More on the Microbiome, Birth and How To Get Your Baby The Good Goop That Live On You

Here’s another great piece about the way childbirth affects a baby’s microbiome (the bacteria that live on and in her), this time an essay by a microbiologist who was all prepared to “inoculate” her newborn if a c-section was necessary.  Inoculate, here, means:  ”take some vaginal discharge and swab the baby’s mouth and nose with it to try to replicate what the baby would have been exposed to during birth.” Check it out.  For more on this topic, see here and here.

The Straight Poop

I’m sharing today’s post from Brain, Child’s new blog for several reasons:

  1. Because it is a hilarious short piece about pooping during childbirth, which also involves a brief misunderstanding about whether the author’s midwife reached orgasm during the labor.
  2. Because Brain, Child is an excellent magazine you should all subscribe to if you are interested in thinking and parenthood.  (I thought this long, long before I had an essay published in it).
  3. Because it fascinates me that this woman took a childbirth class where Pooping During Pushing only came up incidentally and quietly and kind of indirectly.  Did her teacher say “fecal matter”? Ladies, come to my class and we will be real and talk about All The Things. 
  4. Speaking of which, here’s the real scoop on the poop: 

 If you’re pushing something large down the birth canal (i.e. your baby), in all likelihood you’ll also push some stool out, too.  The same muscle groups control all the exits down there. You’ll probably squeeze some pee out, too, while we’re mentioning Things. 

You might not even know it happens:  If you have pain medication, you won’t feel it; if you don’t have pain medication, you may have so much sensation that you don’t particularly register a bit of poo on top of everything else.  In both cases, if your partner isn’t looking, s/he may not see your midwife or doctor wipe it away briskly.  She will wipe it away quickly because she, like the rest of us, does not want to hang around beside a steaming pile of poo while we wait for the rest of your baby to emerge.  This may be what happened in the author’s first two births. 

The thing is, it’s really all OK.  This is not a parenting fail, at all.  At all.  In fact, to the contrary: I hate to gross you all out even more, but it’s actually really OK if a tiny bit of poo is on your baby.  Think about it people:

  • lets say no actual visible turd emerges.  Do you really think that your anus is sterile?  If your baby is born with her nose essentially pressed against your butt hole, she is going to get some particles of poo on her no matter what you do.
  • What is in that poop?  A whole lot of your gut bacteria.  And yes, it goes up your baby’s nose and possibly into her mouth, and from there it gets into her gut.  And that (plus her trip through the birth canal, where, to be clear, your vaginal microbes get on and into her) is what helps “colonize the infant gut with protective microbes” (translation: all the good-guy germs that live inside your tush and vagina go into her nose and mouth and then start growing inside her). And this, despite the lemon face you may have just made, is a very good thing. These great, helpful, protective gut bacteria keep her healthy, protect her against infection, regulate the immune system, and neural development, and apparently affect her metabolism for the rest of her life.  In short, it may be one of the best things you ever do for her!

As my great friend, certified childbirth educator Ceridwen Morris says, “It’s not a mistake that human babies are born with their face an inch away from their mother’s asshole.”  Chew on that for a while.

UPDATE, 5/16/13:  This excellent article in this weekend’s NY Times Magazine discusses the importance of gut bacteria and the “fine patina” of poop that, for better or for worse, coats basically everything.  It’s an awesome piece, but even the intrepid Michael Pollan glosses over the birth-poop-connection.  He says:

Most of the microbes that make up a baby’s gut community are acquired during birth — a microbially rich and messy process that exposes the baby to a whole suite of maternal microbes. Babies born by Caesarean, however, a comparatively sterile procedure, do not acquire their mother’s vaginal and intestinal microbes at birth.”  

It’s a funny world when you can have a feature article about how important your poop-bacteria are, but not be clear that Vadge-And-Butt-To-Nose-Transfer is where it all begins.

More about germs! Yay germs!

Yesterday I blogged about the importance of gut microbes, and recent news showing that birth mode (vaginal vs c-section) and infant feeding (breastmilk vs formula) affect babies’ development of good bacteria for long term health.  Today there’s another piece about this in the Times.  The article covers a Canadian study which found, again, that babies born by c-section and those who don’t have a breast milk diet have less protective gut bacteria at four months old, and more of the harmful germs that make you sick.  The authors of the study believe that this is a pathway for various autoimmune problems in older people.  

You can read the full study here.  I don’t love this study because the total number of infants is low.  More importantly, it, like so many studies that start to examine the nursing relationship, doesn’t really clarify what “breastfeeding” means.  They differentiate “formula feeding” from “exclusive breastfeeding” and “partial breastfeeding” at the time they took the samples, but there’s no apparent guidance about how to use those terms. My concern is that without good definitions, we can’t properly interpret the results. For instance: if a baby was given one bottle of formula on day 1 in the hospital (as so many are) but went on to have nothing but breast milk for the next many months, is that baby “exclusively” or “partially” breastfed?  If we are looking at the effect of early exposure to nonnatural microbes, it seems wrong to compare that baby to one who has had nothing but breast milk from birth.  But if we are looking at whether a protective effect of breast milk is dose-dependent, it seems wrong to lump that baby in as “partially” breastfed with another who has had half breast milk and half formula for four months. These distinctions are rarely made in studies that purport to look at the ways infant feeding affects health outcomes.  But if we’re going to learn anything real, we need to look closely at what it is we’re trying to study. “Breastfeeding” isn’t just one thing.

Germs are Great

If you’ve talked to me in real life for more than five minutes this year, you already know that I am currently obsessed with bacteria.  

I’m not a germophobe — quite the contrary: a host of new research shows that “good guy” bacteria — and there are billions of them on us — are extremely important in keeping us healthy.  I blogged about this  about a year ago after a report came out indicating that babies born by c-section are twice as likely to be overweight later in childhood.  Apparently, the difference is that since those babies didn’t go through the birth canal, they weren’t exposed to the good bacteria that live there, which “paint” a newborn’s skin, and get into her nose and mouth (and down into her gut) in a vaginal birth.

More recently, an article in the New York Times outlined how bacteria may also explain why breast-feeding may be protective against celiac disease and gluten intolerance:  probiotics (“good guy bacteria”) in breast milk, and pre-biotic oligosaccharides in breast milk (sugars in breast milk that exist not to feed the baby but to feed the good-guy bacteria that live in her gut) apparently help protect an infant’s gut from developing an inflammatory autoimmune response to gluten.

So, and here, today is another good piece, at Double X Science, called The Vaginal Ecosystem, which talks about changes in the bacteria that live in your birth canal during pregnancy.  The plain language explanation is:  the goo that lives in you changes while you’re pregnant because your body knows that a baby will be passing through and he’ll need to get a good coating of all your good gunk to get the best start in the world.

I guess the idea that you’re covered in germs (and that that’s a good good thing) is gross to some folks, but I think it’s awesome.  Truly, you’re the Mother Ship, and your crew are the billion germs that keep you in good condition. Go hug and kiss your kid: he’ll be all gooped up with your protective good-guys!

Home Birth, Barbie Style

I’m so not sure what I think of this slide show of Barbie having a home birth, with Ken and a midwife and her older child at her side.  

OT1H, some of the photos are hilariously similar to real birth pics (classically, in Black and White for additional gravitas):

barbie in labor

But OTOH, I hate the idea of the homebirth being glamorized in some Barbie-like way, (making it seem like yet another unrealistically perfectionist thing on the to do list, along with having the Barbie-looking hair, body and face), instead of what it is: one of many options an informed adult can make regarding the care of her body.  

And then, since I have an eleven year old, I immediately wonder what a Minecraft-Homebirth would look like (hopefully no creepers).  I may now go ask my son and his best friend to design that for me…


Why The C-Section/Obesity Study Makes Me Feel Reverence for Bodies and Bacteria and Even, Kind of, Poop

In the past few years, I’ve become fascinated with “good guy” bacteria — the bugs that live on and inside us, and keep us safe from disease and infection.  It’s kind of awesome that we’re home to zillions of microbes.  You’re a walking Starship Enterprise and the crew is doing maintenance and defense work on you even as we speak!

(Let me pause and say that if that concept make you a little squeamish, you may find the rest of this blog post grody).

Along these lines, I was fascinated to read of a recent study which concluded that gut bacteria may be the reason that babies born by c-section are twice as likely to be overweight later in childhood, compared with babies born vaginally.  The study, in the Archives of Disease in Childhood, found a large disparity in childhood obesity rates between kids born by c-sec and those born vaginally, even after considering other factors such as mother’s weight, baby’s size and the length of time they were breastfed.  

We already knew that babies born by c-section have an increased risk of post-birth infection vs. babies born vaginally, in part because of good-guy bacteria:  as babies travel through the birth canal, and all the good bacteria that live there (yes, your vagina is filled with bacteria! It protects you from illness) coat the baby’s skin, providing your baby with an initial coating of anti-germ protection even as he’s being born.  (A baby born by c-section on the other hand, comes out of the sterile amniotic sac, directly into a germ-filled operating room.  Germs that cause illness have the opportunity to colonize his skin before mom’s good anti-sick bacteria can colonize and protect him.  This is why skin-to-skin contact is especially important for babies born surgically — frequent contact helps the baby get a nice coating of protective bacteria from the “Mother Ship.”)

So, but here’s how this plays out with the obesity thing.  Apparently the presence or absence of different gut bacteria play a role in how we use energy, respond to insulin and lay down fat.  And babies born by c-section have different gut bacteria than those born vaginally, even years later.  Why? 

Take a step back.  There’s bacteria in your gut, right?  What happens to it?  Mostly it lives inside you.  Also, some of it comes out when you poop.  So, you can find traces of it around your bottom.  Pan the camera back and let’s think for a minute about how babies born vaginally could come into contact with their mom’s gut bacteria?  As a another childbirth educator once quipped, “it’s not by accident that babies are born with their face an inch from your asshole.”  They’re designed, apparently, to meet that part of you first so they can get exposed to your gut bacteria and, yes, ingest some (microscopic) amount, so it can colonize their gut.  And that is apparently going to help them for the rest of their lives.  Next step for the newborn is to be placed on mom’s belly, where he can get colonized with her external, protective skin bacteria, and after that onto mom’s breast where the colostrum in her breasts is filled with immune factors so that with the first swallow her body tells him:  “all the stuff you were just exposed to is harmless for you, so don’t use your energy mount an immune response to any of it; you can use your energy to grow, stabilize temperature and sugar, and get acclimated, not for defense.”  Her breastmilk also contains pro- and pre-biotics to further colonize his gut and protect him from the inside.

I think this is kind of awesome.  Not the image of a baby with her nose in your rear end — sure, that’s kind of eww-y when you stop and think.  But what’s totally magnificent to me is the way our bodies are designed to do this right.  There are so many small things, invisible until we study them, which turn out to have tremendous lasting significance.  

What can you do?

Don’t feel bad if you had a c-section, that kind of backward-focus doesn’t help.  If you had a c-section, focus on behaviors that lean against any increased potential for obesity; we should all do that anyway.   C-section can be a very, very important surgery, and when it’s medically necessary, it is a tool we are very lucky to be able to use, and to have such phenomenally good results from most of the time.

But what we all can do, I think, is maintain a kind of reverence for the body, and remember that no matter how sophistocated we are, and how good our technology, how advanced our medications, and how grateful we are for the way they save lives, nothing we can invent compares to the complicated beauty and grace of a functioning human body. 

There is much we do not understand.  When it comes to a body that is healthy, we should be very reserved about elective surgeries.  And we ought to manage labors to minimize the likelihood of c-section, not just for all the reasons we know, but, even more, for the reasons we don’t know yet.  

UPDATE, 7/13/12:  Here’s a great article exploring the science of this issue, from Science and Sensibility.  

"Best Childbirth Classes in NY"

Hey folks.  Of course I’m biased, but I totally agree with this article titled Best Childbirth Classes in NY, which names Tribeca Parenting, where I currently teach group childbirth classes.  

There are lots of ways to teach a childbirth class; anyone can hang out a shingle and do it.  But TP hires only teachers who have completed the rigorous 2-3 year certification program through CEA/MNY.  Then, all the TP teachers also participate in regular continuing education, to ensure that we are up to date not just on timeless things (like basic physiology and anatomy) but on things that do change, like local hospital practices and current research about medications, interventions and technology, and perinatal care.  (Plus, sometimes we get to have really fun continuing ed to learn things like how to teach reflexology; which of course requires that we all get foot rubs! :-))  

The TP childbirth series is designed not only to instill knowledge, but to allay anxiety, build confidence, and foster a feeling of community among a bunch of total strangers who are all embarking on a great adventure.  The teachers are smart and funny and real, and we want our students not just to learn, but to appreciate that you can be your regular self throughout the birth process. 

If you’re pregnant and lucky enough to be in NY, I hope you’ll come!  I’m teaching on Wednesday evenings at the 62 St location.  More info on my series here.

Consumer Reports: What To Reject When You're Expecting

This article from Consumer Reports is a great piece on the ten most “overused” procedures in childbirth:

1. C Section in low risk first birth

2. Automatic repeat C Section

3. Elective early delivery

4. Induction without medical reason

5. Ultrasound after 24 weeks

6. Early epidural

7. Continuous electronic fetal monitoring during labor

8. Routine artificial rupture of membranes (“breaking the bag of waters”)

9. Routine episiotomy

10. Sending baby to the nursery

The article, of course, goes into greater detail about how each of these is overused and what the alternatives are.  I like this piece because it’s a great reminder to everyone of a few really crucial points

1. When you’re there, in the hospital in labor?  You’re still a consumer, and entitled to excellent customer service.

2.  Health care is a product we pay for and it is important to think about whether each thing you do is necessary/worthwhile.

3.  You, as an adult, are competent to evaluate whether you need an induction/episiotomy/c-section/ultrasound, just like you evaluate whether you need the other things you pay for.  You don’t need to be a medical expert to do this.  You do need a medical expert *with you* to talk you through the benefits/risks/alternatives, but after that the decision is yours. 

4.  Not all of the things that doctors do routinely are helpful or necessary.

Ask questions.  Get to know your caregiver.  Be the customer.  Get good care.

Ina May: "I wasn't raised to think I was inferior to an animal"

Last night I went to a great event hosted by CEA/MNY — a discussion of modern maternity care between the awesome Jennifer Block and Ina May Gaskin.  

I can’t do justice to the whole event, which was so interesting, but I was particularly struck by the way Ina May described getting interested in birth in the first place.  She reported that when she was pregnant with her first child in the mid-1960s, she went to a doctor and was told she would have medication to knock her out, and a “forceps birth.”  When she asked why it was then-standard practice to extract all babies by forceps, the doctor told her that it was because “all” first-time moms had an “iron-hard” pelvic floor, which the baby would destroy like a “battering ram” unless a doctor cut her perineum and pulled the baby out.

A doctor who talks that way, whether it’s 1966 or 2012 is clearly trying to scare his patient out of further discussion, not provide guidance and counseling and safe, compassionate health care.  

Here was Ina May’s reaction at the time:

"I didn’t know about that.  But I did know I didn’t have any parts that were iron hard.  But I didn’t know that you could fire — should fire — a doctor who says something crazy."

Ina May was inspired by her own common sense — not at first (she did, apparently have the knocked-out-forceps birth that time), but later, after she became a mother, she became inspired to reevaluate the care she and others were receiving, and make dramatic changes.  

She began to think about medical advice and “what people said” about birth not only at face value, but in terms of whether it made sense to her.  She knew that “iron hard” does not sound like a description of any part of a woman’s body, and instead of concluding “I must be wrong about my body!” she began to explore the other possibility — maybe the person saying this is wrong, even though he is a doctor.  

And if so, then what?

The answer is, then I owe it to myself to to find (and ultimately, for Ina May, to provide) care that does make sense.

It’s inspiring.  At one point, Ina May added that another point of inspiration for her was that she had been “an English Major in college.”  Everyone laughed.  

She described how reading Tristram Shandy got her thinking about midwifery care.  Her point was not that reading 18th century literature is all you need to be a caregiver. Her point was that you don’t have to be a doctor to have a thinking cap.  Ina May felt confident that the intellectual gifts that served her in the rest of her life would help her understand enough about maternity care to make competent decisions for her own body’s care.  

You don’t have to become Ina May and start a Farm and catch 3000 babies in 40 years and become a birth guru.  But we can all take action in our own lives by insisting, with ourselves, that when it comes to the care of our bodies, that we use the common sense and intelligence we bring to everything else.  Birth (and breastfeeding, and motherhood) is not so haunted and mystical and weird and shameful that common sense and intelligence don’t apply. 

And when it feels too daunting to do that yourself, let that be a sign to you that you’re not supposed to figure all this out alone.  Childbirth classes, mother’s groups, breastfeeding support — all of these things exist to help you find the kind of care that will help you feel cared for while you do the transformative hard work of becoming a parent (or becoming a parent again!)

Getting Away From An "Either - Or" Mentality About Childbirth

Recently there have been a bunch of good essays (links below) discussing how the birth location, and type of attendant, affect outcomes.  These pieces all take the time for some non-propaganda, nuanced thought and reflection about what would improve things for a diverse American population of mothers.  It’s a welcome change from some of the less rigorous thought we often see on this topic.  Instead of having a pitched battle about whether ALL HOMEBIRTH IS VERY DANGEROUS AND IRRESPONSIBLE AND RISKY!  and whether ALL HOSPITAL BIRTH IS TOTALLY OVERMEDICALIZED AND DANGEROUS AND HATEFUL AND NOT EVIDENCE BASED, these essays look at the improvements we need, overall, to our maternity care system.

Here’s a brief summary (but honestly, these are issues that aren’t well suited to brief summary):

  • we need a standardized care practice for doctors, nurses, and midwives who attend hospital births.  The practice should minimize separation of mother and baby after birth to true medical need, appropriately support normal infant feeding,  prioritize comfort, dignity and infection-avoiding after-care for mother and baby, eliminate practices associated with post-partum depression and PTSD, and train all hospital personnel in all of these areas.  And this should be available to all women in every hospital across the land.  

     Is that really too much to ask for in 2012 in the United States of America?

  • we need a nationally standardized training practice for midwifery that encompasses homebirth and hospital care, so that “midwife” means one thing, everywhere.  Without that, it is impossible to accurately say how “midwifery” care compares to OB care, or how home-birth compares to hospital birth.

These changes would create a more functional system in which each woman could get care appropriate to her particular needs, not the needs of women in general.  This is called reproductive choice, and it should be available to everyone, not just educated, white-glove-insured people in major cities.

A functional system would also get us away from the kind of strident hysteria that too often accompanies discussion about birth, which, when you care about these issues, become truly a pain in the ass to read.  (don’t get me wrong — emotional discussion of one’s birth when you’ve just had a baby is totally appropriate.  Ideally, though, that personal topic is handled separately from a policy discussion of how care can be improved for everyone.)

Here’s what you can do, meanwhile:

  • If you’re pregnant and planning a hospital birth:  take the time to talk to your care provider about her training and experience, including her experience of this hospital’s post-natal care, which she may or may not be familiar with.  If you’re in New York state, you can look up your hospital’s stats including breastfeeding rates.  Take a childbirth class that covers infant care and breastfeeding.  In my childbirth classes, we do role-playing to help students get comfortable with how to talk to personnel in the hospital in a way that gets the information they need and reduce unnecessary stuff happening.
  • During and after your birth, remember that you are the customer.  If you’re not getting good customer service, ask for better.  If that doesn’t happen, write a letter to your care provider’s office and/or the hospital, later, and let them know you weren’t happy.  Policies change when people do this.
  • If you’re pregnant and planning a home birth:  take the time to talk to your care provider about her training and experience in, and out of hospital, and learn about the laws relating to midwifery in your state.
  • Write to your legislators and propose standardized care practices for hospital births and midwifery training.  Send a copy of the letter to all your facebook friends and ask them to do it, too.

Here are the links to the essays:  The original piece in Slate by Emily Willingham, an article about it on Babble by Ceridwen Morris, Emily Willingham’s blog followup, and a Comment by Midwife Amy Romano.

This stuff matters.

How did it go for you?  If you gave birth in the hospital, how did you feel about the post-natal policies and the care you received?  If you gave birth at home, were you in a state where you had access to a CNM?  And what was her home-birth training?  You can email me comments or use the Disqus feature below.

Guess How Many Times A Day Someone Barges Into A Hospital Room On A New Mom?

Here’s one for the “I Can’t Believe We Needed A Study To Tell Us This” file: an article I read this morning from, entitled “Do Interruptions Interfere with Early Breastfeeding?”

I don’t mean that the article was stupid (at all!), and in fact, there’s something validating that someone actually recorded how frikkin’ often new moms and their babies are interrupted while they’re still in the hospital.  Want to know how many times? 

53.  Fifty Three interruptions in a twelve hour period.

This topic came up last week at the new MOMs group — I’d asked a group of new moms who’d just met to talk about what was most surprising since their babies’ births, and although that conversation can go lots of different ways, this group mostly talked about how the births had gone, and the first couple days in the hospital.  Several moms talked with annoyance about how frequently people barged into the hospital room, (“it felt like someone was constantly coming in to do something”) and how difficult it was to get any peace, privacy, or even just a little time to think straight.  

Well, they’re right:  The study found that over the course of a twelve hour period, mothers in the hospital were interrupted an average of 53 times.  There were more than twice as many interruptions as periods of alone time.  That means that a new mom had to deal with someone coming in to do something to her pretty constantly; and the study also found that the interruptions themselves lasted longer than the stretches of alone time.  In fact, half of the “uninterrupted” stretches were less than ten minutes long.

Guess what?  Moms didn’t love that.  

In my New MOMs group, many of the same moms were also complaining that they didn’t have enough help with getting the hang of nursing, or that they were “left alone” to figure it out by themselves.

These things aren’t at odds, at all:  New mothers are not supposed to be left all alone, isolated, without help or company or support.  They are supposed to have easy access to supportive, knowledgeable people who can help them, and who can attend to their needs as they learn to get the hang of dealing with the baby.  They are not supposed to be isolated and when they are, they languish.  And all too often, they not only don’t complain, they feel guilty and weak for not being able to figure everything out themselves.

Isolation is bad for mothers.

But isolation is not the same thing as privacy, and all interruptions are not equal.  One mom I spoke to described how frequently people came in to take her blood pressure and temperature, or to check on the baby, or to have her fill out forms.  Did anyone come in to just sit with her and keep her company?  No.  No one in the hospital is paid to provide company. Did anyone come in saying, “Good morning, what can I do for you that might help you feel more comfortable today?”  Of course not.  The hospital does not provide a concierge.  Did anyone give her a list of resources that might help or educate her if she wanted that?  No, the hospital is not a school that provides education for its customers.

Did anyone assess her breastfeeding before the baby was discharged and provide her with detailed, evidence-based guidelines about how to proceed?  No.  Apparently the hospital is also not concerned with infant growth and nutrition.  You and your boobs are expected to figure it out for themselves.

What did they do?

Well, lots of people commented that she should be breastfeeding.  People talk and talk and talk about how “best” breastfeeding is.  People gave varied opinions about how frequently she ought to nurse and how long the baby ought to stay on the breast.  Most of them disagreed with each other.  

And they got all the data they wanted, about her temperature and blood pressure and wound-healing, and her paperwork was all complete.  They did that on their own schedule, in the way that was most streamlined for the hospital, not for the woman who’d just done a day of labor followed by major abdominal surgery and whose nipples were cracked and bleeding and whose baby had lost a lot of weight.

This. Is. Not. Good. Customer. Service. 

Newborn babies need lots of skin to skin time with their mothers, but new mothers (understandably) often feel modest about showing skin to strangers.  Having the door of your room burst open while your shirt is off can throw even the most unflappable new mom, especially when it happens multiple times per hour.

New babies also need frequent feedings, but new moms getting the hang of nursing often don’t appreciate someone barging into the room just when they’re squeezing the breast and looking at the color of their colostrum.  New moms are human beings; they need privacy.  When they don’t get it, they cover up.

The study found that moms perceived that interruptions interfered with breastfeeding.  This does not mean that doctors and nurses came in and literally said “You need to stop feeding now” or that the moms were told to ignore their babies’ cues to feed if someone else was in the room.  What it does mean is that as a practical matter, the moms felt that being on the other side of a revolving door was getting in the way of learning to nurse.

Why aren’t we making it easier on new moms?  How about some hospital protocols that group necessary clinical interruptions together in a way that makes it a priority to get new moms longer stretches of privacy?  

And how about making sure that, if someone’s going to enter a new mom’s room, that person:

(a) ask the mom “were you about to feed the baby?” and offer to come back later if it’s easier for the mom, so that no mom leaves the hospital feeling like someone was barging in on her every five minutes, and

(b) be prepared, qualified, trained and equipped to ask about nursing, assess the breastfeeding dyad, and provide appropriate, supportive help OR ELSE SUMMON SOMEONE WHO IS, so that no mom is discharged from the hospital without a breastfeeding assessment by an IBCLC.

People like to feel like they know what they’re doing — that’s because we’re human.  And when you’ve just had a baby, you often feel the opposite.  No one wants strangers barging in on them constantly when they’re feeling like a big messy work in progress — that can make you feel like giving up on whatever you were working on.  Instead, what new moms need is enough privacy to get the hang of things, and enough help to be guided in the right direction.  

Here’s what you can do:  

If you’re pregnant and planning a hospital birth:  Make a sign for your door that says, “Please, Only Urgent Interruptions; I Am Feeding The Baby.” Hang it at will.  Feel free to ask anyone who comes in whether they can come back in half an hour.  Have contact information for an IBCLC who can help you out as you begin breastfeeding.

If you’ve just had a baby:  The hospital will contact you with a generic call or letter to ask how your experience was.  I know you have a baby and you’re tired.  But take the time to answer their questionnaire and answer honestly.  If you got lousy customer service and know what would have helped, tell them.  You don’t have to figure out how they should conduct all their business, let them sort out the logistics.  But you ought to let them know you have a complaint with the way they do it now.

If you are a friend of a new mom, and can see that she had a lousy hospital experience because of this: write to the hospital and complain.  

Things don’t change when no one complains.

Are Childbirth Glamour Shots a Good Thing?

Several people have sent me links this week to birth photos entered in National Geographic’s 2011 Photo Contest (examples below).  

Here’s the thing about this.  I think childbirth, and the body, are pretty awesome and fascinating, and I wish we had more images in our collective consciousness that portrayed both as strong, vital, cool, etc.  (instead of dire, freaky, pathological, unreliable, something out of the E.R.)

And yet, I pause, sometimes, at the “beautiful” childbirth shots.  

Yes, there’s a lot of power and awesomeness here, but honestly my first thoughts are, “how does her hair look like that?!”

I like to think I was pretty much a rock star during labor (not because of how the births went, just because I did it, and I encourage all of you to think of yourselves the same way, regardless of how it went, as long as you had a baby that day) but I didn’t look like a rock star.  Or a model.  Or like anything I’d want photos of posted anywhere.  And my babies didn’t look like angelic cherubs at first, either.  Here is my daughter, moments after being born:

It’s not the shot I chose for the birth announcements.

In fact, I can remember seeing my husband holding a camera during one of my kid’s births and totally freaking out at that poor man.  (“I was just moving it! Not taking pictures!” he exclaimed)  I wasn’t upset because there was something wrong with what I was doing, or anything shameful about it.  But — because I’m a pretty vain person, I knew I couldn’t fully concentrate on what I needed to do if I was trying, also, to be camera-ready.  

In fact, it felt kind of liberating to be able to do childbirth without having to be watched and recorded and documented.  I can bring home the bacon.  I can fry it up in a pan.  I can gestate and bear two children.  And I can pull off a variety of looks.  But for f*ck’s, sake.  I didn’t want to have to do it in labor. Some people have effortless beauty that looks a lot like Magazine Beauty.  But most of the labors I’ve been at, my own included, the mom was stunning, awesome and effortlessly beautiful and deeply lovable, but not in the classic mainstream female beauty way you see in mags.  

Even if we put looks aside, there’s something about being photographed for posterity that changes how you act, how you feel, how you behave.  When you’re aware of a camera and an audience, doesn’t it affect everything?  

And why is it that the “triumphant” photos are always at the moment of birth, not the many dull, awful moments, hours earlier, where mom felt like giving up at hour 20 and managed, through her tears, to find a way to carry on?  It starts to feel like the emergence of the baby is the Money Shot, the moment besides which nothing matters, and, especially when the laboring mom looks waxed and skinny, the whole thing starts to feel a little porny to me.

And so I’m not sure how to react to the National Geographic photos.  OT1H, I love the idea of watching birth — what could possibly normalize childbirth as much as seeing it?  And thinking of it as normal totally helps you do it.  And I love seeing how many many different ways there are to be.

But OTOH, when I see the glamour shots, I worry, a little.  Are they like the impossible standards of magazine beauty we all lament?  Are we setting the audience up, a little, suggesting that it’s obligatory to look, or be, or feel a certain way, or at least to try?  

Or are we giving them powerful images to counterbalance the medicalized hospital images with women on their backs, pushing uphill like Sisyphus, strangled up in monitors and IV lines?

What do you think?

Hang on, doc! Let that baby hang on a little longer.

Here’s an article from yesterday’s New York Times about the benefits of delayed umbilical cord clamping, finding that even a few minutes’ delay reduces the likelihood that the baby will develop low-iron months later.

Here’s the background on this issue:  When a baby is born, he is still attached to the placenta by the umbilical cord.  At first, he continues to get oxygen and nutrients from the mom’s body through the cord — you can see the mom’s pulse beating in the cord.  After several minutes, if left alone, the cord will stop pulsating (and stop delivering oxygen and nutrients), and soon thereafter the placenta will come out.  

In the 1950s it became common OB practice to clamp and cut the cord immediately after the birth — while it was still delivering oxygen and nutrients to the newborn.  There was no medical reason to do this, but it saves a few minutes of the doctor’s time and, in an era where so many women asleep during the birth, quick cord clamping allowed nurses to whisk the baby off to the nursery for immediate care.  

In recent years, though, we’ve begun to see a return to the idea of delaying cord clamping until the cord has finished delivering its goods — why not let the baby’s first experience of the world be lying on mom’s belly gazing up at her, while receiving all that additional oxygen and nutrient-rich blood?  It just makes sense.   

The only reason to cut the cord right away is habit.  (Sometimes OBs speculate that immediate cord clamping prevents jaundice, since the newborn gets less of mom’s red blood cells.  But the study found no difference in jaundice for either group). 

What about the benefits?  By the time the babies were four months old, the babies whose cords were cut early had higher rates of iron deficiency, which suggests that premature cord-clamping has longer-term health and nutrition implications.  

That’s cool in and of itself, but there’s another wrinkle — iron deficiency is a reason I hear frequently that moms start their babies on solid foods before the half-year mark. Most moms know that AAP and WHO recommend that infants get only breastmilk for the first six months, but the moms are also pummeled with advertising of infant iron supplements.  No one wants her baby to be anemic, but how do you balance that against the universally acknowledged recommendations to delay solid food for six months? 

Well, maybe we could avoid that whole tangle, and reduce the number of babies who need iron supplements at all, by our choices in the first three minutes after the birth.

Actually funny piece about childbirth

I love The Hairpin, and they’ve pulled off something amazing — this is something I have almost never seen before:  a humor piece about childbirth which is actually funny, as opposed to like every single other humor thing about birth, which are so infused with ignorance about birth / misogyny /general female body-hate that I have to stomp around ranting and eat chocolate even though I already brushed my teeth. 

And there’s a reference to Dune!  

But I have to disagree with #25.  The ultimate post-labor food is bacon-egg-and-cheese on a hard roll ordered in from the diner across the street from the hospital.  And if the diner forgets the bacon, and this omission makes the new mom burst into tears even though she was totally a rock star for the whole labor, and her husband gallantly offers her the bacon from his own sandwich, this is a great sign that the marriage will survive and thrive, even if there is a period where she kind of hates him for a while there during the f&ck-now-we’re-parents transition.

Just, yk, hypothetically speaking.

Childbirth is Natural

     Back in the 1970s, a lot of oat-filled snacks appeared in my lunch box, labelled: “all natural,” “naturally sweet” etc.  At the time, we all thought we were sort of virtuous and extra healthy for eating these. 

     The thing is, “natural” didn’t, apparently, mean anything on food labels; it was just a phrase marketers realized people like.  Granola bars had as much sugar as cookies, though we all thought of cookies as “dessert.”  When I learned that the phrase meant nothing, I felt a little cheated.  After all, the granola bars claimed to be from Nature’s Valley!  

     But then I thought — isn’t any valley just a natural formation between hills or mountains?  Are there unnatural valleys?

     The funny thing is, it’s the same thing with childbirth.  When I’m teaching, invariably a student will use the phrase “natural childbirth,” either to say, “I want a natural childbirth” or “I’m not interested in natural childbirth.”  

     We all know what it means.  And yet, it’s just as empty as the granola bar packaging, and I dislike it just as much, and I suggest we stop using it altogether.

     Because isn’t all childbirth natural?  

     What could be more natural than reproducing?  For adult women who like men, reproduction is so natural that you have to work to avoid it.  Whether you’re partnered or not, your body prepares for pregnancy a dozen times a year.  If you get pregnant, the natural culmination is birth.  Somehow, whether it’s a vaginal birth or a c-section, spontaneous labor or induction, pain medication or no, the natural conclusion of the labor is that the baby comes out.  

     I said “we all know what it means,” but that’s not exactly true either.  Sometimes people use “natural” childbirth to mean “no c-section,” and it’s just a way of avoiding the word “vaginal.”  

     Here’s the thing about that:  I do know that regular people who aren’t childbirth educators aren’t, usually, comfortable with the word “vagina.”  And I remember, when I was a lawyer, one time when the guy in the office next to me (who had overly-long greasy hair and a chronic post-nasal drip, so I’d hear him hawking phlegm, daily, as he berated first-year associates with the door open) told me about his wife’s birth and managed to say “vaginal” eight times, gratuitously in the span of two minutes.  

     The image of him schnuffling beside his wife and her vagina — eight times — was really gross, and I felt, distinctly, that the point of this, for him, was that he got to say “vagina” eight times to the cute, young associate next door, which pretty much sums up why I didn’t like the practice of law, butanyway.

     Still, in truth, if he’d said “natural” it wouldn’t have been much better.  My objection was to him and his slavering TMI, not to the word “vaginal.” 

     So, I get it on the “vaginal” birth thing, but, hey folks, get over it.  Say it quickly, or just say, “I gave birth,” and lets have that mean vaginal birth without having to talk about your Nether Regions.  It might help us remember that c-section is supposed to be a last resort.


     Some people use “natural” to mean “no pain medication,” but that’s tricky, too.  The idea is that a woman who relies on her own internal coping tools is closer to “nature” than someone who gets an infusion of chemicals injected into the epidural space.  But both women — all women in labor — naturally respond to pain by looking for *some* way to cope with it.  A woman who doesn’t use medication isn’t more stoic, she is just using different, non-chemical tools to get through the labor.  It is natural to look for pain relief.

     And the meds argument is tricky:  If you have Pitocin but no epidural, is it natural?  

     Suppose you have no medication at all, but you have IV fluids because you were dehydrated at the beginning of labor?  Natural? 

     Suppose you go into labor on your own labor at home in the tub and using massage and stuff, and, after 4 days of labor, are still a few centimeters dilated and request a c-section because you’re too exhausted to carry on?  Unnatural?  To me, the natural response to exhaustion is to look for something to help you deal.

     And, on the other hand:  suppose you planned to have an “all natural” birth but your placenta is completely previa and there’s no option besides surgical birth.  Do you lose your all-natural status?  Points for having wanted it?


     I hate the way “natural” can sound like a badge of honor: “She went all natural!  If “natural” is good, it seems like all the women whose labors don’t fit into the “natural” box are less entitled to bask in the accomplishment of having made it through a pregnancy and, somehow, gotten a baby out.   And that’s unfair.

     And I hate the way “natural” is, sometimes, a dis.  I don’t feel the need to do it all-natural,” some folks say, as though “natural” means “martyr.”  It’s not being a martyr to rely on non-medical tools for pain.  It’s not selfish.  It’s not a birth fetish.  It’s not crunchy/granola.  People have different ways to deal with pain, period.  


     In the end, though, it’s all meaningless – “natural” doesn’t mean any more in the birth world than it does in food labelling.  All valleys are natural, but that doesn’t mean you’re in the mood for a granola bar today, right?  Childbirth is natural too.  

      Here’s what’s unnatural:

  •  Being pregnant and not having any curiosity about what is going to happen at the end. 
  • A healthcare system that treats women like they can’t comprehend labor unless they are doctors, or probably aren’t smart enough to make good choices for themselves. 
  • Maternity care that is routinely managed in a way that leaves many women thinking their bodies don’t work properly. 


Instead of talking about “natural childbirth,” lets do this:

      When you’re pregnant, become educated about the physiology of labor, about medical tools available to address problem situations, and about all manner of ways to deal with pain.  You do not need an advanced degree; a high-quality prenatal class will suffice.  As you approach the birth, make sure you have access to at least one gentle, loving support person besides your caregiver, to be with you in labor and help you navigate your birth.  

      Afterwards, if you don’t feel like talking about the birth, don’t.  But if you do, I suggest that you say “I gave birth,” to mean a vaginal birth, or “I had a c-section,” if you did.  If you used pain medication and would like to talk about it, say, “I had an epidural,” (or fentanyl, or whatever), and if you didn’t use medication and would like to talk about it, you can say, “I didn’t use pain medication,” or “I had an unmedicated birth.”  If you’d like to add other info, you can do so specifically.  

      Does this sound wordy?  It is.  Childbirth is intimate and private and a big deal.  Your experience of bringing a child into the world and becoming a mother is more than can be captured in any two-word phrase.  You don’t need to tell anyone your personal business.  But if you want to, it’s OK to tell the story.  


In the birthing world, it was big news: After a 15-year decline, home births in the U.S. rose 20 percent between 2004-2008. Though the actual numbers remain tiny — out of about 4 million births, 28,357 happened at home in 2008 — the reversal of the long downward trend is notable. So are the demographics: much of the increase was driven by highly educated white women. A full 1 percent of them decided to forgo the hospital and give birth at home, according to the new report published Friday in the journal Birth: Issues in Perinatal Care.

I’m not sure I’d call it a trend, yet:  even with the increase, fewer than 1% of American women give birth at home. But what’s interesting about the data is that he biggest increase in home-birthing women is among white, highly educated women.  Home-birth is no longer just a “crunchy” option; increasingly, women who don’t even wear Birkenstocks are doing it.

Some folks have suggested that this proves more American women want “natural birth.”  If you’ve taken my childbirth class, you know I don’t like the word “natural” (in food labeling and in childbirth, it’s somehow both too-charged and unspecific).  Becoming a parent is quintessentially natural, though not everyone does it.  It’s natural, irrespective of how you cope with pain. 

To me, though, what’s even more natural is the desire for control and dignity when you face a challenge.   For some women, pain medication gives the sense of control they need, to cope with labor.  For other women, control means a familiar setting, not dealing with strangers, and avoiding hospitals’ institutional protocols that are designed for litigation-avoidance and not always for safety.   Part of the trend towards home-birth may be that more educated women, considering their options, choose a setting that gives them the sense of command they need in order to cope.  Hospitals wishing to draw women back might do well to consider what changes might let women feel more control.

For all women, control involves respect and dignity.  And one area where home-birth is unbeatable is customer satisfaction.  Women who give birth at home tend to describe a relationship of trust and respect with their caregivers.  I don’t mean in a soft-focus-let’s-all-gather-round-the-bonfire-and-talk-about-our-vaginas way.  What I mean is that their midwives treat them as competent adults and consumers, and remind them that birth is not only about the dilating cervix and the fetal heart tones.  It’s certainly more convenient to ignore the woman attached to the cervix – she might have questions!  She might want to tell you everything about her mother and her sex life!  She might need you to talk her down after she’s read all manner of horror stories on the internet!  She might want every single thing to be explained, or she might be so visibly scared that she says she is afraid of any information at all, to her detriment! – all of these things are complicated to deal with.  But it doesn’t compromise safety to take the time to meet her where she is and treat her as a human being so that she can feel respected and dignified.

Not everyone needs an intimate relationship with her doctor or midwife, but no one – not the Granola Birkenstock Mom, and not the Type A Wall Street Mom – can feel dignified if she is shamed, rushed or disrespected.  I meet several hundred pregnant women and new moms per year and the overwhelming majority are college educated women who give birth with an OB in a major hospital.  I hear many, many complaints about being rushed, chastised or even bullied, from moms who simply had questions.   It is upsetting to hear and it’s demoralizing how many of my clients don’t object because they despair that there is “no other option,” or that objecting would just make it worse.   Women planning a home-birth with a competent, professional midwife do not report being rushed, chastised or bullied – to the contrary, they typically report that they are treated like competent adults and human beings, and that being treated properly increases their self-confidence.  In this day and age, shouldn’t that be something we can all expect, anywhere?  

My hope is that the trend of highly educated women choosing home birth is a sign that women are voting with their feet.  And I hope that hospitals and OBs take note:  customer satisfaction is part of maternity care.  

(Full text of quote here).

Can Childbirth Be . . . Delightful?

I’ve watched the clip, below, now, about five times. Those of you who’ve taken my childbirth class know I think video (oy, especially a 2 minute video!) is a pretty limited way to learn what birth is like, and that I think a great birth can take many different forms as long as the mom feels dignified and respected at the end.  

But this video is interesting because of all that it is not.  I’ve taught childbirth classes to over a thousand couples and heard many of their birth stories.  Women who are happy with how it went often sound thrilled, moved, grateful and awed, and universally they describe it as challenging.  When a mom tells me her “great” birth story, the narrative arc includes the moment of self-doubt that comes along with any challenge, and the thrill that came when she learned she could cope with it.  I’m not just talking about unmedicated births, here, or even about vaginal births.  But the “good” birth stories I hear involve a mom who discovers she has the tools to cope with a situation she couldn’t fully anticipate in advance, and the tools worked.  Hallelujah!  

Facing a challenge can certainly be thrilling (and “challenge” doesn’t need to mean “bad” or “dangerous”).  But what’s notable in this video is how the mom’s thrill doesn’t seem to have anything to do with challenge.  Here, the mom seems not just thrilled and moved but enthusiastic, untroubled, even … delighted!  Look at the way she kicks up her legs into a full body hug after her baby’s arrival.  It’s unlike anything I’ve ever seen.  


By far the sexiest birth film I’ve ever seen. Looks like Marilyn Monroe shot by Godard. Also, no sound, which helps.

What do you think?  Can birth be delightful?