Free Birth

Free Birth

Should you climb this mountain alone?

At the risk of sounding paternalistic

As a physician (OB/GYN) I do not believe that any woman should be without professional support at the time of birth. Whether a Midwife or Physician you need a safety net. You need someone to Birth Assist.

At the risk of sounding paternalistic I decided to pen this blog. Hopefully after reading this you will not look at me as a money hungry, self absorbed, OB/GYN but someone who sees the need for everyone excelling in what they are trained to do.

For those who are not familiar the concept of “free birth” or “unassisted birth” is that a mom will deliver her child without the help of a Birth Assistant . My concept of a birth assistant is anyone (Midwife or Physician) that has been trained to assist in the birth of a child. I coin this thought of birth assistant because I believe that too many times patients do not educate themselves enough to actually take charge of the birth of their child and count on me as a OB/GYN to deliver their child.

Partnership in birth

is the key to placing patients in a healthy relationship with their birth assistant

The extreme of this birthing experience is the idea that a patient can spend 7 - 8 months reading text books, blogs, or looking at videos and become proficient enough to become their own safety net during a problematic birthing experience. Now I am quite aware that themajority of births are normal, natural experiences. Yet for the paucity of births that need a birth assistant I believe that a new mom does herself a disservice to not avail herself of this expertise.

Now I believe that the reason that patients turn to free birth is because of a traumatic experience under the hands of a medical professional not listening to the desires of the patient. Janet Fraser who coined “birth rape” is a prime example. Read: http://ecochildsplay.com/2009/05/... You hear in Janet’s experience a patient who felt helpless in a situation where her birthing freedom was taken away. I will not second guess the management of the Midwife but it is obvious that Janet’s experience was one that scarred her for life.

Medical education in OB/GYN focuses solely around the concept of preparing for disasters. This is why the majority of Dulas, Midwives, and birth activist look at OB/GYNs as a hurdle to having a natural birthing experience. In practice I see that the majority of patients only want to have a healthy baby and do not spend much time thinking about how their baby will be born. They count on me to deliver their baby rather than assist in the birth. From my prospective I am prepared to do both. Whether the patient will accept the responsibility to educate themselves on the experience and take control of their birth is something that I await. My job is to educate patients, prepare for the problems, but ultimately sit back and watch the glory that God intended to happen at the birth of a child.

My hope is that less and less patients will be put in the place where they feel that they are better off without the support of a birth assistant when their child is born.

A. Harris Sr., MD

Dayton, OH

I am sure that this will generate conversation. I welcome your thoughts.

Which birth control is right for me?

When thinking about birth control methods it is important to find something that fits your personality. Are you the meticulous person that will remember to take a pill every day. Or are you the person who needs an implantable device because you would lose your fingers if they weren't attached to your body?

Key things to remember when talking to your health provider:

• Discuss your health issues with the provider; He or she should already be probing into that issue BUT you take control of your healthcare by making sure. In particular, a personal history of blood clots (i.e. deep vein thrombosis), uncontrolled hypertension, stroke, severe migraines with any type of neurologic component, smoker over the age of 35, history of breast or endometrial cancer means stay away from OCP's (oral contraceptive pills)

• Have the provider discuss the full range of birth control options

• Have the provider discuss failure rates of the particular birth control method with you

Here is a quick list of the the more popular birth control types and my preference when it comes to prescribing them to my patients. This is based on failure rate. Failure rate is greatly influenced by how much work the patient has to do.

For the FAILURE rate: the number represents the how many pregnancies will happen in 100 women per year.

IUD (intrauterine device) [Mirena and Paraguard]: These are 5 and 10 year birth control devices (respectively). The Mirena is coated with a type of progesterone and the Paraguard is a cooper based mechanism. The IUD is inserted by your provider in the office. It can be crampy for the first 24 -48 hrs. In addition the device can cause irregular bleeding for about 6wks (on average) but up to 3 -4 mos. FAILURE rate <1

Nuva Ring: This is a contraceptive ring that is inserted by you once a month. The ring stays in the vagina for 3 weeks and then comes out for 1 week to start your menses. The issue I see with some patients is getting over the idea of having something in the vagina. The ring is to be worn at all times (most importantly during sex). If the ring is in the vagina comfortable then it is in correctly. The medicine is released by heat and moisture both of which the vagina has plenty. FAILURE rate 1-2

The patch (Ortho Evra): This a patch much like the smokers wear. It is placed on the skin (avoiding the breasts and waist) and the medication is absorbed through the skin. It needs to be changed weekly for 3 weeks and the fourth week is patch free and when your menses should start. The main complaint with the patch is that of skin irritation. FAILURE rate 1-2

OCP’s: The number of birth control pills available is enormous. The key is finding a pill that doesn’t cause you much breakthrough bleeding. ALL birth control pills help with acne so don’t let that influence your choice. Most women let the provider choose for them which is o.k. FAILURE rate: 1-2

Depo Provera: This is a 3 month injection of progesterone. Patient either hate this or love it. The love it group doesn’t have any side effects and no cycle while on the shot. The hate it group has hair loss, weight gain, and 3 months of irregular/constant vaginal bleeding. FAILURE rate <1>

Male condoms: Well, the condom is only affective as the man using it. The plus side is that condoms reduce your risk of STD exposure. The downside is that the FAILURE rate is 11.

Spermicides: Any of the foams, gels, creams. FAILURE rate is 20 - 50

Pull and pray: Need I say more FAILURE rate 20

Just getting started with the blog thing. If you have questions go to my web site www.horizonswomens.com and drop it off there.