Birth Is Just One Day - or Is It?

I originally wrote this post over at BlogHer.com, where it was recently featured on BlogHerMoms and generated some discussion on the BlogHer Facebook page and on Twitter. I've reproduced it here for my Jessica on Babies readers.

I had an interesting discussion at a recent ICAN meeting. Most of us there had had successful VBAC's and were attending the meeting to support the couple of women who were hoping to have one. As a result, the conversation centered on how we can offer information and support without coming across as overzealous.

We talked about how some people wonder why we're so focused on birth, when birth is just one day out of years and years of parenting. It's true that, for some women, birth is "only one day," and it's the many years of child-rearing that come after that "one day" that matter. They feel that as long as your child is born healthy, it doesn't matter how he came into the world, or when, or what the mother's experience was. You have a healthy child, now move on! But for others, that "one day," that birth-day, is a pivotal moment for a woman. It's not just that now she has a child and has 18+ years of parenting to look forward to. It's not just whether she has a healthy baby that matters. Birth is a huge event. It changes you for life. It changes your brain. It changes your body. It changes your life.

For those women, those in the latter category, birth does matter. It matters a great deal. If she has a traumatic birth, it can leave her with deep psychological scars. If she has a picture-perfect birth, she can carry that bliss for years.

Birth, while it may be only one day (or two, or three), does leave a lasting impression on mother and baby. Studies show that there is a difference between being born vaginally and being born via cesarean section. There are documented risks to both mother and baby of a c-section that do not exist for vaginal birth. In a complicated birth, the consequences can continue for more than just "one day," or even just a few weeks. For some, the consequences of a birth that does not go as anticipated can continue for years.

Before my oldest son was born, I was in the camp that as long as you have a healthy baby, it doesn't matter how he was born. I believed that c-section has its place (which it does), that modern medicine has made giving birth safer than ever, and that the goal of pregnancy and labor is to end up with a healthy baby. When he finally emerged from an incision in my stomach, 29 hours after labor began, I felt like I barely knew who my child was. I didn't hold him for hours. I couldn't breastfeed for a day. I lost a lot of blood, was in a great deal of pain, and had no connection at all to this gorgeous boy they'd taken out of me.

After my oldest son was born, even that very day, I knew that birth is more than just the "one day," more than just "having a healthy baby." There is a whole cascade of biological processes that occur in childbirth that make you emotionally and physically ready to become a mother, and when birth doesn't go the way you expect, you miss out on those processes. Because of the craziness of his birth, I feel that I didn't properly bond with my son in those first few hours, like nature intends. I didn't know I was a mother. My brain didn't know. My body didn't know. And because the c-section also interfered with breastfeeding, I didn't get that second chance to bond right away, with the oxytocin rush of nursing.

It's not to say that I don't love my son. He's a healthy, happy almost-six-year-old now, bright, tall, and handsome. But that "one day" of his birth still haunts me, and I still wander down memory lane, thinking of those first few weeks, when this baby was a complete stranger, and I wasn't even sure he was mine.

I've since had two VBAC's, one drug-free, and I can tell you that the "one day" of those births left a completely different, no less important impression on me. When those babies were born, put right on my chest, nursed immediately, well, my brain clicked on. I had had a baby. This was my son. I gave birth. The birth of my second son taught me what it meant to be a mother. The birth of my thirdshowed me that my body is made for motherhood.

The trouble with birth being "just one day" is that you only get one shot at it. You don't get do-overs for births. No birth is the same, just as no woman, no pregnancy, no child is the same as any other. It's important to be educated and informed before that "one day," so that you can make the most of that once-in-a-lifetime experience. It's also important to know that sometimes things don't go as planned and to be active and proactive in making the best out of a situation that might not be ideal. And it's important to admit to yourself, and to allow others to admit, that when things don't go as planned, you can be affected for days, weeks, even years afterward, and that acknowledging the pain or trauma of a birth gone awry doesn't mean you don't love your child less and aren't grateful to have her. Birth is not "just one day."

Guest Post: A Tiny Toddler

The following is a guest post from a reader, who asked not to be identified. Hearing other mothers' stories will open up discussion on topics I may not have any personal experience with and provide a different perspective on parenting. I'm excited to present this first in a series of guest posts, in which this mother talks about her difficulty in getting her daughter to gain weight and grow according to the doctors' expectations. At what point do we go with our gut instinct over what the doctors think? How many tests, specialists, and evaluations do we put our children through before we decide on our own that maybe there's really nothing specifically wrong? And how do you convince a two-year-old to eat when she doesn't feel like it? We'd love to hear your comments!

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I should begin this post with some vital stats- I am barely 5 feet tall and was 20 years old before I hit 100 lbs. My daughter was born 5 lbs 3 oz full term but two weeks early.  At 6 months she was a healthy 11 lbs having doubled her weight as expected.  At 12 months she was just under 14 lbs and at 24 months just under 20 lbs. Twenty pounds is the average weight for a 1 year old . Between ages 1 and 2 my daughter has had 3 visits with a nutritionist, 3 visits with a gastroenterologist, numerous visits to the pediatrician, blood testing for every known allergy and carries a “failure to thrive” diagnosis on her medical record. Between ages 1 and 2 my daughter has also developed an impressive vocabulary, shockingly accurate memory, all of the age-appropriate gross and fine motor skills, “friendships” with her toddler classmates, and a thriving personality.  In that same year, our lives have turned into an endless feeding chore- finding food with the highest possible fat content, finding the best toys/stories/tricks to get food into her and most often finding the energy and patience within ourselves to get through one mealtime after the next.

A few months ago, after yet another period of no weight gain, I decided to do an experiment. I was pretty convinced that her lack of weight gain was due to insufficient intake of calories- there didn’t appear to be anything medically wrong- she just ate very small amounts of food and was much more interested in doing everything else under the sun other than eating.  On any given day she probably burns all of the calories she takes in, if not more. Or whatever is left over for growth translates into height increases and brain development- both parameters for which she is on the charts and growing on the curve. So we found a solution that held her attention and physically kept her seated long enough to shovel large quantities of high fat food into her that required as little chewing as possible: we let her have an iPad.  She watched and played and, blissfully unaware that she was “eating”, swallowed anything on a spoon we put in her mouth. The results were striking- she put on just over 1 lb in 1 month.  QED. But not wanting to make a habit out of it and having proven satisfactorily to myself that this was unlikely to be a medically-based problem, I went back to more “normal” meals. Weight gain over the next 6 weeks- 5 oz.

And so it is that I find myself in my current predicament- do I give in to her current medical providers' requests and put her through specialist visits and further testing? Do I trust my instinct that she is fine, try to cultivate a liking for food in her in a relaxed non-forceful environment (someone please describe what that is because I certainly don’t know!)? Do I find an alternate medical provider who might think more along those lines? Or do I simply go back to the iPad-fuelled feeding frenzy and get her “on the charts”? Do I, as many of my colleagues have suggested, not give a second thought to “Westernized” weight standards? In a society so plagued by obesity the concept of focusing on weight gain is hard to explain. Case in point- the insurance company’s repeated denial of our nutritionist visit claims because they would only be approved if the patients’s BMI is greater that 35. i.e. if you are obese we support your treatment, but if you are underweight we don’t recognize that as a medical problem. Is it time then that I stopped considering this a problem too? 

Reader Birth Story: A Precipitous Birth

Good Monday to you all. Today we have a special guest post from Snehal Naik, a college classmate of mine. Snehal tells us about the rather unusual circumstances of her daughter's birth. 

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At my first childbirth education class the instructor went around the room asking all the women what they were most worried about. Her goal was to make sure she allayed each of our fears during the course. My answer was completely different from everyone else’s: I was afraid I would be in labour and not know it. She assured me that my fear was unfounded. At my 36-week checkup when I repeated the concern to the midwife, she too told me that it was very highly unlikely. Perhaps it was my particular situation that made this fear so acute for me- at the time my husband worked in another state and I would commute a 100 miles daily by car.  My head was full of ideas of having to deliver my baby by myself in my car on the highway or on the bathroom floor, even as my screams went unheard.  But every single person I expressed this concern to told me it was unfounded; since this was my first child, I would surely have plenty of time to get to the hospital and get my husband to rush back too.

On the last day of week 37, I woke up at 4 am to use the bathroom. The instant I climbed back into bed I felt a rush of something and, thinking my water had broken, rapidly waddled back into the bathroom. To my horror, it wasn’t amniotic fluid but blood. I yelled for my husband to call the doctor and get dressed- we were going to the hospital. We were there in 15 mins with nothing but the clothes on our backs, we left two days later with our daughter.  As soon as the midwife finished examining me she exclaimed, “You’re fully dilated, you’re ready to push!” I think my response was something along the lines of, “No, no my baby isn’t due for another 2 weeks, I’m just here to stop this bleeding and then I’m going home.”  They showed me the full-strength contractions on the monitor and kept asking me again and again if I felt anything? No! I had felt nothing at all- the hours of agonizing pain that I had braced for before I would be hearing those exact words the midwife had greeted me with- they never happened. A mere 12 hours before being wheeled into the OR (a precaution due to the bleeding) I was at my baby shower.  I had literally slept through 10 cms of dilation and to everyone’s utter surprise I was, in fact, in labour and did not know it! I watched the monitor with surreal interest as the nurse’s aide told me, “Look here comes another contraction!”  Without the monitor, I would have no idea. I can only imagine how absurd that sounds to anyone who has ever experienced a contraction, and that too one in active labour!

The medical term for what I experienced is precipitous birth- defined as labour lasting less than 3 hours. 5:12 AM I was wheeled into the OR, 7:12 AM I heard that first screeching wail. There was of course no time for medication but I was just glad that I was able to deliver non-surgically.  They had to break my water for me and once that happened I experienced pain that I have no words to describe. Perhaps because I didn’t have the time everyone else spends in labour to prepare my body and mind, perhaps because she turned while coming out and I experienced back labour which is more painful- whatever the reason, I think I delivered in a state of shock. I skipped labour- lucky, unusual, blessed, whatever you want to call it.  I certainly feel blessed that everything turned out fine- it was before office hours and a Sunday so I was not alone, my daughter was healthy despite the bleeding being from a placental infarct, and my doctor and midwife made sure I got every chance to deliver non-surgically even in that unusual circumstance.  I also feel amazed when I think back to my number one concern during the pregnancy- was it instinct or pure coincidence?  My husband wanted a refund on our childbirth education classes. I simply hope that anyone else out there who has an unusual concern about their pregnancy finds a way to prepare for that circumstance no matter how far-fetched it seems. Surely anything’s possible if you can be in labour and not know it!
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Snehal is the mother of a two-year old, a molecular geneticist by training, and a research scientist by profession. Thankfully she only commutes 15 miles now, but her husband continues to work in a different state. Discussions on part-time single parenting or the effects of a traveling parent on a growing toddler are always of interest to her.

There She Goes Talking about Her Car Seats Again

Last Saturday night, on the way home after a rather long day, we stopped for gas while GI screamed in his car seat because he was tired and wanted Mommy to hold him. (Normally, under these circumstances, he falls asleep after five or 10 minutes, but this time he seemed insistent on screaming. This is not relevant to the rest of the story.) I twisted around in the passenger seat to look at him and stroke his head to try to calm him while my husband pumped the gas. I glanced at the other two boys, who were mellow, and then my gaze caught on a seat belt that wasn't buckled. It took me a while to decide that that was indeed the seat belt that was supposed to be securing GI's car seat to the car. Except, it wasn't buckled. I studied it a while longer, then finally said to my husband, "I think GI's car seat is unbuckled." We realized quickly how it had happened. NJ, when unbuckling his own seat belt, must have accidentally hit the button on the center seat belt anchor instead of his own, causing GI's belt to become unbuckled. This meant we had been driving around with, essentially, a useless car seat. For how long? We didn't know. I put GI in his car seat all the time and hadn't noticed the seat belt dangling there, but that doesn't mean it was a recent development.

We asked NJ if he remembered accidentally unbuckling GI's seat belt. He said he did. I said, "You have to tell me if that happens so I can reinstall it! It's very dangerous if the seat belt isn't buckled!" He didn't remember when it had happened. Really, I wasn't interested in punishing him or seeing him get in trouble. I just wanted to know how long I'd been nonchalantly driving all over town, assuming GI was safely buckled in a well-installed car seat! How terrifying!

In reality, I couldn't budge the car seat anyway, with the way it was wedged between SB's and NJ's seats. Naturally, a crash force is much stronger than my tired right arm, but at least it wasn't just sliding around all over the place. I also had connected the rear-facing top tether, so the car seat wasn't completely loose. But the most important bit of installation was completely undone. I reinstalled the car seat as best I could with the baby in it, sitting in a gas station at 10:30 at night, with GI's seat wedged up against SB's and NJ waiting with Daddy while the gas finished pumping. I did a terrible job, and I knew I needed to redo it ASAP. (The lesson here is, check your car seats' installations on a regular basis and re-tighten/reinstall as necessary.)

So, Monday morning, I said to NJ that since I had to reinstall GI's car seat anyway, we may as well try to rearrange the seats the way I'd kept meaning to all summer. I really, really wanted NJ in the center position, rather than the outboard passenger side, and I really, really wanted GI behind the passenger rather than in the middle. I have three major reasons for this: 1) When my husband is driving, he has to move the driver's seat back far enough that it butts up against GI's (admittedly massive) car seat back, and that's not ideal. Behind the passenger seat, his car seat wouldn't be interfered with that way; 2) It's better for the least-protected child to be in the safest, center position, and since NJ is just in a booster, GI is rear-facing, and SB is front facing in a 5-point harness, NJ claims the title of "least protected child;" and 3) The middle position doesn't have LATCH connectors in my car, so GI's seat was installed with the seat belt (which caused the above problem). I was never happy with the installation - it never felt quite firm, and I would much rather be using LATCH if I could. The seat belt anchor in the center position in my car is on a three-inch long stalk, and it was difficult to tighten the seat belt to prevent the car seat from twisting to the left if you pushed on it. Even after consulting with a car seat technician, I couldn't get it installed to my satisfaction. If I put GI outboard, I could use the LATCH to install the seat, and this problem would no longer exist, since NJ would use the seat belt in the middle position, and the tightness issue wouldn't apply.* 


Plus, NJ is the only one who can get in totally on his own, so him being in the middle is more convenient. Plus, GI is getting heavy, and I was less and less enamored of lifting him over into the middle seat, and that was only going to get harder as he gets taller and heavier. So having him in an outside position would be easier on me, too.

The reason the seats weren't already like this is that with his booster seat wedged between two car seats, NJ couldn't access the buckle for his seat belt! However, fortunately, I had stumbled upon this extremely handy tip, which NJ was more than willing to try: Leave the seat belt buckled and have the child climb in and out of the buckled seat belt. So, I reinstalled SB's seat (behind the driver's seat), which I had un-LATCHed thinking I might move it then changed my mind, put NJ's booster in the middle and buckled the seat belt, then installed GI's seat rear-facing behind the passenger. I was extremely happy to be able to use LATCH to get a nice, tight install for GI's car seat, finally. We spent a few minutes in the driveway having NJ practice climbing in and out of his seat without unbuckling the seat belt. He got very quick at it. We then went for a short outing, and he was into his booster before I finished buckling GI. Yay!

For those interested in this trick: Pull out the shoulder belt so you can loosen the lap belt. Have the child sit in the booster and pull the lap belt over his legs and settle it on his hips. Then have him put the shoulder belt in the proper position and pull the belt tight across his lap. To get out, reverse the process: Loosen the shoulder belt, put the shoulder belt behind him, loosen the lap belt, have him pull his legs out from under it, and get out of the seat. This gives you the added bonus of knowing that the booster seat is always buckled in, even when there isn't a child in it, which is the safest thing to do so that the booster doesn't become a projectile in the event of a crash when there isn't a child in it.

Here's NJ climbing into and out of his booster:

To get in, slide feet and legs under loosened lap belt

Settle shoulder belt in place, make sure it's not twisted, and tighten

Good job, NJ!

To get out, loosen shoulder belt and put behind you

Loosen lap belt and pull legs out

And you're done!

And, just for fun, here's GI, buckled (correctly) in his rear-facing Diono car seat:

I have two new problems, which I hope are offset by the benefits. One is that NJ now does not have access to a cupholder. He had been using the one on the door. Minor, but may come up on a long trip. The other is that SB and NJ are now practically touching while in the car, which might mean a lot of bickering and "he pinched me," and "he pulled my arm" and all the other nonsense. We shall see...

* Installing a car seat with LATCH or seat belt is equally safe if done correctly. Do not use both simultaneously. Make sure, if using the seat belt, that the seat belt is LOCKED so it can't loosen in a crash. (In most cars, you pull the seat belt out all the way, then let it retract. This will trigger the automatic-locking retractor.) If using LATCH, check if your vehicle and/or car seat has an upper weight limit for use of the LATCH system. Use the seat belt if your child exceeds this limit.

About Those Formula Freebies and Mayor Bloomberg...

By now, just about every breastfeeding blog I read has made some kind of commentary or another on New York City Mayor Bloomberg's new program for breastfeeding promotion in NYC hospitals. Part of the Latch-On NYC initiative, this voluntary program requires that participating hospitals lock up formula, not routinely give out formula samples and formula-branded paraphernalia to new parents, prohibit the display of formula promotional materials in the hospital, and conform to the New York State hospital regulation that exclusively breastfed babies not be given formula supplementation unless medically indicated. The program is expected to raise breastfeeding rates in participating hospitals because research shows that women who are given formula samples by their doctors or in the hospital are 3.5 times more likely to be supplementing with formula by two weeks of age. If formula is kept under wraps, and new mothers receive education about breastfeeding before their babies are given any formula, the thinking goes, breastfeeding rates will rise and the overall health of the population will improve. Hand-in-hand with this is news of an AAP resolution that pediatricians should not routinely hand out free formula samples to patients, for the same reasons.

I have been reading every blog post I've been linked to, taking in almost every comment on all the major breastfeeding and parenting blogs I frequent, and I still don't quite know how I feel about this initiative. It sounds like they're basically trying to get NYC hospitals to conform to the Baby Friendly Hospital Initiative standards without going through the BFHI certification process. I gave birth to GI in a Baby-Friendly hospital, and I felt that the breastfeeding support there was excellent. Of course, I went in intending to breastfeed. If I had gone in less certain, uneducated, or sure I wanted to use formula, I'm not sure how I would have felt. I didn't need or want to ask for formula, so I don't know what kind of "lecture" or "education" I would have gotten had I made the request. I didn't have any problem nursing or producing milk, so I don't know how I would have been treated had I genuinely felt my baby was starving and needed formula supplementation. Because I've been lucky enough to be able to nurse with relatively few problems, and because I'm extremely pro-breastfeeding, well educated about breastfeeding (I literally wrote a book on it), and because I wasn't going to let anything or anyone stand in my way of breastfeeding, I didn't need to think about "the other side."

I often wonder whether I would have been able to breastfeed NJ had I given birth to him in a hospital like the one where I had SB and GI. Rather than jumping straight to formula when there was the slightest hint of a problem, if they had been more supportive of breastfeeding and, more importantly, had been more supportive specifically of me in my situation, would I have left the hospital breastfeeding instead of with an extra case of formula? It's very hard to say. My husband and I were discussing this last night (in the context of the above-mentioned controversy). His perspective and memories of those early days are different from mine, but we both remember that the lactation consultants who visited me were quite unhelpful. While it may have been true that many women who experience postpartum hemorrhage have difficulty with their milk supply, and while it may have been true that pumping often would help bring in my milk, what I really needed was to spend lots of time skin-to-skin with NJ, nurse him on demand, and be forced to care for him. Yes, I was weak. Yes, I had lost a lot of blood. Yes, I was in pain. But NJ was healthy and strong, had a great latch, and, with a little help, I probably could have initiated breastfeeding while in the hospital and breastfed him several times a day during that four-day stay rather than allowing the nursery nurses, my husband, my mom, and my visitors to feed him for me. It's probable that he would have needed a few bottles (or to be fed via syringe, perhaps?) on the first day when I was fairly down-and-out from blood loss, but on the second day? The third? Through the night? I do remember some good practices, such as telling me to save whatever I did pump and that they could give him that in a bottle instead of formula. They did provide me with a pump and show me how to use it. They did have lactation consultants come every day. But I constantly feel, looking back, that the advice the LCs gave me was, while not necessarily wrong, unhelpful or misleading. If you straight out tell a woman she won't have enough milk, why should she even bother to try? And if you don't tell her or her husband that formula is not, in fact, equal to breastmilk, then why shouldn't she just go straight to formula to begin with?

What's missing in all of this, to me, is that education prenatally is vitally important. The decision to breastfeed can't necessarily be made in the postpartum haze. The desire to stick with it is lowest when in the throes of newborn nursing, and the temptation to use that free formula is highest at the most critical period in the breastfeeding relationship. I know this. I've lived it. You need to walk into that hospital determined to breastfeed. You need a supportive hospital staff, from the OB or midwife to the delivery nurse to the postpartum nurses. You need lactation consultants on hand 24/7 (not just during business hours!). You need good, solid breastfeeding information. And you need to know that you are going to be respected for whatever choices you make.

The loudest complaints against this program seem to be from two basic viewpoints. One is the women who never wanted to breastfeed and don't liked feeling "shamed" or "guilted" by the hospital for their choice. The other is the women who desperately wanted to breastfeed but, for whatever reason, needed to supplement with formula in the early days and struggled long and hard with the decision. Both feel that formula samples are helpful, especially those that only needed a can or two of supplements before being able to go on to exclusively breastfeed. Both feel that being lectured or educated by hospital staff before someone will go get them a bottle for their starving babies is shaming and unfair.

The thing is, I agree with them, too. If my baby is starving because I can't produce enough colostrum or milk to satisfy him (please note that this is rare), then I need to be able to give him something else. If the hospital staff balk at giving me a bottle of formula to feed him, and I have to sign a form or justify my request every time my baby gets hungry, it's going to make me feel even worse and more inadequate. Support doesn't mean just patting a woman on the back and telling her she's doing a good job breastfeeding. Support means sitting down with a woman and figuring out what she wants, what her goals are, and then helping her get there. A good IBCLC knows this, and a good IBCLC will know when formula supplementation is necessary and how best to introduce, use, and wean off of those supplements, if possible. Having a nurse who's had a little bit of lactation training come in and tell you once again that formula isn't as good as breastmilk, and maybe you should have another go at feeding from the breast before you give a bottle, is only going to make a frustrated mother more flustered and upset. We need a balance.

I'm in favor of locking up the formula, but I'm also in favor of giving it to any mother who asks for it. I'm in favor of banning the gift bags and the formula-branded handouts, but I'm also in favor of giving unbranded formula to mothers who need it (in the hospital). I'm in favor of good breastfeeding support and information, but I'm also in favor of education in the proper preparation and use of formula, if a mother chooses to use it. I'm in favor of pediatricians having formula samples on hand to help out mothers who need it, but I'm also in favor of pediatric offices having lactation consultants on staff to help mothers who are struggling. Balance.

We need a more comprehensive solution. While restricting access to free formula will increase breastfeeding rates among those who are on the fence (that's been proven), it will not help those women who truly need it or who adamantly refuse to breastfeed. We need information and education throughout women's lives, and especially during pregnancy, to help them learn about breastfeeding before there's a squalling baby in their arms. We need postpartum support, especially for those women who are going back to work. We need support for pumping in the workplace. We need better, longer maternity leave. We need a cultural shift.

If there is one thing I know, unquestionably, it's that the more babies who are breastfed, the better. Banning formula freebies in hospitals and pediatric offices is a step in the right direction, but it's not the only step.

"Curing" Birth

I'm a huge fan of modern medicine. I'm grateful every day for antibiotics, life-saving surgeries, well-trained emergency room staff, ICU's, NICU's, and PICU's. I find it miraculous that conditions which used to kill us are now easily treated, cured, or managed by medications, surgeries, or simple monitoring and lifestyle changes. Where an illness like strep throat once might have been fatal or cause life-altering disabilities such as deafness and heart disease, now it requires a simple trip to the doctor, a throat culture, and antibiotics to knock it right out and get on with our lives. Appendicitis used to be 100% fatal, and now it can be taken care of with a simple laparoscopic surgery. We can fix or replace teeth so they look better than new. We can repair complicated broken bones with surgically placed pins and help them heal with custom-made splints. We can give people new hearts and lungs and livers and kidneys. We can remove brain tumors with an outpatient procedure using a gamma knife, with no need to even cut through the skull. Modern medicine is a great blessing that has lead to better quality of life, decades-longer life expectancy, and a healthier population.

The problem is that modern medicine is so good at finding and fixing problems that sometimes it seems we're actively looking for things to fix that may not actually need fixing. Or, we go way overboard trying to improve a situation that can be managed with less intervention. For example, often high blood pressure or diabetes can be managed by lifestyle and diet changes, without the need for medications, but we automatically jump to the "quick fix" of medications that may have unknown or unexpected side effects.

Nowhere is this phenomenon more obvious than in pregnancy, labor, and birth. Until about 100 years ago, birth did not take place in hospitals, attended by doctors, hooked up to monitors, using medications. Birth was the territory of women, specially trained midwives, with experienced mothers and grandmothers for support. Indeed, even today, in many other countries, obstetricians only come into the picture if there is a complication or emergency situation where the mother and/or baby need advanced care, made possible by modern medicine.

Statistically, the ability of a woman to safely have a vaginal birth is quite high, possibly over 90%. According to research, the optimal c-section rate (i.e., the total percentage of women who give birth via c-section) should be between 5% and 10% of all births. That is to say that in potentially 90% or more of cases, a woman will not need surgery to help her deliver her baby. Right now, in the United States, the c-section rate is around 32%, meaning that almost one in three women gives birth via c-section. Obviously, there is some disconnect between the optimal and the actual, and the question is, why? It is thought that the high rate of medical interventions during birth, including continuous fetal monitoring, epidurals, and Pitocin, do contribute to the high c-section rate. The bottom line is, in most births, a laboring woman given the proper support will eventually have her baby vaginally using nature's time-tested, age-old methods of contractions to open up the cervix and coax the baby down and pushing to encourage the baby through the birth canal and out into the open. It's primal. It's painful. It's hard work (hey, they don't call it "labor" for nothing!). It involves a lot of bodily fluids and parts of our bodies we don't normally have out in the open. But it's basic. It's biological. And it's a system that has worked to propagate the human race for a very, very long time. I mean, there are, like, seven billion of us. Obviously, we're doing something right.

I'm not saying, by the way, that emergencies don't happen. I'm not saying that interventions, drugs, and surgeries are never necessary. I'm not saying that modern medicine and obstetrical practices haven't saved numerous lives, both mothers' and babies'. I'm not saying that hospitals and doctors don't have a place in the labor and birth process. There's a reason that hospital birth is the norm in the United States and many other Western countries. We feel safe there. We know that if there is, G-d forbid, some kind of emergency, we're right there in a place that can tend to us. I know plenty of stories that end with, "If I hadn't given birth in a hospital, my baby would be dead," or, "If I hadn't been in the hospital already, I would have been infertile after my first birth," or, "Without the c-section, both me and my baby would have died." These stories are true, absolutely. Plenty of mothers and babies died in childbirth in years past from issues that we can now either prevent, treat, or handle because of modern medicine.

The trouble is that because we can make birth "easier" on women, sometimes it seems like we ought to. Obviously, if we have the choice between pain relief and pain in any kind of medical procedure, we typically opt for pain relief. I wouldn't want an appendectomy or tooth extraction without anesthetic! So if we know how to "take away" the pain of childbirth, it makes sense that we would want to. Pain is not typically seen as a good thing, and if we can make it go away, we'd like to do that. I'd rather take an Advil than suffer a headache; I don't know about you.

But birth is different. The pain of childbirth is not a "bad" pain. The pain doesn't mean something is wrong. The process of labor and delivery is part and parcel of bringing a healthy baby into this world. By jumping ahead and providing interventions that may or may not be necessary before finding out if those interventions might be causing problems, we have produced generations of people who were not born "naturally." It's only in the past few years that doctors and researchers are positively identifying real problems that are directly related to interventions during childbirth.

One of the biggest culprits is induction and/or c-section before 39 weeks, which has led to many, many beds in the NICU being taken by "late-term preemies," those born between 37 and 39 weeks, who were not quite ready to be born. Many of these inductions and c-sections were not done for medically indicated reasons but rather for convenience or because the mother was uncomfortable. Hospitals that have started banning non-medically-indicated inductions before 39 weeks are seeing a significant reduction in NICU admits, leaving those beds and resources available for babies who truly did need to come into the world before they were fully developed, in order to save their lives or the lives of their mothers. The use of Pitocin to start and/or "augment" labor is very common, and most women are not told about the risks both to herself and her baby that Pitocin may cause. The use of Pitocin is associated with fetal distress, postpartum hemorrhage, newborn jaundice, and possibly even neonatal brain damage. New studies show that at least half of induced labors lead to delivery by c-section - if the baby is not ready to be born, there is a high chance that induction simply won't work and a c-section will be the only way to get the baby out. Even when labor has started on its own, Pitocin is often used to "speed up" or "augment" the labor, and the risks of the use of Pitocin still apply in these cases.

The fewer interventions and less interference a woman has during labor, the more likely she is to give birth safely and vaginally. And, concurrently, researchers are finding that babies born vaginally tend to suffer fewer neonatal complications and lifelong health problems, such as asthma. Vaginal birth is safer than c-section, and spontaneous labor is more desirable than artificially-induced labor.

The root of the problem is that pregnancy and childbirth are viewed by the modern medical establishment as diseases that need to be treated or injuries that need to be fixed, rather than natural, biological processes that can continue on their own without interference. As more women advocate for their births to be supported rather than treated, the outcome is becoming more positive and healthier for mother and baby.

I'm not advising any woman on how and where she "should" give birth. This post isn't about what choices we as women should be making. Rather, it's about looking at how modern medicine sees birth and to address the changing tides of medical opinion toward better, safer births for all women. We as women need to know our options so that we can have useful, intelligent discussions with our care providers about how, when, and where we want to give birth, and, in return, our care providers need to be sensitive to the changing attitudes toward birth, back to letting nature take its course rather than trying to "improve" upon a system that works better without interference.

Just as we don't try to make our kids grow faster by administering human growth hormone willy nilly, just as we don't try to force our kids to walk before they're ready, or make their teeth start to fall out before the permanent teeth start coming in, just as we only turn to surgery for weight loss as a last resort after trying lifestyle changes, we can look at pregnancy and birth as normal processes that we need to wait out, rather than medical conditions that we need to treat.

Kids Need to See Women Breastfeeding

The other day, we were at a community barbecue at the Rabbi's house. I wandered into the living room of the house, where several of my friends were sitting around and chatting. One friend said she was sorry, but she thinks she made a faux pas. I couldn't imagine what she could have done. She explained that NJ had come in while one of the other mothers was preparing a bottle of formula for her daughter. (Not that she needs an excuse for this, but her daughter is 2.5, autistic, and has feeding issues, so she takes a bottle of formula to supplement her food intake.) He said something along the lines of, "I didn't have that when I was a baby!", to which my friend replied that he had. He argued, and she wasn't going to push the issue, so she just said, "Okay."

I shrugged and said, "No big deal. He doesn't know that he was formula fed." It's not that it's a big secret or anything. It just hasn't come up as a topic of conversation. He watches me nurse GI, and I think he has a vague awareness of my having nursed SB, and he's seen several of my friends nurse their babies, and he has always just assumed that (a) that's how you feed a baby, and (b) that's how he was fed. I call him my little five-year-old lactation consultant because he's very interested in breastfeeding and knows that it's the best choice for a baby. I haven't made a big deal of it, just exposed him to it by feeding his brothers. It has imprinted as "normal" on his brain, and I hope he carries that image with him into fatherhood so that he can be an awesomely supportive husband when his wife (G-d willing) has a baby (G-d willing).

I told my friend not to worry about it and that, if he asked me, I would talk to him about it. Apparently the whole episode didn't make much of an impression on him, because he hasn't mentioned it. It does make me wonder if I should sit him down and have "a talk" about it with him, but I mostly feel that it just isn't that important. At some point, it will come up in conversation, or he'll ask, and I'll explain that when he was born, Mommy wasn't as well-informed as she is now, and she was also very sick, and it was very hard for her to nurse him, so he got bottles of formula instead because he had to eat something. I'll tell him that we don't need to judge other mothers for how they feed their babies. (I wouldn't want to deal with the embarrassment of having him say something rude to a mother giving her baby a bottle! And he's the type who would say something, too, if it occurred to him.). I'll just say that some mothers decide to feed their babies formula from a bottle instead of nursing them for whatever reason, and that's their choice to make.

I'm glad that my sons are growing up exposed to women nursing. I think the image of a baby drinking from a bottle is so ingrained in our society that many girls (and boys) grow up thinking that's the only way to feed a baby. I know that when I had NJ, I didn't even really know what breastfeeding should "look like," or how it worked. I didn't know much about bottles, either, granted, but I think if I had grown up with more exposure to breastfeeding women, the idea of breastfeeding might have come more naturally to me. I didn't wrestle with the decision to breastfeed - I had intended to, before the circumstances of NJ's birth led me down a different path - but I didn't educate myself, and that was the mistake.

I think growing up knowing that babies are fed from the breast will serve more than one purpose. First, it will make breastfeeding normal, and that means that when they have their own babies, these children will think first of breastfeeding rather than bottles. Second, they will know how breastfeeding looks. How to hold the baby will come more naturally, because they'll have seen it live. They'll know how it should sound, and what the baby needs to be doing. They might even have talked to someone about how it feels or what problems she might have had. Certainly, they or their wives will need help and support from friends and relatives and medical providers and society as a whole in order to start and maintain a successful breastfeeding relationship, but they'll be motivated to breastfeed and motivated to seek out such support, knowing that their breasts were designed to feed their babies.

Growing up seeing breastfeeding as a regular and normal thing will also decrease the "breastfeeding in public" debate. If breastfeeding is just another thing you see every day, then it is no longer sensational or controversial, so there will be no need for debate. Feeding a baby is feeding a baby. It's not sexual or indecent or offensive. And if a baby suckling from a breast is as ordinary a sight as a child eating french fries, women will feel more confident in starting and continuing to breastfeed because it won't seem weird or unusual or "out there" or uncomfortable.

So, to my little five-year-old lactation consultant, my son who is so concerned for the welfare of babies, thank you for already being so supportive of breastfeeding. Thank you for showing that a child can process the idea of breastfeeding as normal, take it in stride, and establish a vision of baby feeding that will encourage him to champion breastfeeding for his own babies one day. Kids are not offended or put off by breastfeeding. It's kids who will become the next generation of breastfeeding supporters because they have been exposed to it as children and don't find it exceptional at all. And that's what we want.

And, if my son asks me how he was fed as a baby, he will also get to learn that sometimes we do need to use formula, and we don't think less of a mother just because she isn't breastfeeding. Maybe the next generation of "Mommy wars" won't include a breastmilk-versus-formula category at all.