Another Rousing New Year's Eve

After Elf finishes at 9:38 p.m. My spouse's head lifts off the recliner. He gives a few dazed blinks, wipes a little moisture off the corner of his mouth and asks “was it good?”

I say “I’m going to blog a bit.” And he’s all “No, dude! You got to get to bed or you’ll be a crab tomorrow and I’ll have to take care of those kids.” He’s referring to our children.

Anyway, he is the one who only got 4 hours sleep two nights ago and has never caught up from it (James discovered he could climb out of the port-a-crib while we were at the Great Wolf Lodge and did so at 3 a.m. and didn’t fall back to sleep until 6 a.m.). In fairness I do tend to get fussy if I am awoken before 7 a.m. Which is to say every day.

“Come on. Let’s be responsible grownups here. I’ll even read a while to keep you company. Hey, am I feverish or is it cold in here?”

Never mind that it’s New Year’s Eve. We haven’t met the new year since 2000 when my husband watched the broadcast of fireworks in Paris and I waited for the grid to go down. When your two energetic sons wake up at 6:30 regardless of how late you keep them up you finally resign yourself to getting to bed at an hour that could conceivably give you seven hours’ sleep. If no one wakes up in the middle of the night. And the cat doesn’t have a hairball attack. And no one goes into labor.

So I concede the wisdom of his order and head off to the bathroom to brush my teeth.

When I come out, everything is changed. He has a fresh beer – cheers! – and is wearing an excited smile. “TCM is showing The Last Waltz!”

You don’t say.

I will be going to bed soon. With some luck I’ll either be asleep or closing in on the end of The Little Women (for my book group) in an hour. He will be watching The Last Waltz. (Neil Young has just come on stage and is singing Helpless. Joni Mitchell is doing the vocals offstage. Did you ever realize the Muppet Show Band Dr. Teeth and the Electric Mayhem was made in the mage of real musicians? Dr. Teeth = Dr. John. Janice = Joni Mitchell.)

Husband just conceded “There’s nothing quite so pathetic as a nostalgic middle-aged person is there?” At least he’s self aware.

We’ll have to see which of us is crabbier tomorrow when those kids roll into their first morning of the new year.

Cytotec part II

My doula friend Terri had a client induced Monday night with cytotec. The woman had preeclampsia. She delivered her baby at 5:30 this morning with no complications. It was not until the sixth and final dose of cytotec that labor began in earnest -- and then it was apparently quiet immediate and intense. Contractions were right on top of each other. This after 24 hours' exposure to the medication with no signs or symptoms that it was doing anything.

Therein lies the wild card with cytotec. You never know which dose is going to do anything. And since it can't be taken back once administered, it is hard to control the frequency or intensity of contractions.

Thankfully all is well with Terri's client and her baby.

Cytotechnically speaking

Usually during my second prenatal meeting with a doula client I give them Ina May Gaskin’s article from Mothering magazine on Cytotec. I do so hesitantly, because I do not think pregnant women should read scary birth stories. Yet I believe a doula’s role is to educate parents. The Gaskin article lays out fully all the information parents are not likely to get from the hospital staff.

If you aren’t familiar with Cytotec (generic name Misoprostol), it is an ulcer medication. Its packaging carries strong and extensive warnings against pregnant women’s using it because it can cause premature labor, abortion and miscarriage. It is used to induce labor, especially in women whose cervices are not ripe (i.e. not very thinned or dilated).

From the warning label (page 8):

"Cytotec can induce or augment uterine contractions. Vaginal administration of Cytotec, outside of its approved indication, has been used as a cervical ripening agent, for the induction of labor and for treatment of serious postpartum hemorrhage in the presence of uterine atony. A major adverse effect of the obstetrical use of Cytotec is hyperstimulation of the uterus which may progress to uterine tetany with marked impairment of uteroplacental blood flow, uterine rupture (requiring surgical repair, hysterectomy, and/or salpingo-oophorectomy), or amniotic fluid embolism. Pelvic pain, retained placenta, severe genital bleeding, shock, fetal bradycardia, and fetal and maternal death have been reported.

"There may be an increased risk of uterine tachysystole, uterine rupture, meconium passage, meconium staining of amniotic fluid, and Cesarean delivery due to uterine hyperstimulation with the use of higher doses of Cytotec; including the manufactured 100 mcg tablet. The risk of uterine rupture increases with advancing gestational ages and with prior uterine surgery, including Cesarean delivery. Grand multiparity also appears to be a risk factor for uterine rupture.

"The effect of Cytotec on the later growth, development, and functional maturation of the child when Cytotec is used for cervical ripening or induction of labor have not been established. Information on Cytotec’s effect on the need for forceps delivery or other intervention is unknown."

As Ina May reports in her article and I have observed with several clients, Cytotec is administered by breaking a single pill into smaller parts. One or more of these parts (exact dose unknown) is vaginally inserted into the cervix. After some amount of time (I think it was four hours for my one client), they check dilation and labor pattern and, if necessary, administer another portion of the pill. This continues until the client is in active labor.

Patients are not told that the drug is being used off label. Nor are they told that there are no official studies of the drug as a labor inducer. For a recent example, read what the CBS Evening News broadcast a few weeks ago.

I had given the Ina May article to a client of mine a few weeks before her water broke at 37 weeks. When she arrived at the hospital, several hours later, not contracting, the resident checked her and said she was fingertip dilated and 20% effaced. He said the usual business about risk to the baby from her being ruptured and the need to move labor along. He said “because your cervix is still so thick and closed, we’re going to put a pill inside you to help get labor going.”

She asked “what is the pill called?” He said “Misoprostol.” She said, “Isn’t that the same thing as Cytotec?” He said, “No, I don’t think so. They are similar, from the same family of drugs…well, wait, let me think…Oh, yes, they are the same.” But, he immediately went on to say, it’s very safe and the best thing really when “your cervix is saying ‘I don’t want to do this.’”

The mother asked to speak with HER doctor, who essentially said the same thing. She said the drug is controversial because it is an ulcer drug being used for labor, but that it’s the best thing when “you’re just not ready to have a baby.”

Obviously there were other issues with this particular labor and the messages my client received, but related to Cytotec what I noticed was the complete unwillingness of the doctors to discuss any potential harms that could come from using it. They did not want to say it hadn’t been tested or that women had died from uterine rupture while on it.

In Ina May’s article she discusses some of the reasons physicians and nurse-midwifes like the drug. It is very efficient at moving an unripe cervix along. And in fairness, the labors I’ve been at where it was used, it was precisely to initiate labor in a woman whose body seemed caught off guard by labor’s arrival.

What I cannot understand and cannot abide, however, is its use without any comprehensive documentation of its affects. Doctors will review 19,000 women to see if VBACs are safe, but they won’t keep records on what happens to women on Cytotec.

When we terminated my first pregnancy, they induced labor at 20 weeks gestation using prostaglandin suppositories. It was around 12 hours from the administration of the first suppository and delivery. My cervix was completely closed and thick when they started. If they can get these results from a tested and documented chemical, why dabble with unregulated others?

The Goose is Getting Fat

“Punting again,” you think? Well in a way, yes. But it IS two days before Christmas after all.

Anyway, two recent publications for your last-minute Christmas Wish List:

1. Journey into Motherhood: Inspirational Stories of Natural Birth
I haven’t read it yet, but you can read an interview with the author (and expectant mother) here. Who doesn’t like to read positive birth stories?

2. Blessingways: A Guide to Mother-Centered Baby Showers – Celebrating Pregnancy, Birth and Motherhood
Not only is this the book I thought I’d write one day if I ever got the spare time, it’s written by an Ann Arbor doula and Birthworks instructor, Shari Maser. Way to go Shari!

Season of Wonder

Such a newbie am I to the birth scene. Every day or read something that makes me go “Wow!” Today I was visiting Sage Femme’s blog and learned that she donates unwanted home birth placentas to her local Search and Rescue team for use in training their search dogs. Wow!

In case you don’t follow these things, today is the Winter Solstice. According to Weather Underground (the National Weather Service’s website…not the 1970’s revolutionary group) tomorrow will have THREE MORE SECONDS of daylight than today.

There are many, many rituals, ancient and modern, to mark this time of year.

Ancient Romans celebrated Saturnalia, where people feasted, masters and servants switched places (hence orgies) and gifts were exchanged. Scandanavians celebrated Yule (juul), which leant many features (holly, ivy, mistletoe, elves) to modern Christmas. Sweden has St. Lucia’s Day, where a young girl wears a wreath of candles on her head and enters bedrooms in the morning serving sweets and coffee.

Mummers? Wassailing? Thank the Pagans. Romania has the turta, which is part of a sweet fertility ritual.

As women, there are solstice themes that we can’t help but resonate to: the “wheel” (yule) or cycling of seasons; the rebirth of the sun; the promise of warmth and new life in the months ahead.

Today take a moment and note the day: its low sun, its fast-fading light. Also honor the darkness: sit in it and think of both its comforts and its many negative metaphors; observe how much space it takes up on this its longest presence in our year. Wow!

Capturing Birth

One of these days Doulicia will get some teeth and be vicious and opinionated and show that she is really passionate about some things.

But today, whether it’s hormones or the fact that Avery had us up from 4-5:30 a.m. with more G.I. trouble, I need soft and fuzzy.

So I present first, Jude Roman Fairbanks’ birth. If you can get it to work on your computer, the photography is stunning. And the song is so pretty. I watch it once a month and cry every time.

And if you love watching birth footage, you can order all kinds of homebirth and water birth videos from this site.

If you’re thinking of filming your own or someone else’s birth, here’s a page with good tips.

Meandering around the birth documentary terrain, I have to include Ann Arbor’s own Harriette Hartigan. Her pregnancy, birth and nursing photos are outstanding.

The Big New VBAC Study

This month’s New England Journal of Medicine publishes a study of trial of labor versus repeat Cesarean. It concludes that “A trial of labor after prior cesarean delivery is associated with a greater perinatal risk than is elective repeated cesarean delivery without labor, although absolute risks are low.”

How low? In an editorial appearing in the same issue, Dr. Michael Green, M.D., says “there would need to be 588 elective repeated cesarean deliveries to prevent one poor perinatal outcome [from an attempted trial of labor].” He states that, “Some people will consider the estimated 588 cesarean deliveries needed to prevent a severe adverse perinatal outcome to be a reasonable number, whereas others will consider the perinatal risks associated with a trial of labor small and well worth taking for the benefit of a vaginal delivery. Ultimately, risk, like beauty, is in the eye of the beholder.”

I confess to not having read the study results yet. But a summary in that venerable publication USA Today says that among the VBAC women, uterine rupture was much more prominent among those on pitocin (either to induce or augment labor). In the trial of labor group, the overall uterine rupture rate was 0.7%; in the women on pitocin, it was 1.1%.

And now, because I absolutely MUST be in bed by 9:00 or my spouse will accuse me of loving my laptop more than him, I throw out this one, warm and fuzzy link without much context. It’s about a recently constructed birth center that serves a largely Amish/Mennonite community in Pennsylvania. Much of its furnishings and supplies were donated by Amish and Mennonite families. Can you imagine how pretty the bed covers must be?

The 3 Rs: Reading, Writing and Reproduction

A friend said I should investigate whether “alternative” childbirth is ever taught in high schools as part of a health education or other class. I spent about half an hour and was not able to find anything to indicate that it is.

As I think back on my own high school education, I don’t know that childbirth was taught at all, even in biology. To the degree reproduction was covered in biology, it was all about anatomy and embryology. We were not required to take a health class, and health/body issues were not covered in gym.

I was pleased to see that many high schools do include childbirth as part of their health class curriculum. If the testimonials on the Empathy Belly page are to be believed, some classes go so far as to let their students simulate some of the physical effects of pregnancy.

As an example, the Boulder School District includes human reproduction in its tenth grade health curriculum and has as a learning outcome that students be able to describe the stages of pregnancy and childbirth (see page 41 of the PDF). Fresno schools include an exercise where high school students are asked to consider how they would answer young children’s questions about pregnancy and childbirth (e.g. “How does the baby get out of the mommy?”) (see Standard Six in their curriculum).

Now I suppose teen mothers are not getting their actual childbirth education through a high school class. Hopefully they ARE getting it from somewhere. I have not worked with any teen mothers yet to get a sense of what information they’re given and by whom. I assume that as in most other areas of a teen’s life, their primary source of information is friends. I don’t imagine teen culture having much exposure to or experience with alternative childbirth. Likewise, my suspicion is that even in towns where homebirths or nurse midwife practices exist, teens are steered toward OB/GYNs. So I don’t imagine there are many places where they would butt up against “alternative” birth culture.

This could be an opportunity for midwives, doulas and childbirth educators to approach their local high schools and ask if they could do a guest lecture when the class discusses childbirth. Plant the seed early that there are many ways to give birth.

Ectopic Topic

Illness at our house continues. We’re developing a real knack for sequencing such that at least one of us is under the weather at all times and one or two others are exhausted because of it.

This gets me thinking about women who go into labor while they’re sick. Can you imagine? Labor is a challenge under the best of circumstances. To already be physically run down or undernourished must make it a real trial. I wasn’t able to find any accounts of women who went through labor when they had the flu or a cold.

I did, however, find a story about a baby who was delivered from an ectopic pregnancy at 37 weeks by Cesearian section. They weren’t aware the pregnancy was outside the uterus until they opened the mother up and the baby wasn’t in the uterus>. “"It was very surprising. I explored the abdominal cavity and felt the feet," said the doctor who did the delivery.

And while on the subject of ectopic pregnancy, last month the FDA announced that RU-486 will be getting stronger warning labels. There is concern that in women with ectopic pregnancies, the drug can cause excessive internal bleeding. Reproductive rights watchdogs say this is just a Republican effort to further restrict the drug’s use.

Reason #52 to avoid a Cesarean if you can

They might forget the anesthetic. Needless to say, the woman’s lawyer is talking to her anesthesiologist’s lawyer.

On the other hand, it wasn’t until the mid-1800s that anesthesia revolutionized surgery. For the hundreds of years before that, women had their Cesarean deliveries as sentient as you are as you read this. Not that a lot of them lived to talk about it. Perhaps the surprising thing is that in those days before sterile procedure or understanding of germs, some women DID live.

For an interesting illustrated history of the Cesarean delivery, check out this site. It has the text of a brochure prepared for the National Library of Medicine and includes reprints of woodcuts showing abdominal birth dating back to the 1500s.

Car Birth

So many women I talk to worry about giving birth unexpectedly at home. I always reassure them that babies rarely come so quickly that there isn’t time to get to the hospital, if that is what they’ve planned to do. And I once had a nurse midwife tell me that babies that arrive that quickly usually do so because there’s nothing complicating their delivery and that in fact it’s a sign that the birth is going just fine. Whether or not it’s true, I like the sentiment of it.

I came across this article about giving birth in a car recently. It uses every opportunity possible to reinforce the popular notion that birth is a crisis: “Now bent over and screaming, Carolyn could barely walk. Ram did his best to carry her without adding further pain and hoisted her into the front seat of his Suburban, all the while she was screeching out at the top of her lungs.” It concludes, “This week, Carolyn and Ram Miller met the firemen of Station 69 and gave them all a big hug for their heroic efforts and calming nature in what was a very traumatic moment.”

Gosh, gals! Where would we be without men? In fairness, the article was written by a male friend of the family, not a journalist. But that makes his characterization of birth all the more relevant. I think this is the “car birth myth” most women hear and believe.

If you know of any scared women, please refer them to this car birth story.

Earlier this fall my friend and fellow doula Terri worked with a client, Lisa. Lisa's first birth, daughter Jane, happened very, very soon after Lisa got to the hospital. So when Lisa called Terri to say that her water had broken, Terri made tracks to Lisa’s house.

Terri found Lisa draped over a birth ball moaning deeply during and resting calmly after her contractions. Almost immediately, the contractions became more intense and closer together. This coincided with the hurried arrival of Lisa's husband, Brian, who was in the middle of teaching music class. Everyone agreed it was time to head to the hospital.

Terri reports that when Lisa stood up to go to the car she had a loud and long contraction and sprinted to the car. (Or was it that she started sprinting and then had the contraction?) Either way, as soon as she got to the car she said those eyebrow-raising words “I feel like I have to go to the bathroom.”

It was then that Terri went in to dial 9-1-1. When she came out to look at the house number (after all, you have to know where to send the ambulance) Brian said “The head is out.”

Golly if it wasn’t. Brian asked Terri if that was o.k. Terri said yes. What else do you say? You can’t exactly put the head back in. Terri said “With your next push, Lisa, you’ll deliver the baby,” which is exactly what happened, right into Brian’s hands.

Terri said the 9-1-1 operator kept insisting that she suction the baby, with a turkey baster if necessary, but the baby was crying heartily and Lisa immediately put her to the breast.

Around that time Terri heard the sirens. Both an ambulance and a fire truck showed up. But everything was already under control. All they did was help Lisa out of her Subaru and into the ambulance for a ride to the hospital ex post facto.

These photos clearly show that mom, dad and baby Claire were not traumatized in the least. In fact, have you ever seen a mother more radiant?

Lisa says, “There was no fear during that hour prior to birth, just focus. I attribute that attitude to God's grace, but in very real terms too, the confidence to trust my body that came directly from the knowledge I received from the Bradley Method. When Terri did arrive, certainly, I was VERY glad to see her! And this allowed me to let my body continue the labor in such an efficient way. Certainly, we were blessed that there were no complications and we can cherish the memory of our beautiful daughter saying, ‘here I am’ right outside our front door!”

Here we see Brian meeting his new daughter in the sunshine of a September day.

Incidentally, an ancillary benefit to this birth – at least in the hospital where Lisa went – was that hospital staff would not remove her baby from the room for any of the usual reasons. In fact a nurse midwife who works there told me babies born outside the hospital are considered “contaminated” and are therefore not allowed to mix with other babies or facilities.

Thank you to Lisa and Brian for letting me share their story and photos and to Terri for taking the beautiful pictures.

Naming your nubbin

Julia Roberts had her babies! How come no one told me? Hazel and Phinneaus (though everyone lists the boy first…is that because he was born first or because we like to list boys first?).

Here’s a fun story about crazy celebrity baby names.

Do you know, by the way, that in 2003 Emily was the most popular girls name(according to the Social Security Administration) and Jacob was the most popular boys name? I thought they had fallen a bit out of favor since their peak a few years ago.

Do you know that my son's name has risen from 249th to 222nd in popularity since he was born in 1998. That is on the list of boys names. As a girl’s name, it has gone from 495th in 1996 to 90th in 2003. No wonder all the other Averys I know are girls.

I am not pleased about this. I do not want him growing up thinking his name is a girl’s name. For the record, Avery is historically a male name. And there are some famous MALE Averys to know about:

Literary Averys:
Avery Hopwood is the namesake of the University of Michigan’s prestigious creative writing awards.
Avery is a (male) character in the book Charlotte’s Web (not that he’s a nice character…)

Musical Averys:
Avery Fisher Hall is part of the Lincoln Center complex in New York and is home to the New York Philharmonic; it is named for its benefactor who made his millions in the high-end acoustics business
Avery Sharpe plays a mean bass and has composed some sweet jazz, too

Athletic Averys:
Avery Brundage was a pentathlete and decathlete as well as president of the International Olympic Committee
Avery Johnson is a professional basketball player

Anyway, we named our second son James. In 2002, the year of his birth, the Social Security Administration did not list James anywhere in the top 1000 girls names. It was, however, the 18th most popular boys name

What throws up must come down

I have caught the G.I. bug my kids were enduring all week (and to think I thought I'd dodged that bullet). There is nothing like sitting up nauseous, doubled in cramps to make me think back to my pregnancies.

Hyperemesis Gravidarum (literally "elevated vomiting of pregnancy") is morning sickness on steroids. I had it for my first two pregnancies. Each time I lost between 10-15 pounds in my first trimester and was so debilitated by nausea that I was confined to the house for about seven weeks. Before leaving for work each morning my spouse would bring up a cooler with water, gatorade, a banana and some crackers in it. On a good day I could keep down half the banana and some fluids.

The nausea was persistent and intense. It had the baseline depth of sea sickness. Ordinary events -- getting undressed, having a conversation, smelling water boil -- were enough to send me retching to the bathroom. And unlike the vomiting I'm doing tonight, the vomiting of hyperemesis neither relieved the nausea nor ended quickly. Once started, the vomiting seemed to gather momentum with each retch. It could take up to 10 minutes for it truly to abate. I distinctly remember thinking that if someone told me I'd feel that way for the rest of my life I would kill myself. That was the first time I realized the power of hope for keeping people alive.

Atul Gawande wrote an article on the subject in The New Yorker, July 5, 1999 ("A Queasy Feeling: Why We Can't Cure Nausea"). It used a pregnant woman with hyperemesis gravidarum as a case study, thought it also looked at chemotherapy patients and people with inner ear problems. It's an excellent article and Gawande, at that time a medical resident, is a great writer and thoughtful ethicist. His essays are available in his book, Complications: A Surgeon's Notes on an Imperfect Science. But I digress.

Gawande's article said that women do not cite labor pain as a reason to avoid future pregnancies. But women did say that a past experience of intense nausea with pregnancy limited their subsequent number of pregnancies. The condition can become life threatening; some women even abort pregnancies if they are not able to get the condition under control. Thankfully my condition improved right about the time they wanted to begin IV nutrition and I got away with only a trip to the hospital for IV hydration.

If you're trying to treat at home, there is a long list of products you can try. These include
Sea Bands (sea sickness wristbands that stimulate pressure points on your wrist)
Ginger (some positive evidence, though I've also read it can trigger miscarriage in the first trimester if high doses are used)
homeopathic symforicarpos or nux vomica
Vitamin B6 (in specific doses -- talk with your care provider)

I had some success in my third pregnancy with acupuncture. Another woman I know got temporary relief when injected with her own urine (it only sounds extreme if you're not faced with unending nausea).

There are drugs that provide relief for many women: phenergyn and Reglan are two I know of. Of course the advisability of taking them during pregnancy, especially the first trimester, is always questionable.

A great on-line resource for women (and families of women) with Hyperemesis Gravidarum is http://www.hyperemesis.org/, website of the Hyperemesis Education and Research (or HER) Foundation. I wish it had been around when I was in the throes of my bouts; it was founded in 2000 by a nurse who endured nine months of nausea and vomiting. Bless her soul!

I vowed that if ever I knew of a woman with hyperemesis, I would gladly take in meals for her family so she wouldn't have to cook or smell food or that I would go keep her company if she was home alone, isolated in her misery. Please let me know if you fit this description.

And if you're pregnant and sick while reading this, my deepest sympathies go out to you. Fortunately the end product is usually worth it. And hospital food has never tasted so sweet as the meal after you deliver your baby and that nausea vanishes faster than you can say placenta.

Loss

Eight years ago today my first son was born and died. We knew he’d die. We induced labor at 20 weeks’ gestation when we learned he had hydrocephalus. His name was Louis. His head and trunk rested in the palm of my hand. It was a day of sadness and of feeling numb. Its shadow restrained my joy in future pregnancies and keeps me on guard for the wellness of my two living sons.

When I was pregnant that first time I was cautious through the first trimester, as many women are. The risk of miscarriage, we are told, is one in five. And so we privately steel ourselves for the possibility of that loss. And for 20% of us, we privately grieve its occurrence.

But of course, miscarriage is only one type of pregnancy loss. There is stillbirth. There are babies that are born with a congenital condition and die soon after birth. There are babies that die in delivery. There are “reductions” of multiples. There are abortions. There are babies that grow up to be children and then adults. And, well, in the end, they all die.

And loss is not confined to death. What about deformity and disability? Injury and disease? Babies are vulnerable creatures. Any number of things can come along and turn them from the path of happiness and vigor we imagine for them.

For women facing infertility, the loss occurs before pregnancy. Some women watch batch after batch of embryos fail to implant. Others ultimately have to give up their hope of ever carrying a baby in their body.

Then there are women who would like to have a baby, but are not in a relationship or are in a relationship that is not healthy for a baby. Or they do not have the means or support to conceive and raise a child on their own.

When women wish to be mothers, an aspect – be it overwhelming or faint, permanent or fleeting – of sadness and loss enters our reproductive selves.

I would argue that even in mothers who have never encountered any of these situations (and I suspect such women are rare), there is still a persistent element of loss to their maternal identity. It is the reason we save our children’s first shoes and the reason we check on them once they are asleep. It is the reason our hearts ache the first time they don’t want to hold our hand or sit on our lap. It is the unspoken, often unrecognized knowledge that if not already, then someday they will mean more to us than we do to them. They will leave. And even if we are glad to see them go, a little piece of us will nevertheless be lost.

“There is a sense in which all of motherhood is loss, an on-going continual separation, an unended grieving.”

--Centuries of Solace: Expressions of Maternal Grief in Popular Literature by Wendy Simonds and Barbara Katz Rothman

Bass Ackward

A few months ago Mothering magazine had a great article written by that midwife supreme, Ina May Gaskin, on breech birth. She had several reasons why vaginal breech birth deliveries must continue to be performed and taught in hospital as well as home settings.

If you enjoy birth photos, here are two different breech birth stories. The first is a home breech birth (graphic photos, so watch it if you pull this up at work). The second is a birth center delivery of a breech baby.

And hey – while we’re on birth photos, here’s one of a twin home birth. The twins’ mother maintains a website, www.breechbabies.com, which is the direct or indirect source for the links above. If you’re a junkie for birth pictures, she has links to many breech births here.

Who knows if the story is true, but friends of ours swear their friends had a baby arrive unexpectedly breech at the hospital. To honor his reversed entry into the world, they reversed the name they’d chosen for him and “Derf” is the name that appears on his birth certificate.