“Evidence based care” in maternity care means that a caregiver uses interventions judiciously. It means that when any test or procedure is recommended, it is for a true medical indication.
I get asked quite often how the average parent is supposed to know if their provider is a safe practitioner utilizing evidence based care without wading though all of the technical medical literature themselves.
You’re in luck! Several authors have done the work for you!
· Henci Goer, “The Thinking Woman’s Guide to Better Birth”
· Henci Goer, “Obstetric Myths vs. Research Realities”
· Anne Frye, “Understanding Diagnostic Tests in the Childbearing Year
· Stewert, “Five Standards for Safe Childbearing”
All of the above books have taken scientific facts as they pertain to pregnancy and birth and give them to you in easy to understand language.
Independent childbirth educators and midwives also keep abreast of the current literature and can answer many of your questions.
Before you read on to the facts I’m about to present, I think it is important to make clear my intent in placing them on this website, lest anyone see this public service to mothers as a ploy for business. Let me point out a couple of things so that you read what follows with a clearly receptive mind.
Independent childbirth educators (like me) do what we do not for profit, but to bring the facts to birthing couples so that they can make informed choices. Hopefully better choices for their babies. The majority of us not only do not make tons of money, we may not even cover our own expenses. My husband has called my childbirth work, including midwifery, “one expensive hobby”. Yet, even when the work takes a financial and emotional toll on us, we keep doing it. For years as a childbirth educator, I would teach for free quite often. Or I would reduce my fee for those who said they couldn’t pay the full fee. Some people paid even when I was willing to give the classes for free. Some paid more so that others could have the same great experience that they had, which they attributed to my classes. One couple paid me four times the amount I charge for labor support!
But I don’t do that any more. For one thing, it’s not fair to my husband or my daughter to subsidize other people’s births. For another, over the years I’ve learned that people value more what they have to work for or pay for. (This premise applies to birth as well!) And finally, I have expenses to cover...my continuing education, my overhead, my copies and teaching aids. Independent educators are not subsidized by formula or drug companies. We only get paid if the parents pay us.
It has been cynically suggested that independent educators are trying to ‘convert’ people to home birth or natural birth. To which I would ask, “To what end?”
Even when I was teaching classes and practicing midwifery, what good would it do me to try to talk anyone into anything? I didn’t clear a profit as a midwife either! Many don’t. On average, a midwife will charge 10-20% of what a doctor charges for a birth (about the same as what a client would pay for their insurance co-pay). Even if she got more ‘business’ she logistically could not have as many clients as a doctor. She has to restrict her clientele to a geographical area she is able to safely cover, within the constraints of how many apprentices or partners she has, which will never reach the capabilities of a hospital. So even if I wanted to and was able to convince everyone that came to my classes to change their mind about where and with whom they wanted to birth with, there wouldn’t be enough midwives available at this time to accommodate everyone!
Midwives don’t become midwives because they want to get rich doing it. They become midwives because they want to offer a safer option to mothers. There just simply is no other motive.
That said, what follows is a short list of red flags that should alert the pregnant consumer that they should run, not walk, to a competent care provider. Failure to do so nearly ensures iatrogenic (doctor caused) complications.
Pretty strong statement? Well, for years my approach has been “Well…if it were me, and I heard this statement from my caregiver, I might…” To which the client says to themselves “Well, it isn’t going to happen to me” continues with the caregiver who is throwing red flags all over the place and then, sure enough, it happens just like I said. Nearly every single time. It’s happened once too often and I’m frustrated that the message is not getting through. So I’m going to be blunt so the message is very clear…
If you see yourself in the following examples, and you continue with that caregiver exhibiting red flag behavior, then you do not have the right to blame the provider when the predictable happens. The onus is on parents to be responsible.
True malpractice does exist, and nothing makes me madder than when someone does something that will harm another with full knowledge that what they are doing is harmful…especially if the person inflicting illness or injury has sworn to ‘harm none”. BUT parents have nine months to initiate dialog with their midwife or doctor. Nine months to determine if their care is evidence based, and nine months to show their care provider that only the best care will do for them. Always remember the words of Maya Angelou. “When someone shows you who they are…believe them.” The first time. You will not change them…not even in nine months.
Red Flag #1
You ask your caregiver what percentage of their clients end up having cesareans and their response it “Oh, quite a few.”
This is an actual quote that should have scared the hooey out of the parents. If a doctor won’t give an actual percentage, there’s plenty of reason to be wary.
Most midwives not only keep excellent records, but the freely offer their transport and cesarean rates. It’s usually about 2 to 4%. Often physicians will care for more high-risk clients, either because of the population that they serve, or in some cases because clients become high risk due to misuse of prenatal technology. But even so, in a high-risk practice, anything above a 12-14% cesarean rate is unacceptable, according to the World Health Organization. When the rate climbs higher than that, more mothers and babies die than are saved. This is one of the reasons that 22 countries have fewer babies die per year than the US does. We average a 24% rate, with some regions or private practices much higher!
Also beware if you dialog with your doctor and he says that WHO has outlined an unattainable goal. Not only is it attainable, it’s being done by some very dedicated doctors with superior outcomes. Shop around. They may be few and far between, but considering it’s your baby’s life on the line, some shopping around is reasonable.
Here is a good place to address the issue of HMO’s since the response to the above is often “but my HMO won’t cover a midwife or any other doctor”. My baby was worth an out of pocket expense and I’m sure yours is, too. I’m not willing to let an incompetent doctor harm me, or my child, just because someone else will pay for the damage. Don’t let your HMO kill you. (There’s even a book by that title!)
Red Flag #2
If your doctor starts talking induction for such things as a “big baby” or plants a seed early that you will be ‘overdue’ in a week or two and he has to ‘get that baby out of there’, but does not site verifiable medical indication. Or, if your sisters, friends and co-workers have gone to the same doctor and more than 20% ‘needed’ to be induced or augmented (speeding up labor).
Inductions almost always fail if the mother isn’t ‘ripe’. A high number of unnecessary inductions lead to a nigh number of unnecessary cesareans. If you have read the other web pages I’ve compiled or books with the actual statistics, you already know that means at least a five times greater risk of death for the mother. A risk only worth taking if either mom or baby stands a greater risk of dying without the cesarean.
Women have been given the ‘big baby’ excuse only to have a normal (7-9 lb.) baby cut out of them. “Normal” babies can be 10 or even 11 lb. It is highly dependant on genetics and diet. Genetics’ dictates that a woman will not naturally grow a baby that won’t fit through her pelvis. If that were a frequent occurrence, how did we come to over-populate this planet without doctors to ‘save’, us considering they’ve only been on the birth scene for the last 80 years or so?
This natural law can be circumvented in a couple of situations, however. Rarely…very rarely…a baby will grow too large to pass through a mom’s pelvis if there are extenuating circumstances. If a mother has ever broken her pelvis or had rickets as a child due to poor nutrition. Both of these could conceivably change the mother’s pelvic dimensions.
If a mother has mated into a gene pool with much larger offspring, a large baby could grow in a small woman and outgrow the pelvic outlet. A 4’10” mother who carries the baby of a 6’4” father might not be able to fit that baby through her bones. But she should be given the chance to try, considering that baby’s heads do mould and mother’s pelvic bones have adaptable cartilage for just such occasions. I’ve seen some pretty big babies come out of some really little women very easily!
Finally, nutritional factors. Babies grow bigger on the sugar you ingest. I explain the physiology of this in more detail in class, but for this discussion, just understand that overly large babies are made when sugar is a factor. Any kind of sugar. (Some women may be saying now “No way! I lived on candy bars and soda and my baby was little bitty!” I would ask, “Did you also drink coffee, smoke or have repeated ultrasound exposure?” Poor nutrition and other habits harmful to babies often go hand in hand. Smoking, drinking coffee and repeated ultrasound have all been linked to Small for Gestational Age babies. Again, I discuss the gory details in class.)
So, if you are growing your baby on cupcakes and ice-cream, you could be setting yourself up for an unnecessary cesarean.
Now, for the myth of the ‘due date’.
When a woman is asked when she’s due, I’m continually astonished that the reply is often so specific, as in “March 21st” or “September 10th” instead of “sometime in March” or “This fall” which is actually more accurate!
Why? Because “due dates” are approximations, not to be taken literally!
The doctor who invented the little wheel that your care provider uses to ‘see’ where you are in your pregnancy was using average length of pregnancies at the time he came up with his calculations. It was then commonplace to set very low weight restrictions on mothers. Starving mothers don’t make very good incubators. The placenta becomes compromised and babies are born small and/or prematurely. So, for today’s healthy woman, pregnancy is actually been shown to be about one week longer than is commonly thought.
But there are a number of other factors that determine how long it takes to ‘fully cook’ that bun in the oven.
· Nutrition. (There it is again folks. Are you seeing a pattern here?)
· Genetic obstetrical history (Your mother’s pregnancy)
· How long your cycles are (Women with longer cycles tend to have longer pregnancies)
· Emotional state of mind
That means that for some women, 42 or even 43 weeks is normal. Even if it isn’t ‘normal’ for a particular pregnancy, a bio-physical profile (a test in which the placenta and baby are assessed for wellness) is reasonable…an automatic induction or cesarean is not!
Even an ultrasound (which carries it’s own risks) is only accurate to within 2 weeks +/- (that’s a whole month surrounding the ‘due date’) and only within a 4 lb range (2 bl. either way)! These facts apply to the ‘too big’ baby rational as well.
Think about that. If you are induced because your caregiver is sure…via ultrasound…that you have an 8 lb. baby that won’t fit though your pelvis (myths already debunked) and you have a cesarean, you could end up with a premature baby that's barely six lb.! Preventable prematurity. We all like to pretend it won’t happen to us. But start talking to women with kids. It’s happened to them. Because they didn’t know any better. Or they did and thought, of course, it wouldn’t happen to them. I didn’t make the above scenario up. I hear this tale time and time again.
All of the information under this red flag can apply to those being sectioned for Failure to Progress (FTP) and Cephalo-Pelvic Disproportion (CPD). These diagnoses often turn out to be highly questionable.
Red Flag #3
If you, or anyone you know who has the same doctor, hears these words cross you lips “…and when he broke my water…he always has to break my water…” YIKES!
First order of business here. If the words “all”, “always” or “never” are part of your doctor’s regular vocabulary. Exit. Stage left.
Evidenced based care not only means that there is scientific evidence to back up the action, but there is medical indication in your particular circumstance for this birth and that the benefits out weight the risks.
Amniotomy (breaking the water) carries such substantial risks and so few benefits that it rarely meets these criteria.
The most common reason for doing it is that it ‘speeds up labor.” Does it?
Some studies say no. Some indicated it might…by about 10 minutes. A mother’s perception certainly is that it does, because her contractions go from 0-90 in 2.2 seconds and her body has not prepared her for the increased intensity of a hard head on her cervix vs. the softer feel of basically a water balloon.
But even if it does speed up the labor by 10 minutes, that’s what…three to five contractions? Compare 10 minutes of discomfort (providing you aren’t using hypnosis to breath your baby out gently) with a lifetime of brain damage for your child or even the death of your baby.
This is the conversation I wish I never had, but keeps showing up like a bad penny…
Woman: “Oh! You had your baby at home?! I never would have been able to do that! I was so glad my doctor was right there! He saved my baby’s life!”
Me: “Really? What happened?”
Woman: “The cord washed down before the baby and I needed an emergency c-section” (variations on a theme: “My baby got stuck with it’s head sideways [or backwards] and I needed an emergency c-section” or “I ended up with an infection and I needed an emergency c-section.”)
Me: “Is that so? How soon after they broke your water?”
Woman: “Oh, right after! I was so lucky!”
DING! DING! DING!
These are the most common complications caused by breaking the water.
· Transverse arrest This is when the baby has been in a high, and usually posterior, position. When the water is gone, the baby plunks down without getting a change to get his head in an LOA (left occipital anterior…the choice position for birth) position. So, the baby gets suck with his head either facing sideways, or with his brow-bone caught on mom’s pelvic arch. If this mom is lucky enough to avoid a cesarean (with that higher mortality rate that’s sort of hard to justify when just not breaking the water could have avoided the situation all together) she will probably endure a longer labor (gee…wasn’t the water broke to speed it up?) and there would probably be pain or discomfort that even hypnosis can’t touch. [ed. Note] Hypnosis can take away pain. Surgery can be performed with hypno-anesthesia only. But if the pain is physically/mechanically caused and repeating or constantly aggravated, the body may still let the signal through to warn or guide the client. Childbirth is not meant to be excruciating, our bodies are made to open and let our babies out, so hypnosis has been shown to be very beneficial, within the parameters of normal.]
· Infection often occurs when the water is broken to ‘start’ labor. Once it’s broke it can’t be fixed, and repeated internal exams done in an environment where super-germs thrive is practically a laboratory set-up to show how to create an infection.
· Cord compression and fetal distress are other complications associated with breaking the water.
Red Flag # 4
If your caregiver has told you within 6-8 weeks of your ‘due date’ that he’s “not sure you’re going to make it to term” because you are “already dilated to 2 (or 3).” Even more disconcerting, if your doctor is suggesting you take a tocolytic drug to stop a ‘premature labor” that has been diagnosed from one routine hook up to an electronic fetal monitor, or has suggests that all twins are born early, so can expect to go into labor prematurely. Here’s why.
A. Many women walk around for 2 to 3 months dilated to 2 or 3 cm, especially when the cervix has already been opened once, as in previous birth, miscarriage, abortion or other obstetrical procedures like endometrial biopsy . It does not mean they are in labor and it is not necessarily dangerous!!! Premature labor is defined as “contractions that increase in intensity and duration and dilate the cervix”
B. No one has any business having their fingers in your vagina until you are in labor (and some question even then) anyway because it tells them n-o-t-h-i-n-g. A woman can walk around at 2-3 cm for weeks, go over due and then have a 36-hour labor. A woman can go into labor with no dilation and have a 2-hour labor. And there is no way for anyone to predict which kind of woman you might be even if you have given birth before.
C. Twins are often carried to term, and even ‘over-due’ in midwifery practices with fabulous, healthy, 7+ pound babies. Is it a wonder twins are born pre-mature if the mothers are constantly told that they will deliver early and they are treated as sick people with no nutritional counseling at all?
Some doctors have now added an electronic fetal monitor to the litany of ‘test’ administered in the prenatal period. I personally know one woman who was put on tocolytic drugs to ‘stop’ a ‘premature’ labor that didn’t exist. Yes, she was 2 cm dilated. She did not feel any contractions and even if she had she was not given a chance to see if they would increase in intensity or duration and dilate the cervix. She was frightened into taking the drugs because she feared her baby was at risk and she was a great mom. The machine recorded contractions. Were they Braxton-Hicks or was it a faulty machine? We’ll never know. But one thing is for certain. Not only was she not in premature labor at that time, but she wasn’t even close to going into labor as evidenced by the fact that long after the drugs were out of her system when she needed to be induced (for symptoms of pre-eclampsia…a disorder relating to a compromised liver. Gee…some side effects of the drug used to ‘stop’ the ‘premature labor’ in this healthy woman is…oh! Liver damage, high blood pressure and heart palpatations) it was no easy task because she wasn’t even ripe. [For more on pre-eclampsia and why doctors see so much more of this life-threatening condition, see my page on prenatal testing and where inappropriate testing and treatment of non-problems can lead]
Fortunately, she was strong enough to make some tough choices. She fired the doctor that turned her into a high-risk patient and hired a wonderful team of physicians and others who helped her have a great birth despite the challenges. This woman and her family still inspire me.
Some readers may have noticed that midwives aren’t mentioned in these scenarios. For good reason. I’ve known many midwives. I’ve ‘cyber-met’ hundreds more. One thing most have in common is that they don’t use any of the technologies or interventions I’ve addressed unless they really need to.
“What? But didn’t you just say all of these things are bad?” Not if you were paying attention. I’ve been talking about inappropriate use. No technology, intervention or procedure is inherently bad. All of them came about for good reason. There is appropriate use for each, but not often. In the midwifery model of care, there is much consideration before suggesting an intervention and all less invasive ideas are tried first.
This might include herbs, Chinese Traditional Medicine, massage, acupressure, hypnosis, homeopathy or chiropractic. Are these supported by evidence? Some of them are, some are being tested, and some only have hundreds, or even thousands, of years of experiential evidence behind them. But they also haven’t been proven harmful as the items I’ve covered here have.
But the midwifery model sees birth as a normal, natural process, which means that no tool or technology, traditional or technological, is used without indication, and nothing is ever done without education and approval of the client.
Red Flag #5
Excessive prenatal testing. Again, when people show you who they are believe them. Too many times women have been told “Sure, sure. You can have everything on this birth plan…as long as nothing catastrophic happens, which it can at any time, you know. Birth is a natural thing and I only use interventions when necessary, but...” Ask. “only when necessary” sometimes means 100% of the time. Anyway, if the doctor herself has had a cesarean, most of her nurses have had cesareans, a large percentage of her clients end up with cesareans, and she tests, tests, tests the entire pregnancy, listen to her actions because her words mean nothing. If she doesn’t trust a woman’s body to grow this baby without her ‘help’, how can she trust the birth process? More importantly, if the message that you can’t trust your own body is continually pounded into you though test after non-medically indicated test, you won’t be able to birth, even if physically there is no good reason not to. Birth, like sex, is 90% between the ears. [Hypnosis can help here too, but you can’t expect miracles. If you use hypnosis to overcome the fear, you have to support that action or you’re throwing your money away. For example, if you use hypnosis but then watch daily programs where ‘normal’ birth is portrayed as on the back, in bed, in hospital with an epidural, what you’ll get is what you see, not what you say you want. Your own actions also show you what you really want. If your favorite book is “Girlfriend’s Guide” and you are with the doctor-type we’ve been talking about, “HEL-LO”, no childbirth class is going to ‘give’ you a good experience. You have to work at it and explore your own beliefs and expectations more closely.]
As for testing… I won’t get into details here. I have a whole page on it linked from my main web page. "Understanding Lab Tests in the Childbearing Year” by Anne Frye and “The Tentative Pregnancy” have more information on how the inappropriate use of technology effect the psyche of birthing women.
Red Flag #6
If you try to open communication with your doctor and hear things like “Where did you go to medical school?” “Just let me worry about that.” “You’ve been reading too much.” “If you take any class but the hospital class, I refuse to be your doctor.” “Well, Ok, if want to kill your baby.” Or “So, I guess I care about this baby more than you do?”
(Think I’m kidding? These things are said to women every, single day) This is showing you who they are again…it’s blatantly obvious that this person has zero respect for you and will play the power game ‘till the end. Most often once these phrases come up, the client also gets a healthy dose of hostility to go along with the disrespect. Remember, what I suggest is learning what your options are and opening dialog with your doctor with good evidence for the safety of your requests in hand. If you are making a reasonable request and you are getting an unreasonable response, you should wonder why.
Red Flag # 7
If twins are discovered and it's automatically assumed you will have a cesarean, (addressed above in a different context) and if your baby is breech and it's automatically assumed you will have a cesarean. Most often in both of these cases, not only is a cesarean scheduled, but it's scheduled weeks before your due date so that you don't accidently go into labor before they can get that baby out.
OK. First of all, we've already covered how far off an ultrasound can be, and that even if it is fairly accurate on dates (depending on when it is done), genes determine how big your baby is and intrauterine conditions determine how fast/well the baby devolopes. So, by scheduling a c-section early, the odds are greatly increased that the baby will be premature. Again, I state the obvious. This is preventable prematurity.
Next, not all breech or twin births require a cesarean. Some do, but they are unusual types and configurations which we don't even need to go into. Are breech and twins riskier than 'normal' birth? Yes. But they are a normal variation and in most cases are safer than a cesarean.
And finally, there are good reasons to let labor start, even if in the end a cesarean is required. a.) Letting labor start on it's own usually means baby is ready. b.) The complexity of the hormones involved is precariously balanced. The dance includes hormones that help the baby prepare for life outside of the womb, hormones that will initiate lactation and the body's own pain prevention system to name a few. c.) The hugging action of the uterus helps the baby prepare to breathe.
On my way back from a clinical experience trip to the Caribean, I sat next to a retired physician. We talked for the entire two and a half hours from Miami to Detroit. He was very interested in what I learned, especially in regard to breech birth. He said that he was so glad that someone was preserving this vital information, because doctors are not taught to safely help women with breech babies to deliver, but to schedule a cesarean. Without the knowledge of how to safely deliver a breech, it can be dangerous.
He was a very kind gentleman. I was sad that he was retired...especially when he said that he would have been proud to be my back-up physician if he weren't. Not that I'd be willing to relocate to Detroit!
The ridiculousness of this whole 'breech' thing comes to a head when women are told at 6 or 7 months that because their baby is in a breech position, they will need to schedule a cesarean. In the next two or three months that baby could change positions hundreds of times! Babies can change position in labor, for cryin' out loud! Not to mention there are many different ways to encourage a baby to turn, not including external version, the more invasive of breech turning options.
I won't even go into the postpartum advice that makes me crazy. I can't count the number of women who were given such bad breastfeeding advice that they could not establish breastfeeding even though they wanted to.
So, now with about five hours of work into writing this, and many more to come in editing, I’m asking myself “Why do I care so much about all of this?” I wish I knew. I do care deeply and often wish I knew why I feel compelled to spend so much time on research and creating of my web pages and more hours listening to the horror stories women feel inclined to tell me, when some of the women I come across don’t even want to put eight hours into childbirth and parenting classes.
Why put myself in the line of fire for you? It sure isn’t for me. I won’t be having any more children. If I did, I’d choose a midwife and have my baby at home where I’m safest, the way I did with my first one. If there was some reason I couldn’t do that, I’d choose only one doctor…the highly skilled ob that has a low cesarean rate (but who can get a baby out in seconds if needed). One who will respect my desire to include complementary care. The one who, even if our beliefs are different, respects me enough to say “Well, I don’t agree with you, but I see where you’re coming from and as long as you can show me it isn’t harmful, I’m game.” As a very last resort, if I couldn’t have my choice of midwife or doctor, I’d have an unattended homebirth (which I don’t advocate, which should make my next point abundantly clear) and still be safer than I would with the doctor who abuses technology.
I spoke before of the financial and emotional toll it takes on birth professionals like myself, but didn’t elaborate on the emotional aspects. I’d like to, though, because I don’t think it’s something a lot of people consider.
There are going to be some parents who will read this and get very angry. Any self-help book will tell you that if you have a strong emotional response to something, there’s a good reason and it should be explored. Some will examine that and do deep healing work surrounding their own births or fear of birth. Some won’t, preferring instead to live in denial and a place of blame, irresponsibility and pain…directing their anger at those of us who promote joyous birth as the norm. I don't understand why that anger isn't directed at those that actually did the damage, but until those people heal their own anger, it has to be directed somewhere and we who are vocally ‘out there’ take the brunt of it. They rightly ask "If all of these things are dangerous, why do they do it?". But they are asking the wrong person. I don't know why they do it. But maybe it's because they can. Anger misdirected is wasted energy. Nothing will change until you change it.
And then there are those physicians who are the very types I’m warning you about, who not only don’t practice evidence based care and don’t want to, but take every opportunity to shoot the messenger, expending great amounts of energy casting aspersions on those of us with actual evidence to support our claims, walking a very thin line close to restraint-of trade.
Why do I get so frustrated when I hear a woman say “Well, sure I’ve been in constant pain from the episiotomy the entire 8 weeks since the birth, but sex has hurt worse than labor since the last baby anyway, so what can you expect? I know episiotomies aren’t really necessary and most doctors avoid them these days, but he cares so much about his patients, so I guess that’s the price you pay for a good doctor.”
Huh?!
Anyone can put a caring hand on a laboring women’s belly and she will feel better. It’s part of the psychology and make up of labor. BUT A GOOD DOCTOR WHO REALLY CARES ABOUT HIS MOMS DOES NOT USE A MEDICALLY CONTRAINDICATED PROCEDURE THAT CREATES PAIN FOR A WOMAN’S ENTIRE LIFE. (Oh dear, I'm shouting. And the visual to insert here is me pulling out my hair!)
Consider this. If any other person, stranger or loved one, took a knife and cut any healthy muscle, but especially the muscles between your legs, for no reason at all, what would you call that? How about assault!
Yet, I hear this sort of thing over and over and over again. It has to stop!
I really have no clue why I keep fighting the good fight, or why so many other independent childbirth educators and midwives keep doing this work. Maybe because we’re right and we can prove it. Maybe because you need to know and they won’t tell you. Maybe because if you don’t know, it won’t stop, and the only way I can see to improve birth outcome is to help women make safer choices. The only way to do that is to help them see that they have choices…and some of them are bad! Choices that could be not only harmful, but could have lifelong repercussions.
It seems just when I think I can’t do it any more, that no one is paying any attention and if I hear one more nightmare birth story I’ll scream, someone will tell me that something I said made a difference in their pregnancy, birth, or breastfeeding experience.
So, if you use this information to create a better birth experience, let me know.
See Katie Allison Granju's fact filled article here.
Y2Kid Considerations...my musings on parenting in the new millenium
Discomforts of Pregnancy & Helpful Hints
Nutrition in Pregnancy
But What If...? Questions often asked of homebirth-ers
