What Is Nine Leaves?

Before my career as a solo artist, there was Nine Leaves.  A collective of 4 rappers and myself, the sole composer and non-rapper.  Prior to this, I was interested in one day scoring film.  After this, I didn’t give a shit about scoring film.  Prior to this, I hated rap.  After this, I was rapping.  Prior to this, I was just a composer.  After this, I was a composer, and a lyricist, and a recording artist.

It was Nine Leaves that introduced me to the power of songwriting and the spoken word.  And it was within Nine Leaves that I learned how lyrics can influence and shape the underlying music, for better or worse.  I went from watching the other members react to my music, interact with it, compliment it, and transform it with their lyrics, to eventually doing the same alongside them.  And I ultimately came to see the spoken word as another instrument within the orchestra.  

Lyrics have specificity.  Even the most vague lyrics will inevitably narrow the total possible interpretations that would otherwise be available to a listener.  And thus, the absence of lyrics maintains a lack of specificity in music.  Both states, lyrical and non-lyrical, are powerful.  Both do things the other is incapable of.  And so it’s no surprise that throughout my career I’ve continuously utilized both states, moving between them as desired.

Nine Leaves is where these revelations and insights all started for me.  It’s the prequel to Zack Hemsey.  An effort that spanned 10 years, bridging adolescence into adulthood.  We were all teenage kids at the beginning, and by the end of it, most had children of their own.  It was a garden of ideas, and the studio a laboratory in which we tested our experiments.  Our collective explorations, our personal transformations, and our artistic evolution is all embedded in the body of work that Nine Leaves created.  A body of work that up until now, has largely been unreleased, and generally ignored.

So is the way it sometimes goes.  Except I found myself going through archives, resurrecting and restoring old sessions, and remastering the entire Nine Leaves catalog.  My intention was not to substantially alter the music, or attempt to “modernize” the songs in any way.  Rather, it was to treat the catalog as a historical work, doing only what was necessary to ensure that it speaks as it was intended to speak at the time it was created.

This process has been like opening up a time capsule.  Much of the material I hadn’t heard in two decades.  I fully expected my face to contort with embarrassment and disgust at what I was certain was going to be a sea of flaws, awful performances, and amateur mixes that were painful to listen to.  But instead, I was met with the carefree attitudes of young individuals making songs simply because they wanted to, and performances that were infectious because of their purity and sincerity.  Yes, it all sounded young…but it didn’t sound bad.  Quite the opposite.  The body of work still had value.  It was still worthy of being shared.

And so it’s my pleasure to introduce this.  It’s Nine Leaves music.

Apple Music - https://tinyurl.com/NL-Apple

Spotify - https://tinyurl.com/NineLeaves-Spotify

Bandcamp - https://nineleaves.bandcamp.com

Deezer - https://tinyurl.com/NL-Deezer

TIDAL - https://tidal.com/browse/artist/33583194

Open Letter To Jillian Michaels

Hi Jillian,

I recently read your book Yeah Baby.  You maintained a calm and collected approach in discussing what are typically emotionally charged topics, and it is in that same spirit that I hope you will receive this letter.  Some of the book’s content troubled me, and I’d like to offer some alternative perspectives that you may not have considered.

As a background, my education in childbirth largely parallels your own: I’ve been at my wife’s side through pregnancy and birth on two occasions, and I’ve done extensive research into an assortment of birth related areas via peer-reviewed studies, professional texts, books, lectures, films, and many hours of personal discussion with experienced childbirth practitioners.  Both of my children were planned home births, the first resulting in a hospital transfer 30 hours into active labor and culminating in a pharmaceutically-assisted vaginal delivery, and the second resulting in an unmedicated vaginal delivery in our house.  So it is the confluence of first-hand subjective experience with academic and interpersonal research that ultimately informs both of our perspectives.

To be clear, I think much of the book is excellent.  It wonderfully highlights the importance of being optimally healthy prior to conceiving, along with the link between the health of the mother and baby (even into adulthood).  It stresses the importance of nutrition and legitimate exercise, dispelling the myth of pregnant women being fragile and helpless.  It draws attention to the myriad toxins people regularly encounter and/or ingest unknowingly, and outlines ways to avoid them.  It has very good commentary on the effects of smoking and drinking alcohol while pregnant and trying to conceive.  It dismisses the notion that family bed sharing is controversial or dangerous in the context of sober parents.  And it illuminates the shortcomings and limitations of what doctors actually know.  

With that being said, I find some of the book’s other points of discussion disconcerting.  

After Heidi gave birth to your son, you write: “I was wondering if we were ever going to have a romantic relationship again.  I was being a selfish ass, I know.  However, I guarantee your significant other is wondering this, too.”  

I can guarantee you that not all significant others share your sentiment - I certainly didn’t after the birth of my children.  Yes, some partners do feel ignored and/or left out in the aftermath of a birth.  It's fine to acknowledge this possibility, but it’s not the responsibility of new moms to remedy this, as the book suggests - it’s the responsibility of the partner to sort their issues out and to temporarily put their needs aside.  As a partner, one should be genuinely invested in doing whatever is best for mom and her needs.  It’s not about the partner right now; it’s about the family they’ve (theoretically) chosen to build.

The book stresses the importance of sex in maintaining a connection between partners, encouraging new moms to make a conscious effort to work around all the emotional, hormonal, sleep, and practical impediments that get in the way.  You state that while “sex for some can seem low on the totem pole, I can’t stress enough how critical it is to your overall long-term relationship.”  

Yes, connection between partners is crucial - but if sex is the only means by which partners can maintain connection, then the relationship may have a bigger problem.  

You then offer an analogy: exercising even when you’re not in the mood results in feeling great post-workout, and so it will be with sex.  Thus, the book’s final instructions with respect to intercourse and other forms of sexual relations: “Do them.  When you aren’t in the mood, do them anyway.”

For those new moms who are in the mood (or who wish to do it despite feeling otherwise), they should.  But for those who are disinclined, they shouldn't feel guilty about it, and they definitely don’t need outside pressure to do something about it.  I’m not disputing the benefits of sex - I'm disputing the force with which you appear to advocate it, as it comes across like a mandate.

You decry at length what you perceive as judgement from those who support natural childbirth toward those who choose alternative means of delivery.  I agree that people shouldn’t judge others.  However, let’s not pretend that all modes of delivery are equal.  They simply aren’t.  Stating this fact doesn’t mean medical interventions shouldn’t be utilized as and when necessary, and it doesn’t mean babies born under such circumstances are doomed.  Nor does it mean mothers who elect to receive pharmaceutical and/or surgical assistance are horrible people.  But it also isn't necessary to diminish the virtues of natural childbirth in order to make others feel better about their birth experience, which is what you seem to be doing.

You take issue with the term “natural childbirth” which you feel implies that anything other than an unmedicated vaginal birth is “unnatural.”  As I understand it, “natural" refers to maintaining the integrity of the birth process inherent in our biology - yes, that translates to unmedicated vaginal birth, but there’s no need to turn this into an insult.  

Nevertheless, you write: “Um, pretty sure the birth of any human being who’s been made inside of another body…is “natural,” no matter how the child comes into this world - thank you very much.”  

There is nothing natural about having a baby pulled out of your stomach.  Is it common?  Yes.  Sometimes medically necessary?  Yes.  Natural?  No.  Importantly, cesarean birth not being natural has no bearing on its applicable merit.  C-sections save many babies and/or mothers who would not have otherwise survived childbirth - this should be celebrated - but we don’t need to deceive ourselves that somehow it’s a natural process.  It’s anything but natural, and that’s perfectly ok.

The book attacks The Business Of Being Born and similar documentaries for laying on guilt trips and judging women who choose anything other than natural childbirth, claiming that it’s unfair to put that kind of pressure on women.  Having seen these documentaries, I’m puzzled by your critique.  How is it judgmental to suggest that women have the capacity to give birth naturally?  How is it unfair to inform women of the implications of medicated and/or surgical childbirth?  

Imagine if someone levied a charge that your book’s detailing the importance of eating organic unfairly places pressure on women, guilting those who fail to adhere to the book’s advice; or someone who accused your outlining of the consequences of smoking during pregnancy as being unfairly judgmental to those women that do smoke during pregnancy…surely you would call such characterizations of your work unfounded, misguided, and inaccurate (and rightly so).  And yet, the flawed reasoning displayed by this imaginary critic seems to be reflected in your commentary on natural childbirth films.

Documentaries that educate about unmedicated vaginal birth, midwifery, home birth, etc are also correcting for the cultural narrative in which women are told a) childbirth is nothing but pain and agony, b) they should be afraid of birth, c) they will certainly need medicine to get through the experience because they aren't strong enough, d) even if they are strong enough, there’s no value to be gained, and e) they should just do whatever their doctor tells them.  Thus, the documentaries which you appear to disparage serve to educate and empower women, even those who ultimately choose to birth in hospitals with medical assistance.

In discussing newborn GBS disease, the book summarizes the matter in a paragraph, essentially advising adherence to the CDC guidelines.  While an in-depth analysis of this topic is beyond the scope of this letter, suffice it to say I believe the issue is far less straightforward than the book represents…I invite you to give this a read, at your leisure.

The book goes into detail about the birth of your son and Heidi’s birth story.  The reader learns it was important to Heidi to have a natural childbirth.  Not wanting to discourage Heidi outright, you tried to keep her open minded to alternative potential outcomes.  You state: “All I had to do was look at Heidi to see the size of her belly in comparison to her tiny hips, and I knew (or at least had a very strong feeling) that “natural childbirth” was not going to be in the cards for her.”  

The notion that one can determine the chances of a vaginal birth based on a visual assessment of a woman’s hips and belly has no medical basis, and it naively discounts labor’s physiology, along with how such is affected by maternal position.^1-4 

You write: “the big day came, and big surprise, our baby did not come ‘naturally.’”  Heidi was a week past her due date, so the doctor “deemed it best to induce labor.”  Detail as to what prompted the need for induction is absent.  Heidi gets admitted and induced via Pitocin, after which “there is no more food, just liquids.”  

Unfortunately, the book doesn’t clarify that hospitals banning food is an outdated guideline stemming from a risk of vomiting during general anesthesia that is not applicable today, and the continued ban on food during labors with low risk is not supported by evidence.^5-7 

8 hours later, Heidi dilates from 1 to 2 cm.  The doctor performs a manual rupture of membranes, followed by more Pitocin.  13 hours in, she’s at 3 cm.  Heidi is in a lot of pain, and you beg her to let them give her an epidural.  Heidi consents.  27 hours in, 4 cm.  Heidi still had not eaten since being admitted to the hospital.  Heidi begins running a fever and the baby’s heartbeat goes irregular.  So you take control of the situation:

“The whole “I am woman hear me roar” thing had gone far enough.  I called our ob-gyn at 3 a.m. and said, “Get over here and cut this kid out of her now, or I’m going to MacGyver this myself with an X-Acto knife and some Xanax!””

The ob-gyn came right away and “Heidi was so depleted at this point that she had no strength to fight me.”  I find this statement extremely telling.  Here you have a pregnant woman with a very clear set of intentions, wanting natural childbirth, but having to “fight” those around her, with her partner appearing to doubt her capacity from pregnancy through labor.

Natural childbirth is every bit mental as it is physical,^8-11 and it can derail when the mother is stressed, anxious, scared, disempowered, inhibited, self-doubting, etc.  Even in the best of circumstances it can take 100% of a woman’s focus to successfully navigate labor unmedicated, which is why anything short of complete support and unity in the birthing environment is so toxic to the process.  Moreover, research shows the body’s hormonal system is crucially important in preparing and facilitating labor (among other birth-related effects), and that such hormones can be fostered or disrupted in response to both the psychological state of laboring women and medical interventions that transpire.¹² 

Thus, consider the stripping of Heidi’s membranes, an induced labor at 41 weeks, manual breaking of her water, administration of analgesic and synthetic hormones, presumably high levels of stress and anxiety for Heidi throughout the entire ordeal, not to mention fatigue (exacerbated by lack of food and sleep), and then ask, is it really surprising that labor didn’t “progress”?  For those familiar with natural childbirth, no one is surprised at this outcome.  However, you drew a different conclusion:

“The lesson here?  Our son was 9 pounds!  His shoulders were simply too broad to get past Heidi’s hips, rendering him unable to “drop” and therefore Heidi unable to dilate.”

Or is the lesson here that subverting the innate biological processes of birth, by way of interventions, restrictions, or limitations (whether medically necessary or otherwise), has corresponding physical and mental side effects from which surgical outcomes can result?  This is not an indictment of the medical model - it’s simply to say all actions have consequences.  It’s also important to acknowledge that vaginal births of 9 pound babies (and heavier) do happen¹³…it’s not science fiction; it’s human physiology.

The book proceeds to discuss birthing environment.  While you respect everyone’s choice of birthing environment, you strongly advocate hospital birth.  I take no issue with this, in and of itself, however your characterization of home birth fails to grasp its primary motivation - that of maximizing one’s chances of having an unmedicated vaginal childbirth - and how the home environment relates to that objective.

You include an excerpt from a doctor who argues that contrary to popular belief, medical interventions in labor are not profit driven.  Fine, but those seeking unmedicated vaginal birth are not concerned about profiteering…they're concerned with what they perceive as unnecessary interventions that routinely take place at hospitals for a variety of reasons (arbitrary timelines, impatience, liability concerns, poor judgement, etc), and which can result in a cascade of further interventions,^12,14-18 increasing the chances of undesirable outcomes.^12,17-25 

Surprisingly, the high cesarean rate in this country does not seem to be of significance to you, as you state: “30 percent of babies nowadays are delivered through C-section…most happen due to medical necessity…”  The actual rate is 32% and it’s patently obvious that a significant portion are not medically necessary.^26-28  Just compare US cesarean rates in hospitals to those of planned home births, the latter having C-section rates in the low single digits.^29-31  Granted, most women who plan to birth at home are considered low-risk, which does create an asymmetry in this comparison.  However, according to the CDC, national cesarean rates specifically for low-risk pregnancies are still 26%,³² revealing a tremendous disparity.  And this disparity persists even when looking at birthing centers, whose cesarean rates also average to single percentages,^33-35 similar to planned home births.  The reality is that something is artificially inflating cesarean outcomes among hospital births - failing to give credence to this is misleading in my view.

The book’s argument for hospital birth essentially amounts to “better safe than sorry.”  While you don’t want the reader to feel pressured, you argue that if something goes wrong it is better to have instant access to lifesaving technology.  I understand and respect this perspective, although it should be weighed against a person’s individual pregnancy risk and the risks that hospitals potentially introduce (medically unnecessary intervention / cesarean, lack of food, reduced mobility, environment-induced stress response, hospital acquired infections, etc).  “Better safe than sorry” can work both ways.

You continue: “with the birth of our son, we experienced fairly atypical complications that ultimately required pain medicine and a C-section.”  Except they weren’t atypical complications.  In fact, they are quite common in response to the medical interventions that transpired (which was made clear in those documentaries you were criticizing).  Nonetheless, you conclude: 

“Heidi was considered “low risk” throughout her entire pregnancy.  Yet, when the day came for our son to be born, he was simply too big to be pushed out vaginally.  She ended up requiring all the lifesaving benefits of modern medicine that we have come to take for granted over the last century.  Shit happens - why not be prepared?” 

See the above points.

In discussing induction of labor, the book references ACOG’s guidelines that you can wait up to 42 weeks to induce.  This begs the question, why wasn’t Heidi allowed to wait until 42 weeks?  

You also list scenarios in which induction will be medically required, which includes being “Past term or ‘late.’”  I respectfully disagree.  Being “late" in and of itself does not constitute a medical emergency, particularly given that estimated due dates are notoriously inaccurate anyway.³⁶

Finally, the book outlines the various methods of induction, none of which worked for Heidi because “our son was incapable of “dropping” in order to open the cervix effectively.”  There are many variables that influence the rate at which labor progresses and how a baby “drops” (e.g. fetal presentation, labor position, etc), but I am unaware of any medical diagnosis called “incapable of dropping.”  It seems that you are conflating the fact that your son didn’t drop in that series of events with the notion that he was inherently incapable of dropping.  These are not the same things.  And it’s important to parse that out, as otherwise you instill in the reader an unfounded fear that big babies (or large bellies) pose some insurmountable obstacle to vaginal delivery.  They don’t.

Overall, I find that the book’s commentary on labor exemplifies much of what is missing from birth in modern society.  It diminishes the capacity of women to withstand and navigate labor, has little to no regard for the merits of the biological forces that underpin natural childbirth, and no appreciation for how influential and important the psychology of laboring women is to the entire experience.  It is also remarkable that within the entire 300+ pages of text, there is no discussion of the biomechanics of birth, alignment, or labor technique - knowledge and skills which are of direct importance and applicability to laboring women.^37-53  If the reader is to be armed with the information necessary to successfully navigate pregnancy and birth, as the book purports, then this information would seem to be relevant.

What’s additionally saddening is the book’s recounting of how Heidi went on to struggle with breastfeeding, something that was also really important to her.  The initial pediatrician told her to "pump every hour to increase my milk supply, which only made me want to cry.”  After the baby lost 2 pounds, the choice was made to supplement breast milk with formula.  Heidi writes, “Eventually, I became okay with the fact that my body just wasn’t going to produce enough milk for this enormous child.”  

It seems Heidi is left with the impression that she is a failure on account of her body simply not being good enough to both deliver and breastfeed her baby.  She writes, “I barely spoke for 3 months" and was “unable to snap back into life or be myself again after what felt to me like a somewhat traumatic birth experience.”  

My heart breaks for her.  Her choice of wording is interesting, in that she qualifies the experience as being “somewhat” traumatic.  My sense is that she feels conflicted speaking honestly about the matter, given the upbeat positive context of her partner’s pregnancy book.

Well, Heidi if you’re reading this - as traumatic as your birthing experience may have been, you found the light at the end of the tunnel.  You encountered obstacles you could not have anticipated, and some which had no business being there.  But you found a way through them, and that requires its own degree of strength.  Never make the mistake of thinking you are inferior or incapable…you are quite the contrary.

Lastly, it’s imperative that we recognize a woman is not weak for choosing to receive pain management.  But a society that teaches women they don’t have the ability to endure natural childbirth does create weakness.  Not believing in women does create weakness.  Scaring women without practical cause does create weakness.  Moreover, championing natural childbirth does not intrinsically entail disdain for pharmaceutical or medical assistance.  That Heidi (or anyone else) had a C-section is not a tragedy.  But it would indeed be tragic if a woman wasn’t genuinely supported and given the best chances of having the birth that was important to her, regardless of what the outcome would have been.  Mothers are always going to have strong bonds with their babies, regardless of the mode of delivery.  And birth is always capable of being positive and transformative, regardless of the methods and means utilized.  

I have great respect for what you set out to achieve in writing your book.  It is informative and truly helpful in many respects.  And I know you honestly want to assist readers in grappling with the overwhelming mountain that is pregnancy and birth, and help guide them to optimal outcomes.  You have a tremendous influence - what you say matters.  As a kindred spirit who shares your aims, this is why I felt compelled to write the above words.  May you do with them as you wish.

Sincerely,

Zack Hemsey

---

1. André Michel SC, Marincek B, et al. The effect of maternal posture on pelvic outlet MR measurements. Proc. Intl. Soc. Mag. Reson. Med 9 (2001).

2. Michel SC, et al. MR obstetric pelvimetry: effect of birthing position on pelvic bony dimensions. AJR Am J Roentgenol. 2002 Oct;179(4):1063-7. 

3. Golay J, et al. The squatting position for the second stage of labor: effects on labor and on maternal and fetal well-being. Birth. 1993 Jun;20(2):73-8. 

4. Pyanov M. Small Pelvis? Big Baby? Here’s The Truth About CPD. BellyBelly June 2018. 

5.  Singata M, et al. Restricting oral fluid and food intake during labor. Cochrane Database Syst Rev. 2013 Aug 22;(8):CD003930. 

6.  American Society of Anethesiologists. Most healthy women would benefit from light meal during labor. November 6, 2015. 

7.  Medscape. Researchers Question Ban on Solid Food During Labor. October 30, 2015. 

8.  Gaskin IM. Going backwards: the concept of ‘pasmo’. Practicing Midwife, 2013 Sep;6(8):34-7. 

9.  Whitburn LY, et al. Women's experiences of labour pain and the role of the mind: an exploratory study. Midwifery. 2014 Sep;30(9):1029-35. 

10.  Whitburn LY, et al. The meaning of labour pain: how the social environment and other contextual factors shape women's experiences. BMC Pregnancy Childbirth. 2017 May 30;17(1):157. 

11.  Whitburn LY, et al. The nature of labour pain: An updated review of the literature. Women Birth. 2018 Apr 20. pii: S1871-5192(17)30629-7. 

12.  Buckley SJ. Hormonal Physiology of Childbearing: Evidence and Implications for Women, Babies, and Maternity Care. Childbirth Connection, January 2015. 

13. Hard statistics on birth weight by method of delivery are elusive, however any experienced midwife will tell you vaginal birth of babies weighing 9+ pounds is not an exceedingly rare occurrence, and there are an abundance of anecdotal cases reported in a variety of literature that illustrate the point (for example, see Part 1 of Ina May’s Guide To Childbirth, pg 208 of Katy Bowman’s Alignment Matters, the comments section here, etc).

14.  Tracy SK, et al. Birth outcomes associated with interventions in labour amongst low risk women: a population-based study. Women Birth. 2007 Jun;20(2):41-8. 

15.  Rossigno M, et al. Interrelations between four antepartum obstetric interventions and cesarean delivery in women at low risk: a systematic review and modeling of the cascade of interventions. Birth. 2014 Mar;41(1):70-8. 

16.  National Institute for Health and Care Excellence. Intrapartum care for healthy women and babies. Clinical guideline [CG190].  Section 1.1 Place of birth. December 2014, updated February 2017. 

17.  Jansen L, et al. First do no harm: interventions during childbirth. J Perinat Educ. 2013 Spring;22(2):83-92. 

18.  Lothian JA. Healthy birth practice #4: avoid interventions unless they are medically necessary. J Perinat Educ. 2014 Fall;23(4):198-206. 

19.  Anim-Somuah M, et al. Epidural versus non-epidural or no analgesia in labour. Cochrane Database Syst Rev. 2011 Dec 7;(12):CD000331. 

20.  Adams J, et al. Use of pharmacological and non-pharmacological labour pain management techniques and their relationship to maternal and infant birth outcomes: examination of a nationally representative sample of 1835 pregnant women. Midwifery. 2015 Apr;31(4):458-63. 

21.  Alfirevic Z, et al. Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour. Cochrane Database Syst Rev. 2017 Feb 3;2:CD006066. 

22.  Segal S. Labor epidural analgesia and maternal fever. Anesth Analg. 2010 Dec;111(6):1467-75. 

23.  Klein MC. Does epidural analgesia increase rate of cesarean section? Can Fam Physician. 2006 Apr 10; 52(4): 419–421. 

24.  Chantry, CJ, et al. Excess weight loss in first-born breastfed newborns relates to maternal intrapartum fluid balance. Pediatrics. 2011 Jan;127(1):e171-9. 

25.  Lindholm A, Hildingsson I. Women's preferences and received pain relief in childbirth - A prospective longitudinal study in a northern region of Sweden. Sex Reprod Healthc. 2015 Jun;6(2):74-81. 

26.  Ye J, et al. Searching for the optimal rate of medically necessary cesarean delivery. Birth. 2014 Sep;41(3):237-44. 

27.  Pallasmaa N, et al.  Variation in cesarean section rates is not related to maternal and neonatal outcomes. Acta Obstet Gynecol Scand. 2013 Oct:92(10):1168-74. 

28.  Glantz JC. Obstetric variation, intervention, and outcomes: doing more but accomplishing less. Birth. 2012 Dec;39(4):286-90. 

29.  Johnson KC, Davids BA. Outcomes of planned home births with certified professional midwives: large prospective study in North America. BMJ. 2005 Jun 18;330(7505):1416. 

30.  Cheyney M, et al. Outcomes Of Care for 16,924 Planned Home Births in the United States: The Midwives Alliance of North America Statistics Project, 2004 to 2009. Journal of Midwifery & Women’s Health. 2014 Jan-Feb;59(1):17-27. 

31.  The Farm Midwifery Center.  Statistics 1970-2010. 

32.  National Vital Statistics Reports. Births: Final Data for 2015. Vol 66, No 1, January 5, 2017.  Table C. 

33.  Rooks JP, Weatherby NL, et al.  Outcomes of care in birth centers.  The National Birth Center Study.  N Engl J Med.  1989 Dec 28;321(26):1804-11. 

34.  Stapleton SR, et al. Outcomes Of Care in Birth Centers: Demonstration of a Durable Model. J Midwifery Women’s Health. 2013 Jan-Feb;58(1):3-14. 

35.  Thornton P, et al. Cesarean Outcomes in US Birth Centers and Collaborating Hospitals: A Cohort Comparison. J Midwifery Women’s Health. 2017 Jan;62(1):40-48. 

36.  Jukic AM, et al. Length of human pregnancy and contributors to its natural variation. Hum Reproduc. 2013 Oct;28(10):2848-55. 

37.  Bowman K. The Hunting And Gathering Mama. Nutritious Movement. March 2010. 

38.  Bowman K. Natural Pregnancy, Natural Birth. Nutritious Movement. July 2010. 

39.  Bowman K. When Push Comes To Shove. Nutritious Movement. March 2011. 

40.  Bowman K. Aligning Or Relaxin Before Pregnancy? Nutritious Movement. March 2011. 

41.  Bowman K. Pregnancy And Pain. Nutritious Movement. December 2011. 

42.  Bowman K. Natural Mama. Nutritious Movement. January 2012. 

43.  Gaskin IM. (2003). Ina May’s Guide to Childbirth. New York: Bantam Dell.

44.  Lawrence  A, et al. Maternal positions and mobility during first stage labour. Cochrane Database Syst Rev. 2013 Oct 9;(10):CD003934. 

45.  Simkin P, Bolding A. Update on nonpharmacologic approaches to relieve labor pain and prevent suffering. J Midwifery Womens Health. 2004 Nov-Dec;49(6):489-504. 

46.  Simkin PP, O’hara M. Nonpharmacologic relief of pain during labor: systematic reviews of five methods. Am J Obstet Gynecol. 2002 May;186(5 Suppl Nature):S131-59. 

47.  Field T, et al. Labor pain is reduced by massage therapy. J Psychosom Obstet Gynaecol. 1997 Dec;18(4):286-91. 

48.  Chaillet N, et al. Nonpharmacologic approaches for pain management during labor compared with usual care: a meta-analysis. Birth. 2014 Jun;41(2):122-37. 

49.  Levett KM, et al. Complementary therapies for labour and birth study: a randomised controlled trial of antenatal integrative medicine for pain management in labour. BMJ Open. 2016 Jul 12;6(7):e010691. 

50.  Shirvani MA, Ganji Z. The influence of cold pack on labour pain relief and birth outcomes: a randomised controlled trial. J Clin Nurs. 2014 Sep;23(17-18):2473-9. 

51.  Ganji Z, et al. The effect of intermittent local heat and cold on labor pain and child birth outcome. Iran J Nurs Midwifery Res. 2013 Jul;18(4):298-303. 

52.  Taavoni S, et al. Birth ball or heat therapy? A randomized controlled trial to compare the effectiveness of birth ball usage with sacrum-perineal heat therapy in labor pain management. Complement Ther Clin Pract. 2016 Aug;24:99-102. 

53.  Taavnoi S, et al. Effect of birth ball usage on pain in the active phase of labor: a randomized controlled trial. J Midwifery Womens Health. 2011 Mar-Apr;56(2):137-40. 

Birth Wisdom

Until one experiences natural childbirth firsthand, there’s really no way to anticipate what it entails.  You can do all the reading, all the watching, and all the listening to those who previously went through the gauntlet, but none of it truly captures the one-of-a-kind nature that is untamed birth.  You have to simply go through it to really understand it.

Just shy of 3 years ago, my daughter Scarlet was born.  It was a planned unmedicated home birth, which ended up in a hospital transport due to maternal exhaustion.  Upon much reflection, there were a variety of lessons we drew from Scarlet’s birth (see here) - lessons we fully intended to implement when it came time to have our second child.  So when we conceived back in October of 2016, we felt like fighters training for a rematch.  It would be entirely different this time around, and we would be ready to go the distance and then some, if necessary.

As before, Heather was focused on “preparing her vessel” prior to conception.  This entailed optimal nutrition, exercise, sleep, etc, which continued throughout the entire pregnancy.  Her diet was clean the first time around, but it was cleaner this time.  She swam and aggressively walked while pregnant with Scarlet, but now she mixed in yoga and a whole lot of floor sitting, in order to maintain her hip flexibility and pelvic range of motion, which she knew would be critical during labor.  Once more, she continued regularly seeing an acupuncturist, but this time she also consistently saw an osteopath, who was vital in maintaining a robust musculoskeletal structure and tendon / joint health all throughout the pregnancy - this in turn allowed Heather to maintain a higher level of activity than she would otherwise have been able to, evidenced by her attending yoga classes all the way into her 41st week of pregnancy.

Of course, having to take care of a toddler during pregnancy makes physical and mental preparation of any kind considerably more difficult to accomplish.  But she did everything she could given the circumstances, which is all one can ever do.  Funnily enough, in contrast to our first pregnancy, where we read everything we could get our hands on, with the second pregnancy we read little to almost nothing, because ultimately there is no better preparation than having actually lived through birth before.  Plus, reading becomes untenable once tiny humans are running around and screeching all day long.

So we were ready to go, and on July 7th, 2017, four days past her “due date”, the time was upon us.  After days of intermittent mild contractions, 9 AM brought a new variety.  These required focus.  Active labor had begun.

Thankfully, we had both slept for 7-8 hours, and that morning Heather ate like a champ while she had the capacity to do so.  Both of these paid dividends down the line.

For the first 2-3 hours, we were on our own.  Heather had opened up the windows and patio door, allowing a cool breeze to flow through the house along with the sound of the morning rain, which she found soothing as she labored on the floor of our dining room.  During a contraction, I’d put extreme pressure on her sacrum which aided her ability to navigate the discomfort, while she vocalized and focused on her breathing.  

Labor vocalization is definitely a distinct sound - it’s somewhere between a Tibetan chant and a dying animal - and it’s a little strange when one’s exposure to this sound inevitably ceases to be odd.

Eventually our doula and midwives arrived, joined shortly thereafter by Heather’s osteopath.  Birth team fully assembled, the hard work continued.  Any time her vocalizations started to creep up in tone, she was hit with constant reminders: “keep it low Heather”, “don’t tense up”, “stay relaxed”, “let it resonate downwards”, “let it in”, etc.  

I moved the dining room table into the corner, and we set up a birthing pool in its place, allowing Heather to knock out the next couple of hours immersed in warm water, while the osteopath worked on Heather’s back and legs.

Then the party moved into our bedroom.  Squatting on a small birth stool, Heather’s vocalizations reached a new level of intensity, and she started saying affirmations at the onset of each new wave of contractions - “my body and baby know how to birth” - after which she would lean backwards into my arms and go limp, while I massaged her lower back.

Time has a habit of skewing in labor (even for birth partners), so I don’t really know how long it was before the midwife explained that she was almost fully dilated at 9 cm.  The caveat was that there was a small patch of cervix stubbornly hanging on, preventing the baby from moving downwards.  Feeling wiped out, Heather opted to move to the bed for a momentary reprieve.

FYI, this was not just any bed - it was an organic bed that sat atop a hi tech frame, capable of independently moving the head and feet sections upwards.  Put differently, it was a bed tailored for labor!  And that is exactly what went through our minds when bed shopping the previous year - all things being equal, always go with the bed that will best facilitate a birth!

After a few rounds of contractions lying down, the midwife explained she could attempt to manually push back that last bit of cervix during the next contraction, if Heather wanted; otherwise, Heather should get back to being upright so as to let gravity better assist with the remaining inch of dilation.  Unsure of how to proceed, and since she was already on the bed, Heather instructed the midwife to take a shot at the manual adjustment.  And then she let out a blood curdling scream when that adjustment was attempted.  Having failed to accomplish the goal, and feeling the sensation was entirely unnatural, Heather opted for plan B - back on the feet we would go, but not before her water finally broke in the midst of another contraction, an explosion that took everyone by surprise (as I suspect it probably often does).

Now on her feet, we made our way into the bathroom, where Heather sat on the toilet.  The toilet may strike some as an odd birthing location, but it’s where people habitually go to relax their sphincter, and actually makes for a good labor site.  At this point, Heather was beyond fatigued, and she was sort of swaying in front of me like a drunken sailor from utter exhaustion.  She kept repeating, “I don’t think I can do this” … and we kept repeating, “yes you can - you’re already doing it”.

Sensing we were at a crucial precipice, where her focus and willpower could potentially get carried away from her, I asked the doula to trade places with me.  Then I ran into the kitchen and grabbed an iPod off the counter that contained a playlist of music we had curated specifically for if / when we reached a point like this.  Ear buds secure, I hit play - then she went totally silent for the next 10-15 minutes, breathing through the contractions without vocalizing.  I could see her energy recharging, catching a second wind.  It was fascinating to watch.

The midwives and doula then suggested that she get into the shower.  After some initial protest, Heather begrudgingly relented.  Ear buds removed, I assisted her into the shower.  As soon as the water hit her body, she said it felt good and asked that we make it colder, which we obliged.  And cold it got … like really fucking cold … like the kind of water polar bears approve of cold … like a shower that could offset climate change cold.

I was standing directly in front of her, as a leaning post, and when she had a contraction she would drop into a squat while I supported her underneath her arms.  Cleverly, the midwives’ assistant gave me a towel to put around my neck for Heather to grab onto, and with which I could more efficiently support her.

After some amount of time in the shower, one of the midwives attempted to check her progress but was unable to get an accurate assessment, due to the confined space of the shower stall.  So ironically, now to Heather’s great dismay, she begrudgingly got out of the shower and back into the open space of our bedroom.

The towel remained around my neck and shoulders, and we kept the same stand-squat routine going.  As if in anticipation, the sun had by now reared its head outside, casting a beautiful shimmer over the trees, and it wasn’t long before the midwife proclaimed the cervix had fully receded and the head was descending.  On we went.  I suddenly realized that the midwife was directly behind me, on her hands and knees, in between my legs, checking the baby’s progress between Heather’s legs.  It was like a game of Birth Twister.

Midwife:  “Zack, please don’t sit on me”

Me:  ”Susan, I would never sit on you”.

Heather:  “Is that the head out?”  

Midwife:  “Yes it is!”

Heather:  “Ok, is everyone ready?”

Birth Team:  “Yes!”

The fog of labor was instantaneously lifted as the baby was birthed, preceded only by the warmest gush of fluid across my legs I have ever felt … like wonderfully warm … like water befitting a tropical desert paradise warm … like the kind of water those Japanese snow monkeys submerge themselves in to escape a merciless winter warm.  Yes, I felt like a Japanese snow monkey on holiday.  

As the baby was caught by the midwife between my legs, and handed upward between myself and Heather, I was jolted back to reality as the baby screeched, and I was perplexed at the extreme pale white appearance.  “My God, she’s birthed a White Walker!” I thought to myself.  As it turns out, it was just the vernix (which apparently was unusually plentiful for a full term baby).  Soon thereafter, with vernix rubbed into the skin, the baby pinked up just fine.

And so it is with great delight that I introduce you to Willow Sky Hemsey:

In the aftermath of our first birth, I was surprised at some of the confusion (and borderline outrage) I received in response to what happened.  Some felt our attempted home birth was irresponsible and dangerous, despite no one actually being in danger of anything at any point.  Some felt it was masochistic to have an unmedicated birth and/or that we were trying to prove something (it wasn’t and we weren’t).  Some felt we were exhibiting an unnecessary disdain or disregard for western medicine and/or technology (again, we weren’t).  And some expressed incredulity that we would attempt another home birth after what had happened the first time, as if our birth with Scarlet was physically or mentally traumatic in nature (it wasn’t … it was crushing psychologically to not get the birth we had wanted, but it remained a positive experience on the whole, for both of us).

I found it bizarre (and still do) that so many completely miss the spirit of our actions.  The desire to birth at home stems from a desire to birth naturally, unmedicated, in a familiar, comfortable, and safe environment.  For us, that’s home.  For you, it may be a hospital.  In turn, the desire to birth naturally without medication stems from the physiological benefits of doing so, for both baby and mother (the reader can take it upon themselves to research this, or reference my response to the initial comment on Birth Lessons where I go into greater depth).  Importantly, being unmedicated prevents the natural birth process from being inadvertently undermined and short-circuited, for it maximizes the mother’s ability to coherently and effectively navigate birth, which then minimizes the potential need for interventions (and the domino effect of complications and further interventions that can often ensue as a result).

But there is an additional component to unmedicated natural childbirth that goes beyond the physiology, and it has nothing to do with pain or suffering.  It’s about embracing the enormity of what the human body is designed to do, completely unfiltered and raw.  It’s about surrendering to a process that evades our comprehension, without fear or anxiety.  And it’s about feeling the connection between mother, baby, and body, and tapping into the extraordinary potential of the human psyche.  It is uniquely transformative, capable of changing even those merely in proximity to it.

Of course, birth is not the only one-of-a-kind experience that exists.  I imagine there’s probably nothing like free falling through the sky after jumping off a plane or mountaintop, or being in outer space, or climbing Mt Everest, etc.  There is a diverse tapestry of rich and immensely powerful experiences humans are capable of encountering.  But birth in its purest form may very well be the most challenging and exhilarating human event there is.  It is riding a tidal wave toward the brink of your capacity, and then miraculously going beyond it.  And it is a rite of passage for anyone wishing to come into direct contact with the essence of life itself.

When it was all over and done, Heather said the birth was the single greatest experience of her life.  

My enduring thanks to the birth team: midwives Susan Schmidt and Cathy Gallagher; midwife assistant Nancy McDaid; doula Jen Pifer; and osteopath Karin Lipensky.

The YouTube Red Checkmate

I’ve had many issues with YouTube’s Content ID System and the revenue (or lack thereof) that YouTube pays to content owners.  Without rehashing all the details (which you can find here, here, and here), the short story is that I was strong-armed into utilizing Content ID to monetize user-generated uploads containing my music, under what I perceive to be deplorably substandard deal terms (i.e. 55% of net revenue, with no clear understanding of what “net” constitutes).  

While this compromise was necessary to combat unauthorized uploads of my music (and their illegal monetization of my content), when it came to my personal YouTube channel I elected not to monetize my own uploads with ads, in protest of the revenue splits that I find so distasteful (and in defiance of the emerging ad culture).  So I wasn’t making money on my personal uploads, but neither was YouTube.

Then around the end of 2015, YouTube began unrolling something called YouTube Red.  This was a new subscription based service that would allow subscribers to watch unlimited YouTube content without any accompanying or intrusive advertisements, in exchange for a flat monthly fee.  It was touted as a new revenue stream for creators, who would be paid according to how much their content was watched by YouTube Red subscribers each month.  Sounds good … you know, apart from receiving only 55% of net earnings within this new revenue stream.

Fast forward, YouTube Red is fully up and running in all territories, and Red income begins being collected on my behalf within the Content ID System.  Then a realization eventually ensues.  Shouldn’t I be receiving YouTube Red income for my personal uploads?  After all, my YouTube channel is set up and approved for monetization (I simply disabled the ad option on all my videos).  Let’s go take a look.  Huh, I see there are YouTube Red views, but no YouTube Red money.  What gives?

Well, it turns out that in order to receive my share of Red income for any given video, I am required to enable ads on that video.  Even though these are two completely independent and unrelated revenue streams, YouTube holds Red earnings hostage until you agree to play the ad game.  Of course, YouTube has not volunteered or acknowledged this fact, but it has been unequivocally established in practice (at least in my case).  Basically, YouTube has designed an all or nothing monetization scheme - opt in and collect both ad and subscription revenue, or opt out and collect nothing.

Naturally, this introduces a new variable into the analysis.  While foregoing ad revenue results in a lose-lose scenario, foregoing Red revenue results in a win-lose scenario, whereby YouTube pockets their share of Red revenue regardless of the fact that I have not received mine - my share of Red income just gets distributed to other content owners.  So essentially, not participating in Red income equates to literally giving my money away to other people.  

Thus, I now find myself in a situation where, in order to receive my share of YouTube Red earnings, I must monetize my YouTube channel with ads.  Game, set, match.  Well played YouTube.  Well played.