Natural Birth and Lifestyle

The Food Doesn’t Matter: Choosing a Hospital for Giving Birth (Part 1)

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I’ve gotta be honest.  I’m really tired of seeing “good food” listed as a reason to choose a particular hospital for giving birth.

Ladies, come on. This is the age of Uber Eats. The food doesn’t matter.

Here’s what does matter: Your dignity.  Your health. Your lifelong relationship with this tiny person inside you.  Your perineum. Owning your body, your baby, and your birth. Your finances. Your mental stability.  Those things matter. And hospital policy can have an impact on all of them.

I’ll repeat that: hospital policy can have a huge impact on your life.

So, how do you pick one?

Las Vegas labor and delivery wards are, regrettably, some of the worst in the nation. With unacceptably high cesarean rates and dismal reports from the Mother-Baby Friendly camp, there simply isn’t one which a mother can consider as a low-risk option.

In case you missed that, I just pretty much labeled all the Las Vegas hospitals high-risk places to give birth.  This is an official challenge for the PR reps from any Las Vegas area hospital to prove me wrong. Healthy women with normal pregnancies would be wise to consider all of their out-of-hospital options.

But let’s assume for now that you have weighed your options and priorities, and decided on a hospital birth.  Here are some questions, in no particular order, to ask potential hospitals:

  • What is your hospital’s induction rate? 
  • How many women receive pitocin in labor? 
  • What is your episiotomy rate? 
  • What percentage of women receive epidurals? 
  • What are your forceps/vacuum rates? 
  • What is your cesarean rate? 

Generally, anything above 10% in any of the above categories is cause for alarm.

You might have a difficult time getting straight answers to many of these questions.  Most staff will not have precise numbers, and the public relations department has an interest in shrouding hospital statistics in mystery.

I will save you some footwork: there is not a Las Vegas hospital with a cesarean rate below 30%, and many have rates over 40%, going hand-in-hand with policies forbidding or restricting VBAC (vaginal birth after cesarean) and prohibiting a woman from going past past 40 or 41 weeks of pregnancy.  These policies are not evidence-based, so there is no excuse for them. Epidural rates soar over 90%.  

But ask anyway. Firstly, you’ll be better able to decide which risks are acceptable and relevant to you.  Secondly, Las Vegas hospitals need to feel the pressure. With enough consumers demanding better care, for-profit hospitals in particular are more likely to take steps toward evidence-based percentages. Thirdly, the information you are able to gather helps organizations like ImrovingBirth.org and ICAN. 

Now it’s time to get more personal.

What’s it going to be like to labor and give birth in these hospitals? What can you expect during recovery? As a long-time doula, I’ve attended births at most Las Vegas hospitals, and am thus chock-full of stories and tips to help you. (More posts to come. In the meantime, give me a call at 702 241 4753).

You can also get the inside scoop from other moms who’ve gone before you. There are many excellent childbirth classes and free, casual moms’ groups where families share a wide variety of experiences. Attend as many as you can, and ask lots of questions.

Knowledge is power. Grab your favorite pregnancy snack, make sure your phone is charged, and go make some good choices for you and your baby.

Dr.Doom and Wonder Woman

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Last year, during a birth, I met a real jerk of an obstetrician.  

He was dismissive, condescending, and a bully.  Nobody was too happy to have him in the room, and he had not really been properly invited to this birthday party. 

Dr. Doom had been called because Dr. Wonderful (so carefully chosen) was unable to make it. 

On the bed in front of him was a strong, healthy woman (I’ll call her Lora) having a normal, uncomplicated labor.  Birth was imminent–the baby’s hair was peeking and we were all excited–except Dr. Doom.  

He had tried, a moment before, to take Lora’s ankles in his hands and place them in stirrups.  Lora (heroically, I thought) ignored him, pulling her legs back into a more comfortable position. I smiled, gripped her hands tighter, and whispered, “If this feels good, just stick with it.”

Stirrups: helpful when getting on a horse, unhelpful when giving birth.

“Well!” huffed the amazed doctor. He looked to the faces of the nurses, who returned nothing but faint smiles. (They were nice.  I liked them a lot.)

After muttering, “No epidural, huh? And a previous cesarean…” Dr. Doom sighed deeply, pulled on gloves, and sank heavily into a chair, resigned to dealing with this “uncooperative” patient.

Without any coaching, Lora took a deep breath and pushed.

“Hold it,”  demanded Dr. Doom.  “You can’t be on your side.”

I think every eye in the room rolled.  A tense moment passed, and we all held our breath.  Then another heroic thing happened. Stewart, Lora’s husband, smiled and said calmly, “Doc, Lora likes it on her side, so that’s how she’s going to do it.”

It was a good, strong birth.  Lora was magnificent and her baby arrived with no trouble at all. As she cuddled her newborn, Lora looked up at me with a little disappointment.  Dr. Wonderful had been a caring doctor during her pregnancy, and his absence was unexpected. “Dr. Wonderful wasn’t here!” she said.

“I’m glad,” I replied.  “You get to take the credit for this one!”

Birth, of course, is fraught with the unknown, and much of it is beyond the control of us mere mortals.  We’ve all heard about the drug-addicted women who don’t even know they are pregnant, but who somehow have perfect, smooth births and miraculously healthy babies. And sadly, we are all also painfully aware of the fact that sometimes, terrible things happen to nice people who do all the right things. 

So why am I giving Lisa credit? Here’s where it’s due: she and Stewart had educated and prepared themselves so well that even with the sudden switch of team players, they were able to quickly regroup and remember the things that were important to them.

It had been a long process.  It had been hard work. They had read books, attended in-depth childbirth classes, hired support (me), and practiced what they would say in these kinds of situations. Stewart knew that while Lora’s energy was 100 per cent dedicated to pushing her baby out, she would be unable to advocate for herself.  So, he stepped in. When his own emotions overwhelmed him and his energy seemed to wane, I nudged him with cues we had practiced ahead of time. If necessary, I would have advocated on behalf of both of them.

Now, Dr. Wonderful has a good reputation for a reason.  He’s one of a small handful of obstetricians in Las Vegas who respects women’s choices, and in many ways practices evidence-based care.  Lora was wise in choosing him. 

But he wasn’t there. It turned out to not matter all that much.

I’ve come to believe that women are the heroines in their own birth stories.  And I grow a little weary of the Knight-in-Shining-Armor tales that seem to follow in the wake of these good doctors. In most scenarios, their most noteworthy and appreciated function was doing nothing.

Dr. Doom has a bad reputation for a reason, too. And he is one of hundreds who don’t respect women or practice evidence-based care.  Indeed, the hospitals in Las Vegas, filled with tired, disenchanted obstetricians who just want to keep their heads down until retirement,  offer dismal prospects to birthing women.  

But if there’s a silver lining in this cloud, it’s the strong, capable women who own their births, take a deep breath, and push anyway.  My birth memories are filled with Wonder Women.

https://i.pinimg.com/originals/f3/7d/58/f37d582302fb520302ea579f61f807ed.jpg

There was the mother who sat up, took her newborn from her doctor’s hands, and said, “That’s MY baby,” after he had made a move to send the baby to another room.  There were the mothers who refused to check in for their unnecessary inductions. There’s the mother who removed her monitors, barred herself in the bathroom, and labored alone while the staff knocked and demanded she come out. There’s the mother who fired her doctor during labor, left the hospital, hired a midwife, and had a breech birth at home. There is the mother who, during her home birth by herself, recognized a life-threatening problem and immediately went to the hospital, where her concerns were dismissed.  She loudly persisted until she got the help she and her baby urgently needed.

Let me be clear: choosing a good care provider matters.  No woman should have to negotiate for hostages while she is doing the hard, hard work of giving birth. Naked and vulnerable, no woman or baby should be caught up in a power struggle with those who are used to being obeyed.

But take heart. 

You get to choose whom you trust, which decisions matter the most to you, and which ones you’re willing to concede.  If you find a Dr. Doom at the foot of your bed, reach for those anchors you prepared for yourself: your desires, your team, and your sense of self-ownership.

Now, go own your birth.

The Curtains Don’t Matter: Why Women are Really Choosing Home Birth

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In hundreds of conversations with couples planning their home births, I’ve heard a lot of solid, well-researched  reasons for their choice. They want to allow labor to progress at its own pace, they want to avoid unnecessary interventions, they want freedom of movement and for their basic needs of food, water, and privacy to be met.  Occasionally, the reasons a couple chooses home birth are little more unique; they have important religious considerations, a history of sexual abuse, or such fast births that they couldn’t make it to the hospital even if they wanted to.

But do you know what I have never, ever heard a couple mention in their list of desires for their birth?

The curtains.

Well, at least there’s some privacy in here.

http://Image by StockSnap on Pixabay

Nope, not once.  I know this may come as a surprise. This is a  misconception that frequently comes from anti-home birth activists. The word “curtains” (or some other reference to aesthetics) was mentioned at least three times in a recent, popular webcast questioning the intelligence and education of home birthers. The implication is that folks choose home birth because hospitals aren’t pretty enough.

“We need to make labor and delivery rooms more home-like, so that women feel more comfortable,” they’ll say. “Some nice curtains, more home-like chairs…then they’ll come back.”

There’s a giant billboard here in Las Vegas that sometimes advertises a “birth center” located inside a hospital. The pictures rival those of the fanciest hotel rooms.  Soft colors. Matching pillows. Framed art. Fluffy, drapey, curtains dominating the space. “We got a face-lift!” They cheer.

But the ever-growing number of women choosing home birth aren’t swayed by the efforts of the decorating team. They want natural births, and they know they just won’t get them in the hospital.  They want to be free to move around, eat, drink, and bathe. They want to be treated like women, not patients. They don’t want any number of strangers imposing on their space during a very private experience.  They want the confidence of knowing they can say, “Please don’t touch my vagina.” They really, really don’t want their vaginas cut. They want to find their own most comfortable birthing position, not be forced on their backs with their feet in stirrups. They want to hold their babies immediately.  About half have had a previous cesarean (or two) and they want something their doctors flat refuse to “allow”: a VBAC (Vaginal Birth After Cesarean).

Home birthers know that most newborn checks can be done on their chests, and they place high value on holding their babies immediately.

Do aesthetics matter?  Sure. The atmosphere of a room can certainly affect labor and birth.  But atmosphere has a lot less to do with candles and flowers than it does the people in the room.  When a woman chooses to give birth at home, she is really choosing some people over others, not necessarily one space over another.  

Women choose their birth teams because they care about safety. Because they care about autonomy. Because they care about their families, and how the arrival of this new baby will affect their dynamic in big ways moving forward.

During the slow moments of a home labor, I love to sit back and look around the room at the people (okay, and the books. But mostly the people). These people were hand-picked. The same midwife who saw the mother through her pregnancy is the same one here now, and will be there to help her breastfeed.  I was chosen to help ease the discomforts of pregnancy with massage, and the mother knows my touch now as she works through her contractions. Her husband, comfortable on his own turf, can be himself.  Moms, aunties, grandmas, best friends, other children…she knows them, and trusts them.

The room might have stained carpet and yard-sale furniture, or it might look like the pages of Magnolia Magazine, but when freedom of choice is honored, no one cares about the decor. It is home, sweet home. The choice of thousands of sane, reasonable people everywhere.

Maybe if hospitals had the shabby chic, re-purposed wood look going on…

The Super Simple Sustainability Baby Step Every Homesteader Needs to Take 

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Have you or your kids been looking for an easy, cheap project to move you toward sustainability? A practically bullet-proof accomplishment that can provide fertilizer and maybe even some cash, yet is so simple that a child can do it? Homesteading can be hard. Sometimes, we just need to create something successful to boost morale! Well, let me tell you a little story.

We lived in a hot, concrete suburb of Las Vegas when I first began to get the bug to grow our own food. I was the busy, homeschooling mom of 8 children at the time, and often despaired that I would ever be able to put anything on the table that I had raised.

I failed at so many small-scale homesteading projects that I began to hide the evidence from my husband.

The Perfect Beginner’s Project 

The first true success I enjoyed was not my own at all.  It was a project that I gave to my seven year old son, with little hope that it would produce anything.  But as it would cost very little money and take practically no effort from me, I knew we couldn’t go wrong.  We needed only a handful of little worms, some kitchen scraps, and a few items from around the house. The results were so rewarding that I tried to convince all my other children to join in the fun and multiply our “harvest.” 

“Think of the money you could make!” I cajoled. “Even if nobody else wants to buy from you, I will!” 

“EW,” was the reply I got from my girls.  “We are NOT growing bins of poop.” 

For poop it was.  Worm poop, to be exact.  Fluffy, earthy-smelling red wriggler excrement by the handful!  Called “castings,” the poop of worms is highly prized by gardeners as a wonderful organic fertilizer.  Mild and perfectly composted, worm castings can be added directly to the soil, even around young, tender plants, or made into compost tea.  If you’re looking for a way to create your own inexpensive fertilizer, worms are a great deal easier to raise than other critters, and practically for free.  

Many varieties of worm farms exist on the market, and some of them are pretty brilliant contraptions that make “vermicomposting” so simple that a toddler could do it.  The sale of castings can be quite lucrative.  But I was just looking for a way to produce a steady supply of fertilizer for our own small garden, on a budget of under $20.  I think $10 of that budget was spent on the worms themselves. 

The construction of our worm bin was incredibly easy.  In fact, my young son handled the entire process. 

How to Start a Worm Farm 

∙Clean out a Rubbermaid bin with a lid.  It doesn’t have to be sterile, but make sure it didn’t previously store harmful substances. Avoid clear bins.  (Worms HATE light.)  If you dumped out a Lego collection to use the bin, I applaud you for your sacrifice, but by all means find a replacement quickly.  Homesteading is already a lifestyle fraught with potential pain and danger–you don’t need to step on one of those suckers in the middle of the night. 

  • Drill several holes in the lid.  (If you are always losing your drill, like we are, use another sharp object). Then drill several holes along the upper rim of the bin, about two inches below the lid.  You want your little wrigglers to have plenty of air.  Now, drill some holes in the bottom for drainage.  Be sure to discard any plastic shavings this creates. We’re not like THOSE farmers who feed their animals plastic on purpose.  If you want to prevent bugs from getting in your bin, you might want to line it with mosquito netting.  My son thought that the worms might not mind some friends, so we skipped that step. 
  • Line the bottom of the bin with about six inches of carbonous bedding material like shredded cardboard or newspaper.  Avoid materials with colored inks.  Straw or sawdust is ok, too, but it will take longer to break down. Brown leaves are perfect. Pause for a moment and revel in the warm glow of knowing you have participated in the wondrous process of thoughtful “carbon sequestration” that Joel Salatin talks about. 
  • Lightly wet the materials so that they are damp, but not wet enough to leave more than a few drops of water on the bottom of the bin.  The goal is to provide some moisture for the worms, bacteria, fungi, and millions of other magical microbes to thrive, but not drown. 
  • Toss in a few handfuls of decent soil.  This will make the worms feel at home. 
  • Add a few handfuls of kitchen scraps.  A worm will eat roughly their own weight every day, but some of that will be bedding. It’s common to add too much food at first, so be conservative. Worms are happy to munch on pretty much anything.  Banana peels, apple cores, carrot peelings, coffee grounds, slimy lettuce, etc.  Avoid citrus peels, garlic or onion, meat, or dairy. Now, don’t get hung up on the math or break out a scale to get this perfect, but you want a “carbon to greens” ratio of about 30:1. You’ll know soon enough if the balance is off, and it will be easy to remedy either way. 
  • Gently add your worms to the bin, with greetings of hearty welcome.  Everybody likes to feel appreciated.  (Your worms really do need to be red wrigglers, which you can purchase from most garden supply stores or online.  Other types of worms will not do well). 
  • Cover those babies up QUICK with a few more inches of your moistened  carbonous material and soil.  Maybe you have thousands of worms looking for a new neighborhood.  Go ahead and repeat the layers, making sure that you add moisture as you go.  Worms will die if they get dried out! 

Now We Just Hang Out and Wait 

Put the lid on and find a good spot for your bin.  If properly maintained, the bin should not smell at all, but it might attract bugs, so keep that in mind.  It should be kept at moderate temperatures. Somewhere between 55 to 77 degrees F is best.  Pick a spot that is easy to get to.  Nobody wants to climb over a pile of laundry or tubs of Christmas decorations to feed the worms.  However, those of you with toddlers or determined pets probably don’t need to be told that you’ll just make yourself and your wrigglers miserable if the bin is flipped and the contents spread all over your carpet.   

To prevent bugs, and catch drainage, place a slightly larger lid under the bin and apply a thin border of diatomaceous earth. 

Feeding 

Once a week or so, check on the bin.  It shouldn’t smell terrible or look slimy/gooey.  If it does, or if a huge cloud of fruit flies billows out, you need to add some more carbon bedding.  Dig around gently to investigate. The moisture level should remain at that sweet spot: a hospitable-to-life-but-not-a-swamp level.  If you see excess pools in the bottom, use a turkey baster to suck them out. This “compost tea” is liquid gold for a hungry houseplant.  Did the scraps mostly disappear, and are your worms vigorous and happy?  Great–feed them some more scraps.  If the previous scraps are still there, just let them keep working on them.  Every time you add some scraps, also add some carbon bedding.   

It’s all about balance, baby​

And this is why I encourage all wannabe gardeners to start a worm farm, even if they don’t have so much as a single plant in a pot.  By observing, smelling, feeling, touching, and appreciating your compact microbiome, you’ll learn so much about that sometimes elusive balance that nature loves and needs.  When you encounter really healthy soil outside, you’ll know instantly.  “Hey, I know that smell,” you’ll think.  “It’s like worm castings.” 

Observe and Enjoy 

Congratulations!  You have nurtured life. Depending on your balance of worms to scraps, you should begin to see a significant amount of castings begin to form within six to eight weeks, and an increase in the worm population.  A very exciting learning opportunity for the kids can be found in your humble bin here.  Just scoop out a handful and put it on a paper towel. With some careful observation, you’ll be able to find tiny, white baby worms and maybe even be able to watch some hatch from their eggs (also called cocoons). 

Harvesting 

Advice abounds on the proper way to harvest worm castings.  It really comes down to how tedious of a job you can tolerate, and keeping in mind that those little critters are pretty delicate.  One way is to make a sieve or use a colander to gently shake the tiny castings and save your worms and larger particles for them to work on some more.  ​

A pretty cool tip that worked well for us was to bury a corn cob in the bin a few hours before we wanted to collect the castings.  Most of the worms went right for that cob like it was Walmart on Black Friday. This made it quite easy to gather them and set them aside so that they would not be subjected to the shaking process. If your population has exploded, and your bin is out of room for more layers, you may choose to take some of the worms and either add them to your garden or start a second bin.  Entrepreneurial kiddos will probably be seeing dollar signs at this point. 

Some Variations 

Some folks like to use two bins, one inside the other, separated by a couple bricks.  This allows for more airflow and a place for liquid to collect.  Other people set up more elaborate stacking systems with multiple bins, allowing the worms to migrate to fresh food when they have exhausted the first bin.  Vermicomposting is so easy and rewarding that you’ll likely be investigating these options soon. 

Look at you, you’re a worm farmer!   

You’re really onto something good here.  Keeping a worm farm can provide you with a steady supply of worms, worm eggs, castings, and (if you’re not completely ruined from too much time on your phone) entertainment.  

Questions?  Fun vermicomposting anecdotes to share? Please add them below! 

Nevada Midwives Answer To Whom

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Why Are Lawyers, OBGYNs, and Special Interest Groups demanding that home birthers in Nevada sign a completely useless, possibly self-incriminating piece of paper and hand it to her midwife for “safekeeping” for five years, then…throw it away?

Answer: they’re not.​

After the astonishingly terrible 2021 Midwifery Licensure Bill failed to pass in the last session, the same authors have brushed it off, changed a few things, and re-submitted it to lawmakers again.

Nevada is one of the last states in the union that does not regulate midwifery, and remains a destination for women from surrounding, regulated states. Sometimes they drive hours to have the births they want.  Women are free to choose where, when, with whom they give birth, and midwives are free to practice according to the dictates of their conscience. This bill (which does not have a number yet) seeks to change all that.​

Many will recall that the bill did not pass because the vast majority of Nevada’s home birthers and midwives hated it and fought to see it die.  It didn’t die, unfortunately, but lies gasping for breath in the halls of the legislature.​

I have a sinking feeling that someone is going to give this little gremlin some water, transforming it from a harmless creature to a toothy monster.​

What happens next? The Legislative Counsel Bureau (a group of people consisting of ZERO midwives and maybe completely unaware that planned home birth still happens) will officially translate it into the complicated legal jargon we all enjoy reading in our spare time.​

Since the team doesn’t know a thing about home birth, they’ll likely get a few things wrong, missing the “intent” of the bill, or worse, get it all right, fully understanding the intent of the bill, which is to control how women give birth in their own homes. 

So, about that useless paper. 

It seems that “several stakeholder groups” feel that a “community birth disclosure” form is very important.  This form, which will be written by the Powers That Be, must be signed by every woman seeking to hire a midwife, assuring The Powers That Be that she understands the differences between the types of midwives.​

(Tune in later for some thoughts on what a “stakeholder” is.  Also tune in later for some thoughts on their use of the phrase “community birth.” And, because the fun just never ends around here, let’s also discuss the use of the phrase “traditional midwife.”) 

For now, let’s just ponder the word “disclose,” implying, of course, that some midwives are hiding something about themselves, their training, education, and experience.  This is laughable and ironic, considering that the average first visit with a midwife–the interview, if you will–is two hours long.   

Most women who choose home birth do so after extensive research, and continue to educate themselves throughout their pregnancies. By the time they have arrived for that first appointment, most already have a very good understanding of the differences in birth settings, types of midwives, and what they want for their birth.  Those who get through a pregnancy without this knowledge do not get there for lack of opportunities to learn.   

I will go so far as to say that women have a right to remain uneducated if they so choose.  This is certainly true of thousands and thousands of women who use the mainstream medical system, choosing to trust the professionals and the state that licenses them, and assuming this will protect them against poor outcomes. 

There are other implications to this form, of course.  Another implication is that women must answer to someone about their choices.  Handed a “disclosure” form, a woman gets a pang of self-doubt.  For some, who have chosen to exit the mainstream medical system due to harassment from CPS, it sets off alarm bells: who is going to see this form?  If something goes wrong, will I be viewed as negligent? 

In an attempt to placate those who protest against such an intrusion into the client-midwife relationship, we’re told that midwives won’t turn the form into anybody. 

Then what is the point?  What happens if the midwife refuses to provide the form, or a client refuses to sign?  The most reasonable assumption is that if there is ever a question–say there is a poor outcome, or a client refuses to pay the midwife’s fee for some reason, is that the Board will intervene.​

​Which board?  Why, the one that will dictate– excuse me, “regulate”–the practices of licensed midwives and the women who choose them.  Such a board does not exist in Nevada, and its formation will be one of the trickiest and most contentious parts of this entire messy process. 

The chances of a non-licensed midwife being on this board are next to zero, providing no representation. 

You can see where this is going: the state  expects to oversee all home births, even those of women and midwives who fervently desire to be left alone.  The introduction to this intrusive relationship begins in the form of a seemingly harmless piece of paper, but it ends in Nevada’s women losing a precious legacy of freedom and autonomy in birth. 

How can you help? Write Assemblywoman Monroe-Moreno, especially if you are in her district.  Call or email.  Let her know that you oppose the new midwifery licensure bill and you want to see it dropped before the session opens. 

Then, share your birth story.  Why did you choose home birth?  How did you learn what you wanted to know about your midwife and her training? 

If we come together as we did last time, and do not become complacent, I’m confident we can shoot down this attempt to infringe on our rights once again. 

Let’s fight, Nevada.