Thursday, November 24, 2011

Happy Thanksgiving!

In honour of Thanksgiving, here is a post of some of the things that I am most grateful for.

In no particular order:

I am grateful for my mother. She made a lot of unpopular choices for her time, for the betterment of her children. She was a homebirthing, breastfeeding, babywearing, no-vaxing, homeschooling mom 27 years ago when it was not so well known as it is today. She faced stiff opposition, some of it from dearly loved family, and still did what she knew to be best for us. I realized the other day that, had we been raising our children at the same time, we probably would have been good friends. That’s awesome. I’m proud to say that we now ARE good friends. I love you, Mom.

I am grateful for my dad. He, along with my mom, has stood by me even as I made some terrible decisions with my life. They have never said, “I told you so,” even though they have had plenty of occasions to do so. I’ve inherited many of my traits from him. My strong desire to always be on time (yes, I’m late a lot. I HATE being late and will do everything in my power to not be. Some things are beyond my control though, mostly my husband and kids J ). My attention to detail (a more positive way of saying that I’m obsessive. Thanks for that term, Dad!) My desire to get to know God better every day. I love you, Dad.

My oldest son. He has taught me more about myself than anyone else in my life. He’s taught me about anger and forgiveness, determination and perseverance, what really is important and how to let go of what isn’t. After I had my first miscarriage, he taught me that life goes on. As much as I wanted to lie in bed for weeks, or forever, I HAD to get up to care for him. I love him so much and he is especially dear to my heart.

My middle son. I have a special place in my heart for him as I am also the middle child. He also has taught me a lot, mostly how to multi-task, creative ways of being fair to each child (as much as possible), and just how different one child can be from the next. He taught me that I really could bond with him, even through the hell of colic and ppd. He is such a ham, and has us alternating constantly between pulling out our hair and splitting a gut laughing at his antics.

My third-born. He’s not showing us a whole lot of his personality yet, but I love him so. He is sweet and gentle and just perfect. He has REALLY stretched my parenting skills as I learned how to wrap my brain around caring for three children. He’s made it far easier than it might have been though. Had he been colicky like his next older brother, I don’t know how we would have survived. Once we figured out the reflux, he’s been a dream. He smiles and coos and his face lights up when he wakes up next to me in the morning and sees my smiling face next to his. He likes to jump up and down on our laps and will hold himself upright if someone balances for him. He babbles and laughs. He has the cutest little pouty face.

My father-in-law and stepmom-in-law. They have graciously opened their home to us these past 5 months. Even though we thought we’d be here a couple weeks at the most, they have never made us feel unwelcome. They have been tremendously helpful to me with the kids and I don’t know how I could have done it without them. It takes a special kind of person to invite FIVE extra people into their home and rarely ever complain about the many inconveniences. I will forever be indebted to them and am eternally grateful to them for helping us.

My midwife. As I have said, I had to move away from home 30 weeks into my pregnancy. I had to give up everything, including my midwives. This was devastating. I am SO grateful that I at least did not have to give up my homebirth. I am not comfortable with birthing unassisted, and no other midwives responded to me, so a hospital birth would have been the only other option. If you’ve read #3’s birth story, then you know what I would have missed out on. She took me on, despite already having twice as many clients as she usually takes on for the month, despite me being 30 weeks along already, and despite my inability to pay in a timely manner. She has repeatedly gone above and beyond for me. I could never repay her (although I WILL pay the rest of the fee, I promise!) Thank you so, so much.

The wee monkey is calling for me so I must stop here. Thank you to all my friends and family for standing by me, for sending gifts to the baby and I as we are without so much with all of our stuff in storage, for sending me messages on Facebook, for letting me vent to you, for praying for me. I love you all.

It wouldn't be a post without a picture, so here's the little one right after a bath. I LOVE that smile!

Wednesday, September 7, 2011

Baby #3's birth story - more thoughts

After thinking about my blog for awhile, I realized that I left out some important details. I don’t want to forget these things so here they are.

Almost as soon as I learned that I was pregnant, I called my midwifery group that I'd used with #2. I requested the midwives that had been at his birth. I wasn’t thrilled with everything that had happened, but figured we could work it out. I couldn't get them, they were on vacation when I was due, but I was assigned two of the most experienced midwives in the group. As soon as I met them, I loved them. I had a great first visit with my primary midwife. We chatted and laughed and had a long visit. She was finishing my sentences. We were on the exact same page on everything important to me. I so looked forward to our visits. I could talk about pregnancy and birth and babies all day, every day (just ask my husband!) and finally had some people who were as excited about it as I was.

Fast forward several months. We had to move from Canada to the States. I was 30 weeks pregnant and devastated to lose my midwives that I’d bonded with so well. I told my husband that I HAD to find a new midwife ASAP and I would not give up on my plan to birth at home (unless there was medical indication to do so). That would just be too much. Before leaving Canada, I posted on a board on Facebook asking for recommendations for a midwife in the area that we would be living. I got only one response, but she recommended a few different midwives. I emailed all of them and got only one reply.

We met with her a few days after arriving here. I had anticipated a 45-60 minute meeting, as my appointments in Canada had been (and I was thrilled with that, compared to the 5-10 minutes that I saw my doctor for my first pregnancy!) She spent about 3 hours with us I think, just with us getting to know each other. I really appreciated her taking the time with us so that we could get to know each other, especially with so little time remaining in my pregnancy.

I liked her as soon as I saw her. The more we talked, the more we liked her. Then she mentioned church and we learned that we shared the same faith. I was thrilled. I’d left my home, my friends, my family, my church, my midwives, my country… I’d been pushed entirely out of my comfort zone, and here I was, sitting on a futon in this midwife’s office and feeling totally at home. God had definitely set up our meeting!

I had already basically written my birth plan. I found it funny and wonderful that the opening paragraph of my birth plan was said to me almost word for word by my midwife during our first meeting and she’d never read it. It talked about how I view the role of my midwife as similar to that of a lifeguard: to stand by the side and make sure everything is going okay, and jump in if there is a problem. Almost every point on my birth plan was standard care for her. I was thrilled to hear this.

So this is why I was so happy to see her when I was in labour :) I know that God had everyone there that was supposed to be there.

The second thing I wanted to record is this.

I struggled during the birth, as many birthing women do. As I birthed his head and shoulders, it felt like I was dying. My doula-mind was saying to me, “You feel like you’re dying. This is great! That means that the baby is almost here!” Meanwhile, my body was saying to me, “This is too much, I can’t do this!”

I was meditating on this. Why must we go through this process of feeling so close to death in order to bring forth life? Perhaps it was the memory of being in the water that spurred my epiphany. It was like a baptism for me. I went in a mother of two and emerged a mother of three. I went in broken, with memories of an intense birth, difficult delivery, and traumatic postpartum. I came out healed, with memories of another intense yet good birth, with no complications, surrounded by people I loved and who loved me. I can still remember what happened with my previous births, but the pain isn’t there when I think about it.

There is no less selfless act than to give up your life for another. In giving birth, I thought I was dying. At some point though, I stopped caring about that. I just wanted to make sure that he got out and was okay.

I had really worked during this pregnancy to practice self-hypnosis. I wanted to be able to get out of my own way. As Ina May puts it, to let my inner monkey do it. To stop analyzing every little thing and trying to figure out what I’m supposed to be doing and instead, just do whatever my body told me to do. I didn’t totally stop analyzing. I heard the midwife mention a purple line and knew what that meant. (I even wanted to ask for a picture so I could see but then another contraction hit and I forgot about it.) I felt sick and knew transition was coming. I knew exactly how the double hip press worked to open up my pelvis and take the pressure off my back. Yet this time, I was able to analyze all that and more and it didn’t bog me down. I still let my monkey do what it needed to do. I didn’t get in my body’s way. To put it another way, I died to myself (my thoughts, will, emotions) and just let God and my baby and my body work together to give birth. (Not that I didn’t still need reminders at times ;) )

You can laugh at me; maybe I’m making a big deal out of something that isn’t. However, there’s no denying that I feel different now. I felt totally different literally the instant that he was born. I now have a beautiful birth memory to cherish. I honestly can’t think of a single major thing that I would change if I could have a do-over. I know it doesn’t mean as much to everyone (at least they say it doesn’t) but it means a lot to me. You ask a 90-something year old woman what her births were like and she’ll tell you, in detail! Birth matters :)

Now the real work begins. Now I will die to my wants and needs every day for this wee one, at least for awhile. At least, I’ll do my best to do so :)

Sunday, September 4, 2011

He's here!!! Baby #3's Birth Story!

This was my 3rd baby, 2nd homebirth, and 1st waterbirth (I’m into numbers LOL).

We are staying with my husband’s father and step-mom for awhile so the plan was to birth in their sunroom. The house is over 100 years old with old floors, except for the sunroom which has concrete under it so that’s where the birth pool was set up. (Someone commented at one point that considering the age of the house, it's quite possible that mine wasn't the first baby born in it! That was a neat thought.) In attendance were my midwife, her mom (an l&d nurse), her assistant, my husband, my mom, and my doula. My father-in-law and stepmom-in-law were in the kitchen adjacent to the sunroom. Our older two boys were in bed and slept through the whole thing.

I was at 39 weeks and 3 days when he was born. I had prodomal labour a week before he was born for 2 days so my mom decided to come (she lives 10 hours away). I started getting pressure in my back while on my way from one store to the next and started getting contractions in the 2nd store. My mom and I finished our shopping and went home. I was in a hurry to go. I kept hearing that with prodromal labour, and a 3rd baby, once it got going for "real", it'd probably go quick. I didn't want to be one of those women who birth in a department store bathroom. I wanted to be at home, in my warm tub of water, with my midwife.

My mom walked into the house and told Hubby that I was in labour. He came out and asked me what the contractions felt like. I answered, “different”. As in, different from the prodromal labour – that had been intense, but this was intense – strong contractions – but also a lot of pressure in my back and uterus which I recognized immediately from my first two labours.

I’m funny – I don’t get early labour! Even with my first, I woke up at 28 weeks in active labour. Contractions were 1.5-2 minutes long and 30-60 seconds between them. The L&D nurse said that was impossible... until she saw it on the chart. I was dilated to 3 by the time I got to the hospital about an hour later. Then I was induced at 9 days past my EDD and 3 cm and labour came on full force right away. With my second, I woke up at 4 am in active labour. Anyways, as soon as I said different, he knew what that meant.

He called the midwife and doula and started setting up the pool. I think the midwife arrived about an hour after I got home so 2 hours into labour. I had no awareness of the passage of time though, so I could be way off on that. (This was on purpose. I didn’t want to get hung up on “oh no, it took 3 hours to dilate 1 cm” or anything like that so I told everyone not to tell me what time it was and just didn’t pay attention to time.) I was SO happy to see her. It was like, "Okay, I can relax and have this baby now that she's here."

Midwife checking baby's hearttones. I'm contracting and working hard.
I hadn’t wanted any internal exams, but she needed to know whether to call her assistant to come, and as soon as she suggested it, I wanted to know where I was at so I agreed. I was 6-7 cm between contractions and 8 cm during contractions. Head well applied, bag of water bulging. I was so excited to hear this as I’d stalled at 7 cm both previous times, but as soon as I got past 7 cm, I went FAST (from 7-10 in 15 minutes with #1 and 7-10 in about 1/2 hour I think with #2).

Smiling between contractions - my last belly picture
I got right in the water as soon as it was ready. It was a very intense labour. Being in the water didn't help much during the contractions but did feel good in between. My mom had a hot water bottle on my back and she and various people (hubby, midwife, her assistant, and my doula all took turns) were doing the double hip press which felt amazing, almost totally relieved the pressure in my back.

I had practiced hypnobirthing during this pregnancy. It helped immensely during the braxton hicks and prodromal labour - I had NO pain at all during these when I did the self-hypnosis techniques. I did have pain when I didn't do the relaxation. It helped (to a lesser extent) during the actual labour contractions too. Last time around I was panicking and tensing up. This time, despite the intense pressure, I was much calmer. I definitely felt pain, but it didn't overwhelm me as much. The relaxation techniques worked very well between contractions too. Instead of spending the time between them in fear of the next contraction, I just relaxed and enjoyed the respite.
I started having an urge to push. My midwife asked if I had a sharp pain by my pubic bone and I did. She said not to push because I wasn't fully dilated yet so I just relaxed and waited. After awhile, my body was pushing on its own. It was neat to feel that as I’d never really had an urge to push with my first two – I was just told that I was fully dilated with a lip and I could push now so I did. This time, I couldn’t keep from pushing.

After pushing for a bit, my legs kept cramping. I fought it for awhile, not wanting to give up on my desire to birth on hands and knees (I birthed my first two on my back), but finally had to give up and flip over. At least in the water, gravity didn’t have the negative effect it would have had on land.

I pushed for awhile but didn’t seem to make much progress. My midwife checked me and I had a cervical lip (same as both my other births) so she moved it out of the way (according to Hubby - I remember her checking me but I don’t remember the lip) and then I could feel him moving. I thought I was dying and then thought well if I’m dying anyways, I might as well push him out first.

I kept saying owwwww and my wonderful midwife told me to say “out” instead. That helped a lot. She also said something like “You can keep yelling but you’ll just end up with a sore throat tomorrow. It’s better if you can channel that energy down and use it to push.” So I did what she suggested (I still had a sore throat the next day though).

When his head crowned, she reminded me to reach down and feel my baby. It was unreal. She reminded me again after his head was born to touch him. Then I pushed the rest of him out (thinking for sure this would kill me!) and she told me he’s here, bring him up to you. I was so out of it and grateful that she reminded me that I wanted to catch him myself and bring him up to my chest if my positioning allowed me to do so. If I was on hands and knees then she would have had to catch him and hand him to me. Because I was sitting in the pool, I could catch him myself :D

My doula from my 2nd's birth (who was unable to attend this one because I moved 10 hours away) asked me what it felt like to catch him myself, compared to having someone else catch him. I told her that with the first two, it was like I'd waited 9 months for Christmas only to have someone else unwrap my present for me. This time, I got to unwrap my own present. I loved it.

[Photo removed to protect the identity of my midwife]

He was born after just 5 hours of labour. I have no clue how long I pushed for.

He was COVERED in vernex! That is a creamy substance that protects their skin in the womb. It's more common to see lots of it on preterm babies. It doesn't need to be washed off, I just rubbed it into his skin and it helps protect his skin after he's born too. My first, I think, had very little at 10 days past EDD. My 2nd had none that I can recall at 39 weeks. This one was covered head to toe with vernex at 39 weeks and 3 days. That sure surprised me, I wasn't expecting to see that.

Immediately after he was born, I felt amazing. I’d done it! The water surrounding me kept me warm (I get so cold after birthing!) and I think it lessened some of the painful sensations that come after birthing.

His cord was kind of short so I had a hard time balancing him with his head above the water as the cord kept pulling. After a little bit, I birthed the placenta. They put it in a plastic bucket and floated it beside us until it was time to cut the cord. Hubby cut the cord and marveled again at how thick and hard to cut it is. His placenta was so little! I'd guess it was maybe 1/2 to 3/4 the size of my 2nd's (I never saw my 1st's placenta). My doula encapsulated his placenta for me - I haven't taken any yet though.

He nursed for a short while and then we got out of the pool. I sat beside it on a chair and put my feet up on the edge of the pool. They piled me up with a hot water bottle and blankets as I was shivering hard. My doula hand-fed me eggs and toast and my mom brought me some Evergreen Wheatgrass Juice.

Best wheatgrass in the world! Well, at least North America where it's distributed :D

After a bit, my father-in-law took the baby so I could move to the bathroom and into my postpartum herbal bath. Then the baby joined me. He wasn’t happy in the bath after a bit and kept rooting so I nursed him again. Everybody left hubby, baby and I alone for a bit and that was a special time.

Postpartum Herbal Bath
Then we moved to my bed where my midwife checked me for tears (none!) and did the newborn exam. He was 8 lbs even, 21 1/4” long, and had a 14 cm head. I was tucked into bed (it was about 6 am by this point, 3 hours after he was born) and had a good sleep, cuddling with my new baby.

After my first birth, it took me about 2 weeks to get over the initial “I’m never doing this again!” feeling. It took 3 months to get to that point after #2 (in fact, I cried when I learned I was pregnant because I didn’t want to go through that again yet) and about 2 seconds after #3.  It was so wonderful and peaceful (despite my yelling – sorry ;) ). It was the first birth that I felt totally safe and was not upset with anything that happened. Nothing was done to me without my consent, I was fully supported, and my baby wasn’t taken away after. It was very healing and empowering.

Every time I walk into the sunroom, I think about it and remember how loved I felt during his birth and I feel it all over again. It’s a wonderful feeling :) Just looking at these photos, I want to drive over to my midwife's house and hug her and thank her for supporting me in a way that made it so special.

Tuesday, April 26, 2011

In My Own Defense

I have spent over a week writing this blog. Most of my blogs take about 30-60 minutes (possibly spread over several days – 5 minutes here, 10 minutes there – I AM a mom lol) so that tells you how much time I spent, comparatively, on this. I wrote it, rewrote it, and rewrote it again. I added, deleted, saved it and came back later only to chop it up again. I say this just so you know, I put A LOT of thought into this and how to properly address the issue that I want to address.

It has come to my attention that some of those who call themselves my friends think that I am opinionated and put down anyone who does not think exactly the same as I do, or who has interventions during childbirth – even if it was a situation beyond their control. I will not mention names as I do not wish to ridicule anyone or draw negative attention to them. (I have not mentioned this situation, with names, to anyone except for my husband to ask for his advice on what I should do about it.) However, since I do not know the names of all involved in order to resolve this privately, I have chosen to make a blog post open to anyone to read in the hopes that it reaches these people. I don’t think I need to know or even want to know who all is involved in this; I just want to get this out there.

I have so many issues with this accusation that I hardly know where to start.

Speak for yourself. If others have issues with it also, let them speak up too. Saying, “This is what I think and everyone else agrees with me” implies that either 1. You’re exaggerating or 2. You’re gossiping (or both.) Neither is very flattering and definitely will not add credibility to your argument. YOU are important and your opinion is perfectly valid on its own - so own it and express it and let others express theirs (or not, their choice). (That doesn’t mean I’m obligated to agree with you, I’m entitled to my own opinion as well.)

Speak to me, not others, if you have a problem with me. Noone likes a gossip (unless they themselves are a gossip and are hoping to hear a juicy tidbit…) If you follow the Christian faith, consider what the Bible says:

Romans 1:29–32 “They were filled with all manner of unrighteousness, evil, covetousness, malice. They are full of envy, murder, strife, deceit, maliciousness. They are gossips, slanderers, haters of God, insolent, haughty, boastful, inventors of evil, disobedient to parents, foolish, faithless, heartless, ruthless. Though they know God’s decree that those who practice such things deserve to die, they not only do them but give approval to those who practice them.” Wow! Evil? Deserve to die? Sounds pretty serious! Remember, these are not my words, nor am *I* judging you. These are God’s words.

Matthew 18:15 “If your brother sins against you, go and tell him his fault, between you and him alone. If he listens to you, you have gained your brother." I see nowhere in there where God allows you to first go to others and justify to them your position of being offended at me. Only if we are unable to resolve things privately does it then allow you to take one or two people with you to confront the person (Matthew 18:16 But if he will not hear, take with you one or two more, that ‘by the mouth of two or three witnesses every word may be established.’). Never does it permit for you to say nothing to the person that you are offended at and spread your negative opinion of them to others. I like this article about gossip and try to ask myself the questions suggested before discussing things with others.

If you’re going to make a judgment about a blog or article, at least read the whole thing before doing so. The very thing that you’re so angry at them for having “left out” may be mentioned towards the end.

I was accused of never showing the other side of things. This is completely untrue (as you would know if you read my blog on a regular basis), however, it is redundant to mention the same thing every single time. I do try to mention, however briefly, other circumstances that may exist, but there’s a point when it’s just ridiculous to keep saying the same thing over and over again. And, being that extraordinary circumstances should be the exception rather than the rule, I try to focus on more positive things and how birth really can be. I don’t want to spend so much time on everything that could go wrong that I miss the whole point of my blog. (There’s already a book out there about all the negative things that you can expect to experience if you’re looking for them to happen. If you want to sit and dwell on what can go wrong and work yourself into a tizzy about it, go for it. I won’t even mention the title as I think it is terrible and if you receive it as a baby shower gift, you should immediately return it or throw it away).

If you don’t like it, DON’T READ IT! I am not holding a gun to your head and forcing you to read it. If you know that the topic will trigger negative feelings or emotions in you, maybe you shouldn’t read it. There was a time after I birthed my second child that I could not read any birth stories. I had to come to terms with his birth and the things that happened that I did not like. I didn’t go out and seek positive birth stories/articles and blast the author for their supposed ignorance of the variances of birth just because in that one blog or article they did not mention your specific circumstances. It was only when I could look back at it and, rather than be just angry at what happened, look at it and ask, “What can I take away from this? What can I do differently next time?” that I was able to read birth stories, blogs, and articles again.

Don’t assume that just because I do something differently from you that I am judging you for it. Yes, if you are getting drunk while caring for your kids, or beating them to a pulp, or withholding the necessities of life, then I do think I am a better parent than you. However, just because you had pitocin or an epidural or a cesarean, does not mean anything in that regard. EVEN IF IT WAS PREVENTABLE, you are not a worse parent for having had it. Chances are, there are areas where I do things that you would not even think of doing (such as going to bed with dishes in the sink – sorry Mom, it’s a blue moon that I have an empty sink at the end of the day). I’m going to ignore the discussion that interventions are sometimes necessary, duh. I think we all know that. I’m talking about when you have a choice and you choose to have the interventions anyways. So what if natural childbirth is not your strength or something that is very important to you to achieve? We all have different strengths, weaknesses, and interests. I do not go to someone who is a fitness guru and runs 5 miles a day and say, “STOP THAT! You’re making me look bad when I put a movie on for the kids and veg on the couch all morning.” To each her own. It’s not MY interest, but I don’t seek out fitness blogs and ridicule them for their interests just because they are not mine. And for the record, I have yet to have a totally natural, non-interfered with birth!!!!! So saying that I think I’m better than you because I’ve had a natural childbirth and you haven’t is a totally baseless accusation.

Yes, I do think that what I do is the best thing, for me and my kids. Why on earth would I do something that I did NOT believe wholeheartedly was the best thing? This is not a judgment on you for doing what YOU believe is the best thing for you and your kids. I see it this way: it is like me wearing a red shirt and you wearing a blue shirt. My choice to wear a red shirt in no way judges you for your choice to wear a blue shirt. It would take a very insecure person to take offense at that and say, “You didn’t wear a blue shirt, you must be saying that I have an inferior fashion sense because you did not choose the same colour as I did.” Just because I birth at home, breastfeed, extended rear-face, extended-harness, don’t vaccinate, circ or don’t circ, DOES NOT MEAN that I cannot respect your decision to do the opposite.

Yes, I will put the information out there and yes, it feels nice when someone says, “Thanks, that was really helpful! I never thought of it that way before.” Or “Why didn’t someone tell me this before?” I’ve heard these and similar responses countless times from women. BUT, if you say, “That’s just not for me.” FINE! I am still friends with many people who do not do the exact same thing as me! We still get along just fine as long as we respect each other's decisions. What I never want to hear from a friend is, “Why didn’t you tell me?” Information is power. The truth will set you free. I refuse to withhold the truth just because it might offend someone. I did not see ONCE when my Lord did this so why should I?

I’m not saying I’m perfect in this area. I still deal with fear and intimidation and sometimes do not share information because I am afraid of how people will respond. I’m just saying that this is what I aspire to, to always speak the truth. I never once see recorded where Jesus said, “I wanted to correct this person, but was afraid that it might offend them so I said nothing.” He offended people frequently, yet, knew who He was and knew what the truth was, and knew that their offense was THEIR problem, and not His. Not that He didn’t try to address their concerns when they came to Him with them (as I have done here), but He did not allow that to keep Him from speaking up. As far as I know, most religions have a person that they are founded on that is similar in boldness and desire to spread the truth. No one who spends their life living under a rock and never speaking up for truth will ever make a difference in the world (except, perhaps, for being an example of what not to do to people who know them!)

I write all of this not to humiliate or chastize anybody, but because I love you, my friends, and do not want these offenses and misunderstandings to continue. I hope that this blog brings some peace to you.

I saw this blog today that is very timely and expresses very similar thoughts to mine. Enjoy!

Sunday, April 10, 2011

My own birth

I started out writing why I chose homebirth, but decided instead to write about my own birth first since it is important.

Why does my own birth story matter? Well, the first conscious memory that I have of birth was probably of my mom coming home from a birth as she used to go and help women in the church who would call her during labour. Sometimes they’d been stalled for several hours and the doctor was threatening cesarean. She’d go in, introduce herself as the mom’s pastor, and ask everyone to clear the room so they could pray. Then they’d pray or get out of bed and get upright or sip red raspberry leaf tea or Evergreen WheatGrass Juice. I remember one who was so tired after a long labour and was ready to have the cesarean. My mom (who has had 2 vaginal births and a cesarean) said, “You’re going to hate me for the next couple of hours, but you’ll thank me after. Now get out of bed.” She got her up and walking and that baby was born in less than an hour. Other times their own moms lived far away or were estranged so they’d call her to be there for them. I LOVED hearing these stories and seeing pictures of the new babies and families. I loved going with when she visited with them prenatally and postpartum.

But before all of that, was my own birth. I was there, I was present, and I’ve heard the story over and over, even if I don’t consciously have a memory of it. I DO believe that how a person is born matters and can affect their life (beyond just the immediate health issues that I talk about a lot on this blog.) How a mother tells her child’s birth story to them also matters. This is not to say that a difficult birth will inevitably scar them for the rest of their life, but I’ve heard mothers say – in front of that child – “It’s the most pain I’ve ever felt in my life.” “I thought I was going to die” or “I wanted to die.” “I never want to go through that again.” All of these are perfectly valid and it is good to process the birth, but please do it away from that child’s earshot. They don’t need to hear things that they won’t understand and may take responsibility for. Ie. “Wow. *I* caused my mother the most pain she’s ever experienced. *I* made my mom wish she were dead.” I digress…

My mother’s first birth was in the hospital. My older brother was born 2 weeks past his guess date. She arrived at the hospital with my father and my Aunt Karen, who is a registered nurse. My mom’s doctor had said she would be allowed in but the hospital said one support person only and no switching. So my mom refused to go in and sat in the family waiting room where my aunt helped her until she had to leave for work. She had an epidural after 24 hours of labour. The nurses changed shift and before going off shift, her first nurse gave her a dose of epidural but did not write it down. The next nurse came in and proceeded to get ready to give her another dose. She told her, “Um, excuse me, the last nurse just did that.” The nurse replied, “Well, it’s not written down,” and gave her another dose. Not surprisingly, my mother could not feel at all to push. So she got a terrible episiotomy (which later got infected).

Then she had to fight just to get her baby. This was 1983 and they used to stay in the hospital a lot longer than they do now so she was still there when her milk came in. It came in so she went down to the nursery. She pointed out her baby (who was hungry and crying – a nurse was holding him with her finger in his mouth, trying to calm him) and asked for him. She was told it was visiting hours and she could have him in 4 hours as no babies were allowed on the floor during visiting hours. Understandably, she freaked. “That’s MY baby and he’s HUNGRY and my BOOBS ARE FULL!!! GIVE ME MY BABY!!!” The nurse refused but the head nurse heard her all the way down the hall and around the corner and came to see what was wrong. She said “Give her her baby”. She called my dad, sobbing and unable to speak. He thought something had happened to the baby so he came rushing to the hospital. When he heard what had happened, he said, “That’s it?” I can totally relate to her. I may have tried to break down the nursery door if someone had tried that on me.

She was also roomed with another woman who had a very numerous and very loud family. At one point, they lost count how many people were in the room and were having to shout in order to hear each other. My dad went out and got the nurse and she asked everyone to leave.

Despite my brother being exclusively breastfed, my mom became pregnant with me when he was 6 months old. She did not want a repeat of what she had gone through before. She called up the hospital and asked, “Do you still have the policy of only one support person and no switching?” They answered yes so she sought out a doctor that would do a homebirth. He was from Holland, where most babies are born at home. He was very laid back.

The house I was born in.

I was born 3 weeks past my guess date. My grandma’s birthday was the day before and my mom had spent the day doing gardening and going for long walks, trying to get labour to start. It worked, but I wasn’t born until 3:12 am the next day.

My mom, 41.5 weeks pregnant with me (1.5 weeks to go!)

My mom called her parents to come over and they brought my Aunt Sarah (around 14 years old) with them. My grandma T was dressed up in her Sunday best and my grandpa T, who is colour blind and normally has his clothes picked out by my grandma, was wearing 3 different colours of shirt, pants, and tie. As my mom puts it, Sarah was the only one dressed how she should be for a birth – jeans and a t-shirt.

My dad’s dear parents (Gma and Gpa M) are/were very medically minded and were terrified at the thought of me being born at home. They were out of the country when I arrived.

My grandma started boiling water. She didn’t know what it was for, that’s just what you do at births! The doctor explained that it’s for hot compresses to help the perineum stretch and prevent tearing.

I was born right on my parents’ bed. The doctor handed me right into my grandmother’s church shirt covered arms.

My mom's parents and I

My mom was shocked when he announced that it was a girl. She’d SO wanted a girl that time but convinced herself she was having another boy so that she wouldn’t be disappointed. Not that my brothers were a disappointment! She was thrilled to have them and thrilled to have a daughter too J

Dr. Barel, me, my dad and mom.
I was 9 lbs, 4 oz and my mom had barely a tear that required no stitches.

My dad, big brother, myself, and my mom.
My mom writes:
“Right after you were born we woke Josh up to meet you and he said " whaz zat " pointing at you meaning if course what's that.  He was pretty fascinated by you. A real living doll.”

My big brother and I
My other grandparents called when their plane landed a few hours later. My grandpa T answered the phone. They asked if the baby had arrived yet and he said, “Yes! Right here at home!” Grandma M said “WHAT!?!?!? We’ll be right over.”

My dad's parents and I
She came over and got to give me my first bath. She asked the doctor how she’d know if it was too hot or cold. He said, “Well, if she turns red, it’s too hot. If she turns blue, it’s too cold.”

Grandma M and I
I spent the first night in my parents’ bed while they discussed my name. My mom’s grandmother’s name was Anna, as was my dad’s aunt. My dad’s mom’s name was Grace. They both liked the name Christine. They couldn’t figure out which names to use and then decided I could handle all three so they named me Anna Grace Christine. Anna means “full of grace.” They said I would need a double dose of grace in my life (and boy, were they right).

My mom and I (1 day old)
My Grandma T brought over chicken the next night for dinner. My mom also brought chicken for us in the evening after I had my secondborn at home :)

I love to hear my birth story told, especially when she says, “It was the most wonderful birth, just perfect.”

My mom writes,

“What a wonderful story!  You were a dream birth.  If everyone’s births were like that, people would have more babies.

You were such a beautiful plump baby.  Those eyes and cheeks...

The sight of you made people want to have babies.”

It's a...

Sunday, March 20, 2011

Induction and Augmentation of Labour

I'd love it if you could let me know if you found this helpful or not, and let me know if you want me to write more about anything mentioned here. Thanks!
First of all, we should discuss the reasons for which induction should not be done in and of themselves. In these cases, the risks of induction outweigh the benefits.
  • Doctor, midwife, or family’s schedule, ie. Relative is leaving town and wants to see the baby before they leave or Mom’s preferred doctor is going on vacation.
  • Mom is uncomfortable or impatient
  • Gestational age 40-42 weeks
  • To pick (or avoid) a certain birth date
 Secondly, occasions where an induction MAY be called for, but there may also be other alternatives.
  • Low amniotic fluid. To help prevent this diagnosis, make sure to drink a lot of water, especially in the days before an ultrasound.
  • Baby’s size. With the exception of some women with diabetes or a true malformation of her pelvis, a woman’s body usually will not grow a baby that she is not capable of pushing out.
  • Gestational age 42+ weeks. You can do non-stress tests (NSTs) once or twice weekly to make sure Baby is doing well.
  • Maternal illness, such as diabetes, kidney disease or high blood pressure.
  • Prelabor Rupture of Membranes (PROM). The amniotic sac breaks open before labour starts. As with AROM (see below) care practitioners do not like to allow you to go more than 12 to 24 hours with the membranes ruptured without giving birth. However, studies do not show any increased risk of infection as long as labour starts within 72 hours of ROM. Meconium staining, maternal fever (a sign of infection), and increased number of vaginal exams all increase risk.
Thirdly, when an induction is probably necessary.
  • Uterine infection
  • Fetal illness
  • Severe maternal illness
  • Preeclampsia
RISKS OF INDUCTIONIncreased risk of premature baby even if your calculations say that your baby is term.
  • Placental abruption
  • Fetal distress
  • Uterine rupture
  • Increased risk of cesarean section. Having a cesarean after a long labour or failed induction is associated with increased risk of complications than a planned cesarean.
  • Increased use of interventions including pain medications and continuous fetal monitoring.
Yes. You'll need to have a c‑section (or, preferably, wait for labour to start on its own!) rather than an induction whenever it would be unsafe to labor and deliver vaginally, including the following situations:
  • Tests indicate that your baby needs to be delivered immediately or can't tolerate contractions.
  • You have a placenta previa or a vasa previa (when blood vessels from the umbilical cord are embedded in the amniotic membranes and at risk for rupture during labor); or the cord is lying in front of your baby's head and could be compressed as his head enters the birth canal or prolapse through your cervix when your water breaks.
  • Your baby is in a breech or transverse position, meaning that he's not coming head first. (Breech babies can be birthed vaginally but should NOT be induced.)
  • You've had more than one c‑section. (Some practitioners believe that women with even one previous c‑section shouldn't be induced.This doesn't mean that you cannot birth vaginally though!)
  • You had a previous c‑section with a "classical" (vertical) uterine incision or other uterine surgery, such as a myomectomy (surgery to remove fibroids).
  • You're having twins and the first baby is breech, or you're having triplets or more. (As with a single breech, twins and triplets can be birthed vaginally, but should not be induced.)
  • You have an active genital herpes infection.
HOW - MEDICAL METHODSArtificial Rupture of Membranes (AROM or amniotomy)
  • Using an amniohook (looks like a crochet hook with a sharp point on the end), your doctor or midwife hooks the amniotic membranes and creates a tear, releasing the amniotic fluid. You may continue to leak fluid throughout your labour.
  • The procedure should not be any more painful than a regular vaginal exam.
  • If you have not been contracting, you may start having contractions or feel like your baby has dropped further in your pelvis.
  • If you have been contracting, this is called augmentation. You will likely feel the contractions increase in intensity and frequency.
  • You might not be allowed to take baths due to the risk of infection (studies do not show any increased risk, but some care providers do not allow it anyways) so you lose that pain management technique. Taking a shower should be okay, but does not provide as much relaxation (and thus pain relief) as a bath does.
  • Your temperature and blood pressure will have to be monitored for signs of infection, possibly as often as every 10 minutes.
  • There is no going back after AROM. The baby must be born. If the baby is not born after 12 to 24 hours, your doctor will probably pressure you to have more interventions or have a cesarean section.
  • Risks include:
    • fetal distress
    • failure of labour to start
    • augmentation of induction with Pitocin if labour does not start on its own
    • increased risk of infection if baby is not born within 72 hours
    • increase in fetal malposition
    • increase risk of cesarean section
    • increased pain and so increased risk of pain medications like epidurals being requested. Many women choose to just go ahead and get an epidural before AROM because the pain is so intense afterwards. This risk is lessened if AROM occurs shortly before the birth of the baby.
    • risk of catching the umbilical cord in the amniohook, causing it to bleed and putting the baby in extreme danger.
  • Synthetic form of Oxytocin, the hormone your body produces to start and maintain contractions.
  • When your body produces Oxytocin, it also produces endorphins to allow you to manage the pain (pressure) of the contractions. When given Pitocin, however, your body does not know what is coming and so you do not get the benefits of the endorphins.
  • Your body's natural production of oxytocin will slow down when you are given pitocin, so once pitocin is started, it can be dangerous to stop it or "turn it down".
  • Pitocin dosage is regulated with a medication pump. It is started slowly but the nurses may increase the dosage every time they come into the room (even if contractions are regular and strong) in an attempt to force the labour to progress more quickly.
  • You will have a continuous IV drip and continuous electronic fetal monitoring.
  • Also used to augment "non-progressive" labour.
  • Risks include:
    • fetal distress
    • possible increased intensity of the contractions and so increased risk of pain medications like epidurals being requested. As with AROM, it is pretty much a given that for most women they will end up getting some form of pain medication if they get Pitocin.
    • increased risk of cesarean section
    • uterine rupture in VBAC cases
  • Gel applied to cervix to help ripen it. May stimulate contractions to start labour. Doctors may insert up to three applications of gel to try to start labour.
  • If it doesn’t work, there is probably no harm done. You can just go home and try again later or wait for labour to start on its own.
  • Risks include:
    • fetal distress
    • possible increased intensity of the contractions and so increased risk of pain medications like epidurals being requested. However, this is much less intense then those caused by Pitocin or AROM.
    • uterine rupture in VBAC cases
Foley catheter
  • A device is inserted in between the amniotic sac and the bottom of the uterus. It is filled with a saline fluid in order to force the cervix open. It eventually falls out as the cervix dilates. You have to be dilated a little bit already in order for it to be inserted.
Stripping, or sweeping, the membranes
  • Done during a vaginal exam towards the end of the pregnancy. The woman may or may not be informed about it ahead of time.
  • The midwife or doctor places a finger inside the opening of the cervix and separates the amniotic membrane from the uterus.
  • You may be very uncomfortable during the procedure. Spotting or bleeding afterwards is common, as is feeling achy or having irregular contractions.
  • There is a risk that the amniotic sac may be ruptured during this procedure (either accidentally or on purpose.)
(Anna's note: Even so-called "natural" methods of induction are still interrupting the natural process and should be taken seriously.)

  • Labor Inducing Eggplant Parmesan
One of the methods of self‑inducing labor that's been sweeping the internet in recent years is the myth that eggplant will start labor. This maternity myth started when a news story began circulating about a restaurant in Georgia named Scalini's. Apparently the mothers of over 300 babies have gone into labor in the past 23 years, within 48 hours of eating the eggplant parmegiana. The funny part is, it may just be that the dish causes the women to go into labor, but it's not the eggplant. The herbs Oregano and Basil have properties that may cause contractions, though it is not yet known how or in what quantities. This is why, in aromatherapy circles, these herbs and essential oils are to be avoided whenever possible during pregnancy.
  • Sex to Induce Labor
Semen contains prostaglandins. Prostaglandins cause the cervix to "ripen", or soften and prepare to open. While it is debatable whether there are enough prostaglandins in semen to have any real effect, it is not a terrible way to keep hope alive and while away the last weeks of your pregnancy. Another great side effect is the fact that orgasms produce oxytocin, the hormone that causes contractions. So, between the two, there is a pretty good case for the cure for pregnancy. (In otherwords, what got you in this condition, may help to get you out of it!)
  • Evening Primrose Oil and Red Raspberry Leaf Tea
Neither will actually induce labor. While some lay midwives will argue that statement about the Evening Primrose, which is the reason it is not recommended until 36 weeks or "full term", almost all sources with experience agree that it does nothing that the body was not ready to do on its own. I will repeat this at the end of this section, to make sure you understand this, as there is a lot of confusion and misconception surrounding these two substances.
Evening primrose oil is an excellent source of prostaglandins, which we already determined readies your cervix for labor. It can be taken orally as soon as 34 weeks, and can be applied directly to the cervix at full term (36 weeks). The general recommendation is two 500mg capsules per day until week 38, at which time you increase to 3‑4 per day. The entire capsule can be inserted vaginally (inserted just before bed, it will dissolve before the first time you wake to use the bathroom), or you can use the oil on your fingers for your perineal massage, then also rub on your cervix (assuming you can reach it). Applying directly to the cervix is optimal, but the beneficial ingredients are absorbed through the external skin or the stomach also.
Red raspberry leaf tea is a uterine tonic used by Native Americans for thousands of years. It tones your uterus by helping to "focus" your Braxton Hicks contractions. Think of its job as helping your uterus do more effective exercising while you are pregnant. It does not "cause" contractions and can be safely used throughout pregnancy. It is contraindicated for those having complications "just in case", however, by most doctors who do not understand its use. Many women safely use it from the moment they learn they are pregnant at six weeks until months after delivery. (It helps to tone the uterus after delivery as well, shrinking it back to size more quickly and reducing bleeding.)
Again, neither of these actually causes labor to start!
  • Castor Oil to Bring on Labor
First let me just say that I do not recommend this method. That is because I used it with my second child and it was just about the most horrible mistake I could have made (other than maybe getting another epidural, anyway).
The theory behind this induction method is that the castor oil causes diarrhea and the diarrheal cramps cause sympathetic cramping in your uterus, another smooth muscle. This is another of the methods that "won't work if you're not already ready anyway", as the sympathetic cramping will be ineffectual if all conditions are not already optimal for labor. In my case, my contractions began 10 minutes after my first dose of oil, hours before the diarrhea began. Therefore, it could not have been the castor oil that brought on labor in my case, and I caused myself all that trouble for nothing.
There has been much debate over whether taking castor oil to induce labor will cause the baby to have its first bowel movement in the womb before birth. This pre‑birth bowel movement, called meconium, can be dangerous, because if baby inhales some of it it can cause pneumonia in the lungs. Meconium is also a widely‑held signal that the baby is in some sort of distress. Most professionals with any experience with castor oil inductions agree that this is untrue. They have found that there is no increased occurrence of meconium in castor oil induced labors over spontaneous labors.
The real danger lies in the mother when using castor oil for labor induction. With the severity of the diarrhea, a laboring woman can quickly become dehydrated. Especially in a typically highly managed hospital birth where a woman is allowed few fluids. Dehydration makes one tired and less able to endure through physical activity. Plus, not only does this endanger breastfeeding (proper hydration is necessary to make adequate milk), but a dehydrated uterus is an aggravated uterus, and an aggravated uterus causes more pain for the mother. More pain makes a woman less able to handle natural child birth and puts her and the baby at increased risk for a snowball of interventions.
  • Nipple Stimulation to Self‑induce
This is a practice often recommended by midwives when a woman is long past due or when labor is stalled. Nipple stimulation causes the release of oxytocin, the same hormone that causes uterine contractions. Many women report, however, that the contractions produced from this method are much stronger and more painful than natural labor, but are not any more effective.
Please note: In order to use this method for induction, you must stimulate the nipples for long periods of time. The usual recommendation is 15 minutes of continual stimulation on each nipple each hour for several hours. So, the amount of stimulation you may experience during intimacy, while nursing an older child, or while pumping your breasts while pregnant will not cause you to go into labor. The general recommendation on these activities is to abstain from them when your condition warrants doctor recommended pelvic rest. Please check with your practitioner before trying this.
  • Acupressure/Acupuncture for Inducing or Augmenting Labour
There are two points on your body that will cause uterine contractions. They are always warned against during pregnancy, though they are widely believed to be another labour inducing method that will not work if you are not already ready to deliver. These points are about four finger‑widths above the inner ankle on your calf, and in the webbing between your thumb and forefinger. You will know when you've found the spot because it will be very sore. You rub your calf, or pinch the webbing on your hand, in a circular motion for 30‑60 second at a time, taking 1‑2 minute breaks in between.
  • Stripping Membranes
There is a procedure your doctor or midwife can perform called "stripping" or "sweeping" your membranes. The healthcare professional will insert their finger(s) into your cervix and sweep from side to side, pulling the membranes (bag of water) away from the mouth of the cervix and the lower uterus, and in the process stretching and irritating your cervix. Sometimes this will generate local production of prostaglandins and enough of the necessary hormones to start labor. Sometimes it takes 3 or 4 attempts to begin labor. Many women find this to be a very uncomfortable, if not painful, procedure. This is a medical intervention and should be taken as seriously as any medical induction method.
  • Herbs and Homeopathic Remedies
All substances that would fall in this category, such as Blue and Black Cohosh are general considered to be as unsafe as medical interventions, and if they are to be used must be used only under the recommendation and supervision of your doctor or midwife.
  • Have a good relationship with your doctor. Make your desires known and make sure they are compatible with how the doctor practices medicine. If you are hoping for an intervention-free birth then a doctor that specializes in high-risk pregnancies and has a 50% cesarean rate may not be the best doctor for you.
  • Same thing goes for where you deliver. You are more likely to get an intervention-free birth at home, a birthing centre, or at a hospital that does not specialize in high-risk cases (assuming, of course, that your pregnancy is not high-risk.)
  • Have a birth advocate. This can be your husband or boyfriend, sister, mom, doula, midwife, or just a close friend. They will stand up for your wishes during your labour when the situation might seem confusing or intimidating to you.
  • Avoid unnecessary ultrasounds.
  • Inform yourself about as much as possible.
  • Drink a lot of water.
  • If you are in close proximity to your birthing place, then do not go there until you are in steady, progressive labour. You will know this if you cannot continue to talk through the contractions. If you go in too early, they are more likely to label it as "non-progressive" labour and pressure you to start augmentation when really you maybe should just go home and relax and go back when labour is more established.
  • Charting your fertility cycles when trying to get pregnant will allow you to pinpoint more accurately when conception took place. This will give you a more accurate due date.
  • Due dates are not “Best before” or “Expiration” dates! View it as a guideline only.

Monday, March 14, 2011

Ultrasounds: Are they safe?

During my first pregnancy, I received five ultrasounds. Not one of them was “recreational”; I did not pay to get a 3D ultrasound. I was happy each time an ultrasound was done though, to get a chance to have a peek into my baby’s life in the womb. I probably would have gotten a 3D ultrasound if I had the money. I figured that they do ultrasounds on pretty much every pregnant woman so surely I would have heard if there was anything dangerous – surely they wouldn’t do it on everyone if there was any danger, right? I did come across a study that stated that women who received 5 or more ultrasounds during the pregnancy were more likely to have a low birth weight baby. I figured that women having problem pregnancies were both more likely to have more ultrasounds and more likely to have smaller babies already and that, although there was a correlation, there was not a cause-effect relationship between the two. Besides, I thought, what’s wrong with having a small baby? I was far more concerned about having a big baby as both Hubby and I were big. I think Hubby was almost 9 lbs and I was over 10 lbs. (I later learned what the risks of a baby having a low birthweight are, but I won’t get into that right now.)

I had three ultrasounds during my second pregnancy. I received my prenatal care from midwives and it was a much more straight-forward pregnancy than my first. I was a little hesitant but my primary midwife assured me that it was safe, so I didn’t turn down any offered ultrasounds. The first was a dating ultrasound. I was eager to get this one as I’d had 4 consecutive miscarriages and wanted to see that heartbeat. We waited on this one until we could do the triple screen to test for congenital defects as well. The second was the mid-pregnancy scan, when we learned we were having a second healthy baby boy.

The last one was to check his size as I was measuring small. I told her that I measured small the first time and I have a small build anyways, but she said that I had to have the ultrasound so that she could continue to be my midwife – otherwise she’d have to transfer care to an OB as there was concern about Intrauterine Growth Restriction (IUGR). I was not happy about this. My belly was growing every week – it just wasn’t the cm per week that they want to see. I think I was 30 cm at 32 weeks and so on. I was also gaining weight every week so I did not see the need for an ultrasound. I was close to my due date and was concerned about being told that my baby was very big (despite the fact that I was measuring small, I knew that he was not small). I did not want that affecting my mental state as I birthed him, and I did not want pressure to induce if he ended up looking big on the ultrasound. Still, the alternative being transferring to OB care (where s/he would almost certainly require an ultrasound anyways), I agreed. It ended up being a very quick ultrasound (about 5 minutes). The technician asked how much my first son had been. I said “7 pounds, 9 ounces.” She said this baby would be about the same size. Phew. (She was off by more than a pound, as very often is the case. My secondborn was 8 lbs, 13 oz.)

I’m currently pregnant with our third child. I got an early one because we were not completely sure of the dating and we will be getting the 18-20 week ultrasound again this time.
Baby is that tiny blob on the right.
What is Ultrasound?
Ultrasound uses very high frequency sound waves which bounce off of the baby and back to the ultrasound wand. The computer interprets these results and draws a picture. 3-D or 4-D ultrasound takes a series of 2-D images of the baby and the computer compiles them together to make a 3-D image. Time is the fourth dimension in 4-D ultrasound.

What is it used for?
There are many things that ultrasounds are used for during pregnancy.
  • Early ultrasounds are pretty accurate at estimated gestational age, give or take a few days. Dating accuracy decreases as the pregnancy continues (later ultrasounds are not as good an indicator of gestational age).
  • Ultrasound can detect the baby’s heartbeat sooner than a Doppler, which can be very reassuring to a newly pregnant mama, especially one with a history of early pregnancy loss. Once the heartbeat is detected, the likelihood of a live birth is 82-98%, depending on the woman’s gestational history.
  • Ultrasound is useful for diagnosing many unusual things in a pregnancy, such as:
    • ectopic pregnancy (when the fertilized egg does not make it all the way to the uterus and implants in the fallopian tube. This is always life-threatening to the mother if the pregnancy continues and requires immediate removal of the fetus and sometimes the fallopian tube, depending on how much damage has been done.)
    • molar pregnancy (when the fetus does not develop normally – it grows into a random mass of cells instead of a baby.)
    • slow growth of the baby. This is done by comparing the results of an earlier ultrasound to a later one. Keep in mind that this is subject to human error as it is the ultrasound technician controlling where the computer starts and stops measuring the baby’s bones. Still, if there is a large difference between how the baby should be measuring and how it is measuring, it could be cause for concern.
    • fetal malformation. This can include some forms of dwarfism, spina bifida, cleft lip and/or palate, and problems with internal organs (heart defects, lung issues, bowel imperfections, etc.). It can also detect some clues that may suggest chromosomal abnormalities such as Down syndrome. It cannot diagnose these, however. Further testing, such as amniocentesis, is required for a diagnosis.
  • Ultrasound is used during diagnostic procedures such as amniocentesis and chorionic villus sampling to verify position of the baby and the needle to try to make sure not to stick the baby with the needle.
  • Placental location can be determined with ultrasound. The concern is usually placenta previa, which is when the placenta partially or completely covers the cervix. This necessitates a cesarean and can be life-threatening to the motherchild if normal labour is allowed to progress. As the cervix opens, the placenta detaches and can cause severe vaginal bleeding. If the placenta is only low-lying (close to but not covering the cervix) then it might migrate away and not pose any problem. Placenta previa is uncommon and is associated with scars in the uterus (mostly from a previous cesarean, abortion, or removal or uterine fibroids), a large placenta (such as with multiples), or an abnormally shaped uterus. It is almost always diagnosed before the end of the pregnancy.
  • Ultrasound can pick up multiple babies and watch for problems such as twin-to-twin transfusion.
  • Too much or too little amniotic fluid can be detected on ultrasound. Either condition can negatively affect the baby.
  • 3-D ultrasound is better at picking up smaller defects than 2-D ultrasound and, when done for medical purposes, can be done quicker than 2-D (thus lowering exposure) as it takes more images at once, which can later be dissected on the computer to get the needed images. “It took a mean time of 1.1 minutes to obtain the 3D volumes…With the standard 2D technique, the structural surveys were done in a mean time of 13.9 minutes”.
What could interfere with ultrasound?
Maternal obesity can make it difficult to get a clear image, especially with 3-D imaging or if it is very early in the pregnancy. If it is very early then a transvaginal scan may be performed instead of an abdominal ultrasound. The technician may have to turn up the intensity of the ultrasound in order to get through layers of fat on an obese mother.

Low amniotic fluid can make it difficult to get a clear image as well. Doubling your water intake for a few days before the ultrasound can ensure that the amniotic fluid levels are at a good level to get a clear image (most pregnant mothers need to drink more water than they currently are anyways).

When are ultrasounds performed?
  1. A first ultrasound is sometimes done early in the pregnancy to confirm the pregnancy and estimate gestational age. Ultrasound can pick up the gestational sac as early as 4.5 weeks, the yolk sac from about 5 weeks, and the embryo from around 5.5 weeks.
  2. If the mother opts for prenatal testing for congenital defects (called the triple or quad screen), then an ultrasound will be performed between 11 and 13 weeks. 5% of women who do this test will receive a false positive for Down syndrome. This means that for 1 out of 20 women who get this screening test, the ultrasound will show a high risk of having a baby with Down syndrome when, in fact, the baby does not have it. Around 90% of couples expecting a child diagnosed with Down syndrome prenatally will choose to end the pregnancy so accuracy is extremely important. A positive screening result is usually followed with amniocentesis (after 15 weeks) which is 98-99% accurate; however, it comes with a 1 in 200 risk of miscarriage. If you know that you would choose to continue the pregnancy if you received a positive result, then you may not want to risk it.
  3. A second trimester scan is done between 18 and 20 weeks. This is the most commonly performed scan. This is mostly to check for congenital malformations, multiple pregnancies, placental position, and fetal growth. If the parent(s) would like to know the gender and the baby cooperates, then it can often be detected at this ultrasound.
  4. A scan may be done towards the very end of the pregnancy to check the baby’s positioning if there are concerns about a transverse or breech lie, assess fetal growth, and verify placental position.
  5. Parent(s) may choose to get a 3-D or 4-D ultrasound as a “keepsake”. Most of the time they must pay out-of-pocket for these as they are not prescribed by a doctor. Some places offer a series of up to 6 ultrasounds over the course of the pregnancy.
  6. A scan may be done at any time if there are concerns about the baby or the pregnancy. This may be indicated by premature spontaneous rupture of membranes (amniotic sac breaking before 37 weeks gestation), unexplained vaginal bleeding, abnormal (increased or decreased) fetal movements, or some other circumstances.
Is it safe?
The short answer is that we don’t know. Low birth weights, speech and hearing problems, brain damage, and left-handedness (thought to sometimes be an indicator of brain damage) have been reported by small studies but have not been confirmed by larger studies. Some abnormalities have been observed in studies using animals, but this hasn’t been seen in studies with humans. I can’t word it better than I see here, so I will just cut and paste what is written.

In general, practitioners of fetal ultrasound operate on a Titanic Mentality:  Safety is assured, therefore precautions are unnecessary.  I would be happy to be proven wrong.  Tina Ureten, the operator of a chain of commercial entertainment/bonding fetal ultrasound facilities in Canada (UC Baby), made this point in a spirited response to criticism in the Aug 26, 2003 edition of The Medical Post (Canada): “Ultrasound has been used extensively by Canadian doctors and health practitioners for more than 40 years without any concern.”  This background of indifference has caused difficulties for me in trying to have output intensities given serious weighting in the tendering and selection process for new equipment.  Vendors repeatedly tell me that they have not previously been asked for this information, and without precedent or support from the wider user community it is hard for someone in a small facility to insist on treating acoustic outputs as a priority in the purchase process. 

Equipment choice can make a difference. The General Electric Logiq 9 provides satisfactory fetal imaging for most circumstances with a default Mechanical Index (MI – described in section 3) of about 0.2 using its fundamental frequency.   A recent report (4) gives an MI value of about 1 for second-trimester fetal imaging with the equipment that the authors were using (Philips HDI 5000), which is a similar value to our Toshiba Aplio. While it is not possible to know how much of the rise in acoustic intensities over time was really necessary for essential image improvements and also to satisfy increased penetration requirements in our increasingly obese populations, I have not seen a 1000-fold increase in image quality since 1980. (Anna: emphasis mine)  Comparison with mammography, where there has been intense consumer-driven demand for dose reduction and image improvements, is instructive:  “Standardization of mammography led to a decrease in mean glandular dose from 14 to 1.8 mGy with concurrent improvement in image quality” (5).

Specialized diagnostic ultrasound has been shown to have a therapeutic role in some stroke situations by helping thrombolytic treatment for blood clots involving the middle cerebral artery; this made the grade to publication in the New England Journal of Medicine (13) with commentary and mechanism speculation (14).  The device was different from those used in fetal scanning, there was a deplorable absence of ultrasound intensity measurements/calculations and the duration of exposure was beyond most fetal situations, but the point remains that ultrasound exposure in the diagnostic range of intensities can have demonstrable biological effects.

Unintended Adverse Consequences
Perhaps the most interesting example of unintended adverse consequences in obstetrics is the history of the use of diethylstilbestrol (DES) (18, 19)

Reference 18 is a Centers for Disease Control (CDC) summary with relevant links.  The drug was prescribed to prevent miscarriages; although it was shown to be ineffective in 1953 it continued to be used until the unusual complication of clear cell adenocarcinoma of the vagina in some of the daughters of women who had taken the drug in pregnancy was recognized in 1971.  If this distinctive adverse effect had not occurred when, if ever, would the increase in more commonplace problems of infertility and complications of pregnancy in women who had been exposed as fetuses have been recognized?  A reliable source tells me that she heard a radio interview some years ago in which it was mentioned that the first recognition of the DES-carcinoma of the vagina association was by a group of mothers of affected daughters conversing in an elevator and not by the preceding medical investigational interviews.

Reference 19 has an ad from 1957 recommending one brand of DES for all pregnancies.

A disturbing consequence of the ability to identify fetal gender has been termination of female fetuses in some societies; it has been estimated that up to 10 million female fetuses have been aborted in India in the last 20 years (30).

There is far more information on this website, I encourage you to read all of it.

One big risk (possibly the biggest) is over- or under- diagnosis by poorly trained technicians and/or poor equipment. The emotional strain on a pregnant mom who has received a positive screening test and is waiting for more conclusive results is huge. A couple may make the difficult decision to end the pregnancy if a poor outcome is predicted only to discover afterwards that their baby had been misdiagnosed or they may be told that their baby is fine and then be unprepared when they discover their child has special needs when s/he is born. Keep in mind that ultrasound and other diagnostic tests are not perfect and there is no way to ensure that every extraordinary circumstance is discovered before the birth. There will still be babies born with previously undiagnosed birth defects, the location of the placenta cannot always be determined, and surprise twins even pop up occasionally.

Even as a mom who did not receive a positive screening, but was just waiting to get the results back, it put a lot of stress on me. With my first, I didn’t hesitate to get the screening. With my second, I hesitated but got it. With my current pregnancy, we decided not to do the screening. I would choose to continue the pregnancy so I am okay with waiting until the mid-pregnancy ultrasound when they will check for markers of any defects just so that we can be prepared when the baby is born. The mid-pregnancy ultrasound is very important to us, personally, because we are preparing for our second homebirth. We want to make sure that the placenta location is good, how many babies we are having, and if there are any issues that the baby may have that would make it better for him/her to be born in a hospital.

For those of you that put a lot of stock in the recommendations of government organizations, here they are:

Ultrasound Equipment Used in Making Prenatal Videos for Entertainment
The Food and Drug Administration (FDA) has become aware of several enterprises in the U.S. that are commercializing ultrasonic imaging of fetuses by making "keepsake" videos. We are concerned about this misuse of diagnostic ultrasound equipment
From a medical standpoint, ultrasonic fetal scanning is generally considered safe, and should be used without hesitation when clinical benefit is expected. But ultrasound energy delivered to the fetus cannot be regarded as innocuous. Viewed in this light, exposing the fetus to ultrasound with no anticipation of medical benefit is not justified. Thus, we believe that these prenatal entertainment videos should not be performed.
Persons who promote, sell or lease ultrasound equipment for making "keepsake" fetal videos should know that we view this as an unapproved use of a medical device, and that we are prepared to take regulatory action against those who engage in such misuse of medical equipment.

Concern about Fetal Ultrasound for Keepsake Videos
In all instances, the risks of fetal ultrasound will depend on the ultrasound levels and duration of exposure. The ultrasound level is now displayed on the monitor, and this lets qualified operators assess the potential for damaging the fetus. Risks can be minimized by keeping the ultrasound level and exposure time as low as possible without losing the information needed for diagnosis.
When fetal ultrasound is done for a keepsake video, no medical information is provided to justify exposing the baby to ultrasound.

Health Canada recommends that you have fetal ultrasound only on referral from a licenced health care provider.

Health Canada's Role
Health Canada regulates diagnostic ultrasound devices under the Food and Drugs Act, the Radiation Emitting Devices Act, and the Medical Devices Regulations. This ensures the safety and effectiveness of the devices when they are used for their licenced diagnostic purposes and according to guidelines for safe use.

Health Canada has established Guidelines for the Safe Use of Diagnostic Ultrasound. The Guidelines state that ultrasound should not be used for any of the following activities:
  • to have a picture of the fetus, solely for non-medical reasons
  • to learn the sex of the fetus, solely for non-medical reasons
  • for commercial purposes, such as trade shows or producing pictures or videos of the fetus
Health Canada is also working with the Society of Obstetricians and Gynecologists of Canada (SOGC) to develop a user-friendly clinical practice guideline on the safety of obstetric ultrasound.

UK Department of Health has stated similar concerns here (It’s very long and won’t allow me to copy and paste. Scroll down to pages 64-65).

I have not been able to find any statements about ultrasound from Australia’s Department of Health and Ageing.

The general verdict is that, because we don’t really know what dangers there are, to limit ultrasounds only to those which are medically indicated – just as you wouldn’t take a drug that had unknown effects during pregnancy unless it was absolutely necessary. The current trend towards “recreational” ultrasounds for the sole purpose of a picture for the baby book or to learn the baby’s gender is disturbing. Some parents have even purchased 3-D machines in order to be able to see the baby whenever they want. “Keepsake” 3-D ultrasound booths in malls have been banned. We don’t know for certain that it is 100% safe so why risk your baby’s safety when there is no medical indication to do so? Is it really worth possibly risking your child’s health by getting unnecessary ultrasounds just for that picture for the baby book or so you can pick the colour of the nursery walls?

My personal exception to that would be if my baby was diagnosed with something that would make life outside the womb impossible, then I would likely get at least one 3-D or 4-D ultrasound session, if not more, in order to be able to see the child while s/he is alive and more fully enjoy our short time together. I have heard that there are even some companies that provide this free of charge in this circumstance.

Keep in mind that dopplers use ultrasound technology to detect the baby’s heartbeat. You may want to consider asking your doctor or midwife to use a fetoscope or pinard horn instead of the Doppler for prenatal visits and request intermittent vs. continuous fetal monitoring during labour (side note: intermittent monitoring is proven just as safe as continuous monitoring. Continuous monitoring increases rates of interventions without a corresponding bettering of fetal outcomes.)