Birth & Beyond

Treating normal labors as though they were complicated can become a self-fulfilling prophecy.

~ Rooks



"Debunking Myths about Birth and Breastfeeding" is an idea I had for quite a while. There are so many misconceptions on these two topics, that I felt it necessary to dispel what I am convinced are falsehoods. In order to do my part to help others avoid unnecessary interventions or procedures based on false information, I will start to "debunk myths" on my facebook account. Since I can only "update my status using 420 characters," I will have the full post available on this section of Birth & Beyond. Enjoy and please feel free to email me with any input, questions or ideas for other topics! Thanks for reading!



Myth #1: Big Baby + Difficult Birth

Myth #2: Birth Of Twins Or Triplets Cannot Be A Natural Birth

Myth #3: Once A Cesarean, Always a Cesarean!

Myth #4: Hospital BirthIis Safer Than Home birth

Myth #5: Episiotomies Prevent Tearing And Heal Faster

Myth #6: There Is No Prevention For Preeclampsia

Myth #7: New Moms Should Be Up And Active Soon After Birth

Myth #8: Low Amniotic Fluid Level = Induction

Myth #9: The Timing Of Cord Clamping Doesn't Matter

Myth #10: It's Just The Baby Blues

Myth #11: Contractions 5 MInutes Apart = Go To The Hospital

Myth #12: Don't Spoil The Baby!

Myth #13: Push - Push - Push

Myth #14: My OB Won't Let Me Go Past My Due Date!







This false assumption often leads to induction of labor before the baby and the mother’s body are ready for birth. Even though it may occasionally be more difficult for a big fetus to descend through the pelvis - especially if s/he is in an unfavorable position, most important for a “good” birth is the mother’s position (changing frequently), a calm and supportive environment as well as an unhurried, self-paced pushing stage. Some even say that chunky babies are less painful to birth because they are nicely padded!




Not all women expecting multiples are interested in having a low intervention, natural home or hospital  birth and not all are candidates for such a birth. However, just because a woman is pregnant with twins or triplets does not automatically exclude this option. What better way to "proof" my point as to suggest you watch this video which is a photo montage of moms who have had their twins or triplets naturally (most were unmedicated and with as few interventions as possible), many against great odds!






It is becoming increasingly difficult to find a care provider who is willing to let a woman have a VBAC (Vaginal Birth after a Cesarean). Hospital policies have changed, not because a non-surgical delivery is more dangerous for mother and child but because in most cases insurance companies dictate what can and cannot be done.

Many studies have proven that not only are vaginal births safer for almost all pregnant women and their babies but also that this does hold true for women who have had one or more previous surgical births.

Cesarean deliveries undoubtedly have their place in obstetrics and do save many lives, but in the last three decades the number of surgical deliveries has skyrocketed and some now speak of a “cesarean epidemic”. Most people aren't aware that  - like any other major surgery - c-sections hold risks for the birthing woman and her child.

Since most women who had a c-section will go on to have cesarean births with subsequent pregnancies, the percentage of babies delivered surgically keeps increasing. Some mothers- to-be will choose a scheduled c-section but many want to at least be able to try to birth their babies vaginally. The chance of doing so successfully is increased by preparing intellectually and emotionally for the birth and carefully choosing a supportive birth team. An excellent book on this topic is “Silent Knife” by Nancy Cohen or read this article on



#4 : Hospital birth is safer than Homebirth 




Numerous studies have shown homebirth not only to be safe but to be safer than hospital birth. The maternal and infant mortality rates are lower for homebirths. Whether a woman gives birth at home or in the hospital should be a personal choice. Even though not every woman wants to have or is a candidate for a homebirth, the option of giving birth at home should be available to all women. In a homebirth setting there are few or no interventions. This allows the birthing mother’s body to let birth unfold as designed by nature. If there is no interference the mother’s and the fetus’ body undergo the release of hormones which facilitate the birth process for both. In a hospital setting routine interventions like artificial hormones to induce or increase strength and frequency of contractions, artificial rupture of the amniotic sac, immobility due to too many devices connected to the body and pain medication disrupt this delicate balance. Many births end in an emergency c-section because of iatrogenic problems (caused by doctor: describes a symptom or illness brought on unintentionally by something that a doctor does or says) which later are often attributed to a fault in the mother’s body (failure to progress, cephalic-pelvic disproportion etc). Instead of seeing that the hospital setting caused the problems, the doctor is celebrated as a hero and savior for saving the mother and/or baby with the help of high tech equipment. A home birth makes it possible for a birthing woman to birth at her own pace, in a familiar environment, surrounded by people she knows and chose to be present. A home birth is not less painful but since pain medication is not available the woman will –supported by her birth team – use alternative pain-relieving methods. She and her newborn will reap the benefits of a drug-free birth as not only will the mother recover much quicker but her baby will also be more alert and better be able to breastfeed.

If you are interested in more information on this topic, read the





 #5 : Episiotomies prevent tearing and heal faster


Many studies and experience have shown that episiotomies oftentimes cause extensive tearing, and don't heal as fast as tears that happen naturally. Many doctors perform episiotomies routinely on their patients, even though the delivery could have been completed without this intervention.  This leaves the new mother with a surgical wound which will prolong her recovery and impair her well being during the post partum period.

To prevent tearing it is recommended to employe spontaneous, non-directed pushing (the birthing woman pushes when and how long she feels the urge to) as opposed to prolonged breath holding and straining on command. Warm, moist compresses should be applied to the perineum for perineal support.

Check out this report on the topic on

Midwife Gloria Lemay's article on keeping the perineum intact can be found here:




#6: There is no Prevention or Cure for Preeclampsia


Preeclampsia, toxemia and eclampsia are symptomatic degrees of the same disease which have been shown by Dr. Tom Brewer to be mainly caused by nutritional deficiencies. For decades the findings of Dr. Tom Brewer have been neglected.  In his 1982 (!!!) study Dr. Brewer showed that by improving the diet of pregnant women (a healthy, varied, well-balanced diet that included high quality foods, adequate protein and complex carbohydrates, drink water to thirst, salt to taste and avoid drugs) he all but eradicated preeclampsia in the specific populations where the former rates were upwards of 40 percent. 

The anatomy of eclampsia is complicated, but the basis of Dr. Brewer's research is simple: Eat good food and avoid drugs. Working with a poor, malnourished population, he looked at what the women were eating and the high rate of eclampsia and other serious maternal /fetal health problems (Brewer 1982). Rather than throwing complicated, expensive technology and drugs at the problem, he did something logical—he fed them. He asked what they were eating and recommended they eat whatever healthy, whole foods were available to them. Apparently their diets were especially deficient in protein, so he recommended they eat eggs and drink milk because these were not only nourishing, but also inexpensive and easy to come by. Meat was expensive and scarce, but if the women could afford to obtain some, he recommended they add it to their diets, too. Contrary to the popular beliefs at the time, he told women to salt their food to taste. This supports an expanding blood volume necessary to support pregnancy and grow a baby. He reduced the rates of eclampsia from 40 percent to almost nothing.

Due to the nature of Dr. Brewer's study (the research that was done was not widely accepted due to the fact that it could not include clinically controlled studies. It would not show common sense or ethics to starve a group of pregnant women in order to supply a control group. The researchers did the logical thing and used the women's previous diet and circumstances as the control (Brewer 1982), the results have for the most part been dismissed by the medical community. Unfortunately, most physicians fail to read Dr. Brewer's research and instead base their judgments on hearsay.

A woman doesn't have to be poor and obviously malnourished to experience the effects of nutritional deficiencies in her pregnancy. Many families are still affected by preeclampsia and no drugs have been found to prevent premature births and maternal and fetal deaths caused by preeclampsia.

Information on Dr.Brewer's research can be found at Brewer Diet Web site at, or call the hotline at (802) 388-0276      (802) 388-0276    

I strongly recommend reading  the full article from which I copied and pasted :




#7: New moms should be up and active soon after birth


I found this article on midwife Ronnie Falcao's website: :

In my midwifery training, we were told that women ultimately recover better and more quickly if they rest well in the first few days.  After all, their body is still "laboring" for 10-14 days after the birth, continuing to have contractions to keep the uterus well contracted.  Many people don't realize that after the placenta is delivered, it leaves a placental "wound" that is as large as the placenta, usually the size of a 10-inch dinner plate.  The blood flow to this site before the baby is born is about two cups per minute.  If the uterus isn't able to contract and stay reasonably well contracted, the woman would have significant bleeding from this site.  So when women try to "get back to normal" too soon after the birth, they run the risk of using up the energy that is supposed to be going to keep the uterus well contracted to keep her bleeding to death.  I strongly encourage my clients to respect this miraculous aspect of birth and stay in bed completely until the milk is in, and then to continue resting in bed or in a relaxed environment in a common room until the baby regains the birth weight.
NOTE - I've seen the word "babymoon" co-opted to describe a pre-baby "second honeymoon".  Those are great, too, but they're a completely different concept.  The importance of the post-birth babymoon is for the woman's body to recover physically, which she can't really do before the birth.  :-)





#8: Low Amniotic Fluid Level = Induction


If a woman's pregnancy goes past the due date she will at some point be subjected to what is called a "Biophysical Profile" to determine whether or not her baby is still doing well in utero. One parameter that is being determined is the amniotic fluid level. Unfortunately ultrasound/sonography doesn't lend itself to show the amount of amniotic fluid around the fetus. This often leads to an incorrect diagnosis .... which in turn leads to an unnecessary induction of labor ... which in turn can lead to interventions to coax an unripe cervix to open ..... which in turn can ultimately lead to a cesarean birth. (A truly low fluid level/ oligohydramnios and everything pointing to the baby being at risk of course calls for an induction)

The high tech approach undoubtedly has it's place in maternity care but is in some aspects only an unsatisfactory substitute for more hands-on diagnostic methods like palpation. Through palpating the pregnant abdomen a midwife/OB can gather this information more accurately (and less costly) than through ultrasound.

I recommend reading the article by midwife Gloria Lemay, who wrote this article in her blog .




#9: The Timing of Cord Clamping Doesn't Matter


In most hospitals the umbilical cord of the newborn is cut almost immediately after the delivery. There are few reasons that necessitate this practice. Unless it is a multiple birth, the cord is extremely short or the baby needs medical attention which can't be administered at the bedside, this practice is not only unnecessary but negatively affects the neonate. 

An article in The Compleat Mother #86 called "Severed Lifeline" discusses the topic. Here is a short synopsis: when the cord is cut before placental blood finishes flowing into the baby, he not only misses out on the volume of blood left in the placenta (which can dangerously lower the baby's blood pressure), but also cuts her/him off from the main source of oxygen, iron, antibodies and more. Oxygen starvation due to early cord amputation is enough to cause the brain damage that can lead to autism and cerebral palsy.

In Ann Frye's "Holistic Midwifery Vol 2" on page 496pp I found the following information:                When the cord is clamped too soon, the placenta is prematurely amputated, abruptly preventing or interrupting the transfusion process. As a result the baby may be deprived of as much as one-third to one-half of her blood volume - a circulatory insult no adult could withstand - leaving the baby in a state of hypovolemic shock.

The reasons to await physiological closure of the umbilical vessels are too many to list here but include:

- 50% larger red cell volume which will allow for the iron in these cells to be stored in the body, preventing anemia for months after birth as well as ensuring optimal oxygen transport to vital organs.

- Higher quantity of white blood cells, antibodies and platelets, as well as plasma proteins and other nutrient benefits.

- Better circulation and less trouble maintaining body temperature.

- The baby receives an optimal transfusion of her own stem cells.

There are different opinions on how long to delay the cutting of the cord. Some wait until the cord stops pulsating, others until the placenta is delivered( 20-30 minutes postpartum). Some practitioners wait until there is no more pulsing detectable at the base of the umbilicus. This allows the baby to receive an optimal tranfusion of blood and an adequate opportunity to equilibrate her blood volume through the cord if necessary.











#10: It's just the Baby Blues.... 


Even though most women recover quickly from birth it is important to note that a traumatizing birth increases the risk for the mother to develop a Postpartum Mood Disorder (Postpartum Depression,  Postpartum Anxiety Disorder, Postpartum Psychosis and Post Traumatic Stress Disorder (PTSD) After Childbirth) which does require professional treatment.

Birth trauma includes:

  •  physical trauma (injury  to tissue) causing pain in the postpartum period and impeding adjustment to life with a newborn
  •  emotional trauma in case of emergency situations with risk to the life and health of mother and baby (often leading to surgical delivery)

In our medical system Postpartum Follow-Up care is greatly lacking. The first postnatal appointment  6 weeks after  the birth comes very late as Postpartum Mood Disorders can manifest themselves before this time. Even then many health care providers don't put enough emphasis on recognizing problems in emotional aspects of the postpartum recovery (emotional state of the mother, maternal infant attachment  indicators).

These numbers show that Postpartum Mood Disorders are not a rare:

  • Between 1/4 and 1/3 of women remember their births as traumatic
  • Of these 1/8 to 1/4 develop Post Traumatic Stress Disorder (3-8% of women have PTSD  after Birth)
  • 3% of women who had clinically normal births developed PTSD

This means that of the approx. 4, 25 million births in 2010

  • 1.1 million to 1.4 million were traumatic births
  • 168.300 - 350.625 of the traumatic births resulted in PTSD
  • 127.500 women developed PTSD after clinically normal births

Note: The studies which produced these results are from 2000 and 2008. I used 2010's birth rate which means that my numbers are appoximate...

Very few first time parents are aware what a challenge life with a newborn can be.  In order to not sound ungrateful or admit that their new life isn't as picture-perfect as they expected, hardly anyone talks honestly about their struggle to adjust to meet the around-the-clock needs of a new baby or even of feeling depressed. It is therefore very important that care providers educate families and provide better care and that new parents have enough information and/or support to identify problems and seek treatment.

I highly recommend a comprehensive article by Penny Simkin (in two parts) on this topic:





 #11: Contractions 5 Minutes Apart = Go to the Hospital



Most expecting women and partners have been told and read that they should leave home once contractions have been coming regularly every 5 minutes for an hour. If labor is truly well established and has reached what is called “active labor” (as opposed to early labor) this may be the time to head towards the hospital. However, the contractions may be regular but still fairly mild and a long labor may still be ahead. For a first-time mother it is impossible to tell how strong her contractions are because she can’t compare what she doesn’t know.  Staying at home until the active phase of the first stage is reached allows the laboring mother to rest and save her energy. As with everything, there are exceptions, for example rupture of amniotic sac and bleeding, which are reasons to go to the hospital even before the 5 minute interval has been reached.

Arriving at the hospital too early can lead to all kind of interventions. If contractions are deemed not strong enough or dilation doesn’t progress fast enough, women are told to walk around, possibly exhausting themselves to coax her body to do what is wasn’t ready for yet. The amniotic sac may be ruptured to “speed things up” or “get things going” which puts the laboring woman on the clock. When all this doesn’t work Pitocin is administered to artificially produce contractions. I am not going to go into what the adverse effects of artificially induced contractions are but will just say that this is the first step toward a cesarean delivery.

Having a labor doula helps the birthing woman/couple be comfortable at home longer, ease their fear of staying home too long and delivering in the car and help them determine when labor has reached the active stage.

Midwives and some doctors ask to speak (or listen) to the laboring woman prior to coming to the birth center or hospital to hear her during a contraction. This is almost always a reliable way to tell if a woman is in early or in active labor and can be a great way to avoid the pitfalls of leaving for the hospital too early!



Myth #12: Don’t Spoil the Baby


In my role as Lactation Counselor, Childbirth Educator and Doula I am often asked if picking the baby up everytime s/he cries and feeding on cue will spoil her/him. Many experts, among them Dr William Sears state that babies can’t be spoiled by getting their parents’ attention when they need it. In fact, not tending to an infant when it signals distress can cause emotional and physical harm.

The advice to let the baby cry it out to help him/her become an independent individual as early as possible has for the most part been revised. Still many (new) parents are cautioned against letting the baby manipulate them or they will have to suffer the consequence – a spoiled child - later on.

The cry of a human infant is very unsettling to almost all (especially female) children and adults, and it is supposed to be. Without the help of others the human infant is completely incapable of keeping herself/himself alive. All s/he can do is cry to signal that s/he is hungry/has a dirty diaper, needs to be held etc.

The author and pediatrician Dr.Harvey Karp (The Happiest Baby On The Block) explains that the human infant, born at full term, is still 3 months premature. The gestation period of 9 months is a compromise between full maturation of the nervous and digestive system and the fetus’ size. Due to the immaturity of the infant Dr. Karp recommends to simulate the conditions in the womb in order to help the new baby adjust to life outside the mother’s body. Keeping this in mind it is easy to understand why most babies start fussing when they are lying by themselves – they were never alone, always heard the mother’s heart beat and digestive noises and get upset fast when they are hungry – they were continuously fed through the umbilical cord and never felt hunger.

In most western cultures the topic of co-sleeping (bed/room sharing) is very controversial. Studies have shown that this practice is more common than most believe – many parents prefer to “stay in the closet” to avoid judgment. Margot Sunderland, a British researcher has published a book on the topic in which she argues that the practice common in Britain. of training children to sleep alone from a few weeks old is harmful because any separation from parents increases the flow of stress hormones such as cortisol. (…)For example, a neurological study three years ago showed that a child separated from a parent experienced similar brain activity to one in physical pain. (…)Sunderland argues that putting children to sleep alone is a peculiarly western phenomenon that may increase the chance of cot death, also known as sudden infant death syndrome (Sids). This may be because the child misses the calming effect on breathing and heart function of lying next to its mother.” (excerpt from this article )

I understand that sharing a bed/ room isn’t an option for every family but it is important to be aware of the infant’s needs and to try to meet them to the best of one’s ability.

Similarly, most infants need/want/wish to be held most of the time which is not only impractical if the main care giver can’t afford to sit holding the baby most of her/his waking hours but also physically strenuous. In order to free the hands and still have the baby close to the body, many parents use sling or wrap style baby carriers to meet their new baby’s need for closeness.

Breastfeeding on cue is a good way to ensure that the baby is getting the milk s/he needs, aids the establishment of a sufficient milk supply and helps prevent engorgement in the mother. In the first few weeks this can mean spending almost all day with the baby on the breast. Infants don’t just nurse for food but also for comfort. There is nothing wrong with being a “human pacifier”, after all, plastic pacifiers were modelled after the human breast, and most babies prefer the real thing if it is available

All these practices of listening to the baby and following his/her cues don’t lead to having a demanding but rather an emotionally healthy child who is settled, trusting and interdependent.

Check out Dr Srears’ websites section on Attachment Parenting at




#13: Push - Push – Push


These are the words that can be heard in most delivery rooms in the United States once a laboring woman has reached full cervical dilation. It is assumed that the faster the birth the better the outcome and therefore that pushing should begin as soon as the passage is fully opened. Especially if the birthing woman doesn’t feel the urge to push (yet) the delivering OB will “coach” her to employ directed pushing. She will be told to hold her breath while bearing down (Val Salva Maneuver) and push a certain number of times for a count of ten during every contraction. However, the practice of active management of the second stage has several disadvantages.  

1.      If the woman doesn’t have the urge to bear down yet, it means her body isn’t ready. Once the cervix is fully dilated, it retracts and the fetus’ presenting part moves down into the birth canal, leaving the uterus partly empty. This is called the “latent phase”. The uterus has to contract (mildly and for some women unnoticeably) until it stretches tightly around the fetus again, before the task of pushing the baby out can begin.

2.      Instead of being able to rest and maybe even nap during the latent phase (commonly 10 to 20 minutes) the laboring woman wears herself out before her uterus is ready to effectively move the fetus down the birth canal. Should the mother be too tired to bear down effectively once her body is ready, the delivery may end up being completed with the help of forceps, vacuum delivery or cesarean section. Only when the woman reaches the “active phase of the second stage” with strong contractions that elicit periodic bearing down efforts, should she push actively.

3.      Bearing down too early during a contraction can cause trauma of the vaginal walls and bladder. During the early part of a contraction the vaginal wall is pulled taut and thereby prevents it and the structures underneath from being pushed in front of the presenting part.

4.      Bearing down too often and/or too long can cause the fetus’ to descend too fast for the tissue to stretch in preparation of the fetus’ passage. This can cause tears in the tissue of the birth canal as well as the perineum which are in many cases avoidable by slow pushing and perineal support.

5.      In order to avoid waiting for the physiological stretching of the maternal tissue many OBs routinely perform episiotomies to enlarge the vaginal opening. (See Myth #5) This obstetric operation  speeds up the delivery but is  often performed not for the woman’s benefit but rather the hospital’s convenience.

6.      Prolonged breath holding as well as prolonged bearing down (the spontaneous efforts are ca. 5-6 seconds) has been shown to cause a drop in the mother’s oxygen levels which lead to low levels of oxygen in the baby. A poor fetal heartbeat oftentimes leads to a surgical completion of an otherwise uncomplicated birth.

There are of course times, when active management of the second stage of labor is indicated, for example in a situations when the fetus is in distress and has to be delivered as quickly as possible or when the mother can’t feel her contractions due to a late epidural.

To read more on the topic I recommend an excellent book “ Episiotomy and the Second Stage of Labor” edited by Penny Simkin who suggests that “ management of second stage to protect the perineum from episiotomy or tearing is also management to protect fetal well-being."

Or check out: (scroll down , excerpt from article by Mayri Sagady’s "Renewing Our Faith in Second Stage," The Second Stage Handbook, a Midwifery Today book






The first thing a newly pregnant woman wants to know is her “due date”, the date the fetus is believed to have gestated in the womb for 40 weeks or 280 days. A fetus is considered full term between 38 to 42 weeks. Only 5% of all babies are born on their due date, the rest – obviously – is delivered before or after the estimated date of confinement (EDC). Unfortunately there is a problem with the practice of adhering strictly to the due date and scheduling inductions according to the doctor’s or hospital’s policies. First of, the EDC or due date is calculated by the last menstrual period. Not all women have a 28-day-cycle which means that not all women ovulate on day 14 of their cycle. This is however how the EDC is determined. If, for example, a woman has a longer cycle of 35 days, she will ovulate around day 21 rather than day 14, which sets her due date/EDC a full week ahead of true 40 weeks. Some women don’t know when they last menstruated or haven’t had a period before becoming pregnant because they were breastfeeding or just got off the pill. In this case measurements taken from sonograms are used to calculate the gestational age of the fetus. Just like older children, fetuses don’t all grow at the same rate and the results can be guesstimates rather than fact.  

In the USA most OBs insist on babies being delivered before the pregnancy goes past 42 weeks. The fear is that the post-term baby grows too big to be delivered and that the ageing placenta can’t supply the fetus with sufficient nutrients and oxygen etc. Caution is certainly necessary but inducing every woman because she has gone past her due date is not helping to improve morbidity and mortality rates for mother or baby. For some women it is normal to carry the pregnancies to 43 weeks and deliver healthy babies. Inductions can lead to surgical delivery (cesarean section) if the cervix isn’t ripe and the uterus not ready to release the baby. If a woman’s body isn’t ready to birth any method of induction but high doses of artificial hormones will fail to bring on good strong contractions that can dilate the cervix and expel the fetus. Induced labors are harder on the mother and the baby as pitocin-induced contractions tend to be stronger and more frequent than “home made” contractions. During each contraction the blood flow to the fetus is interrupted. Continuous strong and frequent contractions can deprive the baby of oxygen which leads to what is called a “stressed baby” and a cesarean section becomes necessary to “save” the baby.

As long as the mother and baby are doing well, which can be determined by easy measures like kick counts or more high tech methods like non-stress-tests (NST) and ultrasound. This allows the care provider and the parents to-be to see if the baby is active enough, how s/he is coping with contractions and if the amniotic fluid levels are still sufficient.

As parents we have to make important decisions for our children, whether to induce labor or wait for the baby to decide when the time has come to be born is one of the first big decision. In order to be able to make good choices we need good advice and this is what the OB or midwife is there for: giving professional advise and providing information, not forcing pregnant women to being induced because the OB won’t let me go longer than X number of days past the due date”. It is important to remember that we as clients/patients are the paying customers, we employ the doctor or midwife. Even though we should trust their judgment and take their advice it is – especially on controversial issues and important decisions- a good idea to gather information and possibly get a second opinion. We owe it to our unborn children to request an explanation for a supposedly necessary procedure to be able to determine if it is a routine recommendation or advice made with for your individual situation in mind. 

The Mail and Globe recently published an article on the topic:

Also, midwife Ronnie Falcao has an article on pastmaturity on her website:








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