I would love your input on this article- post to the blog so others can see your ideas... but last night I had a client have a wonderful VBAC and it made me think about what helps make a VBAC happen... here are a few ideas to ponder:
Choosing the right care provider. I put this first because I think it is paramount! Ask your doctor or midwife a few questions- how often do their previous cesarean patients choose to go for a VBAC? How many are successful? Do they enjoy working with moms who choose VBAC? Often times a care provider may say they are supportive but their numbers will show a lot. Often times they change their tone as you become more pregnant. Or they support it only if you birth by your due date- going over your due date is not acceptable. Some will help you into labor if you desire with breaking your water or low dose of pitocin. Others will only schedule another cesarean if you do not birth by your due date. Make sure they are really on board. Make sure you are a good candidate for a VBAC in their view before you proceed.
Choose a doula. It may be helpful to choose one with experience with VBAC but supporting a woman is universal- but having a doula there to help encourage you- to help remind you of your ideals- to help you in determining what may be considered in labor- these help. The studies show a doula reduces the chance of the initial cesarean but I think having one for a VBAC is essential for most couples. They are there to support the partner as well as the mom.
Take a preparation class for your VBAC. Read about how to help you achieve this. Learning techniques that help to align the baby properly- (www.spinningbabies.com), taking a yoga class or a mediation class that will help you get in touch with a mind body connection before hand will help. Take a class, especially if you did not take a childbirth preparation class the first time- techniques to help with pain will be beneficial. Also classes that help you process ideas and concerns- even fears that may be hidden will help.
Keep fit. If the reason your baby did not come out vaginally last time was due to the size- or at least the reason you were given- consider watching your diet closely to help you gain healthy weight- not bulk weight- and keeping your diet in check is good but so is keeping healthy and exercising to keep you fit.
Consider what worked last time and do it again- and consider what you felt hindered you last time and remove it. For instance if you had people with you last time that did not fully support you in the birth ideals you wanted... don't invite them back this time. If your partner was not on board last time with your choices- help him or her get on board this time in order to be the support you need. If you arrived too early last time to the birth location, consider staying home longer this time.
Work through your worries before you birth. Often times folks say they have no worries. The fear or worry may be hidden- but it comes out during labor. So, work through your thoughts. Think about how you want your labor to unfold. Consider what you can control from your previous birth this time. Consider how you will handle things differently this time. See yourself coping differently. There is so much fear around having a VBAC... some need to be addressed and some need to be researched to determine their veracity. Do the research so you will know what is true for you.
This type of preparation helps you achieve the birth you desire whether trying to achieve a VBAC or a vaginal birth anytime. Set yourself up to win.
VBACs don't usually just happen- they happen most often when women set themselves up to win!
I welcome comments from those who have VBAC'd and those who help women achieve this experience.
Friday, December 11, 2009
Thursday, December 10, 2009
"best laid plans always fail"
You know they say "best laid plans always fail"?
I had a "best laid plan" for the birth of Little Miracle. I hired a
doula, switched to a midwife that does water birth, had taken all the
classes, read all the books, and was ready for my HOSPITAL water birth
with my doula and midwife there.
I didn't get it.
I had a "best laid plan" for the birth of Little Miracle. I hired a
doula, switched to a midwife that does water birth, had taken all the
classes, read all the books, and was ready for my HOSPITAL water birth
with my doula and midwife there.
I didn't get it.
Monday, November 30, 2009
Epidural consent form
There was recent conversations regarding informed consent. Often times if a mom chooses to get an epidural it will be after she has been in a situation where she is hurting and it is hard to make a decision much less read the form- so here is a form from http://www.gentlebirth.org/archives/epdrlrsk.html for you to read now so you understand the risks involved.
Epidural Consent Form
Here's the consent form I mentioned a while back. The only thing I'd like to see added is increased c-section rate, which seems to finally be proven.
CONSENT TO EPIDURAL FOR LABOR PAIN CONTROL AND/OR CESAREAN SECTION
1. I authorize the performance upon _________ of the following
procedure ______________ performed under the direction of
______(physician's name).
2. I consent to the administration of local anesthetics, narcotics,
and/or other medications into the epidural space.
3. I understand that the following, among others, are possible
complications or risks of the procedure and that while they are
uncommon, they have been reported in the medical literature:
-Failure to relieve pain.
-Hypotension (low blood pressure).
-Postdural puncture (spinal) headache which may require
medical therapy.
-Persistent area of numbness and/or weakness of the lower
extremities.
-Temporary nausea and vomiting.
-Breakage of needles, catheters, etc. possibly requiring
surgery.
-Hematoma (blood clot) possibly requiring surgery.
-Infection.
-Rapid absorption of local anesthetics causing dizziness
and seizures.
-Temporary total spinal anesthesia (requiring life
support systems).
-Respiratory and/or cardiac arrest (requiring life
support systems).
-Back pain.
-Fetal distress resulting from one of the above complications.
4. I consent to the performance of procedures in addition to or
different from those now contemplated, whether or not arising from
presently unforeseen conditions, which the above named doctor or his
associates or assistants including residents, may consider necessary or
advisable in the course of the procedure.
5. The nature and purpose of the procedure, possible alternative
methods of treatments, the risks involved and the possibility of
complications have been fully explained to me. I understand that no
guarantee or assurance has been given by anyone as to the results that
may be obtained.
Notes from Midwifery Today tape on epidurals
After 7 hours on an epidural, the woman's temp is up 2.1 deg. F, which is considered a maternal fever, which requires a neonate septic workup.
Of 96 first-time moms, 0 w/o epidural had a c-sect., 25 w/ had a c-sect. Of those getting epidurals < 3 cm, 33% had c-sects, 3-4 cm, 26%, > 5 cm, 0% MORAL - try to wait until 5 cm before epidural.
Problems with epidurals: 5% got no pain relief; 5% got inadequate pain relief, often had windows of sensation, which are just as annoying as all over pain.
Epidurals require catheters, which can require antibiotics, which may interfere with nursing.
Another study of 11,000 women having epidurals showed that 18% of women had chronic backache within 6 months of birth, lasting > 3 months. Of those with chronic backache, only 10% didn't have an epidural.
Lactation consultants say that nipples don't get erect for 24 hours after end of epidural. Newborns can't get a good latch. (Ref: Dr. Edie? Laurence, "Measuring Effects of Breastfeeding Success and Epidurals", U. Rochester.)
Rare complications of epidurals: cardiac arrest, respiratory paralysis, convulsions (most often from high spinals or intravascular injection). Other complications, 9 had spinal headache for 6 weeks, 5 for a full year.
Ways to minimize risks: Choose attendant w/low -sect. rate. One study showed that 46% of primips have epidurals. 1% of "clinic" patients have c-sects. 20% or private patients. If you get an epidural, make sure the facility has emergency c-sect. available and full resuscitation team. For a first baby, posterior or VBAC, delay epidural until after active labor is well established.
Robbie Davis-Floyd says "Women's satisfaction with the birth experience is directly related to her sense of having mastered it."
You lose endorphins and euphoria.
Epidural Consent Form
Here's the consent form I mentioned a while back. The only thing I'd like to see added is increased c-section rate, which seems to finally be proven.
CONSENT TO EPIDURAL FOR LABOR PAIN CONTROL AND/OR CESAREAN SECTION
1. I authorize the performance upon _________ of the following
procedure ______________ performed under the direction of
______(physician's name).
2. I consent to the administration of local anesthetics, narcotics,
and/or other medications into the epidural space.
3. I understand that the following, among others, are possible
complications or risks of the procedure and that while they are
uncommon, they have been reported in the medical literature:
-Failure to relieve pain.
-Hypotension (low blood pressure).
-Postdural puncture (spinal) headache which may require
medical therapy.
-Persistent area of numbness and/or weakness of the lower
extremities.
-Temporary nausea and vomiting.
-Breakage of needles, catheters, etc. possibly requiring
surgery.
-Hematoma (blood clot) possibly requiring surgery.
-Infection.
-Rapid absorption of local anesthetics causing dizziness
and seizures.
-Temporary total spinal anesthesia (requiring life
support systems).
-Respiratory and/or cardiac arrest (requiring life
support systems).
-Back pain.
-Fetal distress resulting from one of the above complications.
4. I consent to the performance of procedures in addition to or
different from those now contemplated, whether or not arising from
presently unforeseen conditions, which the above named doctor or his
associates or assistants including residents, may consider necessary or
advisable in the course of the procedure.
5. The nature and purpose of the procedure, possible alternative
methods of treatments, the risks involved and the possibility of
complications have been fully explained to me. I understand that no
guarantee or assurance has been given by anyone as to the results that
may be obtained.
Notes from Midwifery Today tape on epidurals
After 7 hours on an epidural, the woman's temp is up 2.1 deg. F, which is considered a maternal fever, which requires a neonate septic workup.
Of 96 first-time moms, 0 w/o epidural had a c-sect., 25 w/ had a c-sect. Of those getting epidurals < 3 cm, 33% had c-sects, 3-4 cm, 26%, > 5 cm, 0% MORAL - try to wait until 5 cm before epidural.
Problems with epidurals: 5% got no pain relief; 5% got inadequate pain relief, often had windows of sensation, which are just as annoying as all over pain.
Epidurals require catheters, which can require antibiotics, which may interfere with nursing.
Another study of 11,000 women having epidurals showed that 18% of women had chronic backache within 6 months of birth, lasting > 3 months. Of those with chronic backache, only 10% didn't have an epidural.
Lactation consultants say that nipples don't get erect for 24 hours after end of epidural. Newborns can't get a good latch. (Ref: Dr. Edie? Laurence, "Measuring Effects of Breastfeeding Success and Epidurals", U. Rochester.)
Rare complications of epidurals: cardiac arrest, respiratory paralysis, convulsions (most often from high spinals or intravascular injection). Other complications, 9 had spinal headache for 6 weeks, 5 for a full year.
Ways to minimize risks: Choose attendant w/low -sect. rate. One study showed that 46% of primips have epidurals. 1% of "clinic" patients have c-sects. 20% or private patients. If you get an epidural, make sure the facility has emergency c-sect. available and full resuscitation team. For a first baby, posterior or VBAC, delay epidural until after active labor is well established.
Robbie Davis-Floyd says "Women's satisfaction with the birth experience is directly related to her sense of having mastered it."
You lose endorphins and euphoria.
Wednesday, November 18, 2009
Doulas Being Advocates
Recently I received an email from a potential doula client that started like this, “I am looking for a doula to advocate for me and my husband's wishes in the hospital, and for the baby during labor.”
When I replied with a statement, “Why do you feel you will need an advocate to share your wishes in your labor? A doula will not speak for you- you can speak for yourself- if you can't then your partner will do so- we support you- we remind you of what you wanted- we help you find your questions to find your answers- but if you feel some need to be protected we need to discuss why that is- let's talk more about this.” She was taken a back and emailed me back this, “I think there has been a misunderstanding, I have no problem speaking up for myself; I don't know where that came from. I have a list of questions to help me find a doula. What I'm looking for is a good fit, the optimal organization, because I am assembling my team, and would like a doula present. And I don't know where this inference of needing to be "protected" came from? “
This made me think about the word advocate. Perhaps there was a misunderstanding of that word. When someone says initially something like they need an advocate to be with them- it sends up a red flag. My thesaurus lists these words: supporter, backer, promoter, believer, activist, campaigner, and sponsor. One who would support, encourage and be in favor of. I do think a doula can be these things. I do think there was a misunderstanding.
But this email came on the cusp of hearing from one of my doulas about a couple who had hired her. The father to be was initially one who was gun ho on having a very medicalized birth where all decisions were given over to their doctor. And then as they began to examine more of the birth journey- they had begun to explore options available to them and find out more about birth; he had changed quite a bit. The mother to be wanted a low intervention birth and was hoping to have a gentle vaginal birth in the least and was considering going natural.
Well after going a week past her due date and sharing how her care provider was not pressuring her to do anything to push this labor along, she went in for her 41 week prenatal appointment. After doing a non stress test and biophysical, it was determined that the amniotic fluid level was low- actually he admitted it was just what they expected it to be- well within the normal range- but lower than weeks earlier- but he suggested that they go straight to the hospital for an induction.
Her cervix was not ripe- but they could ripen it with cervidil. And after less than the suggested eight to twelve hours, it was removed and pitocin was started to bring on contractions although her cervix had not changed nor was it any more ripened than it had been the day before. The consideration of a second dose of cervidil was not discussed. And sometime in the night, her water had either been broken or had released due to the cervidil.
The pitocin was bringing on mild contractions initially since the couple had been requesting a slow start to the pitocin. But by mid morning, when the doctor made the decision to bring the pitocin up to normal management levels, the mom was struggling with the pain and the baby showed a few signs of also not being happy with the plan. The doctor had even said these contractions were like those of a mom who was close to pushing, but her cervix remained closed and unchanged. An epidural was placed and the doctor told them he would give them until 2pm to make some progress or she would have a surgical birth. I am unclear as to why this time was determined to be the magic hour of calling for the surgical birth- ACOG says a mom should have eighteen hours to be in active labor after her water was broken- perhaps he had broken her water at 8pm the night before.
Now mind you, they were in very little contact with their doula, and she was not with them- she was awaiting them inviting her to come be with them- whenever they needed her- she was ready- but they felt they did not need her yet. For inductions it can be tricky. Cervical ripenings is usually done while the mom sleeps. And the early onset of a pitocin induction can take hours before a mom even feels the first "real" contraction. So not having a doula present for the early parts of an induction is normal. But after several calls to them to help her know what might be occuring, she was finally able to find out at 3pm that they were going in at 4pm to have a surgical birth.
The doula was disappointed to have not been invited to be a part of this birth. What had happened? She was trying to be that supporter, believer, campaigner and encourager that they had wanted. But no phone calls had invited her to do so. And this care provider who was not going to push her into labor was now pushing her bed into the OR. But this was not the doulas's birth. These were not her choices to make. She could not make these decisions for them. But had they been adequate advocates for themselves in the midst of this situation?
It is hard to be an advocate if someone will not be their own advocate. A doula can not step in and throw herself over your bed and say no. She can not give you medical advice. She can not speak up when you fail to do so. She can not save you from the choices you make freely along the journey. And sometimes I think folks hire us to do just that. I was trying in this email to be clear about our role. The antonym to advocate is opponent and discourager. Sometimes we find the folks we choose to be with us may very well be those things- whether it is the care provider or a friend or family member.
I can reassure you that will not be us- we will support the choices you make in your pregnancy and labor. We will remind you of what you desired. We will assist you in getting your questions answered and considering what your options are along the way. If you are desiring that, then we can be your advocates.
When I replied with a statement, “Why do you feel you will need an advocate to share your wishes in your labor? A doula will not speak for you- you can speak for yourself- if you can't then your partner will do so- we support you- we remind you of what you wanted- we help you find your questions to find your answers- but if you feel some need to be protected we need to discuss why that is- let's talk more about this.” She was taken a back and emailed me back this, “I think there has been a misunderstanding, I have no problem speaking up for myself; I don't know where that came from. I have a list of questions to help me find a doula. What I'm looking for is a good fit, the optimal organization, because I am assembling my team, and would like a doula present. And I don't know where this inference of needing to be "protected" came from? “
This made me think about the word advocate. Perhaps there was a misunderstanding of that word. When someone says initially something like they need an advocate to be with them- it sends up a red flag. My thesaurus lists these words: supporter, backer, promoter, believer, activist, campaigner, and sponsor. One who would support, encourage and be in favor of. I do think a doula can be these things. I do think there was a misunderstanding.
But this email came on the cusp of hearing from one of my doulas about a couple who had hired her. The father to be was initially one who was gun ho on having a very medicalized birth where all decisions were given over to their doctor. And then as they began to examine more of the birth journey- they had begun to explore options available to them and find out more about birth; he had changed quite a bit. The mother to be wanted a low intervention birth and was hoping to have a gentle vaginal birth in the least and was considering going natural.
Well after going a week past her due date and sharing how her care provider was not pressuring her to do anything to push this labor along, she went in for her 41 week prenatal appointment. After doing a non stress test and biophysical, it was determined that the amniotic fluid level was low- actually he admitted it was just what they expected it to be- well within the normal range- but lower than weeks earlier- but he suggested that they go straight to the hospital for an induction.
Her cervix was not ripe- but they could ripen it with cervidil. And after less than the suggested eight to twelve hours, it was removed and pitocin was started to bring on contractions although her cervix had not changed nor was it any more ripened than it had been the day before. The consideration of a second dose of cervidil was not discussed. And sometime in the night, her water had either been broken or had released due to the cervidil.
The pitocin was bringing on mild contractions initially since the couple had been requesting a slow start to the pitocin. But by mid morning, when the doctor made the decision to bring the pitocin up to normal management levels, the mom was struggling with the pain and the baby showed a few signs of also not being happy with the plan. The doctor had even said these contractions were like those of a mom who was close to pushing, but her cervix remained closed and unchanged. An epidural was placed and the doctor told them he would give them until 2pm to make some progress or she would have a surgical birth. I am unclear as to why this time was determined to be the magic hour of calling for the surgical birth- ACOG says a mom should have eighteen hours to be in active labor after her water was broken- perhaps he had broken her water at 8pm the night before.
Now mind you, they were in very little contact with their doula, and she was not with them- she was awaiting them inviting her to come be with them- whenever they needed her- she was ready- but they felt they did not need her yet. For inductions it can be tricky. Cervical ripenings is usually done while the mom sleeps. And the early onset of a pitocin induction can take hours before a mom even feels the first "real" contraction. So not having a doula present for the early parts of an induction is normal. But after several calls to them to help her know what might be occuring, she was finally able to find out at 3pm that they were going in at 4pm to have a surgical birth.
The doula was disappointed to have not been invited to be a part of this birth. What had happened? She was trying to be that supporter, believer, campaigner and encourager that they had wanted. But no phone calls had invited her to do so. And this care provider who was not going to push her into labor was now pushing her bed into the OR. But this was not the doulas's birth. These were not her choices to make. She could not make these decisions for them. But had they been adequate advocates for themselves in the midst of this situation?
It is hard to be an advocate if someone will not be their own advocate. A doula can not step in and throw herself over your bed and say no. She can not give you medical advice. She can not speak up when you fail to do so. She can not save you from the choices you make freely along the journey. And sometimes I think folks hire us to do just that. I was trying in this email to be clear about our role. The antonym to advocate is opponent and discourager. Sometimes we find the folks we choose to be with us may very well be those things- whether it is the care provider or a friend or family member.
I can reassure you that will not be us- we will support the choices you make in your pregnancy and labor. We will remind you of what you desired. We will assist you in getting your questions answered and considering what your options are along the way. If you are desiring that, then we can be your advocates.
Monday, November 2, 2009
Isabel's Birth Story
I was 39 weeks pregnant, feeling good physically and emotionally--better than I had for most of the pregnancy. Over the weekend, I started to get the feeling that something was going to happen soon. Isabel had changed the way she was moving inside of me. Instead of kicking, punching, and having "playtime" in there, it suddenly started to feel as though she was getting down to business. Her movements were more studied and intentional, like she was getting lined up for her big entrance into the world. She would move her little head back and forth, telling my body it was time to start opening up. She made little changes to her body position, making sure everything was just right for the big day.
Psychotropic Drug Use During Breastfeeding
Psychotropic Drug Use During Breastfeeding: A Review of the Evidence
Pediatrics 2009;124;e547-e556; originally published online Sep 7, 2009;
Filomena Fortinguerra, Antonio Clavenna and Maurizio Bonati
DOI: 10.1542/peds.2009-0326
OBJECTIVE: The objective of this study was to review the existing literature on the use of various classes of psychotropic medications during breastfeeding to provide information about infant exposure levels and reported adverse events in breastfed infants.
METHODS: A bibliographic search in the Medline (1967 through July 2008), Embase (1975 through July 2008), and PsycINFO (1967 through July 2008) databases was conducted for studies on breastfeeding and psychotropic medications for a total of 96 drugs. References of retrieved articles, reference books, and dedicated Web sites were also checked. The manufacturers were contacted for drugs without published information. Original articles and review articles that provide pharmacokinetic data on drug excretion in breast milk and infant safety data were considered, to estimate the “compatibility level” of each drug with breastfeeding.
RESULTS: A total of 183 original articles were eligible for analysis. Documentation was retrieved for 62 (65%) drugs. In all, 19 (31%) psychotropic drugs can be used during lactation according to an evidence based approach. For 28 drugs, the available data do not permit an evaluation of the drug’s safety profile during breastfeeding and, for an additional 15 drugs, the exposure dose or observed adverse effects make their use unsafe.
CONCLUSIONS: Although most drugs are considered safe during breastfeeding, compatibility with breastfeeding has not been established for all psychotropic drugs. There is a need for additional research and accumulation of experience to guarantee a more rational use of psychotropic drugs during breastfeeding. Pediatrics 2009;124:
e547–e556
AUTHORS: Filomena Fortinguerra, PharmD, Antonio Clavenna, MD, and Maurizio Bonati, MD
Laboratory for Mother and Child Health, Public Health Department, Mario Negri Institute for Pharmacological
Research, Milan, Italy
I love the way this article begins with this statement, “Breastfeeding is essential for the physical and psychological health of both mother and child, and its benefits are well documented.”
And then the comment that, “Despite the increased attention toward breastfeeding, however, information on breast milk drug excretion and knowledge of the adverse effects on the infant are often unavailable or still limited for many drugs that frequently are used by women of childbearing age, and misinformation abounds.” But the truth is it is not profitable for most pharmaceutical companies to research the small population of women breastfeeding to determine if a drug has an interaction with their baby’s breastmilk. It is easier to just determine that it is not okay for a mom to take most medications than to do the tests.
The article then makes this statement, “Worldwide, more than half of breastfeeding women take some type of drug and the concern about potential harm to the nursing infant from maternal medications is often cited as a reason to stop lactation,11 even if discontinuing breastfeeding is often the wrong decision. The Summary of Product Characteristics should not be considered a reliable source of breastfeeding information; it often indicates that a drug is not recommended during lactation, suggesting that it be avoided or that breastfeeding be interrupted. The warnings are not necessarily related to observed or reported adverse effects; they are often used as a defensive measure on the part of the manufacturer when the drug’s safety information is not available.”
What is astounding is how many women who could benefit from drugs are not getting them or not taking them or weaning their babies unnecessarily since no one is doing any real studies on drugs that could be helpful to them.
“It has been estimated that, each year, more than 500 000 pregnancies in the United States are complicated by psychiatric disorders such as depression, anxiety, and psychosis, which often develop, recur, and/or worsen during and after pregnancy. Furthermore, 13% of all psychiatric hospital admissions for women occur during the first postpartum year. Depression is the most frequent mental disorder in the perinatal period: 10% to 16% of pregnant women fulfill diagnostic criteria for major or minor depression, but up to 70% report symptoms of depression. Furthermore, 7% to 20% of women receive a diagnosis of postpartum depression in the first year after delivery. Untreated depression and anxiety can have a negative impact on pregnancy, and adverse short-term and long-term effects can have a negative impact on the developing infant and child.”
This article sited several studies to determine what is really known out there regarding drug interactions with breastfeeding infants from psychotropic drugs that their mothers were taking. They looked at several methods of determining how safe the drugs were- from dosage- to length of time the drugs were taken- to amount found in breastmilk to effect on babies in adverse ways. They looked at what may be compatible, what needed to be used very cautionary and what was contraindicated.
“A total of 19 (31%) psychotropic drugs can be used during lactation according to an evidence-based approach, whereas for 28 drugs, the available data do not allow an evaluation of their safety profile during breastfeeding.”
Antidepressants had been studied most. “In particular, among the antidepressants, sertraline, paroxetine, and fluvoxamine are the first-choice drugs for treatment of depression in breastfeeding mothers because they have the lowest degree of excretion into human breast milk.” “Antipsychotics are the class with the smallest number of studies concerning use during breastfeeding. The available data regarding the use of hypnotic and anxiolytic agents during breastfeeding are scant.”
I found it interesting that, “there have been no studies on infants’ long-term exposure to very low dosages of antidepressants.” It is as if the studies allows the mother to go on the drug but does not care once they determine it is okay what the long term effect on the infant could possibly be. Looking at long term effects seem the most important as that is what will cause the longer lasting issues.
The article stated, “The decision to prescribe psychotropic agents to breastfeeding mothers should depend on an individual risk/benefit analysis: the known benefits of breastfeeding and medication use for both mother and infant must be weighed against the risk of untreated maternal illness or the risk of infant exposure to medications through breast milk.”
But since so often physicians would rather just have the mom wean the baby and treat their patient without regard to the individual desires and needs of the nursing dyad, many moms wean unnecessarily. Or a mother who needs treatment will forgo the treatment at risk to herself and possibly her infant.
The conclusion of these authors was that more studies need to be done and the safety issue of many of these drugs is still unknown and quite controversial. So, this was their call to action report of sorts.
I attended a dinner that Dr Zachary Stowe, a renowned physician (Professor, Psychiatry & Behavioral Sciences Director, Women’s Mental Health Program Emory University School of Medicine in Atlanta, Georgia) presented information about psychotropic drugs and breastfeeding moms. He gave several ways to help a mom avoid depression, which included simple things like receiving postpartum help, going for walks outside in the sunshine and many others. But he stated that it is important in order to have a happy baby to have a happy mom. Getting moms the medication they need without unnecessarily weaning a baby is imperative. We know the benefits of breastfeeding on the baby and we need to stop throwing the proverbial baby out with the bath water. Research needs to be done more fervently and more physicians need to try to keep the baby and mother nursing dyad together. Mental illness needs to be treated like so many other diseases and illnesses- with avid research in order to be treated without putting the baby at risk- and that includes weaning the baby when we know the health benefits of nursing that are well documented.
Teresa Howard
Pediatrics 2009;124;e547-e556; originally published online Sep 7, 2009;
Filomena Fortinguerra, Antonio Clavenna and Maurizio Bonati
DOI: 10.1542/peds.2009-0326
OBJECTIVE: The objective of this study was to review the existing literature on the use of various classes of psychotropic medications during breastfeeding to provide information about infant exposure levels and reported adverse events in breastfed infants.
METHODS: A bibliographic search in the Medline (1967 through July 2008), Embase (1975 through July 2008), and PsycINFO (1967 through July 2008) databases was conducted for studies on breastfeeding and psychotropic medications for a total of 96 drugs. References of retrieved articles, reference books, and dedicated Web sites were also checked. The manufacturers were contacted for drugs without published information. Original articles and review articles that provide pharmacokinetic data on drug excretion in breast milk and infant safety data were considered, to estimate the “compatibility level” of each drug with breastfeeding.
RESULTS: A total of 183 original articles were eligible for analysis. Documentation was retrieved for 62 (65%) drugs. In all, 19 (31%) psychotropic drugs can be used during lactation according to an evidence based approach. For 28 drugs, the available data do not permit an evaluation of the drug’s safety profile during breastfeeding and, for an additional 15 drugs, the exposure dose or observed adverse effects make their use unsafe.
CONCLUSIONS: Although most drugs are considered safe during breastfeeding, compatibility with breastfeeding has not been established for all psychotropic drugs. There is a need for additional research and accumulation of experience to guarantee a more rational use of psychotropic drugs during breastfeeding. Pediatrics 2009;124:
e547–e556
AUTHORS: Filomena Fortinguerra, PharmD, Antonio Clavenna, MD, and Maurizio Bonati, MD
Laboratory for Mother and Child Health, Public Health Department, Mario Negri Institute for Pharmacological
Research, Milan, Italy
I love the way this article begins with this statement, “Breastfeeding is essential for the physical and psychological health of both mother and child, and its benefits are well documented.”
And then the comment that, “Despite the increased attention toward breastfeeding, however, information on breast milk drug excretion and knowledge of the adverse effects on the infant are often unavailable or still limited for many drugs that frequently are used by women of childbearing age, and misinformation abounds.” But the truth is it is not profitable for most pharmaceutical companies to research the small population of women breastfeeding to determine if a drug has an interaction with their baby’s breastmilk. It is easier to just determine that it is not okay for a mom to take most medications than to do the tests.
The article then makes this statement, “Worldwide, more than half of breastfeeding women take some type of drug and the concern about potential harm to the nursing infant from maternal medications is often cited as a reason to stop lactation,11 even if discontinuing breastfeeding is often the wrong decision. The Summary of Product Characteristics should not be considered a reliable source of breastfeeding information; it often indicates that a drug is not recommended during lactation, suggesting that it be avoided or that breastfeeding be interrupted. The warnings are not necessarily related to observed or reported adverse effects; they are often used as a defensive measure on the part of the manufacturer when the drug’s safety information is not available.”
What is astounding is how many women who could benefit from drugs are not getting them or not taking them or weaning their babies unnecessarily since no one is doing any real studies on drugs that could be helpful to them.
“It has been estimated that, each year, more than 500 000 pregnancies in the United States are complicated by psychiatric disorders such as depression, anxiety, and psychosis, which often develop, recur, and/or worsen during and after pregnancy. Furthermore, 13% of all psychiatric hospital admissions for women occur during the first postpartum year. Depression is the most frequent mental disorder in the perinatal period: 10% to 16% of pregnant women fulfill diagnostic criteria for major or minor depression, but up to 70% report symptoms of depression. Furthermore, 7% to 20% of women receive a diagnosis of postpartum depression in the first year after delivery. Untreated depression and anxiety can have a negative impact on pregnancy, and adverse short-term and long-term effects can have a negative impact on the developing infant and child.”
This article sited several studies to determine what is really known out there regarding drug interactions with breastfeeding infants from psychotropic drugs that their mothers were taking. They looked at several methods of determining how safe the drugs were- from dosage- to length of time the drugs were taken- to amount found in breastmilk to effect on babies in adverse ways. They looked at what may be compatible, what needed to be used very cautionary and what was contraindicated.
“A total of 19 (31%) psychotropic drugs can be used during lactation according to an evidence-based approach, whereas for 28 drugs, the available data do not allow an evaluation of their safety profile during breastfeeding.”
Antidepressants had been studied most. “In particular, among the antidepressants, sertraline, paroxetine, and fluvoxamine are the first-choice drugs for treatment of depression in breastfeeding mothers because they have the lowest degree of excretion into human breast milk.” “Antipsychotics are the class with the smallest number of studies concerning use during breastfeeding. The available data regarding the use of hypnotic and anxiolytic agents during breastfeeding are scant.”
I found it interesting that, “there have been no studies on infants’ long-term exposure to very low dosages of antidepressants.” It is as if the studies allows the mother to go on the drug but does not care once they determine it is okay what the long term effect on the infant could possibly be. Looking at long term effects seem the most important as that is what will cause the longer lasting issues.
The article stated, “The decision to prescribe psychotropic agents to breastfeeding mothers should depend on an individual risk/benefit analysis: the known benefits of breastfeeding and medication use for both mother and infant must be weighed against the risk of untreated maternal illness or the risk of infant exposure to medications through breast milk.”
But since so often physicians would rather just have the mom wean the baby and treat their patient without regard to the individual desires and needs of the nursing dyad, many moms wean unnecessarily. Or a mother who needs treatment will forgo the treatment at risk to herself and possibly her infant.
The conclusion of these authors was that more studies need to be done and the safety issue of many of these drugs is still unknown and quite controversial. So, this was their call to action report of sorts.
I attended a dinner that Dr Zachary Stowe, a renowned physician (Professor, Psychiatry & Behavioral Sciences Director, Women’s Mental Health Program Emory University School of Medicine in Atlanta, Georgia) presented information about psychotropic drugs and breastfeeding moms. He gave several ways to help a mom avoid depression, which included simple things like receiving postpartum help, going for walks outside in the sunshine and many others. But he stated that it is important in order to have a happy baby to have a happy mom. Getting moms the medication they need without unnecessarily weaning a baby is imperative. We know the benefits of breastfeeding on the baby and we need to stop throwing the proverbial baby out with the bath water. Research needs to be done more fervently and more physicians need to try to keep the baby and mother nursing dyad together. Mental illness needs to be treated like so many other diseases and illnesses- with avid research in order to be treated without putting the baby at risk- and that includes weaning the baby when we know the health benefits of nursing that are well documented.
Teresa Howard
Friday, October 16, 2009
Neriyah's Birth Story
Months of preparation finally became real on the morning of October 2, 2009. Nyokabi had a restful night and was ready for the day. After Morning Prayer with Jonathan, she decided to call Baby Depot to check on the special delivery of a hutch that she ordered for the nursery. After being on the phone with them for 15 minutes and not getting anywhere she started to get frustrated when she felt her first contraction. She knew right away that labor had started so she ran to tell Jonathan that her contracts had started at 10:56AM. After experiencing irregular contraction for about 30 minutes Jonathan calls Persis, their doula, to let her know today was possibly the day. Nyokabi told her that she saw part of the mucous plug and the contractions were not in any real pattern yet. However, 20 minutes later, Jonathan calls Persis again to let her know Nyokabi has a heavy show off blood. At this point Nyokabi starts to worry so Persis decides to come to the house just in case the labor was going fast.
Tuesday, October 13, 2009
Pediatricians- Not a Good Resource for Breastfeeding Information
Pediatricians’ Practices and Attitudes Regarding Breastfeeding Promotion
Richard J. Schanler, MD*; Karen G. O’Connor‡; and Ruth A. Lawrence, MD§
Pediatrics 1999;103;e35
ABSTRACT. Objective. Public awareness of the benefitsof breastfeeding is expected to increase during and after the national,federally funded Best Start BreastfeedingPromotion Campaign. It is anticipated that this will resultin more breastfeeding-based interactions between families and pediatricians. The American Academy of Pediatrics conducted a survey of its members to identify their educational needs regarding breastfeeding to assist in the design of appropriate information programs. Method. An eight-page, self-administered questionnaire was sent to 1602 active Fellows of the American Academy of Pediatrics. Results. The response rate was 71%. Breastfeeding, as the exclusive feeding practice for the first month after birth, was recommended by only 65% of responding pediatricians; only 37% recommended breastfeeding for 1 year. A majority of pediatricians agreed with or had a neutral opinion about the statement that breastfeeding and formula- feeding are equally acceptable methods for feeding infants. Reasons given for not recommending breastfeeding included medical conditions with known treatments that did not preclude breastfeeding. The majority of pediatricians (72%) were unfamiliar with the contents of the Baby-Friendly Hospital Initiative. The majority of pediatricians had not attended a presentation on breastfeeding management in the previous 3 years; most said they wanted more education on breastfeeding management. Conclusion. Pediatricians have significant educational needs in the area of breastfeeding management.
This study is one that is actually quite humorous to those of us who work with women who are nursing and have an issue that takes them to the average pediatrician. We understand not only the lack of information or education a pediatrician has regarding breastfeeding, but also the level of influence they still have on the breastfeeding relationship. Ironic that a non medical issue is one that parents still seek out medical opinions for.
This study cited that even though the big boy club of the AAP themselves promote breastfeeding as the best form of infant nutrition and encourage the infant to be fed that way, the very members of this association are failing miserably at conveying correct information to their patients parents. If the hospitals are not screwing up the relationship fairly quickly in the postpartum period, then the doctors then do their own lack of encouragement.
This study was timed to ascertain the physicians influence on breastfeeding as federally funded Best Start Breastfeeding Promotion Campaign was launched. “This campaign is targeted initially at 10 states to raise public awareness of breastfeeding through pre- and postnatal parent counseling and media promotion. Increased public awareness is expected to increase breastfeeding-related interactions between families and physicians.” They wanted to know how many of the doctors in the areas were going to be supportive of this endeavor and if they needed to do anything to help make this more likely.
The good news is this study was to “to assess breastfeeding attitudes, knowledge, and management skills of pediatricians, as well as awareness of their hospitals’ breastfeeding promotion activities. Results from this survey are expected to help in the design of appropriate breastfeeding education programs for physicians.” The bad news is the majority of the doctors definitely need more education in this area!
The conducted this study by first giving a survey to the physicians- mostly located in urban areas. The solo and group practices had better breastfeeding initiation and continuation than the clinic physicians. Tragically, only 65% of the pediatricians’ recommended exclusive breastfeeding to new parents during the early weeks of their infants’ births. 13% recommended formula supplementation while actually 2% said formula feeding was ideal. Although the AAP takes a stand on duration of exclusive breastfeeding being recommended for at least six months only 63% made any recommendation regarding duration. And only 31% made the recommendation that AAP suggested. But to be commended are the 61% who suggested the ideal time of at least one year.
Establishing breastfeeding and bonding time with the infant in the early hours after birth is a known factor in helping to increase breastfeeding success. Yet the doctors varied in their initial recommendation to do so. Only 44% recommended that the mom initiate breastfeeding in the first half hour after the birth. Only 59% suggested that demand feeding be established. Almost a quarter of the physicians were not opposed to formula or water be given to the breastfed infant. And keeping the mom and baby together by rooming in was equally divided in the study.
The use of pacifiers was only discouraged by a fourth of the doctors until breastfeeding was established. And the introduction of solids was not at the AAP recommendation either. Many recommended solids at a much younger age than 6 months. As this study states, “These infant feeding practices are known to impede successful breastfeeding and may be unnecessary.”
It was no surprise that in an office several people could be called on for phone consultations to assist new parents with breastfeeding questions. Only 76% of the time it was the doctors- who have proven they were not following suggested guidelines. Fewer than a quarter actually had lactation consultants. And few even knew how or if the staff that supplied information had ever been trained in the area of breastfeeding. Is it no wonder that misinformation was being handed out?
Only 58% of the actual physicians themselves had ever had any education regarding breastfeeding. The younger physicians (under 45 years of age) were more likely than the older physicians. And the female physicians had more training than their male counterparts. And yet although they mostly said they wanted to learn more and had not had sufficient training, 77% said they felt competent to manage common breastfeeding problems. Based on their lack of training or education in the area, it makes you wonder other areas they feel competent managing where they may also lack training and expertise.
It is no wonder that only 60% of the pediatricians had children of their own who were breastfed! Those with no personal experience were more likely to not recommend breastfeeding if the moms had common problems like breast or nipple problems- this was at 37%!
It is also no wonder that few hospitals are meeting the standard of Baby-Friendly Hospital Initiative since 72% of the doctors were unfamiliar with this initiative as well as the Ten Steps to Successful Breastfeeding statement. How can they be supportive and help promote these ideals if they are unaware of what they recommend? More then half of the doctors were unsure if there was a written policy regarding breastfeeding and if there was one what was stated within it.
The study stated, “These data suggest that the lack of clear recommendations may lead to confusion when parents question physicians about breastfeeding.” I find this an understatement. It also uncovered that very few pediatricians were even seeing their patients’ parents prenatally- where good information regarding breastfeeding could be conveyed.
The study was effective in uncovering the strong need to get the pediatricians on board with promoting breastfeeding. Helping parents prepare, initiate, be successful and continue to breastfeed is certainly an area where pediatricians can make a huge difference. But we need to get them up to speed on how to do this and it begins with more education.
Teresa Howard, CD (DONA), CLD, CLE, CCCE (CAPPA), CHBE
Richard J. Schanler, MD*; Karen G. O’Connor‡; and Ruth A. Lawrence, MD§
Pediatrics 1999;103;e35
ABSTRACT. Objective. Public awareness of the benefitsof breastfeeding is expected to increase during and after the national,federally funded Best Start BreastfeedingPromotion Campaign. It is anticipated that this will resultin more breastfeeding-based interactions between families and pediatricians. The American Academy of Pediatrics conducted a survey of its members to identify their educational needs regarding breastfeeding to assist in the design of appropriate information programs. Method. An eight-page, self-administered questionnaire was sent to 1602 active Fellows of the American Academy of Pediatrics. Results. The response rate was 71%. Breastfeeding, as the exclusive feeding practice for the first month after birth, was recommended by only 65% of responding pediatricians; only 37% recommended breastfeeding for 1 year. A majority of pediatricians agreed with or had a neutral opinion about the statement that breastfeeding and formula- feeding are equally acceptable methods for feeding infants. Reasons given for not recommending breastfeeding included medical conditions with known treatments that did not preclude breastfeeding. The majority of pediatricians (72%) were unfamiliar with the contents of the Baby-Friendly Hospital Initiative. The majority of pediatricians had not attended a presentation on breastfeeding management in the previous 3 years; most said they wanted more education on breastfeeding management. Conclusion. Pediatricians have significant educational needs in the area of breastfeeding management.
This study is one that is actually quite humorous to those of us who work with women who are nursing and have an issue that takes them to the average pediatrician. We understand not only the lack of information or education a pediatrician has regarding breastfeeding, but also the level of influence they still have on the breastfeeding relationship. Ironic that a non medical issue is one that parents still seek out medical opinions for.
This study cited that even though the big boy club of the AAP themselves promote breastfeeding as the best form of infant nutrition and encourage the infant to be fed that way, the very members of this association are failing miserably at conveying correct information to their patients parents. If the hospitals are not screwing up the relationship fairly quickly in the postpartum period, then the doctors then do their own lack of encouragement.
This study was timed to ascertain the physicians influence on breastfeeding as federally funded Best Start Breastfeeding Promotion Campaign was launched. “This campaign is targeted initially at 10 states to raise public awareness of breastfeeding through pre- and postnatal parent counseling and media promotion. Increased public awareness is expected to increase breastfeeding-related interactions between families and physicians.” They wanted to know how many of the doctors in the areas were going to be supportive of this endeavor and if they needed to do anything to help make this more likely.
The good news is this study was to “to assess breastfeeding attitudes, knowledge, and management skills of pediatricians, as well as awareness of their hospitals’ breastfeeding promotion activities. Results from this survey are expected to help in the design of appropriate breastfeeding education programs for physicians.” The bad news is the majority of the doctors definitely need more education in this area!
The conducted this study by first giving a survey to the physicians- mostly located in urban areas. The solo and group practices had better breastfeeding initiation and continuation than the clinic physicians. Tragically, only 65% of the pediatricians’ recommended exclusive breastfeeding to new parents during the early weeks of their infants’ births. 13% recommended formula supplementation while actually 2% said formula feeding was ideal. Although the AAP takes a stand on duration of exclusive breastfeeding being recommended for at least six months only 63% made any recommendation regarding duration. And only 31% made the recommendation that AAP suggested. But to be commended are the 61% who suggested the ideal time of at least one year.
Establishing breastfeeding and bonding time with the infant in the early hours after birth is a known factor in helping to increase breastfeeding success. Yet the doctors varied in their initial recommendation to do so. Only 44% recommended that the mom initiate breastfeeding in the first half hour after the birth. Only 59% suggested that demand feeding be established. Almost a quarter of the physicians were not opposed to formula or water be given to the breastfed infant. And keeping the mom and baby together by rooming in was equally divided in the study.
The use of pacifiers was only discouraged by a fourth of the doctors until breastfeeding was established. And the introduction of solids was not at the AAP recommendation either. Many recommended solids at a much younger age than 6 months. As this study states, “These infant feeding practices are known to impede successful breastfeeding and may be unnecessary.”
It was no surprise that in an office several people could be called on for phone consultations to assist new parents with breastfeeding questions. Only 76% of the time it was the doctors- who have proven they were not following suggested guidelines. Fewer than a quarter actually had lactation consultants. And few even knew how or if the staff that supplied information had ever been trained in the area of breastfeeding. Is it no wonder that misinformation was being handed out?
Only 58% of the actual physicians themselves had ever had any education regarding breastfeeding. The younger physicians (under 45 years of age) were more likely than the older physicians. And the female physicians had more training than their male counterparts. And yet although they mostly said they wanted to learn more and had not had sufficient training, 77% said they felt competent to manage common breastfeeding problems. Based on their lack of training or education in the area, it makes you wonder other areas they feel competent managing where they may also lack training and expertise.
It is no wonder that only 60% of the pediatricians had children of their own who were breastfed! Those with no personal experience were more likely to not recommend breastfeeding if the moms had common problems like breast or nipple problems- this was at 37%!
It is also no wonder that few hospitals are meeting the standard of Baby-Friendly Hospital Initiative since 72% of the doctors were unfamiliar with this initiative as well as the Ten Steps to Successful Breastfeeding statement. How can they be supportive and help promote these ideals if they are unaware of what they recommend? More then half of the doctors were unsure if there was a written policy regarding breastfeeding and if there was one what was stated within it.
The study stated, “These data suggest that the lack of clear recommendations may lead to confusion when parents question physicians about breastfeeding.” I find this an understatement. It also uncovered that very few pediatricians were even seeing their patients’ parents prenatally- where good information regarding breastfeeding could be conveyed.
The study was effective in uncovering the strong need to get the pediatricians on board with promoting breastfeeding. Helping parents prepare, initiate, be successful and continue to breastfeed is certainly an area where pediatricians can make a huge difference. But we need to get them up to speed on how to do this and it begins with more education.
Teresa Howard, CD (DONA), CLD, CLE, CCCE (CAPPA), CHBE
Does Income Affect Breastfeeding.... Does a Mom's BMI?
Maternal Variables Influencing Duration of Breastfeeding Among Low-Income Mothers
Anne Chevalier McKechnie, RN, IBCLC, RLC, Audrey Tluczek, PhD, RN, and Jeffrey B. Henriques, PhD
ICAN: Infant, Child, & Adolescent Nutrition June 2009
This is my review of their study….
Who breastfeeds longer? The study was performed on low income moms. The lack of long term breastfeeding is highest in this group. What the findings showed was that moms who had a high body mass index also fed for a shorter period of time. And the moms who fed longer were also moms who breastfed more exclusively. Younger moms did not nurse as long as the older moms in this study as well.
The study was done in hopes to figure out how to improve the outcomes for breastfeeding moms to nurse for a longer period of time. It stated, “US Department of Health and Human Services established the following goals for breastfeeding by the year 2010: a 75% rate of initiation, a 50% rate of breastfeeding for 6 months, and a 25% rate of breastfeeding for 12 months.“ They set a goal to lengthen the duration of breastfeeding and to help moms exclusively breastfeed.
So, let’s look at this study. It makes sense that if you begin weaning- and weaning meaning putting anything in the baby’s mouth besides the breasts- that the breastfeeding duration will be shortened. Many mothers do not realize that sucking needs are normal and should be met at the breasts as often as possible as to increase milk supply. Instead they begin using a pacifier too quickly and too often and wonder why their milk supply dwindles. They also think that just one bottle will not make any difference to their breastfeeding relationship. It does. One bottle quickly becomes more and soon others are feeding the baby and we are trying to pump to keep our supply going when nursing would automatically do that.
Poor women are more susceptible, I suspect, since often they are forced into the work environment to survive and our government assistance offers them free formula in order to feed their baby instead of a stipend to stay home and nurse. When my own daughter qualified for the WIC program I was amazed out how often she was encouraged to take the formula they offered and start supplements sooner. So, I was not surprised to find this study also showed, “Many mothers in low-income populations participate in Supplemental Nutrition Program for Women, Infants, and Children (WIC) programs, and numerous studies have shown that these mothers are less likely to breastfeed as compared with nonparticipants of WIC programs.”
I believe these women are also often encouraged to start solids sooner. The concern I am sure may be that the women themselves have poor nutrition, thus breast milk is compromised. But instead of providing the mom with better nutritional guidelines, the suggestion is made that she offer her infant something that is less nutritious than nursing her baby. This study indeed showed how, “the highest risk for poor health, tend to have the lowest breastfeeding rates.”
The other part of this study looked at how the B.M.I. of women affected their breastfeeding relationship with their babies. “Obesity may also adversely affect breastfeeding in several ways. First, mothers with a BMI at or above 30 kg/m2 may experience hormonal patterns that interfere with milk production.30-32 Second, the infants of obese and overweight mothers may have physical difficulty latching onto the breast.31 Finally, an elevated BMI may indirectly interfere with the initiation and duration of breastfeeding because obesity is also associated with complications of pregnancy and delivery, cesarean delivery, poor maternal self-esteem, maternal depression, and low socioeconomic status. A recent study34 found that mothers with a BMI ≥25 kg/m2 were more likely to have discontinued breastfeeding before 6 months than normal-weight mothers.”
I tried to think about how this factored into the relationships of moms and babies I had worked with over the years. Indeed I saw more women who were considered overweight having complications with their pregnancies. These complications did lead to more surgical births as well as inductions and the edema that inductions sometimes caused in the moms causing latch issues initially. I have not seen the hormonal shift issues but certainly can see where an out of balance hormonal issue can cause milk production issues as well. But recently I had a client who is obese have real issues with her third baby. She found herself unable to successfully breastfeed outside of her own home environment due to how she had to work to latch her daughter onto the breast. It was not something she could do easily or even the least bit discretely.
New moms are concerned with body image as their breasts are larger but their bellies are still on the post pregnancy form- and therefore they want to hide their bulges and are learning to manage the new larger breasts. This makes them uncomfortable initiating breastfeeding in many situations outside of their home. Part of this is how we make women feel about their bodies in general in the USA and how we make breastfeeding a sexual act instead of a natural one. But certainly not feeling good about our bodies makes us not feel good about some of the natural body functions we may have as well. Our environmental support systems are certainly lacking in regards to support for breastfeeding.
This study had a hypothesis of, “Mothers within a low-income population who chose exclusive breastfeeding would likely (a) continue breastfeeding longer than mothers, who chose partial breastfeeding, (b) be of an older age than mothers who chose partial breastfeeding, and (c) have a lower BMI than mothers who chose partial breastfeeding.”
The other factor that was mentioned in this study was age. The younger moms seemed to lack the support of their community in breastfeeding and therefore initiated breastfeeding less as well as length of time of breastfeeding was limited.
The study concluded with this statement, “Breastfeeding is a complex issue with lifelong consequences for both mother and infant. This study found that factors, such as exclusive breastfeeding, older maternal age, and lower BMI, were associated with longer breastfeeding duration. These findings move us closer to understanding the unique needs of low-income, WIC, breastfeeding mothers and support the notion that maternal readiness and capacity for breastfeeding are influenced by dynamic biopsychosocial processes.”
I wonder if we had more pictures of younger moms nursing their babies in ads, women who overweight were nursing their babies, and moms in general nursing in more public areas in ads and government promotional materials, if we would increase these numbers for both initiating breastfeeding as well as duration of nursing exclusively. I wonder if we increased awareness to the communities of the benefits of breastfeeding if we would see the support change in the communities to support all women and babies in breastfeeding.
When as a lactation educator I am still counteracting the negative and detrimental things that are being done in the hospitals to sabotage breastfeeding, in the WIC offices to undermine the moms and in the communities that still want to banish women and their nursling to the bathrooms to nurse, if BMI and socioeconomic conditions are just a drop in the bucket as to why breastfeeding numbers are dwindling in the US.
Teresa Howard, CD (DONA), CLD, CLE, CCCE (CAPPA), CHBE
Anne Chevalier McKechnie, RN, IBCLC, RLC, Audrey Tluczek, PhD, RN, and Jeffrey B. Henriques, PhD
ICAN: Infant, Child, & Adolescent Nutrition June 2009
This is my review of their study….
Who breastfeeds longer? The study was performed on low income moms. The lack of long term breastfeeding is highest in this group. What the findings showed was that moms who had a high body mass index also fed for a shorter period of time. And the moms who fed longer were also moms who breastfed more exclusively. Younger moms did not nurse as long as the older moms in this study as well.
The study was done in hopes to figure out how to improve the outcomes for breastfeeding moms to nurse for a longer period of time. It stated, “US Department of Health and Human Services established the following goals for breastfeeding by the year 2010: a 75% rate of initiation, a 50% rate of breastfeeding for 6 months, and a 25% rate of breastfeeding for 12 months.“ They set a goal to lengthen the duration of breastfeeding and to help moms exclusively breastfeed.
So, let’s look at this study. It makes sense that if you begin weaning- and weaning meaning putting anything in the baby’s mouth besides the breasts- that the breastfeeding duration will be shortened. Many mothers do not realize that sucking needs are normal and should be met at the breasts as often as possible as to increase milk supply. Instead they begin using a pacifier too quickly and too often and wonder why their milk supply dwindles. They also think that just one bottle will not make any difference to their breastfeeding relationship. It does. One bottle quickly becomes more and soon others are feeding the baby and we are trying to pump to keep our supply going when nursing would automatically do that.
Poor women are more susceptible, I suspect, since often they are forced into the work environment to survive and our government assistance offers them free formula in order to feed their baby instead of a stipend to stay home and nurse. When my own daughter qualified for the WIC program I was amazed out how often she was encouraged to take the formula they offered and start supplements sooner. So, I was not surprised to find this study also showed, “Many mothers in low-income populations participate in Supplemental Nutrition Program for Women, Infants, and Children (WIC) programs, and numerous studies have shown that these mothers are less likely to breastfeed as compared with nonparticipants of WIC programs.”
I believe these women are also often encouraged to start solids sooner. The concern I am sure may be that the women themselves have poor nutrition, thus breast milk is compromised. But instead of providing the mom with better nutritional guidelines, the suggestion is made that she offer her infant something that is less nutritious than nursing her baby. This study indeed showed how, “the highest risk for poor health, tend to have the lowest breastfeeding rates.”
The other part of this study looked at how the B.M.I. of women affected their breastfeeding relationship with their babies. “Obesity may also adversely affect breastfeeding in several ways. First, mothers with a BMI at or above 30 kg/m2 may experience hormonal patterns that interfere with milk production.30-32 Second, the infants of obese and overweight mothers may have physical difficulty latching onto the breast.31 Finally, an elevated BMI may indirectly interfere with the initiation and duration of breastfeeding because obesity is also associated with complications of pregnancy and delivery, cesarean delivery, poor maternal self-esteem, maternal depression, and low socioeconomic status. A recent study34 found that mothers with a BMI ≥25 kg/m2 were more likely to have discontinued breastfeeding before 6 months than normal-weight mothers.”
I tried to think about how this factored into the relationships of moms and babies I had worked with over the years. Indeed I saw more women who were considered overweight having complications with their pregnancies. These complications did lead to more surgical births as well as inductions and the edema that inductions sometimes caused in the moms causing latch issues initially. I have not seen the hormonal shift issues but certainly can see where an out of balance hormonal issue can cause milk production issues as well. But recently I had a client who is obese have real issues with her third baby. She found herself unable to successfully breastfeed outside of her own home environment due to how she had to work to latch her daughter onto the breast. It was not something she could do easily or even the least bit discretely.
New moms are concerned with body image as their breasts are larger but their bellies are still on the post pregnancy form- and therefore they want to hide their bulges and are learning to manage the new larger breasts. This makes them uncomfortable initiating breastfeeding in many situations outside of their home. Part of this is how we make women feel about their bodies in general in the USA and how we make breastfeeding a sexual act instead of a natural one. But certainly not feeling good about our bodies makes us not feel good about some of the natural body functions we may have as well. Our environmental support systems are certainly lacking in regards to support for breastfeeding.
This study had a hypothesis of, “Mothers within a low-income population who chose exclusive breastfeeding would likely (a) continue breastfeeding longer than mothers, who chose partial breastfeeding, (b) be of an older age than mothers who chose partial breastfeeding, and (c) have a lower BMI than mothers who chose partial breastfeeding.”
The other factor that was mentioned in this study was age. The younger moms seemed to lack the support of their community in breastfeeding and therefore initiated breastfeeding less as well as length of time of breastfeeding was limited.
The study concluded with this statement, “Breastfeeding is a complex issue with lifelong consequences for both mother and infant. This study found that factors, such as exclusive breastfeeding, older maternal age, and lower BMI, were associated with longer breastfeeding duration. These findings move us closer to understanding the unique needs of low-income, WIC, breastfeeding mothers and support the notion that maternal readiness and capacity for breastfeeding are influenced by dynamic biopsychosocial processes.”
I wonder if we had more pictures of younger moms nursing their babies in ads, women who overweight were nursing their babies, and moms in general nursing in more public areas in ads and government promotional materials, if we would increase these numbers for both initiating breastfeeding as well as duration of nursing exclusively. I wonder if we increased awareness to the communities of the benefits of breastfeeding if we would see the support change in the communities to support all women and babies in breastfeeding.
When as a lactation educator I am still counteracting the negative and detrimental things that are being done in the hospitals to sabotage breastfeeding, in the WIC offices to undermine the moms and in the communities that still want to banish women and their nursling to the bathrooms to nurse, if BMI and socioeconomic conditions are just a drop in the bucket as to why breastfeeding numbers are dwindling in the US.
Teresa Howard, CD (DONA), CLD, CLE, CCCE (CAPPA), CHBE
Saturday, October 10, 2009
Melia Gives Birth
Melia had her first baby using pain medication- I can't remember the details- hopefully she will share them in the comments... She then took my childbirth class and hired one of the LOL doulas and had a home birth. This time she hired a local doula- an excellent one I might add- and took the Birthing Again classes that I teach. They chose to give birth at Athens Regional using the wonderful midwifery group that supports women there. I read her birth story and asked if we could please post it here to share with you. She happily agreed!
Sunday, September 13, 2009
Birth Story of Noah Told By His Mom
My version of Noah's birth story
-by Lindsay
Noah's due date was August 20th, 2009. Throughout my pregnancy I kept thinking/hoping he'd be late so I could attend my brother, Mark's, wedding on August 22nd. Maybe all my pep talks worked because he stayed put! Then, on Monday August 24th I went to my final prenatal appointment. My midwife, Margaret, said I was about 1-2 cm dilated and 80% effaced. She could feel my belly contracting and thought I might be in early labor. They did a non stress test to check out Noah's heart beat and track my contractions. It went just fine. I left the office thinking I'd probably be back for another appointment the following week.
Wednesday, August 19, 2009
Parts of the Puzzle that Make for a Good Outcome
Recently a local childbirth educator made a comment that students in her classes had the average cesarean rate of consistently 10-12%. I thought wow that is great- I have never kept statistics on my students. I have kept statistics on my doula clients- over the last year my primary cesarean rate has been 8% and all of the cesareans- not including planned ones for things like placenta previa- but including women who had previous cesareans had only been 12%. But it made me think of all of the pieces of that go into the puzzle that makes for a "good" outcome. I realize "good" is a subjective word- so for the sake of this blog article, I will classify "good" as non interventive or at least having only the interventions you as a consumer choose.
Often times a couple who chooses our classes- certainly different than the "normal" hospital "how to be a good patient" classes. So they are usually looking for a different approach- perhaps in an attempt to have "their" birth experience- not the hospitals or their care providers. They are usually open to hearing new ideas that will help expand the ideas they are already developing on their own.
Often times a couple who chooses our classes are not choosing the "normal" birth experience and therefore has either chosen a care provider who is open to stepping outside of the "norm" or soon figure out from the class and their own exploration that the provider they have chosen will need to either get on board or they will need to find a new one.
Often times a couple who chooses our classes are not reading "What to Expect When You are Expecting," or "The Girlfriends Guide to Pregnancy and Birth." They are reading books like "Birthing From Within" and "Ina May's Guide to Childbirth." They are refusing to believe the view that you follow protocol even when it is not what you want.
Often times a couple who chooses our classes are considering their support team carefully. They either surround themselves with family and friends who are on the same page- or they choose to hire a doula. The added support of a doula is definitely documented in numerous studies to make a real positive difference in birth outcomes.
So I choose to believe that my classes- our classes at Labor of Love offer one more piece of the exploration process for a couple to consider in their journey to parenting. My mom used to tell me if you take credit for all of your kids positive characteristics, you must also take credit for the bad ones. I choose to be happy about the characters of my children- and will praise them- hoping that I did influence them but fall just short of claiming credit!
My advice is to prepare for your birth as much as you prepared for other important, life changing experiences in your life up to this point. Choose your care provider carefully. Choose your support team carefully. Choose how you educate yourself carefully. Blend all of this together and you will likely have a "good" birth experience and one where you can take full credit for the choices you made along the way.
Often times a couple who chooses our classes- certainly different than the "normal" hospital "how to be a good patient" classes. So they are usually looking for a different approach- perhaps in an attempt to have "their" birth experience- not the hospitals or their care providers. They are usually open to hearing new ideas that will help expand the ideas they are already developing on their own.
Often times a couple who chooses our classes are not choosing the "normal" birth experience and therefore has either chosen a care provider who is open to stepping outside of the "norm" or soon figure out from the class and their own exploration that the provider they have chosen will need to either get on board or they will need to find a new one.
Often times a couple who chooses our classes are not reading "What to Expect When You are Expecting," or "The Girlfriends Guide to Pregnancy and Birth." They are reading books like "Birthing From Within" and "Ina May's Guide to Childbirth." They are refusing to believe the view that you follow protocol even when it is not what you want.
Often times a couple who chooses our classes are considering their support team carefully. They either surround themselves with family and friends who are on the same page- or they choose to hire a doula. The added support of a doula is definitely documented in numerous studies to make a real positive difference in birth outcomes.
So I choose to believe that my classes- our classes at Labor of Love offer one more piece of the exploration process for a couple to consider in their journey to parenting. My mom used to tell me if you take credit for all of your kids positive characteristics, you must also take credit for the bad ones. I choose to be happy about the characters of my children- and will praise them- hoping that I did influence them but fall just short of claiming credit!
My advice is to prepare for your birth as much as you prepared for other important, life changing experiences in your life up to this point. Choose your care provider carefully. Choose your support team carefully. Choose how you educate yourself carefully. Blend all of this together and you will likely have a "good" birth experience and one where you can take full credit for the choices you made along the way.
Thursday, July 30, 2009
Lamaze Six Healthy Birth Practices
Lamaze has done a great job with this ...
Common sense tells us and research confirms that the Six Lamaze Healthy Birth Practices featured in these video clips and print materials are tried-and-true ways to make birth as safe and healthy as possible.
Check out this page for some great video clips and even some printable material!
This is definitely worth your time to check this out!
Common sense tells us and research confirms that the Six Lamaze Healthy Birth Practices featured in these video clips and print materials are tried-and-true ways to make birth as safe and healthy as possible.
Check out this page for some great video clips and even some printable material!
This is definitely worth your time to check this out!
Sunday, July 26, 2009
The hardest part of being a doula- part 2
I have written before about being on call being a difficult issue for doulas. Many times I get a call from someone wanting to be a doula. But besides the erratic schedules, the need for excellent childcare and a supportive partner- it is essential they understand the idea of being on call. We are on call "officially" for the due month- which is 38 weeks to 42 weeks- but of course if a mom goes prematurely we make sure she has a doula, even if her primary is not available. But there was a conversation today that I wanted to share with you.
When you are a doula, you may be hire months in advance of the woman's due month. We have folks who hire us as early as 12 weeks- we will not accept a retainer prior to this time. But things come up sometimes unexpectedly. I am not talking about illness or family emergencies- I mean things like a friend's wedding, a special concert, a last moment opportunity for a vacation, etc. But in Labor of Love's business workings- we ask that when you are hired by a couple, you are fully available during her due month- meaning those things you want to do that arise are back burnered to the mom in labor. The exception to this is of course if when you are hired- you enlighten a couple to a possible date conflict within their due month and they hire you irregardless- knowing you will have a back up in place when that special event occurs.
Well we discussed as a group today the idea of a couple hiring the group- not a specific doula. We came by this idea based on two things. First since this is a difficult if not the most difficult part of doula work it would make our lives so much easier if we knew specific days we would be on call and days we could be free to do other things without worry about not being there for a mom. Second,we get couples all the time who attend the Meet the Doula Tea and say they would be be happy with any of us.
But as we discussed the logistics of offering this as a potential service at a lower rate than the average doula in our group, we realized it benefited us as doulas but was not in the best interest of the couples. Already moms often have no idea who will be the care provider on call when they go into labor. In fact there are several groups who now share call with other groups- meaning you will not have ever even met the doctor who shows up to catch your baby- he or she has never read your birth plan- has no idea what your birth ideals are- and really is not that concerned about it. Their job is to show up and catch your baby and make medical decisions for you but is not invested in your birth experience outside of that.
Often times a woman will even entertain the idea of induction with all of those risks in order to get her preferred doctor. Although that is not guaranteed either since often inductions go longer than expected and the shift change of on call changes too. The last thing we would want is someone to consider an induction to get their favorite doula who would be on call. The risk of induction is somehow out weighed by the familiarity of desire for those who will attend her. This is awful.
Continuity of care is something we offer. We will stay with you during the duration of your labor- no matter how long. I talked with a doula with another group in town recently who has small children- she said she would not be able to attend a mom irregardless of the length of her labor... she said she would call another "fresh" doula in place. We may call in help to allow us a power nap with the mom still fully supported- at no additional cost to the mom- if her labor went unusually long- but that is rare. We have found we make 97% of our births- the other 3% are covered during those rare occasions when an emergency arises for the primary doula- by a back up doula. The fantastic thing about our company is we have several wonderful doulas who folks get to have met at the teas we do bimonthly.
Penny Simkin was quoted in a publication the IHS Provider page 155 "Doulas “hold women” by supporting them emotionally during their pregnancy, labor, and birth. The doula meets with her expectant mother one or more times before the birth and discusses the mother’s expectations or ideas of what the birth will be like, and issues of importance, such as pain medication preferences or infant feeding choices. During these meetings the doula supplements information the mother has learned in prenatal classes and explores misinformation she may have gleaned from what she has heard or read. The doula empowers the client to eat well, observe healthy lifestyle practices, and exercise, all to prepare for a healthy and positive birth experience. A doula may use this time to enhance communication within the woman’s support network, including family and partner, and/or may give advice about how to communicate effectively with the medical staff.
During early labor, the doula and her birthing partner stay in close contact until the mother needs additional support, at which time the doula will join her, meeting the mother at her birth place. She will then stay throughout the entire labor and birth and for up to two hours during the postpartum period. She will talk about normal contractions with the mother and will provide an objective viewpoint. Knowledge of what is normal replaces fear of the unknown. The doula listens to the mother and responds to her needs. The presence of the doula, who is calm and committed to the mother’s well-being, counteracts the effects of elevated stress hormones (adrenaline and noradrenaline), which are released when the mother becomes anxious, fearful, or insecure. A trusting, relaxed mother is able to continue producing oxytocin, which then keeps the labor in its normal rhythm, with the perception of pain diminished greatly. Most importantly, the doula lessens the anxiety of the laboring woman with quiet reassurance and enhancement of the unique talents and strengths the laboring mother brings to the birth."
And at Labor of Love we agree."She will then stay throughout the entire labor and birth and for up to two hours during the postpartum period."
That relationship, "supporting them emotionally during their pregnancy, labor, and birth." is essential and one we are not willing to compromise by having a varying and rotation of doulas on call for the mom. We love having a well established relationship built prior to the labor and birth. We love the phone calls, the personal talks, the emails along the journey.
So, although it would make our lives easier- we realized it would not be easier for the moms themselves. We want to be the consistent,non variable support to couples in their labor and birth. We want them to know we will do our very best to be with them- the doula they selected as their primary- and insure that is our goal. If it makes our life a bit more difficult, then so be it- we love the work we do. For us it is our calling. We love being with women in birth. We feel blessed to do it. Our families are understanding although it is difficult for them at times. But if they love us and they understand our work is in our hearts and gives us that which we need- they support us none the less.
So, know where our hearts are- with you... for you... in support of you.
When you are a doula, you may be hire months in advance of the woman's due month. We have folks who hire us as early as 12 weeks- we will not accept a retainer prior to this time. But things come up sometimes unexpectedly. I am not talking about illness or family emergencies- I mean things like a friend's wedding, a special concert, a last moment opportunity for a vacation, etc. But in Labor of Love's business workings- we ask that when you are hired by a couple, you are fully available during her due month- meaning those things you want to do that arise are back burnered to the mom in labor. The exception to this is of course if when you are hired- you enlighten a couple to a possible date conflict within their due month and they hire you irregardless- knowing you will have a back up in place when that special event occurs.
Well we discussed as a group today the idea of a couple hiring the group- not a specific doula. We came by this idea based on two things. First since this is a difficult if not the most difficult part of doula work it would make our lives so much easier if we knew specific days we would be on call and days we could be free to do other things without worry about not being there for a mom. Second,we get couples all the time who attend the Meet the Doula Tea and say they would be be happy with any of us.
But as we discussed the logistics of offering this as a potential service at a lower rate than the average doula in our group, we realized it benefited us as doulas but was not in the best interest of the couples. Already moms often have no idea who will be the care provider on call when they go into labor. In fact there are several groups who now share call with other groups- meaning you will not have ever even met the doctor who shows up to catch your baby- he or she has never read your birth plan- has no idea what your birth ideals are- and really is not that concerned about it. Their job is to show up and catch your baby and make medical decisions for you but is not invested in your birth experience outside of that.
Often times a woman will even entertain the idea of induction with all of those risks in order to get her preferred doctor. Although that is not guaranteed either since often inductions go longer than expected and the shift change of on call changes too. The last thing we would want is someone to consider an induction to get their favorite doula who would be on call. The risk of induction is somehow out weighed by the familiarity of desire for those who will attend her. This is awful.
Continuity of care is something we offer. We will stay with you during the duration of your labor- no matter how long. I talked with a doula with another group in town recently who has small children- she said she would not be able to attend a mom irregardless of the length of her labor... she said she would call another "fresh" doula in place. We may call in help to allow us a power nap with the mom still fully supported- at no additional cost to the mom- if her labor went unusually long- but that is rare. We have found we make 97% of our births- the other 3% are covered during those rare occasions when an emergency arises for the primary doula- by a back up doula. The fantastic thing about our company is we have several wonderful doulas who folks get to have met at the teas we do bimonthly.
Penny Simkin was quoted in a publication the IHS Provider page 155 "Doulas “hold women” by supporting them emotionally during their pregnancy, labor, and birth. The doula meets with her expectant mother one or more times before the birth and discusses the mother’s expectations or ideas of what the birth will be like, and issues of importance, such as pain medication preferences or infant feeding choices. During these meetings the doula supplements information the mother has learned in prenatal classes and explores misinformation she may have gleaned from what she has heard or read. The doula empowers the client to eat well, observe healthy lifestyle practices, and exercise, all to prepare for a healthy and positive birth experience. A doula may use this time to enhance communication within the woman’s support network, including family and partner, and/or may give advice about how to communicate effectively with the medical staff.
During early labor, the doula and her birthing partner stay in close contact until the mother needs additional support, at which time the doula will join her, meeting the mother at her birth place. She will then stay throughout the entire labor and birth and for up to two hours during the postpartum period. She will talk about normal contractions with the mother and will provide an objective viewpoint. Knowledge of what is normal replaces fear of the unknown. The doula listens to the mother and responds to her needs. The presence of the doula, who is calm and committed to the mother’s well-being, counteracts the effects of elevated stress hormones (adrenaline and noradrenaline), which are released when the mother becomes anxious, fearful, or insecure. A trusting, relaxed mother is able to continue producing oxytocin, which then keeps the labor in its normal rhythm, with the perception of pain diminished greatly. Most importantly, the doula lessens the anxiety of the laboring woman with quiet reassurance and enhancement of the unique talents and strengths the laboring mother brings to the birth."
And at Labor of Love we agree."She will then stay throughout the entire labor and birth and for up to two hours during the postpartum period."
That relationship, "supporting them emotionally during their pregnancy, labor, and birth." is essential and one we are not willing to compromise by having a varying and rotation of doulas on call for the mom. We love having a well established relationship built prior to the labor and birth. We love the phone calls, the personal talks, the emails along the journey.
So, although it would make our lives easier- we realized it would not be easier for the moms themselves. We want to be the consistent,non variable support to couples in their labor and birth. We want them to know we will do our very best to be with them- the doula they selected as their primary- and insure that is our goal. If it makes our life a bit more difficult, then so be it- we love the work we do. For us it is our calling. We love being with women in birth. We feel blessed to do it. Our families are understanding although it is difficult for them at times. But if they love us and they understand our work is in our hearts and gives us that which we need- they support us none the less.
So, know where our hearts are- with you... for you... in support of you.
Saturday, July 25, 2009
ACOG changes their tune on inductions
We know that inductions can lead to two problems- babies who were truly not ready and due date guesses that were wrong- leading to a baby who needs help and therefore earns a stay in the nursery or NICU. Or a mom whose body was not ready and her body did not comply with being forced into labor and therefore her failed induction led to a surgical birth by cesarean. I adore the Cochrane Datebase of evidence practiced medicine. And I adore Medscape which reports new guidelines by the medical societies set up by their specialties- the ACOG guidelines have now changed regarding inductions. I wonder if this was due to the ever increasing premature infants that are being born across the US and also the escalating cesarean birth rates.
So read ahead the newest guidelines regarding induction:
July 23, 2009 — On July 21, the American College of Obstetricians and Gynecologists (ACOG) issued revised guidelines on when and how to induce labor in pregnant women. The updated recommendations are published as a Practice Bulletin, "Induction of Labor," in the August issue of Obstetrics & Gynecology. The bulletin aims to guide physicians regarding their choice of induction methods that may be most suitable in specific settings and to elucidate the safety requirements, risks, and benefits of various regimens to induce labor.
Benefits vs Risks of Labor Induction
For the last 2 decades, the rate of labor induction in the United States has more than doubled, with more than 22% of all pregnant women in 2006 having labor induced. This increase in use necessitates a careful review of indications, risks, and benefits.
The goal of labor induction is to stimulate uterine contractions before the spontaneous onset of labor, resulting in vaginal delivery. The benefits of labor induction must be weighed against the potential maternal and fetal risks associated with this procedure. When the benefits of expeditious delivery are greater than the risks of continuing the pregnancy, inducing labor can be justified as a therapeutic intervention.
"There are certain health conditions, in either the woman or the fetus, where the benefit of inducing labor is clear-cut," coauthor Susan Ramin, MD, from the University of Texas Medical School in Houston, said in a news release. "And, there are some nonmedical situations in which induction also may be prudent, for instance, in rural areas where the distance to the hospital is just too great to risk waiting for spontaneous labor to happen at home."
Recommendations Based on Sound Evidence
Based on evidence from methodologically sound outcomes-based research, the bulletin attempts to review current methods for cervical ripening and for inducing labor and to summarize the efficacy of these approaches. Also highlighted are indications for and contraindications to inducting labor, pharmacologic characteristics of various agents used for cervical ripening, regimens used for labor induction, and the requirements for safe clinical use of these techniques.
The bulletin authors searched the MEDLINE database, the Cochrane Library, and ACOG's own internal resources and documents to identify pertinent English-language articles published between January 1985 and January 2009. Although articles reporting results of original research were given priority, review articles and commentaries were also consulted, as were guidelines published by organizations or institutions such as ACOG and the National Institutes of Health. However, abstracts of research presented at symposia and scientific conferences were excluded. Expert opinions from obstetrician- gynecologists were used when reliable research evidence was not available.
Indications for Labor Induction
Possible indications for labor induction may include gestational or chronic hypertension, preeclampsia, eclampsia, diabetes, premature rupture of membranes, severe fetal growth restriction, and postterm pregnancy. However, physicians should decide whether labor induction is warranted on a case-by-case basis, after consideration of maternal and infant conditions, cervical status, gestational age, and other factors.
Contraindications to labor induction include transverse fetal position, umbilical cord prolapse, active genital herpes infection, placenta previa, and a history of previous myomectomy.
When labor induction is deemed necessary, the gestational age of the fetus should be determined to be at least 39 weeks, or there must be evidence of fetal lung maturity.
The first step in labor induction is cervical ripening using drugs or mechanical cervical dilators to dilate the cervix sufficiently before labor is induced. The next step is to induce labor using oxytocin, membrane stripping, rupture of the amniotic membrane, or nipple stimulation.
Misoprostol, which is approved for treatment of peptic ulcers, is often used off-label for cervical ripening as well as for labor induction. In women who have had any previous cesarean delivery, however, inducing labor with misoprostol may increase risk for uterine rupture and should therefore be avoided.
Clinical Recommendations
Specific clinical recommendations and conclusions, all based on good and consistent scientific evidence (level A), are as follows:
* For cervical ripening and labor induction, prostaglandin E (PGE) analogues are effective.
* When labor induction is indicated, low-dose or high-dose oxytocin regimens are appropriate.
* Regardless of Bishop score, the most efficient method of labor induction before 28 weeks of gestation appears to be vaginal misoprostol. However, infusion of high-dose oxytocin is also an acceptable option.
* For cervical ripening and induction of labor, an appropriate initial dose of misoprostol is approximately 25 µg, with frequency of administration not to exceed 1 dose every 3 to 6 hours.
* For induction of labor in women with premature rupture of membranes, intravaginal PGE2 appears to be safe and effective.
* In women with previous cesarean delivery or major uterine surgery, the use of misoprostol should be avoided in the third trimester because it has been linked to a greater risk for uterine rupture.
* The Foley catheter is a reasonable, effective option to promote cervical ripening and labor induction.
An additional clinical recommendation, based on limited or inconsistent evidence (level B), is that misoprostol, 50 µg every 6 hours, to induce labor may be appropriate in some situations. However, higher doses are linked to a greater risk for uterine tachysystole with fetal heart rate (FHR) decelerations and other complications.
As a proposed performance measure, the guidelines authors suggest that the percentage of patients in whom gestational age is established by clinical criteria when labor is induced for logistic or psychosocial indications.
"A physician capable of performing a cesarean should be readily available any time induction is used in the event that the induction isn't successful in producing a vaginal delivery," Dr. Ramin concluded. "These guidelines will help physicians utilize the most appropriate method depending on the unique characteristics of the pregnant woman and her fetus."
Obstet Gynecol. 2009;114:386- 397.
Authors and Disclosures
Journalist
Laurie Barclay, MD
Laurie Barclay, MD, is a freelance writer and reviewer for Medscape.
Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.
So read ahead the newest guidelines regarding induction:
July 23, 2009 — On July 21, the American College of Obstetricians and Gynecologists (ACOG) issued revised guidelines on when and how to induce labor in pregnant women. The updated recommendations are published as a Practice Bulletin, "Induction of Labor," in the August issue of Obstetrics & Gynecology. The bulletin aims to guide physicians regarding their choice of induction methods that may be most suitable in specific settings and to elucidate the safety requirements, risks, and benefits of various regimens to induce labor.
Benefits vs Risks of Labor Induction
For the last 2 decades, the rate of labor induction in the United States has more than doubled, with more than 22% of all pregnant women in 2006 having labor induced. This increase in use necessitates a careful review of indications, risks, and benefits.
The goal of labor induction is to stimulate uterine contractions before the spontaneous onset of labor, resulting in vaginal delivery. The benefits of labor induction must be weighed against the potential maternal and fetal risks associated with this procedure. When the benefits of expeditious delivery are greater than the risks of continuing the pregnancy, inducing labor can be justified as a therapeutic intervention.
"There are certain health conditions, in either the woman or the fetus, where the benefit of inducing labor is clear-cut," coauthor Susan Ramin, MD, from the University of Texas Medical School in Houston, said in a news release. "And, there are some nonmedical situations in which induction also may be prudent, for instance, in rural areas where the distance to the hospital is just too great to risk waiting for spontaneous labor to happen at home."
Recommendations Based on Sound Evidence
Based on evidence from methodologically sound outcomes-based research, the bulletin attempts to review current methods for cervical ripening and for inducing labor and to summarize the efficacy of these approaches. Also highlighted are indications for and contraindications to inducting labor, pharmacologic characteristics of various agents used for cervical ripening, regimens used for labor induction, and the requirements for safe clinical use of these techniques.
The bulletin authors searched the MEDLINE database, the Cochrane Library, and ACOG's own internal resources and documents to identify pertinent English-language articles published between January 1985 and January 2009. Although articles reporting results of original research were given priority, review articles and commentaries were also consulted, as were guidelines published by organizations or institutions such as ACOG and the National Institutes of Health. However, abstracts of research presented at symposia and scientific conferences were excluded. Expert opinions from obstetrician- gynecologists were used when reliable research evidence was not available.
Indications for Labor Induction
Possible indications for labor induction may include gestational or chronic hypertension, preeclampsia, eclampsia, diabetes, premature rupture of membranes, severe fetal growth restriction, and postterm pregnancy. However, physicians should decide whether labor induction is warranted on a case-by-case basis, after consideration of maternal and infant conditions, cervical status, gestational age, and other factors.
Contraindications to labor induction include transverse fetal position, umbilical cord prolapse, active genital herpes infection, placenta previa, and a history of previous myomectomy.
When labor induction is deemed necessary, the gestational age of the fetus should be determined to be at least 39 weeks, or there must be evidence of fetal lung maturity.
The first step in labor induction is cervical ripening using drugs or mechanical cervical dilators to dilate the cervix sufficiently before labor is induced. The next step is to induce labor using oxytocin, membrane stripping, rupture of the amniotic membrane, or nipple stimulation.
Misoprostol, which is approved for treatment of peptic ulcers, is often used off-label for cervical ripening as well as for labor induction. In women who have had any previous cesarean delivery, however, inducing labor with misoprostol may increase risk for uterine rupture and should therefore be avoided.
Clinical Recommendations
Specific clinical recommendations and conclusions, all based on good and consistent scientific evidence (level A), are as follows:
* For cervical ripening and labor induction, prostaglandin E (PGE) analogues are effective.
* When labor induction is indicated, low-dose or high-dose oxytocin regimens are appropriate.
* Regardless of Bishop score, the most efficient method of labor induction before 28 weeks of gestation appears to be vaginal misoprostol. However, infusion of high-dose oxytocin is also an acceptable option.
* For cervical ripening and induction of labor, an appropriate initial dose of misoprostol is approximately 25 µg, with frequency of administration not to exceed 1 dose every 3 to 6 hours.
* For induction of labor in women with premature rupture of membranes, intravaginal PGE2 appears to be safe and effective.
* In women with previous cesarean delivery or major uterine surgery, the use of misoprostol should be avoided in the third trimester because it has been linked to a greater risk for uterine rupture.
* The Foley catheter is a reasonable, effective option to promote cervical ripening and labor induction.
An additional clinical recommendation, based on limited or inconsistent evidence (level B), is that misoprostol, 50 µg every 6 hours, to induce labor may be appropriate in some situations. However, higher doses are linked to a greater risk for uterine tachysystole with fetal heart rate (FHR) decelerations and other complications.
As a proposed performance measure, the guidelines authors suggest that the percentage of patients in whom gestational age is established by clinical criteria when labor is induced for logistic or psychosocial indications.
"A physician capable of performing a cesarean should be readily available any time induction is used in the event that the induction isn't successful in producing a vaginal delivery," Dr. Ramin concluded. "These guidelines will help physicians utilize the most appropriate method depending on the unique characteristics of the pregnant woman and her fetus."
Obstet Gynecol. 2009;114:386- 397.
Authors and Disclosures
Journalist
Laurie Barclay, MD
Laurie Barclay, MD, is a freelance writer and reviewer for Medscape.
Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.
Tuesday, July 21, 2009
Real Savvy Women
A few years ago I had the pleasure of being a part of a PBS special show about doulas. Here is the link you can view and enjoy!
I was interviewed a few years ago with a client who I have been the doula for two times previously. Here is a video online you can access to see it! http://www.realsavvymoms.com/season-5/episode-2/doulas/
If the link stops working above- then go to
Real Savvy Moms is the location of the video- I wish I could upload it but it won't upload here- so go to this link- click on watch videos on the left hand sidebar. Then click on pregnancy. Then in the section at the top in the middle- it says search by topic. Put in Doulas. Then click on Doulas. The segment has Penny Simkin in it as well as me!
It is the video we usually show at our teas. Hope you can figure this convoluted way of finding it to watch it.
I was interviewed a few years ago with a client who I have been the doula for two times previously. Here is a video online you can access to see it! http://www.realsavvymoms.com/season-5/episode-2/doulas/
If the link stops working above- then go to
Real Savvy Moms is the location of the video- I wish I could upload it but it won't upload here- so go to this link- click on watch videos on the left hand sidebar. Then click on pregnancy. Then in the section at the top in the middle- it says search by topic. Put in Doulas. Then click on Doulas. The segment has Penny Simkin in it as well as me!
It is the video we usually show at our teas. Hope you can figure this convoluted way of finding it to watch it.
Friday, July 10, 2009
New Educational Tools
A great new resource! Childbirth Preparation videos
This is a collaboration by InJoy Birth & Parenting Videos in partnership with Lamaze International and brings the Six Lamaze Healthy Birth Practices to life. Check them out!
This is a collaboration by InJoy Birth & Parenting Videos in partnership with Lamaze International and brings the Six Lamaze Healthy Birth Practices to life. Check them out!
Thursday, July 2, 2009
Lee's Letter About Teresa
Teresa was an invaluable resource during our birth experience!
Although this was our first birth and we have never known anything
different, we would never think to do anything differently from here
on out. First time parents-to-be NEED to have a doula present for
their birth experience. If you are first time parents-to-be, you NEED
to, no matter how much you know about the medical and birth industry.
I don't care if you yourself are a doula, midwife, or OB-GYN. So much
of your knowledge, research, and preparation just sort of goes out the
window when your baby actually starts making his or her entrance. If
you want to be at all in control of your birth (you should not just
let yourself be at the whim of an intervention-hungry obstetrician),
you need to be informed, and a doula will help you continue to be
informed in the heat of the moment(s).
It was so helpful to have a professional there who could keep a level
head and steady hand. Her experienced presence was worth a good
portion of her fee; my wife labored better when Teresa was present,
even when Teresa was not actively helping in some way. She even
helped turn the baby from posterior facing to anterior facing! For
those who don't know, that means Teresa helped turn the baby to avoid
dreaded back labor. TWICE. Our goal was pretty much a party line
completely unmedicated, intervention-free natural birth. Teresa
helped us achieve that goal. For anyone on the fence about hiring a
doula, do it. If not Teresa, someone from Labor of Love.
Although this was our first birth and we have never known anything
different, we would never think to do anything differently from here
on out. First time parents-to-be NEED to have a doula present for
their birth experience. If you are first time parents-to-be, you NEED
to, no matter how much you know about the medical and birth industry.
I don't care if you yourself are a doula, midwife, or OB-GYN. So much
of your knowledge, research, and preparation just sort of goes out the
window when your baby actually starts making his or her entrance. If
you want to be at all in control of your birth (you should not just
let yourself be at the whim of an intervention-hungry obstetrician),
you need to be informed, and a doula will help you continue to be
informed in the heat of the moment(s).
It was so helpful to have a professional there who could keep a level
head and steady hand. Her experienced presence was worth a good
portion of her fee; my wife labored better when Teresa was present,
even when Teresa was not actively helping in some way. She even
helped turn the baby from posterior facing to anterior facing! For
those who don't know, that means Teresa helped turn the baby to avoid
dreaded back labor. TWICE. Our goal was pretty much a party line
completely unmedicated, intervention-free natural birth. Teresa
helped us achieve that goal. For anyone on the fence about hiring a
doula, do it. If not Teresa, someone from Labor of Love.
Sawyer Hawk Lloyd's birth
Born in the water at 7:37 am
7 lbs, 8 oz
19.5 inches
Well, I was going to bed on Sunday night at 40 weeks and one day overdue, and Shane and I joked about the full moon that was high in the sky that night! I woke up at 3:15 am thinking that i had just had a contraction. I laid there for a few minutes, and sure enough, another came, so I got out of bed without waking Shane and went downstairs to start timing them. They were really mild but coming really close together...like every 3 minutes or less, and so I checked email and facebook and waited 45 minutes or so until I felt like they were really starting to be something. I went upstairs around 4 am and woke Shane up and called my parents and our doula.
7 lbs, 8 oz
19.5 inches
Well, I was going to bed on Sunday night at 40 weeks and one day overdue, and Shane and I joked about the full moon that was high in the sky that night! I woke up at 3:15 am thinking that i had just had a contraction. I laid there for a few minutes, and sure enough, another came, so I got out of bed without waking Shane and went downstairs to start timing them. They were really mild but coming really close together...like every 3 minutes or less, and so I checked email and facebook and waited 45 minutes or so until I felt like they were really starting to be something. I went upstairs around 4 am and woke Shane up and called my parents and our doula.
Melody Gives Birth to Abigail
Melody did not sleep well on 6/1. She had contractions off and on once she awakened but she knew it was early. She went for a walk with Luna and the contractions intensified and then diminished. She went on a second walk with Sherwin and Luna and the intensity returned and stayed strong. At 4:30pm she decided to call the on call midwife. Sherry suggested they come in to be checked. What they did not know was Sherry when on call stayed at the hospital, so she often had couples come in even it she thought it may be too early. I had wished they had called me first. It sounded like early prodromal labor to me still when I did talk to them.
Monday, June 8, 2009
Dena shared on doulamatch.net
Thanks Dena- great recommendation for Jennifer Fargar!
"Jennifer was my post-partum doula for several weeks after my daughter Jenna was born in February 2009. She was an excellent help during a very tiring, stressful time. She was so warm and calming and really helped me relax during those initial tiring weeks. One of the things I loved is that Jennifer really catered her help to my particular needs. When we first met, I told her that I had been forgetting to eat. She went into my kitchen and made small individual snacks that I could easily grab during the busy days. She even put the snacks next to my breast pump and bed so I could have some during the night. On days when I needed sleep, she would watch my daughter and help with laundry or whatever needed to be done at the time. She was also respectful of my choices for my daughter (such as supplementing breastfeeding with formula) and gave helpful suggestions without judging or questioning me on my choices. I would highly recommend Jennifer as a postpartum doula to any lucky mom that can have her!"
"Jennifer was my post-partum doula for several weeks after my daughter Jenna was born in February 2009. She was an excellent help during a very tiring, stressful time. She was so warm and calming and really helped me relax during those initial tiring weeks. One of the things I loved is that Jennifer really catered her help to my particular needs. When we first met, I told her that I had been forgetting to eat. She went into my kitchen and made small individual snacks that I could easily grab during the busy days. She even put the snacks next to my breast pump and bed so I could have some during the night. On days when I needed sleep, she would watch my daughter and help with laundry or whatever needed to be done at the time. She was also respectful of my choices for my daughter (such as supplementing breastfeeding with formula) and gave helpful suggestions without judging or questioning me on my choices. I would highly recommend Jennifer as a postpartum doula to any lucky mom that can have her!"
Wednesday, May 20, 2009
Breastfeeding Online Video
Jack Newman is one of the best supporters of breastfeeding! I have had the opportunity to hear him speak several times and love the fact that he has a great online video to help those who forget what they may have learned in a class or heaven forbid did not attend a class prior to their baby being born. Click on the link to view a fabulous video that will ensure a great latch for sure!
Video
Video
FREE Online Book Worth the READ!
A free online book that is based on evidence practices is online and ready for you to take more than a glance at... download it or bookmark it and read it for information that is based on actual truth- the studies have proved it to be so!
A Guide to Effective Care in Pregnancy and Childbirth
A Guide to Effective Care in Pregnancy and Childbirth
Friday, May 15, 2009
Can You Afford To NOT HIRE A Doula?
Recently I gathered some information regarding the costs of an intervention filled birth and received this, "my epidural was $1500 and when it turned c/s there was an additional $600 bill for the anesthesiologist who was present during surgery. between the c/s (which there were bills from 2 different surgeons on top of my $3000 maternity care), the pediatrician bill who was present during the surgery, the 48 hour after birth stay in the hospital, etc, etc, etc....it was about $10,000 in Montana in 2007. i remember looking at the hospital bill (from the stay, not including birth "meds") and seeing over $200 of "drugs" on the bill...which included a few pain pills, some Colace, and i think a calcium supplement."
And a midwife in another area sent me this, "Trying to find "proof" but asking my hospital MW and nurse friends around the country, the average vaginal birth looks to be about $10,000 - without an epidural and with a 2 day hospital stay. This does NOT include the doc's fees. A cesarean seems to be about $18,000 or so, again, not including OB or anesthesiologist's fees (another $2000-$5000 dollars). Epidurals look to be about $2000, not including the anesthesiologist's fees. Hope this helps!"
$17,843 was the amount of the bill from one of my students who ended up with an induction- an epidural- a cesarean and a baby who ended up in the NICU for twelve hours since she was having trouble keeping her temperature up...I do not see on the bill that she sent me that this includes the obstetrician or the anesthesiologist either.
This made me think about how when economic times are difficult a few things happen...
Folks decide that childbirth education is optional. They decide they can not afford to do the preparation for their birth experience. Childbirth preparation is not an item I would consider optional unless you are fine with a birth full of interventions. You can not expect to show up for the Olympics to race purely because you were able to obtain a uniform. It take training to get the birth you desire. It takes preparation to know the questions to ask to determine if a procedure is the one you feel informed enough to make. If you do not prepare, be prepared to hand your birth over to the medical team to make the decisions for you. Now some of you may think that is not a bad option. Just remember if your birth turns out differently than you desired- you gave up any ability to shove the blame elsewhere- it is yours to acknowledge. Kinda like complaining about the government if you don't vote.
Some folks decide that they do not need a doula after all. But the studies show that having a doula not only enhances the mom's view of her birth experience- but the studies show having a doula
* results in shorter labors with fewer complications
* reduces negative feelings about one’s childbirth experience
* reduces the need for Pitocin (a labor-inducing drug),
* reduces the use of forceps or vacuum extraction
* reduces cesareans
* reduces the mother’s request for pain medication and/or epidurals
* mothers who feel better about their birth experience and therefore have less postpartum depression
A study by Klaus and Kennel showed that using a doula as part of the birth team decreases the overall cesarean rate by 50%, the length of labor by 25%, the use of Oxytocin (Pitocin) by 40% and the request for an epidural by 60%.
So, how does this speak to your wallet during these times of trying to save money? Well due to insurance costs, many folks now have a deductible and then have to pay 20%- 30% of the final costs of their hospitalization. So keep in mind if the average birth in the metro area has an epidural- with the cost of an epidural being around $1500- then the cost to a couple could be $300 to $450. If a cesarean occurs the cost to a couple could be an additional $120 to $180 or more for anesthesiology alone. A complicated birth ending in a cesarean could be as much as $17,000 or more. There is an additional day stay in the hospital if not even two extra days. Now your cost could be $3400 - $5100 or more.
Now a doula can not promise you a natural, easy, non surgical birth- but certainly the studies show if that is what you desire- you have a greater chance of getting it if you hire a doula. Now the cost you saved by having a doula may have saved you a lot of money in comparison to her fee which is usually between $500 and $1000 in most areas. And you also can possibly be more assured that if you ended up with a cesarean you did what you could to avoid it by having a great support system in place.
So whether your insurance plan has a percentage you have to pay or not add the cost of a good childbirth class $250 and a doula for the cost of $600 for a doula- the total is $850 which is a far cry less than the upwards of $5000 you could pay for not having the preparation and support. A great class and a fabulous doula may not keep you out of the OR but again- these two things can certainly help do so!
Remember there are other pieces to the pie- care providers and choice of birth location play into this as well.
Keep in mind more and more insurance companies are trying to decrease costs- so some are actually reimbursing doula costs. Some even reimburse childbirth class costs. And I know that most any pretax plan often times does pay for both of these items. Often times if you ask the insurance plan if they cover doula services prior to having the baby, they will say no. But if you end up saving them money by leaving a day earlier- not having an epidural and such- they will consider paying for your doula. So, can you afford to not hire a doula?
And a midwife in another area sent me this, "Trying to find "proof" but asking my hospital MW and nurse friends around the country, the average vaginal birth looks to be about $10,000 - without an epidural and with a 2 day hospital stay. This does NOT include the doc's fees. A cesarean seems to be about $18,000 or so, again, not including OB or anesthesiologist's fees (another $2000-$5000 dollars). Epidurals look to be about $2000, not including the anesthesiologist's fees. Hope this helps!"
$17,843 was the amount of the bill from one of my students who ended up with an induction- an epidural- a cesarean and a baby who ended up in the NICU for twelve hours since she was having trouble keeping her temperature up...I do not see on the bill that she sent me that this includes the obstetrician or the anesthesiologist either.
This made me think about how when economic times are difficult a few things happen...
Folks decide that childbirth education is optional. They decide they can not afford to do the preparation for their birth experience. Childbirth preparation is not an item I would consider optional unless you are fine with a birth full of interventions. You can not expect to show up for the Olympics to race purely because you were able to obtain a uniform. It take training to get the birth you desire. It takes preparation to know the questions to ask to determine if a procedure is the one you feel informed enough to make. If you do not prepare, be prepared to hand your birth over to the medical team to make the decisions for you. Now some of you may think that is not a bad option. Just remember if your birth turns out differently than you desired- you gave up any ability to shove the blame elsewhere- it is yours to acknowledge. Kinda like complaining about the government if you don't vote.
Some folks decide that they do not need a doula after all. But the studies show that having a doula not only enhances the mom's view of her birth experience- but the studies show having a doula
* results in shorter labors with fewer complications
* reduces negative feelings about one’s childbirth experience
* reduces the need for Pitocin (a labor-inducing drug),
* reduces the use of forceps or vacuum extraction
* reduces cesareans
* reduces the mother’s request for pain medication and/or epidurals
* mothers who feel better about their birth experience and therefore have less postpartum depression
A study by Klaus and Kennel showed that using a doula as part of the birth team decreases the overall cesarean rate by 50%, the length of labor by 25%, the use of Oxytocin (Pitocin) by 40% and the request for an epidural by 60%.
So, how does this speak to your wallet during these times of trying to save money? Well due to insurance costs, many folks now have a deductible and then have to pay 20%- 30% of the final costs of their hospitalization. So keep in mind if the average birth in the metro area has an epidural- with the cost of an epidural being around $1500- then the cost to a couple could be $300 to $450. If a cesarean occurs the cost to a couple could be an additional $120 to $180 or more for anesthesiology alone. A complicated birth ending in a cesarean could be as much as $17,000 or more. There is an additional day stay in the hospital if not even two extra days. Now your cost could be $3400 - $5100 or more.
Now a doula can not promise you a natural, easy, non surgical birth- but certainly the studies show if that is what you desire- you have a greater chance of getting it if you hire a doula. Now the cost you saved by having a doula may have saved you a lot of money in comparison to her fee which is usually between $500 and $1000 in most areas. And you also can possibly be more assured that if you ended up with a cesarean you did what you could to avoid it by having a great support system in place.
So whether your insurance plan has a percentage you have to pay or not add the cost of a good childbirth class $250 and a doula for the cost of $600 for a doula- the total is $850 which is a far cry less than the upwards of $5000 you could pay for not having the preparation and support. A great class and a fabulous doula may not keep you out of the OR but again- these two things can certainly help do so!
Remember there are other pieces to the pie- care providers and choice of birth location play into this as well.
Keep in mind more and more insurance companies are trying to decrease costs- so some are actually reimbursing doula costs. Some even reimburse childbirth class costs. And I know that most any pretax plan often times does pay for both of these items. Often times if you ask the insurance plan if they cover doula services prior to having the baby, they will say no. But if you end up saving them money by leaving a day earlier- not having an epidural and such- they will consider paying for your doula. So, can you afford to not hire a doula?
Wednesday, May 13, 2009
Do You Doula?
The person who filmed and edited this film sent me this link
Do You Doula? the video
I thought I would share it. Although I am always a bit concerned with doulas who feel the need to "save" other women due to their birth experience... I do think that can be the initiating impetus that drives some women to become doulas. So although the very first frame makes me a bit concerned- the rest of the film does share some good information regarding doulas.
I think doulas are definitely there to be a birth guide of sorts... a childbirth professional there to remind the parents of their original plans. But also as a support system to help the mom and dad know that they are strong and can do this. I think the message of this film does share those thoughts.
If you have questions about what a doula does and how she interacts with you and the staff, this may be very informative to you. I am a certified doula and I do think it is important to understand that training does set some doulas apart from the friend who is there calling herself a doula. She may not understand how best to work in the medical situation. But having a support system is imperative.
How a woman feels about her birth is something that will be with her forever. Being listened to and respected is paramount and doulas do make an impact with helping her feel this way.
Do You Doula? the video
I thought I would share it. Although I am always a bit concerned with doulas who feel the need to "save" other women due to their birth experience... I do think that can be the initiating impetus that drives some women to become doulas. So although the very first frame makes me a bit concerned- the rest of the film does share some good information regarding doulas.
I think doulas are definitely there to be a birth guide of sorts... a childbirth professional there to remind the parents of their original plans. But also as a support system to help the mom and dad know that they are strong and can do this. I think the message of this film does share those thoughts.
If you have questions about what a doula does and how she interacts with you and the staff, this may be very informative to you. I am a certified doula and I do think it is important to understand that training does set some doulas apart from the friend who is there calling herself a doula. She may not understand how best to work in the medical situation. But having a support system is imperative.
How a woman feels about her birth is something that will be with her forever. Being listened to and respected is paramount and doulas do make an impact with helping her feel this way.
Monday, May 11, 2009
We Are The Only Mammals Who Do It This Way...
Have you considered not cutting the cord of the baby to the placenta later? It is not common practice to wait... but this video may teach you something about what could be more gentle- what could be more helpful- what could be less traumatic... a great source of blood volume and oxygen... view this and consider doing something different.
We could be much kinder the video
seems you tube took this one off due to breasts being at the beginning- no notes or anything to the producer- just kicked it off! I got this from the producer:
"My trailer and my entry to the Better Birth VA contest, "We Can Be Much Kinder" was removed by YouTube for inappropriate content -- breasts in the short entry-- and they took down both. It's crazy as I have taken great care to make my work rather conservative and respectful for the mother and for "mainstream" viewers. There was no notice, no email, no way to find any info or communicate with YouTube. I have spent hours and hours to learn that I can not get them back.
I have created a new account and reposted the revised entry, trailer and few other pieces. I hope they stay up.
Here's the new link to the entry and the trailer will show up soon.
Cord Clamping Considerations more information
Janel Martin- the originator of this wonderful film clip mentioned contacted me to ask me "Did you get the other "point" to wait until the MOTHER Knows she and her baby are ready to separate? And, how, like what we know now "scientifically" about the breast milk benefits, perhaps there is something very profound about the benefits that we have not yet even imagined ... and the spiritual aspects of it all." And of course since I feel like I write and speak all of the time about the instinctual side of birth- how mom's need to listen to their instinctual- intuitive voice in labor and birth and beyond- and how I write and speak about how God did not screw up- her point resonates with me as well on this matter.
We could be much kinder the video
seems you tube took this one off due to breasts being at the beginning- no notes or anything to the producer- just kicked it off! I got this from the producer:
"My trailer and my entry to the Better Birth VA contest, "We Can Be Much Kinder" was removed by YouTube for inappropriate content -- breasts in the short entry-- and they took down both. It's crazy as I have taken great care to make my work rather conservative and respectful for the mother and for "mainstream" viewers. There was no notice, no email, no way to find any info or communicate with YouTube. I have spent hours and hours to learn that I can not get them back.
I have created a new account and reposted the revised entry, trailer and few other pieces. I hope they stay up.
Here's the new link to the entry and the trailer will show up soon.
Cord Clamping Considerations more information
Janel Martin- the originator of this wonderful film clip mentioned contacted me to ask me "Did you get the other "point" to wait until the MOTHER Knows she and her baby are ready to separate? And, how, like what we know now "scientifically" about the breast milk benefits, perhaps there is something very profound about the benefits that we have not yet even imagined ... and the spiritual aspects of it all." And of course since I feel like I write and speak all of the time about the instinctual side of birth- how mom's need to listen to their instinctual- intuitive voice in labor and birth and beyond- and how I write and speak about how God did not screw up- her point resonates with me as well on this matter.
Monday, May 4, 2009
Crisis Initiates Growth...Choosing a Care Provider
"Sometimes it takes crisis to initiate growth." Rachel Naomi Remen
I have had several moms lately who had births with care providers that they needed to fight with in the last weeks in order to even get a semblance of the birth they desired. When they sat down at the postpartum they discussed moving to a different care provider in order to be listened to next time. But sadly it took having a birth they did not love in order to be willing to consider a move to that new provider.
I am often saying, "you don't go to Kentucky Fried Chicken and ask for sushi." I explain that if your care provider is not listening to you when you are fully clothed and not in pain, what makes you think they will do so when you are in labor.
This week I had a mom share that when she talked to her care provider about her birth ideals, they said, "I hope you will rely on our medical expertise to make the right decisions when you are in labor." Which she took to imply that she could not make the right decisions- although she wanted to be fully informed. They were letting her know who would be making the decisions for her labor. But you know what? She continues to seek them for her maternity care. It makes me wonder if she will get the birth she desires. She very well may, but she will need to really fight to get it. I don't understand this. Fighting in labor should not be a part of a woman's labor experience.
This week I had a mom ask what would have been different at her birth if she had been with a provider that I encouraged her to consider in her early part of her pregnancy. The fact is, I do not know if the actual outcome would have been different. But I do know she would not have spent the last two weeks of her pregnancy fighting with her care provider, practicing what she would need to say to him to get the birth she desired, and now wondering if things would have been different.
Midwifery care is very different than physician care most of the time. Occasionally you will find a doctor who practices like a midwife. Just as some times you will find a midwife who is powerless and made to jump through hoops that the physicians demand of her. Although I am a strong proponent of the midwifery model of care, the most important things in choosing a care provider is: Do they respect you? Do they involve you in your health care? Do they listen to your concerns? Do they answer your questions clearly and in a way that makes you truly informed? Do they believe you can make good decisions for you? If they are being condescending and flippant to your questions, dismissive in their responses and rushed, I think you know the answer.
If you are having a hard time being heard or listened to- then my advice is change. Women are very concerned about change- but "Sometimes it takes crisis to initiate growth." Don't wait until crisis occurs to initiate the change that helps you grow into the birthing woman you need to become in order to get the birth you desire.
Let's talk about why folks pick a care provider- specifically a maternity care provider. Often times you pick a provider based on a recommendation from a friend. BUT, do you know what kind of birth you want and what kind of birth your friend wanted? Perhaps the thing she loved most was the fact that he induced all of his moms by 40 weeks. And perhaps you were looking for a care provider who based induction on medical need only and did not feel inductions were best for a normal pregnancy. So choosing a care provider based on this recommendation would not be in your best interest.
Maybe you are choosing your care provider based on where they practice- or do their "deliveries." If the care at that facility is the type of care you are looking for, odds are this provider goes along with the protocol at this particular hospital. For instance, if you are looking for a water birth and this facility provides this, chances are the provider does them. BUT don't assume this. Realize that a care provider can determine if he follows the hospital protocol or if he is a bit of a change agent and he is cutting his or her own path at this facility.
Perhaps you are choosing a care provider based on where their office is - especially if you are concerned about where it is in conjunction to where you work. But I often warn folks that this is not a great reason to choose a provider. Just like there may be a favorite restaurant across town that is always worth the drive... so may a care provider be this same way.
Some women feel more comfortable with a care provider of their same gender. I know I steered clear of a male massage therapist most of my life- but found that Harry is the massage therapist for me... and he is a guy! So, be open to possibilities of a person based on more than their sex. Many times we think a woman who has been through childbirth will be the best. But I have to say two of my favorite midwives have never birthed a baby from their body!
I had a client once tell me that the medical school a doctor graduated was very important to them. When I chose to have my breast reconstructed immediately following a bilateral mastectomy, I chose a doctor who did a particular reconstruction technique that was important to me. But for normal births, sometimes the less intervention is the better. Therefore knowing all the fancy technology may not be of grave importance. You have no idea if your doctor graduated in the top of his class or the bottom. You have no idea if he is keeping up with the newest techniques or has been content in not learning anything new. There is one doctor here in Atlanta who is skilled in the old techniques of assisting a mom to birth a breech baby. That skill is one that is dying since few are learning the old ways.
Some will choose their provider based on who is on their health care plan. This is purely money driven as health care costs have escalated. I just would say, sometimes the things we want badly in life are not reimbursable and we have to stretch beyond the limits sometimes. I have clients who choose a home birth or out of network birth in order to get the birth they desire. It costs them but they feel it was worth it.
So, I am going to offer the five reasons why I think you should choose a care provider.
1. Does this provider take time to listen to your desires and then communicates that they will do their best to help you achieve those desires? Do they enter the room knowing your name and welcome a time of discussion regarding your needs and desires? Or do you feel rushed and herded through?
2. Does this provider practice evidence based medicine? Do they read the research and base their protocols on what is best for you or the way things have always been done? For instance a good question to ask may be how many of their first times moms end up "requiring" an episiotomy. It should be a negligible number- that is what evidence shows us. A tear may be harder to sew up but it is better for the mom to sustain a small tear than have healthy tissue cut and then tear into a larger repair.
3. What percentage of patients have a vaginal birth in this practice? Keeping you safe and the baby safe is important- but that does not mean the increase in cesarean births is a price that should be paid for doing so. Cesareans are on the increase in the US and it is definitely due to the litigious medical environment in which we live.
4. Does this provider support the type of birth you desire? I mean it is one thing to say sure you can have a natural birth- if that is what you desire... but if they have most of their patients end up with epidurals, it may be in your best interest to wonder if they do really support natural birth. If they are patronizing regarding your desire for a natural birth they are probably not full of ideas to help you achieve this type of birth. Are they encouraging you to take a class to learn some techniques to help you with your goal? Are they affirming that you can do this?
5. What is their induction rate and when are you considered late? Your due month is between 38 weeks and 42 weeks. You are not officially late until you are 42 weeks. And since so often due dates are subjective, this is just a guess most of the time anyway. If they make comments about nothing good happens after 40 weeks, they may be suspect of a high induction rate.
So, choose your care provider wisely. This is a decision that will effect the outcome of your birth. Your birth outcome can effect the way you feel about yourself for a lifetime. Choose carefully but also realize that if as you "date" your care provider along your journey of pregnancy, you decide that he or she may not be the one you want to be "married" to for the birth... you can change!
I have had several moms lately who had births with care providers that they needed to fight with in the last weeks in order to even get a semblance of the birth they desired. When they sat down at the postpartum they discussed moving to a different care provider in order to be listened to next time. But sadly it took having a birth they did not love in order to be willing to consider a move to that new provider.
I am often saying, "you don't go to Kentucky Fried Chicken and ask for sushi." I explain that if your care provider is not listening to you when you are fully clothed and not in pain, what makes you think they will do so when you are in labor.
This week I had a mom share that when she talked to her care provider about her birth ideals, they said, "I hope you will rely on our medical expertise to make the right decisions when you are in labor." Which she took to imply that she could not make the right decisions- although she wanted to be fully informed. They were letting her know who would be making the decisions for her labor. But you know what? She continues to seek them for her maternity care. It makes me wonder if she will get the birth she desires. She very well may, but she will need to really fight to get it. I don't understand this. Fighting in labor should not be a part of a woman's labor experience.
This week I had a mom ask what would have been different at her birth if she had been with a provider that I encouraged her to consider in her early part of her pregnancy. The fact is, I do not know if the actual outcome would have been different. But I do know she would not have spent the last two weeks of her pregnancy fighting with her care provider, practicing what she would need to say to him to get the birth she desired, and now wondering if things would have been different.
Midwifery care is very different than physician care most of the time. Occasionally you will find a doctor who practices like a midwife. Just as some times you will find a midwife who is powerless and made to jump through hoops that the physicians demand of her. Although I am a strong proponent of the midwifery model of care, the most important things in choosing a care provider is: Do they respect you? Do they involve you in your health care? Do they listen to your concerns? Do they answer your questions clearly and in a way that makes you truly informed? Do they believe you can make good decisions for you? If they are being condescending and flippant to your questions, dismissive in their responses and rushed, I think you know the answer.
If you are having a hard time being heard or listened to- then my advice is change. Women are very concerned about change- but "Sometimes it takes crisis to initiate growth." Don't wait until crisis occurs to initiate the change that helps you grow into the birthing woman you need to become in order to get the birth you desire.
Let's talk about why folks pick a care provider- specifically a maternity care provider. Often times you pick a provider based on a recommendation from a friend. BUT, do you know what kind of birth you want and what kind of birth your friend wanted? Perhaps the thing she loved most was the fact that he induced all of his moms by 40 weeks. And perhaps you were looking for a care provider who based induction on medical need only and did not feel inductions were best for a normal pregnancy. So choosing a care provider based on this recommendation would not be in your best interest.
Maybe you are choosing your care provider based on where they practice- or do their "deliveries." If the care at that facility is the type of care you are looking for, odds are this provider goes along with the protocol at this particular hospital. For instance, if you are looking for a water birth and this facility provides this, chances are the provider does them. BUT don't assume this. Realize that a care provider can determine if he follows the hospital protocol or if he is a bit of a change agent and he is cutting his or her own path at this facility.
Perhaps you are choosing a care provider based on where their office is - especially if you are concerned about where it is in conjunction to where you work. But I often warn folks that this is not a great reason to choose a provider. Just like there may be a favorite restaurant across town that is always worth the drive... so may a care provider be this same way.
Some women feel more comfortable with a care provider of their same gender. I know I steered clear of a male massage therapist most of my life- but found that Harry is the massage therapist for me... and he is a guy! So, be open to possibilities of a person based on more than their sex. Many times we think a woman who has been through childbirth will be the best. But I have to say two of my favorite midwives have never birthed a baby from their body!
I had a client once tell me that the medical school a doctor graduated was very important to them. When I chose to have my breast reconstructed immediately following a bilateral mastectomy, I chose a doctor who did a particular reconstruction technique that was important to me. But for normal births, sometimes the less intervention is the better. Therefore knowing all the fancy technology may not be of grave importance. You have no idea if your doctor graduated in the top of his class or the bottom. You have no idea if he is keeping up with the newest techniques or has been content in not learning anything new. There is one doctor here in Atlanta who is skilled in the old techniques of assisting a mom to birth a breech baby. That skill is one that is dying since few are learning the old ways.
Some will choose their provider based on who is on their health care plan. This is purely money driven as health care costs have escalated. I just would say, sometimes the things we want badly in life are not reimbursable and we have to stretch beyond the limits sometimes. I have clients who choose a home birth or out of network birth in order to get the birth they desire. It costs them but they feel it was worth it.
So, I am going to offer the five reasons why I think you should choose a care provider.
1. Does this provider take time to listen to your desires and then communicates that they will do their best to help you achieve those desires? Do they enter the room knowing your name and welcome a time of discussion regarding your needs and desires? Or do you feel rushed and herded through?
2. Does this provider practice evidence based medicine? Do they read the research and base their protocols on what is best for you or the way things have always been done? For instance a good question to ask may be how many of their first times moms end up "requiring" an episiotomy. It should be a negligible number- that is what evidence shows us. A tear may be harder to sew up but it is better for the mom to sustain a small tear than have healthy tissue cut and then tear into a larger repair.
3. What percentage of patients have a vaginal birth in this practice? Keeping you safe and the baby safe is important- but that does not mean the increase in cesarean births is a price that should be paid for doing so. Cesareans are on the increase in the US and it is definitely due to the litigious medical environment in which we live.
4. Does this provider support the type of birth you desire? I mean it is one thing to say sure you can have a natural birth- if that is what you desire... but if they have most of their patients end up with epidurals, it may be in your best interest to wonder if they do really support natural birth. If they are patronizing regarding your desire for a natural birth they are probably not full of ideas to help you achieve this type of birth. Are they encouraging you to take a class to learn some techniques to help you with your goal? Are they affirming that you can do this?
5. What is their induction rate and when are you considered late? Your due month is between 38 weeks and 42 weeks. You are not officially late until you are 42 weeks. And since so often due dates are subjective, this is just a guess most of the time anyway. If they make comments about nothing good happens after 40 weeks, they may be suspect of a high induction rate.
So, choose your care provider wisely. This is a decision that will effect the outcome of your birth. Your birth outcome can effect the way you feel about yourself for a lifetime. Choose carefully but also realize that if as you "date" your care provider along your journey of pregnancy, you decide that he or she may not be the one you want to be "married" to for the birth... you can change!
Tuesday, April 28, 2009
Birth by Numbers
I saw this guy speak at the ICAN conference this past weekend- his statistics were amazing. Go here to watch a great video that tells the truth about what is really happening in our birth health care in America.
In Birth by the Numbers, Eugene R. Declercq, PhD, Professor of Maternal and Child Health, Boston University School of Public Health, presents the sobering statistics of birth in the United States today.
View the video by clicking here:
Birth by Numbers
In Birth by the Numbers, Eugene R. Declercq, PhD, Professor of Maternal and Child Health, Boston University School of Public Health, presents the sobering statistics of birth in the United States today.
View the video by clicking here:
Birth by Numbers
Are You Doing Your Kegels?
At the ICAN conference this past weekend, we had the pleasure of meeting the Kegel Queen. She has a wonderful book out on how to make sure you are doing your kegel exercises the right way and the benefits of doing so. She interviewed us and put her video up on the site. It is a must see for sure!
http://kegelqueen.com/videos/video_ICAN_bocce_balls.html
Want to know more about doing kegels - the why, the when, the how, and the how often- check out her site!
Wednesday, April 22, 2009
Evidence Based Medicine
Often a client or student comes to me with a question. Seems their doctor or midwife does things differently than their friend's midwife or doctor. Or they hear about what one hospital allows and what others say is outside of their policy. I believe in practicing evidenced based medicine. That means what do the actual studies say?
Do you want to know what evidence based medicine says about a particular subject? Instead of "this is what we do...." or "it is protocol here to do it this way..." perhaps you should consider looking at what the evidence- what the studies actually say about a certain procedure... so here is the place I do my research- perhaps you should as well. http://www.cochrane.org/reviews/en/topics/87.html
There is nothing better than making an informed decision. We need as consumers to take more of an active role in our health decisions. We need to understand why something needs to be done and how it can be offered to us. When you do not take an active role in the decision making and the outcome is different than you desired- you must take responsibility in the outcome being something you allowed to happen.
Do you want to know what evidence based medicine says about a particular subject? Instead of "this is what we do...." or "it is protocol here to do it this way..." perhaps you should consider looking at what the evidence- what the studies actually say about a certain procedure... so here is the place I do my research- perhaps you should as well. http://www.cochrane.org/reviews/en/topics/87.html
There is nothing better than making an informed decision. We need as consumers to take more of an active role in our health decisions. We need to understand why something needs to be done and how it can be offered to us. When you do not take an active role in the decision making and the outcome is different than you desired- you must take responsibility in the outcome being something you allowed to happen.
Saturday, April 18, 2009
Letter from Jan
This was a letter recently received for Guina from the husband of a woman who had a vaginal birth after cesarean (VBAC) with Guina as their doula.
Dear Guina,
Like most people, the most important thing in my life is the health and happiness of my family. I'm somewhat limited in all that I can do so I ask God to help me with the rest. Sometimes I fail to recognize those blessings, and I just seem to take them for granted. No doubt the birth of a child is a gift from God, but the way that Sarah was born given Amy's history and deep desire, there was definitely a bonus.
I want to thank you for your involvement. Your sensitivity, kindness,professionalism, wisdom and calm not only added to the joy of the event, but I am convinced that it was your presence that allowed Amy to realize one of her dreams. Something that we both know was so very important to her. I have to run to pick her up from the hospital...but I want you to know my gift from God included you.
Thank You so much...Jan
Dear Guina,
Like most people, the most important thing in my life is the health and happiness of my family. I'm somewhat limited in all that I can do so I ask God to help me with the rest. Sometimes I fail to recognize those blessings, and I just seem to take them for granted. No doubt the birth of a child is a gift from God, but the way that Sarah was born given Amy's history and deep desire, there was definitely a bonus.
I want to thank you for your involvement. Your sensitivity, kindness,professionalism, wisdom and calm not only added to the joy of the event, but I am convinced that it was your presence that allowed Amy to realize one of her dreams. Something that we both know was so very important to her. I have to run to pick her up from the hospital...but I want you to know my gift from God included you.
Thank You so much...Jan
Friday, April 17, 2009
Nuchal Cords
"Nuchal Cord: A nuchal cord is an umbilical cord that is wrapped around the fetus's neck. A nuchal cord occurs in about one fourth of deliveries. Normally, the baby is not harmed.
Before birth, a nuchal cord can sometimes be detected by ultrasonography, but no action is required. Doctors routinely check for it as they deliver the baby. If they feel it, they can slip the cord over the baby's head. Sometimes if the cord is tightly wrapped, it is clamped and cut before the shoulders are delivered."
Recently I have heard about several women who had to have a cesarean birth due to the baby having the cord around the neck. But it happens according to this research a fourth of the time. So why does it cause issues for some and not others? In fact my grandson was born with the cord around his neck four times- without any issues at all.
What happens is if the baby is not allowed to maneuver and stretch the cord- making his or her way down the birth canal on his or her own time. But what happens is a mom gets an epidural and then is limited in her ability to move- helping the baby move. If we want to move the baby we move the mom. But if she is immobile then that is limited at best. Then the epidural slows labor down, especially if given too early. And the need for pitocin is increased. And since she is medicated now to not feel the pain, the use of pitocin is usually much more accelerated than it is when a woman does not have an epidural and needs to be able to manage the augmentation.
Pitocin can sometimes slam a baby down into the birth canal and there is no time for the cord to be able to stretch or the baby to move to accommodate having the cord around his or her neck. So the very interventions that are selected can end with an unnecessary surgical birth due to a baby going into distress.
So, just having the cord around the neck of the baby is not a reason for a cesarean birth. I know for me as a doula, I have seen nuchal cords at least 20% of the time. It is easily slipped over the head of the baby or the baby easily slides through the loop as he or she is being born. How often are cesareans performed that could have been avoided if the laboring mom was not induced or augmented during her labor- therefore causing the very problem that would not have been a problem otherwise. Sad.
Before birth, a nuchal cord can sometimes be detected by ultrasonography, but no action is required. Doctors routinely check for it as they deliver the baby. If they feel it, they can slip the cord over the baby's head. Sometimes if the cord is tightly wrapped, it is clamped and cut before the shoulders are delivered."
Recently I have heard about several women who had to have a cesarean birth due to the baby having the cord around the neck. But it happens according to this research a fourth of the time. So why does it cause issues for some and not others? In fact my grandson was born with the cord around his neck four times- without any issues at all.
What happens is if the baby is not allowed to maneuver and stretch the cord- making his or her way down the birth canal on his or her own time. But what happens is a mom gets an epidural and then is limited in her ability to move- helping the baby move. If we want to move the baby we move the mom. But if she is immobile then that is limited at best. Then the epidural slows labor down, especially if given too early. And the need for pitocin is increased. And since she is medicated now to not feel the pain, the use of pitocin is usually much more accelerated than it is when a woman does not have an epidural and needs to be able to manage the augmentation.
Pitocin can sometimes slam a baby down into the birth canal and there is no time for the cord to be able to stretch or the baby to move to accommodate having the cord around his or her neck. So the very interventions that are selected can end with an unnecessary surgical birth due to a baby going into distress.
So, just having the cord around the neck of the baby is not a reason for a cesarean birth. I know for me as a doula, I have seen nuchal cords at least 20% of the time. It is easily slipped over the head of the baby or the baby easily slides through the loop as he or she is being born. How often are cesareans performed that could have been avoided if the laboring mom was not induced or augmented during her labor- therefore causing the very problem that would not have been a problem otherwise. Sad.
Wednesday, April 15, 2009
12 Secrets for A Gentle Birth
This is a collaborative effort on our group's part regarding what we felt were the most important secrets to a gentle birth.
Courage- Amy
Trust – Kim
Confidence- Teresa
Surrender – Pam
Vulnerability – Alicia
Relaxation- Jennifer
Love – Renee
Laughter – Persis
Movement- Guina
Focus – Tracey
Preparation – Melanie
Comfort- Patti
Comfort
When I think of comfort, images of warm socks, gentle embraces, soft lights, and relaxing music come to mind. We all desire comfort - it's a basic need. Nowhere is comfort more important than during labor and childbirth. Being able to relax during labor is so important and is greatly facilitated by various comfort measures. Some of the things that labor and birthing moms' may find helpful are their own lounge clothes to labor in vs. hospital gown, cozy socks, a variety of favorite music, the smell of lavender in oils and candles, a special photograph, their own pillow, blanket and lip balm. However, the most important comfort measures come from the people who are loving and supporting the mom such as a partner and doula. Gentle touch and encouraging words are the ultimate comfort tools.
Vulnerability
Good 'ole Miriam Webster defines vulnerability as “the susceptibility to physical or emotional injury or attack, or to have one's guard down.” But when it comes to birth, vulnerability has a much deeper meaning. To be vulnerable in birth requires not only letting down one's guard, but embracing the idea of allowing a process outside of one's control to take over. When surrounded by people and an environment that are not familiar, it is very easy for a laboring mom to have a “fight or flight” response. This natural reaction is only intensified when a woman has pre-conceived notions of what she should look or sound like in birth, or if she has a rigid plan for creating her “perfect” birth experience. While it may not come naturally to some women, spending time during her pregnancy working towards letting go of some of her inhibitions, and choosing to allow herself to be vulnerable in front of others can be absolutely invaluable in creating a gentle birth.
Courage
Any woman that chooses to bring a child into this world has COURAGE. COURAGE is the firmness of mind and will in the face of extreme difficulty. COURAGE is the ability to let go of the familiar. Most woman in this country do not face birth with COURAGE because we have been taught from a very young age that birth is scary and painful. When a woman goes into birth with these thoughts in her head, her body can tense up and slow down or even stop labor. This makes it even more important for us to educate ourselves on birth so that we can face it with COURAGE. Once we do this our bodies will be able to relax and open up so we can have a more gentle birth.
Move!
The old ways of walking, dancing and squatting through labor and birth are coming back!! As a doula for 6 years now I have seen the benefits of moving throughout birth and encourage mothers to do so from early labor all the way to pushing.
Slow dancing in the arms of the partner or doula, a woman feels loved and supported and her hips, moving side to side help to ease her baby down. Kneeling over the back of a bed, rolling on a birthing ball, kneeling on all fours and doing pelvic rocks are just a few ways to “move your body to move your baby” in the words of Gail Tully, BS, CPM, CD(DONA), There are times when a mom may not feel like moving, it’s easy to get ‘stuck’ in a position and afraid that moving may intensify her labor. Changing positions, even when you don’t feel like, it can help more than you may realize. The slight change of turning from the left to the right side, even with an epidural in place, can help a baby line up better for birth. Many mothers find that rocking or swaying during surges actually help to ease the pain. Have you ever seen a cat, dog, cow, or horse giving birth? They move. Sometimes very little, but they seem to know what they need to do and use their bodies assist in the birthing process. We are no different. If we listen to our bodies we will move with them..
The website www.spinningbabies.com gives helpful tools and advice about how to move through birth.
Laughter
Laughing is certainly one of the last things most women would imagine doing during a birth. However it may be, in this modern age, the best kept secret to a gentle birth. The benefits of laughter in general are extensive. Laughter reduces stress hormones...hmm, no stress certainly sounds gentle. Laughter allows muscles to relax and eases tension... relaxed muscles are a real good thing in labor. Laughter increases circulation and the delivery of oxygen and nutrients to your tissues. Laughter triggers endorphins...hey! aren't those the "pain killer" hormones?. But what’s so humorous about birthing? Ever seen Monty Python- The Miracle of Birth? Seriously, a dose of humor is a vital tool for coping with the pain of labor. This natural muscle relaxer will certainly aid you in a faster, safer, gentler birth. So for all these reasons and more, lighten up!
Relaxation
Giving birth is a normal physiological event and healthy part of a woman’s life cycle. To be able to relax during labor is important because it allows us to get out of our own way and just let our body birth. It needs no help from the outside; it is perfectly capable of giving birth on its own, as labor and birth are automatic, hormonally driven healthy, processes. Labor is hard work and the physical and emotional feelings that usually surface during birth are often unfamiliar and can therefore be scary and create a sense of anxiety in the mama. Anxiety increases pain. Pain increases anxiety. But relaxing the body as well as the mind can allow these intense emotions to just pass thru and not get the best of us. Birth requires our total focus and total strength. Learning to ride the waves of contractions, to dance with the pressure and intense sensations thru calm, natural breathing, closing our eyes, visualizing gentle images will enable our bodies to birth with gentleness.
Preparation
It’s no secret that a woman’s body goes through a lot of physical preparation in the weeks and months leading up to the birth of her child. She can assist this process by taking care of her body, getting plenty of rest, and maintaining a well-balanced diet. What’s just as important, however, yet many times overlooked is mental preparation – doing the work of her mind that will be necessary to achieve the birth she desires. That work begins long before the first contraction ever starts. This includes open communication with a trusted caregiver, partner, and/or anyone else that will be present during her labor to begin to develop her wishes and goals for birth. A good next step is to take a well-rounded childbirth education class which will allow her to learn about and explore all of the options available to her. Finally she should seek out and address any fears and concerns she has about the birth process and then do what’s necessary to release those inhibitions, realizing that nothing in birth is certain, but if she keeps an open mind she can deal with whatever she might face. Only then can she let go and truly just be – be the strong warrior woman that lies within all of us, and go on to enjoy the benefits of the work of her mind that she was willing to do. This is what a gentle birth is truly all about, regardless of the uncertainty of labor!
Trust
Trust during labor and birth needs to be placed in 3 areas: in yourself, in your provider, and in those who are there to support you. When you trust in yourself you believe in your body's ability to give birth. You have faith in your instinctual voice and in your body and how it is telling you to move, breathe and sound in order to allow your birth to progress. When you trust in your provider you know that they believe in the birth process as you do. You both acknowledge that you have hired them to be there in the exceptional circumstance that you need their medical expertise and not to take control of your birth. They are there to follow not lead. Finally, when you have trust in the support people you surround yourself with during birth, you know they will be there to protect and hold both the emotional and physical space you create during your labor. They are able to support your choices and any suggestions made are geared to your goals not their own. When a woman has trust in herself and her preparation for birth, in the provider she has chosen and in the people she has invited to witness her birth she is able to feel safe and protected and know that she can relax into her birth and just let it happen.
Focus
As a woman moves through her pregnancy towards birth, her FOCUS shifts from the day to day mundane to the task ahead of her, the task which will bring her child into the world. This shift in FOCUS is necessary – and involuntary - as it forces the mother to pause and reflect upon the things which are truly most important. When her womb begins to let her know her babe’s time has arrived, she can only hold on for the ride as the birth energy repeatedly moves through her body. The energy of birth is sizable, sometimes feeling overwhelming for the mother, and riding the waves requires the mother to FOCUS, which can take great effort. Some women FOCUS outwardly, zeroing in on sounds around the room or in another nearby space, but many women find it more effective to FOCUS inwardly on the rushes of energy as they surge through their body. Every woman experiences her births differently, as each of us are unique women birthing uniquely new people, but the universal experience of birthing women includes that of FOCUS on the task at hand.
Love
A woman in labor must have LOVE. Love for herself as a woman and mother, love for her baby, or love from her partner. Here's what some real moms have to say about why they needed LOVE during labor and birth:
"My LOVE for my baby is what helped me make choices during labor that were better for him, even if they were harder on me."
"LOVE is the strongest emotion that we have, and it's important for a baby to come into the world feeling that emotion versus anger or turmoil."
"During a birth you are completely vulnerable. If you don't have LOVE during the labor then it could be embarrassing /shaing to the woman instead of the beautiful thing that it's meant to be."
"It's very scary to go through and you need LOVE and support to let you know that it's okay and you WILL make it."
"I could actually feel my husband's love in the form of pain management. It was like an all over warm feeling."
"After my birth, I had a new-found LOVE for myself and what I was capable of."
"I didn't have anyone I LOVE there for my labor. I was lonely and scared, but my LOVE for my baby got me through it. Really, it was all I had."
Confidence
I looked up the definition of confidence and found these phrases: Trust or faith in a person or thing, a trusting relationship, a feeling of assurance and belief in ones own abilities. And I thought about how all of those things enter into a woman’s confidence in birth. She needs to trust the process- that her body already knows how to birth. But she must go beyond just trusting this but she needs to fully embrace it and believe it deeply. She needs to have confidence in those who surround her- her support team: her partner, care provider and perhaps a doula. If she does not have full confidence in this team, it may cause her to waiver in her own belief. She needs to have confidence in herself. That means preparing by taking classes, reading good information and looking very introspectively regarding her desires and expectations. If she goes into her labor and birth with doubts and fears, she is sabotaging the outcome. Confidence is what helps her let go and just birth.
Surrender
The word surrender is frequently used to describe being defeated, giving up. But, it also can mean to yield or resign oneself to something. The latter is a very different way to surrender. In labor and birth, a mother can spend most of her physical and emotional energy trying to control or even just manage her contractions. Fear plays a part when a mother resists the intensity of labor. Trust in her body and in birth as a normal function of her body, allows her to move beyond that fear. It allows her to surrender to her labor. It’s not about giving up anything except the fear. It is about giving in to the reality of the moment. In this moment there may be pressure, exhaustion, even pain. But it probably also includes support, love, and eager anticipation. The next moment will be different. It may hold ease, relaxation, rest. Surrendering to the reality of each moment frees a mother from her story about what is happening. And because suffering only exists in the stories we tell ourselves about something, surrendering to the reality of each moment enables a mother to have pain without suffering. It’s just what is happening now. It is temporary. Birth isn’t about making something happen – it’s about letting something happen.
Courage- Amy
Trust – Kim
Confidence- Teresa
Surrender – Pam
Vulnerability – Alicia
Relaxation- Jennifer
Love – Renee
Laughter – Persis
Movement- Guina
Focus – Tracey
Preparation – Melanie
Comfort- Patti
Comfort
When I think of comfort, images of warm socks, gentle embraces, soft lights, and relaxing music come to mind. We all desire comfort - it's a basic need. Nowhere is comfort more important than during labor and childbirth. Being able to relax during labor is so important and is greatly facilitated by various comfort measures. Some of the things that labor and birthing moms' may find helpful are their own lounge clothes to labor in vs. hospital gown, cozy socks, a variety of favorite music, the smell of lavender in oils and candles, a special photograph, their own pillow, blanket and lip balm. However, the most important comfort measures come from the people who are loving and supporting the mom such as a partner and doula. Gentle touch and encouraging words are the ultimate comfort tools.
Vulnerability
Good 'ole Miriam Webster defines vulnerability as “the susceptibility to physical or emotional injury or attack, or to have one's guard down.” But when it comes to birth, vulnerability has a much deeper meaning. To be vulnerable in birth requires not only letting down one's guard, but embracing the idea of allowing a process outside of one's control to take over. When surrounded by people and an environment that are not familiar, it is very easy for a laboring mom to have a “fight or flight” response. This natural reaction is only intensified when a woman has pre-conceived notions of what she should look or sound like in birth, or if she has a rigid plan for creating her “perfect” birth experience. While it may not come naturally to some women, spending time during her pregnancy working towards letting go of some of her inhibitions, and choosing to allow herself to be vulnerable in front of others can be absolutely invaluable in creating a gentle birth.
Courage
Any woman that chooses to bring a child into this world has COURAGE. COURAGE is the firmness of mind and will in the face of extreme difficulty. COURAGE is the ability to let go of the familiar. Most woman in this country do not face birth with COURAGE because we have been taught from a very young age that birth is scary and painful. When a woman goes into birth with these thoughts in her head, her body can tense up and slow down or even stop labor. This makes it even more important for us to educate ourselves on birth so that we can face it with COURAGE. Once we do this our bodies will be able to relax and open up so we can have a more gentle birth.
Move!
The old ways of walking, dancing and squatting through labor and birth are coming back!! As a doula for 6 years now I have seen the benefits of moving throughout birth and encourage mothers to do so from early labor all the way to pushing.
Slow dancing in the arms of the partner or doula, a woman feels loved and supported and her hips, moving side to side help to ease her baby down. Kneeling over the back of a bed, rolling on a birthing ball, kneeling on all fours and doing pelvic rocks are just a few ways to “move your body to move your baby” in the words of Gail Tully, BS, CPM, CD(DONA), There are times when a mom may not feel like moving, it’s easy to get ‘stuck’ in a position and afraid that moving may intensify her labor. Changing positions, even when you don’t feel like, it can help more than you may realize. The slight change of turning from the left to the right side, even with an epidural in place, can help a baby line up better for birth. Many mothers find that rocking or swaying during surges actually help to ease the pain. Have you ever seen a cat, dog, cow, or horse giving birth? They move. Sometimes very little, but they seem to know what they need to do and use their bodies assist in the birthing process. We are no different. If we listen to our bodies we will move with them..
The website www.spinningbabies.com gives helpful tools and advice about how to move through birth.
Laughter
Laughing is certainly one of the last things most women would imagine doing during a birth. However it may be, in this modern age, the best kept secret to a gentle birth. The benefits of laughter in general are extensive. Laughter reduces stress hormones...hmm, no stress certainly sounds gentle. Laughter allows muscles to relax and eases tension... relaxed muscles are a real good thing in labor. Laughter increases circulation and the delivery of oxygen and nutrients to your tissues. Laughter triggers endorphins...hey! aren't those the "pain killer" hormones?. But what’s so humorous about birthing? Ever seen Monty Python- The Miracle of Birth? Seriously, a dose of humor is a vital tool for coping with the pain of labor. This natural muscle relaxer will certainly aid you in a faster, safer, gentler birth. So for all these reasons and more, lighten up!
Relaxation
Giving birth is a normal physiological event and healthy part of a woman’s life cycle. To be able to relax during labor is important because it allows us to get out of our own way and just let our body birth. It needs no help from the outside; it is perfectly capable of giving birth on its own, as labor and birth are automatic, hormonally driven healthy, processes. Labor is hard work and the physical and emotional feelings that usually surface during birth are often unfamiliar and can therefore be scary and create a sense of anxiety in the mama. Anxiety increases pain. Pain increases anxiety. But relaxing the body as well as the mind can allow these intense emotions to just pass thru and not get the best of us. Birth requires our total focus and total strength. Learning to ride the waves of contractions, to dance with the pressure and intense sensations thru calm, natural breathing, closing our eyes, visualizing gentle images will enable our bodies to birth with gentleness.
Preparation
It’s no secret that a woman’s body goes through a lot of physical preparation in the weeks and months leading up to the birth of her child. She can assist this process by taking care of her body, getting plenty of rest, and maintaining a well-balanced diet. What’s just as important, however, yet many times overlooked is mental preparation – doing the work of her mind that will be necessary to achieve the birth she desires. That work begins long before the first contraction ever starts. This includes open communication with a trusted caregiver, partner, and/or anyone else that will be present during her labor to begin to develop her wishes and goals for birth. A good next step is to take a well-rounded childbirth education class which will allow her to learn about and explore all of the options available to her. Finally she should seek out and address any fears and concerns she has about the birth process and then do what’s necessary to release those inhibitions, realizing that nothing in birth is certain, but if she keeps an open mind she can deal with whatever she might face. Only then can she let go and truly just be – be the strong warrior woman that lies within all of us, and go on to enjoy the benefits of the work of her mind that she was willing to do. This is what a gentle birth is truly all about, regardless of the uncertainty of labor!
Trust
Trust during labor and birth needs to be placed in 3 areas: in yourself, in your provider, and in those who are there to support you. When you trust in yourself you believe in your body's ability to give birth. You have faith in your instinctual voice and in your body and how it is telling you to move, breathe and sound in order to allow your birth to progress. When you trust in your provider you know that they believe in the birth process as you do. You both acknowledge that you have hired them to be there in the exceptional circumstance that you need their medical expertise and not to take control of your birth. They are there to follow not lead. Finally, when you have trust in the support people you surround yourself with during birth, you know they will be there to protect and hold both the emotional and physical space you create during your labor. They are able to support your choices and any suggestions made are geared to your goals not their own. When a woman has trust in herself and her preparation for birth, in the provider she has chosen and in the people she has invited to witness her birth she is able to feel safe and protected and know that she can relax into her birth and just let it happen.
Focus
As a woman moves through her pregnancy towards birth, her FOCUS shifts from the day to day mundane to the task ahead of her, the task which will bring her child into the world. This shift in FOCUS is necessary – and involuntary - as it forces the mother to pause and reflect upon the things which are truly most important. When her womb begins to let her know her babe’s time has arrived, she can only hold on for the ride as the birth energy repeatedly moves through her body. The energy of birth is sizable, sometimes feeling overwhelming for the mother, and riding the waves requires the mother to FOCUS, which can take great effort. Some women FOCUS outwardly, zeroing in on sounds around the room or in another nearby space, but many women find it more effective to FOCUS inwardly on the rushes of energy as they surge through their body. Every woman experiences her births differently, as each of us are unique women birthing uniquely new people, but the universal experience of birthing women includes that of FOCUS on the task at hand.
Love
A woman in labor must have LOVE. Love for herself as a woman and mother, love for her baby, or love from her partner. Here's what some real moms have to say about why they needed LOVE during labor and birth:
"My LOVE for my baby is what helped me make choices during labor that were better for him, even if they were harder on me."
"LOVE is the strongest emotion that we have, and it's important for a baby to come into the world feeling that emotion versus anger or turmoil."
"During a birth you are completely vulnerable. If you don't have LOVE during the labor then it could be embarrassing /shaing to the woman instead of the beautiful thing that it's meant to be."
"It's very scary to go through and you need LOVE and support to let you know that it's okay and you WILL make it."
"I could actually feel my husband's love in the form of pain management. It was like an all over warm feeling."
"After my birth, I had a new-found LOVE for myself and what I was capable of."
"I didn't have anyone I LOVE there for my labor. I was lonely and scared, but my LOVE for my baby got me through it. Really, it was all I had."
Confidence
I looked up the definition of confidence and found these phrases: Trust or faith in a person or thing, a trusting relationship, a feeling of assurance and belief in ones own abilities. And I thought about how all of those things enter into a woman’s confidence in birth. She needs to trust the process- that her body already knows how to birth. But she must go beyond just trusting this but she needs to fully embrace it and believe it deeply. She needs to have confidence in those who surround her- her support team: her partner, care provider and perhaps a doula. If she does not have full confidence in this team, it may cause her to waiver in her own belief. She needs to have confidence in herself. That means preparing by taking classes, reading good information and looking very introspectively regarding her desires and expectations. If she goes into her labor and birth with doubts and fears, she is sabotaging the outcome. Confidence is what helps her let go and just birth.
Surrender
The word surrender is frequently used to describe being defeated, giving up. But, it also can mean to yield or resign oneself to something. The latter is a very different way to surrender. In labor and birth, a mother can spend most of her physical and emotional energy trying to control or even just manage her contractions. Fear plays a part when a mother resists the intensity of labor. Trust in her body and in birth as a normal function of her body, allows her to move beyond that fear. It allows her to surrender to her labor. It’s not about giving up anything except the fear. It is about giving in to the reality of the moment. In this moment there may be pressure, exhaustion, even pain. But it probably also includes support, love, and eager anticipation. The next moment will be different. It may hold ease, relaxation, rest. Surrendering to the reality of each moment frees a mother from her story about what is happening. And because suffering only exists in the stories we tell ourselves about something, surrendering to the reality of each moment enables a mother to have pain without suffering. It’s just what is happening now. It is temporary. Birth isn’t about making something happen – it’s about letting something happen.
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