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

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

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?

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.

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.

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!