Professional Midwives (Johnson and Daviss 2005), and a systematic review of home birth (Olsen 1997). With respect to birth in out-of-hospital birth centers, they pointed to the large prospective National Birth Center Study of 11,814 mothers who began labor in out-of-hospital birth centers (Rooks et al. 1989) and a systematic review of care in out-of-hospital birth centers (Walsh and Downe 2004). Notably, both of the large studies achieved 4% c-section rates whereas about one mother in three now gives birth by major surgery in the United States. All four studies found very low rates of many widely used obstetric interventions and no sign that the settings or conservative use of obstetrical procedures involved extra risk when out-of-hospital births were compared with low-risk women giving birth in hospitals. The systematic reviews concluded that there is no a priori basis for denying planned out-of-hospital birth. The large prospective studies were published in the most prestigious general medical journals, New England Journal of Medicine and BMJ.

The letter from the consumer groups also pointed out that in rejecting the strong available evidence ACOG displayed a double standard. The letter referenced an analysis of ACOG's recent obstetric practice recommendations that found that just 23% are Level A, that is, "based on good and consistent scientific evidence," whereas 35% are Level B -- "based on limited or inconsistent scientific evidence," and fully 43% are Level C, "based primarily on consensus and expert opinion" (Chauhan et al. 2005). In evidence-based medicine, expert opinion when not backed by sound research is the lowest and least reliable level of evidence (Oxford University 2001). Despite the weak scientific evidence for over three-quarters of ACOG’s professional practice recommendations, some obstetricians feel that they are vulnerable to malpractice claims and suits if they deviate from ACOG policies, and recent research supports this (Ransom et al. 2003). Finally, the letter to ACOG from the consumer groups pointed out that the policy endangers the health and well being of mothers and babies in two ways. First, in opposing those who support out-of-hospital birth, ACOG could jeopardize appropriate physician back-up for the considerable number of women who will continue to choose out-of-hospital births. All health professionals need to be able to call on other health professionals for specialized services that are beyond their expertise and scope of practice. Obstruction of such professional collaboration jeopardizes the welfare of mothers and babies and is of grave concern. Second, in taking the position that all women should give birth in hospitals, the statement would consign low-risk women to the high rates of invasive procedures and other interventions that are now the norm in U.S. hospitals, as measured in Childbirth Connection’s Listening to Mothers II survey (Declercq et al. 2006).

Did the revised policy statement address concerns of the consumer groups?
The revised policy statement reflects the best available evidence about planned birth in out-of-hospital birth centers, but continues to reject home birth without justification and contrary to the best evidence. After describing results of the best available research and concern about typical maternity care in U.S. hospitals, the consumer groups wrote:

"These major [out-of-hospital] studies set a standard for what is attainable among healthy low-risk pregnant women in North America and raise troubling questions about current practice trends. Care in these settings should be emulated rather than denigrated."

Another available research review is consistent with the studies and systematic reviews cited above: Stotland and Declercq (2002).The current ACOG policy statement about place of birth continues to raise troubling questions about: current standards of maternity care in the United States, ACOG's disregard for best available evidence, and ACOG's infringement on rights of childbearing women.

References:

American College of Obstetricians and Gynecologists. Ethics in Obstetrics and Gynecology, 2nd ed. Washington, DC: ACOG, 2004.

American College of Obstetricians and Gynecologists Executive Board. ACOG Statement of Policy: Home births in the United States. Washington, DC: ACOG, May 2007.

American College of Obstetricians and Gynecologists Executive Board. ACOG Statement of Policy: Out-of-Hospital Births in the United States. Washington, DC: ACOG, October 2006.

Chauhan SP, Berghella V, Sanderson M, Magann EF, Morrison JC. American College of Obstetricians and Gynecologists practice bulletins: An overview. American Journal of Obstetrics and Gynecology 2006;194:1564-75.

Declercq ER, Sakala C, Corry MP, Applebaum S. Listening to Mothers II: Report of the Second National U.S. Survey of Women's Childbearing Experiences. New York: Childbirth Connection, October 2006.

Johnson KE, Daviss B-A. Outcomes of planned home births with Certified Professional Midwives: Large prospective study in North America. BMJ 2005;330:1416.

Olsen O. Meta-analysis of the safety of home birth. Birth 1997;24:4-16.Oxford University, Centre for Evidence-Based Medicine.

Oxford Centre for Evidence-Based Medicine levels of evidence, 2001. Available at http://www.cebm.net/index.aspx?o=1025 (accessed June 20, 2007).

Ransom SB, Studdert DM, Dombrowski MP, Mello MM, Brennan TA. Reduced medicolegal risk by compliance with obstetrical clinical pathways: A case-control study. Obstetrics & Gynecology 2003;101:751-5.

Rooks JP, Weatherby NL, Ernst EK, Stapleton S, Rosen D, Rosenfield A. Outcomes of care in birth centers: The National Birth Center Study. New England Journal of Medicine 1989;321(26):1804-11.

Stotland NE, Declercq ER. Safety of out-of-hospital birth in industrialized nations: A review. Current Problems in Obstetrics, Gynecology and Fertility 2002;25:134-44.

Walsh D, Downe SM. Outcomes of free-standing, midwife-led birth centers: A structured review. Birth 2004;31:222-9.

ICAN responds

ICAN’s Response to ACOG AND AABC Statements on VBAC and Homebirth
Redondo Beach, CA, February 7, 2008:

The International Cesarean Awareness Network would like to publicly condemn both the AABC (American Association of Birth Centers) and the ACOG (The American College of Obstetricians and Gynecologists) for their statements this week that limit not only women’s choices in birth but imply that birth is a fashion trend rather than a safety concern.

Since VBAC is the biological normal outcome of a pregnancy after cesarean, ICAN encourages women to get all of the facts about vaginal birth and elective repeat cesarean before making a choice. This decision should not include weighing the choices of your doctor’s malpractice payments but only be a concern of the mother, her baby and their health and safety.

Since some mothers will make the choice to give birth outside of the hospital, we encourage the AABC to not cave into ACOG’s demands that all women give birth in a hospital facility with a surgical specialist, but instead allow women to make their own choices about care providers, birth settings and risk factors. ICAN respects the intelligence of modern women and accepts that the amount of information available about VBAC and elective cesarean should serve as informed consent.

ICAN further encourages the governments of individual states to look closely at their cesarean rates (31.1% national cesarean rate as of 2006) and the informed consent laws that apply and help women to reach a standard of care that lowers the risks of major surgery and the risks of elective or coerced cesarean without medical indication. Women and children should not bear the brunt of malpractice risks being conveyed into physical, mental, emotional and spiritual health risks in order to protect their physicians.

Mission statement: ICAN is a nonprofit organization whose mission is to improve maternal-child health by preventing unnecessary cesareans through education, providing support for cesarean recovery and promoting vaginal birth after cesarean. There are more than 94 ICAN Chapters across North America, which hold educational and support meetings for people interested in cesarean prevention and recovery.

AABC statement

ACOG statement

Big Push for Midwives fights back

This is the first (of many, I'm sure) responses to ACOG's statement.


PushNews from The Big Push for Midwives Campaign
CONTACT: Steff Hedenkamp, (816) 506-4630, RedQuill@kc.rr.com
FOR IMMEDIATE RELEASE: Thursday, February 7, 2008

ACOG: Out of Touch with Needs of Childbearing Families

Trade Union claims out-of-hospital birth is “trendy;” tries to play the “bad mother” card

(February 7, 2008) — The American College of Obstetricians and Gynecologists (ACOG), a trade union representing the financial and professional interests of obstetricians, has issued the latest in a series of statements condemning families who choose home birth and calling on policy makers to deny them access to Certified Professional Midwives. CPMs are trained as experts in out-of-hospital delivery and as specialists in risk assessment and preventative care.

“It will certainly come as news to the Amish and other groups in this country who have long chosen home birth that they’re simply being ‘trendy’ or ‘fashionable,’” said Katie Prown, PhD, Campaign Manager of The Big Push for Midwives 2008. “The fact is, families deliver their babies at home for a variety of very valid reasons, either because they’re exercising their religious freedom, following their cultural traditions or because of financial need. These families deserve access to safe, quality and affordable maternity care, just like everyone else.”

Besides referring to home birth as a fashionable “trend” and a “cause célèbre” that families choose out of ignorance, ACOG’s latest statement adds insult to injury by claiming that women delivering outside of the hospital are bad mothers who value the childbirth “experience” over the safety of their babies.

“ACOG has it backwards,” said Steff Hedenkamp, Communications Coordinator of The Big Push and the mother of two children born at home. “I delivered my babies with a trained, skilled professional midwife because I wanted the safest out-of-hospital care possible. If every state were to follow ACOG’s recommendations and outlaw CPMs, families who choose home birth will be left with no care providers at all. I think we can all agree that this is an irresponsible policy that puts mothers and babies at risk.”

The Big Push for Midwives calls on ACOG to abandon these outdated policies and work with CPMs to reduce the cesarean rate and to take meaningful steps towards reducing racial and ethnic disparities in birth outcomes in all regions of the United States. CPMs play a critical role in both cesarean prevention and in the reduction of low-birth weight and pre-term births, the two most preventable causes of neonatal mortality.

Moreover, their training as specialists in out-of-hospital maternity care qualifies CPMs as essential firstresponders during disasters in which hospitals become inaccessible or unsafe for laboring mothers. In addition, CPMs work to ensure that all babies born outside of the hospital undergo state-mandated newborn screenings and are provided with legal and secure birth certificates.

Currently, Certified Nurse-Midwives, who work predominantly in hospital settings, are licensed and regulated in all 50 states, while Certified Professional Midwives, who work in out-of-hospital settings, are licensed and regulated in 24 states, with legislation pending in an additional 20 states.

The Big Push for Midwives (http://www.TheBigPushforMidwives.org) is a nationally coordinated campaign to advocate for regulation and licensure of Certified Professional Midwives (CPMs) in all 50 states, the District of Columbia and Puerto Rico, and to push back against the attempts of the American Medical Association Scope of Practice Partnership to deny American families access to legal midwifery care.

Media inquiries should be directed to Steff Hedenkamp (816) 506-4630, RedQuill@kc.rr.com.

ACOG declares war

The American College of Obstetricians and Gynecologists (ACOG) has declared war against all non-nurse midwives and homebirth. We've known their stance on the issue, but now it is public and in a press release. And, they've tossed in a number of lies to help make their point.

Deep down, I really do believe that someday they will be sorry they fought so hard for inferior care.

The full text of the press release:

ACOG NEWS RELEASE
For Release:
February 6, 2008
Contact:
ACOG Office of Communications
(202) 484-3321
communications@acog.org

ACOG Statement on Home Births

Washington, DC -- The American College of Obstetricians and Gynecologists (ACOG) reiterates its long-standing opposition to home births. While childbirth is a normal physiologic process that most women experience without problems, monitoring of both the woman and the fetus during labor and delivery in a hospital or accredited birthing center is essential because complications can arise with little or no warning even among women with low-risk pregnancies.

ACOG acknowledges a woman's right to make informed decisions regarding her delivery and to have a choice in choosing her health care provider, but ACOG does not support programs that advocate for, or individuals who provide, home births. Nor does ACOG support the provision of care by midwives who are not certified by the American College of Nurse-Midwives (ACNM) or the American Midwifery Certification Board (AMCB).

Childbirth decisions should not be dictated or influenced by what's fashionable, trendy, or the latest cause célèbre. Despite the rosy picture painted by home birth advocates, a seemingly normal labor and delivery can quickly become life-threatening for both the mother and baby. Attempting a vaginal birth after cesarean (VBAC) at home is especially dangerous because if the uterus ruptures during labor, both the mother and baby face an emergency situation with potentially catastrophic consequences, including death. Unless a woman is in a hospital, an accredited freestanding birthing center, or a birthing center within a hospital complex, with physicians ready to intervene quickly if necessary, she puts herself and her baby's health and life at unnecessary risk.

Advocates cite the high US cesarean rate as one justification for promoting home births. The cesarean delivery rate has concerned ACOG for the past several decades and ACOG remains committed to reducing it, but there is no scientific way to recommend an 'ideal' national cesarean rate as a target goal. In 2000, ACOG issued its Task Force Report Evaluation of Cesarean Delivery to assist physicians and institutions in assessing and reducing, if necessary, their cesarean delivery rates. Multiple factors are responsible for the current cesarean rate, but emerging contributors include maternal choice and the rising tide of high-risk pregnancies due to maternal age, overweight, obesity and diabetes.

The availability of an obstetrician-gynecologist to provide expertise and intervention in an emergency during labor and/or delivery may be life-saving for the mother or newborn and lower the likelihood of a bad outcome. ACOG believes that the safest setting for labor, delivery, and the immediate postpartum period is in the hospital, or a birthing center within a hospital complex, that meets the standards jointly outlined by the American Academy of Pediatrics (AAP) and ACOG, or in a freestanding birthing center that meets the standards of the Accreditation Association for Ambulatory Health Care, The Joint Commission, or the American Association of Birth Centers.

It should be emphasized that studies comparing the safety and outcome of births in hospitals with those occurring in other settings in the US are limited and have not been scientifically rigorous. Moreover, lay or other midwives attending to home births are unable to perform live-saving emergency cesarean deliveries and other surgical and medical procedures that would best safeguard the mother and child.

ACOG encourages all pregnant women to get prenatal care and to make a birth plan. The main goal should be a healthy and safe outcome for both mother and baby. Choosing to deliver a baby at home, however, is to place the process of giving birth over the goal of having a healthy baby. For women who choose a midwife to help deliver their baby, it is critical that they choose only ACNM-certified or AMCB-certified midwives that collaborate with a physician to deliver their baby in a hospital, hospital-based birthing center, or properly accredited freestanding birth center.

# # #

The American College of Obstetricians and Gynecologists is the national medical organization representing over 52,000 members who provide health care for women.

The Business of Being Born comes to Corvallis

Ricki Lake's wonderful film, The Business of Being Born, will be playing in Corvallis as part of V-week on Wednesday, February 13th from 4-6 pm on the OSU campus in the MU Main Lounge. There will be a panel Q&A afterwards with a homebirth midwife, a certified nurse midwife, an OB (hopefully), an RN, a birth doula, a postpartum doula, and a family doctor. Vagina Monologues goes on stage in LaSalles Stewart that night from 7-9, and again the next night (V-Day) too. There will be several other events that week as well. Sounds like it is going to great fun!

The Business of Being Born

I've been hearing about The Business of Being Born for a couple of months now. The buzz in the birth world about this film is really catching. Well lucky me...it looks like I'm going to get into an advance screening this coming Thursday. I CANNOT WAIT! The film is a documentary about maternity care in America, and how it is failing families as it falls lower and lower in the international ranks for birthing safety. Ricki Lake, former tv talk show host, is producer of the film and I hear the homebirth of her second child is in the movie. I'm just so excited about it. Look for a review here on my blog soon.

The Birth of Baby Boy M

The Birth of Baby Boy M

Wednesday, October 4th, 2006 at 9:00 pm

7 lbs 6 oz and 20.5 inches

Original due date: October 10th

2nd baby, home waterbirth

While having dinner with Mommy U, Daddy N, Sister E, my husband, and my daughter on Tuesday, October 3rd, I noticed Mommy U had “the look” – the look that meant the end was near. She was exactly 39 weeks pregnant and during her prenatal appointment with her midwife earlier that day, she learned she was 3 centimeters dilated, 30% effaced, and the baby was at -1 station. Mommy U’s belly appeared lower to me. She was waddling pretty badly too and had several painful Braxton-Hicks contractions while we were there. I just had a feeling…the action was going to start in a few hours. This seemed so natural that we would have dinner with them on the eve of their baby’s birth because on the eve of my daughter’s birth, we’d had pizza with them. They later told us that after that dinner, Daddy N mentioned to Mommy U that he thought I would have my baby that night and my labor did start just a few hours later.

At around 10:45 am on Wednesday, October 4th, Mommy U called me sounding very excited. She said she was having regular contractions around 10 minutes apart and that she believed she was in early labor. She indicated her contractions had really started at around 9 am, but that she felt some on-and-off throughout the night. Mommy U felt comfortable on her own for the time-being – Sister E (13 months) was down for a nap, so she could relax and see where things went. We decided she would call me back when she wanted me to come over. At this point, Mommy U gave Midwife C a heads-up as well, and called her husband (at work) and told him today was the day.

I took this time to go home (I was at school) and collect my bag and arrange the car-juggle so my husband could get home from work with our daughter. I returned to school and waited for Mommy U’s call. Just before noon, Mommy U called back and sounded a bit more serious. She said things were getting uncomfortable and that she didn’t want to be alone anymore. I told her I’d be over as soon as I could, and she told me not to rush.

I hopped in the car, went back to my house quickly because I forgot a few papers (and I STILL forgot the birth ball!), and headed towards work. This was the very first birth I would ever attend, and I was a little nervous. Keith (my husband) drove me over to her house and dropped me off and I ate lunch along the way. I arrived a little before 12:45 pm.

Mommy U looked relieved to see me. Sister E was still napping (hooray!) so Mommy U and I had the chance to relax together, get situated, and talk things over. I observed several contractions, and it was obvious they required her full attention. She was relaxing well through them in an extended child’s pose and found relief when I pressed on the center of her lower back. I got Mommy U set up with water and juice, and asked about what she’d eaten so far. She had a bowl of cereal and yogurt shortly before I arrived, so I felt comfortable that she was fed (for the moment). I also encouraged a bathroom visit shortly after I arrived.

Mommy U had been estimating when she said her contractions were 10 minutes apart, so after we were settled, I decided we should time a few. We tried a Movie for distraction, but it wasn’t long before Mommy U said she didn’t like the stimulation. We switched to some calming music. After timing contractions for a while, it was apparent they were about 5 minutes apart and 1 minute long. Mommy U couldn’t talk or walk during contractions, but she was still capable of smiling in between. She was also having mild shakes at times. I estimated she was moving into active labor, but wanted to keep watching for a bit. We tried contractions in standing positions and rear-facing in a chair. The chair worked well, so we stayed with that for a while. I also gave her a comb to grasp firmly in her hand, hitting accupressure points that are supposed to relief labor pains. This comb turned into a magic item that Mommy U clutched for the remainder of the birth.

A little before 2 pm, Sister E woke up so I attended to her briefly while Mommy U relaxed on her own. Sister E needed lunch, so I set her up with a bowl of pasta and returned to Mommy U. Daddy N arrived home at around this time, and began many of the house preparations for the birth. He also took over the care of Sister E. Mommy U continued to work with her contractions, sip water and juice, nibble on banana, and change positions. Shortly after 2 pm, I suggested we call Midwife C to give her an update. I made the call and informed her Mommy U’s contractions had been 5 minutes apart and 1 minute long for over an hour, and that they were requiring her absolute concentration and she could not talk through them. I also let her know they were varying a bit in intensity – some far worse than others. Midwife C indicated they would finish up the current appointment she and her assistant (Apprentice V) were at, they would cancel the remaining two appointments, and they would head our way.

At around 3:15 pm, Mommy U vomited. She vomited a lot, from one contraction straight into the next one. All our hard work with the water and food were now in the bucket! Daddy N and I both worked together to support her during this low point. Immediately afterwards, Mommy U was feeling a little better. Her contractions spaced out a bit more, stretching to about 6-8 minutes apart and as short as 30 seconds long. She was enjoying this break. A comfortable position at this point was kneeling and leaning on the couch because she could completely relax into the soft cushions. At times she almost appeared asleep in between…it was very peaceful. By 4:00 pm her contractions were intensifying again to around 4 minutes apart and about 1 minute long. Mommy U began to shake again. I felt at this point she was strongly in active labor.

Midwife C and Apprentice V arrived at around 4:45 pm just as Mommy U’s contractions hit 3 minutes apart and 60-90 seconds long. Mommy U was rear-facing on the toilet at the time, though she was no longer able to urinate. She was working very hard and required constant firm pressure on her back during every contraction. She was starting to moan softly and at some point whispered to me she didn’t think she could do this. I reassured her that she WAS doing it, that she was doing an excellent job, that she had made so much progress, and that she would be meeting her baby very soon. At this point, I felt she was nearing transition.

Daddy N assisted the midwives in setting up. Luckily, Sister E had been a doll and was content to play on her own for much of the afternoon. The midwives rearranged the kitchen, brought in the birth tub, set up equipment, moved things around, and began sterilizing their tools. At around 5:00 pm, Daddy N and I traded places for a while – I took over care of Sister E and he attended to Mommy U. I needed to call Keith and check in with him about our own daughter, and I desperately needed to grab a bite to eat. Sister E and I visited with each other, played for a while, and tried to stay out of the way. Of course, Sister E’s favorite place to play at the moment was the middle of the kitchen floor – not exactly out of the way! I downed some food and prepared to feed Sister E at the same time.

Shortly after we switched, Mommy U vomited very violently again. At 5:45 pm, Mommy U requested a vaginal exam (her first) from Midwife C. Midwife C had just finished telling her she could visibly tell she was in very active labor, and she thought she was at least 5 centimeters. I could see the disappointment on Mommy U’s face at this number, and I admit I thought she was farther along than that. We were all very excited to hear Mommy U was in fact 7.5 centimeters and 90% effaced! She was progressing very well! When asked if she wanted to get in the tub, she exclaimed, YES!

From here on out, I’m not aware of anyone timing Mommy U’s contractions anymore. We just watched her behavior to determine where she was. Mommy U climbed into the tub with Daddy N, Midwife C, and Apprentice V assisting. Daddy N was in the tub with her at times, providing strong physical and emotional support. I continued to care for Sister E while providing some verbal support when Sister E was calm enough for us to be in the room. By 6:30 pm, Sister E was ready for dinner and bed, so Daddy N and I switched roles again – he took over Sister E and I attended to Mommy U. Mommy U was listening to her body and changing positions in the tub frequently. I worked with Apprentice V, switching between being the front person (holding hands and arms, making eye contact, providing verbal support) and back person (applying back pressure). At approximately 7:00 pm, Mommy U said she wanted out of the tub. Apprentice V and I assisted her out, and I guided Mommy U very slowly through the house. In our walk, I was backwards, she was forwards, and she would collapse into me whenever a contraction hit. It was slow but steady progress towards the couch in the living area. Once nearly there, Mommy U suggested she should visit the bathroom again, so we turned around and headed that way.

Once finally in the bathroom, she took up her rear-facing position and things really seemed to get intense for her. Contractions were very close together with little break, and even the breaks appeared painful. Mommy U was also experiencing violent shakes at times. She needed constant touch, and very strong pressure on her back during contractions. Mommy U was really handling everything extremely well – she let each contraction take over and just flowed with it. Her strength was amazing, even when she began to have doubts. The midwives continued to check in and offer encouragement, but for the most part Daddy N and I were supporting her during this time. We continued (always!) to offer sips of energy drink and water. Mommy U never let go of her magic comb either.

After some time on the toilet, Mommy U was expressing self-doubt and Daddy N was giving her encouragement, and she began asking if she could push yet. I’m not sure of the time anymore, perhaps 7:45 pm? I went to Midwife C and Apprentice V with Mommy U’s status – violent shakes and a request to push. Midwife C said she felt Mommy U was getting very close, but she wanted her to breathe through a few more contractions on the toilet and wait for the NEED to push. She felt it would be soon. Midwife C also wanted to know where Mommy U wished to birth, but at this point Mommy U couldn’t really tell us, so they prepared the couch and the birth tub to the correct temperature.

By 8:15 pm (??), Mommy U got up from the toilet and noticed blood. Midwife C said it was a very good sign, and that it meant her cervix was making important changes. We helped Mommy U make her way back to the birth tub. In the tub, Mommy U continued to change positions as we all waited for to feel the urge to push. Daddy N and Midwife C accompanied Mommy U, while Apprentice V and I took a short break in the other room. After just a few minutes however, I could look to Mommy U and see in her eyes – she needed me. As I came back into the room, Daddy N (who was also in the tub) told me Mommy U was asking for my help. I took up position in front of her so I could hold her hands and arms, lock eyes with her, give her verbal encouragement, and be a firm rock. Mommy U was working for every second now. She clutched the comb, squeezing it in her hands, biting it, and running it through her hair in between contractions. It seemed to give her strength. After some time, she requested I switch to press on her back, so Daddy N took up position in the front.

Midwife C suggested Mommy U try a squatting position with the next contraction. She suggested it would move the baby down lower in her pelvis. For the next series of contractions, Daddy N pulled Mommy U up into the squat as I pushed from behind. Getting a good angle on Mommy U’s lower back was difficult with her in a squat, but it was still very important to her comfort so I kept it up. At one point, Midwife C tried to take Mommy U’s comb away so she could grab on to the side of the tub, but Mommy U whimpered and wouldn’t let it go. The comb had to stay! In between contractions, Mommy U would relax back against the side of the tub and I would run my fingers through her hair. She was doing such a fantastic job and we all knew she was soooo close! At one point, Midwife C suggested Mommy U reach down and feel the baby’s head. Mommy U could feel it, and it was very close, but she felt something was in the way. Midwife C decided to come in to check.

At 8:47 pm, Midwife C confirmed Mommy U was 10 centimeters, but that she had a lip of cervix still near the baby’s head. A cervical lip had held up Mommy U during the birth of her daughter, so this wasn’t great news for her. Midwife C suggested that after another contraction, she would try holding the cervix back to see if it would slip out of the way. We prepared Mommy U for a contraction where Midwife C would be able to reach. I was concerned this may hurt, but once the contraction began, Mommy U did not signal it was any worse than the others. Midwife C said the cervix just melted away from her fingers, and just as that happened, Mommy U’s water popped. It was clear. With that, Mommy U was 10 centimeters and ready to push. For the next contraction, Daddy N climbed back into the tub and sat on the side. He supported Mommy U from behind in a dangling position, so Mommy U was vertical and ready to push.

At about 8:55 pm, the next contraction came and Mommy U could not help but push. She showed so much power and strength, it was really amazing to witness. With that very first push, she could feel burning and you could visibly see her perineal region begin to bulge. It all happened very quickly at this point – Daddy N was supporting from behind, I was in the front, and Midwife C and Apprentice V were on the sides with gloves on. It was literally only a couple of minutes before the baby’s head was completely crowning. Mommy U instinctively reached down and touched it and if I remember correctly, said “My baby.” For me to see this in person was a first. I could see the head with lots of hair and a bit of bloody mucus across the top.

Mommy U continued to push with deep growling sounds, and with a slight heightening of pitch, the head popped out. Midwife C reached in to check for a cord around the neck. Mommy U continued pushing, but it seemed the baby wasn’t progressing out. Mommy U pushed, and she pushed HARD! Midwife C grasped the neck region – I suppose she was checking to see if the shoulders were stuck. For perhaps a minute, the baby was stuck in this position while Mommy U pushed with all her might. It was difficult to watch – I knew the baby should have been at least bobbing with her pushes, but it was stuck like a rock. During this time, the head did rotate ¼ turn so I could see an ear and I told Mommy U I could see this. With the next push, Mommy U really pulled everything out – 110%, and the shoulders both popped out at the same time. My sense from Midwife C’s actions and Mommy U’s hard work was that the shoulders were stuck, but it was Mommy U’s strength that got them out. It was only but one or two more pushes, when a little baby boy was born. Mommy U was immediately reaching as Midwife C brought him up out of the water to her. All the pain and work in Mommy U’s face immediately melted to a mother’s glee. And with that, we heard the first cry.

Welcome Baby Boy M! Born 10/4/06, at 9:00 pm, weighing in at 7 pounds, 6 ounces, and 20.5 inches long.

The rest of the evening was all about little Baby Boy M. He was absolutely perfect. Mommy U bounced back in 2 seconds flat and was her old self again. The placenta came within about 3 minutes and Daddy N cut the cord shortly after that. For a good period of time, Daddy N and Mommy U stayed in the tub and cradled Little Baby Boy M while Midwife C and Apprentice V prepared her bed for the next 24 hours. I manned the video camera and got little Baby Boy M beginning at about 1 minute old. Little Baby Boy M seemed interested in breastfeeding, but wasn’t quite ready yet. The placenta was perfect, and when things were ready, we all made our way upstairs. I assisted the family with settling in by bringing up beverages, making sandwiches, and delivering Mommy U’s first request – cookies! Mommy U snuggled Little Baby Boy M to her breast while Midwife C checked for tears – all clear! Little Baby Boy M received his exam and let out some impressive screams, but settled quickly afterwards once expertly burrito wrapped by Dad. Finally, the new family was settled. Sister E never woke up, despite all the commotion. I said my goodbyes and made plans to visit again in a few days. I walked away exhausted, but on cloud nine because of the beautiful event I had just witnessed. Not only had I seen a new life be born, I’d also seen a mother go to the edge and back during her birth, and I’d seen a father give his all to his family. It left me in awe of birth in a totally new way, and really looking forward to my own.

Alder's Birth Story

The Birth of Alder Rowan
Thursday, May 17th, 2007 at 1:06 pm

8 lbs 6 oz and 20 inches

Original due date: June 2nd
2nd baby, home hypno-waterbirth

Cast of characters:

Christine = Mom

Keith = Dad

Ava = Big Sister

Lisa = Midwife

Ellie = Midwife’s assistant & doula

Stephanie = support friend

Katie = support friend

Kimberly = back-up doula

Alder is my second child, so I went into this birth with some idea of what I would experience. When I started having some noticeable contractions, some that I would even call uncomfortable, as early as 35 weeks, I felt certain this baby would come early. My first baby was 12 days early and still a respectable 7lbs 4 oz, and my last ultrasound during this pregnancy was predicting an even larger baby, so we just knew he would be early.

From 35-37 weeks I had bouts of prodromal labor. Some days contractions were consistently 5 minutes apart for many hours, but they were never very uncomfortable. Some days they were very uncomfortable (even making me nauseous) but were not consistent. When I hit 37 weeks, I breathed a sigh of relief to officially be “full term.” As far as I was concerned this baby was welcome to arrive anytime now.

On May 15th, I woke with some interesting cramps, but they petered out later in the day. On May 16th, I woke to find my mucus plug was coming out in HUGE chunks. I’d never seen so much mucus. It was astonishing that I had that much stuff stored up inside me. I alerted my midwife and birth team that I was seeing mucus and that I was uncomfortably crampy. In my daughter’s birth, this was a sign that labor was about 1 day away. That evening, Keith and I set everything up, knowing it wouldn’t be long.

I woke at 6 AM on Thursday, May 17 th to moderately uncomfortable menstrual cramps that were consistently 5 minutes apart. After 30 minutes of laying in bed and timing them, I decided to get up and make breakfast. In my daughter’s birth, I got nauseous very early in the labor and wasn’t able to keep anything down so for this birth, I wanted to start with a fully tummy. I also paid a visit to the bathroom where I had some very large and loose stools – a good sign this was the real thing. By 7:15 AM or so I’d had breakfast and fiddled around the house, and the contractions were still the same (ranging from 4-6 minutes apart). I knew this was it. I was 37 weeks 5 days pregnant.

I was pleased that in between contractions, I really felt quite normal. This hadn’t been the case in my last birth, since I’d been nauseous and had a baseline of cramping that never seemed to go away. I started my birth treatments for GBS (Hibiclens wash every 2 hours). Two days ago I learned I was GBS positive again, so as a treatment, I used this wash to reduce my bacterial colonization in my vagina. Because I was positive, I’d also decided not to have any vaginal exams during the labor, unless it was really necessary.

At 8 AM I called Lisa (midwife) to tell her I thought this might be the day. I described my consistent cramps and how I’d lost my mucus plug the day before. She agreed it looked encouraging, especially since I’d been changing my activities through the morning but the contractions had stayed the same. I didn’t feel we needed her at the house yet, so we agreed to touch base again by lunchtime, if not before.

By this point I’d stopped doing chores and started focusing on allowing this birth to happen. I put my headphones on and listened to my Hypnobabies Birth CD. I relaxed on the couch. I posted to some of my internet buddies that I thought perhaps today was the day. I alternated between sitting on the couch, sitting on the floor, kneeling on the floor with my head on the couch, and visiting the bathroom. I guess I zoned out for a bit, cause time just went by.

By 9:30 AM , I guess I was starting to work harder through contractions. At this point, all time gets a little fuzzy for me. Keith was asking me questions about how things were going and whether we should start calling people to come over, and I guess I was getting snappy with him about not asking me questions. So he called Lisa and asked her to come on over. He also called Ellie, Stephanie, and Katie. We also let Kimberly know that the birth would be today, but that it didn’t seem we would need her help at this time.

Lisa arrived at a little after 10 AM . I had my headphones on and was face-down on the couch, but I cracked my eyes to smile at her as she came in with her bags of equipment. I told her that I thought it was still early, but I think she knew it really wouldn’t be that long. I continued to focus on my contractions and began telling the midwife when they started and stopped so that she could time them. Stephanie arrived for our daughter shortly after, and now that Ava was taken care of, Keith could begin setting up the birth pool. I had enjoyed seeing Ava that morning but had been pretty much unable to interact with her since she’d woken up. I wanted to have just 10 or 15 minutes to hug her and love her as my only child one last time, but my contractions wouldn’t give me that luxury anymore.

Lisa took my blood pressure (130/80 – higher than during the pregnancy, but okay) and asked me about what I was feeling. I visited the bathroom frequently and saw mucus on occasion. Sometime around 10:45 AM , Ellie showed up. Because Alder chose May 17th as his birthday, the usual assistant who works with our midwife was not available (just for this one day!). We’d discussed this beforehand and decided that Ellie, who is also an apprentice midwife, would act as assistant. So she arrived, checked in with me, and worked with the midwife to set up for the birth. Around 11 AM Katie showed up to help with Ava and taking video. So now, everyone was here.

Meanwhile, my contractions were really intensifying. I’d switched my music to Dema Premal – something one of my good friends had used during her own birth two years ago. Almost immediately I was overcome with the overwhelming need to cry. I was just feeling so many emotions at once. I found that sitting in lotus position on the floor really brought the contractions on strong. I told Lisa that things were really picking up, and that I might want to get in the birth tub soon. It was being filled with very hot water, and I suggested that it should be cooled down cause I didn’t think it would be that long. Stephanie, Katie and Ava walked to the park for a bit, but didn’t go far.

By noon , I was really struggling. I abandoned my relaxing music. Contractions were so much more intense than I remembered from my first birth – at least at this point in the labor. Some of them were just crazy! I was moaning through them by now. I started verbalizing that I was ready for the birth to be over, and that I was ready to hold my baby. I also started spending more time on the toilet because it gave me a little relief from the contractions. I was also feeling increased pressure down low. It seemed like I might be pretty far along, but the morning had been so short…I didn’t think I could possibly be close to birthing. I wanted to save some good work to be done in the birth tub, but I didn’t want to get in too early. Lisa started spending a little more time checking in with me, especially in the bathroom. I continued to see a little more mucus, and eventually it started taking on the slightest shade of pink. Finally! Evidence that progress was being made. At around this time, Stephanie, Katie, and Ava got back home from the park and started to prepare lunch.

Sometime around 12:40 PM , I was hit by an unbelievable contraction – like nothing I could ever remember feeling. At the peak, I felt an uncontrollable urge to push. Thankfully, it was short and disappeared with the contraction, because I was still sitting on the toilet and didn’t want to have my baby there! Lisa and I walked out to the tub. I climbed in and was instantly welcomed by warm peace. The pool was AWESOME! It reduced my discomfort immensely, and the next several contractions were more spaced out and much gentler. I settled into a kneeling position with my arms and head draped over the side of the soft blue tub. Keith kneeled with me, head-to-head, as we prepared to welcome our son.

Stephanie had put Ava down for her nap but just a few minutes later, she was pulled out again. At right around 1 PM , the full power of my contractions returned. They were incredible – really, it was almost unbearable because of the intensity. I was muttering about pushing soon, but was also worried it was too early. At 1:03 PM , I asked if I could push (saying it more as warning that I was about to push than asking permission if I could push). I remembered that at the last birth I’d attended (as a doula), the mother said she felt relief from her pain when she gave some gentle pushes. I decided to give it a try. It was a confusing sensation for me though – it did seem to relieve my pain a little, but it also was triggering the urge to push, which itself is quite powerful. After only a few gentle pushes of my own, my body took over and pushing began in earnest. About one minute later, I felt my water break in a large bubble, and I could feel burning in my perineum. Lisa reached down to support my stretching skin. Now the pushing was unstoppable. I was really ROARING with each intensive pushing wave. I could feel the baby descending fast. I could feel the twists and the turns he was making as he navigated my pelvic bones. I could feel he would be born any minute. He crowned for only a few seconds, and with one giant push his head was out. Unfortunately, I could feel my skin tear as his head emerged, but it didn’t feel very bad. Very quickly I was hit with another push and his body popped out. It was 1:06 PM . I had pushed for just 3 minutes.

I immediately turned over to sit down in the tub as Lisa brought the baby up between my legs and into my arms. I pulled him to me. I was relieved to feel the cord wasn’t as short as it had been with my daughter, but it was still short and I couldn’t lift him very high. Now that I was sitting up, I could see that Ava was in Stephanie’s arms and that she’d just witnessed the birth of her brother. Katie was wielding the video camera. Keith was at my side, as was Ellie. Lisa was navigating the baby end of things. Alder was in my arms! He was here! I was overcome with relief that the birth was OVER. Wow…it had just rocked my world.

His face and body were perfect. He was covered in thick vernix. His cord was HUGE – Lisa said it was the fattest she’d ever seen. I had an immediate separation bleed in the tub, so the water started turning red. We all just sat and looked at this beautiful creature as Lisa checked him over. The cord was pumping good and strong. He let out a few cries as we checked out his digits and confirmed that yes, he was a BOY! Within a few minutes, I began feeling some cramps and tried gently pushing to expel the placenta. Some clots came first. I latched Alder on, in hopes it would promote more cramping. Thankfully (since it took an hour with Ava’s birth), the placenta arrived about 20 minutes after Alder was born. My bleeding was minimal. The third stage was over and was far better than with Ava. Now that the placenta was out, Keith cut the cord. I climbed out of the tub shortly after that.

The next couple of hours were spent resting, cleaning up, and meeting our new son. Alder’s check-up was great. He weighed in at 8lbs 6 oz, despite being 16 days early. He was 20 inches long, had a 13.5 inch head, and 13.25 inch chest. He latched on and nursed heartily. Finally, the inspection of the torn tissues began. This was the part I was dreading, because I knew from Ava’s birth it would be painful to receive stitches. Unfortunately, I was right. I did tear, and it was towards the front. It was a small tear – first degree only, but because of its location, it begged for stitches. I had a small nick in the back and a skidmark to one side, but these did not need treatment. The tear in the front would make me beg for mercy though. Lisa gave me lidocaine to numb the area, but because lidocaine causes swelling, she couldn’t overdose the area or it would hinder her ability to stitch the tear properly. This didn’t bode well for me, as I’m one of those people who usually needs twice the pain meds to be numb. I could certainly feel every little needle stick. And to everyone’s horror, I could feel every single stitch...every pull of the thread…everything. It was an essentially unmedicated repair, and it seriously has scarred me for life. By the end, I was nearly screaming, whimpering, and telling Lisa to stop. Luckily that was the last stitch. It was over. The faces on everyone in the room told me this was a scene they wouldn’t soon forget. Next time someone brings shark needles anywhere near my genitals, I’ll know better what to tell them to do with them.

The rest of my recovery has been smooth. My tailbone hurt quite a lot the next few days (probably from Alder’s very rapid and powerful descent). My after cramps were CRAZY intense! My stitches have mostly healed on their own, though I think it will be a while before I inspect that area too carefully. Alder is a perfect baby, sleeping with relative ease and being very clear when he wants to feed. We are so happy to have him with us here. Welcome Alder!

Some of the coolest things I liked about Alder's birth:
Of course, being at home the whole time (again)
Wearing my own clothes and being on my own couch (again)
Never riding in the car (I can't even imagine getting near the car)
Having the whole party of birth attendants come to me
No vaginal exams to see how dilated I was
No IV
No interference - I made all my own decisions
Pushing for ONLY 3 minutes - it was crazy fast but then it was OVER
My water actually broke this time, so I got to experience that sensation
Alder was born right in our living room
No suctioning of the baby after birth – he spit everything up just fine
Cord wasn't cut until after the placenta was delivered
No separation of Mom, Dad, and baby
Immediate help with breastfeeding
Cuddling in my own bed with my new family

Next time, I’ll be more mentally prepared for the possibility of an even faster and more intense birth. This birth was definitely more intense and even more painful than Ava's, but it was FAR less tiring because it was only 7 hours long (compared to 17 hours with Ava). Just a few hours after the birth, I was already thinking about how I could do that again...in a few years. (smile)

Ava's Birth Story

I plan to post birth stories here, so I ought to start with my own.

The Birth of Ava Skye
Tuesday, July 26th, 2005 at 8:03 pm

7 lbs 4 oz and 20 inches

Original due date: August 4th or 7th
1st baby, home hypno-waterbirth

Cast of characters:

Christine = Mom

Keith = Dad

Lisa = Midwife

Liz = Midwife's assistant

Stephanie = support friend

Angela = support friend

I’ll begin when I had the first signs that Ava might be arriving soon. It was Sunday, July 24th and we had just returned from visiting Keith’s family for dinner. A trip to the bathroom later I discovered I was losing my mucus plug. At that point, I also started to notice an increase in the presence of that menstrual crampy feeling. Keith and I were excited but anxious…this was a real sign that we were going to have a baby soon. We knew that a mucus plug could still mean weeks before the baby came, but most often it meant only 1-2 more days. We went to bed that night and though I woke up feeling very cramping in the middle of the night, the feeling went away and I went back to sleep. I really couldn’t tell if it was contractions trying to get started or if it was just gas. Realizing that Ava might arrive very soon, I had a brief freak-out when I realized I had work to finish up at school. I wanted to meet my baby, but felt like I needed at least one more day at school to tie up loose ends. I asked Ava if she would give me just one more day.

Monday, July 25th we went to work and I did indeed finish up the things I needed to do. Lots of folks at school were surprised to see me when I told them I thought labor wasn’t far away…I was pretty uncomfortable with that crampy feeling getting rather intense at times depending on the position I was sitting in. It was uncomfortable, but definitely not time-able contractions. I wasn’t in labor yet. Parts of my mucus plug continued to come out during the day. We hadn’t called the midwife (Lisa) to tell her this yet because nothing else was happening yet and we had an appointment scheduled with her on Tuesday afternoon. As it turns out, we didn’t need the appointment.

Tuesday, July 26th, 2005 – 9 (or 12) days before my due date

I woke up at 3:30 am with that uncomfortable, gassy, menstrual feeling again and realized it was a bit too uncomfortable to be lying down for. So I got up and hopped on the internet for a while. Over the last several months, I’d been chatting with other women who were expecting in July or August on BabyCenter.com, so I jumped on there and wasted some time reading other birth stories and complaints about late-pregnancy discomforts. During the 4 o’clock hour I realized my crampy feeling was coming and going in waves, so I started to time when each of them started. By 5 am , I’d recognized they were 5 minutes apart. Though short (it was too difficult to time the length by myself in the dark with no watch so I don’t know how long they were), they were gaining in intensity. It was getting uncomfortable and I was beginning to believe I might have a baby today.

At 5:30 I woke Keith up and asked him if he would be awake with me for a while. He asked me what was going on and when I told him I thought we might have a baby today, the excitement in his voice was priceless. That was certainly a great way to get him up out of bed! He worked with me and timed a few contractions. By 6 am , they were 4-5 minutes apart and 60-70 seconds long and I really needed to focus on relaxing through them. I was on the border of no longer being able to talk through them, so we called Lisa to let her know what was happening.

She chatted with me through a couple of contractions and we decided she’d come over shortly to see what was going on (she only lives 6 blocks away). It seemed unlikely that my labor would just start like that so suddenly and intensely, but it was possible. At 7 am she stopped by and checked things out. She thought it was early labor and that given I’d been up most of the night, I should focus on trying to rest rather than pacing and using energy. I also needed to try and eat something. She checked my blood pressure and listened to the baby’s heartbeat too. We discussed what the plan would be for the day. Lisa had a full day of prenatal appointments scheduled (one of which was supposed to be mine), but she was willing to cancel them all if we wanted her to be there with us. Keith and I discussed things and after getting through a couple of contractions in a lying down position, we decided we’d be okay on our own and just try and rest and watch how things were going. We agreed we’d check in again by noon but that we could call her at any time before that if we wanted. After Lisa left, we also called our two labor support friends Stephanie and Angela to let them know what was happening, but called them back shortly after that to tell them not to come over quite yet. So everyone knew labor had started but for now, we were just resting and going to keep in touch.

I spent the morning on the couch or on the toilet. I was able to rest and tried eating some breakfast (bagel, cheese, protein shake) which I vomited at about 10:45 am. The contractions weren’t too bad on the couch. Keith stayed right by my side and helped me breath through them. I had to visit the bathroom often. I noticed that while on the toilet the contractions seemed to be a little less intense and possibly space out a bit more as compared to when I was walking around or on the couch. While on the couch, I was listening to my Hypnobabies Birthing Affirmations CD which I really enjoyed and was sipping on water and Recharge. Steph stopped by some time during the morning (time was a bit fuzzy for me from here on out) with some treats and CDs she made especially for us. Though normally a huge chocolate fan, the treats she brought over sounded horrible to me so I knew I must definitely be in labor.

Lisa called to check in with us at about 11:30 . She decided to stop over and visit in about an hour and see how things were going. She checked the baby’s heartbeat again (all was well) and asked about the morning. Contractions weren’t any closer together or farther apart, and she was happy to hear I’d been resting but the puking wasn’t really great news. We discussed plans for the afternoon and decided she’d go back for more appointments and we’d call when we felt we needed her. She also reminded me to continue all my GBS precautions. At our prenatal appointment one week prior, I’d learned I was positive for Group B strep (GBS) bacteria. This bacteria is normally present in about 1/3 of the population and is transient so sometimes you have it and sometimes you don’t. If a baby contracts it during birth, which is a very small risk in itself, there is a tiny chance the baby could get sick and possibly die. In hospitals, the normal treatment is antiobiotics during labor but there are other side effects associated with this treatment. We researched and decided on some alternative treatments which I had been practicing all week. It was also to my benefit to not have vaginal exams prior to or during labor and definitely not have my water broken. The chances of GBS transmission to the baby without any of these precautions is extremely small, but still, it seemed prudent to take simple steps to reduce any risks.

Early afternoon passed by with more of the same. Contractions were still about 5 minutes apart and required my full attention. I tried nibbling on a little more food but nothing sounded good (in fact all food made me feel sick) so not much actually went down. I got up and decided to get a bit more active with the contractions so I started walking around and trying different positions other than lying on the couch. Tried the birth ball but didn’t like it. Kneeling over the side of the couch was good, as was walking with Keith’s assistance during the contractions. My bowels continued to dump in slow motion. I felt like the intensity of the contractions might be building a little bit but wasn’t entirely sure. By mid afternoon, I was beginning to feel like the birth tub might be a good idea (I’d been in labor for 11 hours now) so we called Lisa at 2:30 and asked her about getting it set up. She said she’d be over in a bit. Throughout the afternoon, I listened to a guided imagery/relaxation CD that Britten, a friend from our birthing class, had given us. We also called Steph in the mid afternoon and asked if she’d like to come over and be some company.

Steph arrived at around 3-ish and began reading birth stories to me from Spiritual Midwifery. It was nice to hear the happy, homebirth stories while working with my own labor at home too. I continued moving around and visiting the bathroom often. Lisa arrived at around 3:30 and worked with Keith to get the tub set up. She checked in with me and I think it was obvious I was getting a little more serious and more tired. She checked the baby fairly often – Ava was always doing really well. We decided to set the tub up in our middle bedroom – the room that would eventually be Ava’s room.

Keith: The day was beginning to wear on and I was wondering if there was something more I should have been doing. Chris seemed very much on top of the waves so I was mostly trying to not distract her. She did not want to be rubbed or massaged so I focused on just being there. It seemed like walking around made her waves more intense so I encouraged her to do that. Lisa and I were trying to think of ways to step things up a bit. I knew that since Chris had not been keeping her food down that it was only a matter of time before she got worn out. She walked around a bit and I shadowed her so that when a wave hit, she could lurch towards me and hold on.

Christine: It was hot. July 26th turned out to be one of the hottest days of the year in Corvallis – 100 degrees. I’m not sure I really noticed. At around 5-ish Steph stepped out to feed and walk her dog. We also called Angela and told her to head on over. The birthing tub was finally filled but it was too hot, so I waited for it to cool down.

It was around this time I was beginning to wonder about whether I was going to make it through this labor at home. It had already been almost 14 hours and things didn’t seem to be progressing much. The contractions were more consistently 4-5 minutes but they still weren’t taking my breath away so I knew I had a long way to go. I voiced my concerns to Keith and to Lisa, wondering how much longer I could hold out with no food and contractions that were hard work. Lisa wanted me to try eating again. The only thing that sounded reasonable to me was chicken, so Lisa ran home and pulled some out of her fridge because she had some leftovers. The chicken went down pretty well, but within 20 minutes or so I puked it up too (and rather violently). Both Angela and Steph were here when I puked…I think it was a little surprising to them. As I finished, I said how I’d heard that throwing up actually made you dilate more, so it was a good thing. We all kinda chuckled at that.

We checked the temperature of the tub again and it was still too hot, so we decided to add some cool water. I continued walking and visiting the bathroom. Throughout the whole day, I got the mild shakes on occasion too – like I was cold but I don’t think I was. Sometime around 6 pm Lisa called her assistant Liz (another midwife who will come over as I get closer to the birth so both of them will be here) and tells her it might still be a while but that she should probably plan on coming up tonight.

My mental state during these evening hours was really starting to deteriorate. I was listening to my Birthing Affirmations CD again, but it was like I could no longer hear what the CD was saying. Knowing that my mother had 2 relatively quick births, I’d expected mine to be quick as well. I hadn’t mentally prepared for the possibility of a birth that took much more than half a day. Here I was already over the average length for a birth (12-14 hours), and I was still not even close! I began to think about how I was going to handle everything. I hadn’t eaten or slept much. I thought about transferring to the hospital, getting an epidural, and even getting a c-section. I was really starting to think about giving up my dream of a homebirth. When I realized where my thought process was taking me, I stopped and made a conscious decision that if I was going to give up and go to the hospital (which was the one thing I’d identified long ago as what I wanted to avoid – I didn’t want to go to the hospital by my choice – if we went to the hospital I wanted it to be because we medically needed to be there), I needed to give this natural, drug-free homebirth more of my effort first. I was afraid of how much longer and more intense things were going to get and I knew this fear was holding me back. Mentally, I decided to just dive in and accept what came my way. The only way this baby was coming out was by moving forward. So from that point on, I blocked all hospital/intervention thinking and the birth started moving forward again.

At 7 pm I decide the tub temperature was acceptable and I was getting in it. No one could stop me. Once I’m in though, I realize the water might be a bit cool so we go about draining some of it and filling it with hot again. Lisa and I discussed whether she was going to check my dilation, which was totally up to me, and I decided not to get checked. We figured the tub would either speed me up or slow me down, so I should just I’d get in and see what happened. Well, contractions didn’t dissipate at all in timing or intensity. Lisa checked the baby’s heartbeat again and it was still doing great. Steph and Ang decided to head to Fred Meyer (grocery store) for some snacks. I said I’d try eating some ice cream if they brought some back. I’d been sucking on Popsicles for a while and that seemed to be okay. So they headed out.

Keith: I was starting to get worried that the labor was not going to progress before Chris got worn out. Her contractions has been so regular for so long that I was also starting to space out and not be as present as I could have been. Chris asked me to give her more encouragement, so I began to focus on how to move things forward. It was clear by this point that she had been too much in control of the waves and needed to let go (not easy!). I finally took the risk to tell her this and she agreed. The energy in the room really shifted as Chris made the decision to let the birth go where it needed. I was very proud of her and us as a team. At the same time, I started encouraging her more. I knew at that point that somehow everything was going to work out.

Christine: After a bit of time in the tub I felt like another trip to the bathroom, so Keith helped me in to the toilet.

7:30 pm – Once on the toilet, I began shaking uncontrollably, almost violently. I couldn’t really tell if it was because I was cold (I was naked and wet from the tub) or if it was from the birth hormones. Keith covered me in a towel and robe and tried to help hold me still. After 1-2 moderate contractions and a major involuntary bowel dump, I went to wipe and found my toilet tissue covered in bright red clotty blood. Something was definitely happening! Keith and I looked at each other and called out to Lisa who was on the back porch. We told her what we saw and she was happy to hear about it – it means important changes are happening in my cervix so things were moving along. Right then I’m hit by a really powerful contraction that causes me to begin moaning. Wow! Things are REALLY picking up. This was intense. It was a long and hard one that really took my breath away. It ended and gave me a short rest, but very quickly another one came along. Suddenly my contractions were maybe 3 minutes apart and lasting 90 seconds or so. At this point Lisa called Liz and told her to head on up because the birth was going to happen in the next few hours (but little did we know)…

Keith helped me back to the tub and I got hit by another contraction right as I was getting in. This was the worst one so far because I was caught mid-motion and not prepared. It was just so intense! The contractions were really coming on top of each other now. I felt like I was getting very little rest in between. Lisa realized things were moving faster than we all thought so she began breaking out all her equipment and getting things ready for the actual birth. As I heard her bustling around, I realized I was going to be having this baby really soon. She wasn’t in here working with me because she had some serious setup to do before we were caught off-guard with a baby on its way out. This realization was a bit scary for me – these contractions were so intense and giving me very little break. How much worse was it going to get? I was afraid…I really wanted things to slow down just a little so I could feel more in control, but it was well beyond my control at this point. I start feeling nauseous and puked in the bucket again. Puking and contracting at the same time – no fun! We’d started putting hot water back in the tub again, but suddenly I was too hot. It wasn’t much longer before I was too cold again, and then I was too hot again. My body was going crazy.

7:50 pm – Steph and Ang come back (I’m only vaguely aware of this) and hear things have really sprung into action. They man their cameras and help where they can. I’m totally absorbed by the contractions. Ever since getting in the tub, Keith as been right here with me telling me how great I’m doing. I’m of course saying I can’t do this anymore and I want it to stop, but Keith is telling me I am doing it and that soon our baby will be here.

Keith: Things are getting really intense, but by now, that’s a relief for me. It’s becoming obvious that this is really going to happen. I feel completely in the moment and continue to encourage Chris. Even though the intensity continues to ramp-up, at no point does anything feel ‘wrong’. Chris seems to dissolve into the effort and we both become singularly focused on the incredible energy that is building fast.

Christine: I can’t believe I’m saying I can’t do this…I know in my mind there is no turning back, but still I find the words coming out of my mouth. I also get overwhelmed with all the people in the room, so Steph and Ang stay in the doorway (but smartly keep videoing cause I definitely wanted to have this on tape). Right around this time, I go from sitting to kneeling with my arms on the side of the tub and suddenly I feel my body pushing. It feels like I really need to take a dump, but that the dump is the size of a cannonball. My body is pushing hard! I yell out “push” and “burn”…it is all I can say at the time. Lisa tells me to reach down and see what I can feel. I can’t really tell – everything feels very swollen down there. The contractions are still right on top of each other and now my body has started pushing the baby out with no assistance from me. I’m trying to breath and relax as best I can through it, but I wasn’t assisting with any pushing on my own. Each contraction had 3 or so major pushes within it. It was all happening so fast. Lisa reached down and checked for what she could feel. She instructed me that in this position, it was very important to keep my butt down in the water as the baby was coming out. The baby couldn’t be lifted out of the water until she was completely out of me, so I had to help keep her under. My moans turn into roars and nearly into screams. I can’t control anything…it just comes out of my mouth as the baby is being pushed out of my body. The power of my body is beyond my wildest dreams. With each push, I can feel things getting lower and lower. At one point, it feels like she is stuck behind something but I think it was just her head sliding behind my pubic bone. The burning I felt continues to grow with each push. Lisa can feel the baby’s head. With the next push, she is totally crowning. She sits like this as one contraction goes away, so I get to feel the crowning sensation for about a minute or so. It is intense – not really painful but more like major stretching. At this point though, I know the baby is coming out very quickly and without adequate time to stretch, it was likely I was going to tear. With the next contraction comes another involuntary push and I ROAR as the head comes out. A few seconds later the next push brings out more of her body. It feels crazy to feel this baby sliding out. The contraction ends before she is totally out though so Lisa instructs me to give another push and I do. This is the first push that I actually participate in. And with that, she slides out.

8: 03 pm – Ava Skye is born. Relief! I feel my belly totally deflate at that moment as both the baby and all the amniotic fluid dump out of my uterus. My water never breaks – as best we can tell, the baby come out still partly wrapped in the amniotic sac. I’m just hanging onto the tub trying to catch my breath. Lisa tells me to come back and sit down and as I do that, she brings the baby under my leg and up out of the water. She is here! We quickly discover the cord is very short, so I need to keep my butt angled up towards the surface of the water so that Ava is up high enough to keep her head well above the water. It is uncomfortable, especially since the cord is tugging on what I think is some torn flesh below, but with the baby in my arms it doesn’t seem so bad. She is so beautiful. She is blue to start but lets out a cry very quickly and pinks up with in a minute or so. She is slippery – she’s absolutely covered in vernix. She looks around a little, cries, coughs, and just moves her body. The 1 minute Apgar is 8 and the 5-minute is 10. All I can say is “Hi” over and over and over again. I can’t believe she has come out of me and that she was born right here in her very own room. It all seems very surreal. Did I just give birth to this beautiful creature? Why does it all seem like a dream? While we are all sitting there gawking at the baby, Lisa is checking her over and making sure everything is alright. The other midwife Liz never made it…I went from the start of transition to delivering the baby in just 30 minutes. Talk about intense!

The next hour is spent admiring the baby and delivering the placenta. First we wait for the cord to stop pulsing before cutting. It takes a little while (15-20 minutes?) so I’m sitting uncomfortably holding Ava above the water. She opens her eyes and looks around quite a bit. The cord finally stops pulsing and Keith cuts it, which is a bit of challenge because it is so tight. Once it is cut she is shortly lifted up out of the water and handed to Keith.

Keith: I’m still in awe at the arrival of our daughter. I was happy to cut the cord, feeling in a small way that I helped bring her into the world. Up until the last few pushes, I hadn’t really thought about the fact that we would have a little baby on our hands. The birth was all consuming. I’m feeling torn between looking Ava over and staying present with Chris and her afterbirth. It quickly becomes clear that the placenta is being stubborn and Lisa’s concern is apparent. My attention stays with Chris until it’s really over and we can both relax. The baby is so peaceful and calm, we hand her around to Steph and Ang. First things first, we focus on the bleeding and delivering the placenta.

I have a separation bleed (meaning the placenta has now become detached from the uterus) and we decide I’ll get out of the tub to try and deliver the placenta on the birthing stool. It takes a minute to set this up and I bleed quite a bit during that time turning the tub water crimson red. Once I’m out on the stool I get the baby back and try to get her to feed to help my cramping. After a bit I feel some cramping and try to push. I push fairly hard and a large pool of blood with lots of clots (some as large as my hand) comes spilling out. Yikes! We sit and wait for more cramps, but there just aren’t many. Lisa gives me an herb to encourage cramping. Another one comes, I push, and nothing comes out. We decide to move to the toilet so Ava goes to Daddy. At this point I realized Lisa’s attention was no longer on the baby. The baby was fine. Her attention was on me – I needed to get this placenta out because I was bleeding quite a bit. Walking to the toilet is amusing with Lisa helping me and holding a pad under me. I get really faint on the toilet though. My vision gets a little blurry and I see stars. Apparently I look really pale too. We decide I need to be on the bed so we move on in there and I feel a bit better. Next time I feel a cramp, I push with all my might and finally the placenta comes spilling out. Wow…that was difficult, and it took an hour! If it hadn’t come out on that contraction, we were going to resort to a shot of pitocin (helps uterine cramping) to work on getting it out. I bleed a bit more after the placenta was out but it slows down relatively quickly as my uterus cramps down. It took me an hour and LOTS of pushing to deliver the placenta, while the baby only took 15 minutes and no active pushing on my part. How odd the body works sometimes…

Later, we checks for tears and Lisa gives me 4 stitches in my left inner labia…not a very comfortable experience. I’m glad my perineum has stayed intact though, which I consider pretty amazing since Ava shot out so quickly. The tear I did get was just on the surface so it didn’t involve any muscles and will heal very quickly. Ava is sitting in my arms for a lot of it, but also visiting Keith, Angela, and Stephanie. We also examine the placenta and amniotic sac, which we keep and plan to bury under a tree on our first anniversary. Lisa looks very carefully over everything and it looks like everything did come out. She guesses that the reason it took an hour to deliver the placenta was because though most of it detached shortly after the birth, there is an odd-shaped lobe of the placenta that probably just held on for a really long time. Lisa takes me to the bathroom again to make sure I am able to pee (after birth, sometimes it can be very difficult to pee and occasionally a catheter is needed) – it takes some effort and I poop in the process, but eventually I pee and we are all happy. I stay on the bed for the rest of the evening while the others clean up and bring me food and beverages. I’m finally hungry! We had bought a cake from our favorite cake-maker and frozen it for Ava’s birth, but I wasn’t quite ready for all that sugar. It was saved for the next day. Next it is time for Ava’s check-up with the midwife and her weighing. She looks so tiny but she comes in at 7 lbs 4 oz and 20 inches long. Overall, she looks perfectly healthy and happy to be here. We then called our families and some time after midnight, Lisa left us with our new daughter.

Some of the coolest things I liked about my birth:
Of course, being at home the whole time
Wearing my own clothes and being on my own couch
Never riding in the car
Having the midwife come to me
No vaginal exams (none for the entire pregnancy)
No IV
No interference
No pushing on my part – my body did everything!
The baby came out in her sac as best we can tell – my water never broke
Ava being born in her own room
No suctioning of the baby after birth – she spit everything up just fine
Delayed cutting of the cord, despite it being very short length
No separation of Mom, Dad, and baby
Immediate help with breastfeeding
Cuddling in my own bed with my new family

Next time, I’ll be more mentally prepared for the possibility of a long birth. I think with the confidence of having had a natural, drug-free homebirth under my belt, the next one won’t seem so scary. So was it painful? Yes, but it was a good pain. And more than pain, it was just a lot of work and stretching muscles. And in the end, it gave Keith and I a perfect little Ava Skye.