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Jennifer Margulis

Mothering Outside the Lines

The Epidemic of Unnecessary C-Sections

December 22nd, 2010

In my last post here at Mothering Outside the Lines I wrote about an amazing mom who decided to have a home birth to avoid a fourth C-section.

I emailed Aneka’s story to my friend Denise who still has angry, unresolved feelings about a second C-section. Denise was fully dilated and pushing when the doctor told her there was “no way” the baby would be able to slip under her pubic bone.

Any birthing woman is incredibly vulnerable. Her senses are heightened. She looks to those around her for support and love and encouragement.

What if that doctor had told Denise she was doing a good job? What if that doctor had offered her something to eat or suggested she sleep between contractions? (In her book, Ina May Gaskin’s Guide to Childbirth, Gaskin observes that women sometimes need to rest, even sleep, after transition to renew their energy to push the baby out. She also notes that food eaten at the right moment during labor can be the fuel a woman needs to rally.) What if that doctor suggested laboring on all fours? What if that doctor had just said and done nothing but stayed with Denise in an attitude of encouragement?

When your body’s working as hard as it knows how to birth a baby it can be devastating if a doctor or a nurse or a midwife tells you you aren’t doing a good enough job. Or even suggests as much with an impatient or unkind attitude.

When I was more than 15 hours into labor with my first child I was only at four centimeters dilated. Instead of encouraging me the doctor on call–the only man in the practice and the only doctor I had never met previously–told me I was being selfish and making my family suffer unnecessarily (my mom and my husband were there) and that I should think of other people and get an epideral and pitocin.

For Denise just trying for a VBAC had already been a fight. But how could that doctor have known that Denise’s baby couldn’t be born vaginally? Was the doctor subconsciously (or consciously) punishing her for having the hubris to try to do it her way? Or was the doctor just impatient for the baby to be born?

We have a C-section rate in this country that is so high that Amnesty International has issued a call to President Obama to address what they call the systemic failures in the maternal health care system in America.

Augustine Colebrook, a midwife and mother of three who has just founded a birthing center in Medford, Oregon, recently taught a childbirth class for six couples.

Three couples were planning home births.

Three were planning hospital births.

The three moms who chose to birth at home had healthy babies and no complications.

The three who chose to birth in the hospital? They all ended up having C-sections.

As Tiffany, a labor and delivery nurse, pointed out in a comment on my last post, Cesarean birth can be a life-saving intervention. It is a wonderful operation, a medical miracle that can save the life of an infant and a mom when used in a real emergency.

An impatient doctor is not an emergency.

A hospital that profits from billable hours for the operating room is not an emergency.

A previous C-section is not an emergency.

A breech baby is not an emergency. (Babies turn during labor. Vaginal breech birth done correctly, which usually means with as little intervention as possible, has been shown to be safer than major abdominal surgery for most women.)

Twins are not an emergency.

Most people don’t realize that the skyrocketing C-section rate in America has devastating ramifications.

The United States lags behind 40 countries in maternal death rates.

It’s safer to have a baby in Bosnia and Herzegovina, a country recovering from civil war, than it is to have a baby in America.

Katelyn couldn’t lift her baby for weeks after having an unplanned C-section. Her son was born 11 years ago. The operation gave her terrible gastrointestinal problems that continue to this day.

Nora’s scheduled C-section ended in weeks of anxiety. One of her baby’s lungs collapsed and he had to be helicoptered to a hospital with a NICU. “I think the doctors got the dates wrong,” she mused afterwards. A doctor herself, she hadn’t realized that the risk of not letting her body go into spontaneous labor includes premature birth.

This major abdominal surgery has many other risks: hemorrhage, infection, organ damage, scar tissue adhesions (including placental accreta, placenta increta, and placenta percreta), delayed interaction between the baby and the mom which can lead to bonding problems and breastfeeding difficulties, a longer and more painful recovery time, post surgery stress disorders, higher chance of rehospitalization, higher chance of complications in subsequent pregnancies, higher risk of respiratory problems for your baby, and more.

Let’s follow Aneka’s lead and stop the C-section epidemic in America. Isn’t it time for American women to be empowered to give birth on their own terms without unnecessary, even life-threatening, intervention?

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Adventures in Lotus Birth

November 16th, 2009
Our newborn daughter with the cord and placenta still attached

Our newborn daughter with the cord and placenta still attached

When I first read about lotus birth—which is the term people use for not cutting the cord but instead letting the placenta detach naturally from the baby—I thought it sounded … kind of gross.

I was dismayed with myself for having such a close-minded reaction. I decided I should challenge my own assumptions and find out more about why some people choose to do it.

One local midwife’s said it’s done for “spiritual reasons.” She mentioned that people usually salt the placenta and put herbs like lavender and rosemary on it to speed the drying process and keep it from smelling.

As I read more, I came to understand that one idea behind lotus birth is to help you slow down during the baby’s first days of life.

There’s no real reason to hurry to cut the cord. In fact, the longer you wait, the more likely the baby is to get back all its valuable blood and nutrients from the placenta.

It’s hard for me to do anything slowly. I’m from Boston where people talk fast, walk fast, eat fast, and live fast. We took our firstborn out when she was two days old (to buy a changing table and a crib) and I was bicycling to the bagel shop a day later (“baby and stitches be damned,” my friend Sue said.) Then my body forced me to slow down when I got a bad breast infection.

I know it’s better to be in a quieter space and I strive to find that space, so the more I read about lotus birth, the more the idea appealed to me.

Most mammals (even ruminants) eat the placenta but, apparently, some chimpanzees practice lotus birth, carrying the placenta with the baby chimp until it falls off naturally.

James and I agreed we’d try it. We wouldn’t cut the cord. Instead, we would clean the placenta, wrap it, and keep it with the baby. Maybe until it naturally severed (another name for lotus birth is nonseverance) or maybe just for awhile.

the placenta just after delivery: look how thick and white the umbilical cord is

the placenta just after delivery: look how thick and white the umbilical cord is

It wasn’t until more than an hour after the baby was born that I delivered the placenta. I sat up, holding the baby, and squatted by the side of the bed over a bowl. The placenta slithered out with a gushing plopping noise.

I was surprised how big the placenta was! And how interesting it looked!

The cord surprised me too—it was so thick and white, it felt cool and gel-like to touch. I’d never given much thought to an umbilical cord before but I found it fascinating, all twisted and white with dots of clotted blood that looked like brown beans inside it. Who knew that’s what the shriveled black stumps actually looked like once?!

James brought a bowl of warm salt water to soak the placenta, then we wrapped it in two cloth diapers and put it in a plastic bag and then inside a pillow case. The plastic bag part didn’t seem right somehow but we weren’t sure what else to do: Sue had promised to bring a cloth bag for it but she couldn’t come down for the birth so this makeshift contraption was the best we could do.

The only problem with all this was I felt worried about hurting the baby by accidentally pulling on the cord. But everything else about it felt right.

Doing it this way made me wonder why in the hospital and even at most home births there’s this almost urgent rush to separate the baby from the placenta. Keeping the cord and the placenta attached made me feel like the baby and I were still connected in a visceral way, since the organ that had grown inside my body was still attached to her.

We left the placenta on until the next afternoon. It had started to smell like roasted coffee (we forgot to actually salt and put herbs on it) and the long twisty white cord had started to blacken and dry up. Though I stopped worrying so much about it, I did find it a bit cumbersome. I tucked the pillow-cased placenta under or over the baby when I was holding her but it felt a bit awkward.

James and I were both glad we left it on for so long, and we also both felt ready to cut it off when we did.

We cut the cord with a sterile razor. We didn’t need to tie it because it was already dry and almost brittle. Then we cut it close to the placenta so we’d have a nice long piece of cord as a … keepsake?

“It’s mine,” my 6-year-old son shouted. “I want it! I want it! I call it!!”

The cut length of umbilical cord is still on the dresser. It looks like something from a different planet and in a way it is—it’s from a time when the baby and I were still living in the same body, sharing oxygen and nutrients, growing together and keeping each other company. Looking at the dried cord fills me with a strange nostalgia.

In the meantime, the placenta’s in our freezer. We’ll plant it in the spring. Maybe under the raspberry bushes.

Our new baby just after she was born, with her placenta and cord wrapped up with her

Our new baby just after she was born, with her placenta and cord wrapped up with her

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[ 9 comments ]






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How to Deal with a Completely Toxic Person? posted by bubbledumpster, Sun, 25 Sep 2011 23:44:20 +0000
TOXIC Family... let's have it. posted by Imakcerka, Sat, 24 Sep 2011 12:55:34 +0000
my parents are coming to visit posted by Linda on the move, Wed, 21 Sep 2011 19:33:00 +0000
In a world of endless choices....how do you choose?? posted by youngspiritmom, Wed, 21 Sep 2011 07:36:13 +0000

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