04 June 2015

The day I decided to give birth in a hospital.

First off, this post is for me.

So I can organize my thoughts, blogs I like, and scientific evidence in one spot, so I can be organized.  So I can fully know why I have chosen to give birth in a hospital.

I believe this choice is different for each person, and I'm not telling you what you should do.  I'm just trying to look at all the evidence and make a good choice for me.  Because a lot of "evidence" is biased.  As a general rule, when someone tries to sell you something, anything, on their website, I don't trust their "evidence."

What about the higher c-section rate?  What about the proposed link between birth-induction and autism?  What about the supposed higher death rate in hospitals? What about the supposed higher risks of hospitals, like higher rates of infection, less autonomy, not respecting a birth plan, or forced pain medication?  What about the risks of epidurals? 

What about the higher cost?  After-all, isn't birth natural, and the medical industry makes billions of dollars each year off of pregnant women and babies. 

I'm using links to science papers (peer-reviewed: meaning other scientists looked over them and confirmed their validity before being published in a respected journal) and blogs, even though as far as evidence goes, I don't respect blogs.  They are only opinion.  I only respect journal articles from a peer-reviewed journal (that haven't been retracted, and meet high quality criteria such as study design and number of participants...) I'll list those links also, for completeness.

I probably won't list links to where the studies were found.  Because anyone can go to PubMed and type in any number of words and copy-paste links "supporting" their side of the evidence.  For instance, if you search for "vaccines and fish" you will get a huge number of hits.  Which have nothing to do with what you're looking for.  

I'll also be looking at "consensus statements" made by large physician groups such as the American Academy of Pediatrics, the Centers for Disease Control and Prevention, and the American Congress of Obstetrics and Gynecology.  Because you can always find "one doctor" to say whatever they want.  But it takes a large body of evidence for the "consensus" of doctors to change their mind about anything.  They look at real proof, not just cherry-picked or biased studies.  Rarely, is the consensus wrong.

And no, I didn't write this post to "prove anyone wrong" or convince people that this is the best way to deliver a baby.  I wrote this for me.  And you, if you want to read it.

I challenge you to oppose my views.  Post contradictory studies in the comments.  Meet me for coffee to further discuss this. While I promise to look into any concerns, at the end of the day this is a decision I am going to make. (With the full support of my husband)  And FYI, natural news is not a reputable site.  I don't believe in what the author of that site believes (ridiculous things like chemtrails, HIV-denialism, and anti-vaccine propaganda) so I won't even bother responding to posts from that website or similar anti-scientific websites.


On home births:

Lets look at information from the scientific consensus:

Here's the committee opinion from the ACOG:

And here's what everyone's favorite web-based encyclopedia (Wikipedia) has to say about home birth:

Here's what one of my favorite blogs has to say about home birth:  (It has a lot to say on home birth...and if you're looking for anything science-based it has a lot to say.  It cites fantastic peer-reviewed studies.)

And my personal favorite: the Centers for Disease Control and Prevention.  Here's official information about the infant mortality rate currently in America. 

CDC report on infant mortality rate:

And finally, the British Medical Journal/s most robust study on homebirth, (The MOST downloaded paper on the subject of homebirth)

(the most pertinent quote in the study): "In 2005 the neonatal death rates were CNM in hospital 0.51/1000, MD in hospital 0.63/1000 and DEM attended homebirth 1.4/1000."

Look how much higher the neonatal death rate was in a homebirth than in the hospital! Neonatal death rate is more important to me than infant-mortality rate because infant mortality rate covers up to 1 year of life, and it's not the doctor or midwife's fault if the baby dies the day before it's 1st birthday.  The death rate for a midwife and MD in the hospital are similar (but remember that MDs (Medical Doctors) often are given the more-complicated patients: patients with pre-eclampsia, diabetes, etc, and CNMs (Certified Nurse Midwives) in hospitals are often given easier, low-risk patients or multiparous patients)  At least, when I was a student and I delivered babies, that's how the hospital I was at did things.

Moral of the story, midwife birth at home has a higher neonatal death rate.

I want to give birth to a baby that stays alive.  If that requires a c-section or medical intervention, I'm okay with that.  I will sacrifice myself/ my body and a "perfect birth" for the life/ health for my baby.

This is a science-based medicine blog perspective on the study listed above:  http://www.sciencebasedmedicine.org/a-critique-of-the-leading-study-of-american-homebirth/

The discussion shows that the paper listed above has an almost TRIPLE neonatal death rate for homebirth. 

TRIPLE the neonatal death rate for PLANNED homebirth.

Meaning, the paper only cites someone that has planned to give birth at home, with a midwife, and not people that accidentally don't make it to the hospital on time.  This is important to note because some people like to say "accidental birth skews the numbers in favor of hospital-birth")

AND the study includes the fact that no matter what "high risk births" (people with diabetes, high blood pressure, other medical conditions) are happening in a hospital.  So they compare the more low-risk births (as a general rule Midwives don't give birth to high-risk mothers) to ALL births in the hospital.  

Low-risk home birth vs. all-risk hospital births.  And hospital birth still has a lower death rate.

At the end of the day, I will risk any medical intervention if it means 1/3 less risk of death for me or my baby.  The medical system in America isn't perfect.  But I'd sure rather put my fate in the hands of a well-trained doctor in the hospital than in the hands of a questionably trained midwife at home. 

PubMed meta analysis (analysis of many papers) published in the ACOG journal:

I respect your right to choose.  A good compromise would be a birth in a home-like birthing center.  But I want no part of a home birth.

Some anecdotes about the babies I have watched get delivered:
I've seen high-risk births delivered by ob/gyns, low-risk births in hospitals delivered by midwives, and even rural-Africa (specifically Zambia) births delivered by a skilled nurse.  I've seen my fair share of births in a diverse number of places.  I was even invited to photograph a home-birth (for a mother who was later sent to the hospital since her midwife declared her unsafe to birth at home, and her baby ended up in the NICU for 1 month, and would have been dead if delivered at home).  

Being a student, I got to deliver some babies. 14 babies.  Most of them moderately low-risk babies that had adequate prenatal care.  All of the babies I delivered were healthy, thankfully!  But that doesn't mean I didn't see complications.

I saw one mom who had a problem with her placenta after the baby was born.  Her placenta wouldn't separate, and she kept bleeding.  She lost a lot of blood.  The interns and students were shoved aside while the resident and attending doctors did everything they could to save the mother's life.

10 minutes, an pitocin drip, and 2 liters of blood later, she was stable again. She would have died had she been at home, midwife or not.

I saw a woman who was delivering twins, who passed out from exhaustion after the first twin was born.  They almost couldn't wake her up.  They were starting to prep her for a c-section to save the second baby, when she woke up and started pushing again. 

I've seen babies who would have been born normally, who had fetal heart rate monitors on and had decelerations in their heart rate, and had to be urgently delivered.

I have seen so many things that "should have been" normal and perfectly fine.  So many moms that "should be able to give birth just fine" who almost didn't.  These moms or their babies could have died if they had delivered at home. 

Probably most moms who deliver at home would be just fine.  But really?  Do you want to take that chance?  Especially with your first birth?  I don't.

I just can't give birth at home, knowing that most moms are just fine at home, but having watched so many moms that "should have been fine" and weren't.  After you watch someone almost bleed to death, it changes you. And I'm okay with that.

At the end of the day, I want an alive baby and mommy.  And the best chance of that happening is in a hospital. (which makes most of the rest of this post a moot-point, but knowing that at any instant something could change, I want to be prepared for why I chose something or didn't choose something.)


On water births:

Who wants a water birth anyway?  Well, many people suggest that water births are safer, more natural, and they decrease the use of medication.  I'm all for reducing medication.  But are water births actually safer?  Are they actually more natural?

The highly respected AAP and ACOG opinion: (remember, I'm looking very closely at committee opinions- not the opinion of just one doctor who promotes themselves on a website or in a documentary looking to make money, but volunteers their time to be on a committee with other doctors to review scientific evidence)

And an article from Pediatrics Journal (by the APP):

Here's what the article says about the risks:
"Water births currently provide no apparent benefit in childbirth. The practice is based on misrepresentations of neonatal physiology and unsupported claims of safety and efficacy. This birthing method fulfills no need for the infant, is of dubious benefit to the mother, is associated with significant, avoidable risks of morbidity and mortality, and currently is unable to pass the risk-benefit test"

Woah.  So you know when you keep reading how great water birth is because of the "dive reflex" (babies won't open their mouth to breathe underwater)?  Well, that's a big myth (It's a myth in warm water, only in ice-cold water babies won't breathe).  Your baby MAY take a breath underwater, opening up RISK of drowning.  Yes, that's right, drowning so you can be more comfortable. 

And everyone's favorite again (Wikipedia):

Here are some science-based blogs on water births- the first one really spells out a lot of what pro-water-birth moms believe and shows why that may not be true.  I highly encourage you to read it if you are thinking about water birth! 
Here is a Chochrane review: (well, just the abstract, because that's free)

(The gist of the paper on water birth is this: there is possible benefit of pain relief in 1st stage of labor which ends when cervix fully dilated, the safety of water birth is not established after.)

Risks of water birth (in quotes because I borrowed these from the first link of the above science-based medicine blog):
  1. Increased risk of infection, especially after rupture of the membranes acting as a barrier between baby and the outside world
  2. Problems with temperature regulation in the baby
  3. Damage to the umbilical cord, or pulling of the cord out of the placenta, leading to severe bleeding complications
  4. Respiratory distress, hyponatremia, seizures and asphyxia from fresh water drowning

The risks don't outweigh the benefits: (article on real risks)

What it comes down to for me is that the risks don't outweigh the benefits.  Not at home.  Not in a birthing center.  Not in a hospital.  While it may be more comfortable for me, it isn't safe for my baby.  I won't be delivering this child in the water.

Now, the first stage of labor (before I'm fully dilated, before the "pushing" starts, before the baby is delivered-which actually occurs in the 2nd stage of labor) is a different story.  If hanging out in a warm water tub before my cervix is fully dilated keeps me from needing an epidural or another form of medication, then that sounds good to me. I can do that.  That's not risky.  Delivering there is.


On C-Sections:

Not many people want a c-section.  While some women prefer one, most people I meet don't.  But it's easy to forget that some people NEED one.

"The following situations are some of the reasons why a cesarean birth is performed:

  • Multiple pregnancy—If a woman is pregnant with twins, a cesarean birth may be necessary if the babies are being born too early, are not in good positions in the uterus, or if there are other problems. The likelihood of having a cesarean birth increases with the number of babies a woman is carrying.
  • Failure of labor to progress—Contractions may not open the cervix enough for the baby to move into the vagina.
  • Concern for the baby—For instance, the umbilical cord may become pinched or compressed or fetal monitoring may detect an abnormal heart rate.
  • Problems with the placenta
  • A large baby
  • Breech presentation
  • Maternal infections, such as human immunodeficiency virus or herpes
  • Maternal medical conditions, such as diabetes or high blood pressure"

Sometimes C-sections are the best option.  Even the best Midwife can't deliver a baby vaginally if a women has plecenta previa.  (the placenta in front of the cervix)  Midwives can't move the placentna for you.  They can maybe rotate the baby, but they can't move a placenta.

But what about the high c-section rate?  Aren't too many women getting c-sections?

Not all c-sections are bad.  With the way things are in America, (1/3 of the population, and 1/3 of mothers are obese) some people need c-sections. Especially if their baby is breech (see below).  Sometimes labor is going well and then a c-section is needed because the baby is in distress.  If I'm at home and my baby isn't hooked up to a fetal monitor, how will someone know if the baby is in distress?

Often, midwives don't know and they can't save the baby.  More on that later.

But if I am laboring and my baby is in distress (in risk of dying) and a c-section is an option to SAVE my baby, then by all means, cut me open and save my kid!

What about a breech baby?  Should that be reason for a c-section?

The Lancet journal, a respected peer-reviewed article on breach birth:

Here's my favorite blog again discussing breech vaginal delivery.  Many midwives proudly boast that they can safely deliver a breech baby.  But is it ACTUALLY safe?

I've seen similar stories in the news about why you may want a c-section for a breech baby and why not.  The bottom line is this:  While the NNT (Number of people needed to treat before a reduction in mortality is seen) is higher than I would like, at the same time, we're talking about people here.  Humans, that could have been saved.


Period.  That's it.  While the risk of death giving birth vaginally to a breech baby, the risk is higher than if you have a c-section.

If my baby is breech, we will have a c-section.  End of story. 

Another abstract discussing how the infant-child mortality rate decreases when the rate of C-Sections increases.  Fascinating. 


On induction:

Sometimes induction is necessary.  It involves risks though.  Why might someone need to be induced?

"Labor is induced to stimulate contractions of the uterus in an effort to have a vaginal birth. Labor induction may be recommended if the health of the mother or fetus is at risk."
(quote from the ACOG website listed above)

If our baby is at risk, I would rather be induced than place my baby in harm's way.  The ACOG website has more info, but sometimes when your membranes rupture early, but you don't go into labor, your baby can be at risk.  The longer you sit without delivering the baby, the higher your risk for infection is. 

Some people are looking at Induction and the risk of autism.  There are some questions about if the two are related?  Here is my favorite scinence website discussing the issue, and following is a study that also discusses it. 

A PubMed article showing CORRELATION, but not CAUSATION:

We all know that correlation does not imply causation.  For example, did you know that when more people consume ice cream, more people drown.  Those two things are correlated.

For this example, it is fairly easy to see that eating ice cream does not cause people to drown.  The fact is, more people eat ice cream in the summer, and more people swim in the summer.  Therefore, more people drown in the summer.

For other factors, correlation and causation get a little more confused.  It is one of the reasons people still think vaccines cause autism.  Because one day their kid is "normal" and the next day their kid is regressing and gets the autism diagnosis.  And they think "the only thing that happened is that my kid got his shots!" Plenty of studies have shown that vaccines don't cause autism, but people still think that they do.  There's more info on that in my upcoming blog post on vaccines.

There haven't been enough studies for me (or any MDs or scientists even) to say that induction DOESN'T cause autism.  But there also aren't enough studies to say that it DOES cause autism.  Most of the research we have now shows that autism starts in the womb.  It has a lot to do with genetics.

I won't be requesting an induction, but if I need one, I will not hesitate to follow the advice of my OB, because he's the expert. And I know he's only going to recommend something if he feels it is best for me and the baby. 

I defer to the experts when it comes to my 401K, to my cars, to banking, why wouldn't I trust the experts when it comes to my medical care?  No, I don't think there's a conspiracy.  If there was some kind of conspiracy, I would have learned about it in school. 

Again, this is for me.  I'm not telling you what to do or believe.


On pain management:

A book worth looking into:

Further expanded (cliffs notes-like version of the book in the 1st blog below:)

Probably the most interesting part of the posts above:

"Unrelieved pain during labor and post-partum has been shown to

  • Cause stress responses that can reduce the baby’s oxygen supply
  • Increase the risk of post-partum depression and post-traumatic stress disorder (PTSD)
  • Interfere with breast-feeding
  • Increase the risk of development of chronic pain conditions"
But what does Wikipedia say about Epidurals?  Do they cause more c-sections?

Quote from Wiki:
"Differing outcomes in frequency of Cesarean section may be explained by differing institutions or their practitioners: epidural anaesthesia and analgesia administered at top-rated institutions does not generally result in a clinically significant increase in caesarean rates, whereas the risk of caesarean delivery at poorly ranked facilities seems to increase with the use of epidural."

PubMed article on the risk of C-section with an epidural (spoiler: there is no increased risk)
With older-epidural techniques an increased risk of instrument-assisted deliveries (forceps, vacuum deliveries) was seen, with newer epidural techniques it is not. 

On early epidurals vs late:

Highly respected New England Journal of Medicine article on Epidural use:

More articles:

Am I definitely going to get an epidural?  Not necessarily.  Am I definitely not getting one?  No.  It will depend on how I'm feeling, my level of pain, and speed of progression.  I don't think they're unsafe, but if I don't need one, why get one? 

I've read UpToDate (a site for providers that compiles all of the research-based studies and makes recommendations) on pain control methods during birth and the two things shown to help with pain control (other than medications) were having a doula and using a birthing ball.  Other things MAY help you, but aren't proven to work.  

So, we'll use alternative forms of pain control if possible, and if not, I'll get an epidural.  I feel they're safe.  But, as I don't take pain medication regularly if I don't need it, I won't use an epidural if I don't need it either. 

A lot of people have personal reasons for not wanting an epidural.  Those views are fine.  I don't have any reason not to get one.  So I might.  


On ultrasound use:

I have seen people claim that prenatal ultrasounds are dangerous and that they should be avoided at all costs?  Why is that?  They say the more ultrasounds done, the higher the risk is that there will be a problem with the baby.

Is this true? 

My OB said he would do 2 sonograms, which is pretty standard.  The original ultrasound at 8 weeks, and the 20 week anatomy ultrasound. I got a few more ultrasounds (well, just 2 more than planned) because my placenta was low-lying and there was a chance it would be in front of my cervix requiring me to have a c-section.  (there's no way I could give birth with a placenta in front of my cervix-if not for modern medicine the baby and I would have died in childbirth.)  Thankfully, my placenta moved. 

More ultrasounds are typically only done with a high-risk baby, who is naturally at-risk for more complications because they are already high-risk.  Midwives would never dream of touching a high-risk patient.  And for this reason, it sometimes looks like they have a lower rate of complications.


A brief note on the Hep B vaccine and Vitamin K injection:

Vit K article- informational, not a study:

Yes, my baby will come out of me and get every standard medical intervention.  A shot of Vitamin K.  A Hepatitis B vaccination.  Erythromycin eye ointment. I've read the studies.  I don't want my baby to bleed out (like 4 kids have already done) because I don't want to give Vitamin K.  It won't hurt.  And if my kid happens to have some kind of clotting disorder, than it will likely save it's life. 

I have another blog post coming on my choice/beliefs on vaccination.  And it's a very similar post.  Nothing accusatory, just information and facts that I want to organize and remember.  There's more information about why I'm choosing to have the Hepatitis B vaccination at birth.  A lot of people refuse this, thinking that Hepatitis B is only passed by IV drug users and people having sex.  But this is not true.  It can be passed by an accidental needle stick, a bite from a kid at the park, etc.  Kids stick everything in their mouth.  I'd rather my kid be protected.  I don't foresee him running into hepatitis B a lot, but I also don't foresee getting into a lot of car accidents and you better believe I have him in the best car-seat money can buy...


And that should cover it.  It covers why I want to give birth in a hospital, why I am not having a homebirth or a water birth.  It covers pain relief/epidural use, c-sections, and it covers ultrasounds.  And I feel better knowing what I know from school and from looking up recent studies about birth.  Now I am ready to have this baby!

27 March 2015

The day Stitch Fix got pregnant!

Most of you know I have Stitch Fix, a clothing service, send me a box of clothes monthly or so.  They've been secretly sending me maternity clothes for the past 2-3 months, but this last month they officially announced they ship maternity clothing!

I let stitch fix know I was pregnant last month.  They asked me my due date, and sent me a box full of perfect maternity clothes, even though I was only 4 months pregnant and not really showing yet, they anticipated that and picked a few things that were perfect.

And a few things that were not-so-perfect. 

But fun to try on.

I love the convenience of getting clothes shipped to me (that I can try on in my own home, whenever I want, with my own accessories) but it has been A MILLION times more awesome now that I'm pregnant and I hate going out shopping, because I only fit into clothes in 1-2 stores, and I'm exhausted a lot of the time.

I really appreciate Stitch Fix, which lets me request specific items.  I wanted to find some work-appropriate t-shirts and tank tops because I haven't been able to find anything I like when I've been shopping. (and maybe that's because it's been winter until recently).

Here's a run-down of my boxes the last two months.  If you've ever thought about signing up for stitch fix, I highly recommend it: if you're pregnant or not! 


I was still pretty small when this box arrived.  I still fit into many of my non-maternity clothes, but they were getting tight.

Immediately, I LOVED this pencil skirt.  It is my style, and I haven't been able to wear a pencil skirt at all lately because they're too tight to make room for the growing baby.

I ended up sending it back because it was too expensive (90 dollars!) but it was great quality and sometimes I regret sending it back...

I loved this dress, but I had almost the exact same dress that my mother-in-law had purchased for me, otherwise I would have probably kept the entire box. Also, it is long sleeved. So it would be too hot to wear when I am huge in June/July.

I initially hated this shirt. Ponchos just really aren't my thing. I almost didn't try it on.  But I actually liked it on, go figure.  I sent it back because it would have been bulky at work with my white coat, which is not super-ideal.

I loved this pink shirt.  Ryan didn't.  It was enough to make me consider keeping the whole box. (you get a 25% discount if you do!) In hindsight, hot pink really isn't my favorite color. But it was one of those shirts that would be perfect post-baby. 



I actually (sometimes) look pregnant now.  I'm still too little for most people who don't know me to ask about my pregnancy, but I'm big enough to actually appreciate the extra room I have in maternity clothes.  And I'm big enough for fun pictures. 

Stitch fix lets you sign up for a date you want to receive your box. I typically pick a Friday because then I have all weekend to try on the clothes.  I have almost always gotten my box either the day I request, or the day before.  This box was (uncharacteristically) late.  I was pretty disappointed because they shipped my box on a Wednesday and it took until Monday for me to get it. This was the first time in 9 boxes that I was disappointed in the shipping service.

I immediately loved this blue tank top.  I tried it on first-thing and then instantly decided to keep it.

I liked this shirt when I first saw it, but LOVED how it felt on.  I thought I would probably keep it since the sleeves were so small.

I was curious about this next shirt.  I have been reading those blogs that have the title "20 things I wish someone had told me about getting pregnant" and a lot of them recommended loose clothing for after giving birth.  I liked the colors of this shirt. I tried it on with one of my belts (the advantage of trying things on at home.

The belt made the bottom of the shirt come up so high that my belly was visible. And I'm only 5 months pregnant right now.

Not cool.

So I put it in the "return" pile.

I liked this dress, but it was long-sleeved.  My stylist said they didn't have short-sleeved dresses.  I thought about keeping it since it was SO soft and comfy.  But the long-sleeves made me send it back.  My kid is due in July.  Nothing about July makes me think a long-sleeved black dress sounds appropriate. 

I almost didn't try these leggings on.  Gold zippers aren't exactly my favorite style.  But, as I'm trying to be bold and try new things, I put them on.

And disliked the zippers as much as I thought I would. (At the bottom near my socks. The zippers are open in the pic)

They won a point for bravery.  But was put in the return pile anyway.


Now I have my first-two work shirts that are sleeveless.  I'm pretty thankful for Stitch Fix.

And If you want to be thankful for them too, here's where you sign up (and give me 25 dollars credit!!)


Help a pregnant sister out, try it! :)