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Cesarean Scar: Heather R.

To me my scar is a tattoo of my daughter's name.  Everytime I see it it reminds me of her, but everytime I touch it, it's just to scratch an itch!


Cesarean Scar: L.


To be honest, I can't see my scar. It is covered by a flap of skin that I can't get rid of due to having a c-section (unless I can afford plastic surgery, that is) I had to hold the flap back even to take this picture. When I look at this picture, I see something that shouldn't be there. I see the evidence of a failure to wait c-section. I see a doctor who tried to convince me that I could never birth a baby vaginally due to a *small pelvis* even though she was very wrong. I see everything that went wrong during my first birth.

It says, it is numb and hypersensitive all at the same time. On occasion, it still hurts even though it's been over 5yrs. It is bumpy and uneven and thick as my pinkie finger. It is indented in some places and bulges in others. It says, it is ugly. 


Cesarean Scar: Sarah V.


The first picture (above) was 2 weeks postpartum. Both ends of my incision became infected and opened up. I was back in the hospital for 3 days on IV antibiotics.

 The other 2 pictures I took today, 7 months postpartum (to the day). I have a small 'bump' above my scar that hasn't gone away.
I would say my scar says "look at me, I want you to remember what you had to go thru during labor and surgery so you don't forget how hard of work you did to get your baby girl out into the world!"
My scar says "I feel funny when you touch me. I'm not numb anymore but I'll remind you from time to time that it still isn't comfortable for me when you wear jeans."
My c-section was unplanned and I had labored for 19 hrs after my water broke on its own, then pushed for 1 1/2 hrs. After the help from a vacuum she still wasn't coming and her heartrate started to drop with contractions so we had to do a c-section. My pelvis was too narrow for her to fit thru. 


Cesarean Scar: Nastassja H.


When I look at my scar it says, "Don't look". It hides under a flap of skin that no diet or exercise will rid me of. I glance past it quickly, it's hidden, why think of it? Why look at it? Why think of how my body will never, ever be the same there? My body has changed in many, many ways in the last few years. I have other scars. Scores of stretch marks, flab that my bony teenage self never dreamed she would bear. I drink it all in easily, before the mirror. I don't spend any inordinate amount of time wondering what others will think when they see it. If they will be disgusted. Stretch marks are normal. Having your appendix out isn't too weird. Heck, that appendectomy scar is kind of cool! Want to see?

But my scar hides. Even in a skimpy swimsuit, it's invisible. Even naked, I have to pull up my belly to see it. And that makes it easier, not having to look at it all the time. I can almost pretend it's just a fold of fat.

It says that I should have done something different. It says that knowledge is not enough to save you. It says that acting on knowledge is hard, so hard, when you are alone, and everyone is telling you it's ok, it's not a big deal, sometimes it happens this way, you tried it all, it's time to let THEM try. Time to hand over the reins of your body to the experts. They know the buttons to push. They can make it work.

And I believed them.

When I touch my scar it yells "DON'T TOUCH!". I cringe and grimace. My muscles tense. Sometimes touches hurt. Sometimes they don't. It has been years, and my subconscious says that it's still not healed. "Don't touch! Be careful! You just don't know what will happen if you press here, or push there. It may hurt!"

The worst part is I've proven to my scar that it's fine. I've carried another healthy, beautiful child, in that scarred uterus. I pushed him into this world with minimal fuss and to-do. Working as intended! Fully functional!

But oh so fragile. Please don't touch. Will my scar ever believe it has healed? 


Cesarean Scar: Kim - 11/11/05

My name is Kim, my surgical birth was on 11-11-05. I do not have a picture of my scar, I don't know what my scar looks like, and I don't touch it.

I was pregnant and in my 30th week of pregnancy with twins. At a "routine" appointment, I was told that the babies and I were in a great amount of danger and I could not go home, I was told I had HELLP. I spent almost a week in the hospital on a half dose of "mag" when the window began to close. I was informed that the time where I was healthy enough and the twins were big enough was getting smaller. I was transfered to a different hospital, my contractions "broke through," my water broke, and baby A began to deliver breech; rapidly. I was taken into surgery, given an ineffective epidural and surgery began. I could feel the cutting, began screaming and was then basicly paralyzed by medications and fear. I was in a twilight state and have a small memory of the babies being held above the sterile field, they were then taken away to the NICU. It was a week before I held my boys, I had complications from the epidural and complications from the complications. The surgical birth was the most horrific event in my life. I don't believe I gave birth to the twins, I feel they were taken from me. I had a very hard time bonding with them in the begining, the NICU made it harder. I know I was pregnant, but really they could have been hatched.

I don't touch my scar, it hurts often, aches or burns, I stay way from the scar.

My boys stayed in the hospital for 4 and 5 weeks, I was able to get them off of the formula and were 100% breast fed until solid food was introduced. They continued to breast feed past their 1st birthday. They are not behind too far in size and are up to speed everywhere else, minus slight speech issues. The older 3 kids love the boys and everything has come full circle, better than I would have dreamed.

But my scar is something I do not and can not visit.


Moving CesareanScar.com

For a variety of reasons, I'm moving the CesareanScar stories and photos here to my Navelgazing Midwife site. I think there will be more interaction that way and women's stories deserve to be heard.

It will take some time, but look for the entries to begin being moved.


Waterbirth Revisited

Let’s just say, I’ve seen some awesome water births. Peaceful, lovely… the baby sliding out of mama and being caught in her hands just before total ejection… then being lifted to –and out of- the surface, pulled into his or her mother’s breasts for safekeeping. Heartwarming at the very least.

But, as I’ve been re-evaluating all the different aspects of home and hospital birth, I couldn’t let water births go without examination.

There is no doubt that being in the water is calming for a mom, allowing the uterus to “float” off the nerves, diminishing pain considerably. “The midwife’s epidural” it’s been called and I would attest to that many times over. But what of the ick that is a common and pervasive part of birth? “Ick” being bodily secretions like urine, feces, and mucous. We might include blood, sweat, tears and possibly even saliva, even though most people don’t think of those as being too icky.

Mind you, I’ve never had a problem with bodily secretions during birth. (Well, except for that one time when I co-barfed in a metal bowl during one woman’s transition.) Poop, pee, vomit, sweat, saliva, tears, blood, mucous… none of them remotely bothers me… so while I use the word “ick” it isn’t so much that I think of them as icky, but know that, as we delve into the topic, many reading will find some of the normal bodily functions icky, especially when discussed in conjunction with birth.

During birth, it behooves a woman to abandon any societal restrictions she has about bodily functions. That requires a trust in her care providers and a belief that everything she might emit is normal, unless told otherwise (too much bleeding, for example). In fact, midwives are a hilarious bunch that find bodily functions applause-worthy. “You threw up? Fantastic!” or “You’re having lots of loose stools? Great!” And that isn’t to help a woman feel comfortable in her emissions, but because the various actions are positive signs regarding the progression of her labor. Loose stools can herald impending labor and throwing up can be a sign of transition. Women like to be told they are progressing in their labors; bodily secretions can give everyone wonderful clues about those progressions.

But what if the poop and vomit were in the birth pool? Oh, women don’t vomit in the pool, you say? True enough, but they do vomit in the toilet (or whatever is barfed into a bowl goes into the toilet). Poop and pee go into the toilet usually, too. But, in birth, both of those can –and often do- happen in the pool.

This is where I started re-thinking waterbirth.

If mom pees and poops into the pool… and a baby is born into the pool with poop and pee… is that gross or is that not gross? For ages, our birth kits included a fishnet to scoop poop out of the pool, but hasn’t the poop already contaminated the water? And there isn’t a fishnet small enough to get liquid poop or urine out of the water… what of that?

When women have asked these questions, we’ve appeased them with, “it’s diluted to almost nothing” or “it’s only yours,” but are these adequate? Or even true? What if dad gets in and can’t get out to pee? And does dilution make it any better? All kinds of stuff can be in poop and pee, including e coli and group b strep. Do we want to dredge our newborn child through those possibilities?

We poop and pee in the toilet every single day. Would we dunk our child in that water… even after flushing? The thought is nauseating. Why then is it okay to have our newborn come out into the ick of a birth pool?

Suddenly, I understand the requirements of so many birth centers and hospitals to only allow labor in the tubs, but birthing out of the water. I always thought that was a dumb rule and even heard the arguments about why without really thinking the whole thing through; the baby is born in a toilet bowl. Isn’t that kind of gross?

I remember one dad who was in the pool with his wife and as soon as she let him get out, he ran to take a shower even though he had a newborn to cuddle with. We all thought it was kind of silly, but on second thought, did he have the right idea and the rest of us were somewhat deluded?

I used to think I’d love to have a waterbirth. Now, not so much. How have you been able to wrap your head around birthing in a tub with poop, pee, mucous and blood? I look forward to what folks have to say.


Doulas & Advocacy

Patrice Nichole Byers of Birth Your Way wrote a great post entitled, “Doulas and Advocacy: Are they mutually exclusive?” In there she discusses the role of doulas and whether speaking out for the mother during birth is an appropriate thing to do or not.

“I hear time and time again. I'm sitting in an interview with potential clients and they tell me that one of the reasons they want to hire a doula is to have someone advocate for them in the birthing room. I'm constantly explaining to clients that while I do consider myself an advocate of choices in birth, natural birth, and natural postpartum choices; I do not advocate for you during birth, but rather help you to advocate for yourself.”

I’ve also heard women say they want someone to “advocate” for them in labor. What I’ve learned they really are saying is they want someone who will speak up for them so they don’t have to. When women are in the throes of labor, it’s understandable they don’t want to be the one to disagree with the nurse or doctor. How appealing to have someone else be the heavy, deflecting any of the negative energy that might be coming from the medical personnel, allowing the laboring woman more peace to work her birth.

But when a doula opens her mouth with “She doesn’t want that,” it all too often sounds like the doula is directing the labor, not the woman herself. Especially if the client is wrapped up in her labor and doesn’t affirm what the doula said, the doula really does begin digging a hole for herself, credibility falling precipitously into the chasm.

If the doula was only saying “She doesn’t want that,” it might not be so bad, but it’s far worse as Patrice continues:

“I'd hear over and over about stories of doulas who would get into heated conversations with doctors and nurses about hospital policy, clients wishes, evidence-based practices and more. I'd hear doulas brag about arguments they felt they won, shouting matching, standoffs, and more. The worst to me are the stories of doulas who unhooked IV's, stopped the pit machine, and spent time interpreting fetal monitor readouts.”

You’d think these rogue doulas are rare, but from talking to my nurse friends (who are extremely doula and natural birth friendly), they are not. Many doulas seem to see their role as adversarial instead of supportive. That attitude alone sets the client up for a negative experience. Not that it’s always bad, but cooperation works much better for women than hiring a body guard.

If a woman feels she needs a body guard, if she’s in a state with legal midwives and can find one with impeccable education and skills, she should look elsewhere to birth. (I know, that’s a lot of “ifs.”)

I don’t have a perfect answer for the women who do feel they need to hire someone to speak for them. Perhaps in their experience they aren’t very vocal in labor or they want to immerse themselves in Labor Land instead of remembering, as one woman recently said, to try to remember “intermittent monitoring, not continuous.” In these cases, I would say the burden falls onto the partner. I usually encourage the other parent to let go and be in labor, too, that they don’t need to stand guard over their wives, questioning every move the nurse makes, but perhaps there is a place for a Bradley course after all.

I’d love to hear what doulas and women have to say about this topic. Thoughts?


"Questions to Ask About Homebirth"

That was a recent post by Peggy O’Mara of Mothering Magazine. While I have long admired Ms. O’Mara… her words got me through many difficult parenting moments over the years…, I felt it was important to address this specific post.

After highlighting the safety of homebirth (many of the studies are, of course, debatable), she lists questions to ask your prospective homebirth midwife. What’s challenging about this, however, is that she doesn’t say what the answers should be. How is a novice birthing mom supposed to know what answers she needs to hear in order to have a safe birth? Does she go by what the natural birthing sites say are the right answers? Does she go by the medical standards?

How does she find the middle ground (if that’s what she’s looking for at all) –or the safest ground- if everyone answering has their own agenda?

I recently wrote a series of posts on this topic, but I felt it was important to address this again since it seems the more natural side of the coin has begun to understand women might want more than the standard, “Are you a hands-off midwife?” question.

Here are Ms. O’Mara’s questions in italics. My answers that might clarify things in standard text.

What is your midwifery education and experience? What certifications or licenses do you have?

What does she think the answer should be? An apprenticeship only? A Certified Nurse Midwifery education? A MEAC-accredited school plus apprenticeship? Knowing what the most education and skills training should be is crucial to answering the question.

How long have you been practicing? How many births have you attended?

Instead, “How long have you been practicing as a primary homebirth midwife?” is the way to ask that question. And instead of how many births have you attended, the question should be, “How many births have you attended as a doula? As an apprentice? A midwifery assistant? How many births have you been the primary midwife with supervision and then without supervision at a homebirth for? How many years have you been a primary homebirth midwife?”

Asking how many births have you attended allows a woman to fudge on her primary homebirth experience, leading the mother to believe she has been the primary for far longer and for far more births than she has been. I did this myself; I am clear it is done all the time. This does not, in any way, discount the midwife’s experience as a doula, especially as a doula in the hospital, because she will have seen aspects of birth she would rarely (if ever) see in a homebirth practice. Complications occur more often in the hospital, whether iatrogenic or not, they are still complications the later-on midwife will have seen and watched handled, adding to her overall education. Not skills training, but merely observational experience.

I can’t stress this enough, asking the midwife more pointed questions will give the woman more information than just, “How many births have you been to?”

But, what should the answers be? Because there is no standardization in midwifery education or skills training, the answer depends a lot on the woman.

In my opinion, arbitrary as it might seem, I believe a midwife should have at least a hundred births in the hospital as a doula or at least observer of much of a labor, birth and immediate postpartum time in the hospital. Some could be at home, but seeing more complications adds to the woman’s education more than learning how to sit on one’s hands. I also think the midwife should have about 40-50 assists and then another 30-40 as a primary with supervision before being let out on her own. Hiring a midwife who’s had this level of experience would make sure she’s had at least a couple of shoulder dystocias, hemorrhages, malpresentations and other more common complications, including several transports as the primary with supervision. Being the primary midwife with a more experienced midwife overseeing her is one aspect of midwifery skills training that is glaringly missing. More on this in another post.

Who is your midwifery back-up? Who is your medical back-up?

This is more a logistical question. While it’s important to know the education and skills training of the back-up midwives, it is rare the back-up midwife will be the one the client ever sees. Unless the potential midwife takes on more than 3 or 4 clients a month. In that case, be sure to interview the back-up midwives, too, asking these same pointed questions.

A note about pointed questions:

If you are embarrassed to ask the questions lest you offend the midwife, stop it. Any midwife who bristles about these questions needs to be left in the dust. She should have complete composure, no defensiveness and be clear and truthful in her answers. If she can’t act professional with you, how will she act with a doctor in front of her if you transport? It’s a midwife’s job to answer these questions; it’s your right to know the answers.

How often will I see you during my pregnancy? How long will prenatal visits last?

Truly irrelevant as a question. I’ve never known a midwife to see clients on anything different than the standard monthly until 28 weeks, bi-weekly until 36-37 weeks and weekly until the birth. Plus, appointments are almost always 45-60 minutes long, most of the time being spent on social interaction… getting-to-know-you aspects. The actual medical/technical part lasts less than 15 minutes. When going to an OB, the social aspects are what is missing. I’m not discounting the importance of a homebirth midwife knowing you and your family better. In fact, the appointments help the midwife know how you handle stress and learn the nuances of your personality, but they are not the meat of the prenatal appointments. Again, the length of time is the question and these two questions are, in my opinion, fluff and can be dropped from the list.  

How will my partner (and children) be involved in prenatal visits, during labor and at the birth?

They will be as involved as you want them to be! Another odd question that is pretty irrelevant in a homebirth setting. What midwife is going to say, “Your husband can’t do anything but sit there”? None.

Will you provide me with nutritional guidelines?

This is standard midwifery care. Dump the question.

What is your philosophy about prenatal testing?

How are you supposed to know what answer you’re looking for? Instead, research and you decide what you want to do. Do you want the AFP test? Tell the midwife that’s what you’re doing. If she balks or tells you it’s unnecessary. Listen to her side of it and if you still disagree and she tries to talk you out of it, walk out. If you don’t want the test after researching and she believes it’s necessary, listen to her, decide if you want it or not and if you still disagree, leave. Don’t waste anyone’s time because if you disagree on something as small as prenatal testing (and the AFP or even prenatal testing doesn’t have to be your litmus test; pick your own), there will definitely be other things that you won’t gel together on. However, if she accepts your decisions gracefully, there is hope for an amicable relationship.

Do you offer childbirth education classes?

Who cares? You can find childbirth classes anywhere.

Will you suggest non-drug soothers, and different positions during labor?

If you’re interviewing a homebirth midwife, you will have someone who suggests “non-drug soothers” (what an odd way to say non-medical pain relief) and different positions in labor. The only midwife I can think of who wouldn’t would be a staunch hands-off midwife and you were asking a test question to see how hands-off she really is. If a midwife doesn’t offer assistance, she is, in reality, not being much of a midwife at all.

How long after birth is the umbilical cord cut?

This might be a relevant question during the pregnancy, but seriously, not as a midwife determination question. You can discuss this and any midwife worth her salt is going to adhere to your wishes and really, most midwives that I know do not cut the cord early at all. If anything, the medical establishment would have hairy cows about how long a homebirth midwife leaves the cord attached. (Wrongly so, too.)

How long will you stay at my home after the birth?

This is so arbitrary it would be hard to get a real answer. Perhaps the right answers are: “As long as you and the baby need me.” Or “Until you and the baby are stable and you are able to take care of yourself.” That doesn’t mean you might not need help, but if you need help getting to the bathroom because you’re continuing to faint, you need to be in the hospital. (Fainting once, especially after peeing, isn’t the most unusual. However, if you have bleeding and faint, that is a serious red flag and needs to be addressed.)

What emergency equipment do you carry?

Finally, an important question! But I’d expand it to “What equipment do you carry?” The answer should be: Doppler (preferably waterproof) with extra batteries, blood pressure cuff (two sizes), thermometer, glucometer with in-date supplies, lancets, IV equipment with in-date fluids (Lactated Ringers, Sodium Chloride, Dextrose 5% Lactated Ringers are the most common types of fluids needed in birth), in-date Pitocin (which is supposed to be kept cool), Methergine (IM and tabs), Cytotec (for postpartum hemorrhage), in-date lidocaine, in-date sutures of at least two sizes (one smaller one for the labia), in-date Erythromycin eye ointment and Vitamin K for the baby, in-date antibiotics for GBS+ women, scissors, needle holders, forceps (not the kind that pull babies out), oxygen (I always carried two tanks… one for mom, one for baby), a bag and mask with new masks for each baby (they are marketed as disposable; most midwives I knew re-used the masks [after cleaning]), in-date blood draw supplies, in-date catheters, a Sharps container… I may have missed something… anyone else think of something?

While it can be hard to know what answers you’re looking for when you ask a midwife about various complications,  it is easy for midwives to show their integrity and trustworthiness by their equipment and not-expired medications and sutures.

Again, if you’re worried about insulting her by asking these questions, that’s what you need to look at… and whether you’re ready to have a homebirth or not. Any midwife worth her salt will welcome these questions. If the woman in front of you balks, get out of there. Fast.

What back-up hospital do you use? Under what circumstances do you transport? What is your rate of hospital transport?

I’ve always felt these questions were kind of odd. The list of transportable reasons is endless and it’s the midwife’s job to know what they are. Listing them all out for you, you might as well read William’s Obstetrics (an incredibly technical book). The midwife will surely say something like, “Breeches, twins, high blood pressure, a fever...” things like that, but do you really want to hear, “If there’s unresolved tachycardia, if the baby’s baseline fetal heart tones continue declining, if mom can’t pee for several hours (and the midwife can’t or doesn’t use a catheter), if mom won’t eat for a certain length of time (to be determined in the moment),” and the list, as I said, is endless. We’re hired to know when to transfer (non-emergency) and transport (emergency).

A back-up hospital? How about, “What hospital will I go to in a transfer?” In a transfer, picking a hospital can be done. However, in a transport, the ambulance decides almost always.

Regarding what the hospital transport rate is, this can be taken any number of ways. Low transfer rate? She only takes very low-risk women, maybe none who’re having their first baby. Or, maybe she stays home hoping complications will resolve (which often enough do, but that’s just luck and not something to gamble on) or she’s afraid to transport. Maybe she has a lot of experience and takes appropriately low-risk women. How are you to know why she has a high or low rate of transfer? You can’t; it’s all in how she sells herself.

I hope these discussions are helping.


Medical Board vs. Dr. Biter

Here's the most recent public information about the allegations against Dr. Robert Biter, a doctor I previously supported here in this blog.

As you read, know that the patient "LS" is a dear real-life friend of mine and the information you see about her case is a fraction of what actually occurred. Having had a baby with Dr. Biter before the birth discussed here, she is just as shocked and disillusioned as I continue being about the whole thing.

It seems there will be a Hearing in June where some sort of ruling will be given. That's the word on the street anyway.


"Big Healthy Babies"

The headline read: “Record Breaking Baby Born at Paoli Hospital” and then the abbreviated story of one mom’s birth of her extra-large child unfolded.

“Six-day-old Blake Alexander Ciarlone is the new biggest baby born at Paoli Hospital, according to available records dating back to 2002.

“Born to Allison and Daniel Ciarlone, he was 12 pounds nine ounces, beating the previous record, set last year, by two ounces.

“Blake is Allison and Daniel’s second child and follows the trend set by his 2-year-old brother, Landon James Matthew Ciarlone, who was born at 10 pounds 13 ounces. Both births were planned Cesarean sections because Allison was getting too big. Blake was born four days early, and his brother Landon was born two weeks early.”

I posted the story on my Navelgazing Midwife Facebook Page and surely made some comment or another about the mom having Gestational Diabetes. Often when these articles come out, there is a disclaimer inside the piece stating, “Gestational Diabetes can cause babies to be this large, but <mom’s last name> did not.” Or, “Baby Ciarlone was born healthy.” In this article, we get a hint about mom’s diet during the pregnancy, unusual in these stories.

“Both were pretty normal pregnancies, said Allison. She ate what she wanted, but it wasn’t anything excessive…. ‘I guess I just carry big babies,’ she said.”

Does she?

Here unfolds the discussion and I’ll answer the questions directed at me as we go along even though it becomes clear I didn’t answer during the discussion. These interjections will be in italics.

JT: Is it just me or are these stories getting more and more common?

KBH: They are! I have seen so many news articles and stories of babies 10lb+ lately who are obviously macrosomic, etc. and it's driving me nuts! Every single one, mom is "I guess I just make them big." Really, really wish people would wake up and realize that this is an issue!

CG: "big healthy baby" /sigh. Big doesn't mean healthy.

TWJ: But big doesn't necessarily mean unhealthy either. Just a thought.

SS-R: There's a difference between a "big, healthy baby" and a "macrosomic baby". Unfortunately, most news stories don't differentiate. I've seen a 10lb+ baby that was lean, stocky and long. Both parents were tall and stocky, with mom hovering around six feet tall and dad towering over her. Baby had great APGARS and perfect blood sugar. THAT is NOT the typical "biggest baby born" you see cropping up in the news.

HH: "Since she was measuring about 40 inches around (t)he waist at 36 weeks, her doctor “didn’t want to take any chances,” said Allison."

I am confused… I was almost 60 inches with my last. What's the big deal. (This was referring to: “Since she was measuring about 40 inches around he waist at 36 weeks, her doctor ‘didn’t want to take any chances,’ said Allison. They planned the cesarean section and were expecting another 10 pound baby, but were surprised by the extra two pounds.”)

Also, not to be rude, but she is a plus size momma. 40 inches isn't that big of a waist. Was she a size 5 before the pregnancy or something?

I can testify... I make big babies. My last was 9'13. I only gained 35 lbs and NO GD. Big can be healthy.

I wonder how much weight she gained.

NgM: It’s important to know that diet is not the only way to control GDM or IR. Sometimes it takes medications as well. I’ve known women to be meticulous with their diets and still have 10+ pound macrosomic babies because their pancreas needed more help than just the dietary changes. The diet certainly helps in these cases… imagine how large the babies would be without that help from mom… but the baby sometimes needs more help than even mom can offer.

KL-D: Is there any indication that this baby wasn't healthy?

NgM: A baby that big is, most assuredly, not healthy. ‎HH: There can be Insulin Resistance long before GDM and IR affects the size of babies, too. The GTT is an archaic screen/test, the best we have at the moment, but it doesn't catch all cases of IR (the lower limits catch some, however). ‎HH: They meant fundal height, not waist measurement.

TS: So, stupid question maybe for NGM-- if a mom is diagnosed with GDM or insulin resistance and is untreated aside from changing one's diet, is it possible to have a normal-sized baby?

NgM: No question is stupid! However, I’m not sure I understand this one totally. Let me try, though. If mom IS diagnosed with IR or GDM and changes her diet, is it possible to have a normal-weighted baby? Absolutely. If mom is diagnosed with IR or GDM and changes her diet, is it possible she might still have an LGA or macrosomic baby? Absolutely, because of the possibility of the pancreas needing more help than diet can offer… mom needing medications to help as well. Did I answer that right?

We don’t talk about it enough, but it isn’t just diet… there is also a huge part of the puzzle with exercise. Exercise helps the pancreas metabolize the food in many different ways. Simplistically, it gives the pancreas more power to shoot out the insulin as well as burning some of the food through energy expenditure instead of it needing to be metabolized with insulin. If pregnant women walked for 15-20 minutes after each appropriately sized meal (and appropriate carbs!), it can make or break an IR/GDM experience.

AKS: TS, I believe the answer has to do with tight control of blood sugars, which is sometimes possible via diet and sometimes not.

Also, I have a friend who just had a 9 lb. 2 oz. 23 inch baby. Definitely no GD--she tested her blood sugar 4 times/day before the GTT, which she passed. Baby had heel sticks after birth, zero blood sugar problems. Maybe some women really do grow big healthy babies? They just don't make the news?

NgM: Depending on who you ask, 4000 grams (8lbs 13oz) or 4500 grams (9lbs 15oz) = LGA or macrosomic (two different definitions, by the way, but often used interchangeably), so 9lbs 2oz would barely fit one description and not the other one at all. I hardly waggle my eyebrows unless the baby is over 4500 grams. Unless mom is under about 5’5”.
Also, I’ve read in diabetic literature that testing four times a day is hardly adequate to determine how a person’s blood glucoses are doing in any 24 hour period. Even four times a day and the HgbA1c together won’t track the ups and downs that happen throughout the day. 10-12 times a day is a more accurate number of finger sticks needed.

This is why I’ve wished the three day continuous monitor might replace the Glucose Screen and GTT. The continuous monitor measures glucoses every 3-5 minutes for three days. Now that’s accurate! Here’s a great explanation about why the four times a day and the HgbA1c aren’t the most accurate ways to gauge BGs.

CS: This is the topic that had me hooked to NgM :) I ended up on her blog a few months ago for something entirely unrelated, and went to bed that night with a sigh of relief. I knew I had big babies and I always knew there was something not right. Hearing that IR can cause macrosomic babies was the light bulb I needed in this pregnancy. It makes sense. I'm 5'2, and both dads are 5'11 and under. So I always questioned where 9lb 2.5oz 23" and 9lb 5oz 24" babies came from. I hated hearing that I just made big babies, but it was a mantra I began to accept. My second son is huge. He's the size of his 4 year old brother. If I was going on just him, I'd agree I made big babies. But his brother normaled out quite quickly after birth. My first had a perfect APGAR, my second had a 7 and they took him to the nursery and his sugars were off. Add that with my dad's diabetes diagnosis at the beginning of this pregnancy, and the pouch around my middle that I can't get rid of, and I believe that I fit the category of IR macrosomic baby maker. Up until getting sick over a month ago, my diet was great. But I've gone off the diabetes lifestyle change as it was harder to maintain while battling chest infections with little sleep and raising my boys. I'm 24 weeks now, so I'm hoping to be healthy enough soon to regain my energy levels so I can change my lifestyle again and hopefully better my pregnancy, delivery, and my daughter's future. Thank you NgM for your logical and informative information on this subject. I wish you were able to reach more women on the subject.

Also, what was the test you recommended again? The one that tests 3 months worth opposed to the blood glucose level test? I'm going for the routine one next week and I don't suspect anything will come of it, but whether during pregnancy or after, I want to take that test just to see.

(Ps. I thought it was funny when my midwife asked if I wanted the glucose testing, I told her yes, but that I already changed my lifestyle based on the information I read on your blog. She smiled at me and nodded. She totally knew who you were and was supportive of the same information you speak of! Just thought it was cool that you are that well known up here in Canada too!)

NgM: Hilarious! And I’m flattered.

KDK: A1c is the more accurate test.

NgM: Yes, the Hemoglobin A1c is another measure of how a woman’s glucoses are doing, but it can only see from the point of the test backwards three months. Therefore, testing in pregnancy is good for observation, but not for diagnosing GDM. The reason the GD screen and GTT are done about 28 weeks is because that’s when the mechanism for pancreatic stress takes effect. While it seems gradual, it wouldn’t be surprising if it was a light switch reaction to the pancreas hitting its stress limit. Not diabetic one day and diabetic the next. Doubtful, but sometimes it’s easier to visualize what happens if you think of it that way.

But we know that Diabetes is a spectrum, it’s a ramping up of glucose in the blood because the pancreas gets more and more exhausted trying to keep up with metabolizing food intake. That’s why there can be tight control over food and exercise, but the pancreas still needing more help with medications because mom can only do so much. Diet and exercise are crucial… taking meds instead of changing the diet and exercising is inappropriate and probably pretty ineffective… but together, it can be awesome for the mom and baby.

SS-R: At 60, my mother has no signs of IR or Diabetes, she had four babies ranging from 9lbs even to 9lbs 15.5ozs. Diabetes in all its forms is virtually unheard of in our family at all, in fact. MOST babies born on my mother's side of the family are between 9 & 10 pounds (big, but generally not considered macrosomic). I think we need to be careful to distinguish between the two. There is such a thing as big and healthy, and I think we are going to be seeing more and more of it as people are eating better during pregnancy, as humans get taller with each generation, as smoking decreases- both during pregnancy and prior to it. There are a lot of things known to contribute to SGA babies, even in a good-sized baby, those things- or the lack of them- can cause a variation of a few ounces one way or the other, and when you are talking about people with a family or genetic disposition to babies that are on the upper end of that size bell curve, a few ounces can make a big difference.

That said, I am not one of the people who believe that all big babies are healthy, or that GD doesn't exist. I simply think we need to be cautious not to be diagnosing mothers and babies with medical conditions based on a single factor and without access to their medical information.

S: as I pointed out in my previous comment (and if someone could link the blog post where NgM discusses this in full) I kind of have a triple threat against me. I may have self-diagnosed, but it's not affecting my life. It's a lifestyle change that really is a billion times better for me. Diabetes can hit anyone at any time, regardless of genetics (although usually they do play a part). I would rather change my lifestyle now and possibly have a smaller baby (less traumatic birth) and possibly avoid becoming full-fledged diabetic later in life. Some women obviously make big babies. Genetics is great like that. But, the 3 strikes were that I had one child who was born large but who normalized after birth (i.e. he wasn't that high in the percentiles, but rather quite normal), diabetes runs in my family with my dad being diagnosed quite recently, and I've had recent weight gain (mainly in waist area). One thing on that list doesn't necessarily mean IR. It doesn't mean that it's not IR either, but I firmly believe that with each checkmark on the list, the chances are increased immensely. I think more needs to be studied on this to help more women. Diabetes is awful on its own, but to know what it does to your heart and the rest of your systems is enough to want to avoid it at all costs. I don't ever think that NgM is throwing everyone under the big babies = undiagnosed IR or worse bus. But I do think that her way of thinking could change the face of pregnancy and even diabetes as we know it for the world over.

LA: Seems to me that generalizations do one thing: hurt mom and babies (yeah, generalizing about generalizations).

There are big healthy babies. There are big unhealthy babies. There are small healthy babies. There are small unhealthy babies. ...There are many in between.

Lumping Mommas and babies into predetermined risk categories based on generalizations and assumptions is killing maternity care in the US. It ties everyone's hands. I don't understand why providers perpetuate one size fits all care. Who benefits? Not me. Not my kids. Lazy, CYA based medicine. Hmmm. There ya go.

I have 10-11 lb babies. In nearly 15 years of having babies I have never shows signs of or tested remotely positive for diabetes or IR (not GD bullshit, real diabetes). I have no family history of diabetes. I have children who have remained in the 90th + percentile to off the charts into their teens.

I grow big, healthy, strong babies and they grow into big, healthy, strong kids. My family has lots of big, healthy long lived adults.

Maybe those providing maternity care need some diversity training and lessons on genetics.

NgM: The size of your babies alone puts you at risk for future diabetes and unless you stay active and normal-weighted, you could very well end up with diabetes, too. It’s great you’ve avoided it so far, but I find it incredibly difficult to believe your babies were that big without any IR issues going on. But, that’s part of your argument, right? That I (and other providers) lump you in with the others… so ‘round and ‘round we go.

SS-R: C- I was in no way directing my comment at you. I was speaking about how quick some people are to call every large baby unhealthy when ALL they know is birth weight. In fact, I would be MORE inclined to give credence to your strong sense that something was off than to the medical professionals that told you everything was fine. If you were my friend and you were telling me this, I would PUSH you to fight for answers and to trust your gut.

I also think that IR does need to be taken into account, especially given the rise we are seeing in PCOS and related issues being diagnosed, and more attention needs to be paid to nutritional counseling prior to and during pregnancy than simply the 'weigh and shame' routine that many moms encounter.

CS: I think the problem is simply the testing for GD doesn't screen for IR which can cause problems much the same. To know that and to see big babies being born and to hear statements like "She ate everything she wanted" (which usually equates to salt and sugars... not many people make that statement when referring to copious amounts of fruits and vegetables and steak), you can't help but wonder. I don't think she is throwing this mom or anyone else under the bus, but raising an important topic of concern. How many babies are born that big where it is genetics? Are they still truly healthy or is there lower APGARS, messed up blood sugars, or even outside of just birth, what are the risks in the future? And if it's genetics, can diet and exercise (assuming there is no true GD that requires insulin) bring the size of the baby into normal parameters to minimize the risks? Or does genetics truly determine that the baby will be large no matter what (and presumably healthy)? In which case how can screening be done accurately to risk out women who do have undiagnosed IR? Can studies be done to prove the risks associated with living a lifestyle that creates a larger baby in that case?

So many questions, so many theories, and I think everyone just wants happy, healthy babies in the end. But I'm happy that someone is asking these questions and getting people talking about it. I'm kind of ill right now and heading to bed, but I'll try to find the link to NgM's blog entry on this. She does mention the 3 strikes rule instead of just focusing solely on the big baby aspect. Like I said, I have 3 strikes against me. It doesn't mean I have IR or will most certainly develop GD or DM, but it does light a fire under my bum to make some needed changes in my life. Do I need pop? Nope. Do I need 4+ teas with 2tsp of sugar every day? Nope. Do I need more exercise? Certainly. Living the lifestyle like I have diabetes isn't limiting at all. In fact I never felt better and I'm sure I was increasing my quality of life as well as my life expectancy. Even if the testing comes back that I'm not even IR and even if I just do make big babies, I'll still be thankful for the motivation to change my life and my habits as it can only be making my life better:)

MM: I had diet-controlled GD with my first pregnancy - my sugar control was spot on and I delivered a healthy 9lb 7oz boy. I figured he was big due the GD but my second, with absolutely no GD was 9lb exactly. My last, again with absolutely no GD, was born at 37 weeks, perfectly healthy weighing 7lb. By his due date he was 9lb. I've come to the conclusion that I do just make big healthy babies. They stay big til about 6 months, and then they even out to average size.

NgM:This was a great conversation, ladies… thanks for exploring it more in-depth. It certainly is one of my favorite topics.


The Cursor

The cursor blinks at me
Like a finger tapping its impatience.
I write a few words,
Then they fall off the edge of the page.

I ache to compose,
But gathering, then assembling
My thoughts
Seems overwhelmingly difficult.

Please forgive my poor neglected blog
(as I have come to call it).
I hope to find my way back to it soon.
I miss her as much as she surely misses me.

Responsible Blogging

Angela Horn, on her new blog Doula2You wrote a post entitled, “Ethics in the Childbirth Blog-sphere” (sic) about the responsibility a blogger takes just by writing her (or his) words on the Internet. 

“When we proclaim ourselves as experts, by certification or opinion (blogs) we are responsible for our words. We have an obligation to our clients and/or readers to provide accurate information and to disclose our bias. When we conduct ourselves as experts in a particular field many followers of that field will trust what we say and take it as fact. While I don’t disagree that readers have the obligation to do their own research and make their own informed decisions that doesn’t absolve the birth advocate/blogger of the responsibility for their own words and how they are presented.” 

This topic comes up every few months, especially when someone took the advice of an online “counselor” and had a negative or even tragic outcome. Women who let their pregnancies continue past 42 weeks or who have Unassisted Births with a breech baby readily come to mind; certain “natural birth” community forums leading the way against safety and, all too often, even common sense. What is it that makes it so easy to take a stranger’s advice when real life advice says otherwise? I’m reminded of second (and third) opinions… continuing to ask for “opinions” until someone finally says what you want to hear. “Aha! See! I was right after all!” When it comes to childbirth, ask ten women what they think and you’ll get fifteen answers. Eventually, you’ll hear what you wanted to hear in the first place. 

But blogging isn’t quite a community forum. Bloggers taking on a more serious tone, sounding more professional, when, in fact, all we bloggers really are are darn good writers (for the most part). We don’t necessarily know any more than anyone else, we’re just good at getting the information out there. And yes, myself included. 

So, do we bloggers have a responsibility to our readers? Do we need to put disclaimers on each post saying, “This is my opinion. To figure out yours, read and research a LOT. Do not just take my word for it.”? 

I’d love to hear from the women themselves how they think we should present ourselves, how we remind women we’re human, too, and don’t know it all (despite some believing they do). How do we demonstrate our specialties while also showing our warts? Is it only through time that someone earns respect?

What do you think?


What Should a 4-6-Week Miscarriage Be Like?

This was a Facebook question I thought would translate well here. Here’s how the thread unfolded. 

A mama asks: What should a 4-6 week miscarriage be like? (bleeding, cramping, clots, etc.) 

CDM: Mine was like a normal period, but I'm not sure if that is the norm or not. Had I not taken a test on a hunch I would just assumed it was my period starting a little late. Sorry for your loss, mama. 

HH: I just miscarried at 4w5d. It was heavier than normal, lots of larger clots (dime to nickel size), and painful cramps. I never have clots or more than light cramps. I also had a migraine that lasted 3 days. 

SMP: Please visit http://stillbirthday.com/. There's a lot of info there about what mother's go through, symptoms, and support for when this happens as well as thousands of mother told stories. Stillbirthday also lists doulas for moms in this situation and we are all very nurturing and caring. Sending good thoughts for this poster. 

MA: Sorry to piggyback on this question, but could answers please also include a 7-8 week miscarriage? Thank you. 

BO’B: All of the above.. but they can be so different for everyone.. I think even the two-week difference of 4 weeks to 6 weeks changes things. My 6.5 week miscarriage was like a very heavy and very crampy (VERY emotional) period, with a definite day of passing larger clots and greyish matter. Probably two weeks total. 

KL-D: Mine at 5w1d was much heavier than a period and longer. I bled for at least 10 days on and off. I also passed some obvious tissue with the clots. It will depend on the reason probably (blighted ovum/empty sac/chemical pregnancy will probably be less bleeding and clots than a clinical pregnancy with a fetal pole observed, but I'm just guessing there, mine have all been clinical.) 

Also sorry for your loss. It sucks. 

SCM: It'll be an extra crampy period, will probably last a few days longer than normal. I've got six of those under my belt. ((hug)) 

MW: Just had mine in July....nobody told me what it would be like and I thought the unstoppable bleeding for days and days enough to back up all the plumbing in my house (it was a mess) must have been normal since nobody would tell me ANYTHING. It wasn't. If anything seems wrong it probably is.... go to the ER and MAKE them bring in the on call OB. It took 3 visits before I finally forced them to do something and the OB is the only one who could finally tell me I had miscarried 4 weeks earlier and had to go in for an emergency D & C. The regular ER docs didn't care enough to look even when I asked and it could have been MUCH worse. PLEASE be seen if it seems excessive. 

KT: Like the worst period of my life, for so many reasons. 

NS: mine at 6w was like this. cramps worse than usual, bleeding heavy, a day longer. feeling down emotionally. 

KLD: My 8.5 week one was worse, I lost a lot of tissue and a week after the initial loss, when I'd almost stopped bleeding, I had another big bleed and lost the tiniest, saddest placenta ever. (I also laid in a supply of zofran and oxy when we saw the ultrasound where the baby was gone, and spent the worst of it in a haze. I recommend that strategy if at all possible.) 

ALB: I miscarried at 6 weeks with no symptoms at all. A check up at 10 weeks showed no heartbeat, growth only to 6 weeks. I had a scheduled D&C, but began to spontaneously bleed that day. They still performed the D&C, which I agreed to, thinking it would shorten my bleeding and let me begin to heal. I didn't realize I would bleed even longer. So sorry for all your losses, reading brings it back, even after 12 years ♥ 

SC: My 6 week mc was crampy, clotty, and long-lasting. I bled (moderately like a period) for about 3 weeks and I tested positive for hcg and felt pregnant for a month after the bleeding started. My 12 week miscarriage (baby measured 9 weeks) was full on labor with short but intense contractions every 15 seconds until my water broke and the baby was born (then I hemorrhaged and things got SERIOUS really quickly. Please do not hesitate to get medical help of the bleeding is really heavy or you get a temperature (I bled through a super maxi pad in less than 5 minutes... If you go through more than one an hour- get help!). Sorry for your losses, everyone! Pregnancyloss.info and misdiagnosedmiscarriage.com are also helpful. 

CS: Mama- whoever you are, I went through one in February. You may email me at acaringpresence at gmail dot com. I was just a day short of 6w. 

MA: Thank you and I'm sorry, K. I have 2 embryos that are implanted but not viable, I'm trying to decide whether to wait for things to end naturally or book a D&C. 

KS: I bled for 3 weeks with my first miscarriage, horrible cramps and heavy period flow bleeding for the first week, medium flow for the 2nd and light during the 3rd. I passed at least 3 clots bigger than a quarter. I also felt very tired and weak. (Not positive of how many weeks). With my 2nd MC at 5 weeks it only lasted a week and there wasn't many sizable clots but fairly heavy bleeding for a few days, turns out I lost a twin, the other survived. 

SM: Ladies, thanks for answering a very sensitive question. This has been very helpful. There has been no information where I've looked. I am nursing my 8 month old son so I also ask if anyone has had an early miscarriage while nursing? Did it affect your milk supply at all? I estimate that I was around 5 weeks with an unplanned pregnancy and I have lost it. As for my milk supply it has dipped some but not enough to upset my baby. 

KL-D: So sorry, M. It's something I wouldn't wish on my worst enemy. Mine were IVF pregnancies, too (sounds like yours are.) ::hugs:: 

MA: Yes they are K, thanks for your info (and hugs). 

HH: I am still nursing my daughter. She will be 2 on the 26th. She nurses 8 times a day still. I did notice a dip, but I normally do before my period begins anyway. It's enough where she notices (wants to nurse longer and more frequent), but it picked right back up. 

I miscarried 8 days ago. My supply was low for about 3 days, like normal. 

SC: Both my miscarriages were while nursing my 1 year old and I didn't notice a significant difference in supply. I was very glad I was still nursing so that I didn't have empty arms after the losses! 

HW: I miscarried at 6-7 weeks. It felt like labor from Friday to Sunday. Normal period amount with some large clots including what looked like a sac (I scooped it out of the toilet). BIG HUGS! There is no right or wrong. Just be gentle with yourself. So sorry. 

ES: I have some thoughts I will be back to share. Barb actually saved my life when I had a cytotec induced, missed miscarriage, at 16 weeks 3 days( baby measured 8wks 3 days upon ultrasound confirmation) more of my thoughts to follow shortly. 

NgM: That was flippin' terrifying, Beth. Oh, I remember it like it was yesterday, too. 

JM: I was nursing 21-month old twins when I had a miscarriage at 13 weeks. I went with a d/c option and it didn't really affect my milk supply. The anesthesiologist suggested I wait 24 hours to nurse my girls. My nurslings were older though and it wasn't an issue to hold them off. When I had a miscarriage at about 5 weeks, it was like a very bad, very long period and I nursed my 1-year old through it with no issues. Many hugs your way ! 

JU-M: I had a D and C several years ago. I was just over 10w, but embryo only measured 6w. I opted for a D and C for several reasons. I had light bleedings/spotting for several days with some minor cramping, but that's all. 

SDC: My 6wk m/c started like a light period, then I passed one large clot (the size of a prune) & I knew I'd miscarried ‘cause I felt my uterus sag like after a birth. I bled for a few more days but it was never as heavy as a period. 

NgM: I can't thank you all enough for y'all's kind sharing. You're so loving and gentle with each other sometimes... my heart just melts at your tenderness. 

SM: I found out at 10 weeks that baby no longer had a heartbeat, and was measuring 8ish weeks. Declined a D&C. Didn't miscarry for another week, with spotting off and on. Once miscarriage started, it was a gush of blood followed by an egg-sized clot and another gush of blood, every 5 minutes or so, for over 7 hours. I was feeling really badly... on the verge of passing out, high heart rate, etc. I ended up in ER, pumped full of fluids, with low blood pressure/high heart rate. Then I ended up needing a D&C anyway, because there was still retained tissue with blood flow. After surgery, I had light bleeding for a few days. 

NgM: I just re-posted Beth’s story

AW: Hugs to the mamas who asked for this info. 

My three were all between 4 and 6 weeks and every one was different. The first was a surprise; I just had a bad backache and when I went to the bathroom I noticed a bit of blood and then a small sac slid out. The second was long and drawn out; I bled and cramped heavily for almost a month before it passed. The third was just like a heavy period that was a little extra long. 

KC: You've gotten plenty of responses, and both of mine were D&C's, so I don't have any info to add, but I wanted to send (((hugs))) to all the mamas who posted on here. It's an awful, sad experience, and I'm so sorry any of you had to go through it, too. 

Thanks to everyone who responded. This is a topic not often spoken of, so I really appreciate you women allowing us to witness your pain for a few moments. Love to everyone.


What I've Seen Up to Now

In Wherever You Go, There You Are, by Jon Kabat-Zinn, in the chapter entitled “Mt. Analogue,” Kabat-Zinn says: 

“In a way, that’s all any of us do when we teach. As best we can, we show others what we have seen up to now. It’s at best a progress report, a map of our experiences, by no means the absolute truth. And so the adventure unfolds.” 

This is a great way to describe why I write. 

Thought I’d share.


Extract This

Sara, of Flutterby Butterfly, wrote a post entitled, “Do You Judge or Support the CSection Mommy?” wherein she says, in (large) part, cesarean moms looking for support online will find: (emphasis Sara’s) 

“Instead of congratulations, you're more likely to get note of sympathy, like you lost someone. You'll be told that it was probably not really not needed. You will be told that the cascade of interventions caused it. You will be told that the epidural was responsible. You will be referred to ICAN and the Unnecessarian (sic). You will be told that maybe next time you can try for a VBAC. You will (be) encouraged to try an HBAC.  If you refer to the c section as a birth, you will be corrected and informed that it was just an extraction. You will be told that your bond with the baby isn't as good as the bond that is created by vaginal birth. You will be told that you should have trusted birth more. 

“If you give your reasons for the c-section, you will be told that whatever it was (pre-eclampsia, nuchal cord, breech, transverse, high blood pressure, twins, big baby) was just a variation of normal. 

“In other words:  The amazing and joyful experience of bringing your child into the world will be torn apart and judged as not good enough.  The wonderful moments of meeting your baby for the first time will torn apart and judged as not good enough.  The reasons that you had a c-section in the first place will be torn apart and judged as not good enough.” 

What Sara says is so true it makes my stomach turn. What the heck is with women that they have to terrorize new moms, making them second (and third and fourth) guess what happened during their labors and births? Why is it so important to make women feel like crap about their births? Who does that serve? Certainly not the healing mother. 

Yet, in the original thread in Facebook, other women said: 

“I experienced the opposite of what this blogger describes. After my c/s, I was depressed, angry, and bitter. I so so wish someone had told me that it was ok to feel this way. Instead, I got the ‘at least you have a healthy baby’ and no one seemed to understand why I felt the way I did. This made me feel even more alone, even more guilty for the poor bonding, and pushed me further into depression. I was ECSTATIC when I found out that there were people that felt the way I did after my c/s and that I wasn't alone or crazy-- I sought them out, not the other way around.” 


… finding (virtual) support at long last, I also learned that my hellish-induced-labor-turned-c-section-and-eleven-days-at-NICU was not a birth. Nothing's perfect in this world, I suppose.” 

What the heck is this “extraction” crap? I suppose I’m not supposed to contradict another woman’s perception of birth, but what Sadist started this “extraction” crap? 

Can I tell you how sorry I feel for the child born of a mother who says she didn’t give birth to the kid? That s/he was “an extraction,” like an infected tooth or a cancerous mole? What is that going to do for his or her self-esteem? Has anyone thought that far ahead yet? What a horrible set-up for loving parenting, starting out thinking your baby was “extracted” from your body. 

Birthing occurs in far more places than the vagina. We birth ideas. We give birth to ourselves as understanding occurs through introspection. We’re reborn when we embrace a new religion. Birth is a beautiful metaphor for many aspects of our lives on earth. Can’t birth via cesarean at least be a metaphor for the beginning of a new life despite the baby not coming via the vagina? 

Women in many places around the world would give their lives to have a cesarean birth… and do, by having vaginal births that kill them. Do you think that women in Somalia have a remote belief that a cesarean isn’t a birth? Puh-lease. What an amazingly arrogant luxury it is for a woman in our culture to pick apart the way/location/method of birth, designating a cesarean as a non-birth when so many women are dying in other regions and countries. And for the women that die, there are many others who would have killed to avoid the trauma of an obstructed vaginal birth. Ask the women who are now non-persons because of their obstetric fistulas whether they believe a cesarean is an “extraction” or not. Or the women who delivered dead babies vaginally when a cesarean would have saved their babies’ lives. 

Quit being dramatic, you Extraction Queens. Find a way to get over your selfish belief your birth wasn’t real because of the location the kid entered the world from. That doesn’t mean mourning a vaginal birth isn’t warranted (if that is your inclination; not all women need to), but it does mean to knock it off about the desire to use shock value to get pity from others.

Enough already.


Beth's Hemorrhagic Miscarriage

This is a re-post from several years ago, but the topic came up recently on Facebook, so was led to re-post it now. Plus, Beth, the woman in the story, is writing her view of the experience and when she has finished, I will add that to the end of this one. Check back in a few days.

Trigger Warning: Miscarriage discussed in detail as well as a photo of the Products of Conception (POC) at the end of the post. 

I got a call from the glamour sono place 3 days ago. My client, 16 weeks along, had gone in on a whim to see the baby's gender. She brought her best friend and all the kids as well. During the ultrasound, it was apparent there was no heartbeat and, of course, the sonographer couldn't say anything, so she mentioned that the baby actually measured 8 weeks... perhaps she was off on dates? As soon as my client left, the sonographer called me even though she didn't have a prescription from me or anything. I am very grateful for her caring. Immediately I called Beth (she was still driving home) and told her what she already knew. Beth is very calm and quiet, very matter-of-fact, so calling her while she was still on the road wasn't an odd thing to do. For another woman it might have been totally inappropriate. 

I was Beth's midwife for her last baby. She's had 2 hospital births, a UC and then the birth with me. She'd asked me to be her midwife this time, too, so I was very much looking forward to working with her again. 

For another reason, she had to go to the doctor, so sent her to a beautiful, gentle doctor we were just getting to know. Dr. G(entle). I had not done a prenatal on her at all, still, so technically, she was his patient. 

Because she had not had a spontaneous miscarriage and it had been so long since the fetus had died, it was important for her to consider inducing the miscarriage (technically, it is called an abortion, but doesn't mean it in the political sense, merely a medical sense... an SAB - spontaneous abortion). She went to see Dr. G and after another sono verified the demise, mom had labs drawn (to check her iron levels with a Hemoglobin and her HCG [pregnancy hormones], both as baselines) and then filled the prescription for Cytotec ("medically managed miscarriage"). Beth is very aware of the controversy around Cytotec, but for miscarriage, this is an absolutely correct usage for it. Even so, not everyone would prefer this, instead choosing a D&C. Weighing the risks and benefits is really important because D&Cs come with their own set of risks. 

On June 30 at about 7pm, she placed the Cytotec into the os of her cervix. (I didn't know she was putting it in so quickly; I would have recommended she wait until first thing in the morning after a good night's sleep. Note! Inductions of any kind are best done first thing in the morning!) She had no contractions and nothing really happened until about 1:30am on July 1. Then she started bleeding and didn’t seem to stop. Sitting on the toilet, she dropped clot after clot and dripped blood that sounded like she was peeing. She began going through more than a Poise an hour (extra large pad), but thought it was all normal (and very well would have been except it didn’t stop). 

I got a call at 5:17am with Beth saying she felt faint and was getting worried. I jumped out of bed and was out of the house in 11 minutes, the only make-up on was from the day before. I barely combed my hair and poured a Diet Coke in my Big Gulp cup and headed out the door. Being 45 minutes away, I talked to her once I was on the road, asking about the bleeding and she telling me about the clots she could hear plopping into the toilet and the large amount of blood that kept coming out. I asked her to please not get up without help and she said she was going to wait for me. I told her she might have to pee and if she did, please have help. She said, again, she would wait for me. 

Beth was at another client of mine’s home because she has 3 small girls in a little house and knew she would need some help as she began the letting go process. I am so, so glad she was at my other client’s home, a woman who’d caught Beth’s UC baby and was a wonderful and loving best friend. L has two beautiful girls and her husband R was home, too. In fact, when I got to the house, R opened the door, ushering me right to Beth who was on the couch in the living room. I arrived at 6:25am. 

I sat with Beth on the couch, listening to her tell me she felt so dizzy when she got up, but she needed to pee. After a few minutes, I walked with her to the bathroom and she sat, plops of clots and blood gushing into the toilet. The clot that I saw was twice as big as my fist, but it was quickly covered with blood, the toilet looking like only thick blood was in the bowl. Had she been doing this since early in the morning? She said she’d wanted to call me at 3:00am, but thought she should wait longer. I wish she’d have called me earlier! Don’t ever worry about waking a midwife! 

I learned at Casa de Nacimiento (a birth center I trained at in El Paso, Texas) that when women tend to faint, it is often after they pee. The fluid shift in the body might be one reason, but I don’t know the exact technical reasons; I just know that it happened at Casa a lot. My Anglo clients didn’t faint nearly as much as the Hispanic women… don’t know what’s up with that either. 

Beth felt very dizzy, so she rested her head on my thigh for a few minutes. She would pick her head up, then lower it again; we stayed there for about 15 minutes, blood dripping the whole time. Then she took a deep breath and said she could get back to the couch, so she cleaned up a little, pulled up her undies and pj pants and we left the bathroom. She stepped out first and I was sort of behind/beside her and knew I needed to get in front of her. As I was stepping to scoot around her (we were in a hallway), she went down. And went down fucking hard. 

Beth fell as if she were a Sequoia… straight forward, stiff… and right onto her face. Onto a tile floor. Horrified, I fell to her side, touching her gently as she twitched in the way women who faint do. R came to be with us, too. L and the kids were still asleep. I spoke softly to Beth, telling her she wasn’t alone (I know that many people who faint lift out of their bodies and can see and hear what is happening even though they can’t respond) and apologizing for not catching her as she fell to the floor. Today, Beth said that was the first thing she remembers after the bathroom, my telling her, “I’m so sorry I didn’t catch you!” As she got back into her body and could talk, she said her face hurt. Her lips swelled immediately, her top lip nearly touching her nose. Later we were able to joke that women could naturally plump their lips simply by falling on them each morning. Who needs those pesky bee sting injections? 

Beth fainted at 7:15am didn’t move from her exact same position for over 45 minutes. L woke up and we all sat on the floor next to her, talking with her about how she was feeling and what I felt we needed to do. Right after L woke up, I grabbed my phone and called Dr. G, relaying the events to him. I told him I thought we should come in and he shared with me what would happen if we went into the ER… fluids, a sono and if there were still POC, she would need the D&C. He said that he felt the worst was over and asked how much she was bleeding. We took her pants off, put a Chux under her and there was very little bleeding. He asked for her BP and I didn’t leave her to grab the cuff right when she fell, but took the few seconds to get it and took her BP… wrong. She was face down, upside down to my usual orientation, and I put the cuff on upside down. Rolling my eyes, I re-placed it, taking her BP and it was 80/40… a re-take a few minutes later was 90/50, so it was coming up. I asked Dr. G if he felt a shot of pit might be called for. He said the Cytotec worked in much the same way, but it couldn’t hurt. I had an instinct that it would help, but think that’s because of my limited ability to attend to hemorrhage in the home setting. The doctor said he still felt comfortable with her remaining home as long as I stayed with her and if there were changes, we would go in. After hanging up, I went and got a pit out of the car along with some homeopathics (after talking to another midwife who is far more skilled than I in homeopathy). I gave her the shot of pit in her left upper arm. L got Beth some arnica and gave that to her as soon as we thought of it. 

Beth loved lying on the cool floor. We also got ice packs and put them on her bare back, her neck and gave her ice chips as well as sips of water. After that first 45 minutes, we turned Beth over to her back (it was horrible see the whole damage of her lips and teeth!), getting her a pillow and then really encouraging her to drink water to increase her fluids. L also got her a Popsicle to suck on to help quell the swelling. Any thought of sitting up was squashed as she said she knew she would faint if she did. One of L’s daughters woke up and casually asked, “Why does Miss Beth have no pants on?” We said she wasn’t feeling well and was hot, so didn’t want any covers. 

Once Beth was on her back, she rested for quite awhile longer. I checked her uterus and it was very firm and easily felt. When I talked to Dr. G, he suggested that perhaps some tissue was still in the uterus or in the os of the cervix and uterine massage would be a great idea to move the tissue along. While initially, it didn’t seem there was any bleeding, slowly, I could see blood seeping through the Chux pad. The doctor also said some bimanual compression would be necessary if she started hemorrhaging badly, but we never got to that point. 

Beth began getting cold, so L found a Nemo towel (she asked for Scooby-Doo, but L and I scoffed… nothing but Disney; it really was the only choice) and we covered her with it. She really liked my massaging her uterus. When I had to step away, she did it herself. It seemed the uterus was always firm, but there was one side that got boggier and needed massage. We talked about my calling 911, but if the ambulance came to take her, they would take her to the only hospital in the county that all of us despise. This was the hospital where my client was abused and I turned them in to JCAHO – and ever since, they won’t let me past the front desk, even when transporting my own clients. Beth refused to go to this hospital, so we talked about how to get her to the hospital. She said she was feeling better, but still didn’t think she could get to the bed that was about 10 feet away. R said he would carry her there, so she put her arms around his neck and he lifted her, straight off the floor and carried her to the bed L had gotten ready with Chux and clean sheets. Beth melted into the bed. She said it was much more comfortable than the tile floor. 

I gave Beth some Nat Mur for the bleeding (I didn’t have anything else the midwife recommended) and Arnica 200 for her swelling. We did a couple three doses altogether. She had to go to the bathroom and getting up was out of the question, so I told her to just go on the Chux, but she couldn’t so B got her a Pull-Up and she easily peed into that. Beth was lying on L’s youngest daughter’s bed and L said it had great pee karma, so she shouldn’t have any trouble going; she didn’t. Maybe urinating would help keep the uterus firm? 

Beth felt so much better in the bed. Perhaps the bleeding really was done. Dr. G called again and said it can be so hard, the Cytotec/miscarriage experience, that sometimes it’s such a storm and he was sorry she’d been experiencing that aspect. Certainly the storm had blown itself out. 

With Beth resting, I told L I was going to sit in my car in the driveway and try to nap for a few minutes, but I would be back in shortly to check on her. L stayed with her. About five minutes after I got into the car, L came out and said Beth was sweating. I dashed in and knew then she was absolutely going into shock. I called Dr. G to let him know we were on our way in and he said he would call the ER to let them know we were heading in. 

R had left for work a few minutes earlier, so L called him back and while we waited, L got the van ready to hold Beth in the back row, still lying down. Any lifting of her head brought her complete dizziness and an urge to faint. R came in and lifted Beth easily and put her in the back of the van, feet raised and she was put in charge of massaging her own uterus, not only to keep it firm, but also to give her something to do, focus on something other than how poorly she was feeling. 

I followed L and instructed her that if Beth needed help, to pull over and I would call 911 immediately. Blessedly, even though it was 9:00am, the traffic heading south wasn’t bad at all. 

We got to the hospital Emergency Room parking lot and I calmly (but quickly) went in to get a gurney for Beth. I had to wait for the nurse fill out the paper wait for the nurse again tell her she can’t go in a wheelchair she can’t sit up she needs a gurney… “Let me go talk to my supervisor” oh, hello supervisor, oh, the gurney won’t fit here how about we move the van so the gurney can get next to the van where is everyone why don’t they frickin’ hurry UP already oh, move the van how clever of you. L moved the van to where the ambulances drive up and then Beth slid out of the van on her butt and rolled onto the gurney. I breathed a huge sigh of relief that we were at the hospital. Writing this, it brings tears to my eyes. The two hours of worry and concern… and heightened awareness… were over… at least with regards to my personal responsibility. 

Monitors were attached, the blood pressure cuff attached and the pulse oxymeter all attached within seconds of getting to the curtained off section we would be assigned to for the next 12 hours. Blood was drawn and the IV started, even before the nurse got orders to do so. Over and over, Beth, L and I would sigh deeply and say, “I’m so glad we’re here.” Sometimes the hospital is a wondrous place to be. 

Know that things were done very quickly –for an emergency room. Beth had a sono and a CT scan, the ER doc was an angel, asking me what I thought about a D&C, saying he didn’t want to counter her HCP. I was flabbergasted. Oh, and the nurse knew who I was… had looked over my website and wanted to be a CNM but didn’t know how to get there. I gave her my card and she promised to email me. 

Dr. G came in, cancelling his afternoon so he could spend it with Beth, looking at the sono results which showed something in the os of the cervix, so he was going to do an exam to see what he could find. The CT scan’s results came later and were normal. (She had the scan because she smacked her head so hard on the floor.) The blood work came back showing that her hemoglobin had gone from a 12.7 to a 10… not really horrid, actually. The doctor wanted to re-check her Hgb after the vaginal exam to see if it continued dropping. 

Dr. G came in with “drumsticks” – long, long cotton swabs, gloves and a nurse to assist. Within moments of the exam, it became apparent why Beth had been hemorrhaging. The POC had gotten trapped between the uterus and the vagina, lodging itself in the os, not allowing the uterus to clamp down on the “open wound” area the delivering placenta left inside. It didn’t take five minutes to relieve Beth’s body of the baby that seemed to linger inside. Whereas we thought her uterus had been clamping down before, after the POC was removed, it was a distinct difference, how low the uterus shifted and how firm it finally stayed. There still was some bleeding, but not anything like there had been, so the doctor talked about rectal Cytotec which made Beth shudder. We both explained that rectal Cytotec is used for hemorrhaging and since she’d had several babies, it might not be a bad idea to stop all the inappropriate bleeding. Beth very much wanted to avoid the Cytotec. Later, she began taking methergine, the other medication many midwives carry, along with Pitocin. We give methergine to women who might have retained membranes, so this seemed like a good idea. 

Another sono showed the uterus, os and vagina were empty. The miscarriage was complete. 

It became apparent that she was going to spend the night. They offered to let her go if her Hgb wasn’t much lower (it was lower), but Beth really felt she needed to stay. For a former UCer to say she needed to stay in the hospital, they best listen to her! 

All the major drama and work completed and the waiting for a bed begun, I excused myself about 2pm and went home to nap; I am on call for a term mama and definitely needed to rest up a little. It won’t surprise birth workers, but I wasn’t the least bit yawn-y when with Beth until things started to wind down. In the moment, I felt unlimited energy, no pain in my feet and completely present. As I drove home, however, I was groggy and couldn’t wait to climb inbetween my bamboo sheets. 

Beth got a bed about 12 hours after entering the ER. L stayed with her the whole time, feeding her ice chips and juices now that the possibility of surgery had vanished. I learned the next morning why she wasn’t eating food; her teeth’s re-positioning didn’t allow her to chew, her molars unable to meet because of the way her front teeth had moved around. I continue to feel just horrid about her falling face down. I wish I could re-play that moment (I would step out of the bathroom ahead of her) or fix her teeth as easily as I can measure dilation. 

I went to see Beth the morning after and her Hgb was now 6. She accepted the offer to receive two pints of blood (A Positive, just like me). Dr. G said she didn’t have to have the blood, but after L’s hemorrhage (after her last birth), she saw how it took three months for her to get back on her feet and knew she couldn’t take that long with three young girls. She said if she hadn’t seen L’s recovery without a blood transfusion, she would have refused. Seeing it, however, she knew it was the best choice for her. Each bag takes about three hours to drip in and I was there for ¾ of the first bag. When I walked into the room, she was the color of the sheets. By the time I left 2 hours later, she had some color in her cheeks and already felt much better. After both bags, she felt like a new woman. 

Walking in, there was a sono machine and tech next to Beth’s bed. She was getting a heart ultrasound to make sure there were no misfirings that caused her fainting. I yacked with Beth as we watched and listened to her heartbeat on the monitor. 

After the really long sono, she had to go to the bathroom and was doing that at a bedside toilet. She’d gotten up twice to sit on the toilet, always with someone present, and didn’t faint sitting up for a couple of minutes each time. 

While the sono tech was still there, another woman came in and stood to the side. She was a Physician’s Assistant (PA) for the cardiologist who ordered the ultrasound. I asked her to please wait until Beth went to the bathroom and she stepped out. 

Sitting the bed up a little, Beth slid out of the bed and sat on the toilet, peeing tons (the heck if she was going to get swollen from those IVs!). While she was on the toilet, I straightened her wrinkly, unruly sheets and blankets, including the ever-present Nemo towel. I needed more Chux and the PA brought me giant diapers instead, I putting her back in bed, tucking the Chux under her once they delivered them. 

I was only there two hours and 100 annoying things occurred. The sono tech dislodged Beth’s IV and I had to grab the nurse to fix it, but not before blood gooshed all over the blankets and sheets. The bed across from her was empty, but the phone rang as the person on the other end looked for the former occupant. A nurse asked her what she could do for her and when Beth asked for grape juice, the nurse said they didn’t have any… “We have apple juice…” “Um, they’ve been bringing me grape juice all morning.” A nurse’s tech went to get some for her and I followed with her pitcher to get her some ice and even more juice. The tech returned with two grape juices and a small cup of ice. I trumped him with two more juices and the pitcher of ice. Ha! She’d explained she needed a soft diet, but no one put that in to food services. I don’t know if it finally happened, but L was bringing in soft food for Beth to chew. A nurse came in to take vitals. 

And then the PA came in during the cacophony of medical visitors. She asked 100 questions about Beth’s medical history and then when we got to the part about her fainting, she asked me what it looked like. I told her how she fell (groan) and how she had those typical jerky movements of someone who faints. Her ears perked up and she said, “Like seizures?” Um… not really, but you could say it looked a little like that. She bit on that concept like a pit bull on a beef bone. I repeated that it wasn’t a seizure, per se and finally settled on the word “twitching.” She matter-of-factly said, “We’re going to move you up to the cardiac floor so we can put a heart monitor on you until you leave and then we’ll send you home with a holter monitor that you’ll wear for twenty days and then come back so we can determine if your heart was the reason for fainting. Beth kind of sat there for a second and I said, way too loud, “Um… how do you FEEL about that Beth?” and she said, “I think it’s stupid.” (I think she really said, “I think that’s overkill,” but she really meant the stupid comment.) The PA was taken aback. In her gentle way, Beth refused the visit to the Cardiologist and even the move up to the Cardiology wing. The PA wished her well and left. Beth and I laughed our heads off about that until her (new) nurse came cheerfully in saying, “Okay! We’re going to move you now up to Cardiology…” and Beth said, “I’m not going.” The nurse was totally taken aback and a back and forth, “But you have to,” “But I don’t want to” went between the two. The nurse saying, “We need the bed” as if that was going to convince her. Beth pointed to the empty bed across the room and said, “They can have that one.” I said, “Maybe you want to talk to the Nursing Supervisor?” and the nurse kind of huffed out. Again, we laughed, but were a bit peeved that she ignored the supervisor comment. About 15 minutes later, she came in and said the Nursing Supervisor said she didn’t have to move. Beth said, “I wasn’t going.” 

During all of this we talked about all the meds she was on and I chuckled saying she’s probably taken more meds in the last two days than she has combined in the last 15 years! She said that was surely the truth. She also had a running list of firsts for her: fainting, blood transfusion, IV antibiotics and more. 

During the day, she finally stood and walked, walking around the whole floor before she left. About 7pm last night, 36 hours after entering the hospital, Beth was released, but only after Dr. G called the Cardiologist who wasn’t going to release her because she was being non-compliant! He finally did and she left, going to L and R’s house again to recuperate and be taken care of. I got the greatest text that said, “I‘m gonna make you proud at how much nothing I will be doing.” 

So, amidst all this drama and trauma, we’d barely touched the issue of losing the baby. Every once in awhile I would ask how she was doing and she would always say, “Okay.” Last night, I texted her that as things got quieter, she would probably find herself feeling more and to let the emotions wash over her, for the miscarriage and the hospital stay… and reminded her that women who hemorrhage have a tendency to be sadder than usual as the hormones of un-pregnancy find their balance. She said she would be gentle on herself and would call me anytime she needed to talk. 

I’m glad she’s resting and being lovingly taken care of… she deserves it at this challenging time. 

Twice during the experience, I was told, “You saved her.” I didn’t really think about that, but if I did, I’m glad and also know it is all a part of my calling as a midwife. It didn’t feel heroic, but apparently it was a really good thing, my going to help and getting her more help. I’m just glad my friend is still here.



After I wrote “Hiatus,” I really delved into why it’s fairly easy for me to yack and share my thoughts in Facebook, but it had become so hard to do here. What I came up with was interesting. 

In Facebook, I feel like I’m mingling at a party, moving from person to person or even group to group (depending on how many people are participating), talking informally to each one. Not being more important than anyone else, each person’s opinion heard and validated. I can be humorous, snarky, sympathetic and respectful there in a way that mimics me in real life. 

However, here on the blog, I feel like I’m standing behind a podium, speaking to an audience and what I say better be earth-shattering… or at least good. That feeling has gotten uncomfortable and I’ve felt stilted and stifled in sharing who I am, the original purpose of the blog. 

So, I’ve decided to go back to the reason I started writing in the first place… to share ideas, to discuss them and to have a good time with my writing. I’m going to write more like Facebook and hope others will participate like the women do over in that corner of the Net. 

We’ll see if the mental removal of the dais helps the words flow better.


What a Doula Said

On my Facebook Page, I dropped a link to this piece, “Journal Article Review – Bipedalism and Parturition: An Evolutionary Imperative for Cesarean Delivery?”, an article about (just what it says) walking around on two legs and does that fact make it more likely that we’d eventually need to deliver our babies (at least more of them) by cesarean section. It’s an awesome piece and the comments have, for the most part, been great… Creationists aside. Well, their comments are interesting. Hard to believe people still think like this, but who am I to poo poo another person’s religion. 


Along the thread comes this doula who says, and I quote verbatim: 

This is the most insidious article I have ever read and it figures that it was written by a man with a penis who will never experience childbirth. Fact: only 3% of women in the US actually need a Ceasarean due to try complications. In most cases they are performed out of laziness and impatience on the hospitals and docs part. And insurance companies, lest we not forget those bureaucratic jackasses.” 

I couldn’t help laughing outloud, but what I wrote was: 

Where did you come up with only 3% of women need a cesarean? I have NEVER seen that number in 30 years of birth work. Source, please.” 

And this was her answer, again quoted verbatim: 

I got the stat in an article I just read, I will find it and repost. In my experience with my clients he need for C/S deliveries is 0 with home births and about 2% for hospital deliveries. The procedure has skyrocketed unneccisarliy.” 

My short answer to that was: 

So, <Doula’s Name>, how many births have you been to? 4? Talk to me when you've been to the 900 or so I have, then we'll see what "your" cesarean rate is. 

You have a LOT to learn, young lady. Your arrogance is going to bite you in the ass and I hope you will then learn some humility. 

And quoting ONE FREAKIN' ARTICLE that said the c/s rate shouldn't be above 3% is the height of gullibility. Do you not know discernment? It scares me there are doulas like you out there.” 

What is this doula teaching her clients? What is she saying to women all around her? Spouting off her amazing statistics without so much as any qualification of how she got to that number. 

I started thinking, “How could I get a 0% c/s rate at home and a 2% for hospital births?” 

  • I could have only attended 5 births.
  • I could take only clients that have had babies born vaginally before and are truly low-risk in this pregnancy.
  • I could lie about my statistics. 

There are so many parts to her comments that annoy me, it’s hard to just pick out a couple. But, I’ll try. 

  • If we are to believe she’s been to at least 100-200 births to even get a somewhat valid number, “her” 2% hospital birth cesarean rate is incredible considering the cesarean rate in hospitals. Is she so magical that when she is there her clients miraculously avoid the operating room? If she is that magical, she should be teaching courses all over the world so the rest of us can know her secrets. 
  • If you throw out the word “Fact,” you better have a buttload more than one article to point to and, at the very least, one you can put your finger on at a second’s notice. That she even had to look for it stuns me. 

Note to doulas and other birth workers: Just because you want it so badly you can taste it, doesn’t make it so. If you repeat crap others say, even others who proclaim they are (or who are heralded as) experts in birth, you best be able to back up your beliefs. Sure, statistics can be skewed, but looking deeply into anything touted as real and true will probably give you a much clearer picture of what you’re talking about. 

No one… NO ONE… in this community has The Answer. If she did, it would be headline news.



It seems a few of us are watching Disney’s version of the Rapunzel story, Tangled, and one of my birthy friends chuckled about the Queen’s life being saved by herbs. Well, it’s not quite as simple as Disney makes the story out to be. Having loved the Rapunzel story as a kid and teen, I leapt at the chance to put a midwifery spin on the very old Grimm Fairy Tale. I’ll share it with you, too. 

Once upon a time, there was an old couple who ached to have a baby, but the woman couldn’t keep a pregnancy and despaired of ever having a child. When she miraculously got pregnant, she wanted to do everything in her power to keep the pregnancy growing so she could have the much-desired baby. 

Now, this was the olden days where, in many places (if not most), pregnancy was a challenge even with those that had money and means. For the poor, pregnancy all too often meant death, so all sorts of Old Wives’ Tales and superstitions came about and one of the most common was that when a pregnant woman craved something, she was to be indulged, no matter the cost. It wasn’t unheard of for complete strangers to give a wandering pregnant woman their best meat or a glass of cherished wine; anything to help the baby inside come to fruition. In some cultures, it was even okay to steal food if the pregnant woman testified it was for her, no charges brought against the offender. 

It’s in this setting that the older pregnant woman began having cravings, specifically, cravings for the rapunzel plant, a very leafy green, spinach-like plant. Her cravings, unmet, made her very ill. Was she anemic? Did she need the iron in the rapunzel plant? 

The distraught husband tried to find his wife’s desire, but no one could grow any in their gardens, nor knew where to find it. But, there was that farm next door and that amazing gardener, Gothel… and lo and behold, she had the rapunzel plants growing like weeds just over the fence from the old couple. When the pregnant woman spied it, she begged her husband to please get her the leaves. Gothel was a total bitch, er… witch… and the husband despaired, knowing the crotchety gardener wouldn’t ever share anything, even for a pregnant woman.

Therefore, the husband knew what he had to do. He had to sneak over the fence and grab the rapunzel leaves for his wife. Dangerous? You bet, but if he didn’t, the baby… and mother… were surely going to die. 

When there was no moon, the old man snuck across the fence and grabbed a few leaves for his wife. Upon eating even those few, she grew much stronger. (Ah, it was anemia!) But, any time she didn’t have rapunzel leaves at a meal, she grew weak again, so her man had to keep sneaking over the fence for his wife and child. He did great… until the full moon. 

As he crossed the fence on that fateful night, Gothel grabbed him and demanded to know why he was stealing from her precious garden. When he explained the dire need of the rapunzel leaves for his wife, Gothel seemed to soften a bit. Wondering why he didn’t just go ask in the first place, the husband let his guard down as the witch cheerily said he could have all he wanted. She would put it in baskets for him so he wouldn’t have to sneak at night anymore. He was so relieved! 

Then, Gothel struck her bargain. 

Yes, the woman would be able to save herself and her child with the plant, but the baby would have to be given to Gothel in exchange. Certainly, because the baby was a nebulous unknown and his wife was a living, breathing being to him, the husband/father-to-be thought for merely a moment before agreeing to the deal. He probably should have consulted with his wife, but she was busy gestating and eating salad. 

True to her word, Gothel supplied the couple with copious baskets of rapunzel and the wife was ecstatic, thinking the neighbor wasn’t a crazy old loon like they’d thought she was. Scared, her husband neglected to explain why so much lettuce was being foisted over the fence. 

(We can imagine) The baby’s birth was awesome! The midwife was extremely educated and had tons of experience, had a long line of three generations alive and well before she came to the old woman’s bedside to help the baby be born. The elderly primip, pumped up to the gills with iron and love, was the picture of health during labor and didn’t even tear a tiny bit when the beautiful baby girl was born. 

As the mom reached down to pull her new baby to her breast, Gothel appeared and demanded payment for all that rapunzel. Horrified, the mother screamed… the new father begged Gothel to reconsider… he now saw his daughter as real, not so ethereal anymore. Gothel, the bitch that she was, snatched the newborn away from the midwife and took her back to her farm. 

I can imagine the mom had a helacious case of postpartum depression over this and probably demanded a divorce, but we never hear from them again in the story, so I’m kind of at a loss as to find a happy ending for them. 

Gothel, on the other hand, loved being a mother. She doted on the baby, then toddler, then child, flaunting her in the garden, within clear eyesight of her parents. Year after year passed and the baby, now named Rapunzel (after the plant that kept her alive, of course), was the most beautiful girl in the entire world and she had amazingly gorgeous blonde hair that grew and grew and grew. 

Rapunzel had another talent besides growing hair; she could sing like a bird! All day and night, the child sang so beautifully, all who heard her marveled at its beauty. 

Knowing that Rapunzel would one day want to leave her, Gothel couldn’t abide by that and built a tower with no doors and one window, building it around Rapunzel when she was 12 years old. Menarche. (What did the tower represent? A phallus, surely. So it seems Gothel’s goal was to seclude Rapunzel from all phalluses except for the one she built for her child.) 

Rapunzel had amazingly long hair, so when Gothel came to her each day, she would cry up to the girl: 

“Rapunzel, Rapunzel, let down your hair, so that I may climb the golden stair.” 

 And the girl would first toss her hair up onto a hook and then let it down to the ground far below. Gothel would wrap the hair like a sling, step into it and Rapunzel would hike her up, bringing her into the only entrance into the tower. 

Stuck inside the tower, Rapunzel’s main entertainment was her own singing. She sang all the time, the animals enthralled with the beautiful melodies. 

Then, when she was 16-years old, singing her heart out, a Prince road near and heard the amazing songs. He sat near the tower, imagining the beautiful girl whose voice moved him to tears. Each day, he came to listen to Rapunzel sing, not seeing a way into the tower to witness her performances. 

One day, however, he got there early enough and watched as Gothel called out, 

“Rapunzel, Rapunzel, let down your hair, so that I may climb the golden stair.” 

Rapunzel’s hair fell to the ground and the old woman was lifted into the tower. “Aha!” thought the Prince. He now knew how to get in to see the singing beauty. 

He watched for a number of days and saw that Gothel only came in the morning and left before dark, so one night, right after the sun set, the Prince went to the tower and cried out,

“Rapunzel, Rapunzel, let down your hair, so that I may climb the golden stair!” 

On cue, the hair unfolded down to the ground. The Prince followed what Gothel had done and was soon aloft, getting closer to the woman he surely loved. 

After Rapunzel got over the initial shock of having company, she quickly fell in love with the Prince, singing for him as often as he asked her. 

During his nightly visits, they also began having sex as their hormones were a’raging, both being 16 and all. The planned Rapunzel’s escape and each night, the Prince would bring a swath of silk for his love to braid into a ladder for her to flee from her captor. Rapunzel was very careful to hide the silken rope so Gothel would not see it. However, instead of finding it, during one absent-minded day, Rapunzel asked the witch, “Why is it you weigh so much more than the Prince when he comes at night?” Oh, no! She gave away her secret! 

The crazy-with-anger Gothel tied up Rapunzel until that night when the Prince came. The witch used  the flowing hair to lift the Prince and when he made it just inside the window, the witch immediately, with great force, threw him back out, his landing face-first into the thorny bushes below, blinding him, thereby forbidding his ever seeing his beloved Rapunzel again. 

The young girl wasn’t out of the woods herself. The witch was livid, so banished Rapunzel into the wilderness. What the old woman didn’t know was Rapunzel was already pregnant, with twins, and as she wandered, her belly grew and grew. Still singing, she gave birth to her babies (an unassisted birth, apparently) and wandered in the deserted land with her son and daughter. 

When the Prince was blinded, he could no longer find his way home, so he, too, wandered all over the land, unable to find anyone to help him. Then, one day, he heard his precious Rapunzel’s singing voice and followed it from whence it came.

When they were reunited, it was a glorious day! The Prince felt his lover up and marveled that he had two children. Rapunzel was so sorry she’d put the Prince into the situation where he was blinded that, embracing him, she cried sad tears of intense love and begging for forgiveness. As the tears fell into the Prince’s eyes, they were so pure, his eyesight was restored. 

The Prince could then find his way home and the Kingdom rejoiced their Prince had come home… and with a wife and kids to boot. 

And they lived happily ever after, especially knowing that Gothel, stuck in the tower without Rapunzel’s hair, was going to die a lonely and miserable death.

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