Empowered to Birth Naturally in an Alabama Hospital

Newborn Bo snuggles with Mama

by Erin Mize, guest blogger

At midnight, with fast, irregular contractions, I called my doula, Hannah.  My body felt wildly out of control.  She was calm and reassuring, telling me to take a shower, relax, and if they persisted, to call her back.  If not, she encouraged me to try to rest.

My heart was racing with excitement as I got undressed to get into the shower.  I caught a glimpse of myself in the mirror; cheeks flushed and out-of-breath from the struggle to remove my socks.  I stopped, turning my bountiful belly straight-on to the mirror and smiled.  I marveled at my body’s miraculous work, swelling to accommodate and sustain this new life.  I felt strong and capable.

After a few minutes in the shower, sure enough, my contractions slowed.  Before I even knew it, my mind had quieted and I decided to dry off and try to rest.  Fortunately, I was able to sleep until about 3:30 AM when I awoke to 10 minute-apart contractions that weren't really any stronger than before, yet I intuitively knew these were purposeful.  The whole of my uterus would tighten, not just the top like during Braxton-Hicks, and my sacrum down through my thighs ached. 

I was tossing and turning in our king sized bed so I quietly moved into the living room, leaving Andy asleep.  I didn't wake him just yet.  He would need to be rested to take care of our 3 and 4 year old children, and to be perfectly honest, I wanted to labor free from his concern.  I needed to let go and succumb to this process, so I took advantage of the quiet. 

In my sleepy, yet excited state, I went to the shower.  I knew the hot water would help.  I immediately relaxed.  I breathed in the steam slowly as I propped myself against the shower wall letting the full force of the spray concentrate on my sacrum.  I thought about my baby, Bo, working right along with me.  As I rocked my hips slowly back and forth, I visualized him descending through my body while I intentionally relaxed my mouth, shoulders, arms, back, and pelvis.  “Here we go, little one,” I whispered.  I wanted to make his descent as easy as I could.

When I returned to the living room, the TV was on, and one of those cheesy infomercials selling '60's music CDs played.  I wasn't watching it.  I just needed it on to give my mind some distraction.  I curled up on the couch and was even able to sleep a little between contractions.

All of the lights were out in the house except the glow from the TV, and it was otherwise silent.  I continued in this early stage of labor peacefully as my family slept.  I was in total control, calm and comfortable.  I wasn't afraid.  I didn't feel alone.  I felt safe and able to relax into my labor in my home, relishing this time with my baby, just the two of us, doing our work together.

As my labor progressed, I was no longer comfortable lying on my side through contractions. As one would start, I would get up and stand with my head on my arms, resting over the arm of the couch and swaying my hips back-and-forth through the contractions, consciously relaxing my mouth and muscles and visualizing my baby easing down. 

After my second trip to the bathroom, I recognized that my body was “voiding” and I had a feeling it was time to get everybody up and on the road for the 40 mile trip to the hospital from our home in Hartselle.  I did not look forward to the impending road trip or the bright, unfamiliar hospital delivery room, full of strangers, that awaited me.  Would my doctor be on-call or would a stranger deliver my baby?  Would I get a nurse that was educated about and supportive of natural birth?  Would my birth plan be respected?  It would have been so nice to have made one phone call and had a midwife show up at my door with the same supplies that a level one hospital stocks, but unfortunately, assisted home birth remains illegal in Alabama. 

Andy and Hannah helped Erin maintain her focus.

I'd like to take a brief detour here for a moment to point out that actually, home birth is legal in Alabama.  More specifically, unassisted home birth is legal in Alabama.  Oddly enough, I could have had my baby at home, but I most certainly could not have had a trained attendant, like a Certified Professional Midwife, on hand to ensure that my baby and I remained healthy and safe.  Just for being present she could be charged with a class C misdemeanor.  Additionally, because Alabama does not license or regulate CPM's, she could not have easily transferred my care to a hospital or carried the life-saving equipment that she needs and can use legally to attend home births in 31 other states.  Therefore, after laboring at home without incident, I woke my family up to go to the hospital so my birth could be attended by an OBGYN, a specialist. 

Before I woke the boys, I made their chocolate milk, just as I did every morning; except this time, I paused to work through strong contractions while I rested on the kitchen countertop.  I made my way into the boys' room and with muted excitement said, “This is it guys!  You're going to meet your baby brother today!”

I woke Andy and told him it was "for real" and we needed to get to the hospital.  I called and let Hannah know how it was going.  After I paused our conversation to work through a contraction, she confirmed what I suspected, that my labor was advancing nicely.  She expertly advised that we meet at my parents’ home prior to going to the hospital so we didn't arrive right at shift change.  I agreed, and Andy and I loaded the boys up and got on the road.

It was about 5:30 in the morning, pitch black, and starry.  I remember the boys sleepily singing "twinkle-twinkle little star” as my contractions came and went.  This time, however, I didn't have the luxury of moving around to work through them.  I pulled at the seat belt to move it away from my taut abdomen and writhed and twisted in a vain attempt to alleviate the pain in my back.  Each passing mile marker seemed a reminder of my distress as Andy raced to our destination.  I was beginning to panic.  It took everything in me to suppress my instinct to move my body freely through these contractions. 

We finally rounded the corner in my parents’ neighborhood, and I was filled with relief at the sight of Hannah’s car parked in front of their home.  Andy got the boys out while I went up the stairs as quickly as I could to labor in the shower until we would go over to the hospital. 

I turned the water to almost as hot as it would go.  The relief was immediate.  Slowly breathing in the steamy air, I began getting my labor back under control. I visualized the water softening my tissues and gently encouraging my baby out as I slowly swayed through the awesome pressure.  How I would have loved to have had a water birth! Unfortunately, hospital policy in my area prohibits the practice.  But, I knew that I would be allowed to labor in the tub or shower until my water broke.

Thank God for Hannah!  She took the lead on thinking out the timing of our arrival.  All I had to do was labor. 

We pulled up to the valet stand, and I remember feeling strange about the security guard approaching me with a wheelchair.  I got out of the car looking behind me for the patient that needed this apparatus, even willing to help him or her into it.  Then, of course, it dawned on me that it was meant for me.  Even though it felt rather unnecessary, and I certainly didn't identify as a “patient,” I obliged the helpful parking attendant.

First Feed

While I couldn't help but feel like a diva waving a birth plan with a lavender-scented, birth stool-carrying Doula in tow, the hospital staff and nurses never treated me as such!  We were greeted warmly and taken straight into a labor/delivery/postpartum room.  I had pre-registered and therefore was able to get through the intake paperwork quickly with Andy's help.  To my amazement, my labor and delivery nurse was actually trained as a Certified Nurse Midwife!  And let me tell you, the care she gave me exemplified a midwife's model of care.  She was respectful and supportive of my choice to birth unmedicated.  She read my birth plan diligently and then asked before she did anything including waiting to start my hep-locked IV until after a contraction. 

My doula was calmly unpacking her bag-of-tricks and making the room more comfortable by lowering the lights, playing soothing music, and starting the lavender.  Hannah’s presence calmed the frenetic pace of the hospital, and her attention to detail made the unwelcoming hospital room homey.  In a way, she represented my conscious self that, in the throes of labor, I had distanced myself from.  Her presence of mind was invaluable.

I continued laboring unencumbered from an IV or continuous fetal monitoring.  I drank when I was thirsty, remained in the clothes I came in, and moved about freely.  In fact, I didn’t get into the hospital bed until after I had given birth!  Andy sat at the foot of the bed and I rested my arms and head across his lap between contractions.  I was most comfortable on the exercise ball and during contractions I would roll my hips in big circles while Hannah applied counter pressure to my sacrum and Andy gently encouraged and loved on me. 

My nurse asked if I'd like my cervix checked for dilation and being that my water hadn't broken yet, I allowed her to examine me.  Believe it or not, I was actually a little concerned that the exam would reveal that I was only a few centimeters dilated. Much to my surprise, I was fully dilated!  However, I did not feel the strong urge to push as I did during the birth of my second child and I speculate that it was related to the fact that my membranes (and amniotic fluid) were still intact.

My nurse indicated that she would call the doctor, and that she may break my water upon her arrival.  My doula sensed my hesitation and encouraged me to discuss with the doctor the risks and benefits of doing so.  Interestingly, my doctor never brought it up.

At some point I remember saying "I could push", emphasis on the could.  Hannah asked if I'd given any thought to what position I'd like to push in.  Believe it or not, it wasn't until I hired her for the birth of my 3rd baby that I learned there are many pushing positions a woman can assume to birth her baby, the least efficient of which is lying flat on her back with her feet in stirrups and knees in the air. 

Big Brother gets to hold baby Bo

I had learned through my research that an upright birthing position would allow gravity to aid in bringing my baby down and out as well as allowing my uterus to contract more strongly and efficiently.  Staying off of my back would keep my aorta from being compressed and, in turn, help my baby to stay oxygenated.  Also, it would allow my sacrum to expand backwards, increasing my pelvic outlet.  Hannah gently encouraged me to go with what felt “right,” and I confidently replied that I'd like to use the birth stool.  She went straight to work getting it prepared.

It was no time at all before I took my place on the vinyl cushioned wooden stool.  I was sitting with my knees a comfortable distance apart and bent to slightly less than a 90 degree angle.  My OBGYN patiently sat cross legged in the floor in front of me, my doula behind me, and Andy at my side with my nurse observing attentively.

And then we waited.  I was eager to meet my baby, my third son, and in stark contrast to my other unmedicated birth, I just didn't have a strong urge to push!  I knew to wait for my body to “do its thing” but I was growing impatient!  Hannah reassured me that I was “laboring down” beautifully so I closed my eyes and waited patiently. 

My water finally broke as my OBGYN was doing perineal massage with mineral oil and applying a warm compress.  At this point my contractions began to intensify. 

I believe it was about eight contractions later that I began feeling pressure on my perineum and Andy commented that he could see the top of Bo’s head through the amniotic sac, and yet I still didn't have a strong urge to push or a ton of pain as you might think.  Now don't get me wrong, it was no walk in the park, but once I resigned myself to the necessity of the contractions, that they were working for and with me to bring my baby to me, I embraced them as part of the physiological design.  

My favorite part of my labor happened next:  Hannah whispered to me, “reach down and feel your baby.”  I tentatively reached down and felt my baby’s velvety soft head beginning to emerge. 

As I pushed along with a contraction, I heard my doctor quietly and calmly say, "his head is out.” I was shocked and caught off guard.  With renewed purpose I let out a primal groan with my next, final contraction and all 8 lbs, 12 oz of my baby boy was out and on my chest!  I remember hearing someone exclaim, “He's big!” which surprised me because I didn't feel like I had worked that hard to get him out. 

Bewildered, I questioned, "that's it?"

Hannah helped me out of my dress so I could get Bo skin to skin.  I had my baby in my arms.  He was so calm.  He stared right into my eyes, never breaking his gaze, as mine filled with tears.  I'll never forget this moment.  In a strange way, I recognized him.  I'd never laid eyes on him, of course, but I felt like, “oh, there you are.”

My body had not only created and grown this little life, but brought him forth into our world, or earth side, as Hannah affectionately said as she welcomed him. 

I felt as though I had come full circle.  Rather than handing the process over as I had during the highly medicalized and, for me, detached birth of my oldest son, I had embraced the process.  Instead of placing my childbirth in the hands of the hospital staff, this time I had a plan and then trusted my instincts and my body to do what it was Divinely designed to.  I learned that I could not put the burden of a safe childbirth squarely on the shoulders of my chosen birth attendant.  I must be accountable for educating myself and then carefully choosing who would attend my birth.

If my three radically different childbirth experiences taught me nothing else, they showed me that there is no "right” way to birth, but there is a right way to treat a laboring woman: with respect.  There are many factors at play, and sometimes the choices are very limited. The most important part is that we are informed and respected in our choices. 

I evolved with my experiences to guide me, and my expectation of birth changed. I learned what it could be with the right preparation and careful consideration of who was present at my births. 

I found the Alabama Birth Coalition about six months postpartum as I continued to process the impact my first two children’s births had on me and our family.  That's when I learned that for more than 13 years, ABC has fought to give families in Alabama the right to choose Certified Professional Midwives for their maternity care and safe home birth. 

Everybody is so happy that Bo is here!

I had three hospital births:  a medicalized, an unintentional unmedicated, and finally a planned natural birth.  Many variables aligned in my favor to achieve the above described birth.  Yes, with careful preparation and crossed fingers, you can have a beautiful, natural hospital birth. However, consider one thing: hospitals by their very nature are not designed to embrace healthy physiology.    On the other hand, they expertly save the lives of high risk mothers and babies every day, but the anticipation of abnormality is palpable for a healthy laboring woman and unfortunately can often lead to unnecessary interventions. 

I believe that the future of maternity care in our state can and should include out of hospital birth options for healthy women   Home birth isn’t for every family, but we owe it to the futur

e of birthing women in a our state to at least allow them this choice.  I firmly believe I could have easily had my baby in the comfort of my home had I been able to do so safely with a CPM. 

I am proud to now be a part of the Alabama Birth Coalition and their effort to introduce legislation that will finally let Certified Professional Midwives legally attend home births in Alabama and thereby give us real choices regarding our maternity care. 

Educate yourself, know your choices, and hire a Doula!

For more information, please visit the Alabama Birth Coalition’s website at http://www.alabamabirthcoalition.org or Facebook page at https://m.facebook.com/alabamabirthcoalition/.  

My Road to a Home Birth

Bethany with her midwives and baby Eli

by Bethany Hyder, guest blogger

I am a natural childbirth junkie. I LOVE it! I love to learn about it and hear other people’s experiences with it, and I’d REALLY love to educate others about it! I really wish all women could have such a gratifying birth experience. It makes me sad to hear the horror stories of some women’s births. It doesn’t have to be that way! So when I got pregnant at 16, I learned a lot about natural childbirth. My mom had all four of her kids naturally, so why shouldn’t I?!? I read a lot of books, and although I can’t remember all of them, I do remember reading The Bradley Method. I went on to have a (mostly) natural birth with an awesome OB/GYN – Dr. G, at a small hospital (Parkway Medical Center) in Decatur. Anna’s birth is another story though (which I’d love to share, too!).

Fast forward 10 years, and I was 26, married, and had OVER planned for this sweet baby I was pregnant with (seriously…over-planned). At 8 weeks gestation, Christian and I excitedly went to see Dr. G and had an ultrasound – perfect little baby cooking away! Expected due date of January 1^st (but I already knew that, because I had over-planned)! We continued with regularly scheduled prenatal appointments, but I always had a nagging desire for a home birth. It was always just one of those “maybe one day” type things. I had met a mom of a girl in Anna’s girl scout troop that had numerous home births. I wanted to be her. Then my cousin had planned a home birth, and although she did deliver in the hospital, it helped to know more people that actually planned this sort of thing.

Curiosity got the better of me, and I started looking into midwives. In Alabama, it is completely legal to have a baby at home. However, it is ILLEGAL for a midwife to attend a home birth. The state only recognizes Certified Nurse Midwives (CNMs) and they are only authorized to work in hospitals, under an OB/GYN. So basically, you can have your baby at home, but not with anybody that’s trained or skilled in home deliveries! Surrounding states license Certified Professional Midwives (CPMs), but these women would face prosecution if they were caught assisting home births in Alabama. It’s sad, really. I found out that there are some midwives that work “under the radar” in AL and will come to your home for birth. This seemed a little dangerous to me given that 1) I don’t really want to get anybody arrested, and 2) if I did need to transfer to the hospital, the midwife would not be able to come. What if the midwife had important medical information that the doctor needed?

Through a random facebook post, a co-worker recommended his wife’s midwife – Karen Brock. I emailed Karen. I really just wanted to ask questions and figure out how it “worked.” Karen offered to meet with me. So, at about 24 weeks gestation, Christian, my mom, and I drove to Cullman on a Sunday afternoon to meet her. Karen is a CPM, licensed in Tennessee. She does prenatal appointments at her office in Cullman, and has a house just across the TN state line for births. I immediately trusted her. The conversation about birth that we had was SO reassuring. It was nice to talk to somebody that recognized birth as a normal, natural process and not a medical emergency. I was like a giddy school girl leaving her office. I had made up my mind, but I wasn’t too sure about Christian. When I initially told him that I wanted a home birth, before we met with Karen, he said, “Ok…will Dr. G be there too??” HA! No, honey, she won’t. I don’t know if he just trusted that I would make a good decision, or if he didn’t know to be worried, but he agreed to it!

My next appointment with Dr. G would have been my 28 week appointment, before which I was supposed to have the nasty glucose test completed. I never took that test. I faxed Dr. G’s office a medical records release form to have my information sent to Karen, not knowing the can of worms I was opening up. In my mind, I was going to keep going to Dr. G AND go to Karen, and then assuming everything kept going good, I’d just birth with Karen. Good idea, right? WRONG! Later that day, as I was walking out of work, my cell phone rang. It was Dr. G calling to inquire about sending my records to Karen. She was not happy to hear that I was planning a home birth. She made sure I knew that was illegal in AL, and I assured her that I would be birthing in TN. She gave me a few horror stories and tried her best to dissuade me. I was about to get in a van full of coworkers (we have a ride share program) so I told her I’d think about it and let her know. Her scare tactics worked…for a few minutes. I had done enough research and knew enough about childbirth and the midwifery model of care to know I was making the right choice. When I called back, I told her nurse to send the records to Karen. Dr. G had made it clear that she would not be able to continue to provide OB care during this pregnancy knowing that I was going to Karen. She stated that it was a conflict of interest. She would, however, continue to see me as a GYN patient in the future. When I went for my first prenatal with Karen, she told me that Dr. G had called her as well! She quizzed Karen about what she would do if I started to hemorrhage, etc. It turns out that every year when the midwifery bill is presented in Montgomery, Dr. G is one of the opponents there speaking against the bill. It sounded like Karen and Dr. G were going to meet to discuss how both parties could come together for the benefit of mothers and babies (i.e. the midwives and the medical community), but I never heard more about that happening.

I loved so many things about seeing a midwife. Number one was probably the “hands-off” approach. There were no “routine” pelvic exams. Even when I was in labor, she didn’t need to “check my cervix” or see how far along I was. She certainly would, if I wanted her to, but it was not mandatory. Listening to the body is so much more indicative of where you are in labor. Second, the personal relationship we had. Every prenatal appointment was at least an hour long – no rush. Every decision made was ours (mine and Christian’s) to make. We researched, asked questions, and made decisions about how this birth would go and what kinds of things would happen immediately after. We made a transfer plan in case of emergency, and thankfully didn’t have to use it. I felt in control at every point of the pregnancy and birth, and trusted my midwives 100%. I am SO happy I left Dr.G and went to Karen. Best.Decision.Ever!

The Birth Tub felt amazing to Bethany!

Eli’s Birth

Saturday, Dec. 29th

That morning, I woke up and headed straight to the bathroom to pee. I noticed a little bit of blood when wiping. I got excited because SOMETHING was happening! I went on about my day, but made everybody aware that things were slowly getting started, hopefully. Christian went to work, and my sister

Julie, Anna, and I went to walmart to get various things. We drove out to where I work because I had left some information I would need while out on maternity leave. Later in the day, I took a little nap on the couch. All throughout the day, I was aware of very light contractions - nothing worth paying much attention to. Julie made homemade chicken noodle soup (I requested that for while I was in labor), and that evening we went to the mall to “walk the baby out” / get contractions going stronger. That night, I called my midwife, Karen, to let her know that early labor had begun. There was actually a birth going on at that time at the house in Elkton, but she told me to check back in to give her an update before going to bed. Contractions remained fairly mild, so I tried to sleep, knowing my sleeping days were soon to be over!

Sunday, Dec. 30th

Stronger contractions woke me up around 3am, and I lay in bed and timed them with my phone (yes, there’s an app for that). They were around 6 minutes apart. At 4am, I woke Christian up and thought it was time to head to Tennessee. I wanted to go up there with plenty of time to labor in the tub and relax. I called Karen, and she told me to get up and get moving to see if the contractions were going to stall out. Once Christian, Anna, Julie, and my mom had been alerted and the car packed up, I decided it wasn’t time! Contractions had waned again, so Karen suggested trying to get some rest.

Around noon, Karen and Wetawnya (assisting midwife) were ready to leave the house in Elkton after ANOTHER birth (they had 3 that night before me!), so they stopped by my house to check on me. I decided I wanted to know how far along I was, and it turned out to only be about 2cm! Again, rest was prescribed. I took a nap for about an hour before contractions woke me up. I spent the next couple of hours or so walking around, swaying, and finally rocking in the rocker in the nursery while looking out the window. Christian and Anna were so quick to get anything I needed, and they both helped time my contractions. Anna got bored and decided to go to her grandparents’ house, but she wasn’t there long.

Around 4pm we checked in with my mom, and she suggested that we head on to TN so that I could get in the Jacuzzi tub to labor. Christian packed up the car (again) and we headed out. Julie and Nana went to pick up Anna. We called Karen on our way to let her know we were headed there and to see what we needed to know about the tub. She said that she and Wetawnya would head that way too. The drive was about 40 minutes, and contractions were steady at around 4 minutes apart. I wasn’t all that uncomfortable during the drive. I thought it would be hard to sit still for that long, but I made it fine and kept concentrating on the task at hand. We got to the house a little before 6pm, and my mom, Julie, and Anna arrived shortly after.

When my mom got there, I started to cry because I felt like I was nowhere close to having the baby, and I was worn out already. I really felt like I had several more hours of labor left (this was actually most likely transition, but I did not recognize it bc my contractions were not THAT intense yet). She helped me get undressed and into the tub. I tried several different positions until finally settling into a squatting type position. Karen and Wetawnya arrived and I was vaguely aware of them setting up the bedroom. I was very much “within” myself. They periodically checked the baby’s heart rate and encouraged me to eat and drink something. I did not want to eat, but did have a little bit of gatorade to drink, although I really didn’t want to be bothered with that either. Christian sat/squatted (I’m not sure?) next to the tub and kept up with my contractions. I would announce when one started and when it ended, as best I could.

Newborn Eli on Mama's chest

I announced that I felt the need to push, and Julie later told me that Wetawnya had left to get some food, and Karen was eating some of the chicken noodle soup we had brought (remember my request?) so she called Wetawnya to come back! I guess everybody thought we were in for a few more hours of labor. I thought I only wanted to labor in the tub, and would get out of the water when it was time to push, but decided in the moment that I wasn’t going anywhere! We discussed whether or not my water had broken, because I wasn’t sure....but shortly after that it did. I heard/felt something like a rubber band popping, and could somewhat feel the warm liquid, even though I was in a tub full of warm liquid! The contractions quickly became much more intense. My hips and thighs started to ache, and I could feel the baby descending. For the most part, I kept my eyes closed and head down. My mom said that she thought I was going to dunk my head in the water a few times! The urge to push was so pronounced, and it felt so good to do so! I thought I was being quite loud with the guttural/moaning sounds I was making, but I’m told I was actually very quiet.

Crowning took me by surprise...I THOUGHT I had a natural birth with Anna, but apparently I missed a LOT at the end when she was crowning due to the pudendal block I received so that I would be able to stop pushing while Dr. G did some deep suctioning to remove meconium before she inhaled it. The pressure was insane, and I wanted that head OUT! It’s hard to describe, but I started to shift my weight from one foot to the other, while squatting, almost like I was trying to crawl away and “deposit” the baby! At one point, one of my midwives (I can’t even remember which one) got eye level with me and reminded me to breathe and focus. I put my hands between my legs and felt his sweet, soft head FULL of hair. I pushed with all my might to get his head out, and once it was, I SMILED. What a relief! I kept my hand on his head while I waited for the next contraction. I asked Karen how long I had to wait because it seemed like it was taking FOREVER! When his body slid out, I pulled him up to my chest and sat on the seat in the tub. He gurgled and cried, and was just absolutely perfect.

It was ONLY 7:08 pm...just ONE HOUR since we had gotten to the house! I was amazed. I felt like it had been longer, but time seemed to stop once things got more intense in the tub. I really believe that the water worked its magic to help me relax and everything jumped into gear. I wish I had gotten in that water sooner!

It was a bit cold in the water, so after a little bit of time had passed, Karen cut the cord and handed Eli to Christian. They had towels fresh out of the dryer to keep him warm while I delivered the placenta and got out of the tub. I sat on the bed and was able to nurse Eli while we all enjoyed him. He pooped on me while he nursed! Black, tarry meconium all over my tummy!  After we had a while with Eli, Karen and Wetawnya did all the baby checks right next to me on the bed while I ate some chicken noodle soup. He weighed in at 7lbs 9oz. Christian put his diaper on him and got him dressed, and I got in the shower to clean up. Anna, Julie, and my mom got to hold him a little bit too. Karen and Wetawnya left the house, and we were right behind them. We were back at home by 11pm.

I had a 2nd degree tear, and I KNEW I had pushed too hard to get his head out. It took me by such surprise - I was not prepared for the burning and stretching, so I pushed as hard as I could to get it over with! Bad idea...but I chose not to get stitches after discussing it with Karen. I healed just fine :)

Big sister Anna was very emotional, too!

Shortly after the birth, I looked at my sister and said, “THAT HURT”...ha! I told her I’d absolutely do it again, but I would need some time to forget first ;)

Anna has always been very sensitive to my emotions, so when I cried when we first got to the house, she got upset/nervous. Julie took her to the living room to find something on TV, but when I started pushing they came back to the bedroom. I’m sure Anna was nervous, not knowing what to expect, even though I had showed her videos of natural births. She cried and cried once Eli was born. It wasn’t a sad cry, more of a pent-up emotional release. She didn’t want to hold him until he had clothes on since he had pooped on me! Now, Anna says she is going to adopt…no childbirth for her! HA! I sure hope I didn’t scar her for life ;)

How You Give Birth Affects Your Breastfeeding Relationship

By Glenni Lorick, IBCLC

When thinking about birth option, mothers often fail to take into account the impact of birth on the initiation and establishment of the breastfeeding relationship. In this video I talk about that impact, and offer suggestions for mothers who want to get off to the best possible start.

Several key points to remember include the following:

• Research shows that babies born in an unmedicated birth tend to latch better right after birth than babies born to mothers with epidurals.
• Regardless of birth method, the single most important factor is skin-to-skin contact with your baby.
• It has been suggested that frequent feeding during the first 96 hours of life help to create prolactin receptors on your milk glands increasing the total amount of milk your body will ultimately produce. It isn't unusual for a newborn to nurse as many as 18 times a day in the early days. Let your baby nurse as frequently as he wants to.
• If you have a Cesarean, push for skin-to-skin in the operating room. If your hospital does not allow it, provide evidence for its efficacy and push. (the article referenced above includes several studies). The more mothers who push for it, the more quickly it will become accepted as routine practice.
• Make sure your care team is aware of your breastfeeding plan. As long as you and baby are both healthy, there is absolutely no reason for you to be separated at all. The AAP recommends that the newborn remain with mother throughout the recovery period. 

How did your birth impact your breastfeeding? Please leave a comment to help other mothers!

Women's Rights, Alabama Law and Midwives

For the last several years, an amazing group called the Alabama Birth Coalition has been working

Photo from SoulVegMama

tirelessly to bring about legislative change which will allow Certified Professional Midwives (CPM's) to practice in Alabama. This legislation is important because in many rural counties, women have to drive an hour or more to the nearest hospital with a maternity unit. Families who don't want medical community involvement may end up giving birth at home without any attendant at all. Legalizing CPM's and home birth would offer these women another option. Furthermore, creating legislation that sets forth licensing requirements and regulates the practice of CPM's actually helps to ensure that women choosing home birth receive a high standard of care.

The Opposition 

Opponents of the bill, however, are many and powerful. Unfortunately even within the midwife community, there is sharp disagreement about this legislation. Certified Nurse Midwives (CNM's) sometimes cite the lack of medical training received by CPM's as a reason not to support the bill. Are their concerns legitimate? Certainly the kind of training that CPM's receive is different in nature than that received by CNM's. It is definitely more focused on out-of-the-hospital births. In fact, a candidate cannot even become a CPM without experience in at least 10 births in a non-hospital setting.

While it is true that we do currently have 17 CNM's in the state of Alabama, only a very small handful of them are actually catching babies! Some work in doctor's offices, others teach, but only 3 or 4 hospitals in the state have a CNM delivering babies. Why is that?  Why isn't there a single freestanding birth center in this state? In one word, the answer is MONEY.  Blue Cross, Blue Shield of Alabama, the largest insurance provider in the state, doesn't reimburse for midwife delivery the way they do for a physician delivery...not even close! Plus, the Alabama law is written in such a way that a midwife may only practice under direct supervision of a physician. Essentially, her supervising doctor is supposed to be on the premises when a midwife is delivering. Few doctors are willing to have midwives deliver under those conditions.

The Reality

Dr. Pippa Abston 

Within the medical community here in Alabama, it is common to hear how unsafe home birth is. But is it really? Dr. Pippa Abston, a pediatrician and instructor in the UAB family residency program used to agree with those who opposed home birth. In fact, she was a rather outspoken opponent. However, she began to thoroughly examine this issue, to actually see what a CPM does, and to understand just how badly we need the quality of care in many Alabama communities that a CPM would provide. In fact, Dr. Abston wrote a 5 part series about the importance of CPM's for Alabama women. It will take some time, but if you really care about this issue, you need to read Dr. Abston's excellent series. She has covered everything from the training of  a CPM to the safety issue to the desperate need in our rural counties.

The Root Issue

This is, at it's most fundamental point, a human rights issue. Last Friday evening The Alabama Birth Coalition sponsored a presentation of the film, Freedom For Birth. Take 15 minutes to watch the abbreviated web-version of this film. It details the cases of Hungarian midwife, Agnes Gereb and Hungarian mother, Anna Ternovsky. In 2010, The European Court of Human Rights affirmed that a woman has the right to give birth in the place and manner of her choosing.

Hungarian midwife Agnes Gereb

The United States Supreme Court in the infamous Roe v. Wade decision in 1973 stated that a woman has the right to abort her unborn baby - a decision I don't personally support. However, based on that precedent, it is utterly illogical to say that she doesn't have the right to choose how and where her baby (whom she has chosen not to kill) can be born.  Even in the highly unlikely event that Roe v. Wade were ever reversed, it should be a common-sense decision to view a woman's right to give birth as she pleases as her decision to make. Whether a physician or a competent midwife  performs her prenatal care should be up to her. If a mother has chosen the midwifery model of care, and her midwife realizes that something is amiss, then her midwife should be able to have a collaborative professional relationship with a physician and should be able to stay with the mother throughout  whatever kind of birth the mother needs at that point. Opponents may say that this endangers mothers and babies. However, in the Netherlands where this is the model, the maternal and infant death rate is lower than that of the United States.

A Call to Action

There are many states in this country where women have absolute freedom to give birth in the manner that is most comfortable for them.  Alabama, however, is definitely not one of those states. We would do well to look at the maternity care models in states like Texas, Tennessee,  and New York. Two separate and very important things need to happen legislatively in Alabama:

Hungarian mother Anna Ternovsky

1. CNM's need to be authorized by law to work without direct physician supervision in any birth setting, and insurance reimbursement for their services needs to be mandated.
2. CPM's need to licensed and regulated by the state to ensure that mothers desiring their services are getting the highest possible standard of care. This will stop the mass exodus of birthing mothers to surrounding friendlier states, and allow mothers in the poorest Alabama counties access to local well-trained professional birth support.

Anna Ternovsky was willing to take her fight to the highest court that held jurisdiction over her country.  Will it actually take a mother here beginning that judicial fight to create the changes that must occur? I would hope that our legislators, midwives and physicians will find a way to come together in respectful support of mothers and babies before that happens. However, the Alabama Birth Coalition has been struggling for twelve years to bring about legislative change. Maybe now is the time to seek the kind of judicial ruling that will ensure all mothers have their basic right to give birth as they choose protected.

Someday I would love to see a Free-standing birthing center here in Huntsville where both CNM's and CPM's work together and have healthy collaborative relationships with local physicians. There is absolutely no valid reason why this can't happen. And I believe it will. If all those who are concerned about birth in this state would simply work together, we could lower our infant mortality rate, provide high-quality care to the poorest among us, and make certain that every Alabama mother receives her basic human right to the birth of her choosing.

Natural Birth 50+ years ago

I was born in the district of San Isidro in Lima, Peru.

Fortunately my mother didn't live in the United States when I was born. She lived in Lima, Peru. There was a wonderful German obstetrician practicing in Lima in those days by the name of Dr. Stricker. He operated the Clinica Stricker near Avenida Conquistadores in San Isidro, a lovely part of Lima.  Dr. Stricker was from the region of Alsace Lorraine in Germany. 

My mother doesn't know exactly where he received his medical training. But what we do know is that he was obviously a student of the work of Dr. Grantly Dick-Read, the author of the 1933 pioneering work, Natural Childbirth  which was eventually published in 1959 as Childbirth without Fear. 

Dr. Dick-Read's classic resource on childbirth.

When my mother first met with him (bear in mind this is 1959, when most US women were having babies with "twilight sleep") he told her that she would not have any anesthesia because she wouldn't need it for the natural process which is childbirth. He emphasized that she must exercise daily, and he gave her special exercises to do.  He also told her that she could only gain 18 lbs! (She was tiny to begin with....) In fact, he told her that if she gained more than that he wouldn't be able to be her physician. On that first visit he also told her that I would be breastfeeding right after birth.

During the course of her visits he explained that when she had contractions she would feel a lot of pressure. However, he never once referred to labor as pain. He explained to my mother that she would probably have to work harder than she ever had at anything in her life, but demonstrated absolute confidence in her abilities. 

This is the Lima my mother remembers!

Her water broke at 5:00 in the morning, but she didn't really worry about it because nothing was going on yet. Around 11:00 she called Dr. Stricker to tell him that she was having contractions -- still spaced far apart. Upon learning that her water had broken several hours earlier, he insisted she come in immediately. They brought her lunch (yes, he DID allow women to nourish themselves during labor), but apparently I interrupted her lunch....

It all happened rather quickly once labor really started; I was born in just a couple of hours.  She swears that there was no pain. She was exhausted, but it didn't hurt.  She had two nurses who helped her sit up when she needed to push. I was breach (yes, doctors back then knew how to deliver breach babies vaginally). He told her that the cord was wrapped around my neck and ordered her to push harder or I would die. So she did as she was told. 

Moments later there I was. They didn't even clean me up before laying me on my mother's stomach where I enjoyed my first meal at her breast. She didn't have any idea how extraordinary this birth was  because Dr. Stricker had, from the beginning, told her exactly how she would behave in labor. 

The Plaza de Armas in 1960

Every morning I was brought in to nurse at 6:00, and I nursed as often as I wanted until 10:00 at night. At 10:00 I was taken away to a nursery where I was expected to sleep until 6:00 the next morning. My mother stayed at Clinica Stricker for a week, so by the time we got home, she says I was trained to sleep through the night! 

I must say that I don't advocate separating mother and baby at night, but I do think that the majority of the things Dr. Stricker did were absolutely amazing! I am so thankful my mother had me in Lima instead of in the US! Fifty-three years later she is still one of the very most important people in my life. We talk daily and see each other several times a week. In fact, many days she is right here with me helping mamas at ANM. So next time you come in and see the lovely gray-headed lady behind the counter, be sure to let her know how much you enjoyed reading her birth story!