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Sunday
Sep042011

Suddenly...

… I notice I don’t fit in the Natural Childbirth Community (NBC) anymore. This is probably a “duh” moment for many folks, but it wasn’t until I was invited into a Natural Birth Professionals group in Facebook that I really caught up that I just don’t belong anymore. 

I cannot support the unrealistic and non-evidence-based beliefs of so many of these women. I stuck it out for a couple of days thinking a dissenting opinion could be a good one, but it was obvious peer pressure was the unspoken rule of the road. 

When the topic of the Brewer Diet came up and I said it was pure bunk and could actually cause harm to the kidneys in susceptible women (which I have seen happen first-hand), several women defended it saying so-and-so had preeclampsia in one (or more) pregnancies and then followed the Brewer Diet and miraculously didn’t have preeclampsia in that pregnancy. Another woman said some woman was an “expert” on the Brewer Diet and she was on their faculty. Surprised, I looked to see what college she was the faculty of and it was a non-NARM-accredited “midwifery school.” Can you see me rolling my eyes? I’ve been asked to discuss the Brewer Diet here on several occasions and am sure I’m getting close to expending the time and energy to do so, but that isn’t the purpose of this post. 

This post is to express my dismay at the Natural Birth Advocates (NBAs) and their continued insistence on evidenced-based care and then going completely against what evidence there is! From homeopathy to acupuncture… from not acknowledging anything being too risky to deliver at home to the blasé acceptance of babies dying or being damaged in homebirths… I just can’t take it anymore. 

I may never have another reader again… may be boycotted the way the SOB is, but that’s fine with me. I am not going to tow the party line any more. I don’t know what I would consider myself, but I do need to separate myself from the NBC. 

The Birth Professionals group was one thing, but the cesarean birth my daughter just had was the last piece of patience I had. 

When Meghann got pregnant, we discussed home and hospital birth. I simply did not feel comfortable encouraging a homebirth for my granddaughter and helped her find a wonderful group of CNMs. They were fantastic! Then, on August 31, my daughter went into natural labor and we went to the hospital when it seemed she was in active labor. I’m leaving out a slew of details because I don’t want to tell her story yet, but we were treated like royalty at the hospital, a truly unhindered birth even with tiny bits of technology thrown in (an oxymoron to the NBAs). Meghann and her husband Brian were kind enough to let me chronicle her labor and birth on my Navelgazing Midwife Facebook page and the grand majority of folks were lovely and incredibly supportive. But, when things shifted and it was obvious a cesarean was necessary, a couple of purists felt it was their place to comment… er, judge… what they thought was happening, without the benefit of actually knowing because I wasn’t expressing everything online. 

I paused as things moved to more complicated, thinking, “How will this look to others? A midwife whose UC-born daughter needing a cesarean?” And I hated that I even had to expend an ounce of energy on such a stupid, irrelevant thought. Why should I care one iota what others think? 

Because (too many) others will tear apart her birth story… especially if I wrote her story out, which I am not sure I even want to anymore. Even if I wrote the facts as I know them, her decisions will be picked apart like so much carrion; like I have done to others’ stories myself. 

This acknowledgement that I have dissected other women’s stories is another aspect that lets me know I’ve left the NBC; I am embarrassed and even ashamed that I have hurt other mothers and perhaps tarnished their stories. I pray I won’t ever do that again. 

Just the few negative comments about Meghann’s choosing to have a cesarean after 32 hours of labor and bouts of fetal distress soured me on laying out her birth, knowing criticism will be a side effect of the story here in my blog. 

This morning, I read through the comments and questions on the Natural Birth Professionals page and winced seeing women I simply cannot have civil conversations with anymore. I try to be polite, but their out and out ignorance… and, I’ll just say it… stupidity about what they think birth is supposed to be irks me no end. And the topics? rolling my eyes again How many times can we hear to leave women to labor indefinitely because their body will work it out if left alone? Or that pain relief should be the absolute “last resort” after trying every single idea the judging woman thinks is appropriate? 

I just can’t take it anymore. I’ll have to find a name for myself. I embrace “Medwife” now, but think there’s a place for us middle-of-the-roaders… Realistic Birth Advocates? I kind of like that. It’s taken nearly thirty years to get here, but here I am. And perhaps for the first time, I feel at peace with my place in birth.

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Reader Comments (111)

Ditto Barb..and very well said. Brava!

September 4, 2011 | Unregistered CommenterDeb O'Connell CNM, MS

Barb,

Unfortunately, the version that you describe of the "Brewer Diet" is not the accurate, legitimate one. You listed only protein as the identifying mark of the version that you were referring to. This is a very common misperception that is being passed around. The accurate, legitimate version of the Brewer Diet actually has 3 legs--protein (80-120), PLUS calories (2300-2600), PLUS salt (to taste). The kidneys are stressed by the pregnancy, not this version of the diet. This version of the diet actually protects the kidneys from the stress imposed by the pregnancy. You are correct in thinking that a diet that focused only on the protein would be harmful to the kidneys, and particularly when adequate calories are not consumed to protect the protein intake and to protect the kidneys. However, the legitimate version of the Brewer Diet is not low-calorie and does not harm the kidneys.

In addition women who attempt to focus only on the protein will most likely find that eating in that way will not "work" in preventing complications of a rising BP, PE/E, HELLP, IUGR, abruption of the placenta, premature labor, and low birth weight. Only a nutrition plan which also adds 2300-2600 calories and salt to the mother's diet as well will work for preventing those complications in pregnancy.

In addition, another common misconception about the Brewer Diet is that it is a one-size-fits-all proposition--which it most definitely is NOT. Every mother must assess her own unique pregnancy, history, lifestyle, family situation, season of the year, and activity level, in order to custom-fit the Brewer Diet to her individual needs. When this kind of custom-fitting is not done, the diet is likely to not fulfill the special needs of each individual woman and her pregnancy.

Joy Jones

September 4, 2011 | Unregistered CommenterJoy Jones

What a wise and insightful essay, NGM - thank you!

It takes both courage and maturity to see beyond what one has always assumed and take a wider point of view. I admire your courage!

September 4, 2011 | Unregistered CommenterSue

I've never commented on this blog before but I have to comment on this post. First, even though you don't know me from Adam, CONGRATULATIONS on the birth of your grandchild!

My daughter was delivered by c-section and I endured some armchair quarterbacking from the NCB crowd. While on maternity leave I learned that I'd done it all wrong. I'd seen an OB, given birth in a hospital and had - gasp - an epidural. Even though at the time, I was relieved when the OB told me I needed a c-section, I began to second guess myself. I told myself that my next child would be a VBAC baby. I'd do it the "right" way next time around. I'd have an "empowering" birth. I'd choose an CNM and no epi. I'd have one of those births like you see on Youtube.

It's almost 2 years later and I've realized that there probably won't be a next baby. I can't get pregnant again and we're not willing to do IVF. Most women grieve the idea that we won't have another child but in addition to that, I grieved the lack of a 'do-over.'

But that's crazy. Why do I want a do-over? My daughter's birth wasn't traumatic even though I've been told that it should have traumatized me. I have a beautiful, healthy toddler.

At the root of this lie my insecurities as a mother. The more fear I have as a mother the crunchier I want to be. I work full time. I feel guilty for being away from my daughter during the day and even more guilty for liking the work that I do while I'm away from my daughter. So I respond to this by buying my daughter a Waldorf doll and only giving her organic milk.

But the ironic thing here is that I want my daughter to have a life like mine instead of the mommybloggers I envy.* I want her to have a good education and a career. I want her to be financially independent of a man. I want her to choose motherhood instead of having motherhood forced upon her.

Online NCB rhetoric can really do a number on a new mom. A few weeks ago you were in an office doing adult work with other grown ups. Now you're up all night long with a newborn so you're chronically sleep deprived. Let's not forget that sleep deprivation is a form of torture! You're stressing about breastfeeding and whether such and such toy contains toxins. You're isolated and stuck in the house all day by yourself while your husband and friends are at work doing adult meaningful things while you are doing mountains of laundry. It's a real shame that the online quarterbacks prey on that insecurity.

The only real solution to this problem is to do what you've done here, tell real stories about birth, even those that don't fit the "truth birth" narrative.

Let me also tell me how much I admire you for your series on licensure.

*You guys know the mommybloggers I'm talking about. Every meal served is nutritious and visually appealing. Made with local produce from the Farmers Market. Their children play only with beautiful wooden toys from Germany and produce beautiful works of art in their Waldorf inspired art corners. No television for those kids who are dressed in sweaters handknit by Mama.

September 4, 2011 | Unregistered CommenterJenna

Congrats, Grandma! I bet Zack is thrilled to be a grandpa, too. :) Gabriella is absolutely gorgeous.

I don't think it's all that unreasonable for you to realize now that you're not as "into" natural birth as you once were. You follow your own experiences. If I recall correctly, you had a hard, medicalized birth with Tristan and didn't think anything of it until you learned about natural birth at the La Leche League meetings for his donated breastmilk, right? Then you had better experiences with Meghann's and Aimee's births, and many of the women you saw were having great natural birth experiences. But you've seen a lot of things over the years. Complications. Completely necessary transfers, whether that be to OB care earlier on or to the hospital in labor. And yes, even necessary but non-emergency C-sections. You've seen firsthand what blind trust can lead to.

Also, my mom said it's way different when it's your daughter in labor than when it was you. That you're willing to go through way more than you're willing to watch your baby go through. She had a 42 hour unmedicated labor, pushed for 4 hours, and had a huge episiotomy when my shoulders got stuck. She still thinks things went well for her. But she was PISSED at the hospital when I hit day three of labor -- she later told me that she told the nurse to give me pain meds or she'd give me the knife I was asking for. And she sobbed with relief when I called on day four to say I was having a c-section. So I can also see why seeing Meghann need a c-section was a catalyst for walking away from the natural childbirth community.

I hope Meghann is recovering well both physically and emotionally. I know that I really felt like I'd failed at birth, especially since my mom had also had a difficult labor with me. I felt like I was a total wimp who had taken the easy way out. Knowing she was a UC with shoulder dystocia, I really hope she doesn't feel the same way. Please give her a hug for me and tell her she did a great job!

September 4, 2011 | Unregistered CommenterManapan

I've read your blog for over a year, but never posted. I couldn't let this pass without comment, though -- I want to let you know that I respect you for your intellectual honesty and your genuine committment to women and babies, even at the expense of your ideologies. That integrity is vanishingly rare, and you should wear it with pride. There's no shame in embracing new knowledge.

Congratulations to the new parents, and to you!

September 5, 2011 | Unregistered CommenterSAS

Joy Jones: Yeah, that's the one.

That amount of calories is incredibly stressing on the pregnant body. That amount of protein IS stressing on the kidneys! How do you remotely defend that amount of protein... even if we didn't include that many calories? Have you SEEN Brewer Babies? Their enormity of size? Their mothers' drinking gallons of milk and eating cheese to get enough protein (horribly LOW quality protein, I might add)?

*Especially* the way you've written the Brewer Diet out, it is absurd to expect any pregnant woman to attempt such a taxing regimen.

Have you READ any of the research that demonstrates Brewer is, in the least, useless and the most, dangerous? Wander over to preeclampsia.org... they have slews of studies to pore through.

September 5, 2011 | Registered CommenterNavelgazing Midwife

Manapan: Dang, woman... you've got one heck of a memory! I'm impressed!

There was really only one part of being with Meghann during her labor and birth that she was very consciously my daughter... and it shocked me when it happened. After a zillion hours with no more dilation, Meghann chose an epidural and that hospital didn't have a policy of only one person in the room, so Brian's sister and I both were in there as Brian sat close to Meggie during the procedure. It was as the anesthesiologist poked and hurt Meghann, over and over... that I honestly began to feel faint and incredibly nauseous; I thought I was going to throw up and had to look away the rest of the time. I gave her encouraging words, but willed the doctor to HURRY UP so my child could be out of pain... the pain HE was causing.

I didn't have that feeling at all the rest of the labor or postpartum. While I knew she was my child (who could forget?), I also knew she was a very strong woman who'd done Hypnobabies until it was memorized and assimilated into her heart and mind and I did *not* have that poor, pitiful kind of feeling I've seen in many mothers' eyes during their daughters' births.

I honestly don't feel I treated Meghann any differently than I've treated any other woman in labor... nothing different or special. I merely was WITH her, the same as I am WITH women in labor and birth. I told her how beautiful she was, how magnificent she was, how very strong she was... because she was (is!), but those are truths about ALL women in labor! I left her alone (emotionally) with Brian most of the time, stepping in only when asked for my thoughts/opinions/reassurances. It would be interesting to hear Meghann's thoughts, though. I'll ask her today if she felt I was different than with other women... she's seen me with others in labor several times. Of course, her perception was busy with other things, so... well, I'll ask without any expectations.

Thanks so much for your tender comment. Really.

September 5, 2011 | Registered CommenterNavelgazing Midwife

To those that have suggested I take some time off the Net... that ain't happenin'.

September 5, 2011 | Registered CommenterNavelgazing Midwife

For those that asked, while it is only Day 4 postpartum (and I haven't seen her yet this morning), she is not only healing incredibly well physically, but her emotional state is great! She said something like, "It sure didn't turn out like we planned, but it was a good experience anyway." And sure, it *is* early. Things *can* still happen to her incision, her emotions *will* go up and down (and I reminded her of that) and it *will* take time, perhaps a lot of time, before she's able to put the whole thing in an understandable moment in her life, but she is resilient, brilliant, well-read about birth and is one of the most positive women I've ever met, so I expect she is going to be just fine.

For right now, she's being a new mama... and that's all she needs to do.

September 5, 2011 | Registered CommenterNavelgazing Midwife

Jenna: May I take your comment and make it the beginning of a post about that topic? It's a *beautiful* springboard to talking about the way so many of us strive for something we either don't have or *can't* have and, as you pointed out, something we might not even really want.

Let me know. And thank you for a beautiful, beautiful essay.

September 5, 2011 | Registered CommenterNavelgazing Midwife

Michelle... way at the beginning of the comments. I did NOT call *anyone* "stupid." I called IDEAS stupid. There is a huge difference.

September 5, 2011 | Registered CommenterNavelgazing Midwife

For all of you who've expressed kindness at my words, thank you so much. I am overwhelmed with gratitude for your being in my life.

September 5, 2011 | Registered CommenterNavelgazing Midwife

I had natural childbirth 40 years ago-- but when my soon to be born grandson was in distress, I was more than grateful that her wonderful OB went in to save the baby mode and I have my strapping grandson and my beautiful daughter. My best to you and your family.

September 5, 2011 | Unregistered Commenterlindajones

Thank you. Thank you for being willing to look at reality above ideology. Thank you for having a truly open mind, one which weighs evidence not just wishful thinking. Thank you for being brave enough to post about it openly here.

I don't believe in "medwives". I live in a country in which most midwives work within the medical system, while still providing the support women need to make the choices they desire whenever possible. I've had a midwife support me through a c-section and another support me through a "natural" VBAC. This is what a true midwife does. He or she provides the care a woman and her baby need, not the care a certain ideology requires. The ones who are not midwives are the ones who leave women to labour well past the signs of life-threatening problems until babies are born lifeless, then shrug it off with "some babies are not meant to live". Thank you very much for not being one of them.

September 5, 2011 | Unregistered CommenterWren

You said in this post, "I simply did not feel comfortable encouraging a homebirth for my granddaughter and helped her find a wonderful group of CNMs." What message was that sending, Barb? Birth is dangerous, risky, an accident waiting to happen. How could that message affect her mental ability to give birth instead of relying on the epidural and doctors to "save" her?

Barb, I respect you and believe you have every right to feel however you want. But please don't blame the NBC for believing that a natural birth is safe, normal and within reach of every woman. It is.

September 5, 2011 | Unregistered CommenterMonica

Oh, it's MY fault Meghann had a cesarean! Stupid me... I should have known that. It's my fault... *rolling eyes*

I guess the NBC has to blame *someone* and I'm willing to deflect it from my daughter.

Don't be obtuse, Monica.

I didn't feel there were TWO homebirth midwives worth their salt to take care of my daughter. She interviewed midwives herself and made her OWN choice. I only gave information when I was asked. I only know ONE homebirth midwife I'd feel safe with myself, but there weren't two.

And how in the HELL do you get "Birth is dangerous, risky, an accident waiting to happen" out of her having CNMs? That's quite a dramatic leap, isn't it?

And you say, "How could that message affect her mental ability to give birth instead of relying on the epidural and doctors to 'save' her?" Um... the message has ZERO to do with doctors or an epidural or her "mental ability" to give birth. The words "CNM" might have that connotation for you, but I guarantee you, that is not the way our family hears the initials or knows the midwives to be.

By choose CNMs, she chose the most qualified midwives to keep herself and her baby safe. The end. What you read into it is YOUR issues at play, not ours.

Please keep your paranoia out of Meghann's beautiful birth experience.

September 5, 2011 | Registered CommenterNavelgazing Midwife

I don't think you should publish her story. I think you should write it for your daughter and granddaughter and leave it to them to decide what to do with it. I feel like birth stories are really private and the mother alone should be the story teller.

As I read some of these comments here and on the Facebook page I'm struck by how little room people leave for Meghann to feel her own emotions about her experience. It seems like either she is supposed to feel extremely happy that she has a healthy baby, or she is supposed to feel sad and traumatized that it was not the birth she planned for. I think that is what I have the biggest problem with - this lack of wiggle room. I am sure she will feel a range of emotions, she is an early postpartum mama! I think to assume that she will be traumatized or extremely upset about it is a big stretch - from my reading of your updates it sounded like she was in control of her experience the entire time. And being in control and able to make those decisions is a really good way to prevent any trauma. It is how it should be every time diversions from our ideal experience must happen. I think though, for other commentors to yell at the group assuming major trauma by countering it with the assumption that there will be only happiness and thankfulness for a healthy baby, and further if one is not happy and thankful for a healthy baby or does not bond right away then there is something very wrong with that woman as a mother, is not only harmful to Meghann (who should be free to experience a range of emotions at this time without guilt) but to any mother reading who felt traumatized by her birth experience and didn't feel bonded to her baby right away. I think what postpartum women need most is room to feel any way they want to about their birth and their baby and their adjustment to motherhood. And we all need to learn to accept that other women have the right to their own feelings about these things and we don't need to judge them. Their experience does not say anything about our own - we are individuals and will all have unique and valid experiences in life. Any woman who doesn't allow room for some sadness or for feelings of not being bonded to baby must have had only extremely ideal circumstances and completely lacks the ability to see things from another's point of view. Even under the best of circumstances, we should give postpartum women the room to feel whatever emotions they need to. If they are sad, let them be sad, it will flow through them faster if they don't feel such pressure to not feel that way. If they are happy, let them feel happy, even if you weren't happy in the exact same circumstance. Let's just allow women to feel whatever they need to about their own experiences and then support them where they are at.

As for the NCB thing, yeah, join the club. I have not identified myself as a "natural childbirth advocate", well, ever. For me, that would mean that I feel everyone should have a natural birth. I'm not a homebirth advocate for the same reason. I think women should have the birth they want. I think the lack of informed consent and the right to choose or refuse treatment (without pressure: manipulation, coercion, force) is what the problem is - both in and out of the hospital. The right to informed consent and refusal is what I advocate for.

September 5, 2011 | Unregistered CommenterJennifer Z.

ITA, Barb. I saw those comments in the snippets on my newsfeed (even after you had deleted them from your page) and thought, Give me a frackin' break. It's like that person is saying, 'It's so SAD that the daughter of homebirth advocate super duper natural midwife Barb Herrera would have to have *GASP* a CESAREAN!" What we should be saying is, "Sometimes we need to acknowledge that, even though mama and staff did everything they could, sometimes a cesarean is the best way to go." That bias and negativity definitely goes both ways.

I personally detest the "Trust Birth" mantra. Nothing convinced me of this more than the post a blogger did after a traumatic home birth - did all the right things, and it still ended the way "it's not supposed to," and she felt the NCB crowd ganged up on her as if she "hadn't trusted birth enough." WTF ever.

The human body is often a paradox - for as predictable as it can often be, it can also be predictably unpredictable. You can have five labors that go like clockwork and nothing happens, and the minute you assume your sixth will also proceed that way, something changes. To expect that it won't is complete hubris, which can often be very dangerous.

September 5, 2011 | Unregistered CommenterThe Deranged Housewife

For me, I'm leaning heavily in a "humanized birth" direction, because interventions have no moral value. They just don't! But how the mother is made to feel during birth absolutely has a moral value.

September 5, 2011 | Unregistered CommenterJH

Love this post. Love this blog. Sorry you're getting grief from the hallowed halls of sanctimonious superstition.

Congratulations on the beautiful journey into being a grandmommy.

Clearly the birth community needs far more "middle way" advocates like you.

Keep up the good fight and enjoy that baby!

September 5, 2011 | Unregistered CommenterHolly

Well I posted another one, but I think it got eaten by the blogosphere monster :(

So, I will just say that you did not lose a reader here. You just became one of my favorite blogs. And, I'm mentioning you in my personal statement for CNM school. I love that your ideas and philosophies are evolving, which I think is very important for a wonderful and educated provider. I know people have already posted the link for hospital birth stories, but if you are willing, I would love to read what you have to say. I think it's important for women to be able to read about positive birth experiences in the hospital.

And for as much as we hear the defense for a homebirth being that a woman should have a right to choose, it irks me that this right to "choice" for NCB-ers only includes choosing nonmedicated at home births. When a healthy mom and baby are the result, birth is joyous and wonderful no matter what. Poo-poo on the people that judge others for choosing an experience different than their own. It's all about what feels best for the mother and her partner (and what is safest for her and baby!!).

I loved reading your updates on facebook, they were so wonderful, I felt like I knew you and I was getting so excited for you being a nana! Congrats on your new grandbaby, congrats to mom, dad, you and zack!
I hope you keeps us all updated as she grows up too! :)

September 5, 2011 | Unregistered CommenterEmily

Monica wrote: "But please don't blame the NBC for believing that a natural birth is safe, normal and within reach of every woman. It is."
No it isn't. Really? You really cannot believe this.

I wanted a natural birth (I got one, too), but I always knew that if my birth went certain ways, I'd make a choice away from 'natural' to safe and hopefully still empowering. I believe that birth is normal for the majority of women- but not every woman. My first birth was not 'normal' but I was still hoping for a natural birht- just with different parameters around it. I believe that good midwives and doulas (and CNM and OB & family practice docs, etc) support birth and lead to more positive outcomes, but in no way do I believe that every woman can have a 'normal' 'natural' birth.

I'm a strong supporter of natural childbirth but it isn't within reach of every woman. A respectful, safe birth should be our birthright and I know we may have to advocate for that, but there's not enough "woo" in the world for anyone to state that _everyone_ gets a normal birth. Even in a 'perfect' world, if everyone 'believed' and was able to channel positiveness, birth still is not perfectly safe. That's a ridiculous premise. That kind of statement is what makes a lot of people roll eyes and leads to homebirth and midwifery being disrespected (and kinda deservedly so).

The whole point of having a birth supporter is to be there to keep it safe, to assess progress, respond to signals, and even to advocate for a safe peaceful birth even if it doesn't end up being natural. Yes we still have to work to have births where the mother has choices and has access to accurate information and trusts her supporters and environment. I get that is easier at home BUT that trust should be the goal of every birth provider from homebirth midwife to OB and everything in between.

I just hope that the people like Barb and others CAN come together despite titles and terms to work towards this. There's not enough of that going around it seems. Birth does NOT have to be categorized as 'home' 'natural' - good and 'hospital' 'medicalized' bad. The great news is there are so many ways we can work together to support positive birth for ALL regardless of the path each person takes.

I'm not ready throw out the term natural birth or NBC as all bad because I see more mothers and midwives like you Barb, but maybe I'm just lucky that way. It is important to call people out and you have been doing that. I hope this opens some doors for you (and for others) and whatever the terminology there are just so many people looking to improve birth- there's enough work to go around. Obviously there is not going to be one right way or answer- but most mothers want the middle ground and most homebirth mothers think they are getting a midwife like you- one that will transfer in safety before an er, one that is highly trained and skilled at normal birth and will work well with a doctor when necessary..

For me, too many NBC are trying to skip ahead to an ideal situation--- we've got a long way to go and hospital birth is always going to be a huge part of the equation. I often have to change language and remind people to include the huge number of mothers that want natural birth options, more information, that want a peaceful hospital birth etc. No, homebirth is not the only answer.

SOrry this is all scrambled up- I've wanted to respond to you earlier. Thanks for your information and for caring so much to put this out there.

Congrats on your grandchild- your family is beautiful and blessed.

Jessica
(an occasional poster)

September 5, 2011 | Unregistered CommenterJessica

Congratulations on your grandchild!

Nothing the NCA/B community says surprises me any more and I only respect your decision from stepping out to tell your truth, both in changing the scope of your practice and this post. I had a vaginal (it was not in the end completely natural) delivery with my first baby, who died as a result. There was distress on the monitor but it wasn't taken seriously until it was quite late, and then the OB wasn't available for the c-section in time.

People in the NCA community shunned me (I wasn't welcome at the post-birth childbirth class reunion, as just one example) and people continue to insist that a c-section wouldn't have saved my daughter's life. The amount of blaming of mothers and women who experience difficulty or adverse outcomes is crazy - I mean seriously, awfully crazy.

I'm sorry to see that assumption appear in the comments.

I am so very glad Meghann got the c-section for distress; people can Monday-morning quarterback all they like but trust me, she did not want to make the reverse decision and be mistaken.

September 5, 2011 | Unregistered CommenterJenn

Jenn: I am so, so sorry about your loss. I can't image the horror that experience was for you as it unfolded and the results. My heart goes out to you.

And you are right, Meghann will, most likely, never look back and think she made the wrong decision. Not if I have anything to say about it.

September 5, 2011 | Registered CommenterNavelgazing Midwife

Absolutely loved this post! I regret many of the things I've said in the past in regards to birth and breastfeeding. I was so judgmental. Women have enough to deal with becoming new mothers, who am I to cast judgement because someone ended with a c-section, or didn't produce enough milk?

I was planning to have a homebirth with my next baby, however, I have come to the point where I just can't. I have had 4 losses in a row, and have had more time to lurk around the internet reading birth stories etc. Your blog has probably had the most influence on my decision to choose a hospital birth with a CNM. We have been so devastated in regards to our infertility, I can't risk losing a baby that finally chooses to come to us. Maybe I have lost confidence in my body, but whatever the reason, I have come to a peaceful place in regards to my choice of a hospital birth. At first I felt as if I was betraying my passion, but I am confident I can have a trans-formative experience in the hospital. Heck, I just want a baby. Going through our heartache has put things in perspective big time. If I have to get a C-section to grow our family, so be it. I used to hate (and still an not a big fan) of when people say, "well at least you have a healthy baby". At this point, that really doesn't sound too shabby.

God bless you Grandma! Your daughter fought the good fight, and even if she chose to have a c-section, power to her! Thank you for helping me evolve into a more realistic less judgmental person. Hugs!

September 5, 2011 | Unregistered Commenterbri

I find myself with mixed feelings after reading this post. I've only read a bit of your blog, but what from what you've said here, it sounds like you've been a part of this "movement" for years. You've dished it out to others, likely made careless, thoughtless, and hurtful comments to and about other women, and now that the spotlight is on the "choices" of someone that you care about, suddenly you see how utterly inappropriate it is to second guess someone else's experience. How absurd it is to judge them for how they gave birth, as if they're in complete control of the universe and the dreaded C/S is a badge of their lack of real "womanhood" or a sign of weakness. The fact that this is a monumental realization for you and that it actually took a personal experience for you to have it, instead of a basic sense of empathy for others, is actually kind of depressing.

Here's the thing: however much you've been absorbed in NBA, they do not represent the feelings of most women about birth. Despite the hand-wringing of Lamaze in their Listening to Mothers II Survey over less than 2% of women giving birth the "normal" way, they also reported that >90% of women were satisfied with their experience. The vast majority are satisfied with birth the way it is now, probably because for most women, the health of the babe is the most important, and the US has a great track record for that. And when they have a friend who has to have a C/S, they don't cluck their tongues and make negative comments about how she couldn't "take it", they congratulate her on the birth of her baby, and might even ask her if she needs help with her other kids, with food, etc. That's the real, normal world of women. NBA, with its judging of women for something largely outside of their control, is the aberration.

On one hand, I admire that you're able to evaluate evidence and change your mind about things when it seems warranted. On the other, I don't know why I should expect any less, especially from someone who has claimed to be a health professional for years. I do that every day in my line of work (I am a scientist), and I don't do anything nearly as important as caring for the lives of mothers and babies.

Nevertheless, I do sympathize. I understand exactly what it's like to have members of a community turn on you for "unorthodox" thought. It sounds like your motives have always been to provide the best care for mothers and their babies, whatever you thought it to be at the time. I hope you are able to continue advocating for better care for mothers and babies, because people like you, especially with your perspective, are very needed. But I think that you'll need a lot of persistence and a thick skin, because the women who patronize this movement appear to be a very unforgiving bunch.

And of course, the birth of a child and grandchild is always a great blessing. Mazel tov! Your daughter is very lucky to have you for her mother.

Good luck.

September 5, 2011 | Unregistered CommenterEllen

NGM, use my comments in any way you wish.

September 5, 2011 | Unregistered CommenterJenna

Ellen: What a horrid picture you paint of me! I think your image of me making "careless, thoughtless, and hurtful comments to and about other women" is quite off; I am never careless or thoughtless and certainly do my damnedest to not be hurtful, but know in almost 30 years, I have had my moments of judgment regarding women's births. It is those I am sorry for, not that I have been a vile beast for all time. And, believe me, if I *had* been, I would totally admit and apologize for it. (See my posts on birthrape and birth trauma.) My "navelgazing" isn't for someone's entertainment, it's for me to figure out where I can do better, be better... work harder to improve not only my life, but the lives of women (and children and their partners) around me.

What an interesting comment for me to address.

September 5, 2011 | Registered CommenterNavelgazing Midwife

Bri: Wow. Oh, how I hope this pregnancy sticks and you finally get your dream fulfilled. I will send sticky baby thoughts your way (and know the others will, too).

I should have started counting the women who've changed from homebirths to hospital births because of something I've said, but will start with you. The other column will be the women who've switched their desire for homebirth non-nurse midwife to CNM. I had no idea what I said would have any impact like that... thank you so much for letting me know you and I had a connection, even if it is from afar.

You know I wish you only the best. Please keep in touch.

September 5, 2011 | Registered CommenterNavelgazing Midwife

Ellen,
Actually, those are often the women who look at you in horror and say, "You gave birth naturally/VBAC? With no drugs?" and think, "What a freaking moron! I can't believe she risked the life of her baby like that!" It goes both ways.

September 5, 2011 | Unregistered CommenterThe Deranged Housewife

The news that a healthy child is born should be met only with joy and love.

So, welcome, Gabriella! Congratulations, Meghann and Brian! And, may you, Barb, and Zack and the rest of your extended family, continue to surround this baby and her parents with love and joy.

September 5, 2011 | Unregistered CommenterE

"That amount of calories is incredibly stressing on the pregnant body. That amount of protein IS stressing on the kidneys!"

Well, Barb, I have to say that the research that was done for over 50 years time does not agree with your position on this. The pregnant body works much differently in this regard than the non-pregnant body does.

"How do you remotely defend that amount of protein... even if we didn't include that many calories?"

I defend it by the research done by several doctors over 50 years of time (one of whom used 260 gm protein with no ill effects at all), and by the knowledge of the mechanisms of how the pregnant body works--the blood volume increase that is necessary for the maintenance of the A/V shunt and the lake of blood behind the placenta, and the osmotic pressure that is needed in the mother's bloodstream for maintaining that blood volume.

"Have you SEEN Brewer Babies? Their enormity of size?"

I think that this is one of those unfortunate urban myths that has become popularized on the internet. The average birth weight of babies whose mothers have eaten like this, from what I have seen, is about 7 lbs to 9 lbs., which does not seem enormous to me.

"Their mothers' drinking gallons of milk and eating cheese to get enough protein (horribly LOW quality protein, I might add)?"

This may be another one of those unfortunate myths that has been passed around. No mother wanting to use the Brewer Diet is forced to drink any milk at all, nor eat any cheese at all, if she prefers not to. There is a vegan version of the diet that is available to anyone who wants to use it.

"*Especially* the way you've written the Brewer Diet out, it is absurd to expect any pregnant woman to attempt such a taxing regimen."

Many mothers have done it and have found it to be completely manageable. Some of the tricks include becoming informed about the serving sizes, which are much smaller than many mothers expect, and using a "grazing" style of snacking (rather than eating just 3 meals a day).

"Have you READ any of the research that demonstrates Brewer is, in the least, useless and the most, dangerous? Wander over to preeclampsia.org... they have slews of studies to pore through."

I have discussed those studies and the viewpoints of the PEF with them at great length. Unfortunately, the assertions of the PEF that the research that they cite demonstrates somehow that the Brewer views are useless or dangerous are completely baseless. None of that research mentions or alludes to or tests out any of the Brewer principles in any capacity at all.

And none of their studies even provide any proof that anything other than the unmet needs of the normal physiology of pregnancy are the cause of PIH,PE, E, HELLP, or any other disease that has been shown to be associated with low blood volume in pregnancy. All that their studies possibly suggest is that certain physiological phenomenon occur in the placenta and the body AFTER the PE process has already been caused by something else.

I invite you to see more of my responses to the claims of the PEF, on the "Inaccuracies" page of my website..... drbrewerpregnancydiet.com

Joy

September 5, 2011 | Unregistered CommenterJoy Jones

As a pregnant woman I hope you're the future of conventional medicine.
I hope the CNMs at the local hospital in the very un-crunchy town where I live practice like you do.

September 5, 2011 | Unregistered Commentercalioak

Oh Barb, I just love you. While I'm sure you won't step away from the interwebs, I hope Meggie's too occupied with other things (nursing, sleeping) to keep away from them now. She's got more important things to focus on without the peanut gallery chiming in.

I think the thing that really breaks my heart about the C/S judgements I saw on FB was all the comments expressing sympathy, made with the kindest and best intentions, that are still the most judgmental comments. Just because people have sucky C/Ss (which we all know there are), they assume all C/Ss are sucky. That logic's not so, and it's presumptive and insulting. It would be like me scolding people for eating corn-on-the-cob since I'm frightfully allergic to it. Just because the same event happens to two people, there's nothing that says they'll react the same way.

I feel like women with happy C/Ss end up being quiet about having a happy C/S because it's not the NBA ideal. By definition, a C/S is the Evil Enemy of natural childbirth. Most times when I express in an NBA crowd that I had an emergency C/S and that it was fine and I was fine, I'm treated like a sweet but ignorant moron. That's why I only attended one ICAN meeting; it seemed like a group of women seriously working through their C/Ss and it wasn't a good resource for a woman happy with her C/S, even if I was actively pursuing an unmedicated VBAC.

I wish M all the grace and peace in world during this time, Barb.

September 5, 2011 | Unregistered CommenterKim

From someone who once was buying in to the NCB, and am still, you know, "crunchy"... so good of you to write this. It speaks a lot to your character.

September 5, 2011 | Unregistered CommenterSMDCM

Dearest Barb,

I really appreciate your straightforwardness. Unfortunately, what you are reporting reminds me so much of some of the stuff I've witnessed over the years in other communities, particularly the environmental advocacy one. I think people get very attached to their "truth" and lose very easily the ability to keep an open-mind and use dialogue. We are a society geared towards debate! We have forgotten a very important skill necessary for true dialogue: the ability to listen without judgement. I hope this will change with time... As a scientist myself, I have a very hard time with people who only read the bits of research that reassure them in their thinking and dismiss anything that would jeopardize their feeling that this is "truth", we all know truth is a moving territory...

I hope you are enjoying every minute of being a brand-new abuela.My thoughts go to your daughter. I know the courage it takes to make the decision to have a cesarean, it's a special delivery and despite the scar it is a birth she should remember with pride and joy! I'm certain she will be the most wonderful mama ever. And fear not, some of us will continue to read your blog with much pleasure!

September 6, 2011 | Unregistered CommenterElodie

This is the best goddamn thing I've read in a long, long time.

I believe in women, in our ability to birth our babies. I also believe that Mother Nature is not some kindly hippie lady skipping through a field of poppies. I planned a home birth. I ended up with severe pre-eclampsia and HELLP syndrome (ironically, after following the Brewer diet) and had a life-saving section. Four years later, I had another section.

I have been told point-blank that my children did not have births, that true birth is only vaginal. Well, then what the hell did I have? These are their only births. I owe it to them to make sure my memories of it are of experiences where I was presented with the options, where I looked at the evidence, and where I made the choice I did because I believed then and now that it was the safest thing for them given the information I had at the time. Because I birthed at a hospital with truly humane and evidence-based birth care, I can say that, with absolute honesty.

I'm a CNM now. I practiced as a labor nurse for almost a decade. I'm in a PhD program, and as I look at my options for my dissertation topic, I'm drawn to questions of why we enforce birth norms in hospitals, but I know the NCB community enforces their own set of norms outside hospitals. Why are we so quick to ignore evidence, on both sides? Why is making sure everyone agrees with us more important than recognizing the very large gray area in OB research?

September 6, 2011 | Unregistered Commentermeghan

I don't know if there could be a shift in terminology. I believe that natural birth can, in most cases, be the 'normal' birth, but that many many women have been brought up to believe that all birth is normal and therefore, at no risk. So many woman do not even entertain the belief that they CAN birth without drugs that it gets disheartening to those of us who believe a much larger number of women can do it. They don't even consider that the drugs that are "normal" could cause issues ("just get the epidural as soon as you're admitted!!" Gag).
However, I'm not one of those "trust birth" and poo-poo to modern medicine and "all natural at any cost". Advances in maternal care and labour and birth practices are wonderful. It just seems that so many women rely on others to make their choices, or rely on drugs simply because they don't believe in themselves or don't educate themselves.
It's possible to believe in natural birth AND embrace modern medicine. They don't have to be exclusive, but sometimes I feel like you....my births weren't "natural" because I was induced so the "nba" doesn't want me. Well, pooey on them, LOL. My kids want me and that's all that matters.

September 6, 2011 | Unregistered CommenterTracyKM

I really do hope y'all reading this aren't thinking I've totally abandoned women's choices to delivering without medications or even without a homebirth choice. That was not/is not what I'm saying at all.

I believe in a woman's INFORMED choice to where and with whom she births, but, as I've asked many times, who decides when informed has been completed? And what IS informed? Is there even a standard definition of Informed Consent... a *legal* one?

I *love* helping women have natural births, *love* working with VBAC women, *love* the emotional, spiritual and educational prep (for women) for a natural birth. I feel equally strong with women wanting as unhindered a birth as possible as I do with women scheduling a cesarean.

Just felt I needed to say something lest someone thinks I've completely abandoned natural birth.

September 6, 2011 | Registered CommenterNavelgazing Midwife

Congratulations on becoming a grandmother! You are not a 'medwife' you are a midwife, a midwife who listens to women, not her own ideas of how birth 'should' be. Thank you so much for posting this. So much love to you!

"To those that have suggested I take some time off the Net... that ain't happenin'."

Hallelujah! I said it Facebook, but I'll say it again: you are truly one of my heroes. You've been so kind in personally helping me parse through some of the more difficult nonsense when it's come up in my own birth-contemplating life, and once again you are the voice of deeply- considered reason.

Also: Ellen has already been addressed, but I think it's worth pointing out that this isn't a sudden, out-of-the-clear-blue epiphany. Not that it would be without worth even if it were, but Barb's thoughts have been evolving on this whole range of topics for quite some time now. It seems to me that Meghann and her baby just brought it to a personal head.

September 6, 2011 | Unregistered CommenterDou-la-la

"I don't know if there could be a shift in terminology. I believe that natural birth can, in most cases, be the 'normal' birth, but that many many women have been brought up to believe that all birth is normal and therefore, at no risk. So many woman do not even entertain the belief that they CAN birth without drugs that it gets disheartening to those of us who believe a much larger number of women can do it. They don't even consider that the drugs that are "normal" could cause issues ("just get the epidural as soon as you're admitted!!" Gag)."

Why should you feel disheartened that most women don't want to give birth without drugs? Do you really not grasp that throughout human history, women have begged for a means to relieve labor pain? And what evidence do you have that epidurals actually cause "issues?" (please don't say that it affects breastfeeding - there is absolutely NO evidence that there is any impact).

This is my huge problem with the extremists in the NCB world. If a woman wants to try to go med free, that's her choice, and it should be supported. But why should any woman's birthing choices be criticized or judged? Why should you feel disheartened or upset? And I say this as someone who did have a totally natural vaginal delivery. I felt betrayed by my childbirth educator because the pain was so horrible. I had done everything right, and it was still a miserable experience. And thanks to all of the fear-mongering about "uneccessary interventions," I didn't even have a hep-lock. When I started hemmorhaging, I got to endure manual clot extraction with no pain relief. Thankfully, they were able to run an I.V. and give me twilight sedation before wheeling me to the O.R. to stitch up my cervical laceration.

September 7, 2011 | Unregistered Commentermoto_librarian

Joy Jones, I had two normal sized babies (7-8 lbs) on a normal diet. I then had two macrocosmic infants (10 and 11 lbs) on a protein binging Brewer Diet, with gigantic placentas. The birth of my 11 lb infant was traumatically painful. And I went back to a more normally sized baby for my 5th birth having dumped out of the Brewer Diet because it is harmful, difficult and worthless.

Do not sit there and tell me that the Brewer Diet is a perfect cure all for every ill that could not possibly cause harm. I sit here with birth trauma from a baby who would never have been that large without the tripe fed to me by natural birth advocates saying that I needed to be on the Brewer Diet or I would get pre-eclampsia. Y'all harmed me and could have endangered my infant. Stop advocating a set of dietary rules that are freaking harmful for some of us.

September 7, 2011 | Unregistered CommenterJH

@Joy way to blame those of us who have had complicated pregnancies for not following the woo diet you describe. Frankly nothing would have prevented the IUGR in my first pregnancy except a functioning placenta. That's one of the most annoying aspects of NBA'S: the attitude of had you done it my way this wouldn't have happened to you. I NEVER got that attitude from the OBs, etc. who treated me.

@Barbara congratulations on the birth of your first beautiful grand baby. Please pass my love and support to her parents as well. Your words are moving and wise. While I would love to read Meghann's birth story, I know how hurtful it was when my choices in birth and pregnancy were dissected. I was not forced into my first section and I am not being forced into my second one in October. Removing all the NCB baggage placed on sections, it is simply another way to  have a baby. Yes everyone has their own reality and perceptions and are entitled to their feelings/emotions, and I have the right to reject it. Anyone who dares say that a section is not a birth near me deserves the anger they will receive.

I will keep reading. Your audience may change, but we all change as we mature and grow in life.

Life is what happens when you're busy making other plans. John Lennon

September 7, 2011 | Unregistered CommenterWendyLou

JH, I have no idea which version of the Brewer Diet was taught to you, so I cannot comment on how it may compare to the accurate version of the Brewer Diet.

I am very sorry to hear that you had such a difficult time with a couple of your births, and that it caused you so much grief.

"Do not sit there and tell me that the Brewer Diet is a perfect cure all for every ill that could not possibly cause harm."

I am not telling you or anyone that. I am only teaching the truth about how placentas work and how pregnant bodies work to assist the placenta in doing its job well. And there are a few diseases--not every ill--that occur when that process is not allowed to happen. That is what I am teaching in order to help any mothers who may be interested in that information.

I do not know what you were taught. It could very well be that the version of the Brewer Diet which was taught to you was one of the harmful versions that is out there.

I do not believe that the information that I teach is harmful to any woman or her baby. I have seen it save many lives. So I will continue to teach it to as many people as want to hear it.

I wish you peace and health.

Joy

September 7, 2011 | Unregistered CommenterJoy Jones

Another response to a comment.

@Monica FYI: a safe and natural birth is not something all women can have. Because of a uterine malformation, it is a miracle that my uterus can sustain life. Expecting it to push out a live baby is asking way too much of it. Remember that next time you pronounce that everywoman can have a safe vaginal birth. I can't, and I know many women in the same category.

September 7, 2011 | Unregistered CommenterWendyLou

Wendy, I know that there are women out there who feel blamed when they hear about the Brewer Diet. And I know that there are a few childbirth educators, and a few doulas, and a few midwives who are insensitive in the way that they teach nutrition, and in the ways that they respond to women who are having difficulties, both with nutrition and with complications.

I deplore that way of practicing and interacting with mothers. It is nothing more than cruel to put down or shun or otherwise hurt pregnant and birthing mothers who are doing their very best to grew and birth babies that are healthy. I work very hard at not practicing in that way, and everywhere I teach I try to inspire all who are listening to not practice that way.

Dr. Brewer himself did not feel that way either. He was passionately outraged at the ways in which women were ignored and oppressed by a male-dominated system which imposed diets and medications on them which actually caused their illnesses. So at the end of his career his goal was to bring his information right to the women who had the ultimate control of their nutrition, their bodies and their health. He wanted to empower them. He wanted to enable them. He wanted to teach them that they were not at the mercy of some random act of nature, or at the mercy of some all-knowing union of men who would keep them in the dark about how their bodies worked. He wanted to empower them with the knowledge of how their bodies worked and what they could do to help their bodies do their best at having healthy pregnancies and healthy babies and healthy births.

He never had it in his mind to blame any woman for any illness in pregnancy. He very strongly put the blame on her doctor--for not teaching her properly, for not even taking the time to find out what her diet history and practices and preferences and needs were, and for not paying attention to the physiology of the placenta and how that physiology related to the blood volume of the mother.

Here are some of his direct quotes on that issue....

Brewer: "Our culture has a long history of treating women as inferior, and that's especially true in medicine. Women who educate themselves, listen to their bodies, stay away from prescription drugs, and feed themselves the way healthy women have fed themselves for thousands of years, not the way Americans are feeding themselves today on low-fat, low-protein, high-carbohydrate, low-salt, low-calorie foods--those enlightened women are going to have healthy, full-term pregnancies with no complications."

That message is an empowering message, not a blaming message. It's just as empowering and non-blaming as are the messages that we commonly give pregnant women to avoid smoking (and second-hand smoke), to avoid certain kinds of fish, certain kinds of cheeses, recreational drugs, used kitty litter, some herbs, and certain medications. Knowledge is power, and one thing that Dr. Brewer and I had in common was that we wanted to give women the knowledge of how their bodies work in pregnancy and what they can do to assist their bodies to do what they are already trying to do, and the power to make decisions that could positively impact their health.

Joy

September 7, 2011 | Unregistered CommenterJoy Jones

Joy: You *sound* so logical, but you aren't.

The most prevalent theory/research is that changes that occur in the placenta that trigger preeclampsia happen in the first few weeks. And no diet can "fix" it later in the pregnancy.

You can serenely speak what you think is true, but that doesn't make you any more right than if you were shrill and annoying.

I'm scared for the women who listen to your advice.

September 8, 2011 | Registered CommenterNavelgazing Midwife

Joy:

One of the requirements of scientific research is that it be replicable. Brewer's work hasn't been replicated. There is no current evidence (and in the 40 years since his original work was done, you'd think someone would have found something, anything) that diet does anything to affect the incidence and course of pre-eclampsia. Current consensus is that a problem in angiogenesis and the invasion of the spiral arteries during the initial development of the placenta plays a role, which has absolutely nothing to do with protein intake later in pregnancy.

The Brewer diet is bad science. It's illogical. It's never been replicated. What do you have except anecdata to recommend it?

September 8, 2011 | Unregistered Commentermeghan

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