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?
Friday, May 15, 2009
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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