Today in the local AJC newspaper this was an article I was sent...
"Circumcision victim gets $2.3 million
By Ty Tagami
The Atlanta Journal-Constitution
Tuesday, March 31, 2009
A Fulton County jury has awarded $1.8 million in damages to a boy injured in a botched circumcision.
Tuesday, March 31, 2009
Tuesday, March 24, 2009
Induction methods
Many women feel if they go past their due date- they are late. Many times providers will put pressure on a mom when she goes past her due date... please before you read this read my article on due dates- so you totally understand you are due within a four week period- week 38 to week 42... so going past the magical date is not being late at all.
Today I received a text from a mom who is 10 days past her magical date assigned to her by her doctor as her due date. She sees her doctor tomorrow and she wanted to review some induction methods prior to going to the doctor. So I thought I would share them in this blog and hope others will chime in with more.
I think there are several methods- so I will start with the least invasive first... Relaxation- just realizing that the pressure needs to be lifted will help some moms relax enough to begin labor on their own. I sell a cd from Earth Mama Angel Baby called "Getting Labor Started." The relaxation methods on it along with the guided imagery will help many moms begin to let go and begin to release what it may be that is holding them back. The mind body connection is a strong one. It can cause labor dystocia if you are not able to allow your body to begin the work that it needs to do.
When one sees herself as normal- and relaxed... letting go of the preconceived notion that she is no longer beautiful or sexual- she may be able to also have some great sex. The prostaglandins in semen help to ripen the cervix and nipple stimulation in foreplay along with the orgasm that hopefully follows or accompanies the sex releases oxytocin. Pitocin is the synthetic form of oxytocin- but one that does not pass through the blood brain barrier. Trust me oxytocin is much nicer than Pitocin!
Making sure the baby is lined up properly will also help. This is especially important if you have been having lots of "false starts" to your labor. If the baby is not quite lined up right it could cause your labor to not only begin but could also cause a longer labor. We offer a class based on Gail Tully's knowledge (www.spinningbabies.com). So make sure the baby is lined up great.
Evening Primrose Oil is taken by some women orally - first day with breakfast- then day two with breakfast and lunch- then day three with each meal and then on day four adding it vaginally from week 37 on. This is considered a natural prostaglandin and certainly could help to ripen your cervix. If you already have a diet rich in good oils- Vit E, Fish Oil. Omega 3 oils- this may make little difference. Some say it increases the chance of meconium with the baby- but that is still undetermined.
Getting your membranes "stripped" may be a good way once you go past your due date. Some care providers do this without really even talking to you about it first. You must be at least one centimeter dilated to help make this make a difference. But they insert their finger in your cervix- no this is not a comfortable event. It is also not without risks- infection, breaking your water by mistake, causing contractions that do not produce anything if your uterus is sensitive, etc.. but it can also help to release some prostaglandins to help get labor started. But keep in mind if you take your panties off and get up on the exam table this could happen if you don't have a conversation prior to taking your panties off.
Getting the party started by having your colon begin the party is another way that some women resort to in order to avoid a medical induction. You may take castor oil- it is done in numerous ways- in root beer- in the blender with orange juice and ice- spread on toast with nutella, in the pan when you cook eggs, etc- or you may take borage oil instead. This is also why an enema may cause your labor to begin. What it does is start your colon contracting and thus the party begins and your uterus jumps in as well. Ask a mom who has been up all night with diarrhea if this is a good way to begin labor. If you are going to do this- I would suggest at least having a ripe cervix and beginning it early in the day so it kicks in before the middle of the night. (See my article on fatigue being an issue with the need for medication in labor to understand why a lack of sleep is never a good way to begin labor.)
Some natural prostaglandins can be found in foods as well. Fresh pineapple- rich in bromelain, eggplant, flaxseed, nuts and seeds...foods rich in Omega 3 Oils are great for this. We have always known that a great diet does effect pregnancy and certainly can effect labors.
Acupuncture and acupressure can be useful in helping to get labor started. As doulas we have some areas we may use to help get labor to kick in if your water is broken and you are on a time crunch. There are several places that can help to align your body rhythms to help your body ready for labor to begin. A good acupuncturist is imperative- www.grdhealth.com, dr khalsa is my personal acupuncturist. A good massage therapist can also massage certain areas that will help to get your labor going as well. If you insist on seeing a female massage therapist I can recommend Regina Elvis at themiracleofmassage.com and if you want an active KMI type massage I can recommend Harry Kramer at www.kmiatlanta.com.
There are several herbal things that can be taken. Since I am not an herbalist, I will encourage you to seek one out if you need guidance with the use of herbs.
Now if these things don't work- and your care provider begins to look at the need for medical inductions there are several methods. One is to break your water to help begin labor. My suggestion is to ask the questions- What are the risks? What is the time frame they require before they begin the next intervention? Often labor when it starts by having your water break on it's own- will begin within 8-12 hours- but when it is broken artificially that is not always the case.
You may ask about ripening a cervix by having a foley catheter inserted to help to stretch your cervix or having cervidil- tampon type method that is embedded with prostaglandins- inserted may be the next step prior to any other intervention. This increases your bishop score and therefore allows for a more favorable chance for an induction to end with a vaginal birth. If either of these cause a problem they can be immediately removed. Some believe that cervidil does cause your cervix to be irritated, causing vaginal exams afterwards to be possibly more painful.
There are some care providers who still use the very controversial Cytotec or misoptrostil. Although the manufacturers of the gastro medication warn severely of using it with pregnant women for induction- and 60 minutes and 20/20 have both done exposes against it's use... it is still be done. The small pill is inserted vaginally or orally and once in your blood stream could possibly cause problems that could be very dangerous. Once it is in your blood stream the removal is virtually non existent. I will encourage you to do a google search and read about it for yourselves.
Pitocin is a most used method for induction. It requires constant monitoring. Whenever constant monitoring is involved- keep in mind it is because there are inherent dangers. This is given intravenously and can be closely monitored. But some care providers use it gently and increase it very slowly- therefore mimicking natural labor often. But often times it is given very actively since the care provider does not feel you need to be going without an epidural and senses that rapid infusion will help you get that epidural sooner than later. If Pitocin causes problems, it can be discontinued.
Remember that inductions are not without risks. Certainly there is a risk to going more than 42 weeks as well since it does increase the risk of stillborn births. One of the best ways to determine how your baby is doing is to do agree to a non stress test and biophysical. This test is one that is able to let you know how your baby is really doing- how the environment of the womb is doing. Often I have been at inductions for postdates to see a baby born with tons of vernix and showing signs of not being late at all. Due dates are subjective. Your normal gestation is also subjective.
I walked around 70% effaced and 3 centimeters dilated for over three weeks with my first two babies. You may wonder about my third pregnancy. I did not allow anyone to check my cervix since I did not value the findings as being information that was needed. I was ten days "late" with each of my babies. My first grandson was born to my youngest ten days past her magical date. My oldest daughter gave birth to her first two babies four days early and her last baby on her magical date. So... what does that all mean... that labors are all individual. That you are an individual and so is your baby.
Enjoy the last weeks or days of your pregnancy. Change your phone message to "No baby yet, we will update this message when He/She is born with the details. Don't leave a message unless it is urgent as we are nesting." And then don't answer your phone. When sharing your due date- share a due month instead. Don't let others determine how you feel about the last weeks of growing your baby.
Please feel free to comment to this entry. I would love to hear what worked or what did not work for you personally. Thanks!
Today I received a text from a mom who is 10 days past her magical date assigned to her by her doctor as her due date. She sees her doctor tomorrow and she wanted to review some induction methods prior to going to the doctor. So I thought I would share them in this blog and hope others will chime in with more.
I think there are several methods- so I will start with the least invasive first... Relaxation- just realizing that the pressure needs to be lifted will help some moms relax enough to begin labor on their own. I sell a cd from Earth Mama Angel Baby called "Getting Labor Started." The relaxation methods on it along with the guided imagery will help many moms begin to let go and begin to release what it may be that is holding them back. The mind body connection is a strong one. It can cause labor dystocia if you are not able to allow your body to begin the work that it needs to do.
When one sees herself as normal- and relaxed... letting go of the preconceived notion that she is no longer beautiful or sexual- she may be able to also have some great sex. The prostaglandins in semen help to ripen the cervix and nipple stimulation in foreplay along with the orgasm that hopefully follows or accompanies the sex releases oxytocin. Pitocin is the synthetic form of oxytocin- but one that does not pass through the blood brain barrier. Trust me oxytocin is much nicer than Pitocin!
Making sure the baby is lined up properly will also help. This is especially important if you have been having lots of "false starts" to your labor. If the baby is not quite lined up right it could cause your labor to not only begin but could also cause a longer labor. We offer a class based on Gail Tully's knowledge (www.spinningbabies.com). So make sure the baby is lined up great.
Evening Primrose Oil is taken by some women orally - first day with breakfast- then day two with breakfast and lunch- then day three with each meal and then on day four adding it vaginally from week 37 on. This is considered a natural prostaglandin and certainly could help to ripen your cervix. If you already have a diet rich in good oils- Vit E, Fish Oil. Omega 3 oils- this may make little difference. Some say it increases the chance of meconium with the baby- but that is still undetermined.
Getting your membranes "stripped" may be a good way once you go past your due date. Some care providers do this without really even talking to you about it first. You must be at least one centimeter dilated to help make this make a difference. But they insert their finger in your cervix- no this is not a comfortable event. It is also not without risks- infection, breaking your water by mistake, causing contractions that do not produce anything if your uterus is sensitive, etc.. but it can also help to release some prostaglandins to help get labor started. But keep in mind if you take your panties off and get up on the exam table this could happen if you don't have a conversation prior to taking your panties off.
Getting the party started by having your colon begin the party is another way that some women resort to in order to avoid a medical induction. You may take castor oil- it is done in numerous ways- in root beer- in the blender with orange juice and ice- spread on toast with nutella, in the pan when you cook eggs, etc- or you may take borage oil instead. This is also why an enema may cause your labor to begin. What it does is start your colon contracting and thus the party begins and your uterus jumps in as well. Ask a mom who has been up all night with diarrhea if this is a good way to begin labor. If you are going to do this- I would suggest at least having a ripe cervix and beginning it early in the day so it kicks in before the middle of the night. (See my article on fatigue being an issue with the need for medication in labor to understand why a lack of sleep is never a good way to begin labor.)
Some natural prostaglandins can be found in foods as well. Fresh pineapple- rich in bromelain, eggplant, flaxseed, nuts and seeds...foods rich in Omega 3 Oils are great for this. We have always known that a great diet does effect pregnancy and certainly can effect labors.
Acupuncture and acupressure can be useful in helping to get labor started. As doulas we have some areas we may use to help get labor to kick in if your water is broken and you are on a time crunch. There are several places that can help to align your body rhythms to help your body ready for labor to begin. A good acupuncturist is imperative- www.grdhealth.com, dr khalsa is my personal acupuncturist. A good massage therapist can also massage certain areas that will help to get your labor going as well. If you insist on seeing a female massage therapist I can recommend Regina Elvis at themiracleofmassage.com and if you want an active KMI type massage I can recommend Harry Kramer at www.kmiatlanta.com.
There are several herbal things that can be taken. Since I am not an herbalist, I will encourage you to seek one out if you need guidance with the use of herbs.
Now if these things don't work- and your care provider begins to look at the need for medical inductions there are several methods. One is to break your water to help begin labor. My suggestion is to ask the questions- What are the risks? What is the time frame they require before they begin the next intervention? Often labor when it starts by having your water break on it's own- will begin within 8-12 hours- but when it is broken artificially that is not always the case.
You may ask about ripening a cervix by having a foley catheter inserted to help to stretch your cervix or having cervidil- tampon type method that is embedded with prostaglandins- inserted may be the next step prior to any other intervention. This increases your bishop score and therefore allows for a more favorable chance for an induction to end with a vaginal birth. If either of these cause a problem they can be immediately removed. Some believe that cervidil does cause your cervix to be irritated, causing vaginal exams afterwards to be possibly more painful.
There are some care providers who still use the very controversial Cytotec or misoptrostil. Although the manufacturers of the gastro medication warn severely of using it with pregnant women for induction- and 60 minutes and 20/20 have both done exposes against it's use... it is still be done. The small pill is inserted vaginally or orally and once in your blood stream could possibly cause problems that could be very dangerous. Once it is in your blood stream the removal is virtually non existent. I will encourage you to do a google search and read about it for yourselves.
Pitocin is a most used method for induction. It requires constant monitoring. Whenever constant monitoring is involved- keep in mind it is because there are inherent dangers. This is given intravenously and can be closely monitored. But some care providers use it gently and increase it very slowly- therefore mimicking natural labor often. But often times it is given very actively since the care provider does not feel you need to be going without an epidural and senses that rapid infusion will help you get that epidural sooner than later. If Pitocin causes problems, it can be discontinued.
Remember that inductions are not without risks. Certainly there is a risk to going more than 42 weeks as well since it does increase the risk of stillborn births. One of the best ways to determine how your baby is doing is to do agree to a non stress test and biophysical. This test is one that is able to let you know how your baby is really doing- how the environment of the womb is doing. Often I have been at inductions for postdates to see a baby born with tons of vernix and showing signs of not being late at all. Due dates are subjective. Your normal gestation is also subjective.
I walked around 70% effaced and 3 centimeters dilated for over three weeks with my first two babies. You may wonder about my third pregnancy. I did not allow anyone to check my cervix since I did not value the findings as being information that was needed. I was ten days "late" with each of my babies. My first grandson was born to my youngest ten days past her magical date. My oldest daughter gave birth to her first two babies four days early and her last baby on her magical date. So... what does that all mean... that labors are all individual. That you are an individual and so is your baby.
Enjoy the last weeks or days of your pregnancy. Change your phone message to "No baby yet, we will update this message when He/She is born with the details. Don't leave a message unless it is urgent as we are nesting." And then don't answer your phone. When sharing your due date- share a due month instead. Don't let others determine how you feel about the last weeks of growing your baby.
Please feel free to comment to this entry. I would love to hear what worked or what did not work for you personally. Thanks!
Friday, March 13, 2009
Gentle Births
Today I reflect on two recent births... one is my daughter's third baby- her second daughter. I viewed the slideshow that Tracey produced for us from the beautiful images she photographed at the birth, only 13 days ago. The laughter- the intensity- the beauty made me cry once more as I remembered having her little head emerge into my hands. It was such a gentle birth. (you can read about this birth and see some photos at my personal blog http://laboroflovedoula.blogspot.com/)
And I reflect on one of the few cesarean births that I was a part of yesterday. A healthy mom who did everything right- she eats great- is in good shape, had the mind body connection- no fears going in- so in touch with her spiritual connection not only to her God but also this baby girl who grew within her. And somehow after more than 37 hours of labor did not bring forth her daughter the way she planned.
I often think of the indigenous woman and what would have happened to her in this situation. She would have labored for another day- difficult labor like this mom had- and perhaps brought a baby forth from her vagina without incidence. But this mom upon examination in the hospital- the exam that would determine if she would stay or go home also brought with it a rupturing on membranes. Not on purpose or with any intent- but bulging forth it just released. And then 23 hours later brought with it a fever that caused this little girl to have such an increased heart rate that she was telling us she would feel better outside of her mom's body quicker than later. Now perhaps the indigenous woman would not have had an exam that caused this- but more than likely a bulging bag would be breaking sooner than later anyway.
But when this direct occiput posterior baby was lifted from her mother's abdomen- having not signaled us that she had been laying like that- and I wonder if only after a very late epidural did that happen- after a long, arduous and unusually patterned labor that seem to have a fully occiput anterior presenting baby- albeit a pendulous uterus- all of which we did all the "magic tricks" we could muster- using all of the spinning baby techniques we knew of- her normal birth weight body emerged with beautiful APGARs leaving us wondering- why?
I want to scream out "unfair" and am left feeling like although I feel this cesarean birth was truly needed- it was still so sad. So sad to seem the mother writhe with anguish over the interventions as they unfolded. She had gone intervention free except for the exam where her water released- for more than a day of contracting- and had to be open to interventions as her labor became more unmanageable as fatigue and lack of progression overtook her.
I cry for the women who have to have cesareans at all- but am not saddened by the choices this mom made- they were truly doing the next best thing- but saddened by the why it had to happen... and wonder why this baby girl declined to be born as we all desired. We had such a supportive team of nurses- Ann and Nancy were the best! We had a super supportive midwife who only wanted the birth to be as the mom desired- there were no hidden agendas- only love and support. The friends and her partner who were there were lovingly fully supportive of this mom. And as a doula, I gave her my very best. So the why lingers in my heart. As the physician entered the room with his verdict- one we all knew was the only logical option at the time- he too had been fully supportive of avoiding this all day long.
So at the end of the day, I still stand by my phrase, "control is merely an illusion." That will someday be a tattoo across my abdominal scar and as much as I hate the truth applied to birth- it is still true. And just as I was thinking of these two births, Joni sent me this link today- one I want to leave you with- a view of birth very different than we usually consider- gentle birthing- enjoy and take care!
http://www.dailymotion.com/video/x7yo8v_naitreenchantee_lifestyle
And I reflect on one of the few cesarean births that I was a part of yesterday. A healthy mom who did everything right- she eats great- is in good shape, had the mind body connection- no fears going in- so in touch with her spiritual connection not only to her God but also this baby girl who grew within her. And somehow after more than 37 hours of labor did not bring forth her daughter the way she planned.
I often think of the indigenous woman and what would have happened to her in this situation. She would have labored for another day- difficult labor like this mom had- and perhaps brought a baby forth from her vagina without incidence. But this mom upon examination in the hospital- the exam that would determine if she would stay or go home also brought with it a rupturing on membranes. Not on purpose or with any intent- but bulging forth it just released. And then 23 hours later brought with it a fever that caused this little girl to have such an increased heart rate that she was telling us she would feel better outside of her mom's body quicker than later. Now perhaps the indigenous woman would not have had an exam that caused this- but more than likely a bulging bag would be breaking sooner than later anyway.
But when this direct occiput posterior baby was lifted from her mother's abdomen- having not signaled us that she had been laying like that- and I wonder if only after a very late epidural did that happen- after a long, arduous and unusually patterned labor that seem to have a fully occiput anterior presenting baby- albeit a pendulous uterus- all of which we did all the "magic tricks" we could muster- using all of the spinning baby techniques we knew of- her normal birth weight body emerged with beautiful APGARs leaving us wondering- why?
I want to scream out "unfair" and am left feeling like although I feel this cesarean birth was truly needed- it was still so sad. So sad to seem the mother writhe with anguish over the interventions as they unfolded. She had gone intervention free except for the exam where her water released- for more than a day of contracting- and had to be open to interventions as her labor became more unmanageable as fatigue and lack of progression overtook her.
I cry for the women who have to have cesareans at all- but am not saddened by the choices this mom made- they were truly doing the next best thing- but saddened by the why it had to happen... and wonder why this baby girl declined to be born as we all desired. We had such a supportive team of nurses- Ann and Nancy were the best! We had a super supportive midwife who only wanted the birth to be as the mom desired- there were no hidden agendas- only love and support. The friends and her partner who were there were lovingly fully supportive of this mom. And as a doula, I gave her my very best. So the why lingers in my heart. As the physician entered the room with his verdict- one we all knew was the only logical option at the time- he too had been fully supportive of avoiding this all day long.
So at the end of the day, I still stand by my phrase, "control is merely an illusion." That will someday be a tattoo across my abdominal scar and as much as I hate the truth applied to birth- it is still true. And just as I was thinking of these two births, Joni sent me this link today- one I want to leave you with- a view of birth very different than we usually consider- gentle birthing- enjoy and take care!
http://www.dailymotion.com/video/x7yo8v_naitreenchantee_lifestyle
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