Epidurals have become so common place that I think many folks feel they must have no risks at all. So, I thought I would write about some of the risks you need to consider. First let me give you a definition of an epidural from an anesthesiology website "Epidural anesthesia is most commonly placed in the low back (lumbar region). Unlike Spinal this technique may also be accomplished in the mid-back (thoracic region) for surgery in the area of the chest. After a sterile prep and draping, local anesthetic is placed in the skin numb the area where the Epidural need will be placed. The needle for Epidural passes between the vertebrae of the Spinal column to the Epidural space. Once the position is verified, a very small catheter(tube) is placed via the needle. The needle is then removed and the catheter remains in the Epidural space. The catheter is then taped to the patients back. Local anesthetics and narcotics given epidurally via this catheter. The procedure usually takes 10 - 25 minutes."
One great website with a fabulous article is http://www.healing-arts.org/mehl-madrona/mmepidural.htm
The doctor writing the article posts these concerns. A possible increase to having a cesarean birth, Hypotension- a drop in your blood pressure. Fetal Distress, Toxic issues, Trauma to blood vessels, Dura punctures causing spinal headaches, Infection, Backache, Pitocin being needed and causing abnormal contractions, Inability to push effectively, Mothers expecting great pain relief and not getting it, Medication getting into spinal area instead causing issues, heart attack and heart issues, Drug interactions, Fever, Respiratory issues, Nuerological issues, Fever, and more...
"Local anesthetics rapidly cross the placenta, and when used for epidural, caudal or pudendal anesthesia, can cause varying degrees of maternal, fetal and neonatal toxicity....
Adverse reactions in the parturient, fetus and neonate involve alternations of the central nervous system, peripheral vascular tone and cardiac function....
Neurologic effects following epidural or caudal anesthesia may include spinal block of varying magnitude (including high or total spinal block); hypotension secondary to spinal block; urinary retention; fecal and urinary incontinence; loss of perineal sensation and sexual function; persistent anesthesia, paresthesia, weakness, paralysis of the lower extremities and loss of sphincter control all of which may have slow, incomplete or no recovery; headache; backache; septic meningitis; meningismus; slowing of labor; increased incidence of forceps delivery; cranial nerve palsies due to traction on nerves from loss of cerebrospinal fluid. "
So, if you think this guys is off his rocker- let's list the issues that an anesthsiology abstract stated http://journals.lww.com/anesthesiology/pages/articleviewer.aspx?year=2006&issue=08000&article=00023&type=fulltext
"Of the 4 million annual births in the United States, 2.4 million involve epidural analgesia. Serious adverse events are rare but are important in young women. Robust estimates for the risk of harm are not available. Data for superficial and deep infections, hematoma, and transient and permanent neurologic injury were obtained from studies reporting adverse events with obstetric epidural analgesia, and incidence presented as individual risk for a woman, number of events per million women, and percentage incidence. A total of 1.37 million women received an epidural for childbirth, reported in 27 articles. Most information (85% of women) was in larger (> 10,000 women) studies published after 1990, with risk estimates as follows: epidural hematoma, 1 in 168,000; deep epidural infection, 1 in 145,000; persistent neurologic injury, 1 in 240,000; and transient neurologic injury, 1 in 6,700. Earlier and smaller studies produced significantly higher risk estimates for transient neurologic injury plus injury of unknown duration."
Another good website to share information from is http://www.americanpregnancy.org/labornbirth/epidural.html
"What are the Disadvantages of epidural anesthesia?
* Epidurals may cause your blood pressure to suddenly drop. For this reason your blood pressure will be routinely checked to make sure there is adequate blood flow to your baby. If this happens you may need to be treated with IV fluids, medications, and oxygen
* You may experience a severe headache caused by leakage of spinal fluid. Less than 1% of women experience this side effect from epidural use. If symptoms persist, a special procedure called a “blood patch”, an injection of your blood into the epidural space, can be done to relieve the headache
* After your epidural is placed, you will need to alternate from lying on one side to the other in bed and have continuous monitoring for changes in fetal heart rate. Lying in one position can sometimes cause labor to slow down or stop
* You may experience the following side effects: shivering, ringing of the ears, backache, soreness where the needle is inserted, nausea, or difficulty urinating
* You may find that your epidural makes pushing more difficult and additional interventions such as Pitocin, forceps, vacuum extraction or cesarean may become necessary
* For a few hours after birth the lower half of your body may feel numb which will require you to walk with assistance
* In rare instances, permanent nerve damage may result in the area where the catheter was inserted.
* Though research is somewhat ambiguous, most studies suggest some babies will have trouble "latching on" which can lead to breastfeeding difficulties. Other studies suggest that the baby may experience respiratory depression, fetal malpositioning; and an increase in fetal heart rate variability, which may increase the need for forceps, vacuum, cesarean deliveries and episiotomies."
So, although they are sometimes necessary- realize that there is risk involved. Now you may think this entry to my blog is one sided. The truth is we all know the reasons why folks want to get an epidural- pain relief. But the risks are so overlooked I thought it was worth reviewing the risks.
If you truly need an epidural in your labor, you will be able to be informed and know the risks. Sometimes doing the next best thing does include an epidural. It will sometimes keep you from having more interventions. But realize that although it is common place it is not without risks.
Wednesday, December 31, 2008
Monday, December 29, 2008
"Labor, the hardest work you'll ever love!"
Another doula is publishing a book soon that has a chapter named "Labor, the hardest work you'll ever love!" That made me think about what that means. It reminded me of the quote that Pam England shares in her Birthing From Within book- "Labor is hard work, it hurts and you can do it."
Many folks don't get why anyone would want to have a baby without medication being involved to numb or dull the pain. The comments about how you would not get a root canal without novacain are spouted by many. Do they realize a endodontist will not perform a root canal with novacain on a pregnant mom!
So how in the world is labor something you can say you love? Why would you want to do this unmedicated? Nurses many times will tell a mom she does not get a crown for doing it without an epidural. But is this really true?
I hear moms tell me later that they could not believe how tough it was. But in turn they could not believe how strong they are. How proud they are of themselves. How amazed their partner is at the work they did. How quickly they bounced back from the birth. Many women will tell me how they feel they can do anything now after laboring and birthing naturally.
Shoot some moms don't even end up without medication but they are amazed at how hard they worked prior to getting medication and they feel the same way. Amazed, powerful and extremely proud. So isn't that a crown? Isn't that a reward?
The benefits of laboring and birthing with little or no medication are many. Being able to move in labor and allow your body to let you know the way you need to move helps facilitate labor. Having no bad reaction to medications causing the mom or the baby to crash and need to be born by cesarean is certainly beneficial. Having an alert baby whose mom has not been pumped full of fluid and has no edema issues creating breastfeeding issues is great.
But the benefit I see the most is the glow the mom has after she has worked- been a warrior like she has never been before. And again this is not just if she goes unmedicated- it is about the way she approaches her labor. If she goes into labor thinking "Labor, the hardest work she'll ever love!", then her view of it is not one of fear and desire to not feel pain. But instead she moves into it knowing it will hurt- but that she has prepared-that she has dealt with her fears prior to the labor beginning and she is confident she is able to make decisions along the way that are right for her.
Many folks don't get why anyone would want to have a baby without medication being involved to numb or dull the pain. The comments about how you would not get a root canal without novacain are spouted by many. Do they realize a endodontist will not perform a root canal with novacain on a pregnant mom!
So how in the world is labor something you can say you love? Why would you want to do this unmedicated? Nurses many times will tell a mom she does not get a crown for doing it without an epidural. But is this really true?
I hear moms tell me later that they could not believe how tough it was. But in turn they could not believe how strong they are. How proud they are of themselves. How amazed their partner is at the work they did. How quickly they bounced back from the birth. Many women will tell me how they feel they can do anything now after laboring and birthing naturally.
Shoot some moms don't even end up without medication but they are amazed at how hard they worked prior to getting medication and they feel the same way. Amazed, powerful and extremely proud. So isn't that a crown? Isn't that a reward?
The benefits of laboring and birthing with little or no medication are many. Being able to move in labor and allow your body to let you know the way you need to move helps facilitate labor. Having no bad reaction to medications causing the mom or the baby to crash and need to be born by cesarean is certainly beneficial. Having an alert baby whose mom has not been pumped full of fluid and has no edema issues creating breastfeeding issues is great.
But the benefit I see the most is the glow the mom has after she has worked- been a warrior like she has never been before. And again this is not just if she goes unmedicated- it is about the way she approaches her labor. If she goes into labor thinking "Labor, the hardest work she'll ever love!", then her view of it is not one of fear and desire to not feel pain. But instead she moves into it knowing it will hurt- but that she has prepared-that she has dealt with her fears prior to the labor beginning and she is confident she is able to make decisions along the way that are right for her.
Sunday, December 28, 2008
planning and preparing
It is frustrating to me that folks spend more effort and time planning and preparing for their wedding day than they do for the birth of their child. Yet the birth of their child will effect a woman for the rest of her life...much more so than the flowers she chooses for the ceremony. I get it that it is expected that they will plan their wedding- but I think we need to change the perspective on preparing for their births. Many folks will not take a class since their friends said that the class they took was worthless. But then if you ask more, it was a one day, slam bam class where they hardly had time to formulate their questions before the class was over. I am not sure that is a good measure of a class that prepares you for your birth.
I get calls from folks who have not scheduled in the time to take a childbirth series- they want one private class or maybe two... because they do not have time to attend a full preparation course. Now granted that is better than nothing, but it is not ideal.
Or they hire a doula to fill in the gap of not attending a class. To me that is like I will add more eggs to the recipe since I do not have flour. It does not work- you need to take classes and not rely on the doula to teach you while you are in labor! It takes time to take what you learn and practice it, to formulate what works for you and what does not. The prenatal(s) you have with your doula are not meant to be childbirth classes. They are an opportunity to communicate the ideas you have formulated from your classes and possibly explore a few more. It is a time to review what you find has worked from the exercises you have already learned and to share those with your doula so she knows what your ideal birth would entail.
Or I get calls from women who have breastfeeding issues once the baby is born, but failed to attend any La Leche League meetings or attend a breastfeeding preparation class. Some women had no idea that they had inverted nipples and that there was preparation during their pregnancy that would have helped with this situation. And the time to learn about how to properly latch a baby is not after a bad latch has caused damage. Or the time to realize one bottle of formula really can disrupt a new nursing relationship is not after the bottle has been given and the baby's stomach has been stretched past the walnut size it was on day four.
Please consider preparing ahead of time for something you want to have work so badly. Why do we just think that everything will go as we desire when we fail to plan to prepare? I remember my coach saying, "Fail to plan...play to fail." I truly feel this is true about birth and breastfeeding. Reading the right books are essential. Watching videos to help prepare you may help. Sitting in an active classroom with others who are also in the same situation will help a ton! Take a class- go to a FREE La Leche League meeting to see women actually breastfeeding babies. It can only help!
I get calls from folks who have not scheduled in the time to take a childbirth series- they want one private class or maybe two... because they do not have time to attend a full preparation course. Now granted that is better than nothing, but it is not ideal.
Or they hire a doula to fill in the gap of not attending a class. To me that is like I will add more eggs to the recipe since I do not have flour. It does not work- you need to take classes and not rely on the doula to teach you while you are in labor! It takes time to take what you learn and practice it, to formulate what works for you and what does not. The prenatal(s) you have with your doula are not meant to be childbirth classes. They are an opportunity to communicate the ideas you have formulated from your classes and possibly explore a few more. It is a time to review what you find has worked from the exercises you have already learned and to share those with your doula so she knows what your ideal birth would entail.
Or I get calls from women who have breastfeeding issues once the baby is born, but failed to attend any La Leche League meetings or attend a breastfeeding preparation class. Some women had no idea that they had inverted nipples and that there was preparation during their pregnancy that would have helped with this situation. And the time to learn about how to properly latch a baby is not after a bad latch has caused damage. Or the time to realize one bottle of formula really can disrupt a new nursing relationship is not after the bottle has been given and the baby's stomach has been stretched past the walnut size it was on day four.
Please consider preparing ahead of time for something you want to have work so badly. Why do we just think that everything will go as we desire when we fail to plan to prepare? I remember my coach saying, "Fail to plan...play to fail." I truly feel this is true about birth and breastfeeding. Reading the right books are essential. Watching videos to help prepare you may help. Sitting in an active classroom with others who are also in the same situation will help a ton! Take a class- go to a FREE La Leche League meeting to see women actually breastfeeding babies. It can only help!
Friday, December 26, 2008
doing the next best thing in action!
Okay I am going to share a birth story of sorts... with anonymity but with permission from the mom.. but with a time line of sorts to show you how a first time mom's labor went recently... but first let me tell you a few things...
She chose to birth at North Fulton with ISIS midwives.(She drove from Norcross there)
She chose to take Hypnobirthing as her only formal childbirth education.
She chose a doula from our group, although her doula was called out of town on an emergency and she got a back up doula from our group instead.
Her water broke on it's own just after midnight on Wednesday morning. She had had an exam on Friday and was 3 cm dilated. Within 30 minutes she was mildly contracting 10 minutes apart. By 2 am they were coming every five minutes but again were still very manageable and mild.
By 5 am although they had slowed some of the time in between but the contractions were now beginning to hurt and had sped up. She was ready to be heading to the hospital soon.
Upon arrival the first exam at the hospital, now 6:30 am, by the midwife Kay showed her cervix had no real change from her appointment earlier in the week and the baby was high at -2 station. She is kept in the observation room after the monitoring strip is completed- she is out to walk about with her doula. The contractions are five minutes apart and she is having to work during each one.
At 9:30 am she is 5 centimeters dilated and the cervix is 80% thinned out although still posterior. She is moved to a labor room- the one with the nice birthing tub.
She had decided to use techniques outside the tub and wait to get in the tub since the baby was posterior and has been from the start of labor. Her doula uses open pelvis positioning, sitting on the birth ball doing figure 8’s and moving her hips. The mom is coping well. Although the doula keeps trying to get her in open knee positions and on her hands and knees, this is only tolerated for short stints as the mom did not like that position. She would tolerate it for no more than 10-15 minutes at a time.
The doula and the dad offered counter pressure and the next check showed she was dilated to 5-6 cm. It was now 1pm. (She has been at the hospital for 7 hours and laboring for more than 12 hours.) She decided to try the tub; she had thought she wanted to try for a water birth, but being in the tub totally did not work. She wanted to stand and have counter pressure more than she wanted the water. So she practically crawled over the side of the tub to get out. The mom was feeling very discouraged since she had not made any significant change in 3 1/2hours. (This is where most facilities in our area would have suggested Pitocin if not earlier. This is where some would have suggested an epidural to help the mom relax.)
Margaret, the next midwife arrived and checked her at 3pm and now the mom was 6-7 centimeters and almost fully effaced. She suggested the mom get in the exaggerated Sims position and concentrate on her hypnobirthing CD. The mom laid down and quieted after receiving a dose of Fetanyl(a short acting narcotic given by IV). She began to relax in between her contractions but still benefited from getting counter pressure applied to her back.
By 6pm she was feeling pressure in her bottom and declared that she was done! The exam showed she was now 7-8 centimeters but totally tight and tense. She had been inquiring about speaking to an anesthesiologist since she had not done any research on epidurals and had no real knowledge of them but thought she wanted to consider one. Margaret agreed that an epidural may really prove to be effective since the mom could no longer relax and getting this baby to turn would mean we needed to have her be relaxed. So after a second dose of Fetanyl, an anesthesiologist was called. This mom has a strong case of scoliosis. This makes inserting an epidural catheter quite difficult. And after 4 attempts although not a good placement, the mom did not feel like she had good relief. Soon after this Pitocin was added.
After attempting several boluses of medication it was decided to attempt a new placement of the epidural at 10:30 pm. This one worked great and gave the mom full relief. (Some moms do not get full relief from an epidural, but this was thought to be more due to the curvature in her spine)
By 3am an exam showed she was fully dilated and the baby had moved down to 0 station! Since she had an epidural on board and needed more rest, it was decided to have her only grunt when she felt the pressure and she did not actively begin to push until 4am. (Some facilities would have had her actively pushing as soon as she was completely dilated- others would have followed this plan to let her "labor the baby down".)
Again beginning to feel more unwanted pain, she received another bolus of epidural medication at 6am. The posterior baby was down to +1 station but they were attempting to get him to turn by putting his mom in the exaggerated Sims position again. (Most facilities would have suggested a cesarean at this point if not earlier. The would have sited that she had been completely dilated for three hours.)
By 9:30 am the baby was down to +2 station but was not budging any further over the next hour. Margaret called Dr. Frederick at 10:30 pm, her back up physician. Although the baby and the mom were both doing fine, she must have thought that they needed instrumental help at this point. He was in the room within 15 minutes. A decision was made to assist the mom's pushing with the use of the vacuum. Margaret felt all the mom needed was to turn the baby a bit to get it to come on out. She shared her feelings with both the doctor and the parents. Her years of experience were providing her with confidence. After two attempts, and the baby making quite a bit of progress but not quite enough, he reluctantly said he would try the forceps once before heading into the OR.
At 11:05 am the baby boy was born. He was not a huge baby- only weighing in a just under 8 pounds 5 ounces. (As a doula I have seen vaginal births of babies who weighed in excess of 12 pounds!)(One of the midwives in this group- not any of the attending ones, had projected the birth weight a week earlier as already being over 9 pounds! Just goes to show you can't predict the future!)
So think about this... if she had had Pitocin earlier perhaps it would have caused the baby to born sooner.. or perhaps it could have caused the baby to be stressed... or perhaps it could have caused the baby to be jammed down in that posterior position insuring he would not fit and insuring a cesarean birth...who knows? What if she had gotten an epidural earlier? Could this have caused the pelvis to relax and perhaps get the baby to turn sooner? Or would she have had Pitocin needed earlier and her contractions may not have continued well without the use of Pitocin?
What would have happened if the staff at the hospital had not been on board with this mom's desires? Having a nurse enter the room and undermine her confidence or choices is the last thing this mom needed. (At some hospitals their natural rate is so low the staff does not feel prepared to support a mom in going without medication. This causes some to seem like epidural pushers.)
What would her labor have been like if she had not had a midwife who believed and trusted in the process? What would have happened if they did not have a doula who was there encouraging (to give courage) them to keep trying? They must certainly have had a cesarean birth if they were held to a clock and the standards used in most hospitals. After all she had broken water for 17 hours. (Although this is totally acceptable- it is rare today to have moms outside of this facility and a few choice others go this long without a lot more intervention.) She would have certainly had a cesarean birth if the standard use of 2-3 hours of pushing had been used to determine that she could not push her baby out. She had been fully dilated for 7 hours before the birth!
It is about having all the pieces of the puzzle: location- birth team- educating yourself- and doing the next best thing along the journey. This mom may not have had the hypnobirthing, non interventive birth she desired. But she had a vaginal birth of a baby with APGARs of 8 and then 9- born screaming to show his delight in finally getting out! Having only one of those elements may not have ended up with the same outcome. A doula without the supportive staff is not fully equiped to help you get the birth you desire or if the care provider is not on board. So, it is a full team effort.
The mom said she felt having the doula kept her drug free for over 24 hours of her 36 hours of back labor. The doula was the one constant throughout her labor- never changing shifts or going off call during the whole labor. She stated that the way that the doula worked with her kept her from being exhausted earlier in labor. She said she would tell other pregnant moms that her flexible birth plan helped. It had been a long and painful journey, but she did it! She did not realize that at the time of labor- in that moment, it is hard to make decisions. She never knew how overwhelmed and delirious she would feel when having to make decisions. She said she now really understood the importance of having a great support team that she trusted as they sometimes had to help lead her through tough moments and decisions she otherwise would have felt unequiped to handle. The had remained calm.
I asked her about her choice for classes; hypnobirthing. She said she feels it would have worked without 36 hours of back labor! In the classes they are dismissive of the "what ifs" due to not allowing that negative thought to enter into your mind. So since they were dismissive of back labor- of a baby not being positioned properly, she would not have known what to do if she had not had a doula to help her. She had listened to the tapes over and over in practicing. She had visualized her baby being positioned perfectly. She had felt relaxed when she practiced the techniques. She said she may have chosen a different class if she had not had a doula, but felt the doula would be there in case of the "what ifs".
I will say I think hypnosis for birthing is a good tool- but it is one tool. I think just because you prepare yourself with other tools- more knowledge about the "what ifs"- it does not set you up for those negative things happening- it just makes you more informed and prepared. I teach some hypnosis for birthing ideas and sell some products that support this practice- but I personally do not see it as an end all for most labors. I think a woman needs to have her "tool box" full of tools.
Her doula shared that when we usually discuss the "what ifs" in discussing birth options, she has sometimes found it hard to work with these moms because their fear of talking about the "what ifs" cause them to be unprepared for them if they do arise. Talking about how to deal with them when they are happening is hard for everyone.
This mom told me she knows she missed having a surgical birth by the hair on her chiny chin chin! I think she is right. She had set herself up with the right team and many of the right choices for her birth to have the outcome she most wanted- a healthy baby- and a healthy mom without a surgical incision on her abdomen to get them both!
She chose to birth at North Fulton with ISIS midwives.(She drove from Norcross there)
She chose to take Hypnobirthing as her only formal childbirth education.
She chose a doula from our group, although her doula was called out of town on an emergency and she got a back up doula from our group instead.
Her water broke on it's own just after midnight on Wednesday morning. She had had an exam on Friday and was 3 cm dilated. Within 30 minutes she was mildly contracting 10 minutes apart. By 2 am they were coming every five minutes but again were still very manageable and mild.
By 5 am although they had slowed some of the time in between but the contractions were now beginning to hurt and had sped up. She was ready to be heading to the hospital soon.
Upon arrival the first exam at the hospital, now 6:30 am, by the midwife Kay showed her cervix had no real change from her appointment earlier in the week and the baby was high at -2 station. She is kept in the observation room after the monitoring strip is completed- she is out to walk about with her doula. The contractions are five minutes apart and she is having to work during each one.
At 9:30 am she is 5 centimeters dilated and the cervix is 80% thinned out although still posterior. She is moved to a labor room- the one with the nice birthing tub.
She had decided to use techniques outside the tub and wait to get in the tub since the baby was posterior and has been from the start of labor. Her doula uses open pelvis positioning, sitting on the birth ball doing figure 8’s and moving her hips. The mom is coping well. Although the doula keeps trying to get her in open knee positions and on her hands and knees, this is only tolerated for short stints as the mom did not like that position. She would tolerate it for no more than 10-15 minutes at a time.
The doula and the dad offered counter pressure and the next check showed she was dilated to 5-6 cm. It was now 1pm. (She has been at the hospital for 7 hours and laboring for more than 12 hours.) She decided to try the tub; she had thought she wanted to try for a water birth, but being in the tub totally did not work. She wanted to stand and have counter pressure more than she wanted the water. So she practically crawled over the side of the tub to get out. The mom was feeling very discouraged since she had not made any significant change in 3 1/2hours. (This is where most facilities in our area would have suggested Pitocin if not earlier. This is where some would have suggested an epidural to help the mom relax.)
Margaret, the next midwife arrived and checked her at 3pm and now the mom was 6-7 centimeters and almost fully effaced. She suggested the mom get in the exaggerated Sims position and concentrate on her hypnobirthing CD. The mom laid down and quieted after receiving a dose of Fetanyl(a short acting narcotic given by IV). She began to relax in between her contractions but still benefited from getting counter pressure applied to her back.
By 6pm she was feeling pressure in her bottom and declared that she was done! The exam showed she was now 7-8 centimeters but totally tight and tense. She had been inquiring about speaking to an anesthesiologist since she had not done any research on epidurals and had no real knowledge of them but thought she wanted to consider one. Margaret agreed that an epidural may really prove to be effective since the mom could no longer relax and getting this baby to turn would mean we needed to have her be relaxed. So after a second dose of Fetanyl, an anesthesiologist was called. This mom has a strong case of scoliosis. This makes inserting an epidural catheter quite difficult. And after 4 attempts although not a good placement, the mom did not feel like she had good relief. Soon after this Pitocin was added.
After attempting several boluses of medication it was decided to attempt a new placement of the epidural at 10:30 pm. This one worked great and gave the mom full relief. (Some moms do not get full relief from an epidural, but this was thought to be more due to the curvature in her spine)
By 3am an exam showed she was fully dilated and the baby had moved down to 0 station! Since she had an epidural on board and needed more rest, it was decided to have her only grunt when she felt the pressure and she did not actively begin to push until 4am. (Some facilities would have had her actively pushing as soon as she was completely dilated- others would have followed this plan to let her "labor the baby down".)
Again beginning to feel more unwanted pain, she received another bolus of epidural medication at 6am. The posterior baby was down to +1 station but they were attempting to get him to turn by putting his mom in the exaggerated Sims position again. (Most facilities would have suggested a cesarean at this point if not earlier. The would have sited that she had been completely dilated for three hours.)
By 9:30 am the baby was down to +2 station but was not budging any further over the next hour. Margaret called Dr. Frederick at 10:30 pm, her back up physician. Although the baby and the mom were both doing fine, she must have thought that they needed instrumental help at this point. He was in the room within 15 minutes. A decision was made to assist the mom's pushing with the use of the vacuum. Margaret felt all the mom needed was to turn the baby a bit to get it to come on out. She shared her feelings with both the doctor and the parents. Her years of experience were providing her with confidence. After two attempts, and the baby making quite a bit of progress but not quite enough, he reluctantly said he would try the forceps once before heading into the OR.
At 11:05 am the baby boy was born. He was not a huge baby- only weighing in a just under 8 pounds 5 ounces. (As a doula I have seen vaginal births of babies who weighed in excess of 12 pounds!)(One of the midwives in this group- not any of the attending ones, had projected the birth weight a week earlier as already being over 9 pounds! Just goes to show you can't predict the future!)
So think about this... if she had had Pitocin earlier perhaps it would have caused the baby to born sooner.. or perhaps it could have caused the baby to be stressed... or perhaps it could have caused the baby to be jammed down in that posterior position insuring he would not fit and insuring a cesarean birth...who knows? What if she had gotten an epidural earlier? Could this have caused the pelvis to relax and perhaps get the baby to turn sooner? Or would she have had Pitocin needed earlier and her contractions may not have continued well without the use of Pitocin?
What would have happened if the staff at the hospital had not been on board with this mom's desires? Having a nurse enter the room and undermine her confidence or choices is the last thing this mom needed. (At some hospitals their natural rate is so low the staff does not feel prepared to support a mom in going without medication. This causes some to seem like epidural pushers.)
What would her labor have been like if she had not had a midwife who believed and trusted in the process? What would have happened if they did not have a doula who was there encouraging (to give courage) them to keep trying? They must certainly have had a cesarean birth if they were held to a clock and the standards used in most hospitals. After all she had broken water for 17 hours. (Although this is totally acceptable- it is rare today to have moms outside of this facility and a few choice others go this long without a lot more intervention.) She would have certainly had a cesarean birth if the standard use of 2-3 hours of pushing had been used to determine that she could not push her baby out. She had been fully dilated for 7 hours before the birth!
It is about having all the pieces of the puzzle: location- birth team- educating yourself- and doing the next best thing along the journey. This mom may not have had the hypnobirthing, non interventive birth she desired. But she had a vaginal birth of a baby with APGARs of 8 and then 9- born screaming to show his delight in finally getting out! Having only one of those elements may not have ended up with the same outcome. A doula without the supportive staff is not fully equiped to help you get the birth you desire or if the care provider is not on board. So, it is a full team effort.
The mom said she felt having the doula kept her drug free for over 24 hours of her 36 hours of back labor. The doula was the one constant throughout her labor- never changing shifts or going off call during the whole labor. She stated that the way that the doula worked with her kept her from being exhausted earlier in labor. She said she would tell other pregnant moms that her flexible birth plan helped. It had been a long and painful journey, but she did it! She did not realize that at the time of labor- in that moment, it is hard to make decisions. She never knew how overwhelmed and delirious she would feel when having to make decisions. She said she now really understood the importance of having a great support team that she trusted as they sometimes had to help lead her through tough moments and decisions she otherwise would have felt unequiped to handle. The had remained calm.
I asked her about her choice for classes; hypnobirthing. She said she feels it would have worked without 36 hours of back labor! In the classes they are dismissive of the "what ifs" due to not allowing that negative thought to enter into your mind. So since they were dismissive of back labor- of a baby not being positioned properly, she would not have known what to do if she had not had a doula to help her. She had listened to the tapes over and over in practicing. She had visualized her baby being positioned perfectly. She had felt relaxed when she practiced the techniques. She said she may have chosen a different class if she had not had a doula, but felt the doula would be there in case of the "what ifs".
I will say I think hypnosis for birthing is a good tool- but it is one tool. I think just because you prepare yourself with other tools- more knowledge about the "what ifs"- it does not set you up for those negative things happening- it just makes you more informed and prepared. I teach some hypnosis for birthing ideas and sell some products that support this practice- but I personally do not see it as an end all for most labors. I think a woman needs to have her "tool box" full of tools.
Her doula shared that when we usually discuss the "what ifs" in discussing birth options, she has sometimes found it hard to work with these moms because their fear of talking about the "what ifs" cause them to be unprepared for them if they do arise. Talking about how to deal with them when they are happening is hard for everyone.
This mom told me she knows she missed having a surgical birth by the hair on her chiny chin chin! I think she is right. She had set herself up with the right team and many of the right choices for her birth to have the outcome she most wanted- a healthy baby- and a healthy mom without a surgical incision on her abdomen to get them both!
Thursday, December 25, 2008
Sherpa Doula...
Sherpa: "The term sherpa is also used to refer to local people, typically men, who are employed as guides for mountaineering expeditions in the Himalayas, particularly Mt. Everest. They are highly regarded as elite mountaineers and experts in their local terrain, as well as having good physical endurance and resilience to high altitude conditions."
At my last birth, (my 400th as a doula!) the dad said that just as they had used me for their first birth, they would not consider having a baby without a doula. In fact he sings my praises to many pregnant couples. His sister was present during the labor and just after the birth and she was told by both the mom and the dad of this baby, that they need to hire me when they have their first child!
But a comment that the dad said resonated with me. He said just as you would not climb the Himalayas without a Sherpa, you should not give birth without a doula! I loved the statement. It made me feel like smiling! It was great because I consider myself a birth guide.
If the dad or the woman's mother or sister want an active part in the labor and birth, I am more than willing to step back and only offer suggestions along the way. But when the other support people need or want to step back, I am there to offer any support needed. But considering myself a labor sherpa is kinda sweet! Thanks Trey!
At my last birth, (my 400th as a doula!) the dad said that just as they had used me for their first birth, they would not consider having a baby without a doula. In fact he sings my praises to many pregnant couples. His sister was present during the labor and just after the birth and she was told by both the mom and the dad of this baby, that they need to hire me when they have their first child!
But a comment that the dad said resonated with me. He said just as you would not climb the Himalayas without a Sherpa, you should not give birth without a doula! I loved the statement. It made me feel like smiling! It was great because I consider myself a birth guide.
If the dad or the woman's mother or sister want an active part in the labor and birth, I am more than willing to step back and only offer suggestions along the way. But when the other support people need or want to step back, I am there to offer any support needed. But considering myself a labor sherpa is kinda sweet! Thanks Trey!
Monday, December 22, 2008
why do we stop prematurely...
...I had a delightful call today from a young lady who made nursing bibs. These are similar I am sure to the "hooter hiders" who due to poor name marketing changed to http://www.bebeaulait.com/. I told her politely that I did not want to sell anything like that because I felt it made a statement of shame in regards to breastfeeding- not just discretion but that the statement was that the mom should be hiding her breasts to nurse.
She asked some great questions regarding moms who were concerned about nursing publicly and felt they wanted discretion. I do sell mobeleez nursing bonnets for nursing discreetly- but it does not seem the same to me...does not scream- I am hiding my breasts and I am breastfeeding like I feel the bibs do. I encourage women to nurse in public- not in a nasty, germ filled bathroom- and to wear clothing that encourages ease at getting the baby latched on without flashing their breasts. (Although in our state you can flash all you want when nursing in any public place- you do not have to be discreet. We worked hard to make sure the law did not say that since it is so discretionary in what someone feels is discreet.) But...
I feel like if a mom tucks the corner of the blanket into her bra strap at the top and into the back band of her pants the blanket stays put. And for the baby who despises and fights with the blanket a nice bonnet helps and also wearing a button down shirt and a cami or nursing bra underneath and then buttoning the shirt from the top and leaving it open at the bottom also offers a great deal of discretion.
But we also talked about how her mom told her that you must wean a baby before they will potty train. And that the whiny, clingy stage that some babies go through is totally due to the nursing too- and they will not outgrow it until she weans. Hogwash!
So I thought about why we nurse for such a short period of time and here are my thoughts- I would love yours...
1. We just don't fully understand the benefits of nursing past the first few months- if we did we would continue it.
2. We get so much flack from others who do not understand the value of nursing that they wear us down.
3. We are still not the "norm" in our society so folks give us strange looks or comments.
4. We feel we need our lives back- and therefore we consider ourselves more highly than the baby or toddler who wants to nurse
5. Others make us feel we are strange for continuing to nurse and we cave to pressure from them.
6. We never did get the nursing in public thing down and we hate being banished every time we need to nurse.
7. Being banished led us to using bottles and now nursing is not something that the baby does very often- soon weaning.
8. We are afraid that if we don't wean the baby we will have a nursing teenager- have you ever really seen a nursing teenager?
9. We want our bodies back- we are tired of leaking- tugging- being demanded of- hmmm not sure if motherhood is what you are seeking to get away from here since nursing is not the cause - it is you have a baby or toddler!
10. We think the baby will...sleep better at night...sleep better during the day...gain faster...gain less...potty train...whine less...like others more...whatever.
11. We are afraid when they get teeth that they will bite.
12. We want to get pregnant again... or we want to go on birth control and not get pregnant again.
13. We think we will be happier if we quit nursing- although now you just got rid of the prolactin that was making you happier.
14. We want to diet- hmmm did you realize how many more calories you can have when you nurse?
15. We are afraid it will cause our breasts to sage...afterall look at National Geographics natives- could it be no support of their breasts all their lives? hmmm
16. We have sore nipples - hmmm a good latch will deal with this almost immediately. It is a lie that you have to get sore nipples when you nurse!
17. Rather than help a mom to learn to breastfeed, others including the medical establishment suggests supplementing and then it is a short time before milk production is diminished.
18. We don't know anyone else who is doing this- join La Leche League!
19. We see breasts only as sexual objects- we failed to understand why God made them- maybe they can be a two- fer!
20. We start offering solids- cereal is a solid ladies- and that is like giving dessert instead of a main course to our babies and soon they are not interested in what is best for them... wonder if they will ever brush their teeth when they are older?
It is disturbing to me that we have made breastfeeding such a difficult thing over the years. The ads in the magazines show the breastfeeding mom alone and banished in the nursing chair in the bedroom alone- while the bottle feeding mom has a cute husband- happy baby- huge diamond and is well dressed and out in the public having fun! It is a lie! But we have bought it!
I almost wish we could have a huge number of "brazen" women who would start nursing really indiscreetly in public- now wait before you say it will give nursing a bad name- perhaps it will become so common place that it causes no reaction at all... kinda like Victoria Secret bra ads on television with scantily clad women... or bikinis on the public beaches that only cover her pubic patch and her nipples... or violence on television... we have become numb to that. Wouldn't it be wonderful if when a mom met her baby's needs by unbuttoning her blouse and putting her nursling to her breast it did not cause a stir- instead elicited a smile!
Pinch me I must be dreaming!
She asked some great questions regarding moms who were concerned about nursing publicly and felt they wanted discretion. I do sell mobeleez nursing bonnets for nursing discreetly- but it does not seem the same to me...does not scream- I am hiding my breasts and I am breastfeeding like I feel the bibs do. I encourage women to nurse in public- not in a nasty, germ filled bathroom- and to wear clothing that encourages ease at getting the baby latched on without flashing their breasts. (Although in our state you can flash all you want when nursing in any public place- you do not have to be discreet. We worked hard to make sure the law did not say that since it is so discretionary in what someone feels is discreet.) But...
I feel like if a mom tucks the corner of the blanket into her bra strap at the top and into the back band of her pants the blanket stays put. And for the baby who despises and fights with the blanket a nice bonnet helps and also wearing a button down shirt and a cami or nursing bra underneath and then buttoning the shirt from the top and leaving it open at the bottom also offers a great deal of discretion.
But we also talked about how her mom told her that you must wean a baby before they will potty train. And that the whiny, clingy stage that some babies go through is totally due to the nursing too- and they will not outgrow it until she weans. Hogwash!
So I thought about why we nurse for such a short period of time and here are my thoughts- I would love yours...
1. We just don't fully understand the benefits of nursing past the first few months- if we did we would continue it.
2. We get so much flack from others who do not understand the value of nursing that they wear us down.
3. We are still not the "norm" in our society so folks give us strange looks or comments.
4. We feel we need our lives back- and therefore we consider ourselves more highly than the baby or toddler who wants to nurse
5. Others make us feel we are strange for continuing to nurse and we cave to pressure from them.
6. We never did get the nursing in public thing down and we hate being banished every time we need to nurse.
7. Being banished led us to using bottles and now nursing is not something that the baby does very often- soon weaning.
8. We are afraid that if we don't wean the baby we will have a nursing teenager- have you ever really seen a nursing teenager?
9. We want our bodies back- we are tired of leaking- tugging- being demanded of- hmmm not sure if motherhood is what you are seeking to get away from here since nursing is not the cause - it is you have a baby or toddler!
10. We think the baby will...sleep better at night...sleep better during the day...gain faster...gain less...potty train...whine less...like others more...whatever.
11. We are afraid when they get teeth that they will bite.
12. We want to get pregnant again... or we want to go on birth control and not get pregnant again.
13. We think we will be happier if we quit nursing- although now you just got rid of the prolactin that was making you happier.
14. We want to diet- hmmm did you realize how many more calories you can have when you nurse?
15. We are afraid it will cause our breasts to sage...afterall look at National Geographics natives- could it be no support of their breasts all their lives? hmmm
16. We have sore nipples - hmmm a good latch will deal with this almost immediately. It is a lie that you have to get sore nipples when you nurse!
17. Rather than help a mom to learn to breastfeed, others including the medical establishment suggests supplementing and then it is a short time before milk production is diminished.
18. We don't know anyone else who is doing this- join La Leche League!
19. We see breasts only as sexual objects- we failed to understand why God made them- maybe they can be a two- fer!
20. We start offering solids- cereal is a solid ladies- and that is like giving dessert instead of a main course to our babies and soon they are not interested in what is best for them... wonder if they will ever brush their teeth when they are older?
It is disturbing to me that we have made breastfeeding such a difficult thing over the years. The ads in the magazines show the breastfeeding mom alone and banished in the nursing chair in the bedroom alone- while the bottle feeding mom has a cute husband- happy baby- huge diamond and is well dressed and out in the public having fun! It is a lie! But we have bought it!
I almost wish we could have a huge number of "brazen" women who would start nursing really indiscreetly in public- now wait before you say it will give nursing a bad name- perhaps it will become so common place that it causes no reaction at all... kinda like Victoria Secret bra ads on television with scantily clad women... or bikinis on the public beaches that only cover her pubic patch and her nipples... or violence on television... we have become numb to that. Wouldn't it be wonderful if when a mom met her baby's needs by unbuttoning her blouse and putting her nursling to her breast it did not cause a stir- instead elicited a smile!
Pinch me I must be dreaming!
Sunday, December 21, 2008
Did God Screw Up?
... I just blogged about the medicalization of birth and then laid back down to try to sleep- I woke really early today and did not sleep well... and the phrase just get screaming in my head... Did God screw up?
Women do not allow their bodies to signal when to go into labor these days- instead doctors or midwives determine that their babies are due... so did God screw up?
Women are not allowed to stretch as their bodies were meant to stretch when giving birth- instead doctors cut episiotomies believing that a baby is not really meant to fit through that space...Did God screw up?
The hormones we were given as women to signal our uteruses to contract used to be enough to bring out a baby- but today doctors and midwives have come to use synthetic hormones- oxytocin to bring about contractions...Did God screw up?
One in every three women today in the metro area of Atlanta will have her baby cut out of her- cesareans are on the increase, do women no longer have the capacity to birth their babies out of their bodies...Did God screw up?
And you know all babies need a shot of Vitamin K for blood clotting issues- after all God must have screwed up right- why in the world is there an increase of Vitamin K on day eight after all- didn't God know we needed it earlier- at least the doctors know it!
Women have been given a super power that allows them to make milk- but the CDC reported in 2005 only 11% of babies were breastfed at six months of age...Did God screw up?
Boys were born with foreskins to protect their penises...but today only 25% of boys penises are left intact (40% in the south!)...Did God screw up? (only the Jews were told to circumcise and it was before they went on a 40 year journey in the desert)
Just makes you wonder who died and made man God. I don't think HE screwed up at all. I think we think we know better...but it seems we do not.
We need to trust our bodies- trust our births- trust God...
Women do not allow their bodies to signal when to go into labor these days- instead doctors or midwives determine that their babies are due... so did God screw up?
Women are not allowed to stretch as their bodies were meant to stretch when giving birth- instead doctors cut episiotomies believing that a baby is not really meant to fit through that space...Did God screw up?
The hormones we were given as women to signal our uteruses to contract used to be enough to bring out a baby- but today doctors and midwives have come to use synthetic hormones- oxytocin to bring about contractions...Did God screw up?
One in every three women today in the metro area of Atlanta will have her baby cut out of her- cesareans are on the increase, do women no longer have the capacity to birth their babies out of their bodies...Did God screw up?
And you know all babies need a shot of Vitamin K for blood clotting issues- after all God must have screwed up right- why in the world is there an increase of Vitamin K on day eight after all- didn't God know we needed it earlier- at least the doctors know it!
Women have been given a super power that allows them to make milk- but the CDC reported in 2005 only 11% of babies were breastfed at six months of age...Did God screw up?
Boys were born with foreskins to protect their penises...but today only 25% of boys penises are left intact (40% in the south!)...Did God screw up? (only the Jews were told to circumcise and it was before they went on a 40 year journey in the desert)
Just makes you wonder who died and made man God. I don't think HE screwed up at all. I think we think we know better...but it seems we do not.
We need to trust our bodies- trust our births- trust God...
There's a way to do it better - find it. Thomas A. Edison
I noticed my quote of the day "There's a way to do it better - find it." by
Thomas A. Edison and I thought about birth... and doulaing...
There are so many ways we have screwed up the natural birth process these days for the sake of a better way... I think what Ina May Gaskin said- "if you want to understand birth, watch the Animal Channel." is so right. Do not watch the Birth Story shows- no Maternity Ward, no Deliver Me! The television has propagated the lies of what normal birth looks like.
In fact normal birth today has become one of inductions, pitocin, epidurals, and cesareans. That is not normal birth. In fact if you step into most hospitals today you will be hard pressed to see normal birth.
I understand why the home birth movement is on the rise. Women want to take back their births. It has been taken away from them in the hospital settings.
When a woman calls her doctor in what appears to be early labor it is suggested she come on to the hospital early to be checked out. Upon arrival, after doing the neccessary paperwork, she is shuffled into a room and asked to disrobe and put on a hospital gown. She may have been transported to the room in a wheel chair- although her legs may work perfectly fine. She is then instructed to pee in a cup. And then get in the bed for monitoring. Although she can be monitored while sitting up or standing, the easiest way for the staff is laying in the bed. After all it is about their ease, not the mom's comfort!
She is then instructed to not eat any longer and may even be restricted on what to drink if anything. Lab work is done by drawing her blood. They may also "require" a small plastic catheter to remain in her arm just in case she needs IV fluids or medication and some "require" this to be done even if she does not plan on any medication.
So, the cascade of interventions have begun...
Soon someone may suggest breaking her water, starting her on synthetic oxytocin, getting her comfortable with an epidural and so forth...
I wonder if the medical establishment feels this is a way to do it better - and they feel they have found it. I personally am not sure they have. In fact as I reflect on my next birth being my 400th one as a doula, I am pretty sure this is not the better way for the normal, healthy woman of today.
Thomas A. Edison and I thought about birth... and doulaing...
There are so many ways we have screwed up the natural birth process these days for the sake of a better way... I think what Ina May Gaskin said- "if you want to understand birth, watch the Animal Channel." is so right. Do not watch the Birth Story shows- no Maternity Ward, no Deliver Me! The television has propagated the lies of what normal birth looks like.
In fact normal birth today has become one of inductions, pitocin, epidurals, and cesareans. That is not normal birth. In fact if you step into most hospitals today you will be hard pressed to see normal birth.
I understand why the home birth movement is on the rise. Women want to take back their births. It has been taken away from them in the hospital settings.
When a woman calls her doctor in what appears to be early labor it is suggested she come on to the hospital early to be checked out. Upon arrival, after doing the neccessary paperwork, she is shuffled into a room and asked to disrobe and put on a hospital gown. She may have been transported to the room in a wheel chair- although her legs may work perfectly fine. She is then instructed to pee in a cup. And then get in the bed for monitoring. Although she can be monitored while sitting up or standing, the easiest way for the staff is laying in the bed. After all it is about their ease, not the mom's comfort!
She is then instructed to not eat any longer and may even be restricted on what to drink if anything. Lab work is done by drawing her blood. They may also "require" a small plastic catheter to remain in her arm just in case she needs IV fluids or medication and some "require" this to be done even if she does not plan on any medication.
So, the cascade of interventions have begun...
Soon someone may suggest breaking her water, starting her on synthetic oxytocin, getting her comfortable with an epidural and so forth...
I wonder if the medical establishment feels this is a way to do it better - and they feel they have found it. I personally am not sure they have. In fact as I reflect on my next birth being my 400th one as a doula, I am pretty sure this is not the better way for the normal, healthy woman of today.
Friday, December 19, 2008
statistics
What do they really mean? Can we make them say what we want? Can the numbers be manipulated? Of course- but over the last few days of documenting the cesarean stats, the infant mortality and maternal morbidity rates makes me realize that we don't care about most of those numbers as a society until they effect us personally.
When my youngest daughter was diagnosed with epilepsy as a young child, I was appalled at how little was known about the disorder. But before she was diagnosed I had never once been concerned about it.
When my dad was diagnosed with Alzheimer's, I was amazed at how little was known about medications that would be beneficial to controlling the disease. I had no knowledge really of the disease until I was personally effected.
Although I had made a point of knowing a lot about breast cancer and genetic components of the disease due to my family history, I learned so much more when I was diagnosed with the genetic mutation of BRCA1. And although I researched to a huge degree the information regarding reconstruction of my breasts after my mastectomy was decided upon, I had no idea of the complications that arise only 5% of the time! And now I know a ton more about that!
So, I share the stats to make you aware. This does effect you. It effects us all when births and outcomes from those births are taking away from birth experiences and lives. Our postpartum depression rates are climbing and some say it is the dissatisfaction with births that causes this for some women. Women who have great birth experiences according to Klaus and Kennels studies as documented showed that women had *Improved Breastfeeding, *Decreased Postpartum Depression,
*Greater Maternal Satisfaction and *Better Mother-Infant Interaction.
So if moms feel better about their babies- better about themselves- and bond more appropriately with their infants- that helps everyone! In a presentation I attended by Drs Klaus and Kennel they said that moms who had a good birth experience felt their babies were smarter, cuter and more advanced than their counterparts. So if those moms were treating their babies that way, who does that help? Everyone! You are personally being effected by birth outcomes- whether you realize it or not!
When my youngest daughter was diagnosed with epilepsy as a young child, I was appalled at how little was known about the disorder. But before she was diagnosed I had never once been concerned about it.
When my dad was diagnosed with Alzheimer's, I was amazed at how little was known about medications that would be beneficial to controlling the disease. I had no knowledge really of the disease until I was personally effected.
Although I had made a point of knowing a lot about breast cancer and genetic components of the disease due to my family history, I learned so much more when I was diagnosed with the genetic mutation of BRCA1. And although I researched to a huge degree the information regarding reconstruction of my breasts after my mastectomy was decided upon, I had no idea of the complications that arise only 5% of the time! And now I know a ton more about that!
So, I share the stats to make you aware. This does effect you. It effects us all when births and outcomes from those births are taking away from birth experiences and lives. Our postpartum depression rates are climbing and some say it is the dissatisfaction with births that causes this for some women. Women who have great birth experiences according to Klaus and Kennels studies as documented showed that women had *Improved Breastfeeding, *Decreased Postpartum Depression,
*Greater Maternal Satisfaction and *Better Mother-Infant Interaction.
So if moms feel better about their babies- better about themselves- and bond more appropriately with their infants- that helps everyone! In a presentation I attended by Drs Klaus and Kennel they said that moms who had a good birth experience felt their babies were smarter, cuter and more advanced than their counterparts. So if those moms were treating their babies that way, who does that help? Everyone! You are personally being effected by birth outcomes- whether you realize it or not!
maternal morbidity rates in the US
Okay so the doom and gloom of our infant mortality rates in the US caused me to wonder about the maternal morbidity rates- so here is the news on that...
"Article Date: 29 Aug 2007 - 3:00 PDT
The maternal mortality rate in the U.S. is the highest it has been in decades, according to statistics released this week by CDC's National Center for Health Statistics, the AP/Washington Post reports. According to the figures, the U.S. maternal mortality rate was 13 deaths per 100,000 live births in 2004. The rate was 12 deaths per 100,000 live births in 2003 -- the first year the maternal death rate was more than 10 since 1977 (Stobbe, AP/Washington Post, 8/24). A total of 540 women were reported to have died of maternal causes in 2004, 45 more than were reported in 2003, according to the report (NCHS report, 8/21)."
And the full article can be found
http://www.medicalnewstoday.com/articles/80743.php
They state the reasons are high rates of cesareans causing excessive bleeding. Other causes seem to highlight that same disparity of economics and race as a factor in poor health care. Obesity is a factor due to diabetes and the need for my cesarean births. And this is only the reported deaths that were actually related to pregnancy issues.
What the heck are we doing wrong? How is this ever going to be better if we keep following the same path?
One article from 2005 stated that, "Throughout the 20th century, maternal mortality in the United States gradually went from 900 deaths per 100,00 live births to about 10, noted Dr. Berg, who is a medical epidemiologist at the Centers for Disease Control and Prevention, Atlanta. "But in the past 20 years, there hasn't been a meaningful drop."
20 years and no significant drop? Has medicine not improved health care for pregnant women during that time? There seems to be a correlation in most every article I read about mother morbidity and cesarean births- and yet we keep having an incline in cesarean rates... is someone going to wake up and see that this must change!
"Article Date: 29 Aug 2007 - 3:00 PDT
The maternal mortality rate in the U.S. is the highest it has been in decades, according to statistics released this week by CDC's National Center for Health Statistics, the AP/Washington Post reports. According to the figures, the U.S. maternal mortality rate was 13 deaths per 100,000 live births in 2004. The rate was 12 deaths per 100,000 live births in 2003 -- the first year the maternal death rate was more than 10 since 1977 (Stobbe, AP/Washington Post, 8/24). A total of 540 women were reported to have died of maternal causes in 2004, 45 more than were reported in 2003, according to the report (NCHS report, 8/21)."
And the full article can be found
http://www.medicalnewstoday.com/articles/80743.php
They state the reasons are high rates of cesareans causing excessive bleeding. Other causes seem to highlight that same disparity of economics and race as a factor in poor health care. Obesity is a factor due to diabetes and the need for my cesarean births. And this is only the reported deaths that were actually related to pregnancy issues.
What the heck are we doing wrong? How is this ever going to be better if we keep following the same path?
One article from 2005 stated that, "Throughout the 20th century, maternal mortality in the United States gradually went from 900 deaths per 100,00 live births to about 10, noted Dr. Berg, who is a medical epidemiologist at the Centers for Disease Control and Prevention, Atlanta. "But in the past 20 years, there hasn't been a meaningful drop."
20 years and no significant drop? Has medicine not improved health care for pregnant women during that time? There seems to be a correlation in most every article I read about mother morbidity and cesarean births- and yet we keep having an incline in cesarean rates... is someone going to wake up and see that this must change!
Thursday, December 18, 2008
infant mortality rates in the US
There are 42 countries that have a better infant mortality rate than the US! What are they doing that we are not doing? Midwifery is the model of care for their pregnant women! Home birth is also a viable option for them to choose.
CNN reported "Wednesday, May 10, 2006; Posted: 12:02 p.m. EDT (16:02 GMT)
(CNN) -- An estimated 2 million babies die within their first 24 hours each year worldwide and the United States has the second worst newborn mortality rate in the developed world, according to a new report.
American babies are three times more likely to die in their first month as children born in Japan, and newborn mortality is 2.5 times higher in the United States than in Finland, Iceland or Norway, Save the Children researchers found.
Only Latvia, with six deaths per 1,000 live births, has a higher death rate for newborns than the United States, which is tied near the bottom of industrialized nations with Hungary, Malta, Poland and Slovakia with five deaths per 1,000 births.
"The United States has more neonatologists and neonatal intensive care beds per person than Australia, Canada and the United Kingdom, but its newborn rate is higher than any of those countries," said the annual State of the World's Mothers report."
For the full article go to http://www.cnn.com/2006/HEALTH/parenting/05/08/mothers.index/
What the heck is going on! Why in the world in such a prosperous nation is this not changing?
Health news said, "Infant mortality is one comparative measure of national health, widely used because of the scarcity of other standardized health data in much of the world. In the United States, the infant mortality rate (IMF) has continued to steadily decline over the past several decades, from 26 per 1,000 live births in 1960 to 6.9 per 1,000 live births in 2000, which looks great on the surface. However, when you compare U.S. infant mortality to that of other developed countries, a different picture emerges. While other countries have improved their international standing in infant mortality, the United States has worsened, going from 12th in 1960 to 29th in 2004, according to a new report issued by the Centers for Disease Control and Prevention’s National Center for Health Statistics."
for the full article go here http://www.healthnews.com/family-health/child-health/infant-mortality-how-does-the-us-compare-with-other-countries-1954.html
Preterm births is part of the issue- but the CDC says that part of the reason for preterm births is our increasing rate of inductions and miscalculations of due dates causing babies who are thought to be full term to not be.
The disparity of health care for the poor and women of color shows a huge disparity of unhealthy babies being born to these women.
We need to look at the 42 countries that are doing a better job than we are and seek some input on changing our health care system for pregnant women and infants!
CNN reported "Wednesday, May 10, 2006; Posted: 12:02 p.m. EDT (16:02 GMT)
(CNN) -- An estimated 2 million babies die within their first 24 hours each year worldwide and the United States has the second worst newborn mortality rate in the developed world, according to a new report.
American babies are three times more likely to die in their first month as children born in Japan, and newborn mortality is 2.5 times higher in the United States than in Finland, Iceland or Norway, Save the Children researchers found.
Only Latvia, with six deaths per 1,000 live births, has a higher death rate for newborns than the United States, which is tied near the bottom of industrialized nations with Hungary, Malta, Poland and Slovakia with five deaths per 1,000 births.
"The United States has more neonatologists and neonatal intensive care beds per person than Australia, Canada and the United Kingdom, but its newborn rate is higher than any of those countries," said the annual State of the World's Mothers report."
For the full article go to http://www.cnn.com/2006/HEALTH/parenting/05/08/mothers.index/
What the heck is going on! Why in the world in such a prosperous nation is this not changing?
Health news said, "Infant mortality is one comparative measure of national health, widely used because of the scarcity of other standardized health data in much of the world. In the United States, the infant mortality rate (IMF) has continued to steadily decline over the past several decades, from 26 per 1,000 live births in 1960 to 6.9 per 1,000 live births in 2000, which looks great on the surface. However, when you compare U.S. infant mortality to that of other developed countries, a different picture emerges. While other countries have improved their international standing in infant mortality, the United States has worsened, going from 12th in 1960 to 29th in 2004, according to a new report issued by the Centers for Disease Control and Prevention’s National Center for Health Statistics."
for the full article go here http://www.healthnews.com/family-health/child-health/infant-mortality-how-does-the-us-compare-with-other-countries-1954.html
Preterm births is part of the issue- but the CDC says that part of the reason for preterm births is our increasing rate of inductions and miscalculations of due dates causing babies who are thought to be full term to not be.
The disparity of health care for the poor and women of color shows a huge disparity of unhealthy babies being born to these women.
We need to look at the 42 countries that are doing a better job than we are and seek some input on changing our health care system for pregnant women and infants!
absurdity
So we have a client in our group who recently changed to N Fulton because she found out that water birth is an option there. She had asked her doctor at Piedmont about water births but they told her they did not offer them anywhere in Atlanta... hmmmm... so when she found out they did- she changed in her eighth month!
So the policy at North Fulton is in order to have a water birth you must take this 3 hour required water birth class and pay $30 to do so. But guess what? In December they offered it only one time instead of the usual two times. It has already occurred for December. The next one is two days before her due date!
I told her to pitch a fit to the hospital administrator about it! It is absurd to require a class that you then require payment for and then only offer it one time in a month due to the holiday!
I feel the nice little birth center we have had at North Fulton is becoming polluted with policies that do not have the mothers best interest in mind! I feel policies are about covering their butts- instead of meeting the moms needs.
I spoke to my friend- one of the midwives there today and she said "its the rule" and most of the policies were established by one doctor who is not even there any longer. Absurd! Ridiculous. But as she said to me tonight- it is still the best birth situation in town.
I hate that there is pollution in the water of the minds of administration that is polluting the birth experiences that used to be so pure there... augh!
So the policy at North Fulton is in order to have a water birth you must take this 3 hour required water birth class and pay $30 to do so. But guess what? In December they offered it only one time instead of the usual two times. It has already occurred for December. The next one is two days before her due date!
I told her to pitch a fit to the hospital administrator about it! It is absurd to require a class that you then require payment for and then only offer it one time in a month due to the holiday!
I feel the nice little birth center we have had at North Fulton is becoming polluted with policies that do not have the mothers best interest in mind! I feel policies are about covering their butts- instead of meeting the moms needs.
I spoke to my friend- one of the midwives there today and she said "its the rule" and most of the policies were established by one doctor who is not even there any longer. Absurd! Ridiculous. But as she said to me tonight- it is still the best birth situation in town.
I hate that there is pollution in the water of the minds of administration that is polluting the birth experiences that used to be so pure there... augh!
Wednesday, December 17, 2008
Cesarean Rates- Atlanta
One of the mamas on the local ican group (http://atlanta.ican-online.org) posted the stats from2006-2007 cesarean rates in the metro Atlanta area.
She calculated these from the gahospitalpricecheck.org. It's July 2006-June 2007. The #s are total births/cesareans/cesarean rate. Piedmont & Northside are still highest, North Fulton still lowest. Now keep in mind this includes those who choose to repeat a cesarean birth after having had a previous one. (The rates have only climbed since these stats- so the 2007-2008 will only be higher!) I have put the stats that Atlanta Parent posted in italics under the ga hospital check numbers- they break down the primary and repeat numbers for you to consider.
She calculated these from the gahospitalpricecheck.org. It's July 2006-June 2007. The #s are total births/cesareans/cesarean rate. Piedmont & Northside are still highest, North Fulton still lowest. Now keep in mind this includes those who choose to repeat a cesarean birth after having had a previous one. (The rates have only climbed since these stats- so the 2007-2008 will only be higher!) I have put the stats that Atlanta Parent posted in italics under the ga hospital check numbers- they break down the primary and repeat numbers for you to consider.
Tuesday, December 16, 2008
Illusions and Assumptions
Today I met with a repeat client for her prenatal meeting- she is due in a few weeks. We were talking about how three years ago I suggested she consider a different hospital than the one she was planning on birthing at. I don't always recommend a change- but this mom was describing the birth she desired and I knew that the hospital she was choosing would be hard pressed to give her what she desired.
I am often known to say going to some hospitals and asking for a non interventive, naturally supported birth is like going to KFC Chicken and asking for sushi. Now you can occasionally find a store manager who if you go every day and ask for sushi- goes out and gets you sushi knowing that you are coming today to ask again. So, you can have a great birth most everywhere but it may be not the norm and therefore you may have to work harder to get what you want.
This young woman chose to stay at her hospital last time- even though one midwife in the group she did not like- and you guessed it- that is who attended her in labor. After a few hours with no increase in dilation, there were threats of a cesarean being needed and this mom chose to have some interventions she originally had not wanted... then the cascade began- but she ended up with a vaginal birth...her ultimate desire... and of course a beautiful, healthy baby.
This time she travels across town to the hospital I had recommended three years ago. She feels safe with any of the midwives. She knows this hospital embraces the kind of birth she desires. She feels safe. She nows sees that the allusion of having a hospital around the corner from where she lives, a practice of midwives or docs who were convenient to where she lived, and the thought that she could get what she wanted only if she let her desires be known, were illusions and assumptions.
I had a dad tell me when he heard me warn to not leave the baby in the nursery since they adamantly did not want a bottle to be given to the baby was erroneous. His wife had a normal birth only to have the baby need to go to the transition nursery due to rapid breathing after the birth. They did not allow the mom an opportunity to nurse. The dad went with the baby to the nursery and told the staff no bottles were to be given- the baby was to be breastfed only.
He then left to return to the mom. The mom after a short while wanted him to go to check on the baby. He went to the nursery window and searched for his son. He saw who he thought was his baby in a nurse's arms being given a bottle of formula. He picked up the phone and it rang several minutes before being told the nurse who answered the phone would check. She turned to finish what she had been doing. Then he knocked on the window since the baby he thought was his baby was continuing to be fed the bottle.
Finally someone came and explained that the baby's blood sugar was borderline- and they felt he needed a bottle. No one spoke to the parents- they did not regard the instructions of the dad earlier- they had dismissed that entirely. He told me later that he was appalled that the assumption that they had to follow his desires and that the illusion that they would honor his desires for his son were not valid.
I recently had a couple who took my class hear me discuss these things. But they felt armed with knowledge they could stay where they were birthing and their outcome would be different. Sadly they realize the illusion they were under. The mom told me recently she feels she is emotionally struggling to heal from the birth of their daughter. This is not the way it needs to be!
The mom I met with today is working hard to have the birth she wants this time. She has all of the puzzle pieces in place... her support team- her husband and myself will be there. Her medical team- the midwives with the lowest cesarean rate in the state will be there for her. Her hospital staff is used to natural births and is supportive of that. And she is feeling safe and supported. There are no illusions or assumptions being made.
I am often known to say going to some hospitals and asking for a non interventive, naturally supported birth is like going to KFC Chicken and asking for sushi. Now you can occasionally find a store manager who if you go every day and ask for sushi- goes out and gets you sushi knowing that you are coming today to ask again. So, you can have a great birth most everywhere but it may be not the norm and therefore you may have to work harder to get what you want.
This young woman chose to stay at her hospital last time- even though one midwife in the group she did not like- and you guessed it- that is who attended her in labor. After a few hours with no increase in dilation, there were threats of a cesarean being needed and this mom chose to have some interventions she originally had not wanted... then the cascade began- but she ended up with a vaginal birth...her ultimate desire... and of course a beautiful, healthy baby.
This time she travels across town to the hospital I had recommended three years ago. She feels safe with any of the midwives. She knows this hospital embraces the kind of birth she desires. She feels safe. She nows sees that the allusion of having a hospital around the corner from where she lives, a practice of midwives or docs who were convenient to where she lived, and the thought that she could get what she wanted only if she let her desires be known, were illusions and assumptions.
I had a dad tell me when he heard me warn to not leave the baby in the nursery since they adamantly did not want a bottle to be given to the baby was erroneous. His wife had a normal birth only to have the baby need to go to the transition nursery due to rapid breathing after the birth. They did not allow the mom an opportunity to nurse. The dad went with the baby to the nursery and told the staff no bottles were to be given- the baby was to be breastfed only.
He then left to return to the mom. The mom after a short while wanted him to go to check on the baby. He went to the nursery window and searched for his son. He saw who he thought was his baby in a nurse's arms being given a bottle of formula. He picked up the phone and it rang several minutes before being told the nurse who answered the phone would check. She turned to finish what she had been doing. Then he knocked on the window since the baby he thought was his baby was continuing to be fed the bottle.
Finally someone came and explained that the baby's blood sugar was borderline- and they felt he needed a bottle. No one spoke to the parents- they did not regard the instructions of the dad earlier- they had dismissed that entirely. He told me later that he was appalled that the assumption that they had to follow his desires and that the illusion that they would honor his desires for his son were not valid.
I recently had a couple who took my class hear me discuss these things. But they felt armed with knowledge they could stay where they were birthing and their outcome would be different. Sadly they realize the illusion they were under. The mom told me recently she feels she is emotionally struggling to heal from the birth of their daughter. This is not the way it needs to be!
The mom I met with today is working hard to have the birth she wants this time. She has all of the puzzle pieces in place... her support team- her husband and myself will be there. Her medical team- the midwives with the lowest cesarean rate in the state will be there for her. Her hospital staff is used to natural births and is supportive of that. And she is feeling safe and supported. There are no illusions or assumptions being made.
Breastfeeding Latch Issues
There is a misconception that early breastfeeding should hurt and cause cracked and bleeding nipples. IT IS A MISCONCEPTION! A good latch should cause this to never happen. Now one time latching wrong can cause a bit of soreness- but once it is corrected it will diminish greatly. Engorgement is not the same thing.
Engorgement is not only a huge supply of milk- after all your breasts do not know if you have had twins or triplets... but the blood supply increase and the swelling of tissues also adds to the engorgement issues. So for engorgement I encourage nurse often and on demand- but also massage your breasts before nursing- get out any spots that may be considering getting clogged. And fill a large mixing bowl- a metal one is perfect- fill it with very warm water... pour in a handful of salt- table salt, epson or sea salt- mix it with your hand. If the water is too hot for your hand it is too hot- but it needs to be very, very warm. Lean over the counter and put one breast in the water. Massage in a downward motion and soon the water is filled with milk.
This will help with not only engorgement but if you did have a poor latch- it helps heal any sore spots. You can do this several times a day- each breast. And the swollen tissues will appreciate an ice pack on them between nursings.
Okay now latch... I have an acronym BREASTS that I devised to help you with this:
B...bring the baby to the breast- make sure you are not leaning over- but instead you are leaning back and getting comfy and then you are bringing the baby to you... what came first the baby or the breasts? Never lean over to latch the baby on!
R...remember to velcro the baby on- belly button toward your belly. You should wear the baby like a bra- feet and legs are tucked into you as well. If you can see the baby's belly button you are not turning her into you enough.
E...eat a big mac! Point the nipple of the the breast toward the baby's nose intially. You can stroke the nipple between the nose and the upper lip or across the lip to initially get the baby interested- but for latch purposes have the baby climb up the mountain- like you do when you are eating a big mac sandwich. The baby climbs up the nipple with the bottom lip flanged out- this puts the nipple in the safe spot of the roof of the baby's mouth- and puts it in deeply so it does not rock back and forth thus creating a blister.
A...allow the baby to open wide... don't try to finagle the nipple into a small mouth. Babies are imitators- so open your mouth wide- say "open" and then allow the baby to imitate you with a wide open mouth. Then bring them in quickly to latch.
S...support the neck not the head. When you hold onto the baby's head you are not allowing the head to tilt back- and thus causing the nipple to be driven into the tongue rather than in the safe spot of the roof of the mouth. Create a little neck brace for the baby with either the crook of your arm or with your hand- do not touch the head at all.
T...too late if the baby is crying! It is so much harder to latch a baby on when they are distressed. The first sign they want to nurse is mouthing like a little bird- smacking their lips. Then they begin to mouth their hands. Lastly they cry- so watch for the early signs so as to not have to calm them down before you can nurse them. If they wake with a poopie diaper- nurse one side- then change them and then top them off on the second breast.
S...see the nose not the chin. If the baby is tucked in close- then you should have their head tilted up- tucking the chin in tightly to the breast but allowing the nose to have access to breathing easily. Keep the head tilted back and the body tucked in tightly. Some soreness comes from a baby sliding off to only the nipple and then beginning to vigorously nurse again but this time the nipple is not in the safe spot.
So enjoy the early weeks with your baby while you both learn how to nurse properly. It is well worth the time spent to get the latch correct every time. Plan to spend the first several weeks doing little more than rocking, cuddling, soothing and nursing your new baby. It is well worth if for a lifetime!
Monday, December 15, 2008
Inductions have real risks!
New Kerala.com- a Sydney newspaper reported this on December 10th...Italics in parenthesis are mine for my input.
Inducing labour in pregnant women is risky
Sydney, Dec 10 : Inducing labour in uncomplicated pregnancies can be risky, according to a study.
A quantitative study based on 50,000 first births between 2000 and 2005 showed that induced labours were more likely than spontaneous births to lead to forceps delivery, caesarean section and haemorrhage. (now keep in mind- 50,000 births is a lot of births! and the data was recorded over five years!)
Babies were also more likely to be admitted to nursery care and to require active resuscitation after induced labour.
Mary-Ann Davey of Mother and Child Health Research at La Trobe University, who conducted the study, stressed that the sample included only those women whose pregnancies were progressing in a healthy and normal manner. (so these were not moms or babies at risk of something happening to cause a more interventive birth!)
"I used data that are routinely collected on all births in Victoria by the midwife attending the birth," Davey said. "I selected those first births that appeared to have no clinical indication for induction of labour. (so these were elective inductions- not medical inductions! keep in mind most inductions today are just such inductions- "I am tired of being pregnant." "I am afraid your baby is getting too big.")
These were all single pregnancies of normal presentation born between 37 and 40 weeks. (so again these are not "late" babies- these are women being induced actually early at times- 37 weeks is considered premature still- what if the due date was off by a week- yes remember full term is between 38 and 42 weeks and many times gestation is just a guess at best! all women do not ovulate at day 14 and some women do not menstruate at every 28 days!)
Mothers had no complications, such as pre-existing diabetes, hypertension, cardiac disease or mental illness and those younger than 20 years or older than 45 were excluded from the analysis.
Davey believes that many of the labours were induced for reasons of convenience rather than for any medical indications. Sometimes the pregnancies might be induced because they are past the due date but only by six days or less. (so convenience is worth what cost? having your baby end up in the NICU? having a surgical birth with the complications that can cause? six days late is not even considered really past due yet!)
The risk of haemorrhage following induced labour was increased by 17 percent, of an instrumental delivery by 20-70 percent, of nursery care for the infant by 24 percent and active resuscitation by 15-100 percent, depending on the method of induction, said a La Trobe release. (so instead of having a healthy mom bonding gently with her new baby- soon to be nursing at her breast, she is recovering from an instrumental or surgical birth and her baby is in the warmer being tubed or worse sent to the nursery...for what?)
The risk of a caesarean was between two and four times more likely after induction. (so in Atlanta where some hospitals are already nearly 40% think about what the rate would be if inductions were only allowed when medically neccessary? would the rete drop back down to below 20%?)
...So can we safely say that inductions are not safe? Can we conclude that when it is done it is not without risk to both the mom and the baby? Can we share this with a mom when she complains about being tired of being pregnant? Or when a doctor "thinks" a baby may be too big? Can we just allow babies to decide for themselves when to be born? Can we stop playing God?
Inducing labour in pregnant women is risky
Sydney, Dec 10 : Inducing labour in uncomplicated pregnancies can be risky, according to a study.
A quantitative study based on 50,000 first births between 2000 and 2005 showed that induced labours were more likely than spontaneous births to lead to forceps delivery, caesarean section and haemorrhage. (now keep in mind- 50,000 births is a lot of births! and the data was recorded over five years!)
Babies were also more likely to be admitted to nursery care and to require active resuscitation after induced labour.
Mary-Ann Davey of Mother and Child Health Research at La Trobe University, who conducted the study, stressed that the sample included only those women whose pregnancies were progressing in a healthy and normal manner. (so these were not moms or babies at risk of something happening to cause a more interventive birth!)
"I used data that are routinely collected on all births in Victoria by the midwife attending the birth," Davey said. "I selected those first births that appeared to have no clinical indication for induction of labour. (so these were elective inductions- not medical inductions! keep in mind most inductions today are just such inductions- "I am tired of being pregnant." "I am afraid your baby is getting too big.")
These were all single pregnancies of normal presentation born between 37 and 40 weeks. (so again these are not "late" babies- these are women being induced actually early at times- 37 weeks is considered premature still- what if the due date was off by a week- yes remember full term is between 38 and 42 weeks and many times gestation is just a guess at best! all women do not ovulate at day 14 and some women do not menstruate at every 28 days!)
Mothers had no complications, such as pre-existing diabetes, hypertension, cardiac disease or mental illness and those younger than 20 years or older than 45 were excluded from the analysis.
Davey believes that many of the labours were induced for reasons of convenience rather than for any medical indications. Sometimes the pregnancies might be induced because they are past the due date but only by six days or less. (so convenience is worth what cost? having your baby end up in the NICU? having a surgical birth with the complications that can cause? six days late is not even considered really past due yet!)
The risk of haemorrhage following induced labour was increased by 17 percent, of an instrumental delivery by 20-70 percent, of nursery care for the infant by 24 percent and active resuscitation by 15-100 percent, depending on the method of induction, said a La Trobe release. (so instead of having a healthy mom bonding gently with her new baby- soon to be nursing at her breast, she is recovering from an instrumental or surgical birth and her baby is in the warmer being tubed or worse sent to the nursery...for what?)
The risk of a caesarean was between two and four times more likely after induction. (so in Atlanta where some hospitals are already nearly 40% think about what the rate would be if inductions were only allowed when medically neccessary? would the rete drop back down to below 20%?)
...So can we safely say that inductions are not safe? Can we conclude that when it is done it is not without risk to both the mom and the baby? Can we share this with a mom when she complains about being tired of being pregnant? Or when a doctor "thinks" a baby may be too big? Can we just allow babies to decide for themselves when to be born? Can we stop playing God?
Friday, December 12, 2008
does one bottle make a real difference?
Marsha, a nurse and international certified lactation consultant wrote the following article and I wanted to share it- the italics are mine.
At many hospitals they will suggest and perhaps even almost demand that you offer your baby formula. This is probably a great article to print off and take with you to your labor. If it is suggested, perhaps you can help to spread the truth about one bottle of formula and the problems with receiving it.
Many people don't realize that one bottle of formula can begin a series of problems... read more below:
Supplementation of the Breastfed Baby
“Just One Bottle Won’t Hurt”---or Will It?
Marsha Walker, RN, IBCLC (Marshalact@aol.com)
*The gastrointestinal (GI) tract of a normal fetus is sterile
*The type of delivery has an effect on the development of the intestinal microbiota
...vaginally born infants are colonized with their mother’s bacteria
...cesarean born infants’ initial exposure is more likely to environmental microbes from the air, other infants, and the nursing staff which serves as vectors for transfer (this is one of the risks of a cesarean birth)
*Babies at highest risk of colonization by undesirable microbes or when transfer from maternal sources cannot occur are cesarean-delivered babies, preterm infants, full term infants requiring intensive care, or infants separated from their mother (again the reason why a vaginal, unmedicated (since it can lead to infant complications), non induced birth is ideal)
*Breastfed and formula-fed infants have different gut flora
*Breastfed babies have a lower gut pH (acidic environment) of approximately 5.1-5.4 throughout the first six weeks that is dominated by bifidobacteria with reduced pathogenic (disease-causing) microbes such as E coli, bacteroides, clostridia, and streptococci (the colostrum and milk of the baby's mom provide immune building protectants]
*Babies fed formula have a high gut pH of approximately 5.9-7.3 with a variety of putrefactive bacterial species
*In infants fed breast milk and formula supplements the mean pH is approximately 5.7-6.0 during the first four weeks, falling to 5.45 by the sixth week
*When formula supplements are given to breastfed babies during the first seven days of life, the production of a strongly acidic environment is delayed and its full potential may never be reached (formula dilutes the power of the immune building characteristics of breastmilk)
*Breastfed infants who receive supplements develop gut flora and behavior like formula-fed infants
*The neonatal GI tract undergoes rapid growth and maturational change following birth
*Infants have a functionally immature and immunonaive gut at birth
*Tight junctions of the GI mucosa take many weeks to mature and close the gut to whole proteins and pathogens (so adding something foreign like formula can cause issues with digestion)
*Open junctions and immaturity play a role in the acquisition of NEC, diarrheal disease, and allergy (one of the reasons for infants to be hospitalized early in life are due to diarrheal diseases)
*sIgA from colostrum and breast milk coats the gut, passively providing immunity during the time of reduced neonatal gut immune function
*Mothers’ sIgA is antigen specific. The antibodies are targeted against pathogens in the baby’s immediate surroundings
*The mother synthesizes antibodies when she ingests, inhales, or otherwise comes in contact with a disease-causing microbe
*These antibodies ignore useful bacteria normally found in the gut and ward off disease without causing inflammation
*Infant formula should not be given to a breastfed baby before gut closure occurs
*Once dietary supplementation begins, the bacterial profile of breastfed infants resembles that of formula-fed infants in which bifidobacteria are no longer dominant and the development of obligate anaerobic bacterial populations occurs (Mackie, Sghir, Gaskins, 1999)
*Relatively small amounts of formula supplementation of breastfed infants (one supplement per 24 hours) will result in shifts from a breastfed to a formula-fed gut flora pattern (Bullen, Tearle, Stewart, 1977) (so that little bottle due to borderline low blood sugar really does make a difference!)
*The introduction of solid food to the breastfed infant causes a major perturbation in the gut ecosystem, with a rapid rise in the number of enterobacteria and enterococci, followed by a progressive colonization by bacteroides, clostridia, and anaerobic streptococci (Stark & Lee, 1982) (a solid food is anything other than colostrum or breast milk)
*With the introduction of supplementary formula, the gut flora in a breastfed baby becomes almost indistinguishable from normal adult flora within 24 hours (Gerstley, Howell, Nagel, 1932)
*If breast milk were again given exclusively, it would take 2-4 weeks for the intestinal environment to return again to a state favoring the gram-positive flora (Brown & Bosworth, 1922; Gerstley, Howell, Nagel, 1932)
*In susceptible families, breastfed babies can be sensitized to cow’s milk protein by the giving of just one bottle, (inadvertent supplementation, unnecessary supplementation, or planned supplements), in the newborn nursery during the first three days of life (Host, Husby, Osterballe, 1988; Host, 1991)
*Infants at high risk of developing atopic disease has been calculated at 37% if one parent has atopic disease, 62-85% if both parents are affected and dependant on whether the parents have similar or dissimilar clinical disease, and those infants showing elevated levels of IgE in cord blood irrespective of family history (Chandra, 2000)
*In breastfed infants at risk, hypoallergenic formulas can be used to supplement breastfeeding; solid foods should not be introduced until 6 months of age, dairy products delayed until 1 year of age, and the mother should consider eliminating peanuts, tree nuts, cow’s milk, eggs, and fish from her diet (AAP, 2000)
*In susceptible families, early exposure to cow’s milk proteins can increase the risk of the infant or child developing insulin dependent diabetes mellitus (IDDM) (Mayer et al, 1988; Karjalainen, et al, 1992) (yes one bottle can make the difference in a life long situation)
*Ihe avoidance of cow’s milk protein for the first several months of life may reduce the later development of IDDM or delay its onset in susceptible individuals (AAP, 1994)
*Sensitization and development of immune memory to cow’s milk protein is the initial step in the etiology of IDDM (Kostraba, et al, 1993)
...sensitization can occur with very early exposure to cow’s milk before gut cellular tight junction closure
...sensitization can occur with exposure to cow’s milk during an infection-caused gastrointestinal alteration when the mucosal barrier is compromised allowing antigens to cross and initiate immune reactions
...sensitization can occur if the presence of cow’s milk protein in the gut damages the mucosal barrier, inflames the gut, destroys binding components of cellular junctions, or other early insult with cow’s milk protein leads to sensitization (Savilahti, et al, 1993)
References:
American Academy of Pediatrics, Work Group on Cow’s Milk Protein and Diabetes Mellitus. Infant feeding practices and their possible relationship to the etiology of diabetes mellitus. Pediatrics 1994; 94:752-754
American Academy of Pediatrics, Committee on Nutrition. Hypoallergenic infant formulas. Pediatrics 2000; 106:346-349
Brown EW, Bosworth AW. Studies of infant feeding VI. A bacteriological study of the feces and the food of normal babies receiving breast milk. Am J Dis Child 1922; 23:243
Bullen CL, Tearle PV, Stewart MG. The effect of humanized milks and supplemented breast feeding on the faecal flora of infants. J Med Microbiol 1977; 10:403-413
Chandra RK. Food allergy and nutrition in early life: implications for later health. Proc Nutr Soc 2000; 59:273-277
Gerstley JR, Howell KM, Nagel BR. Some factors influencing the fecal flora of infants. Am J Dis Child 1932; 43:555
Host A, Husby S, Osterballe O. A prospective study of cow’s milk allergy in exclusively breastfed infants. Acta Paediatr Scand 1988; 77:663-670
Host A. Importance of the first meal on the development of cow’s milk allergy and intolerance. Allergy Proc 1991; 10:227-232
Karjalainen J, Martin JM, Knip M, et al. A bovine albumin peptide as a possible trigger of insulin-dependent diabetes mellitus. N Engl J Med 1992; 327:302-307
Kostraba JN, Cruickshanks KJ, Lawler-Heavner J, et al. Early exposure to cow’s milk and solid foods in infancy, genetic predisposition, and risk of IDDM. Diabetes 1993; 42:288-295
Mackie RI, Sghir A, Gaskins HR. Developmental microbial ecology of the neonatal gastrointestinal tract. Am J Clin Nutr 1999; 69(Suppl):1035S-1045S
Mayer EJ, Hamman RF, Gay EC, et al. Reduced risk of IDDM among breastfed children. The Colorado IDDM Registry. Diabetes 1988; 37:1625-1632
Savilahti E, Tuomilehto J, Saukkonen TT, et al. Increased levels of cow’s milk and b-lactoglobulin antibodies in young children with newly diagnosed IDDM. Diabetes Care 1993; 16:984-989
Stark PL, Lee A. The microbial ecology of the large bowel of breastfed and formula-fed infants during the first year of life. J Med Microbiol 1982; 15:189-203
Thursday, December 11, 2008
Breastfeeding and offering a bottle...
A while ago I saw a mom and baby who had begun to add several bottles of breast milk bottles to the daily schedule. She was readying to return to work and wanted to also allow the father time to bond with the baby during feedings. The baby would fuss at the breast expecting to have a steady, fast flow of milk coming from the breasts, as she was used to getting from the bottles. After nursing on and off and fussing, the bottle of breast milk was used to top the baby off since she was not satisfied.
The mom had a goal of six months to nurse the baby. I knew with only being at the breast two times a day- morning and evening, this was not likely to happen. The baby was already showing signs of nipple confusion and a lazy suck at the age of 3 weeks. I could tell the baby was used to the faster flow of the bottle and was demanding the same of the mom.
When I explained this to the mom, she asked me for solutions. I called my favorite IBCLC, Anne Grider for her input. This is what was shared:
As far as providing the baby with slow flow nipples to make it more difficult to get the breast milk from the bottle, she said: Nipples have no regularity or quality control- so you have to buy a bunch and just try them over the faucet with water in the bottles and mark the ones in the package that are the real slow flow ones- there is just no telling without testing them if they are really slow flow. She said a package of nipples marked “slow flow” could have a plethora of different flows within the same package. The premie ones they make now are too small- use a slow flow instead.
Her recommendation was to not use Avent- it is too wide for most babies. She also said not to use Nuk, ironically it has shown too many orthodontic issues later. She said we all are different and we have to determine what kind of nipple is right for this baby. It is up to the size of the baby’s pallet. So put your finger in the baby’s mouth and take it back to the hard part of the pallet and mark on your finger how long the nipple needs to be to reach there. And notice the baby’s size of her mouth- not too wide or is it a large mouth and width is not an issue.
Get a symmetrical nipple- a silicone one is preferred. And use a regular shaped bottle. The slanted bottles actually were meant for babies with medical issues who had to feed lying on their tummies- they actually make the milk flow even faster- so don’t use that kind.
Sit the baby up in a full sitting position to bottle feed. For example sitting the baby where the baby’s back is against the provider’s chest is best- less mom and baby dyad confusion that way- mom nurses the baby everyone else feeds the baby this way. The bottle needs to be parallel to the floor. Don’t worry about keeping the nipple full of milk- the issue of air has been proven to not be as big of an issue as they once thought.
Listen to the baby- is she swallowing comfortably? No gulping and she has time to breathe in between swallows? If not you need to make sure the bottle is parallel and not tipped up too high. Check the flow of the nipple. And if need be you may need to pace the baby’s feeding.
Paced feeding is to sit the baby up and when the baby is gulping and not breathing- pull the nipple out so it only touches the lip and then when the baby breathes- put the nipple back in- do this several times. After the third or fourth time the baby catches on and does not protest when you do it. The ideal feeding is a comfortable one no gulping or problems breathing.
When a mom returns to work she needs to be prepared to have a lot of mother baby time when she returns home. Nursing on demand is what is best. No bottles should be given if the mom is available to nurse. This will help her keep her supply and also keep the baby satisfied during growth spurts as well as continue the breastfeeding bond between the mom and the baby. A side car- co-sleeper is best if the family does not share a bed so that the mom is fully accessible to the baby. A baby being fed on demand at the breast is usually essential for breastfeeding to be successful once a return to work has occurred. And night time nursings are important as well to this success. The family bed or side car allow the mom the rest she needs while still meeting the baby’s needs.
The mom had a goal of six months to nurse the baby. I knew with only being at the breast two times a day- morning and evening, this was not likely to happen. The baby was already showing signs of nipple confusion and a lazy suck at the age of 3 weeks. I could tell the baby was used to the faster flow of the bottle and was demanding the same of the mom.
When I explained this to the mom, she asked me for solutions. I called my favorite IBCLC, Anne Grider for her input. This is what was shared:
As far as providing the baby with slow flow nipples to make it more difficult to get the breast milk from the bottle, she said: Nipples have no regularity or quality control- so you have to buy a bunch and just try them over the faucet with water in the bottles and mark the ones in the package that are the real slow flow ones- there is just no telling without testing them if they are really slow flow. She said a package of nipples marked “slow flow” could have a plethora of different flows within the same package. The premie ones they make now are too small- use a slow flow instead.
Her recommendation was to not use Avent- it is too wide for most babies. She also said not to use Nuk, ironically it has shown too many orthodontic issues later. She said we all are different and we have to determine what kind of nipple is right for this baby. It is up to the size of the baby’s pallet. So put your finger in the baby’s mouth and take it back to the hard part of the pallet and mark on your finger how long the nipple needs to be to reach there. And notice the baby’s size of her mouth- not too wide or is it a large mouth and width is not an issue.
Get a symmetrical nipple- a silicone one is preferred. And use a regular shaped bottle. The slanted bottles actually were meant for babies with medical issues who had to feed lying on their tummies- they actually make the milk flow even faster- so don’t use that kind.
Sit the baby up in a full sitting position to bottle feed. For example sitting the baby where the baby’s back is against the provider’s chest is best- less mom and baby dyad confusion that way- mom nurses the baby everyone else feeds the baby this way. The bottle needs to be parallel to the floor. Don’t worry about keeping the nipple full of milk- the issue of air has been proven to not be as big of an issue as they once thought.
Listen to the baby- is she swallowing comfortably? No gulping and she has time to breathe in between swallows? If not you need to make sure the bottle is parallel and not tipped up too high. Check the flow of the nipple. And if need be you may need to pace the baby’s feeding.
Paced feeding is to sit the baby up and when the baby is gulping and not breathing- pull the nipple out so it only touches the lip and then when the baby breathes- put the nipple back in- do this several times. After the third or fourth time the baby catches on and does not protest when you do it. The ideal feeding is a comfortable one no gulping or problems breathing.
When a mom returns to work she needs to be prepared to have a lot of mother baby time when she returns home. Nursing on demand is what is best. No bottles should be given if the mom is available to nurse. This will help her keep her supply and also keep the baby satisfied during growth spurts as well as continue the breastfeeding bond between the mom and the baby. A side car- co-sleeper is best if the family does not share a bed so that the mom is fully accessible to the baby. A baby being fed on demand at the breast is usually essential for breastfeeding to be successful once a return to work has occurred. And night time nursings are important as well to this success. The family bed or side car allow the mom the rest she needs while still meeting the baby’s needs.
Tuesday, December 9, 2008
options and information
...got an email today from a client saying she would not need the doula she hired after all. Seems her baby is breech and so her doctor has told her she needs to have a cesarean birth. Hmmm... her doctor made this decision when she is only 36 weeks pregnant. I do not know if he talked to her about her options... the various ways to get the baby to turn... the medical ways to get the baby to turn...the option of a vaginal birth with a skilled physician... I do not know if he told her about these things... All I know is as of tonight, she has somehow been convinced that a surgical birth- one which would more than likely determine all of her future births, was her only option... I find this sad. [www.gentlebirth.org/archives/breechbr.html]
Sad because she put her trust in her doctor to guide her. His or her guidance should be information that then allows her patient to make a decision based on that information. I sent her information tonight in that email in case he or she did not. It makes me sad that she is four weeks from her due date- and actually six weeks from when the baby could come without being officially "late," and her care provider has already determined that it is hopeless for her to consider a vaginal birth! And sad that the truth may be hard for her since she does not know me or trust me- and her medical care provider is the "good" guy here that she may trust more than the full truth.
Sad because instead of birthing a baby who has had the hormones generated to get that baby ready to be born, will be removed surgically from his mom in a cold operating room. His airways will be deeply suctioned since he did not have the benefit of having the contractions squeeze out the fluid in his lungs. He will be born early perhaps- even prematurely if the due dates are not correct. He may have low blood sugar and then the interventions of formula to his ability to breastfeed will be complicated. Sad because often times the bonding of the baby and mom is interrupted by pain medications due to having had surgery... it is all very sad.
Now this baby may need to be born surgically- his breech position may indicate that he desires that method.He may not be willing to turn. But doesn't he and his mom deserve the information to determine if there are some options that may help this birth turn into a gentle vaginal one instead?
Sunday, November 30, 2008
Doulas
What does Doula mean?
Who is a Doula?
What does a Doula NOT do?
Who needs a Doula?
A doula is an additional member of the labor and birth team as well as a helper to the new mother and family. Although doulas do not require any special training to call themselves a doula, many have found it helpful in knowing more about how to help a woman by taking training and choosing certification with one of the many international organizations such as Childbirth and Postpartum Professionals Association (CAPPA) or DONA (Formerly Doulas of North America) or Association of Labor and Childbirth Educators (ALACE).** The training usually consists of required reading, a workshop of several days, essays or tests, and evaluations by professionals.
Besides certification there are other differences in doulas. All doulas do not offer the same services. It is important to ask what services are covered by the fee that is charged. Some offer prenatal meetings to review your birth ideals and options. Some offer unlimited labor support no matter the length of labor, others charge extra for longer labors. Many have a back up doula in case of the unexpected events that could occur. Most offer continuity of care and come to you when you need them. Some come to your home and then attend you where you plan to birth while others only meet you at the hospital. Some based their fees on experience and others are based on what the market will bear. Some offer a sliding scale or payment plan if it is needed. Some offer their services both for labor and birth as well as the postpartum period.
The most important thing in hiring a doula may not be experience or certification but instead who do you feel like you can be most vulnerable with in your labor and birth? Her heart and hands and how you feel when you are with her is paramount. It is this relationship that will help you the most in your labor and birth. Does she listen? Do you find her words and wisdom comforting? Is she relatable? It is not how much she knows that is important but knowing how much she cares. Does she help you find your intuitive voice and your power within?
Some things that have been said about our group of doulas by first time and seasoned parents when asked why they hired a doula were, “ I felt lost in my wife’s first labor and jumped at the opportunity to have someone there who knew more than I know,” Andy, a second time expectant dad. Regarding a doula this couple selected, Donnie a dad who has hired this doula for both of their babies writes, “You can see it in her eyes, you hear it in her voice, and you just know that you are in good hands. Not only do you get the benefit of her knowledge, she somehow empowers you to believe in yourself.”
A new mom, Liz, when asked, What were the most helpful things about having her doula present for your labor and birth said, “ Where do I begin? Peace of mind that someone was ‘in my corner’ and knew how I wanted to labor are top of my list. It was also helpful to have you reminding me and Rob about what was going to come next and how we might be feeling at the next step/stage. You ensured that we got to experience our son’s beautiful birth! “ and another when asked, Overall, did having professional labor support meet your expectations and was the experience what you expected? Tonya said, “ It was everything I needed!” She went on to hire the same doula for her next birth experience.
So, if you want to help have a more memorable and gentle birth experience, consider hiring a doula! It may well be worth more than you would even expect.
- The most favored female slave in the Greek household of yesteryear.
- A servant to meet your needs and your partner’s in labor and birth and the time just after the birth.
Who is a Doula?
- A companion who knows the road you are about to travel in pregnancy, labor, birth and in the journey of bringing home the new baby to your family.
- A friend who is there to provide continuity of care- by your side throughout labor, no matter how long.
- A “birth guru” of sorts who knows what your options are for pain management and relaxation methods, well versed in these ideas.
- A support person who is there to help you have the birth of your choice without any hidden agendas on how your birth should be.
- A reminder of the goals you originally set out to achieve and help you in determining if your path needs to veer off of that and do the next best thing.
- A guide for when you venture off your path and need to be redirected.
- A massager, encourager and whisperer of the gentle things you want to hear in the midst of the storm.
- A photographer and story teller of the journey.
- A woman who helps you with learning how to be a new mother or parent.
- A guide in nursing and caring for a newborn in the transitional path of parenthood.
What does a Doula NOT do?
- She does not do any clinical treatment- no exams, no heart tones, nothing that is in the medical realm. She is not a midwife or doctor or nurse when she is acting in the role of doula.
- She does not give you medical advice but may remind you or your original goals.
- She does not decide what type of treatment you need but may help you in determining what questions you need answered before you make an informed decision.
- She does not speak for you; she instead encourages you to speak for yourself.
- She does not take the place of a partner who wants to remain involved in the process of labor and birth.
- She does not run interference between you and the medical staff. But she does help you in ways to ask questions prior to your birth to get the information you need.
- In the postpartum period she is not a housekeeper but will tidy up and do some light chores as well as prepare meals.
Who needs a Doula?
- Women who want a medicated birth.
- Women who want an unmedicated birth.
- Women who may have surgical birth.
- Women who have a midwife or doctor.
- First time moms and seasoned moms.
- Women who are having a baby at the hospital, birth center or home.
- Women who are induced and those whose labor begins spontaneously.
- Women who want to decrease the use of Pitocin, epidurals, forceps and cesarean birth*
- Partners who want an additional team member in the support of labor, birth and just after the birth of a baby
A doula is an additional member of the labor and birth team as well as a helper to the new mother and family. Although doulas do not require any special training to call themselves a doula, many have found it helpful in knowing more about how to help a woman by taking training and choosing certification with one of the many international organizations such as Childbirth and Postpartum Professionals Association (CAPPA) or DONA (Formerly Doulas of North America) or Association of Labor and Childbirth Educators (ALACE).** The training usually consists of required reading, a workshop of several days, essays or tests, and evaluations by professionals.
Besides certification there are other differences in doulas. All doulas do not offer the same services. It is important to ask what services are covered by the fee that is charged. Some offer prenatal meetings to review your birth ideals and options. Some offer unlimited labor support no matter the length of labor, others charge extra for longer labors. Many have a back up doula in case of the unexpected events that could occur. Most offer continuity of care and come to you when you need them. Some come to your home and then attend you where you plan to birth while others only meet you at the hospital. Some based their fees on experience and others are based on what the market will bear. Some offer a sliding scale or payment plan if it is needed. Some offer their services both for labor and birth as well as the postpartum period.
The most important thing in hiring a doula may not be experience or certification but instead who do you feel like you can be most vulnerable with in your labor and birth? Her heart and hands and how you feel when you are with her is paramount. It is this relationship that will help you the most in your labor and birth. Does she listen? Do you find her words and wisdom comforting? Is she relatable? It is not how much she knows that is important but knowing how much she cares. Does she help you find your intuitive voice and your power within?
Some things that have been said about our group of doulas by first time and seasoned parents when asked why they hired a doula were, “ I felt lost in my wife’s first labor and jumped at the opportunity to have someone there who knew more than I know,” Andy, a second time expectant dad. Regarding a doula this couple selected, Donnie a dad who has hired this doula for both of their babies writes, “You can see it in her eyes, you hear it in her voice, and you just know that you are in good hands. Not only do you get the benefit of her knowledge, she somehow empowers you to believe in yourself.”
A new mom, Liz, when asked, What were the most helpful things about having her doula present for your labor and birth said, “ Where do I begin? Peace of mind that someone was ‘in my corner’ and knew how I wanted to labor are top of my list. It was also helpful to have you reminding me and Rob about what was going to come next and how we might be feeling at the next step/stage. You ensured that we got to experience our son’s beautiful birth! “ and another when asked, Overall, did having professional labor support meet your expectations and was the experience what you expected? Tonya said, “ It was everything I needed!” She went on to hire the same doula for her next birth experience.
So, if you want to help have a more memorable and gentle birth experience, consider hiring a doula! It may well be worth more than you would even expect.
Woman Affecting Change In Birth
The 60’s and 70’s birth experience for a woman was going to the hospital, separated from her partner, laboring virtually alone and medicated. Times gave way to a surge of women seeking an unmedicated birth. But the 90’s brought the epidural epidemic, climbing to 80% or even upwards of 90% of Atlanta women giving birth this way. What has happened to women’s bodies – why do they no longer feel able to birth without the use of medications that numb their bodies and for many, their birth experience?
When a woman asks can wear her own clothing in labor, or if she can choose her birth position, she has fallen prey to the idea that once entering the birthplace, she gives up rights that are not medically indicated. Choices are available.
Location for a birth is a paramount decision- home or hospital. With no birthing centers in the Atlanta area, there are limitations. Homebirth is alegal in Georgia. This means if all goes well, no one cares, turning a blind eye. If anything goes wrong, the midwife can be prosecuted. There’s fear and lack of information regarding home birth. Home birth costs substantially less, but is rarely covered by insurance plans. Therefore most women will choose a hospital birth. This insurance company determines the prearranged contracts with the hospitals. Location may be something a woman feels she has little control over.
There is choice of provider. Choosing a midwife rather than a doctor may open up options for birth. Midwives, in this state work under the supervision of physicians. The provider book may not state if a practice offers midwifery care, so research is essential. Midwives tend to look at birth as a natural occurrence providing care for most normal pregnancies. Many doctors’ perspective is one of a medical emergency about to happen, being quicker to intervene.
Who will be your primary support person- only her partner, or mother or sister or friend? Many like the idea of being with just their partner. Others will want to include a woman to “mother” her in labor. Surrounding the mom with those who are fully supportive of her choices is important.
Doulas are professionals who specialize in mothering the mother in labor. They are trained and experienced in supporting birthing women, knowledgeable regarding birth options; pain management techniques and positions. Studies show a remarkable difference in birth outcomes- less medication and interventions, and also the mother’s perception of her baby and herself as a mother. The doula and partner join together insuring a smooth working team helping the mom achieve the birth of her choice.
Having her other children in labor and present at the birth is an option. If so, it is advisable to have someone solely as his or her care provider. The child can come and go as their needs arise. The mom may need help controlling the visitors. Calling a few friends at the onset of labor can mean a party begins to take place in her room. The mom should be allowed to limit or control who is part of her birth environment.
What to wear in labor becomes a concern. The stiff, impersonal gown opening in the back, leaving you feeling vulnerable and exposed is not the only option. Women find big t-shirts, their partner’s shirt or a loose fitting gown is more comfortable, offering security. Making her feel more relaxed will help her to allow her body to release and open.
Women are bringing music, sound machines, aromatherapy and birth art to their labor rooms. Physical therapy “birth” balls provide a comfortable seat in which to keep their pelvis open and moving. The environment should be one in which a woman feels safe and is able to let go and let her labor unfold gently.
Choices of birth positions are available. Many midwives and some doctors are open to positions in which to give birth. Squatting, dangling, kneeling, leaning, and standing are available to many women. (Most of these positions are available for only unmedicated births.) The studies show that if you allow a mother to choose the position to birth in, the birth will go easier and faster.
There are a number of ways to manage pain during labor. Movement-rocking, walking, bathing, swaying and even dancing are good coping measures in labor. There is hypnobirthing, guided imagery, non-focused awareness and other techniques that allow a woman to let go and labor. Informed decisions about her choices in medication if she should choose, should begin before her labor.. Her decisions should be based on information that she has acquired from unbiased sources.
Moms may choose to touch their baby’s crowning head or reach down and lift their baby onto their own abdomen. The days of dad just cutting the cord have also changed. Dads many times can assist in the actual birth as well.
If she needs to have a cesarean birth, who does she wish to accompany her? Only in rare situations are there the restrictions of no one accompanying her. Does she want her partner, mother, sister or doula? Would the hospital allow two to attend her? Each hospital has it owns policies. Asking brings about change. To fail to ask for a change in policy changes nothing.
Once the baby is born, couples have options as well. Does the mom want the baby placed directly on her skin after the birth? Do they want the new born procedures done on the mom’s belly, or in the room? Does the mom want to nurse right away? Do they want to be a part of the first bath? Do they want to delay medications such as erythromycin and vitamin K or do they want to forgo those all together? These are all the parents’ decisions unless there is a medical reason to do so. Does the mom want to avoid any artificial feeding? Does she want to breastfeed on demand? Has this couple decided to leave their son intact instead of a routine circumcision? Possibilities are endless.
In the 70’s and 80’s we fought to ban those things that made birth more pristine and proper for the doctor but had no medical bearing to birth- routine enemas, pubic hair shaving and episiotomies and birthing in the supine position. What has made the change? Women. This is a consumer driven industry. Women are taking back their birth experience. The use of medication, where you birth, who is your provider, who accompanies you, what you wear, how your room is decorated, what position you birth in, what happens to the baby after the birth; these should be your choices.
You can affect change in the birthing environment by asking for what you want. Question protocols. In teaching I use the anagram BRAIN: B is the benefits, R is the risks, A is the alternatives, I is the instinctive and intuitive voice that is within you- listen to it, N is for the “now what”- or what needs to happen now- how will this affect me and my choices? So, women use your brain in making your childbirth decisions. Women can effect change by asking more questions and questioning more answers.
What Are Some Important Things To Know Before the Birth of Your Baby?
So, you have taken childbirth classes, read a ton of books and now you think you are ready for the birth of your baby. Well, let me share some things you need to know before you give birth. I share these things because recently I have encounted clients who have realized some difficulties that could have been avoided if a few more questions had been asked before the birth of their babies.
Read my article on using your BRAIN. Ask more questions so that you are an informed consumer taking a proactive role now in the outcome of your birth and your bonding experience with your baby.
About your care provider:
Do they understand your birth desires? Sometimes there is no planned time to share what your desires for your birth are with your doctor or midwife. If it is not a scheduled appointment, then ask for a longer appointment time so that you can discuss your desires. Sometimes this is done really late in the pregnancy and it becomes apparent that they may not agree with your desires. But early in pregnancy you may not have formulated your desires yet. So, changing providers, although an option, is not one many people want to do. But don't be afraid to share your desires and your plans expecting them to honor your wishes even if it is not what they would normally do. This is a consumer driven industry and you do have a say in your birth process. The law says they must give you informed consent. Ask questions, you have to live with the repercussions of the decisions.
What is the induction protocol at your provider's office? There are many doctors and midwives that don't even start doing vaginal exams until the 41st week. Then others do them at 36 weeks and arbitrarily do stripping of the membranes each exam thereafter. While others will schedule your induction date after you have gone 40 weeks. You are due between 38 weeks and 42 weeks- that is when you are "late." So, ask ahead of time or before an exam is done what they plan to do. Even better, ask in mid to early pregnancy what their normal protocol is.
What about malpresentations? Does your doctor perform external versions if the baby is breech? Will he let you have a trial of labor for a vaginal breech if you have had a previous baby and have a "proven" pelvis?
If he or she is a solo practioner, who is the back up care provider? Many times you select a solo practitioner and then you find out that he shares weekend call with some other solo practitioner. So much for knowing who will be at your birth. Ask ahead of time about this and set up a time to at least meet the back up, just in case.
About breastfeeding preparation:
What shape are your nipples? If you plan to breastfeed you can overcome problems ahead of time if you make sure you do not have flat or inverted nipples. There are preparation techniques that will help to make it easier to breastfeed. Don't wait until the baby is born to address those issues. Go to La Leche League meetings while you are still pregnant. I can't stress the importance of meeting with other women who are nursing before your baby is born. A pound of prevention is worth a ton of cure!
Do they expect a large or small baby? There are weight limits that cause certain protocols at different hospitals. If so, having a lactaid or SNS system in your labor bag would help to assure if the baby needs supplement due to low blood sugar, you can do so while having the baby at the breast, not a bottle. The best thing to do is not have the baby weighed until you have had a chance to nurse the baby at both breasts. The colostrum goes a long way to raise blood sugars.
What is your pediatrician's stand on breastfeeding? Will he come to the room while you are still hospitalized so that the exams can be done there and your baby can avoid going to the nursery? Did she breastfeed, or did his wife? How long? Even if you do not know how long you plan to do so, it is helpful to find out how positive the environment will be beforehand.
About baby separation:
What is the hospital's protocol regarding baby procedures? Have a baby plan- tell them what you want. Again, they respond to consumer demand. Write a letter to the head of nursery staff and have a copy of it upon arrival. Let them know what you need- a delay in the bath, or eye ointment, or Vitamin K, no circumcision, no immunizations, etc. This is your baby. You decide what you want to have done if the baby is healthy. Routine procedures don't have to be so routine. Room your baby in so that you know what is being done and so you can have bonding time with your baby.
If you want a lactation consultant, ask as soon as the baby is born to have your name on the list. Do they have 24/7 lacatation consulting? Doubt it. Do they have weekend help? Doubtful as well. All the more reason to go beyond the lactation class or books you have read to the attendance of LLL meetings.
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