Tuesday, January 5, 2016

Open Letter To Cosmo in Response to Expose on Home Birthing.

Click here to view:
Cosmopolitan's photo montage of "what it really looks like to give birth at home"

An Open Letter To Cosmopolitan:

Dear Cosmopolitan,

As a birth worker who has been at MANY home births, I find this shock and awe photo collection to be in very poor taste.  Not because the pictures aren't an accurate representation, but because you have a broad audience and without putting these pictures into context, telling the story that accompanies the moment in time, they could scare people who might otherwise happily consider a home birth.  One sentence.  Really?

Discalimer: I was not present at ANY of these births...but since you didn't add any description, or provide any quotes from the women, or provide a thorough and thoughtful interview about what I'm sure were very interesting birth experiences to allow us to understand what was going on in these moments, I am just going to speculate.  I recognize many of these scenarios and have seen these expressions and experiences many times before.  Please Mama's, forgive me (and feel free to comment and correct me) if I'm wrong, I'd love to hear your full account, but I want to a make a couple guesses that will tell more of the beautiful story that home birth in general can be, using these photographs as examples.

I'd recommend that you open the expose in another tab so you can click across to see each pic, and then click back to read my interpretation of what might be happening.

Photo 1.
At home births, or any birth in which a woman's need for freedom of movement is honored, we move around a lot, change positions to break up the labor process and to allow baby lots of opportunities to navigate through a pretty narrow passage.  This is certainly often one of them, but when I've seen this pose, combined with the double hip squeeze, the lack of modesty that normally accompanies active labor/transition, my guess is that this strong woman may be working on reducing an anterior lip of cervix or she has a baby that is in a slightly wonky position, causing more pressure on her back.  This position can apply the baby's head towards the front/anterior, and help to reduce the cervix, as well as remove some pressure from moms back.

Photo 2. 
This picture could represent any number of labor practices.  It's entirely possible that it might just feel good.  In labor, it can be extremely rejuvenating to take a shower, and this limber mama may feel like this stretch is good for her legs, back, arms, I kinda want to drop into that position right now, just thinking about it...pause...Damn that was a good stretch...Un-pause...She may also be trying to encourage a stubborn bag of fluids to break on its own.  Midwives don't (as a general rule) break the bag of fluids.  It's part of the natural process and keeping the bag intact can assist the baby in positioning, cause more even pressure inside the cervix (reducing the risk of the devil above), and eliminate the concern of baby coming into contact with bacteria that could cause infection if labor goes on for awhile.  At a certain point though, once there is considerable dilation, maybe 8cm, the intact bag of fluid can sometimes make it harder for baby to move down and apply more firm pressure against the cervix to help it open that last few pesky centimeters and a position like this can encourage it to bust on it's own...conveniently in the shower!

Photo 3.
Not much to go on in this one, but enough for me to say that this woman is probably in the pushing stage of labor.   Unfortunately for someone who has not seen birth, the act of pushing can look awfully painful.  She looks (to me) like she is working hard, but aside from a strong feeling of pressure in her pelvis, and probably some pressure in the birth canal/vagina, she doesn't look like she is in a great deal of pain, rather, I see effort.  This may change as the baby crowns, and I never try to sugar coat crowning, but up to that moment...AND THAT IS REALLY WHAT IT IS, A MOMENT...pushing is mostly what could best be described as a minute of really hard work followed by a few minutes to rest, recover, nap (I've heard women snoring between the contractions of second stage), and prepare for the next minute of work, all combined with the excitement of hearing that baby is getting closer and closer with every push, to being in her arms.

Photo 4.
This is a really beautiful moment.  It's really important to know that there may be a little blood that accompanies the baby regardless of where you give birth.  As you can see by this mama, she is transfixed looking at her baby. It's hard to imagine, but when a baby is placed in a new mothers arms, they see right past any blood, vernix, even meconium. This mama might have just found out if she has a son or a daughter, she might be recognizing some familiar attribute that is clearly her, or clearly the father.  She might be mesmerized by baby trying to open their eyes and seeing her for the first time. There is a lot about birth that is hard to imagine ahead of time, and for many people, being totally fine with a little blood is one of them.  The gloved hands you see belong to a midwife, she is likely checking the baby for one of the 5 things they evaluate for the apgar score.  This kiddo looks perfect at a glance, but they will be evaluating baby's heart rate, respiratory effort, color, responsiveness, and muscle tone. She may also be checking to see if baby is warm enough and evaluating if a warm blanket should be draped over both mom and baby.

Photo 5.
Another powerful pushing shot.  You can see the tension in her arm as she grasps the hand of someone she trusts. Partner, Doula, Midwife...Her face looks like effort to me, with a side of happiness, so perhaps someone has just uttered the powerful words, "You're so close!".

Photo 6 & 7.
Cosmo. Come on. That's a foot. If you knew home birth at all, you would know that a footling breech baby is not delivered out of hospital if it is avoidable.  This is a reason for a swift transport.  I'm not saying that that is the way it should be, I'm not saying it's not, but it is the way that it is. There are increased risks in delivering even a full/frank/butt first breech, and footings have additional risk factors. If this was an accurate representation of home birth, there should be a reassuring firefighter/EMT behind her. I live in, probably, the home birth capital of these united states and if it's not accepted practice here to deliver a footling breech at home, I highly doubt that it would be accepted anywhere else. Either way, it is certainly SO UNCOMMON that it shouldn't be included in a photomontage depicting normal home birthing.

Photo 8. 
This picture is being taken very shortly following birth. The cord is in the process of being clamped here, and there is a plastic clamp place close to the baby; the cord will then be cut in between those two clamps.  It's possible that it is being done by dad/partner, I'm just guessing due to the lack of gloves. The Midwife is listening the the heart rate or the lungs.  Baby is active, crying, and color looks great.  Dry towels are being placed under  and around baby to help baby maintain body heat.  The gloved hands are decorated with both blood and meconium, so baby's pooper works! 

Photo 9.
Pushing in a labor tub.  This will likely result in a water birth, but not necessarily.  Some women like to push in the tub, cradled in the arms of their partner, and go on to give birth in the water.  Some choose, and some are asked, to get out of the tub for various reasons.  This mama is holding onto a piece of fabric that is encouraging her body to naturally curl into a C shape around her baby, this helps the baby to move past the pubic bone and begin to crown. 

Photo 10.
This one is so important to explain.  This baby is about to be placed on mom's breast at the moment of birth.  Many people may look at this picture and be concerned about the bluish/purplish color of the baby's skin.  The grimace on the baby's face tell me that he or she is likely already making some noise and will be "pinking up" very nicely in the moments that follow this snapshot.  I hear a lot of birth stories in which women assume that something is wrong with the baby because of this color of the skin.  Babies are not born pink; as the lungs inflate and oxygenate the blood, the skin becomes pinker over the course of the first few minutes, their hands and feet can take 24 hours or more to lose that purplish hue. Aside from the baby's color, I love the look on mom's face; it's a perfect mix of intensity, relief and pure joy. And Dad back there...I mean really. Happiness. Happiness that the birth is over, mom is safe, baby is safe, the pride swelling in his chest for the strength of the mother of his child. If we could pan up a bit, it would not surprise me in the slightest if there were tears in his eyes.  

So Cosmo, if you are going to do an expose on home birth, either consult with those you are exposing and ask for the story behind the picture, or at least consult with a specialist in the field of home births.  These families, as well as families who will be informed by your media, deserve better than just a collection of pictures that, while "gorgeous and intense" as your one sentence synopsis stated (unless you consider the title, which is longer than your article, a sentence, then it could be two), without context, intense pictures can cause anxiety and fear, and possibly influence someone to opt away from a home birth.
Not that I really want Cosmo to become a medium for childbirth education...I don't...but don't use home birth pictures to get clicks and then leave the pictures completely open to speculation.  Not fair or kind.  I'd be happy to write an article or provide some pictures WITH interviews if you are really interested in getting alternative birth practices into the mainstream media. 

Kristin Dibeh
Kind Birth Services
Author of "Expecting Kindness"

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