More and more we are hearing about women being “denied” a VBAC (Vaginal Birth After Cesarean) by their OBs, Midwives, or local hospitals. Here is some information that can help you get the birth you want and deserve:

#1- VBACS ARE NOT ILLEGAL! Anyone who tells you this is lying (or grossly misinformed.) Period.

#2- Any hospital that accepts Medicaid or Medicare that states they have a “VBAC BAN” is in direct violation of federal code 42CFR482.13 which states that any hospital that is federally funded can lose funding if they deny care and can lose all funding if a complaint is received. 

#3- EMTALA, Federal Emergency Medical Treatment and Labor Act, also known as COBRA or the Patient Anti-Dumping Law. EMTALA requires most hospitals to provide an examination and needed stabilizing treatment, without consideration of insurance coverage or ability to pay, when a patient presents to an emergency room for attention.

This means hospitals HAVE to take you if you show up in labor. If you have been denied a VBAC by a hospital or know of a hospital with a ban you can call EMTALA at (404)562-7500 to report them.  You can also contact www.medlaw.com if you have been threatened by a hospital for court ordered cesarean, told a hospital has a VBAC ban, or dropped from a providers care within 30 days of your due date or while you were in labor. 

#4-  Check out birthaction.org, specifically your state’s resource page on where you can file other complaints. Also check out  Birth After Cesarean for lots of other specific info on how to get your VBAC.

And last but most importantly!

#5- Contact a local home birth midwife! Even if you think “you could never have a home birth”, or “home birth is too scary!” it can be an eye opening moment when you sit down for a consultation with someone who protects normal, natural birth. It gives you  a chance to ask any and all questions you may have, understand how birth at home works, and provides you with an opportunity to see that not all midwives are long skirted, patchouli smelling, hand-it-to-the-man-ers(although we love those kinds too!!!) and are trained in handling low-risk birth outside of the hospital setting. 

Women have called these capsules “happy pills” and report phenomenal energy levels while taking them. Raw placenta is extremely high in hormones such as progesterone and oxytocin. Midwives have traditionally used fresh placenta to stop bleeding immediately postpartum by slicing off a piece of the maternal side and having the mother put this between her cheek and gums. The high hormone levels cause the uterus to close down and bleeding is diminished.

Here are answers to questions we receive frequently regarding placenta encapsulation:

Why should I consume my placenta?
During birth women lose 1/8-1/10 of their blood supply. The mammal placenta was made to be consumed and make up for this loss by giving the new mother essential fats, amino acids, vast amounts of iron
and essential hormones to aid the body in self recovery after birth.

Will placenta capsules help with my breast milk supply?
Dried placenta has been proven to increase a breast-feeding mother’s milk supply. The first and still one of the few ever studies on using placenta as a lactagogon gave incredible results. 181 out of 210 women who were given dried placenta to increase milk supply had positive results and saw an increase in their milk supply.
Placenta as a Lactagogon; Gynaecologia 138: 617-627, 1954

I’m delivering in a hospital. Can I still have my placenta encapsulated?
Absolutely! When you sign up for our service, we will provide you with instructions and paperwork to give to all your hospital caregivers to make bringing the placenta home easy and stress free for you.

How long does the placenta encapsulation take?
Once we receive your placenta we are usually able to complete the encapsulation process is about 24 hours.

How many capsules can I expect from my placenta?
It all depends on the size of your placenta. We have seen anywhere from 100 – 200 capsules from various placentas.

What about sanitation? I’ve been told the placenta is a bio-hazard.
Uninformed people call the placenta a biohazard. We thoroughly disinfect the area where we work before , during, and after the process. All of our equipment is used solely for encapsulation and is disinfected with a hospital quality cleaner that is effective against HBV and HIV (the viruses that cause hepatitis B and AIDS), EPA registered, and meets OSHA requirements for blood spill clean up. We are careful to go beyond OSHA’s rigid requirements to ensure total safety everyone involved.

I delivered some time ago; my placenta is in the freezer. Is it too late to encapsulate?
Absolutely not. Although it is best to process the placenta within six months, all hormones and some nutrients are still viable and beneficial.

Disclaimer
Despite centuries of safe placenta use, the information in this entry have not been evaluated by the Food and Drug Administration. The services we offer are not clinical, pharmaceutical, or intended to diagnose or treat any condition. Families who choose to utilize any such services take full responsibility for researching and using the remedies.

This story comes to us from one of our beautiful clients, Diana. She wanted to share her story with other mamas so that they might be empowered to fight for the birth that they want.

My story is a tad different from many women. I knew what I wanted from my birth experience. I knew from the very beginning that my body was made to do this so I treated my pregnancy as a blessing. In month 4 I went to my OBGYN and handed over the rough draft of my birth plan to see what their thoughts were. I was a member of a practice of 6 doctors, 5 women, and 1 man. The doctor during this visit sat down with me and said “You are going to need some sort of classes to help you get through your first birth naturally. Try either Bradley Method or Lamaze classes. But you’ll need something. We get a lot of women that want to do it naturally…..until they get into the labor suite. Women who prepare have a better chance.” That afternoon I got on my computer, contacted Melissa, the local Bradley instructor, and by 6 pm I was sitting in week 3 of a 12 week session. I got all the materials I needed and my partner, Anthony, and I looked forward to how the class would prepare us for the birth of our child.
Weeks went on and on and Bradley Method graduation day came. After completing the course I started toying with the idea of switching to a birth center birth though I planned on a hospital birth. Unfortunately, due to my pregnancy history of anemia, I was risked out of that being an option. Because of this same reason I did not consider a home birth because our house was too far from a hospital should anything go wrong. I had my final birth plan approved by the obstetricians who were on call around the time of my due date, I had two wonderful doulas, bags were packed, and I was prepared to deal with a hospital staff who may scoff at my desires to do things naturally.

At 7 pm June 18th my contractions began. They were not bad by any standards and I was able to talk and move. I must have baked 6 pounds of brownies for the hospital staff to enjoy. Comfort was an elusive state for me. My labor was not painful, just very uncomfortable. No position was the “right” one. The night passed and early morning came. Megan, one of my fabulous doulas, was called at the un-Godly hour of 4:00 am. She arrived at 5-ish and sat up with us all night/morning as we talked and joked. Labor progressed and contractions started to get more rhythmic. Their interval timing decreased and I started to get shaky. When I began heaving and vomiting regularly with contractions Megan was sure I was entering transition and we should leave to the hospital where my doctors would be waiting for me. We called ahead and arrived at roughly 9:00 am. I went to the office of the OBGYN practice and had a vaginal exam. Charlie, doula number 2, met us here. At this time I was I was 4 cm dilated.

I was sent down to triage and family started arriving to await the baby’s arrival. I was hooked up to a monitor to assess my progress. In my birth plan I clearly stated I wanted AS LITTLE INTERVENTION and MONITORING as possible. Though, to be fair, they informed me an initial monitoring would be required to see “where in the labor process my body was”. While this monitoring session was taking place I started to notice it was quite lengthy so I asked if everything was okay. The nurse replied “Well, the baby’s heart rate showed a deceleration and we need to monitor it to make sure it doesn’t happen again. If we can go for a full half hour with no decells we’ll be in the clear.” Let me prepare you now…..this is where it all started. Also, keep in mind these monitors are highly uncomfortable belts that strap around the largest part of your belly and squeeze whether you are contracting or not

After further monitoring the OB on call, Dr. R, arrived and read the findings as they were being sketched out by the machine. Dr. R was not thrilled. She suggested we go ahead and move to a room and keep me on the monitors. I told her I would not like to stay strapped down in a bed and asked politely if this was a possibility. She was happy to put me on mobile monitors that were wireless and even waterproof so I could labor in the tub. When I arrived to my room the nurses were told laboring in the tub had been approved by my doctor because my bag of waters had not broken. Apparently a tub labor is very rare at this establishment. But they sanitized everything and when I was all “monitored up” I got in. When in the tub, covered with a towel, family members trickled in and out to say hello and comfort me. I was only allowed 3 people in the room at a time so many people traded off.

While the tub was a wonderful place for me, the nurses were having a hard time letting me enjoy it because every time the baby would move they could not clearly hear the fetal heartbeat and they were under the impression it was decelerating. They claimed this was happening “too often for their comfort”. So out of the tub I went. I was laid down in the bed for another vaginal exam, as it had been about 2 hours since the first one. Still 4 cm. At this point the staff was starting to get slightly annoyed with my wishes to be mobile. When they would leave the room I would get up and move to my heart’s content. I continued laboring in the best way I saw fit.

I decided the tub was where I needed to be so I got in. I also decided the monitors were a little too much for me at this point and they came right off. They were causing too much discomfort and unnecessary panic from the staff. Of course when there was no reading being emitted from the machine a nurse rushed in quite panicked until she saw me. She asked me to return to the bed, even though I was clearly in the middle of a contraction, she tried assisting me up. Anthony told her politely to please wait until I was finished with the contraction before trying to help me into bed. After the contraction ended I told her the tub was where I was going to stay and that if I absolutely had to, I would hold the monitor responsible for the fetal heart rate reading to my belly and move it as the baby moved to be sure they could hear everything properly. Straps were not an option any longer. They baby continued to kick the monitor as if to say “Get that thing out of here.”

Another hour passed and the nurses were getting quite worried about the baby. Charlie, my second doula, informed me “What they failed to inform you of is that heart decelerations are normal during contractions due to constriction and that a few are nothing to worry about.” She was reassuring me that everything was ok and to listen to my instincts about the baby. These instincts also reassured me things were perfect. My last little bit of confidence came from the fact that the baby was moving and that even when she moved you could hear a faint heartbeat coming from the machine at an obviously NOT slower rate than before.

Even so, Dr. R came in and informed me they were going to start IV fluids and oxygen. I told her no. Anthony told asked her “Why?” In my birth plan I specifically outlined IV fluids were not an option. She asked us why and my explanation was evidently not good enough for her. For the next 30 minutes Dr. R and the nurse argued with Anthony, myself, and Charlie about IV fluids stating they were needed to help keep the baby’s heart rate up. They did not relent just because a contraction came. They did not relent when Anthony and Charlie asked them to please stop talking to me during contractions. Eventually I consented to wearing an oxygen mask for a few minutes to get them off my back and they gave up about IV fluids. I then went back to mobile laboring and the machine kept pushing out readings.

After this oxygen treatment failed to work to their liking, they went off to a corner of the room. There was a decent amount of whispering as they reviewed my birth plan. Charlie informed me, after eavesdropping, they were going to start asking me to consent to things I previously told them I would like to avoid. IV fluids were once again brought up. I was asked to return to and stay in the bed. I did neither. I continued to move around. I continued to do what felt natural and right for me.

When Dr. R returned for the 5th time and completed the third vaginal exam I was still 4 cm. It had now been 5 hours. At this point the serious conversation which led to much insult towards myself began. I explained to the nurse who was “caring” for me that I disagreed with the reading coming from the monitor. I knew that movement was a good sign and told her “the heartbeat only decelerates when the baby moves into a new position and the monitor can’t get a good reading. I think it’s slightly misgiving.” She seemed to not hear a word and pressed on with the issue of heart decells. Anthony interjected with a similar statement to mine but she cut him of to say “We go to school for YEARS to learn to read these machines. I think I know when I see a decell in a fetal heart rate.” At this point we knew in what direction things were headed.

Dr. R started telling me that if there was no progression within the next few hours we would have to start considering breaking my bag of waters. In a previous office visit I asked how many hours they would wait during labor until deciding it was necessary to break the bag and this same doctor told me to my face “18 to 24 hours depending on the condition.” Again, it had been 5 hours. I didn’t object, just listened to what she had to say, knowing what I was willing to do to get my ideal birth. Contractions came and went, Dr. R and her nurse came down hard about starting interventions I was not comfortable with. Finally the exchange of words which can be called no less than a one-sided argument as I refused to let myself become flustered by their persistence came to a zenith when my own doctor, whom I hired, voiced to me verbatim “I can get an order of non-compliance to properly treat this child,” It was this statement which lead to my decision to go home.

I stopped talking. Dr. R said her peace. The nurse continued to monitor me and the baby. After a few minutes the nursing coordinator for the hospital was sent in to try and convince me to stay. She was very nice, but then again someone had to be in order to get me to stay. I knew I had to maintain with her my viewpoint that I needed to be in a caring and nurturing environment in order to properly deliver my child. I told her the hospital had been nothing but stress since the moment of my arrival and that it was my belief that this was the cause of my failure to progress. I told her there was no other option for me but to return home. I looked my doctor in the eye and told her I was sorry if she felt I was insulting her expertise, as that was not my intent, but for the health of myself and my child it was in my best interest to leave.

I can honestly say I don’t remember the ride home. According to Anthony I slept through most of it, awaking only when I had a contraction. At home our tub was sanitized and Charlie prepared me a wonderful lavender oil filled bath to labor in. I got in and slept a bit. After no more than 30 minutes my labor started getting much harder. My moaning got much deeper and new instincts came over me. I wanted to get out of the tub. I wanted to stand, I wanted to be on all fours, I wanted to sit on the toilet and try that. I could not get into a position I was okay staying in. My restlessness eventually landed me on all fours, with my head against a wall for support. Anthony helped me then sit and sat behind me to help me. After another 30 minutes of position “musical chairs” I settled on all fours again. While all this was happening my father was having a panic attack after listening to what the nurses and doctors told him while we were at the hospital. So he decided he needed to come into the bathroom where I was laboring with Anthony, Charlie, Megan, my mother, and my best friend to tell me I was being irresponsible and should get my ass back to the hospital. He neglected to recognize my calm efforts to tell him this was not the time and continued to upset me to the point of sending me into a contraction. It came on hard and, this time, with the sensation I needed to use the bathroom.

I looked at Anthony and told him to get Charlie and Megan. I told them I thought we should go. Since I had not yet experienced a feeling of “I can’t do this” and they didn’t want to leave too soon to the hospital and risk a repeat of that morning, they told me they thought we should wait a little longer. A minute later another contraction came on and I looked Anthony in the eye saying in all the seriousness I could muster, “We need to go now”. As I was contracting I reached back and felt the baby crowning along with a strong urge to push. I calmly tried to control my breathing and the head went back up into the canal. We packed into the car. Anthony drove his SUV as my mom rode shot-gun. I was in the back bent over the car seat on all fours once again. We sped off t the hospital hoping no cops would try and stop us while Anthony did 80 mph in a 40 mph zone. We ran one red light (after stopping and checking for oncoming traffic).

Halfway there the baby crowned again. I told my mom “Look.” She turned over her seat and said “Oh my God, that’s the head.” I was able to again, keep calm and let my baby go back in. As we had the hospital in view I finally felt the contraction that wasn’t going to be controlled. I told my mom to tell me how far out the baby was and she said “Ok the nose is out, you need to push.” I pushed and out came the head. One more push and I heard my baby crying. We were in the hospital parking lot. My mom proclaimed “He’s here! He’s here!” I said “It’s a boy?!?!” She replied “No! It’s a girl!!!” My daughter was finally here. Anthony flew out of the car to get nurses and doctors and after we got all situated on the stretcher with a crowd of onlookers amazed at the rare event of a “car-baby” we were wheeled inside. I kept my daughter held close with the umbilical cord still in tact as her APGAR scores were taken. Anthony cut the cord. I was given a small private room just outside of the ER to deliver the placenta. As soon as that was done Anthony carried in our daughter with the most awe-struck expression on his face. We looked down at her in pure amazement with full knowledge our lives had just been changed forever. Mirielle Airi Diez De AShe’s the love of my life.
ndino was born at 6:54 pm on June 19th 2009 weighing 5lbs 10 oz and measuring 19 ¾ inches long. The smallest angel I’ve ever seen.

The quality of infant formula is of paramount importance in the United States–where, despite the American Academy of Pediatrics’ endorsement of breastfeeding for a minimum of twelve months and WHO’s recommendations to breastfeed for at least two years–only slightly more than half of all mothers offer their newborns any breast milk at all. Fewer than twenty-two percent of American babies are still breastfed at five months of age, and this figure drops to under ten percent by twelve months. These statistics mean that the vast majority of American babies rely solely on the synthetic infant nutrition known as infant formula for their critical first year of life.

Minority and disadvantaged children are most likely to be fed a diet of artificial breast milk substitutes. The United States government’s food program for Women, Infants and Children (WIC) serves the nutritional needs of low-income women and children, and is the single greatest purchaser of commercial infant formula. WIC provides free infant formula to thirty-seven percent of all infants born in the United States at a cost of almost $600 million annually.

With so many American babies–particularly those at socioeconomic risk–relying on this single food source for their growth and nutritional well-being, it is incumbent upon those concerned with infant-maternal health issues to examine breast milk substitutes carefully and critically. Unfortunately, many health-care professionals and public-health officials avoid scrutinizing the production and marketing of commercial infant formula in the United States under the mistaken assumption that providing consumers with all the facts on synthetic infant nutrition will cause bottle-feeding mothers to feel guilty for not breastfeeding. In fact, this unwillingness to explore the safety and nutritional competency of infant formulas retards consumer pressure for better quality product. Marsha Walker, R.N., International Board Certified Lactation Consultant, and recognized expert on infant-nutrition, wrote in a September, 1993 issue of THE JOURNAL OF HUMAN LACTATION, “This paternalistic view seeks to protect women from making ‘poor’ choices for themselves and their infant, and robs parents of the right to informed decision making. Withholding information generates more anger than guilt in parents . . . “

Formula manufacturers aggressively promote the idea that today’s “highly-scientific” breast milk substitutes have been “specially formulated” to be “like breast milk.” One leading manufacturer’s advertising campaign even equates its product to a “miracle.” Yet, common commercial representations fail to reveal the rest of the story: researchers are increasingly convinced that despite advances, infant formulas cannot now or ever accurately imitate human breast milk. According to the Food and Drug Administration (FDA), pediatric-nutrition researchers at Abbott Laboratories, one of the largest manufacturers of commercial infant formula, recently conceded that creating infant formula to parallel human milk is “impossible.” These scientists, writing in the March, 1994 issue of ENDOCRINE REGULATIONS, state, “[It is] increasingly apparent that infant formula can never duplicate human milk. Human milk contains living cells, hormones, active enzymes, immunoglobulins and compounds with unique structures that cannot be replicated in infant formula.”

Some infant-health advocates advise a move away from formulas based on ingredients such as cow’s milk and soybeans–undoubtedly chosen for their agricultural abundance and low cost–and call for the development of formulas based on milk closer in composition to our own. Indeed, some researchers are asking why infant formula cannot be prepared on a base of human milk.

In the meantime, commercial infant formulas are not only distant in composition from human milk, but various brands of synthetic milks aren’t even comparable to one another. Contrary to what the name implies, there is no fixed “formula” for commercial synthetic milk. Content and quantities of nutrients vary widely between brands and types of formula (soy, cow’s milk, and meat-based). According to formula manufacturers, a pediatrician should recommend an appropriate brand and type of formula for each particular baby–advice implying that each baby’s nutritional needs are unique and that physicians can recognize these special needs upon examination and select a formula accordingly. This is, of course, neither accurate nor possible.

Compositional variance between formulas persists because manufacturers must attempt to simulate a product for which they do not have the recipe – a fact FDA officials recognize in their recent statement that “. . . . the exact chemical makeup of breast milk is still unknown.” As Marsha Walker notes, “Formula-fed infants depend on products which can be quite different from each other, but which are continually being found deficient in essential nutrients . . . These nutrients are then added, usually after damage has occurred in infants or overwhelming market pressure forces the issue.”

Iron fortification serves as a startling example of this ongoing experimentation on infant consumers. Today’s breast milk substitutes are designated as either iron-fortified or low-iron. However, William J. Klish, M.D., chairman of the American Academy of Pediatrics Committee on Nutrition (the body which recommends formula-nutrient requirements to the FDA) states: “There should not be a low-iron formula on the market for the average child because a low-iron formula is nutritionally deficient.”

The Food and Drug Administration, which allows the mass marketing of low-iron formulas, states that “researchers continue to try to determine the best amount of iron for infant formula. While low iron formulas don’t supply enough iron, the best amount of iron for formulas has not been established.” Dr. Klish verifies that the medical community “did not have much data at the time the regulations [which are still in effect today] were written for different intake levels of iron.” Studies are now underway to determine how much iron should be included in a can of infant formula. Meanwhile, commercial formulas can offer no real assurances that bottle-fed babies are receiving the proper amount of this vital nutrient. The late Dr. Derrick Jelliffe was quoted in a 1980 interview with the WALL STREET JOURNAL as saying, “Hindsight shows the story of formula production to be a succession of errors. Each stumble is dealt with and heralded as yet another breakthrough, leading to further imbalances and then more modifications.”

Yet another contentious issue in the manufacture of infant formula involves the omission of docosahexaenoic acid (DHA). Although most formula sold in the United States still lacks this ingredient, many other nations have now mandated that DHA be added to all commercial infant formula. DHA was recently discovered to be an important component in human breast milk, leading to optimal neurologic development. Several peer-reviewed medical studies have now revealed that formula feeding is consistently associated with learning deficiencies later in childhood.

Researchers have demonstrated that, even after adjusting for socioeconomic and educational differences among parents, children who were not breastfed as infants experience significantly lower test scores on several measures of cognitive ability, including the Denver Development Screening Test, and the Bayley Mental Development Index. One 1994 study reported in DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY showed some aspects of intellectual attainment at five and ten years of age to be inferior among children who were formula-fed compared with those who were exclusively breastfed for at least three months. In another 1988 study, test scores were directly correlated with duration of breastfeeding; the more months a child was breastfed, the higher she scored on the test.

One of the least publicized risks of infant formula is inescapably inherent in the consumption of any commercially prepared and mass-marketed food product: between 1982 and 1994 alone, there were twenty-two significant recalls of infant formula in the United States due to health and safety problems. At least seven of these recalls were classified by the FDA as “Class I,” meaning the problem could be life threatening. In several instances, random lots of lab-tested infant formula have been found to contain bacterial and elemental contaminants that, while a risk to infant health, do not rise to the level of threat considered appropriate for a widespread recall by the FDA. In February of 1995, FDA special agents uncovered a successful criminal scheme in California in which thousands of cans of substandard infant formula had been improperly labeled for resale. No one knows how many infants received this counterfeit product in their bottles.

Many consumers are under the mistaken impression that the FDA closely and carefully monitors infant formula, perhaps more scrupulously than other foods, since infant-consumers are particularly vulnerable by virtue of their age and total dependence on this one product. In fact, the FDA sets forth only minimal standards regarding the production and sale of synthetic milks. The mandated nutrient requirements for formula are contained in the outdated Infant Formula Act of 1980, which the U.S. Congress passed in reaction to a formula-manufacturing error that flooded the market with chloride-deficient formula. Today, manufacturers are required simply to include an insignificant number of mandated ingredients and to list them on the package.

News of any real health risks associated with modern formulas surprises most Americans, whose only point of reference on the subject is often the well-publicized Nestle Boycott of the 1970s and ’80s. Many Americans recall seeing the photos of severely malnourished “bottle babies” from various third-world nations as consumer-advocacy groups alerted citizens for the first time to the marketing practices being employed in the third world by major infant-formula corporations.

Physicians and other health-care providers in the developing world were influenced by formula manufacturers to steer patients away from breastfeeding and toward a particular brand of synthetic infant nutrition. Age-old cultural norms of exclusive and extended breastfeeding were disrupted as huge advertising campaigns convinced women that commercial infant-formula was the “modern, sterile, western” way to feed babies. New mothers were lured into giving birth in hospitals funded by infant formula manufacturers. There, these women were encouraged to offer bottles of artificial breast milk substitutes–a practice proven to disrupt breastfeeding.

Mothers and babies were then sent home with a small “free” supply of infant formula. By the time the supply ran out, baby was refusing the breast, mother’s own milk supply was diminished, and the typical, impoverished family was unable to pay for any more infant formula. These practices, combined with an unsanitary water supply, lack of sterilization and refrigeration facilities, and poor access to medical care, conspired to kill millions of Third-World babies each year, according to the World Health Organization (WHO).

That is why, in 1977, a world-wide boycott was launched against Nestle Corporation, determined to be the most egregiously unethical actor in this sad drama. Consumers all over the world stopped purchasing Nestle products, and WHO convened a meeting to discuss what could be done to influence corporations marketing breast milk substitutes in the Third World. At the time, the acting World Health Director stated, “In my opinion, the campaign against bottle-feed advertising is unbelievably more important than the fight against smoking advertisements.”

WHO subsequently drafted the International Code on the Marketing of Breast Milk Substitutes. The Code’s main points called for no sales promotion to the public of products used as breast milk substitutes, and distribution of factual, ethical information to parents by health care workers. While the rest of the world signed onto the Code in the early 1980s, the United States withheld its support until the Clinton administration voiced its approval in 1994. Public-health and consumer activists have charged that Nestle and other corporations continue to violate the Code. According to WHO and UNICEF, between one and two million infants around the world still lose their lives each year due to artificial feeding. That is why, after a brief hiatus, the Nestle Boycott was relaunched in 1988 and continues to this day.

While American parents of the ’90s may find information about bottle-feeding in the Third World interesting, most consider it irrelevant to their own infant-feeding choices, and believe that differing health outcomes between breastfed and artificially fed infants are minimized, if not negated, when the artificial breast milk substitute is a modern, commercially available product, regulated by the government and prepared in a sanitary fashion. Although it is estimated that the risk of death from diarrhea in less-developed nations is twenty-five times greater for bottle-fed infants than for breastfed ones, artificial feeding methods still carry significant health risks in the United States. Naomi Baumslag, M.D., MPH, and Dia Michels note in their book, MILK, MONEY AND MADNESS (Bergin and Garvey, 1995): “Even where bacterial contamination can be minimized, the risks of bottle-feeding are not inconsequential. Bottle-fed infants raised by educated women in clean environments, to this day, have significantly greater rates of illness and even death… In a study that analyzed hospitalization patterns for a homogeneous, middle-class, white American population, bottle-fed infants were fourteen times more likely to be hospitalized than breastfed infants.”

According to Diane Weissinger, International Board Certified Lactation Consultant and nationally-known speaker on the topic of infant nutrition, “The only advantage that American women who formula-feed tend to have over Third-World women is better sanitation and medical care–and that’s far from a culture-wide advantage. That in no way alters the long list of ailments to which their bottle-fed babies are prone.”

The Texas Department of Health’s Bureau of Nutrition Services says that artificially fed infants in the United States are three to four times more likely to suffer from diarrheal diseases (the number-one killer of infants worldwide), four times more likely to suffer from meningitis, and have an eighty-percent increase in the risk of lower respiratory infections. Marsha Walker, in her article, “A Fresh Look at The Risks of Artificial Feeding,” published in the JOURNAL OF HUMAN LACTATION in 1993, refers to research demonstrating that artificially-fed babies see their risk for moderate to severe rotavirus gastroenteritis increase by five-fold. “Formula feeding is consistently associated with immune system disorders,” she states. “Formula feeding accelerates the development of celiac disease, is a risk factor for Crohn’s Disease and ulcerative colitis in adulthood, accounts for two to twenty-six percent of childhood-onset insulin dependent diabetes mellitus [and] imposes a five- eight-fold risk of developing lymphomas in children under fifteen if they were formula-fed or breastfed for less than six months.” One of the most startling discoveries concerning artificial feeding is that it appears to increase an infant’s risk for Sudden Infant Death Syndrome. The U.S. Centers for Disease Control’s Morbidity and Mortality Weekly Review reported in 1996 that lack of breastfeeding (or artificial feeding), along with exposure to tobacco smoke and a prone sleeping position, is now recognized as one of the only known modifiable risk factors for SIDS.

Not surprisingly, in light of health risks associated with formula, is the 1995 study by Kaiser-Permanente Health Maintenance Organization in North Carolina finding that these babies’ annual health costs averaged over $1400 more per infant than their breastfed counterparts. Unfortunately, even with the excellent medical care available to most American infants who become ill with formula-related maladies, the infant mortality rate has repeatedly been shown to be higher for U.S. infants who are fed infant formula. Research conducted by the U.S. National Institute of Environmental Health Sciences estimated that for every 1,000 infants born in this country each year, four will die because they were artificially fed. In another study, Dr. Miriam Labbock, a nutrition expert at Georgetown University, says that universal breastfeeding in the United States during the first twelve weeks of life could lower the overall U.S. infant-mortality rate by almost five percent.

Many Americans respond to the recent explosion of research into the hazards of artificial feeding by pointing out that most bottle-fed infants appear to be “just fine.” Infant-health advocates counter that the vast majority of infants who ride without a car seat or who are placed to sleep in a face-down position will also be “just fine,” yet concerned caregivers take the precaution of buckling children up and placing them to sleep in the medically recommended position in order to lessen risks to their health. The same is true for artificial feeding. While not every bottle-fed infant will become ill, a large and convincing body of information now demonstrates that as a group, these infants’ risk for negative health outcomes is increased by a statistically significant margin.

Still, many parents simply cannot believe that their own doctor or hospital would take a neutral or even pro-formula stance if it posed such a threat to their babies’ health. It would, indeed, be puzzling why physicians have continued to ignore the ever-growing mountain of evidence warning against routine artificial feeding for infants–if it were not for the close ties between formula companies and the medical establishment. The manufacture and sale of artificial breast milk substitutes is a hugely profitable venture. The average bottle-feeding family in the United States spends $1500 to $2000 per year on infant formula. According to the Attorney General of Florida, for each dollar charged for infant formula, the manufacturer spends only sixteen cents on production and delivery. This renders an astounding profit margin for the manufacturers. With such a lucrative product to promote, corporations have wisely enlisted the assistance of new parents’ most trusted advisors–health care providers–in order to retain and increase their markets.

According to Baumslag and Michels in Milk, Money and Madness, the infant-formula industry contributes $1 million annually to the American Academy of Pediatrics (AAP) and provided at least $3 million toward the cost of building the AAP’s headquarters. Formula manufacturers routinely host lavish parties and receptions for pediatricians at AAP functions. Other medical groups, such as the American College of Obstetricians and Gynecologists, the American Medical Association, the Association of Women’s Health, Obstetric and Neonatal Nurses, and the American Dietetic Association receive cash grants and advertisements for their publications totaling hundreds of thousands of dollars annually.

Individual medical students and doctors receive loans, grants, and “gifts” from the pharmaceutical companies which produce infant formula, and a 1991 study found that the U.S. pharmaceutical industry spends $6,000 to $8,000 per doctor per year in promotion. Increasing amounts of medical research into infant health and nutrition is being underwritten by the infant formula industry. Physicians and nurses who choose to formula-feed their own infants frequently receive a year’s free supply of formula. With all of this financial support, it’s no wonder the U.S. medical community accommodates infant-formula manufacturers’ distribution of advertising and “free samples” to parents in doctors’ offices and hospitals, a practice which has been proven to discourage breastfeeding and which is in clear violation of the WHO Code on the Marketing of Breast Milk Substitutes. The infant-formula industry needn’t worry, however, since health care providers are the group ethically responsible for reporting Code violations in the first place.

At present, concerned parents clearly cannot rely upon the medical community, the government, or the formula manufacturers themselves to effect change in favor of better quality commercial infant nutrition. It will require a consumer movement in the United States approaching the scale and intensity of the Nestle Boycott to bring about reforms. In the meantime, breastfeeding–an option available to an estimated ninety to ninety-five percent of new mothers–remains the safest, least expensive, and most healthful choice in infant feeding.

http://www.breastfeeding.com/reading_room/what_should_know_formula.html

      “It’s not your birth.” This is a phrase I hear quite frequently from other birth professionals. Whether they are childbirth educators, doulas, or midwives. That statement seems to be an automatic reply in the birth community when a women chooses something that we know, on a professional level, is an unhealthy choice. Whether it be birthing in a hospital, allowing interventions, or choosing not to breastfeed. Are we, as a birth community, standing idly by while mother’s make uneducated choices because it is politically correct?
     As a doula, I feel it is my duty to educate women on the options they have regarding their birth. With my daughter I desperately needed someone to educate me. I needed someone to say that the hospital is not the place for a healthy woman to give birth. Someone to explain that out of hospital births are just as safe, if not safer, as hospital births. I wish someone would have told me my choices were not the best. I wish someone would have been brutally honest with me. Sure, it was MY BIRTH…but doesn’t every mom want what is best for themselves and their babies? Don’t we all as mothers want to give our children the best start possible?
      I understand a natural, intervention free homebirth is not the right choice for every woman. However, shouldn’t we encourage all women to do their research on what is the best birth? Shouldn’t we be providing them with good information and not leaving them at the hands of a Google search? Midwives, you should be shouting about your good outcomes from the rooftops! Doulas, tell every pregnant woman you meet about what you have to offer! Give them the numbers, the facts, book recommendations. Childbirth Educators, give women the truth. They have come to you because they WANT to learn. They need to know what really lies ahead for them at the hospital if they choose to birth there. They need to know that interventions during pregnancy are not always necessary. They need to know what to expect out of a homebirth. Lets teach women that it is their body and their choice to birth however they choose.
     I will say, that if after we all do our jobs to adequately inform parents, that it is ultimately their choice to choose what is their best birth. Like many other things, we take all of the information we have acquired and apply it how we feel is appropriate in our lives. At the end of a woman’s journey into motherhood she should be able to say, “I made the best educated choice for myself and my family, and I do not regret anything about it.”
      We, as a community, need to stop making the excuse of “its not your birth” and start reaching out and sharing valuable information with childbearing women. No, It is not my birth…but it is my job as a fellow human being to stand up for what I believe in, what my quest for information has taught me. It is my job to make sure there is never another woman who crosses my path who will end up with a traumatic birth experience because she simply did not know any better.

There’s a saying that birth is as safe as life gets. Sometimes birth can become dangerous for the baby or, very rarely, for the mother. This is when hospital-based maternity care really shines, and we’re able to save mothers and babies who might have died a hundred years ago. Thank goodness that there are skilled surgeons who can come to the rescue when truly necessary.

There’s also a saying that when you’ve got a hammer in your hand, everything looks like a nail. So it is that for hospital-based birth attendants, it is easy to become accustomed to treating every birth as a disaster waiting to happen. Many obstetricians have lost touch with the possibility of normal birth, so much so that even a pitocin induction with an epidural, fetal scalp electrode and vacuum extraction is called a “natural birth”. Some hospital staff seem offended by the idea of minimizing interventions, as if preferring not to have a needle the size of a house nail inserted near your spine is the same as declining to have a second piece of Aunt Sally’s Fruit Cake. Sadly, some of today’s younger doctors may never even have seen a truly physiological labor and birth—a birth completely without medical intervention.

This is how the saving grace of the hospital can become the scourging disgrace of maternity care. In their rush to prevent problems that aren’t happening, hospital personnel may aggressively push procedures and drugs that can actually cause problems. Pitocin can cause uterine contractions that are so strong that they stress the baby and cause fetal distress. [1] IV narcotic drugs affect the baby so strongly that the baby may not breathe at birth [2] ; there is even a specific drug that is used to counteract the narcotics to help these drugged babies to breathe . [3] There is considerable debate as to how epidurals affect the progress of labor, but they certainly affect a woman’s ability to get into a squat, which opens the pelvic plane by 20-30%; anyone can understand that this could affect the possibility of the baby’s fitting through the pelvis. Epidurals can lower the mother’s blood pressure so that the baby isn’t getting enough oxygen through the placenta; this can cause fetal distress and the need for an emergency c-section to rescue the baby . [4]

In addition to the specific dangers of individual obstetric interventions, hospital births suffer the effects of any form of institutionalized care. Perhaps the best-known risk of hospital birth is hospital-acquired infections. Those most susceptible to hospital-acquired infections are those with compromised immune systems, such as newborns. In particular, babies are born with sterile skin and gut that are supposed to be colonized by direct contact with the mother’s skin flora. If antibiotic-resistant hospital germs colonize the baby’s skin and gut instead, the baby is at high risk of becoming very sick from infections that are very difficult to treat. The overall infection rate for babies born in the hospital is four times that of babies born at home [5], and these infections are more likely to be antibiotic-resistant.

More people die every year from hospital-acquired infections (90,000) [6] than from all accidental deaths (70,000), including motor vehicle crashes, fires, burns, falls, drownings, and poisonings. An additional 98,000 people die each year from general medical error . [7]

Another obvious risk of institutionalized care arises from the piecemeal nature of the care. Because there are so many different kinds of personnel performing so many different procedures, there is a lot of potential for miscommunication about critical matters. In an astoundingly progressive admission of institutional shortcomings, Beth Israel Hospital published a paper [8] about a tragic miscommunication that resulted in a baby’s death. To their great credit, instead of covering up this horrible mistake, they used it as a wake-up call to revise their protocols, in an attempt to reduce miscommunication and increase safety. Unfortunately, other hospitals are slow to adopt the reforms of Beth Israel Hospital.

One of the most dangerous aspects of hospital care is that those providing most of the direct care (i.e. the nurses) are hierarchically subservient to those managing the care from a distance (i.e. the doctors). This kind of a power structure can prevent knowledgeable nurses from mitigating the potentially dangerous actions of the doctors.

Many people feel that the hospital must be the safest place to birth because of all the equipment they have. Well, the equipment is only as good as the people using it. In many hospitals, there are not enough Registered Nurses to cover all the patients, so they use Medical Technicians, who are trained to perform procedures but not necessarily trained to interpret fetal heart tracings. Most labors start at night, and women birthing second or subsequent babies often birth during the night. This is the time when the senior staff are home sleeping in their beds, because their seniority allows them to opt for the more desirable daytime shifts. A recent study confirmed that outcomes at births are worse during the night, because even the most sophisticated equipment is useless in the wrong hands . [9]

(For the record, many homebirth midwives now carry equipment that is as sophisticated as that in most hospital birth rooms. This includes continuous electronic fetal monitors and equipment for performing neonatal resuscitation if necessary.)

Institutionalized care also suffers from the economic pressures of running an efficient organization, regardless of how this might interfere with the normal process of labor and birth.

Sometimes doctors recommend pitocin without true medical necessity, simply to hasten the birth. This may be due to a need to free up a birth room to make room for other patients, or because the doctor has other responsibilities elsewhere. Stimulating labor artificially overrides the baby’s ability to space out the contractions if the labor is too stressful. This increases the risk of fetal distress.

Hospital staff have a strong bias towards confining the laboring woman to the bed and requiring her to push in a reclining position. This often puts the baby’s weight on the placenta or umbilical cord, possibly restricting the baby’s supply of oxygenated blood from the placenta. In contrast, upright positions put the baby’s weight downward, towards the open cervix and away from the placenta and umbilical cord, reducing or eliminating fetal distress caused by cord compression.

A rush to clamp and cut the umbilical cord within seconds after birth is one of the most dangerous hospital practices. This premature severance of the umbilical cord cuts the flow of oxygenated blood to the baby before the baby has established the lungs as the source of oxygen. Premature cord clamping also deprives the baby of the blood that would naturally fill the pulmonary vasculature as it expands in the minutes immediately after the birth. This practice is documented to increase the risks of neonatal hypoxia, hypovolemia, and anemia, thus increasing the need for blood transfusions. [10]

There is some very new research showing that placental tissue itself may be a rich source of pluripotent stem cells, in addition to the blood stem cells in blood drawn from the umbilical cord. [11] We do not yet know whether premature cutting of the umbilical cord halts the migration of pluripotent stem cells from the placental tissue into the baby’s body to repair damage from even minor birth trauma.

Perhaps the most egregious and unnecessary interference with the normal birth sequence is the separation of mother and baby immediately after birth. Even a ten-minute separation is too long during this critical first hour after birth – it prevents the natural nipple stimulation that increases the mother’s oxytocin to contract the uterus and prevent a postpartum hemorrhage.[12] Instead of baby-provided nipple stimulation, hospitals are now routinely using synthetic oxytocin by IV or injection after the birth to control bleeding.

Similarly, early cuddling of mother and baby stimulates oxytocin production in the newborn, thus raising the baby’s body temperature to help with the adaptation to the extrauterine environment. The mother’s body is the best warmer for the newborn. [13]

Because different personnel are involved in providing piecemeal care for mothers and babies, providers do not always see how their actions in one area may cause problems in another area. For example, because obstetricians are not involved in breastfeeding issues, they may not realize that cutting an episiotomy hampers a woman’s ability to sit comfortably in order to nurse her baby. Likewise, the pediatricians also are not involved in breastfeeding, so they may not realize that separating the mother and baby right after the birth in order to do a routine newborn exam also interferes with breastfeeding. Nursery nurses often do not seem to appreciate the importance of minimizing the separation of mother and baby and thus also unwittingly interfere with breastfeeding. They tend to ignore the World Health Organization’s recommendations to delay initial bathing of the baby until at least six hours after the birth, even though bathing causes the baby’s temperature to drop so dangerously low that they do not return the baby to the mother for an hour or more. [14] [15]

I emphasize the hazards to the breastfeeding relationship because breastfeeding is so vital to a newborn’s well-being, reducing infant mortality by 20%. [16] This is a huge health benefit, and hospitals should be taking the lead in tailoring their routines to support breastfeeding. But because the functions of caring for mother and baby are separated into the roles of maternity nurses (who care for the mothers) and nursery nurses (who care for the babies), sometimes the mother and baby are also physically separated. Most of the time, there are no lactation consultants in the hospital – they are often only available during weekday business hours. But babies need to be fed around the clock, and if a Lactation Consultant isn’t available to help a struggling mother/baby pair, it might become necessary to feed the baby artificial breastmilk with a bottle, which further interferes with successful breastfeeding.

Because the entire model of hospital birth is based on the birth as a medical procedure, hospital staff seem to miss the fact that they are interfering in a delicate time in a new baby’s life. Perinatal psychologists describe the first hour after birth as the “critical period”, during which the baby will learn how to learn and whether or not it is safe to relax and to trust the outer world. This has tremendous implications for mental health and stress-related disorders. [17]

There was a time when cesareans were acknowledged to be a risky surgery reserved to save the life of the mother or baby. Now even cesarean surgery has become almost routine. Some obstetricians and hospital administrators are advocating for a 100% cesarean rate as a solution to liability and scheduling problems that are inherent in providing maternity care. [18] Unfortunately, cesarean surgeries increase risks for the mother and for this baby. They also increase the risk for subsequent pregnancies, with higher rates of placenta previa and placenta accreta, and small but non-zero risk that a pre-labor uterine rupture could result in the baby’s or even the mother’s death.

When someone needs to be in the hospital and needs to be receiving medical treatment for a life-threatening condition, the risk-benefit tradeoff comes in heavily on the side of benefit.

But for women who are hoping to have a drug-free birth, it makes no sense to expose themselves to the infection risks associated with simply being in the hospital. Most people know that it is unwise to take a newborn baby out and about in public because of the risk of exposing the baby even to ordinary germs. It is even a worse idea to expose the baby to the antibiotic-resistant strains of germs commonly found in hospitals.

When a woman planning a homebirth needs medical care and care is transferred to a hospital-based provider, the phrase “failed homebirth” is often written in her chart, even if she goes on to have an outcome that is better than if she had started out in the hospital. I would like to propose the concept of a “failed hospital birth” as any birth where hospital procedures specifically cause more problems than they solve. When you consider hospital infection rates, surgical complications, and the damage to the breastfeeding relationship caused by routine separation of mother and baby, we might find that close to 95% of planned hospital births are failed hospital births. They failed to support the mother in an empowering birth experience to better prepare her for motherhood, and they failed to satisfy the baby’s overwhelming need and desire to enter and adapt to the outside world as nature intended.

Our society has an obligation to improve maternity care services as much as possible. Consider that the countries with the safest maternity care rely on midwives as the guardians of normal birth, reserving risky medical procedures for cases of true need. “In The five European countries with the lowest infant mortality rates, midwives preside at more than 70 percent of all births. More than half of all Dutch babies are born at home with midwives in attendance, and Holland’s maternal and infant mortality rates are far lower than in the United States…” [19] The United States needs to return to a model of midwives as the default maternity care providers, reserving the surgical specialists for the highest-risk patients. We need to educate pregnant women so that they understand that the choices they make about drugs during labor affect their baby, just like the choices they make about drugs during pregnancy. We need to offer women realistic pain relief alternatives to dangerous pharmaceuticals; warm water immersion during labor provides risk-free pain relief that many women find as satisfactory as an epidural. (Mothers who are uncomfortable with the idea of waterbirth can easily leave the tub to give birth “on land”, while still deriving tremendous comfort and safety benefits of laboring in water.) Hospitals need to develop new routines that protect mother-baby bonding and the breastfeeding relationship as if they are a matter of life and death, because they are.

Obstetricians would do well to practice according to the wisdom contained in the phrase, “If it ain’t broke, don’t fix it.” This means supporting healthy women with normal pregnancies in birthing at home if they choose and encouraging women planning hospital births to work with them to minimize interventions that turn normal births into risky medical procedures.

[For references, see gentlebirth.org/original or e-mail midwife@gentlebirth.org]

_______________________________
Ronnie Falcao, LM MS, is a homebirth midwife in Mountain View, California. 650-961-9728

1) Oxytocin for labor induction.
Stubbs TM.
Clin Obstet Gynecol. 2000 Sep;43(3):489-94.
2) Neonatal Resuscitation Textbook from the American Heart Association and the American Academy of Pediatrics, p. 7-3, “Narcotics given to the mother to relieve pain associated with labor commonly inhibit respiratory drive and activity in the newborn.”
3) Neonatal Resuscitation Textbook from the American Heart Association and the American Academy of Pediatrics, p. 7-3, “In such cases, administration of naloxone (a narcotic antagonist) to the newborn will reverse the effect of narcotics on the baby.”
4) A comparison of the hemodynamic effects of paracervical block and epidural anesthesia for labor analgesia.
Manninen T, Aantaa R, Salonen M, Pirhonen J, Palo P.
Acta Anaesthesiol Scand. 2000 Apr;44(4):441-5.
5) Outcome of elective home births: A series of 1146 cases.
Mehl–Madrona, L. E., Peterson, G., et al.
J. Reproductive Med., 1977 (5), 281–290.
6) http://www.cdc.gov/ncidod/dhqp/healthDis.html
7) http://www.cdc.gov/washington/overview/patntsaf.htm
8 ) A 38-year-old woman with fetal loss and hysterectomy.
Sachs BP.
JAMA. 2005 Aug 17;294(7):833-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=AbstractPlus&list_uids=16106009&query_hl=112&itool=pubmed_docsum
Articles at:

http://www.rmf.harvard.edu/risklibrary/cases/r_dec2001news-C-TeamworkFlaws-incP.asp
9) Time of birth and the risk of neonatal death.
Gould JB, Qin C, Chavez G.
Obstet Gynecol. 2005 Aug;106(2):352-8.
10) Neonatal transitional physiology: a new paradigm.
Mercer JS, Skovgaard RL.
J Perinat Neonatal Nurs 2002 Mar;15(4):56-7
11) Stem Cell Characteristics of Amniotic Epithelial Cells.
Miki T, Lehmann T, Cai H, Stolz DB, Strom SC.
Stem Cells. 2005 Aug 9
12) MISSING
13) Randomised study of skin-to-skin versus incubator care for rewarming low-risk hypothermic neonates.
Christensson K, Bhat GJ, Amadi BC, Eriksson B, Hojer B.
Lancet. 1998 Oct 3;352(9134):1115.
14) THERMAL PROTECTION OF THE NEWBORN: A SUMMARY GUIDE from the WHO
15) The effect of bather and location of first bath on maintaining thermal stability in newborns.
Medves JM, O’Brien B.
J Obstet Gynecol Neonatal Nurs. 2004 Mar-Apr;33(2):175-82.
16) Breastfeeding and the risk of postneonatal death in the United States.
Chen A, Rogan WJ.
Pediatrics. 2004 May;113(5):e435-9.
There’s a newish book, “Impact of Birthing Practices on Breastfeeding” by Mary Kroeger
17) This statement is a summary of a number of different books, papers, etc. The two key books for someone interested in this topic are:
“The Magical Child” by Joseph Chilton Pierce
“The Scientification of Love” by Michel Odent, MD
There’s a group of psychiatrists dedicated to the topic:
Association for Pre- & Perinatal Psychology and Health

This last article contains numerous additional research references.
18) Who is responsible for the rising caesarean section rate?
Usha Kiran TS, Jayawickrama NS.
J Obstet Gynaecol. 2002 Jul;22(4):363-5.
http://forums.obgyn.net/forums/ob-gyn-l/OBGYNL.0006/0219.html
Phelan, J. P. (1996, Nov.). Rendering unto Caesar cesarean decisions. OBG Management.
Cesareans: Are they really a safe option? by Henci Goer
Bruce Flamm: “I have heard some doctors say that all women should have babies by C-section, that vaginal births are archaic. ” from Are Women Having Too Many C-sections?
19) Midwives Still Hassled by Medical Establishment,” Caroline Hall Otis, Utne Reader, Nov./Dec. 1990, pp. 32-34

Birth is an internal process that is easily disturbed by unnecessary interventions. According to midwife Ina May Gaskin, “sphincters are shy”.

A woman’s dilated cervix can easily close in the presence of disruptive people or actions (cervical reversal). In a normal birth, vaginal exams and other handlings of the perineum during labor are interventions that can interfere with the natural birthing process.

At any other time in our lives, our vagina is considered “private”. During birth a woman is told to lay back, open her legs and allow her body to be explored by strangers. A laboring woman loses her dignity, privacy and trust in herself in the hands of the people that she has hired to assist her in this sacred moment.

Gloria Lemay, Canadian birth attendant and birth activist, writes: “Why avoid that eight-centimeter dilation check? First, because it is excruciating for the mother. Second, because it disturbs a delicate point in the birth where the body is doing many fine adjustments to prepare to expel the baby and the woman is accessing the very primitive part of her ancient brain. Third, because it eliminates the performance anxiety/disappointment atmosphere that can muddy the primip (woman having her first baby) birth waters. Birth attendants must extend their patience beyond their known limits in order to be with this delicate time between dilating and pushing.” http://www.glorialemay.com/blog/?p=72

Why Should We Be Concerned?

• Vaginal exams are the traditional clinical method to evaluate progress in labor. According to Freedman’s Curve (a 1955 study of 500 women), a woman should dilate 1 cm per hour after she has reached 4 centimeters of dilation. When women don’t perform to this standard, some birth attendants become frustrated and push for drugs such as Pitocin and other augmentation methods to speed labor to progress “normally” initiating the cascade of interventions.

• A woman may become discouraged by multiple exams and mindless comments such as, “you are only __cm”. Labor then can stall giving way to interventions that often end in cesarean.

• Vaginal exams increase the risk of infection by bringing bacteria towards the cervix, even when done carefully and especially after the release of the membranes.

• Vaginal exams are not a reliable way to predict when labor will begin. Labor normally begins when the baby is ready and a wonderful cocktail of hormones begin to release.

• Vaginal exams are particularly painful during contractions and disrupt a woman’s concentration.

• Perineal massage during labor, besides being intrusive and invasive, according to research does not protect the perineum. http://www.bmj.com/cgi/content/full/322/7297/1277

• There is a higher incidence of perineal tears with the hands-on approach to perineal care during the pushing stage of labor than with the hands-off approach. http://www.ncbi.nlm.nih.gov/pubmed/12092017

• Some practitioners routinely do a stripping of the membranes, with or WITHOUT the woman’s permission. Using their fingers they separate the bag of waters from the cervix. The thought behind this is that it will stimulate the production of prostaglandins to help labor begin and irritate the cervix causing it to contract. This is a painful procedure, can leave you spotting or bleeding and has not proven to be effective for everyone. It could start the cascade of interventions.

• Informed consent means that you need to have all the information to accept or refuse treatment. Do not open your legs unless you understand why and agree with the reason. If you don’t agree, ask for the research.

How To Have A Gentle Birth And Protect The Perineum:

• Hire a midwife who trusts the birth process and will support and encourage you to listen to your body.

• Review your birth plan with your midwife at every prenatal visit during your last trimester. (You are not being “difficult”. It’s your body, your baby.)

• Reprogram your mind by immersing yourself in images of normal gentle birth.

• Prepare your perineal muscles and tissues during your pregnancy by having a healthy diet and regular exercise. Read more.

• Walking, squatting, pelvic rocks, tailor sitting, kegels and swimming are useful exercises to strengthen the pelvic floor.

• Gentle perineal massage during the last weeks of pregnancy could help a first time mom get acquainted with different sensations in the perineum.

• Try different positions to birth your baby. Stay vertical. Listen to your body!

• Labor down/Breathe the Baby Down, this is the opposite of directed pushing or purple pushing which can harm your baby by depriving him/her of oxygen.

• While laboring down, you can support your own perineum to help you stay in control of your body.

• Instead of vaginal exams, the most accurate way to judge progress of normal labor is by noticing the changes in the mother’s behavior. For that you need a birth attendant willing to be present and compassionate.

• Visualize: “I am stretching beautifully,” “There’s lots of room for the baby to come through,” “I’m doing this nice and easy”, “I’m getting huge.”

• Vocalize deep sounds by chanting, moaning, grunting. A loose jaw = a loose perineum.

• Apply warm compresses everywhere on the woman’s body so there is less focus on that one spot (the perineum). The woman relaxes, the midwife relaxes. -Naoli Vinaver, CPM, Mexico

• Refuse an episiotomy.

• Avoid an epidural.

• Hire a doula to be your advocate in the implementation of your birth wishes.

In conclusion: Stay. Away. From. My. Vagina!

Other Resources:
http://www.mothering.com/easing-tension-and-fear-natural-childbirth-understanding-sphincter-law-conversation-ina-may-gaskin