_You probably have learned by now that what is free is not always a
bargain and what is expensive is not necessarily quality, and that not
everyone is equal. Since pregnancy is not a disease, medical
qualifications are not your only consideration. Vibes and chemistry are
equally important. Remember, stay away from external stress! This means
that if the doctor is patronizing and impatient and non-communicative,
go shopping for better. You deserve the best treatment in pregnancy, and
there are plenty of good health providers out there, so make the effort.
If the nurse at the clinic is nasty, don`t go again. You also have the
right to communicate your needs and desires to your doctor. If he is
doing an ultrasound every visit, this should be questioned. The World
Health Organization has stated that there is no benefit to frequent
ultrasound examinations in low-risk pregnancy, and in fact, ultrasound
has never been sufficiently researched and proven absolutely safe in
pregnancy. There is much contraversy, as we do know that ultrasound does
cause cell damage. However, many other things do also, like the sun.
Some researchers claim vauious side effects, like learning disabilities,
stunted growth, and more, but this cannot be proven either. It is
probably safe, but one must learn from the lessons of the past. It took
forty years for scientists to realize a connection between X-ray
radiation and cancer. Thousands of pregnant women in the l950`s were
routinely given a hormone, DES (diethistilbistrol) at the beginning of
their pregnancies to stregnthen their pregnancies and prevent
miscarriage. Many years later this was proven to be a cause of genital
defects, infertility, and vaginal cancer among the females born to these
women. Ultrasound is a marvellous tool, that enables us to see where the
placenta is located, if the fetus is alive, if all the organ systems are
properly formed, and to check the growth of the fetus. However, it is
not a toy to be abused. If a women has regular monthly periods, and she
is aware of the date of her last period, it is not necessary to do an
ultrasound exam until week 20-21 to do an organ screen. Naturally, if
there is vaginal bleeding, it should be done to see where the bleeding
is coming from, and if all is well with the baby and placenta. If the
baby seems very small or too big for your pregnancy dates when the
doctor or midwife feels or measures your abdomen, then this is a just
indication for an ultrasound. Make sure that the organ screen is done by
an ultrasound expert, with modern equipment. Just because a doctor owns
an ultrasound machine, doesn`t mean that he is qualified to do an organ
screen. There are only a handful of experts in Israel, and their fee is
expensive. The exam should take about half an hour, and should include
the heart structures. The great majority of scans are fine, but rarely a
fetus with incompatable with life defects is detected, such as no
kidneys, or skull bones. The couple is then offered the choice of
abortion. Some women refuse to have an ultrasound exam for fear of yet
unknown side effects in the future. This is definately legitimate and
should be your decision. Some women have inner fears that something is
wrong with the baby and need the reassurance of the ultrasound exam.
This is OK too. It is your choice to have or refuse. Some couples like
the bond that forms when the fetus is actually viewed on screen , and
husbands especially start to feel connected. While the mother can feel
her baby moving inside, the father can feel detached unless he can see
the baby. Some docotors even give out detailed pictures and video
cassettes. We are products of our environmnet. We are surrounded by
television screens, computors, and movies and pregnancy too needs to be
viewed lately. Remember that birth and pregnancy has been here way
before TV and electricity and there are other more basic ways to connect
with the baby inside, based on hearing, feeling, and touching. Fathers
can rest their hands on the tummies and feel the movements, and later on
in pregnancy, you can put an ear to the lower abdomen and hear the
heartbeat. In the ninth month, if the head is down, it can be usually
heard between the hairline and navel 4-5 cm to the right or left of the
navel. This can create a special intimate closeness between the three of
you, without any possible side effects. Sometimes simplicity has
advantage over high technology. _Basically every prenatal
examination should include a physical _exam and also a time to chat
and ask questions and establish a relationship of trust,communication,
and a chance to verbalise your feelings and emotions. Very often your
partner will want to be present. Sometimes it is nice to bring along
older siblings if there are convenient facilities and ample time. In the
first trimester, issues such as proper diet, exercise, and establishment
of correct pregnancey dates should be addressed. Various laboratory
tests are done, such as blood type and®
RH, complete blood count, Rubella titer to see if you are immune or not
(German Measles), and a urine culture to make sure that you do not have
any bacteria, which although asymptomatic can cause premature labor.
Every visit your urine should be checked for protein, acetone, glucose,
and nitrates. Also it is important to check your blood pressure every
visit. Blood pressure and urine checks help to discover signs of Toxemia
of pregnancy, a serious disease which affects the blood vessels of the
placenta and thereby affecting your babies nutrition and oxygenation and
also can cause convulsions in the mother. It is routine in many places
to also check your blood glucose to screen for Gestationsl diabetes,
which can also affect the babies proper developemnt and avoid having a
huge baby (macrosomia) which can lead to a traumatic birth or a Cesarian
Section. There are various ways to screen for gestational diabetes,
depending on your risk factors,such as over 40 years, familial history
of Diabetes, unusually large fetus,or a past baby weighing more than 4
kilos, glucose in your urine, or a bad obstretrical history of
stillbirths or malformed children. Tests include a regular blood
glucose, a fasting blood glucose, a post-prandial glucose (after eating
a carbohydrate meal), or the one-hour 50 gram glucose challenge test. If
tests are abnormal, then a 3 or 4 hour glucose tolerance test is
performed. This is quite an ordeal, as your blood must be drawn hourly
for several hours. Many more naturalists are objecting to routine
glucose screening for low-risk women who have good nutrition and
followup. Some are questioning the high rates of women testing positive
for gestational diabetes as the latest obstretic high-tech myth created
by the obstetricians searching for yet more pregnancy pathology. There
is currently a controversy as to what is the necessary screening. Once a
woman is labelled as a gestational diabetic, she beocmes high-risk and
is a candidate for much intervention in pregnancy and birth. Many
midwives and women are refusing routine testing if they are not
high-risk. To prevent developing gestational diabetes, it is wise to
avoid refined sugars and sweets and junk-food, and to eat a diet high in
complex carbohydrates, protein, dairy, and vegetables and low-sugar
fruits. You should be seeing your care-provider once a month during the
pregnancy and in the eighth month twice, and in the ninth month 3-4
times. Make sure that you have a number to call for emergencies, and
prepare your questions in advance of your visits to maximize your time.
Ideally the first visit should be 45 minutes to one hour in order to get
to know each other and to take an accurate medical history and
examination. Subsequent visits should be about a half hour. The babies
heartbeat is listened to at each viisit, and you are examined for
swelling (a possible sign o f toxemia) by pressing your ankles and
observing if the skin remains depressed. In the ninth month it is
important to assess the babies position to be sure that it is head down.
If it is breech (butt-up) or transverse (sideways), then will be offered
the chance to externally rotate the baby , or do turning exercises, or
just wait and hope it will move on its own. If it stays breech, it is a
high risk birth with a high chance of a cesarian section , especially if
it is a first birth. If it stays transverse, there is no way to birth
naturally, and a cesarian is imperative. At every exam your uterus is
measured to see that it has risen higher in the abdomen, meaning that
the baby is well-nourished and growing. Most practicioners use a tape
measure from the pubic bone to the top of the uterus, but some
experienced ones will suffice with just feeling around and the visual
use of landmarks such as the pubic bone and the bellybutton and the
sternum. Others will only measure by ultrasound (which should give you a
clue as to their high-tech verses hands-on inclination.) Periodically
you will be assessed for anemia in pregnancy, and many doctors will
routinely prescribe iron supplement pills. Naturalist midwives may offer
herbs instead, or more natural iron supplements, like gentle iron or
Floridex, which are more easily tolerated by the gastrointestinal
system. It is comon for women taking conventional iron pills to have
stomach aches, constipation, or diarrhea, with very black and tarry
stools. Solgar puts out a prenatal natural multvitamin and mineral
supplement, called Prenatal, that has gentle iron and Vitamin C among
otehr nutrients that is well tolerated and popular. However, if you have
a diet that is well balanced and healthy and your were not anemic at the
start of pregnancy, it is most likely not necessary to take any
supplements. It is normal for your hemoglobin to drop in the second
trimester®
For the last eight years I have been working in a Jerusalem maternity
hospital, Misgav Ledach. It is the only hospital in Israel to outwardly
espouse a philospphy of natural childbirth and minimal intervention for
low-risk pregnancies. People come from all over Israel to birth here.
Misgav Ledach Hospital also recognizes choice in childbirth and is the
only hospital allowing private midwifery. Most women in Israel birth
with whoever is on duty at the time of their labor. This sometimes works
out very well, but is a matter of luck and chance. Sometimes the
chemistry is not great, and sometimes the shift is very busy and couples
can feel that they are being neglected. This can be a cause of stress,
and stress can affect your labor as it interferes with your hormones. It
is very important for a woman to feel safe and secure with her care
providers in labor. More and more women are opting for private
midwifery, where the women shops around for the midwife of her choice,
consulting with her on her birth plan and assuring her that the
chemistry is right for her. The best way to find a good midwife is
through word of mouth. Talk to other women who have birthed with this
midwife and get their recommendations. Other sources of recommendations
might be childbirth educators, or La Leche League leaders, or
breastfeeding counselors. Call the midwife and arrange a meeting.
Prepare for the meeting by making a list of questions. It is best if you
have already completed half your childbirth course so that you can make
a birth plan and know what to ask. Bring your medical records so that
she can get a thorough medical history. Find out her views on birth, ask
her specific questions regarding her role and in what ways she can help
you. Of course, your partner should be present and also an active part
of the interview. Communicate your needs to the midwife so that she
knows what is expected of her. Ask for references if necessary. Discuss
prices, backup in the event of her being unable to attend, and find out
her experience with natural birth. There needs to be a balance between
the fervor and enthusiasm and idealistic passion of the young midwife
and the hands-on experience of the older, perhaps more set- in- her-
ways midwife. A good midwife should be passionate about the ideals of
her profession, very experienced (hundreds of births through her hands),
and warm and nurturing yet allowing you your privacy and space.®
_What is the right environment for natural birth? Privacy is of the
utmost importance. Staff cannot come and go as they please, but must
knock before entering and respect couples` privacy. Unfortunately most
hospital delivery rooms are not accoustically soundproofed. A woman in
early labor hears the moans and screams of the woman in transition or
pushing out her baby and can be frightened. Woman are jealous hearing
other babies first cries and think that their turn will never come. Try
to find a facility offering birth away from the main delivery room, such
as the private homestyle birthing rooms of Misgav Lecach. If this is not
an option, then be sure to bring earphones with music to block out
sounds of other women birthing. A laboring woman needs comfort, like a
low thick mattress, a bean bag, many pillows and cushions, a rocking
chair, a low stool or special birth stool, chairs, tables for leaning
on, etc. We need to bring the home into the hospital with kitchen
facilities, private bathrooms, music, shower, and a deep bathtub or
birth pool or jacuzi. The atmosphere must promote quiet and relaxation
so the woman can be in touch with her inner self and her basic instincts
to maximize endorphin flow. Endorphins are natural morphine-like
substances that the body produces as a painkiller and to promote a state
of well-being. It has been said by Sheila Kitzinger and Michel Odent,
both leaders in the world`s natural birth reform, that the right
environment for birth is the same as for making love. Husbands don`t
need special robes and women can be naked or in their own clothes. All
threatening hospital emergency equipment should be out of sight but
readily available. Anthropologist Niles Newton studied animals` birthing
habits, and found that they prefer small, dark, and private places. Any
disturbances caused the "flight for life" reflex, and labor stopped. An
animal in labor sensing danger, will stop its labor in order to flee to
safety. Many women act the same. Laboring women who feel threatened by
an unfavorable hospital environment or staff can subconsciously stop
their contractions because they do not feel secure. Often a women can be
laboring and progressing just fine at home and everything stops when she
enters the delivery room. Proponents of home birth state this as the
major reason for staying home in the nesting environmnet. Humans are the
only mammals that make a nest and go elsewhere to birth. Anxiety causes
the body to release adrenalin, which is an antagonist to oxytocin, (the
hormone causing contractions) and labor stops or slows down. Now think
about your hospital environment for birth.®
_It is every womens inalienable right to a proper birthing
environment. The proximity of a hospital to your home should not be your
first priority in choosing a hospital. Especially with a first birth
averaging l8 hours length, there is plenty of time to travel one or two
hours to a hospital that caters to its birthing womens` needs. Besides
which, hospitals never change policies unless it hurts their pockets.
When too many women choose to avoid their local hospital and travel to a
different city to a more favorable environment, their local hospital
loses money from the national health service for each empty bed and it
is a blow to their esteem. As vehement as they were against certain
policies, you will slowly see that changes will occur and the birthing
environment will change. On the other hand, if you choose to birth in a
hospital that imposes many restricions that you object to, then you have
two options. One, stick to your grounds and refuse to cooperate. This
will no doubt create anxiety as you will be treated as a hostile patient
and the staff will retaliate by ignoring you or being belligerent. In
rare instances, you will be lucky by having a saintly midwife who
believes in your cause but has not yet come out of the closet. Most
commonly, there will be an atmosphere of stress, which could adversely
affect the progress of your labor. Your other option is to give in on
your principles and be cooperative. However, you are forfeiting your
inalienable feminine right to the birth of your choice and you must live
with this. You cannot redo your birth. Birth is a climax emotional and
physical time in a womans` life. You owe it to yourself and your baby to
make the most of it. Remember, you do have choices, but you must take
the responsibilty to make them.
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