So, today during a consult I was asked about my stats.  It is common for me to be asked how many births I've been to, how many at hospitals vs. birth centers vs. home, or how many at a particular hospital, etc.  But, this expecting father today was specifically curious as to how many of my clients had unmedicated births.  I am surprised actually that more people do not ask that now that I think about it.  I remember wanting to know the same of my childbirth educator/doula when pregnant with my first, too.  And I'm now also curious if other doulas know those kinds of statistics off the top of their head.  I, personally, had to make a guesstimate.  I guessed 70% roughly have birthed their babies without medication.  I think this is something I should maybe know at least for consult purposes, but not be focused on in any way, though.  To be honest, I am a statistics/research gal.  I like to see numbers.  I like to analyze them especially.  I see numbers and want to know WHY.  I do not like to assume anything...but I do like to question them and use information I may be privy to in order to see behind the numbers.  I think I'm pretty fair in my assessments, too. I've read so much birth related evidence-based research and explanations from Henci Goer at this point that I know what kinds of questions to ask of the studies to see what facts we're really dealing with.  

However, in discussing my client's birth stats, I would never want them to enter my mind as being important or telling.  Here's why.
Number one reason:  What is MOST important to me AND them is whether or not they had a positive birthing experiece.  Ya know?  This is not about if drugs in labor are good or bad, generally speaking, this is about each specific woman being happy vs. traumatized on the day of her child's birth.  I want them to feel as good as possible about their labor and birth.  I want them to feel supported, empowered, and loved... and that they were able to make informed decisions. 
Reason #2: My clients give birth in every different setting possible.  I've said it before a hundred times and I'll say it again.  Where you CHOOSE to birth your baby matters. It DOES affect your labor and birth.  Period.
Reason #3: My clients are all different people.  My clients have been first time mothers to fifth time mothers, VBACers, low risk, some with medical conditions, some with supportive care providers, some not, some with supportive partners and some completely alone, some that for whatever the reason could not freely move based on restrictions in the hospital, some who didn't have access to drugs, some with malpositioned babies, some with long exhausting labors, some with labors that struggled to progress, some with fast labors, I could go on and on - but you get the point. 

My clients all have stories.  I know those stories, I know their labors, I know their circumstances, and I know that whether or not they got medication during labor only tells one piece of the story.  Whether or not it was necessary is not something I EVER know.  And whether or not it was a reason for their labor experience being either positive OR negative, I will NEVER truly know.  It is just one piece.  One decision.  Yes, maybe it is a huge one, but behind each of my clients' decisions is a story.  I do not view any as 'better' than another based on this decision on pain medication, or as any of my client's as failing to labor naturally because they chose medication.  It is SO individual.  Labor is unpredictable.  Do I believe MOST women are ABLE to do it without medication if they really want to?  Yes.  Does it sometimes take the combination of a comfortable laboring and birthing environment matched with the right support and the labor not being complicated by factors or interventions that may cause dystocia or more intervention?  Absolutely.  And do sometimes women set themselves up with the perfect recipe for a great unmedicated normal birth and it still go another way?  Absolutely.  Do some women doubt their abilities to manage without medication and leave all options open without a 'birth plan', etc and then birth their babies easily without much assistance from anyone or anything?  Absolutely.  I know one thing, though - Having a doula matters.  We DO make a difference.  Yes, overall we lessen the need for epidural pain relief.  Not a guarantee, though, as nothing is.  Ya know what difference we almost always make?  Whether or not the mom feels good about her birth-day.  And that IS important.

That being said, is it still all that interesting to know what percentage of my client's labored without the famous epidural?  Hmmm....

I serve such a diverse population with varying situations and perspectives on medicine, interventions, and birth beliefs as well as varying hospital practices influencing my client's labor experiences. I think it would be interesting just to see what my small numbers say and if my guesstimate was close or not.

Check back later after I do some calculations.  :) :) :) 

Originally I posted the calculations and some more stats in the comment section and then changed my mind about posting them publicly. I fear that people will focus on it as being important.  And it's really not.  Every client and every situation is individual.  I'd prefer to not calculate again, actually, and probably never will.  I learned that I'm a good enough guesser if any potential client ever really wants an answer from me again.  :)

I'd love to hear feedback from other doulas on this topic, too. 

About: MATERNAL MORTALITY IN THE US: A HUMAN RIGHTS FAILURE

http://www.arhp.org/publications-and-resources/contraception-journal/march-2011

I know I'm passionate about birth and everything surrounding it.  It is emotional for me.  And I'm glad actually.  I am proud of the work I do with women and for women.  I really care about women and babies.  It is not something to be handed over to medical technology as a condition (most of the time). So this kind of update just infuriates me and makes me even more vocal.  I respect informed choice.  Truly informed choice.  And good prenatal care. I cannot respect the current state of maternal health care in any way.  I do, however, feel that change is coming.  Because of these maternal and infant mortality statistics and US pride, yes, AND because of people like me, yes.  I am proud of the support, education, and advocacy I provide women. Doulas and other birth professionals and advocates are out there everyday letting women know their options and that there is MORE TO KNOW than they are being told.  We are helping to guide them through their pregnancies and stay with them during their entire labor.  That alone is making a difference!  But, every woman deserves that, not just ones who can pay.  Midwives and doulas are being requested more and more.  Women are taking more independent childbirth classes and opting to have care and births outside of hospitals.  They are asking for more nutrition counseling, yoga classes, chiropractors, and water exercise classes.  Insurances are reimbursing more now for alternative out of hospital care, education, and therapies. AND, I must say, too, that SOME hospitals are taking steps in the right directions.  Yes, maybe accreditation pressures is a push they need, but they are trying to implement changes in some places regarding birth and baby care - I see it when I attend births at different locations.  Praise to them, too!  And shame on those who are banning birth plans, doulas, and VBAC's and those that don't encourage skin to skin time immediately following birth.  Improvements are coming because of the demand for it, though.  But we have lots of work to do!  I must discuss why it is so sickening to me to see our maternal and infant mortality rates so poor. Don't get me started on the disparities those face who are on medicaid.  I've been through a pregnancy on it.  I know firsthand!  And lucky for me I was who I was and I knew health and I knew my options!  Oh, AND I figured out a way to eventually pay my midwife since she was not covered by medical assistance. Lucky for me, right?  That's me - someone who is health, pregnancy, and birth informed and involved.  What about all the other women on medicaid? 

SOOO......Not only does the US (with all of our money and technology) fall 50th in line after 49 other countries for our maternal mortality, but we have THE HIGHEST infant mortality rate among developed nations (18). THE highest! Please read this article and see the research yourself on maternal mortality, and be informed as a woman or someone who loves one. Yes, it applies to you or someone you love. As our cesarean rate continues to increase, so do our maternal deaths.  Even more so if you are a woman of color - 4 TIMES more likely to die during birth than white women.  And no, don't even go there anyone - It is NOT because women of color have higher prevalence of disease!  Treatment and care is NOT equal!  Please recognize the disparities, and acknowledge the truth in that.

"In contrast to many countries where women lack access to life-saving medical interventions, women and infants are often exposed to more procedures than are medically necessary or beneficial. This overuse of medical procedures increases injuries as well as costs. Indeed, we are unaware of any study indicating that the 56% increase in the rate of surgical births from 1996 to 200827 as improved outcomes. However, there are data to show that the overuse of medical procedures has increased both infant28 and maternal morbidity.11, 29"

ALL women need to protect themselves with information and share it with the women we love. Do not trust you are safe because you 'really like your doctor' and you know 'he/she wouldn't ever make choices for you that could be harmful'.  Be an informed party in all decision making.  Get the information you need from other sources in addition to what you get at your office appointments and ASK QUESTIONS.  Demand better choices, chances, and cut your risks down - take an independent childbirth class and hire a doula, learn about proper nutrition during pregnancy, the importance of healthy living, and how to make that all happen so you can prevent hypertensive disorders and interventions that can both lead to riskier births then and later.  

"Because all medical interventions carry risks, their use in situations when they are not demonstrated to offer benefits exposes women to risks that are unwarranted. For example, overuse of induction of labor and of cesarean sections, and lack of access to vaginal births after cesarean sections, all can lead to higher incidences of postpartum infection and higher rates of hysterectomies.30, 31"

And also, we need to stop making excuses when moms do die during childbirth and afterwards.  I'm tired of hearing all the reasons it wasn't related to the 'actual' birth or that there was nothing that they could have done.   Prevention, as far back as we can get prior to pregnancy or early on, is #1.  Cut down on unwanted pregnancies.  Educate our teens on the responsibility not only of having a baby but of gestating!  And hospitals need to learn how to better support women who want to birth without medication or those who want to move freely for a good bit of labor instead of being in bed hooked to a monitor the entire time (continuous monitoring has not been proven to improve outcomes for moms or babies and in fact IS directly related to increasing the risk of cesarean), decreasing surgical births (even more risky as the number of cesareans a mother has), and REAL post partum CARE where someone is checking on mom's uterus and her overall well being - no, not just to document on their checklists, but to actually spend some time sitting with a mom who just had a baby and get a good sense for how she's feeling.

"It is a human tragedy when a woman dies giving birth; her death forever changes her community and family for all future generations. It is both a tragedy and a human rights failure when a woman dies needlessly of preventable causes in a country that lacks the political will to have prevented her death."

The way we are treated and cared for prenatally needs to CHANGE!  More routine procedures prenatally and in the labor room lead to more interventions and technology. More interventions and technology = more deaths.  PERIOD. 

Thank you Ina May for all the work you are doing to bring awareness to the public and to the obstetrical community on what we can all be doing to save mothers, and of course for remembering those lost with the Safe Motherhood Quilt Project.

For more information visit the Healthy Mothers Healthy Birth Summit page.

Let's all try this together for the next 3 weeks (how long it takes to adopt a habit), whether you are doing it for prenatal reasons or not! I'm going to focus on the importance of dark leafy greens for pregnancy in this blog post, though.  Feedback on what worked best for you is appreciated!  Pass on the goodness to others...

Making green smoothies are a super easy and fun way to get some of the very important nutrients into your pregnant body for you and your baby. Yes, you can cook dark leafy greens, but you should know that just 10-15 minutes of cooking kale, for instance, destroys more than half of the water soluble vitamins, such as vit. C. Smoothies are a delicious way to preserve and consume the raw nutrients. This is also a great (secret) way of increasing your bio-available protein which is one of the most important parts of growing a healthy (and smart) baby and staying categorized as a low risk pregnancy.

Vary the use of spinach, kale, chard, bok choy, and mixed southern greens (collards, mustards, turnip tops - tip: sold already chopped and bagged together at Trader Joe's) blended with your choice of fresh or frozen fruit - blueberries, raspberries, strawberries, pineapple, mango, papaya, and the favorite go to staple - bananas.  Add some water and maybe a splash of apple juice for extra sweetness if needed. Yummo way to grow a healthy baby and feel full of energy each day! People are always surprised how easy this (less than 5 min) and how good it tastes!  With some experimentation, you'll figure out how to make the amount you'd like so that you can keep some in the fridge for the week.  It is best to have small cups of this throughout the day, that is, if you can help from drinking a large glass down all at once. The more you consume dark leafy greens, the more you crave and enjoy them!  The better your digestive system works, too!  Say goodbye to constipation in pregnancy with this addition to your mornings!  Your body will thank you now and forever...and if you keep up this healthy habit through breastfeeding as well, your baby will already love the flavor of leafy greens - how cool is that???

Varying the greens and fruits is important because if you do so, you will be sure to include all of the following vitamins and minerals into your diet that every pregnant mom needs (And for those wondering "Don't I get this stuff from my prenatal vitamin?"  NO, They cannot come close to replacing the real thing.): 

Vitamins: A, B (folic acid), C, K
Minerals: Iron, Calcium, Magnesium, Potassium, Phosphorus, Zinc

Also, when you consume certain vitamins at the same time as certain minerals, you increase absorbability and usability - such as partners like Vitamin C and Iron, both found in dark leafy greens, especially raw.  Another pregnancy plus!

And carotenoids!  These are naturally occuring pigments that when consumed from fruit and veggie sources, are linked to people being much healthier and dramatically lowering mortality and the number of chronic illnesses. 

Can't go wrong with increasing the inclusion of raw dark leafy greens into your diet, pregnant or not - but for a pregnant mama - a MUST! :)  - Green smoothies aid in the prevention of increasingly common problems occuring in pregnancies in addition to "morning" sickness such as pre-eclampsia, anemia, GD, HELLP, and placental abruptions. Feeding our placenta is a very important job.  When these problems creep up, often in the mid to late third trimester, women frequently must be medically induced which in turn leads to higher risk of problems for mom and baby including but definitely not limited to: cesarean section, premature birth, and breastfeeding problems.

I'd imagine throwing in some parsley and other healthy herbs for pregnancy such as dandelion, nettles, red raspberry leafs, would be fantastic, but I need to find more information on how to's and such...any thoughts my herbal friends?  I know some of those could be considered diuretic in certain amounts and forms...

Any other tips?  Please share in the comments below! 

Resources:
The Dr. Brewer Pregnancy Diet
The Bradley Method of Natural Childbirth book and my specific class (2006)
Birth Arts International Doula Training (2009)
Midwifery Today Conference session on Nutrition with Elizabeth Davis (2010)
The Complete Book of Pregnancy and Childbirth by Sheila Kitzinger
Herbal for the Childbearing Year by Susan Weed
http://www.thehealthycookingcoach.com/2010/10/got-kale.html
The Pregnancy Book, by William Sears, MD, Martha Sears, RN, and Linda Holt, MD
http://www.smoothie-handbook.com/how-much-should-i-vary-greens-in-green-smoothies.html

~ Lori