7 Practices for a Natural Birth

Interested in a drug-free birth? Here’s are some tips!

It’s amazing to me how quickly the mothering instinct sets in. Perhaps when the pregnancy test shows up positive, or seeing that tiny little body on the ultrasound screen, or especially feeling baby kick for the very first time. Something changes inside us at some point and there is an undeniable urge to protect, nurture, and sacrifice for the health and wellbeing of our babies.  

There’s an article published in the Journal of Perinatal Education entitled “Safe, Healthy Birth: What Every Pregnant Woman Needs to Know”  in which Dr. Judith A. Lothian describes six practices to ensure the safe arrival of that sweet bambino through the miracle of birth, we’ve added a bonus seventh!

Let Labor Begin on its Own

As the baby nears the end of gestation it puts on layers of protective fat, it moves down into position, and the cervix ripens on its own. The uterine muscles also prepare for that approaching influx of oxytocin. Inducing labor before these vital things happen naturally can really put a lot of strain on mother and baby as things are forced into motion (sometimes unsuccessfully). There is a greater risk of shoulder dystocia, birth augmentations, c-sections, and fetal heart distress. If the pregnancy is progressing normally, it’s best to wait it out until mom’s body and baby’s body are ready and ripe all on their own. Read more about Types of Induction—Risks and Benefits

Move During Labor

labor support

Nature intended for women to move during labor. Strong contraction waves and pain are signals to mom that moving to more comfortable positions will help labor progress. And it will, as more oxytocin is released in response. Moving has been associated with shorter labors, less injury and harm to baby, and less blood loss for mom. Walking in early labor can also decrease the chances of birth interventions like forceps, cesarean, or vacuum extraction. Types of Medical Interventions—Informed Consent and Risks/Benefits

Get Some Labor Support

If a woman is surrounded by a trusted team of people who can advocate, support, and empower her, it provides an almost sanctuary for her, even in a sterile hospital room. She will be able to better relax, cope, and focus on laboring, all resulting in less interventions and complications.  Women who labor with doulas, midwives, friends, or family present have higher rates of spontaneous vaginal birth, less requests for pain medication and an overall positive view of her birth experience. Emotional support is as vital as physical support during labor. If you’re on the fence about getting some extra help, do it! Read Do I Need A Doula and How to Find One?

movement in labor

Decline Unnecessary Interventions

These days hospitals and OBs can find themselves on autopilot, motivated by policies and procedures, rather than the reality of what is really going on. Continuous electronic fetal monitoring (EFM) is pretty standard in hospitals. This can result in unnecessary c-sections for moms. Contrastly, intermittent monitoring has no increased risk for the baby, and decreases incidence of instrument vaginal delivery and c-sections.

Epidurals, and listen up because this is very interesting, interfere with labor because there is no pain. The brain, not processing pain, does not receive the signal to keep releasing oxytocin, therefore moving things along. Labor slows down. Pitocin is needed to induce labor. Pitocin induced contractions are unnaturally strong. Baby and mom don’t respond well, more interventions are needed. Epidurals are associated with more tearing, longer labors, instrument delivery and increased cesarean risk.

Avoid Laying on the Back to Birth, and Wait to Push until you Feel the Urge

Giving birth while laying on the back is so convenient for doctors, but can be bad for mamas.  The pelvic opening narrows and it’s much harder to get the baby in the right position to make its entrance, not to mention it puts mom at greater risk of tearing.  Doctor-directed pushing (“Push NOW!  Hold it for 1-2-3-4….”) puts incredible strain on the pelvic floor muscles and is stressful for baby. Find a better position—side lying, squatting, kneeling, all fours, etc. Baby will let you know when to push, and you’ll be in better shape when it’s all said and done. That being said, some women DO find being on their back to be the most comfortable and some really thrive with a little directed pushing so as always be informed of your options and follow your instincts in the moment.

Mother-Baby Bonding is Vital

mother baby bonding

It’s ideal to keep that sweet little babe right next to mama for the foreseeable future. It’s better for baby as it results in better body temp regulation, stable heart rates, better nursing. And it’s better for mom as it results in less hemorrhaging and lots of oxytocin-induced bonding with baby. Plus, you get the added bonus of staring in awe at those sweet baby cheeks. Who doesn’t want that?  

Listen to Birth Stories

We constantly receive messages of thanks from mothers who benefitted from listening to The Birth Hour during their pregnancy. It helps them feel prepared and pull from the experiences of women who have face similar birthing experiences.  

There it is! Seven key practices for a natural birth experience. Good luck mamas. You can do this!

 

This guest post was written by Austyn Smith.

VBAC: What to Consider from a VBAC Mom

Vaginal Birth after Cesarean

Making the choice to pursue a VBAC (vaginal birth after cesarean) is a hard decision to make. Many women may desire a VBAC but find themselves at odds with family members, partners, care providers, friends, and even society as a whole. There is so much misinformation out there, outdated practices being staunchly defended, and fear floating around the topic of VBAC that it can be overwhelming for even the most determined of mamas seeking a VBAC. In this post I would like to address some of these roadblocks and provide solutions for overcoming them as well as some tips for increasing your chances of achieving a VBAC.

Find Local VBAC Support

As a VBAC mom myself, the very first thing I would suggest to anyone considering a VBAC do is find support. You will need it. There will be plenty of people telling you why you shouldn’t opt for a VBAC. You need to surround yourself with people who support your decision to VBAC and will be there for you. While considering going for a VBA2C with my third child I was introduced to ICAN, International Cesarean Awareness Network. My local ICAN chapter provided me with the support, resources, and information I needed to make this hard decision and to educate myself to make informed choices for me and my child.

You can find a chapter local to you through their website, as well as lots of other resources for information regarding VBAC and cesarean recovery and support. ICAN is also on Facebook and Instagram. Search online for encouraging VBAC birth stories, and of course, listen to The Birth Hour for stories from women who have had every type of birth you can imagine—you can find VBAC stories here. Hearing other women’s experiences is an incredible way to learn so much about birth and find other women who have had similar experiences to yours as well as those who have had the types of birth you might desire.

Find a VBAC Supportive Care Provider

Achieving a VBAC is dependent on many things other than you and your baby’s health. Who you choose as your care provider, where you choose to give birth, and who you choose to have with you make a difference. A recent Consumer Reports study found that one of the most important factors for whether a woman will have a cesarean or not is where and with whom she chooses to give birth. Cesarean rates vary drastically from hospital to hospital and care provider to care provider. Research the options in your area. Ask other moms, ask doulas, ask your care provider about the cesarean rates for the hospitals and birth centers available to you.

Evidence shows that for healthy low-risk pregnant women, care provided by professional midwives reduces the risk for cesarean section when compared to care provided by physicians for a similar group of women. Family physicians also have a lower rate of cesareans compared to obgyns. Explore the idea of home birth. Connect with home birth moms in your area to find out the reputations of local home birth midwives. This is an area where your local ICAN chapter can be a tremendous amount of help. The chapter leaders and members will know which care providers are truly VBAC supportive as opposed to those who are only VBAC tolerant. They will be able to direct you to cesarean rates for local hospitals and you can ask other moms their experiences with specific doctors and midwives.

Once you have an idea of a few possibilities for care providers, call and set up a consultation appointment and interview them. Most doctors and midwives will see you for a consult appointment for free, but be sure to ask prior to booking. I was so nervous interviewing the two doctors I was considering for my VBA2C, what if they thought I was being rude? Who was I to question them? They were the ones with medical degrees! But my husband pointed out that WE were hiring them. WE would be paying them for their time and expertise and placing the care of our child and myself in their hands. We were entitled to ask a few questions. And he was right. Both the doctors we interviewed were completely welcoming of my questions and encouraged me to ask away.

A wonderful list of questions to use when interviewing a care provider for a hospital or home VBAC can be found here. I printed this list off and took it with me, don’t try to wing it!

Another thing to consider is when you will start this process. Many women choose not to start looking for a supportive provider until they are already pregnant. By then you are on a clock, you need to begin prenatal care and you can start to feel rushed. So often I hear of women who go ahead and go see their current provider just to confirm pregnancy and get things going with plans to switch later. Choosing to switch from a provider you may actually really like but who doesn’t support VBAC is difficult enough, but doing so after seeing them once or twice during a new pregnancy is even harder. Consider beginning this process prior to conceiving if possible. You won’t be on a time crunch and you won’t be in the throes of first trimester hormone surges! You will be giving yourself the time to make an informed decision that is the best one for you and baby.

Books We Recommend

Birthing Normally After a Cesarean or Two
Cut, Stapled, and Mended

Hire a Doula with VBAC Experience 

Vbac waterbirth

A doula is a person who is trained to assist women during childbirth and who may provide support to the family after the baby is born. A doula does not replace your partner. A doula does not provide medical advice. A doula does not tell you what to do. A doula rocks. My husband thought I was wacko for wanting someone we barely knew to be there with us during labor and delivery but was willing to go for it since I was so adamant about it. Within hours of our first VBA2C baby’s birth he stated that our doula’s fee was the best money we spent the whole nine months of pregnancy. Studies have shown that the most important thing for women to have during labor is continuous labor support from someone–whether that person is a nurse, midwife, partner, or doula, but in many instances doulas have a stronger effect than other types of support persons. Doulas wear many hats during a woman’s pregnancy and labor, but they are trained to provide the following:

  • Provide emotional support
  • Use comfort measures to assist the mother: breathing, relaxation, movement, positioning
  • Give information about the choices before the mother
  • Continuously reassure and comfort the mother (the key word is continuous—a doula never leaves the mother’s side)
  • Help a mother become informed about various birth choices
  • Advocate for the mother and help facilitate communication between the mother and care provider to insure there is always informed consent
  • Look after your partner as well (give them bathroom breaks!), but their primary responsibility is to the mother

A good doula is like magic. They know birthing women inside and out and provide invaluable support to both you and your partner. Doula fees vary from person to person and depending on where you live, and doulas who are still training or have completed their training but need to attend a certain number of births to finish their certification often offer lower rates. You can find a doula via websites such as Doula Match or simply by asking friends who have used one.

Educate Yourself on Evidenced Based VBAC Facts

Research, research, research. Read everything you can get your hands on about birth and VBAC. Take an out of hospital childbirth education class. Attend local ICAN meetings. Talk to other VBAC moms. This is your birth and you are in charge, but you can’t run the show without knowing the facts. Learn what the accurate statistics are for uterine rupture and the difference between complete uterine rupture and uterine dehiscence. (Spoiler alert-one is dangerous, the other is not.) Arm yourself with the facts about the risks of VBAC. The risk of uterine rupture after one low transverse (bikini) cut cesarean is about 0.5% – 1% depending on factors.

First time moms are at risk for complications that are equally serious to uterine rupture and occur at a similar rate such as placental abruption, cord prolapse, and shoulder dystocia. Check out this list of myths about VBAC. I used info gleaned from this and other articles on that site repeatedly when defending my choice to VBAC. Be smarter than me, accept early on that not everyone agrees that VBAC is a safe and appropriate choice for most women, (even though the American College of Obgyns says it is), and that it is NOT YOUR JOB to convince them that it is. Know your facts, be prepared to back up your decision with evidence but also be prepared to walk away.

Think back on your cesarean birth(s) and consider the reason you had a section. Were you induced? Induction can almost double your chances for having a cesarean. Learn more about physiological birth and how induction can affect the body’s natural processes. Sometimes an induction is absolutely necessary so learn about the different options should that need arise-not all inductions are created equally.

Oh and, physiological birth was a term I had never heard used until I was pregnant with my third child—I had to look it up. So, in case you’re like me… The website Spiritual Birth explains it well. “Natural physiological birth is an involuntary process orchestrated by neurochemicals and hormones that unfurl in a woman’s body, enabling her to give birth to a baby and make the transition to motherhood. Physiological birth is directed from within the limbic system of the brain and body in response to and in collaboration with the endocrine system of the baby and placenta… It can occur best when a mother is not disturbed during the process of labor and birth.”

Were these any of the reasons you had a cesarean?

  1. Did your water break but labor hadn’t yet begun? Read about your options here.
  2. Had labor not begun by your care provider’s ‘cutoff date’? Learn about the risks and benefits of inducing postdates here.
  3. Did a late third trimester sonogram show you had low fluid? Learn what the evidence says about fluid levels and induction here.
  4. Were you sectioned due to ‘failure to progress’? Research Friedman’s Curve, an outdated method used to determine if a woman is progressing ‘adequately’. Falling off this curve can result in being sectioned unnecessarily. The research used to develop this decades old method has been reevaluated and proven inaccurate and not supported by evidence, does your care provider still follow Friedman’s Curve? Many do. Learn more about it and the ‘failure to progress’ label here.
  5. Was your cesarean due to a breech baby? Learn what the evidence says about vaginal breech delivery, ECVs and VBACs, moxibustion and what your options are here and here.
  6. Do you have adorably squishy big babies? Did your doctor do a third trimester sonogram and estimate your baby’s weight using pelvimetry? Did this result in your being told you should induce early to get the baby out before it was ‘too big’? Or were you told your baby was already ‘too big’ and you should have a cesarean because your baby was never coming out vaginally?

The evidence does not support any of these practices. VBAC.com states that, “Research shows that routine late pregnancy screening does not improve health outcomes for mothers or babies when compared with women who do not have the screening. However, routine late pregnancy ultrasound screening can potentially increase the use of major interventions including a cesarean section.

Cesarean for Big Babies. Not Evidence-Based

Sometimes a care provider recommends that a woman be screened (by X-ray, ultrasound, computerized tomography scanning or magnetic resonance imaging (MRI) to determine the weight of her baby at birth. Based on these measurements the care provider decides whether or not the baby is “too big” to be born vaginally. This is called pelvimetry. Pelvimetry is an inaccurate method of predicting the size of the baby and cannot predict whether or not the baby will move down through the mother’s pelvis. An ultrasound screening has an error margin of 10% to 20%. Women who have pelvimetry are more likely to have a cesarean, but there is no evidence that the health outcomes of babies are improved. Medical experts state that pelvimetry should not be used to make decisions about a vaginal or a cesarean birth.”

Learn what the evidence says about ‘big babies’ here.

Did you have an epidural or other pain meds? Do you want them again? Learn about the risks and benefits of common pain management and their effect on the labor process. Did you get to the pushing stage but baby wasn’t descending well? Was your baby posterior? Research the use of chiropractic care in optimizing pelvic stability and baby’s positioning. Were you told your pelvis was too small to allow a baby to pass through? True cephalopelvic disproportion is very rare and can require imaging to properly diagnose. Learn more about the possibility that you have CPD before giving up on the idea that you can birth a baby vaginally.

hospital vbac

You get the idea. Learn more. Ask questions. Know your options.

Vaginal birth after cesarean is not right for every mom, but neither is a repeat cesarean. Women deserve the right to make their own informed decisions about how they give birth. If you decide that VBAC is right for you—surround yourself with a support system that will encourage you and be there for you. Connect with other VBAC moms and find a group such as ICAN that can provide the support and resources you need. Find a supportive provider and vet them carefully. Hire a doula to support you and your partner during pregnancy and birth. Arm yourself with accurate information and learn everything you can about labor and birth. Around 75% of women who attempt a VBAC will be successful, prepare yourself and your partner in the best ways you can to increase your chances of achieving your VBAC goal. Women do it every day and you deserve the chance to as well.  

This guest post was written by Elizabeth Quinn. Elizabeth and her husband, Percy, live in Jackson, Mississippi with their three daughters one son. She had two cesareans followed by two vba2c’s. Elizabeth serves as the chapter leader of ICAN of Jackson, Mississippi and advocates for evidence based care in maternity healthcare through her volunteer efforts within the birth community there. She is passionate about being educated about birth and helping women who have had cesarean sections to know their options.

What is Evidence Based Maternity Care & Birth

Why evidence based maternity and birth care are important

Simply put, evidenced-based maternity care and birth are policies and procedures based on proven scientific evidence from medical research and peer-reviewed journals. It is the practice of effective care with the least amount of harm. Unfortunately in many parts of the world, standard hospital care is not practiced in this way. In fact, many hospital procedures go in direct contrast to recent medical evidence, and increase the risks for healthy mothers and babies.  

Standard care in hospitals can be intervention-intensive. IVs, continuous electronic fetal monitoring, epidurals, restricting food and drink, restricting movement, and having mothers push in the supine position all increase stress to the mother and baby, disrupt the natural flow of hormones, and may lead to complications.  

There are a few reasons for this dichotomy between research and practice

Tradition

Many birth practices in America, were put in place in the 1950s and 60s, using research based on the past rather than looking forward. Although more information and education is now available, it is a challenge to turn research into practice. Traditional methods are simply easier to continue.

Profit

It benefits hospitals financially to use interventions like induction, pitocin, epidurals, c-sections, and lengthened recovery stays.

Liability

OB/Gyns can be nervous about being sued, and for good reason.  They are the second highest sued doctors after neurosurgeons. If worry creeps in to a doctor’s mind about the “traditional potential dangers” of labor (say, if water has been broken for a while, baby’s heart rate is decelerating, labor has stalled at a certain point, or the pushing phase is getting long), he can choose to order a c-section. If he is potentially sued, he can make the case that he took action by doing all he could, rather than waiting it out. The same can happen with other worries before labor—if a woman measures big, or has some minor concerns, a doctor may order induction to prevent possible negative outcomes and being sued.

Convenience

Unfortunately, these situations happen more commonly than they should. An OB might have a vacation coming up and therefore will push an induction to have the birth before he leaves. He might be at the end of a very long shift and ready to go home, so may order some pitocin to be administered to speed up the labor. It’s a sad reality, but it does occur.

Reliance on Specialists

Although doctors are traditionally trained to handle higher risk pregnancies and use many interventions, healthy women with low-risk pregnancies often choose to be under their care. This is certainly a woman’s prerogative and she should go wherever she feels the most comfortable. However, this can contribute to the slow progress of change being implemented in birth. A woman with a low risk pregnancy might be in better care with a midwife.

Lack of education

More support is needed in terms of evidence based maternity research, not only in the healthcare field, but for patients as well. Many women are simply not informed of the data and their options when they meet with their healthcare providers. In addition, there needs to be more awareness and implementation requiring performance measurement, improvement, and reporting in hospitals.

There is great need to close the gap between the evidence and the standard practices in hospitals, especially in the United States. Consider this table.

evidenced based care

There is, however, progress being made in certain parts of the country. Some hospitals are starting to encourage natural pain relief methods and utilize tools like birthing tubs, birthing balls, squat bars, showers, and supportive nurses on hand. A local hospital in Portland, OR has midwives deliver the majority of babies, and the doctors handle only the high risk cases and emergencies. These things are certainly encouraging, and a sign that change is possible, no matter how slow.

How to know if your care provider is using evidence based birth methods of care

Get familiar with the science. Here is a great article about evidence based birth and 6 key practices to a safer delivery for mother and baby. Essentially, induction, epidurals, and c-sections are overused, whereas labor tubs, labor support, changing of positions, eating and drinking during labor, and delayed cord clamping are all underutilized. Know your options for these procedures. Learn about other standard procedures like vitamin K shots, failure to progress, the science about mothers over the age of 35, the truth about waterbirth, etc,  Evidence Based Birth is a great resource with many scientific articles.

Discuss your findings with your current care provider. How do they feel about each of the practices? What are the local policies if you will be delivering in a hospital? Is your doctor flexible and willing to allow modifications to certain “standard” procedures? The better informed mothers become, the easier these implementations will be for communities.

Resources for learning more about Evidence Based Maternity Care and Birth

Evidence Based Maternity Care: What it is and What it Can Achieve

The American Congress of Obstetrics and Gynecology

Biomed Central

Evidence Based Birth

When it comes to evidence based maternity care and birth practices, education is key.

This guest post was written by Austyn Smith.

Meaningful and Practical Push Present Ideas

First of all, what’s a push present? It’s a gift that a partner gives to the mother as a ‘thank you’ for all of those hard months carrying their child and eventually ‘pushing’ that baby out through the ultimate gift of birthing their baby. I struggle with the term “push present” because a.) it sounds pretty dumb; and b.) it excludes mama’s who birthed through cesarean. But terms aside, I do love the idea of honoring the mother in this way. Many men choose jewelry that commemorates the baby’s birthstone or name which is lovely but I thought it would be nice to share some practical and meaningful ideas that might be out of the norm.

Postpartum Herb Baths

postpartum herb bath

I talked extensively about herb bath in the Must Have Postpartum & Breastfeeding Items post. Such a meaningful gift as it promotes bonding for mom and baby and relaxation for mama. My two favorite herb baths are here and here.

Postpartum Doula

A postpartum doula supports the new mom with evidenced based information on breastfeeding and physical and emotional recovery from childbirth. She will assist with mom/baby bonding, nursing, basic newborn care, care associated with mother’s cesarean or vaginal birth and soothing the infant when mom needs sleep. Postpartum doulas can be essential to new parents who don’t have family (or helpful family) to come in the days and weeks right after birth. You can hire a postpartum doula to come for a few hours each day or even to sleep overnight and help with those exhausting night feedings and care.

Comfortable rocker

baby rocker

@mel_jensen

With all of the expenses that quickly add up on a baby registry, it can be easy to move this one to the bottom of the list but the truth is mama will be spending endless hours in her nursing chair so surprising her with the one she was swooning over at the baby store would be an awesome push present. A few of my favorites are this recliner, this rocker+ottoman and this double rocker which is perfect for an older sibling to feel included and snuggle up next to mama while she’s nursing!

New phone or camera

New moms spend a TON of time taking pictures and videos of their precious babies. In the digital age don’t spend a lot of money printing photos but we do get to capture every adorable thing our babies do. Having the most recent camera specs on a new phone will make those pictures practically professionally taken. You can also opt for a nice DSLR camera if mom is really into photography.

Massage or massage subscription

After you give birth your body sometimes feels like it’s been hit by a truck—you used muscles you’ve never used before sometimes for days and then once baby arrives you find yourself contorting into all kinds of crazy positions to nurse and care for the baby. A postpartum massage is a VERY meaningful and practical gift. You can opt for a one-time deluxe massage at a local spa or a massage subscription that gets her regular massages at a more affordable price.

Photoshoot

breastfeeding photo shoot

We are huge fans of postpartum and breastfeeding photoshoots. These early newborn days are truly such a blur and having a professional photographer come to your home and document this time is a priceless gift. Many mothers enjoy herb bath photoshoots as well.

Weekend Getaway or Family Vacay

It’s surprisingly easy to getaway with a newborn—they are free to fly, require very little (boob and diapers) and usually sleep through flights. Although we recommend taking the first few weeks to bond with your baby in the comfort of your own home, a surprise trip to a relaxing spot would be a welcome gift for many mothers who feel isolated or swallowed by the sometimes intense postpartum experience. If you have older children maybe arrange for a sitter for them and getaway just the two of you with baby.

 

Circumcision: How to decide?

As a childbirth educator, there are a couple of topics that fill me with dread when addressing a group of soon-to-be parents, and one of them is circumcision.

If you’ve spent any time at all on the internet as it relates to parenting, you may have noticed that this topic can spark some very heated discussion, so much so that it can be hard to wade through the rhetoric to find solid information. Folks hold some strong opinions on this topic—and for good reason! The decision whether to circumcise or not will carry into every day of a boy’s life. So, how to give accurate information that will help parents decide? Here’s how I do it:

There are basically 3 things for parents to consider in deciding whether or not to circumcise their baby boy:

Religious or cultural reasons

On this point, I don’t figure I have too much to contribute as a childbirth educator, though occasionally I have helped Jewish clients who did not want to circumcise to explore the idea of holding an alternate ceremony (known as a brit shalom).

Aesthetic reasons

These usually fall under the headings of: “wanting him to look like Daddy” or “wanting him not to be bullied in the locker room.” Again, I don’t feel that I can speak to one person’s sense of what looks right or wrong, and I particularly don’t need to know which of the fathers in my class were circumcised or not. But I can note that since the rate of infant circumcisions performed nationwide in the US is around 55%, there is a high probability that there will be another boy in the locker room whose penis looks like your kid’s, whichever route they choose to take.

Health benefits and risks

Since I work very hard to research and present information based on current research evidence in my classes, this final category is the one to which I can really speak. And it can be surprisingly hard to sift through the claims that are out there about risk and benefit!

The American Academy of Pediatrics has been equivocal, to be sure. Their current statement on the one hand seems to endorse the practice, and on the other hand it doesn’t. This statement can be found on their website for parents:

“The American Academy of Pediatrics believes that circumcision has potential medical benefits and advantages, as well as risks. Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks and that the procedure’s benefits justify access to this procedure for families who choose it, however, existing scientific evidence is not sufficient to recommend routine circumcision.

Therefore, because the procedure is not essential to a child’s current well-being, we recommend that the decision to circumcise is one best made by parents in consultation with their pediatrician, taking into account what is in the best interests of the child, including medical, religious, cultural, and ethnic traditions.”

Their longer policy statement can be found here and the very detailed and long article from the task force behind the policy statement is here.

So, according to the AAP, the benefits outweigh the risks, but not so much as to become “essential to a child’s current well-being.” Which leaves us where, exactly?

I did my best to dig for solid numbers, and came up with this handy chart to compare benefits and risks. Let’s work our way down the list together, shall we?

circumcision infographic

Yes, Circumcision is painful

First off, circumcision is painful, and medical professionals recommend adequate pain relief both during the procedure and during the healing process (which takes about a week). The choice to circumcise your baby means he will feel pain, and there is always a small risk that he will have an adverse reaction to the pain medication.

Complications can occur

Further, the choice to circumcise means incurring the risk that there will be complications to the procedure. It is basically impossible to get hard numbers on this, since there is no universal reporting standard on complications. The numbers in my chart are a good guess. Mild to moderate surgical complications include: irritation of the glans, infection, excessive bleeding, painful urination, or scarring of the urinary outlet. The much more rare severe surgical complications include: hemorrhage or having too much skin removed. Some babies will need to have the procedure redone, either because the first attempt was inadequate, or because the skin re-adhered while healing.

For a small number of babies whose parents chose to leave them intact, they will develop a medical reason (often phimosis) that will require circumcision in adolescence or as an adult.

in tact baby boy

Perceived benefits of circumcision

Now we get to one of the benefits of infant circumcision: the reduction in risk of UTI. It is important to note that most UTIs in males occur in the first year of life, but overall incidence is still low at 1%. Baby boys who are circumcised do have a three to ten-fold reduction in risk of contracting a UTI in the 1st year of life.

Sometimes a reduction in the risk of penile cancer is mentioned as a benefit of circumcision, but the overall incidence of this type of cancer is so low, that the slight reduction in risk for circumcised men is barely statistically significant.

Finally, the other major purported benefit of circumcision is the reduction in the risk of contracting HIV and some other STIs. There have been several high quality studies done in Africa that show significant reduction of these risks. Whether their findings can be generalized to the population of American men is debatable.

It is important to note that rates of contracting sexually transmitted infections are affected to a high degree by socio-cultural influences. For example, the rates of circumcision in Northern Europe are much lower than the United States, but their STI rates are much lower as well. Regardless, the reduction in risk for circumcised men would not be completely protective. In other words, parents would need to teach their sons to wear condoms.

And on the somewhat uncomfortable topic of considering one’s baby boy’s future sex life, it is debatable whether adult men who have been circumcised experience diminished sexual satisfaction and function. I’m not sure whether this could ever be definitively proven, but there are certainly plenty of people who like to argue this point.

And that’s it. The risk/benefit ratio for circumcision as it regards to health concerns. You can see why the AAP has had a hard time making a definitive recommendation in favor of circumcision. It is, as they wisely put it, a decision that parents must weigh for their own sons. If you want to read more science-based conclusions, check out The Informed Parent: A Science-Based Resource for Your Child’s First Four Years.

This guest post was written by Stephanie Spitzer-Hanks. Stephanie gave birth to her first child in the Netherlands, where the nurturing and encouragement she received from so many women there inspired her to become a doula. Now she strives to give unconditional support and evidence-based education to families so that they can be confident in making the choices that are right for them. She is an ICEA certified childbirth educator, an Evidence Based Birth® Instructor, a DONA certified birth and postpartum doula, a StillBirthday certified bereavement doula, and a certified lactation counselor through Healthy Children’s Center for Breastfeeding. On the side of all of that, Stephanie is an ordained minister in the United Church of Christ, and she serves as a chaplain at a hospital and writes and speaks about birtheology when she gets the chance. You can find out what she is up to at www.revdoula.com.

What is MTHFR & How Does it Affect Pregnancy?

MTHFR and Pregnancy

My personal experience with MTHFR started in 2014 when my best friend lost her son due to stillbirth at 34 weeks gestation. There was no explanation for this loss after a healthy pregnancy up till this point. She just noticed reduced movement one day and when she went in to get checked there was no heartbeat. I stood by her side in that moment and our lives went into a tailspin. In the months following her son Greyson’s death, and many many appointments and tests later we found out that she had a gene mutation called MTHFR which we promptly started referring to as the “Mother F*cker” gene mutation because the problems it causes make it a total Mother-Effer!

Since learning all of this, my friend has gone on to have two healthy pregnancies and now has healthy 4 year old and 2 year old boys, but the journey was really hard and we’ve all learned a lot along the way.

What is MTHFR?

MTHFR is a gene mutation that affects the way your body processes folate. Most people don’t even know they have this gene even though it’s estimated that 40% of individuals do. It often doesn’t present any obvious problems but many woman that have this mutation often find out during pregnancy and reproduction when faced with repeated miscarriage or stillbirth. Even then, many women with MTHFR mutations have multiple successful pregnancies before they discover that they have an MTHFR mutation, they often discover it after it’s too late and they’ve suffered the unbearable loss of a baby.

Blood Clotting caused by MTHFR

Research has shown that the MTHFR mutation can cause blood clots during pregnancy between the growing placenta and uterine wall, in an area called “low flow maternal-placental interface”, which prevents transport of nutrients to the baby. It can occur early in the pregnancy when the fetus is super vulnerable causing repeated miscarriages or later in the pregnancy when a clot forms in the placenta or umbilical cord and causes stillbirth. 

MTHFR and Blood Thinners

Depending on which type of mutation of MTHFR you have, your doctor may prescribe a daily baby aspirin or a more extreme protocol of daily injections of a blood thinner called Lovenox. If you know you have MTHFR and are pregnant than you should already be seeing a maternal fetal medicine (MFM) specialist who will discuss your specific mutation and whether you need injections or not.

With her subsequent pregnancies, my friend ended up needing Lovenox and started giving herself a daily shot in her abdomen every day around 8 weeks and continued until several weeks after her baby was born. She saved all of the syringes and took this amazing picture with her rainbow baby when he was a newborn.

MTHFR lovenox

Folic Acid

Most pregnant women know that taking a prenatal vitamin is common practice, but for moms with MTHFR, who process folate differently, it’s important to take a prenatal vitamin that uses methylfolate instead of synthetic folic acid which can be harder to find (here’s the one my friend took).

Other Complications

Since excess homocysteine is a common side effect of MTHFR and high homocysteine can cause complications like pre-eclampsia and miscarriage it is important to monitor these levels although it’s been pointed out that complications can occur as a result of MTHFR even if your homocysteine levels remain normal.

Hope for the Future

I know all of can be really scary and confusing and is often amplified by the emotional trauma and devastation of having already suffered one or more losses but it often helps moms to know that there is hope and that many women with diagnosed and treated MTHFR have gone on to have healthy pregnancies and babies and when you are holding your rainbow baby in yours arms, everything will be worth it.

rainbow baby after mthfr