Globe and Mail ~ June 19, 2009

C-section not best option for breech birth

The Society of Obstetricians and Gynecologists of Canada will launch program to teach physicians breech vaginal delivery

Carla Wintersgill

Friday, Jun. 19, 2009

Physicians should no longer automatically opt to perform a cesarean section in the case of a breech birth, according to new guidelines by the Society of Obstetricians and Gynecologists of Canada.

Released yesterday, the guidelines are a response to new evidence that shows many women are safely able to vaginally deliver babies who enter the birth canal with the buttocks or feet first. Normally, the infant descends head first.

“Our primary purpose is to offer choice to women,” said André Lalonde, executive vice-president of the SOGC.

“More women are feeling disappointed when there is no one who is trained to assist in breech vaginal delivery,” he adds.

Since 2000, C-sections have been the preferred method of delivery in breech births. Studies suggested that breached births were associated with an increased rate of complication when performed vaginally.

As a result, many medical schools have stopped training their physicians in breech vaginal delivery.

The problem now, according to Dr. Lalonde, is that there is a serious shortage of doctors to teach and perform these deliveries.

With the release of the new guidelines, the SOGC will launch a nationwide training program to ensure that doctors will be adequately prepared to offer vaginal breech births .

The new approach was prompted by a reassessment of earlier trials. It now appears that there is no difference in complication rates between vaginal and cesarean section deliveries in the case of breech births.

News of the change is a boon for the Ottawa-based Coalition for Breech Birth.

“We're really, really pleased,” said Robin Guy, co-founder of the coalition.

Ms. Guy started the group after the birth of her second child in the fall of 2006. Although she had given birth to her first child at home with a midwife, Ms. Guy delivered her daughter in the hospital because of the baby's breech position.

“I was cornered into an unneeded and unwanted C-section because the obstetrician that I had didn't have the experience to catch her,” said Ms. Guy.

The aim of the coalition is to ensure that women know what their options are when it comes to breech birth. Ms. Guy believes that many women don't realize that vaginal breech births are even possible.

“Educating women is our primary goal because it takes more than just a guideline change,” she said.

The SOGC stresses that because of complications that may arise, many breech deliveries will still require a cesarean section.

Breech presentations occur in 3-4 per cent of pregnant women who reach term. That translates to approximately 11,000 to 14,500 breech deliveries a year in Canada.

The new decision to offer vaginal breech birth aligns with the SOGC promotion of normal childbirth – spontaneous labour, followed by a delivery that is not assisted by forceps, vacuum or cesarean section. In December of 2008, the society release a policy statement that included its recommendation for a development of national practice guidelines on normal childbirth.

“The safest way to deliver has always been the natural way,” said Dr. Lalonde.

“Vaginal birth is the preferred method of having a baby because a C-section in itself has complications.”

Cesarean sections, in which incisions are made through a mother's abdomen and uterus to deliver the baby, can lead to increased chance of bleeding and infections and can cause further complications for pregnancies later on.

“There's the idea out there in the public sometimes that having a C-section today with modern anesthesia and modern hospitals is as safe as having a normal childbirth, but we don't think so,” said Dr. Lalonde.

“It is the general principle in medicine to not make having a cesarean section trivial.”

The SOGC believes that if a woman is well-prepared during pregnancy, she has the innate ability to deliver vaginally.

The national average for babies delivered via cesarean section in Canada is 25 per cent.

Film Night ~ A Must See for Every Parent to Be

Yukoners for Funded Midwifery
invites you to a special showing of
Ricki Lake's film

The Business of Being Born
Saturday, October 18, 2008
7 pm @ Alpine Bakery
(Admission by Donation)

A must see for every parent to be.
You will never look at giving birth the same way.

Hosted by Yukoners for Funded Midwifery
Sponsored by Alpine Bakery, Due North Delivery, and Copy Copy

Los Angeles Times ~ July 9, 2008

Big Medicine's blowback on home births

Why do U.S. doctors strong-arm women into our standard maternity care system?

By Jennifer Block
July 9, 2008

You'd think the healthcare establishment would have bigger fish to fry than Ricki Lake. (The 47 million uninsured, maybe?) But Lake's recent documentary, "The Business of Being Born," which includes footage of her own delivery of her second child at home, was on the agenda at the American Medical Assn.'s annual meeting in mid-June. Lake was personally name-checked in a "Resolution on Home Deliveries" introduced by the American College of Obstetricians and Gynecologists: "Whereas, there has been much attention in the media by celebrities having home deliveries, with recent 'Today Show' headings such as 'Ricki Lake takes on baby birthing industry.' " The AMA ultimately passed the resolution without the Lake citation, but not before the Hollywood media got wind of it and, overnight, home birth was thrust into the mainstream light.

It's about time.

Last year I flew to Britain to be with a good friend for the birth of her first child. She's American but married into Britain's National Health Service, lucky duck. The differences in the prenatal care she got there were striking. First and foremost, she never saw a doctor. As a healthy woman with a normal pregnancy, she saw midwives. And one of their first questions to her was, "So, would you like to give birth in the hospital maternity ward or at home?"

Planning a home birth with a midwife may sound old-fashioned -- maybe you think it sounds crazy -- but a solid body of research shows that for healthy women who seek a normal, nonsurgical birth, there are several benefits. At home, a woman can get one-on-one care and monitoring from a midwife trained to support the normal labor process. The mother-to-be is free to move about, eat and drink, sit in a birth tub -- Britain's national health guidelines call water the safest, most effective form of pain relief. A woman will be helped to give birth in positions that are effective and protective: sitting, squatting, on hands and knees, even standing.

The physiological birth process is automatic: hormones fire, the cervix gradually opens, the uterus contracts, the baby descends, muscles engage. An optimal birth, one in which mother and child emerge as healthy as can be, is one that begins spontaneously, progresses on its own and concludes with the least amount of intervention necessary.

But hospital maternity care in the U.S. is typically not supportive of this process. More than half of women are induced into labor, or it is sped up with artificial hormones; the vast majority of women labor and push in the desultory flat-on-the-back or leaning-back position; and (perhaps not surprisingly) nearly one-third of women end up giving birth through major surgery, the caesarean section.

This has led to an epidemic of pre-term births in the United States. A 2006 survey showed that the majority of babies are now born before the spontaneous onset of labor, which leaves them more prone to breathing and feeding difficulties. Caesareans are also contributing to a rising maternal death rate, announced by the Centers for Disease Control and Prevention last year.

Which is why some women, such as those in the film Lake produced, choose to give birth somewhere other than a hospital. Their choice is backed by sound science. Studies of "low-risk" women in North America planning out-of-hospital births with midwives have found that 95% give birth vaginally with hardly any medical intervention. The largest and most rigorous study to date, published in the British Medical Journal, found that in North America, babies were born at home just as safely as in the hospital.

Organized medicine can't believe this. Dismissing the research evidence, the AMA resolution states that "the safest setting for labor, delivery and the immediate postpartum period is in the hospital" or an accredited birth center. In its own statement earlier this year, the American College of Ob/Gyns went even further, implying that women who choose home birth are selfish and irresponsible: "choosing to deliver a baby at home ... is to place the process of giving birth over the goal of having a healthy baby."

Compare that to this information in Britain's NHS-issued handout my friend was given at her first prenatal appointment: "There is no evidence to support the common assertion that home birth is a less safe option for women experiencing uncomplicated pregnancies." In a joint statement last year, the Royal College of Obstetricians and Gynecologists and the Royal College of Midwives said, "There is no reason why home birth should not be offered to women at low risk of complications, and it may confer considerable benefits for them and their families."

The AMA's statement calls for legislation that could be used against women who choose home birth, possibly resulting in criminal child-abuse or neglect charges. The group says this is about safety, but with no credible research to back up its claim, this argument falls flat. Women are simply caught in a turf war over the maternity market, and it would appear that the physicians' groups are perfectly willing to trample the modern medical ethic of patient autonomy -- grounded in our legal rights to self-determination, to liberty and to privacy -- in their grab for control.

If these groups were truly making maternal and child health a priority, they'd be reforming standard maternity care, not strong-arming women into it.

Jennifer Block is the author of "Pushed: The Painful Truth About Childbirth and Modern Maternity Care."

Midwifery Update

This update is long overdue, as I have been extremely busy with a new baby and a new business. You can read Eowyn's birth story (at home with midwife Christina) in the previous post. My husband and I have started Due North Delivery, a baby and maternity store that offers customers 5% of their purchases as a credit towards doula and midwifery services. We decided to start this business in large part because the government has been slow in funding midwifery services in the Yukon. You can access the store at www.duenorthdelivery.com

The last midwifery working group was held in June, at which time a new policy analyst from Health and Social Services was introduced. I have not yet received any reports or documentation from our meetings, although Health and Social Services should be preparing a document.

I personally feel that Yukoners for Funded Midwifery is at a bit of a crossroads. Having been through the working group meetings and discussing the idea of regulation at length with the midwives, government personnel, medical workers, and other consumers, I do not believe it is in the best interests of women who wish to use midwifery services in the Yukon for midwifery to be regulated. This is mostly because regulation of midwifery in Canada has a history of limiting women's choices surrounding birth with a midwife, which in many cases is contrary to the safety and well-being of the woman and/or her child. However, I would like to see midwifery services become a more accessible choice for women in the Yukon through funding and for midwives to have status at the hospital to better meet the needs of women who either choose a hospital birth or require transport to the hospital.

The government has said repeatedly that the only way to funding is through regulation, but I am wondering if perhaps we should challenge this. What I would ideally like to see is a government program of reimbursement, where the women who receive midwifery services are reimbursed for their bill, rather than the government dealing with the midwives. Does anyone know of any program that would set a precedent for this? I would like to propose to the government that they have a list of midwives (which right now would be the two practicing midwives in the Yukon, Christina and Heather) whose services they will reimburse women for. The Canadian Midwifery Regulators Consortium has a standardized Canadian Midwifery Registration Examination, and the government of the Yukon could require midwives who would like to be on the list to pass this examination. The hospital could establish a set of guidelines or protocol for the interactions between midwives, doctors, nurses, and hospital staff when a midwife is attending a woman at the hospital. Does this seem really outside the realm of possibility? I've always liked to dream big! If you think this would best serve the needs and enable the choices of women in the Yukon please email me back! And come to a meeting! The government takes action in response to what we, the consumers, want and the more the better. We need to figure out a way to really get our voices heard and get the message through that this is what we want. We can discuss ideas at the next meeting.

The next meeting will be on August 26 at 7pm at my house, 17 Redwood St. in Porter Creek. Please feel free to email me at info at yffm dot ca or call me at 456-7711 for directions. We need to hear your voice!

Eowyn's Birth Story

This is Eowyn's birth story, submitted by Asheya Hennessey, the founder of Yukoner's for Funded Midwifery. It's long and detailed!

I am writing Eowyn’s birth story on April 2, 2008, and she is right here with me sleeping in the sling. Eowyn’s birth story starts with the choices I made about my prenatal care and where I wanted to give birth. I chose to have a home birth with a midwife as my health care professional, Christina Kaiser.

I had mildly painful contractions on Wednesday night, and during the morning on Thursday, March 20. I let Eric know. At about 11 am I started nursing Elias, as he had hurt himself and needed comforting. While he was breastfeeding I had some more strongly painful contractions, but they were manageable lying down, and I decided to let him continue nursing. He nursed for about twenty to thirty minutes. As soon as I stood up from nursing him I felt a gush, and went straight to the bathroom. There on my underwear was a huge blob of bloody something, and I had a lot of blood that was going into the toilet. I felt calm but excited – this was definitely happening! I called out to Eric, who was working from home, “I think my water broke!” He came in to look, and of course Elias was there too. Eric brought me the phone and I called Christina. I didn’t remember what my mucus plug had looked like with Elias, but I thought this was rather bloody. When I told her that the blood was bright red, she told me she would be there in an hour, and that I should feel for the baby moving and watch for any gushes of bright red blood. If the baby moved I should call her, and if I started bleeding I should call her. At this point I could blot up blood on the toilet paper, but I wasn’t actually bleeding into the toilet.

I spent an anxious twenty minutes lying on the couch waiting for the baby to move. Finally, I felt something! Just a gentle movement low in my belly, but definitely a movement. I called Christina, and a few moments later felt a little more activity. Having felt the baby move helped me to be calm while I waited for Christina to arrive. I felt anxious about the blood, but knew Christina was on her way.

By the time Christina arrived the fluid I could wipe on toilet paper was pink, not red. I had saved the bloody blob in a jar, and Christina confirmed that it was my mucus plug. She said it was the bloodiest mucus plug she had ever seen. There was a lot of blood in the toilet, but I was not still actively bleeding, and Christina’s presence helped me to feel reassured. She also confirmed that my water had broken, and smelled the fluid on a pad, telling me it had a somewhat sweet smell. I couldn’t smell it, really, but I was glad she could. At this point I was having some mild contractions, which I couldn’t feel at all unless I was lying down. Christina stayed for about an hour, asking questions, taking my blood pressure, listening to the baby’s heartbeat, and giving instructions and information. She also brought in all of her equipment for the home birth and showed us what was in her kit, which included all of her emergency supplies (such as pitocin and oxygen masks for mom and baby) as well as basics for the birth (such as sterile scissors and clamps for the cord).

I remember when she asked me how I felt, I told her that I felt pretty normal, which I thought was strange since my water had broken. She told us that after the water breaks labour usually starts within 24 hours, but it can be as long as three days. She said I should only dab, not wipe, when I went to the bathroom, to try to keep as sterile an environment around my vagina as possible, to prevent infection.

I called my mom to let her know that my water had broken and that labour could start anytime, since she would be coming over to look after Elias during the labour and birth. She dropped by later in the afternoon with some more sheets from the Thrift Store and some grocery items, such as green grapes. She also brought me a dozen red tulips, which were absolutely gorgeous! I kept in touch with Christina by phone, and let her know that nothing had changed.

All day Thursday I tried to rest and eat as much as I could, since I knew I would need energy for the birth. The contractions were still mild, but even though I didn’t feel much pain I still felt a little worn out from them. What does that song say? “Waiting is the hardest part.” At one point on Thursday evening I remember I was lying down, trying to rest, and I just felt so lost. Birth is an uncontrollable event, and I didn’t know what was going to happen when. We went for a walk as a family at about 9:30pm, and I hoped that this might help speed up contractions and get things going. In fact, the opposite happened! My contractions slowed down to about every 10 minutes. My sister Emily came over and brought the movie “Enchanted,” which she had just bought and which I hadn’t seen yet. I sat on the birthing ball, and we only watched part of the movie as we were all getting tired. I went to bed at around 11:30 pm, and woke up every half hour to an hour to go the bathroom. I could feel the contractions, but was able to get back to sleep.

At 3 am on what was now the morning of Friday, March 21, I woke up with contractions that were more intense and I knew I couldn’t sleep through. I got up, had a bowel movement, poured myself a big glass of apple juice, got a bowl of chocolate chip mint ice cream, and went downstairs to see if I could watch some of a movie. I turned on the little white Christmas lights that we had set up in the rec room, and put the tulips on top of the dryer. I watched all of 30 seconds of “Enchanted” and realized that it was only making things worse. I decided to wake up Eric, since I wanted some company. I went back upstairs, and at this point had to stop and breathe through contractions while I was leaning against the wall. I woke Eric up around 3:30 am, and called Christina to ask her to come around 3:45 am. At this point my contractions were about 3 minutes apart, lasting about 45 seconds, and I had to stop and breathe through them.

Eric put the plastic on the futon, and made the bed with the sheets I had bought at the thrift store. When I had a contraction he would stop and put his hand on my shoulder. With the presence of his hand on my shoulder I would feel myself relax. I tried to sit on the birthing ball, but it wasn’t working for me the way it had with Elias’ birth, probably because my water had broken so there was more pressure. Eric started pumping up the birthing pool (an inflatable kiddie pool from Canadian Tire!).

Christina arrived around 4:15 am. I was managing a lot of my contractions by leaning against the washing machine, making low moaning noises, and trying to breathe deeply and relax. I would also move my hips and bend my knees during a contraction. Christina started helping to pump up the tub. *** Stopped writing and am now starting again on June 22, 2008. I am referring to Christina’s record of events now as well as my own memory as I write this.*** Either Eric or Christina would pause what they were doing to come over to me during a contraction, and lay a hand on my shoulder. I was trying to notice when the baby moved, as Christina had told me that movement is an indicator that the baby is doing well, and if the baby is moving there is no need to check for a heartbeat. I hadn’t paid any attention to movement during my first labour, but now that I was trying to feel it I definitely noticed when the baby moved. The baby moved before Christina arrived, and I let her know. I felt the baby move again at 4:53 am.

I had been feeling like throwing up since eating that chocolate chip mint ice cream, and at 4:55 I threw up. I never throw up, so this was an uncommon and unpleasant experience for me. I threw up until I was dry heaving; luckily Christina had brought a bucket out from the bathroom and it was on the floor at my feet. I had been leaning on Christina with my arms around her neck during a contraction when I started throwing up, and she brought the bucket up to me. Then we went over the sink in the bathroom. At some point after this I asked Christina how far along she thought I was. I didn’t want an internal, and she didn’t want to give me false information based on her guesses of how far along I was, so at that time she didn’t tell me. Later she said that many women throw up as they are entering transition, and that I was probably about 8cm dilated at that time. But, some women throw up at 3cm, 5 cm, and 8 cm, so the throwing up was not necessarily a sure indicator.

My contractions were getting pretty intense at this point. It was sometime after this that I remember thinking, “Why did I think this was going to be so great?” I had been so excited about having a home birth, and I knew it was going to still be painful, but time erases the memory of the pain I had felt during Elias’ birth. I just wanted to lie down and go to sleep. I knew lying down would only make things worse, but I decided to try it anyway. I lay down on the futon in between contractions, and instead of trying to get up as a contraction was starting I just stayed there. That one really hurt! I didn’t stay lying down during a contraction again, although I would lie down between and then get up so I could cope with the pain during the contraction.

I drank quite a bit of water and apple juice while I was in labour, and I tried to eat some grapes. Christina had thoughtfully bought me some frozen grapes (I really liked eating frozen things during the pregnancy!). At 5:23 am I went pee on the toilet. Sitting on the toilet during contractions has never worked for me, so I didn’t stay there but got back up and went back to leaning on the washing machine. I really appreciated having the tulips there that my mom had brought; they helped to remind me of beauty in the midst of my pain.

I started to feel a bit like pushing soon after this, around 5:30 am. Christina asked me if I felt “pushy at the peak,” which is a good way to describe it. I didn’t feel like pushing during the whole contraction, but I had the urge to bear down in the middle of the contraction. I followed my body and just did what felt right. I started to really, really want to get in the tub, and if the tub wasn’t ready I wanted to get into the shower.

There had been some difficulty in hooking the hose up to the faucet in the sink in the bathroom, which I didn’t pay attention to, but Christina and Eric had both been busy trying to get the tub filled with water. One of them would always come back to me during a contraction, and I would instantly feel more relaxed as soon as I felt a hand on my shoulder.

I asked Eric to call my mom and ask her to come, as things were getting pretty intense and if Elias woke up I wanted her to be there to look after him.

At 5:35 I got into the tub, and it was instant, warm relief! Of course not all the pain was taken away, but that first minute was intensely soothing. I thought I felt the baby move at around 5:36, but I couldn’t be sure. At 5:46 Christina asked if she could listen for the heartbeat, and used the fetoscope. She heard the heartbeat and it was around 120bpm – 130bpm, totally normal. At this point I was starting to really feel more like pushing, and there was a lot of pressure. I was hoping the bath would help to take the pressure away, but being in the tub during labour is not the same as relaxing in the tub when you’re not in labour! At one point I said, “It hurts,” and whimpered a bit. Christina said, “You’re doing so well.” Christina asked me if the contractions still hurt in front, and by 6:00 am they didn’t and I was fully pushing. Again, I just followed my body and did what felt right, without outside direction. I tried different positions in the tub, like kneeling and squatting. I was trying to find a position that would take advantage of the buoyancy of the water and help relieve the pressure. Christina suggested I lean back against the tub and squat, and this ended up being a good position for me.

I started wondering where my mom was, and asked Eric to call her again, which he did. She said she was just leaving the house.

Elias woke up sometime around 6:00 am, and Eric went upstairs to attend to him. We had the monitor on. Eric came back down and said Elias was back in bed. I told Eric to go get him, as I thought we were getting pretty close the baby being born. Elias came down, and was quite enchanted by the fish on the tub! Soon after this my mom arrived, and started talking to Elias. I asked them both to be quiet – I didn’t want any noise interrupting my concentration on coping with pushing.

To cope with the pushing contractions I vocalized strongly, in a higher pitch than when I was having dilating contractions. In between I would rest and ask for water to drink. Eric was in the tub with me at this point.

I put my hands down near my vagina so I could feel if the baby’s head came out. I felt the baby’s head, and then it went back in. Eric asked if he could touch the head, but I said no, since there was no head there to touch. With a few more pushes the baby’s head came again, and I told Eric he could feel it.

At 6:22 am I had a contraction and pushed and could feel the baby’s head coming out! Christina advised me to slow down, so I tried to hold back on the pushing so I wouldn’t tear, although it was very hard and I just wanted the baby out! I didn’t know if I had slowed down or not, as the baby’s body was born into Eric’s hands! He scooped the baby up out of the water and placed her on my chest. I felt pure joy, a moment of pure emotion, and I started crying as I looked at my sweet, beautiful baby! In that moment I was totally in the moment, totally myself, fully vulnerable and overcome with intense feelings of joy, delight, and relief.

A few moments later we looked and found out that we had a girl, a daughter! She was so peaceful, and just lay on my chest. I thought she was breathing, but she wasn’t crying, so I asked Christina just to be sure. Christina reassured me that our girl was fine. She let out a few little cries a couple of minutes after she was born. Eric was so happy too, and we both talked sweetly to our precious new daughter.

I invited Elias over to touch her, and he was very gentle with his new baby sister. I wanted a few photos of her when she was first born, so Christina and my mom took a few pictures. About twenty minutes after she was born, Eowyn started leaning toward my left side. I made sure my breast was out of the water, and supported her neck. She found my nipple, latched on, and started nursing!

Very soon after she started nursing (about three minutes) the placenta was born. I had wanted to stay in the water until the placenta was born. Christina told me she would like me to get out of the water soon so that she could see how much I was bleeding, so at 6:48 I got out of the tub, with Eowyn still nursing and still attached by the umbilical cord to the birthed placenta, which we put into a bucket. I went over to the futon and lay down on my side, with Eowyn still nursing. We snuggled in bed as a family for a bit, and Elias got to kiss and hug his new baby sister! Then my mom took Elias upstairs to get him some breakfast and give us some time to settle with Eowyn.

Eric cut the umbilical cord at 7 am, and Christina inspected the placenta. The placenta was a little bit small and had some calcification, but it wasn’t too small. Calcification is an indicator that the placenta was wearing out, which would explain why Eowyn was born two and half weeks early. The amniotic sac was broken right next to the placenta, where there were also some blood clots. This is unusual, as the sac usually breaks on the opposite side of where it is attached to the placenta. This shed some light on the bloody mucus plug when my water broke and the early delivery. Implantation had probably occurred very low in my uterus, close to my cervix, so that the placenta grew into the mucus plug. If this is what happened, then I would have had placenta previa marginalis, but not full placenta previa as the placenta was not covering my cervix. Eowyn had been head down for some time, and her head was probably against the placenta preventing more growth, which would account for the calcification. She was very engaged when my water broke, and so her head acted as a plug stopping any bleeding that might have happened from the torn vessels that were part of the mucus plug.

If I had had a routine ultrasound, which I didn’t want, the doctor who viewed it may have been concerned about a vaginal birth given the placement of the placenta, and recommended a c-section. I am so glad that I did not have an ultrasound! And I am so glad that I had Christina to assess me when I was in labour. If I had been actively bleeding she would have recommended we go to the hospital, but everything was fine and there were no symptoms that would cause alarm. I am glad that I had a healthy vaginal delivery without interventions, and that I had a health care professional I trusted to assist me. I have realized that I cannot have a doctor as my primary care giver for any of my subsequent pregnancies because I simply do not trust their recommendations for what they might consider necessary interventions.

It’s interesting that I had Braxton-Hicks contractions early in my pregnancy when I would do simple things like carry a relatively light basket of laundry down the stairs. I think my body was telling me to take it easy, possibly because of the placement of the placenta. I listened, and stopped doing things that gave me Braxton-Hicks or that made me feel uncomfortable.

I had some pretty severe afterpains while Eowyn was nursing, which I always find really annoying because they are just as bad as labour contractions but I am lying down nursing through them , so they are difficult to cope with. I have to breathe deep and slowly, but it’s still really painful. I took some cramp bark tincture, but that didn’t seem to have any effect so I took some ibuprofen.

I wanted Eowyn to stay right with me for at least an hour after she was born, so we didn’t weigh and measure her until 9:00 am! She was 7lbs 5 oz and 19 ¾ inches long. Even though she was born a little early she had no signs of prematurity. She was healthy, pink, and fast asleep after nursing for about half an hour, which is why we waited until she woke up to weigh and measure her.

I had a small one degree tear just inside my vagina, which I opted not to get stitched. I guess I did a pretty good job of slowing down, considering I had a third degree tear almost to my anus with Elias’ birth! Because I decided not get stitched I had to mostly lie down with my legs together for a week, which I thought was a good thing anyway to make sure I rested and bonded with Eowyn. Those first few days are so fleeting, and so precious.

I am overjoyed with the way Eowyn’s labour and birth went, and I feel empowered and confident in myself as a women through the experience. I feel satisfied that I was able to bring her into the world in the best environment possible, with dim lighting, gentle sounds, people that I knew and trusted, the loving hands of her daddy to catch her, and the comfort of my skin and my breast in the first hours of her life.

SOGC makes changes to guidelines for vaginal birth of breech babies

This is not strictly midwifery related, but it is an interesting development in the world of maternity care. My friend Robin has been working hard in the last few years to make vaginal birth a viable option for women with breech babies. (C-sections still have their place, of course, but there are some breech presentations that are suited to normal vaginal delivery, but many women are never given the information let alone the choice. You can learn more about it at the Coalition for Breech Birth website.)

Last week, Robin got this great response from the Society of Obstetricians and Gynaecologists of Canada.

Dear Ms. Guy:

Thank you very much for your letter dated June 25th, 2008 regarding Breech Birth in Canada. Your letter was perfectly timed as the Society of Obstetricians and Gynaecologists of Canada’s (SOGC) Council Committee has just discussed and approved new guidelines that will offer choices to women who want to have a vaginal birth when there is a breech presentation. The breech guideline is now being copy-edited and will be published in the fall in the JOG. At that time, it will become official SOGC policy. A full press release will be prepared and we would be happy to have you, or someone from your group, participate.

The SOGC had a guideline in 1994. In 2000, given the results and the publicity surrounding breech delivery, we felt it was necessary to warn our members about the study and suggested they discuss it with their patients. At no time did the SOGC ever recommend cesarean sections for all breech presentation. I regret these comments reported by physicians and we will certainly work hard to correct these impressions.

The SOGC will also collaborate with the Association of Professors of Obstetrics and Gynaecology (APOG) to make sure that Breech Vaginal Delivery is taught properly in all medical schools in Canada.

Thank you very much for sending this information to me, I will circulate this information to SOGC Council. I will also put you on the mailing list for our guidelines, which are printed in the JOGC as well as being available on our website.

Yours Sincerely,

André B. Lalonde, MD, FRCSC, FSOGC, FACS, MSc
Executive Vice-President

Veronika from Dawson - Birth Stories

Thank you to Veronika, from Dawson, Yukon, for sharing the birth stories of her two daughters with us!

In Prague, Czech Republic, I spent most of my working life in marketing business. The closest I ever got to the “birthing” was while working for Procter & Gamble, Pampers being my main brand. I visited lots of hospitals and even picked one for my own delivery. It amazed me with all its services – there was big hot tub, jumbo bouncing balls, single rooms with beds not only for mum and the baby, but for dad too.

Then I came to Yukon, met Tom, got pregnant and started to ask about Whitehorse Hospital. All the information I had got was pretty much positive – except for the rate of c-sections. That figure shocked me – for European it was unheard of. In spite of being pregnant for the first time I knew that I was built to bring my baby to this world in a natural way… and then I heard of midwives – midwives that were in Czech banished when communists took over and never established their practice again. That settled it.

I met Christina Kaiser in seventh month of my pregnancy. We spent whole day, we talked, she loaded me with advice and delicious brownies, checked on the baby, helped with leg-cramps by applying acupuncture. All felt very natural.

The day we arrived to Whitehorse next time, my labour started. It was at 9 am, August 18^th 2005, and I honestly did not realize what had been happening until about 3 pm. We called Christina and headed for Mendenhall, where she lived. When we arrived, “our” little cabin was ready, kids swimming pool was ready, and so was my midwife. I plopped myself into a soothing warm bath that took most of the initial pain away and enjoyed the peaceful atmosphere ( so peaceful that my husband actually fell asleep :o). When the bad pain came, Tom held my hand when I needed and Christina was massaging my lower back making the pain go away, talking me into breathing and, above all, telling me over and over again that I was doing a great job. At 1:51 am, August 19^th, Sofia was born. Pink, beautiful, those big dark eyes starring at me, perfect. Tom cut the cord.

Most of the necessary checking then went without us noticing – uninterrupted in our joy we spent hours with our new baby before we all hit the bed. It took us almost a month to leave Christina’s little cabin – month full of advice and practical help. Thanks to Christina I turned from literally all-that-everyday-baby-stuff illiterate into quite a confident mum.

… and so when Eva let us know she was there, we did not hesitate about where this one was to be born. But how different two pregnancies can be! While I hardly noticed with Sofia, Eva was giving me a really hard time. Problems culminated in the eight month with hemorrhoids so bad that after unsuccessful treatment with the only two ointments available and heavy painkillers, I ended up with a letter from one of the Dawson Medical Clinic’s doctors pleading Whitehorse Hospital staff to do a surgery on me. I called Christina instead. She gave me a shopping list and since very little could be purchased in Dawson, she went shopping in Whitehorse and found a way how to deliver that big box full of goodies (herbs, ointments, barks and lots more) to me. In two days I was able to operate again! (All the shopping, driving and phoning was part of the $2500 fee!)

Just like with Sofia, Eva decided that the dreadful trip from Dawson to Whitehorse was enough. The labour started at about 1 pm, December 8^th 2007.We went to Christina’s and again – my little pool was ready :o) Kids and daddies got together and ladies started to work. Eva was born at 8:17 pm, December 9^th.

It was a long and painful journey completed fully naturally only thanks to Christina. To each of mine “I can’t anymore!” she replied “Yes, you can.” and she would never let go of my hand or stop saying something about a great job :o) After teas, acupuncture and a brisk walk outside, we used an up-and-down the stairs method to enhance the contractions that subsided every time I went for the soothing bath. Eventually, we walked our way back to the pool and after quite a bit of pushing, Eva finally decided to come out. Tom ran in to see her coming, Sofia joined us right after.

Unfortunately, as exhausted as I was, I could not take care of Eva right away but there was somebody who did it for me: my midwife. Thank you, Christina, from all my heart!