The Babymoon Bulletin
After experiencing giving birth in both a hospital and a birth center setting, Tieska Jumbo sums up her thoughts about another hospital birth in five words: “Heck No, I Won’t Go!”
In an article for Jacksonville Moms Blog, Jumbo explains why she sought out midwives and a birth center for her second pregnancy.
“I’ve heard women say that giving birth is an amazingly beautiful experience and that they continue having babies because they forget the toil that is pregnancy and labor. After being traumatized by the hospital birth of our first son and going back to work after six weeks, those sentiments did not compute for me. So, when we found out we were pregnant again, I was determined not to give birth in another hospital, nor to return to work so soon. After thoroughly researching my options, I settled on a local birthing center.”
Jumbo listed the personalized approach to care, small staff, and the patience and flexibility demonstrated by her midwives as reasons she would choose birth center care over a hospital birth again. She also found the setting at the birth center to be more conducive to labor.
“Mostly, I enjoyed the privacy of the setting and the ability to create the atmosphere we desired. Our room was big and naturally lit with a with a full-sized bed, artwork on the walls, a chest of drawers, two chairs, a garden tub, and a thermostat. With my music on, I sat on my birthing ball and made figure eights while praying aloud. Before getting us lunch, my husband joined in and we created our peace. Although (midwife) Ashleigh entered periodically to check my vitals, she was very quiet, polite, and sensitive to the mood we’d created. In the hospital, it was virtually impossible to find peace with the noisy machines, different strangers constantly coming in and out, the awful lighting, being limited to eating ice chips and being held hostage by the bed.”
Notably, Jumbo’s first birth in the hospital had included an epidural, but she found her unmedicated birth in the birth center to be less painful.
“Without an epidural or any kind of medical intervention, my water birth was by far easier and less painful than my hospital birth with an epidural. Instead of being discharged feeling traumatized, I left feeling empowered, healthy and strong and like we’d made the best decision for our family.”
Have you experienced birth in both a hospital and a birth center? How did they compare?
More than 73% of women prioritized choosing their care provider over choosing the hospital in which they would give birth, according to research published earlier this year. Only 17% chose a hospital first and then sought out a care provider.
The research included more than 6,000 women who answered survey questions through the Ovia Pregnancy app.
In an article for Slate.com, Christina Cauterucci looked at the Ovia survey and also at a recent assessment of 12 childbirth facilities that examined the correlation between the design/layout of the facility and the Cesarean rate. The assessment included both freestanding birth centers and hospitals.
“Neel Shah, a Boston OB/GYN who works at health-care research center Ariadne Labs, was one of the authors of the Ovia Pregnancy survey. He says U.S. hospital C-section rates range from around 7 to 70 percent, often with wide ranges in a single zip code. And though hospital choice can be a woman’s biggest risk factor in the care she receives, including her chances of needing a C-section, few women pick their delivery hospital first. ‘Nobody picks a restaurant based on who the waiter is,’ he told Slate, comparing restaurant service to hospital care. The service might be impeccable, but, if the restaurant has a higher-than-average record of food poisoning, not many customers would want to take that risk.”
The 50-page assessment, published by Ariadne Labs, found the following:
Cesarean rates were higher in facilities where delivery rooms were farther apart
Cesarean rates were higher in facilities where the call rooms for staff were farther away from the delivery rooms
Cesarean rates were higher in rooms that see more than 100 annual deliveries
The primary lowrisk Cesarean rate was lowest in the three freestanding birth centers included in the study
So what does this mean for you? It means that while your choice is provider is important, so is the location you choose to have your baby.
For example, the correlation between the design of Babymoon Inn birth center and its Cesarean rate matches the correlation found in the Ariadne Assessment. This freestanding birth center features the following:
Two birthing suites eight feet apart
A midwife in the building during the entire labor and birth, no farther away than the next room
Birthing rooms that see around 90 births a year
A Cesarean rate around 56%, similar to the national birth center Cesarean rate
To make an informed choice about your birthing location, consumers must tour potential birth locations early and ask questions and seek out information that may not otherwise be offered. According to the Slate article:
“Shah recommends that pregnant women and their partners look at the whole ward and the process of delivery care, not just the delivery room, when touring birthing centers. Where will they check in, sit for triage, and recover? Where are the nurses and doctors hanging out—is it near the labor and delivery area or further removed? Prospective patients could also benefit from looking at publicly reported hospital data, like C-section rates and rates of hospital-acquired infections, on internet databases such as the one run by the Leapfrog Group before choosing a facility.”
How early in pregnancy did you tour your birth location? What questions did you ask to help make your decision?
In at least one large study, the rates of full-criteria PTSD in the U.S. following childbirth are now higher than those following a major terrorist attack
Nearly one in ten woman suffers from Post Traumatic Stress Disorder after giving birth, a sobering statistic reported by The Lamaze International “Listening to Mothers II” survey of more than 1,500 mothers.
In an article for Women’s Health Today, Kathleen Kendall- Tackett, PhD, IBCLC, FAPA explores the topic of birth trauma, its prevalence, and its effects on breastfeeding and the postpartum period for mothers. A full 9% of women in the Lamaze study met the diagnostic criteria for PTSD.
“If the number of women meeting the full criteria for PTSD does not seem very high, then let’s compare it to another number. In the weeks following September 11, 7.5% of the residents of lower Manhattan met those full criteria (Galea et al. 2003). Take a minute to absorb these statistics. In at least one large study, the rates of full-criteria PTSD in the U.S. following childbirth are now higher than those following a major terrorist attack.”
Kendall-Tackett looked at similarities among women who experienced PTSD after birth.
“In a meta-ethnography of 10 studies, women with PTSD were more likely to describe their births negatively if they felt “invisible and out of control” (Elmir, Schmied, Wilkes, & Jackson, 2010). The women used phrases, such as “barbaric,” “inhumane,” “intrusive,” “horrific,” and “degrading” to describe the mistreatment they received from health care professionals.”
Breastfeeding following a traumatic birth may be negatively impacted, or it can be a healing experience when the mother is provided with assistance and support, Kendall-Tackett said. She cited a study by Beck and Watson where women described their breastfeeding experience after birth trauma:
“The first five months of my baby’s life (before I got help) are a virtual blank. I dutifully nursed him every two to three hours on demand, but I rarely made eye contact with him and dumped him in his crib as soon as I was done. I thought that if it were not for breastfeeding, I could go the whole day without interacting with him at all.”
“My body’s ability to produce milk, and so the sustenance to keep my baby alive, also helped to restore my faith in my body, which at some core level, I felt had really let me down, due to a terrible pregnancy, labor, and birth. It helped build my confidence in my body and as a mother. It helped me heal and feel connected to my baby.”
To help women who may be experiencing PTSD or struggling with breastfeeding after a traumatic birth, Kendall-Tackett recommends the following:
Recognize the symptoms
Refer women to resources for diagnosis and treatment, which may include psychotherapy, counseling, and journaling
Anticipate potential problems, like a delay in the mother’s milk coming in
Continue working to reform birth in the U.S.
If you feel like you or someone you know are experiencing PTSD or are struggling to process a traumatic birth, please call Babymoon Inn at 602-314-7755 so we can support you in getting the help and resources you need.
In Babymoon’s 5-week Lamaze series, we discuss at length the six “Healthy Birth Practices” that have been linked to better outcomes for moms and babies. One of these healthy birth practices is to avoid unnecessary interventions.
But how does one determine when an intervention is necessary or unnecessary? We recommend using your BRAIN – examining the Benefits, Risks, and Alternatives to an intervention, and then asking yourself what your Intuition says and what happens if we do Nothing (right Now).
In the first of series of her blogs on her web site, Sarah Buckley begins to examine the benefits and risks of an epidural and shares some of the research surrounding this common intervention. Buckley, a physician who also authored Gentle Birth, Gentle Mothering: A Doctor’s Guide to Natural Childbirth and Gentle Early Parenting Choices, says:
“Obviously, the main benefit of an epidural is the very effective pain relief that most women experience. Because of this effective analgesia, epidurals also reduce stress, and stress hormones, in labour. This can be beneficial when women are experiencing very high levels of stress and pain, which can slow labour progress.”
To understand some of the risks or side effects of an epidural, we first must understand oxytocin. As we discuss in our Lamaze series, the hormone oxytocin – also known as the “love hormone” – is a key player in the process of labor and birth.
“Receptor cells that allow your body to respond to oxytocin increase gradually in pregnancy and then increase a lot during labor. Oxytocin stimulates powerful contractions that help to thin and open (dilate) the cervix, move the baby down and out of the birth canal, push out the placenta, and limit bleeding at the site of the placenta.”
Buckley explains that within the oxytocin “positive feedback cycle” (as illustrated in the diagram), uterine sensations lead to oxytocin release which contributes to stronger contractions, more sensations, and more oxytocin. The cycle continues and helps baby to be born quickly and easily. Oxytocin also activates reward and pleasure centers in the brain.
When epidural analgesia is introduced into the equation during labor, there are no longer sensations to trigger oxytocin release, and therefore levels will decline.
Buckely will explore the consequences of a lack of oxytocin in Part 2 of her series, coming soon.