12/21/09

Placenta Encapsulation Pictures

Yes, yes... I know most of us think that eating the placenta is barbaric and taboo, but thanks to the information in the research studies about the surprising benefits, there has been a recent push by mothers to discreetly ingest the placenta by encapsulating. I have recently started encapsulating client's placentas following the Traditional Chinese Method.

Ingesting the placenta helps prevent PPD, "The baby blues" and fatigue as well as increases the milk supply, replenishes nutrients and decreases postpartum bleeding. More information about the benefits of Placentophagia can be found here.

I encapsulated my sister's placenta today and thought I'd take a few photos to document the process. I forgot to photograph a few steps, but you get the idea!

WARNING: These are not for the squeamish!








Cleaning and draining the maternal side of the placenta

Cleaning and draining the fetal side (Also known as "The Tree of Life")

Checking out the umbilical cord my nephew was tethered to for the last 9 months

A perfect design of harmony, the placenta is half maternal cells and half fetal cells.

Steaming the placenta lightly (According to TCM (Traditional Chinese Medicine)

Dehydrating the placenta

Putting together capsules after the placenta is ground

Aimee's placenta yielded 170 capsules!

A gift of postpartum wellness!

12/9/09

The Lie of the Estimated Due Date (EDD): Why Your Due Date Is Not What You Think



We have it ingrained in our heads throughout our entire adult lives-pregnancy is 40 weeks. The "due date" we are given at that first prenatal visit is based upon that 40 weeks, and we look forward to it with great anticipation. When we are still pregnant after that magical date, we call ourselves "overdue" and the days seem to drag on like years. The problem with this belief about the 40 week EDD is that it is not based in fact. It is one of many pregnancy and childbirth myths which has wormed its way into the standard of practice over the years-something that is still believed because "that's the way it's always been done".

The folly of Naegele's Rule

The 40 week due date is based upon Naegele's Rule. This theory was originated by Harmanni Boerhaave, a botanist who in 1744 came up with a method of calculating the EDD based upon evidence in the Bible that human gestation lasts approximately 10 lunar months. The formula was publicized around 1812 by German obstetrician Franz Naegele and since has become the accepted norm for calculating the due date. There is one glaring flaw in Naegele's rule. Strictly speaking, a lunar (or synodic - from new moon to new moon) month is actually 29.53 days, which makes 10 lunar months roughly 295 days, a full 15 days longer than the 280 days gestation we've been lead to believe is average. In fact, if left alone, 50-80% of mothers will gestate beyond 40 weeks.

Variants in cycle length


Aside from the gross miscalculation of the lunar due date, there is another common problem associated with formulating a woman's EDD: most methods of calculating gestational length are based upon a 28 day cycle. Not all women have a 28 day cycle; some are longer, some are shorter, and even those with a 28 day cycle do not always ovulate right on day 14. If a woman has a cycle which is significantly longer than 28 days and the baby is forced out too soon because her due date is calculated according to her LMP (last menstrual period), this can result in a premature baby with potential health problems at birth.

The inaccuracy of ultrasound

First trimester: 7 days

14 - 20 weeks: 10 days

21 - 30 weeks: 14 days

31 - 42 weeks: 21 days

Calculating an accurate EDD

Recent research offers a more accurate method of approximating gestational length. In 1990 Mittendorf et Al. undertook a study to calculate the average length of uncomplicated human pregnancy. They found that for first time mothers (nulliparas) pregnancy lasted an average of 288 days (41 weeks 1 day). For multiparas, mothers who had previously given birth, the average gestational length was 283 days or 40 weeks 3 days. To easily calculate this EDD formula, a nullipara would take the LMP, subtract 3 months, then add 15 days. Multiparas start with LMP, subtract 3 months and add 10 days. The best way to determine an accurate due date, no matter which method you use, is to chart your cycles so that you know what day you ovulate. There are online programs available for this purpose (refer to links in resources section). Complete classes on tracking your cycle are also available through the Couple to Couple League.

ACOG and postdates


One of the most vital pieces of information to know when you are expecting is that ACOG itself (American College of Obstetricians and Gynecologists) does not recommend interfering with a normal pregnancy before 42 completed weeks. This is why knowing your true conception date and EDD is very important; if you come under pressure from a care provider to deliver at a certain point, you can be armed with ACOG's official recommendations as well as your own exact due date. This can help you and your baby avoid much unnecessary trauma throughout the labor and delivery. Remember, babies can't read calendars; they come on their own time and almost always without complication when left alone to be born when they are truly ready.


Mittendorf, R. et al., "The length of uncomplicated human gestation," OB/GYN, Vol. 75, No., 6 June, 1990, pp. 907-932. ACOG Practice Bulletin #55: Clinical Management of Post-term Pregnancy For more sources see: http://www.ccl.org - Couple to Couple League


Misha Safranski is a freelance writer and mother of five, specializing in natural birth, VBAC advocacy, and cesarean prevention issues. See more of her work here.

11/22/09

Adamina's Birth



These are birth notes from the last birth I attended from my perspective. The official birth story belongs to this family. I'm sure I left something out, as birth brings so many magical moments.

It was Thursday, November 19th and you called me at 2:00am to tell me you were in labor. Your contractions were 3 minutes apart and you'd been having contractions since 7:00pm. I get to your house shortly after and you are handling contractions beautifully. You are walking through them, leaning on me, swaying, and breathing softly. After timing your contractions at 2-3 minutes apart, the midwives suggest you come into the hospital. We arrive at the hospital at 4:00am. As we enter the elevator to go to L&D floor you are trembling a bit, which I remind you is a sign of transition! When you are admitted to triage you are already 7cm/100%. As we wait in triage you wanted to stand and walk, following your bodies urges to stay mobile. You brace yourself on me in a slow dancing position to stay loose during contractions. Once admitted into the birthing suite you mention back pain between contractions, both the midwife and I suspect that baby is Malpositioned. To encourage baby is move into a better position for birth, you lean over onto the bed while I apply counter pressure to your lower back to relieve the pain. You go from this position to a supported squat, allowing your pelvis to widen. During the contractions I notice that you start tapping one of your feet in the rhythm of your body, a sign of your inward focus that allowed you to distract your body from the contractions.

You only hesitate once when you say "I'm so tired..." and I remind you "You are so close to meeting your baby girl. This is like a marathon, and your in the last leg."

At 6:50am you are 8cm and you get into the tub while I use the shower head to alternate a warm stream of water from your belly to your lower back. The hydrotherapy worked wonders to calm and relax you during contractions. You stay in the tub until 8:3oam when you move to the bed. You are 9-10cm and the midwife asks you if you would like her to break your bag of waters, you agree and shortly after have the urge to push. You start pushing in a hands and knees position on the bed. After a few contractions, you try pushing in a sitting position on bed while doing a "Tug of War" with a towel supported by the nurse. This helps the perineum stay relaxed while your body is in an ideal alignment for maximum pushing effect.

At 10:46am baby Adamina is born and placed on your chest. She was 8lbs and 20 1/2 inches long and stayed skin to skin with you following the birth.

Congratulations Mama! You were so trusting of birth as you followed your body's innate urges to stay mobile, breathe deeply, and find a rhythm during labor.


Why Mothers Kiss Their Babies



Check out this revealing essay on the elegant partnership between human physiology and emotion.

After a baby is born, it is a natural thing to see the mother kissing the baby. One would think that this is simply because of the emotional bond that has formed between mother and child. While this is the case, there are also some other very compelling biochemical reasons as to why this occurs. These reasons reinforce the understanding that our bodies have inner wisdom which we seldom recognize or trust. Just as our bodies know how to give birth even if we don't have intellectual knowledge of the process, our bodies' biological systems also have reasons for the complex social interplay between mother and baby. It just goes to show that, more than ever, we should trust our mothering instincts.

When an animal gives birth to its young, you will notice that the mother spends a lot of time licking it's child. It exposes the five senses to the young, so that the mother knows the taste, smell, feel, sound, and sight of her new baby. In this way, the mother claims the child as her own. When a human mother gives birth to a baby, and does so in an environment which allows her immediate and free access to her child, you will notice that over a period of time the mother performs certain behaviors which we call claiming behaviors. She will caress the child, exploring the softness of the baby's skin and probably counting and fondling the unique little fingers and toes. She probably marvels visually over how much the baby looks like her or her husband or another family member, the color of the hair and eyes, and other physical features. She hears the baby's cries and learns to distinguish her baby's cry from all others. As she leans down to kiss the child, she undoubtedly smells the scent of her new baby, and through the actual act of kissing the baby, she actually learns to know the taste of him/her. She has also exposed her five senses to the baby so that she attaches to the baby, feeling that the baby is now her own. It is not unusual to note that women who are deprived of the privacy and opportunity for bonding immediately after birth often state that there is an emotional distance between them and their babies, that they are never really sure that the baby is theirs.

Claiming behaviors such as kissing the baby provide not only emotional but biological attachment. There is also a very real health benefit for the baby in terms of kissing. "When a mother kisses her baby, she 'samples' those pathogens that are on the baby's face - the very ones that the baby is about to ingest. These samples are taken up by the mother's secondary lympoid organs like the tonsils, and memory B cells specific for those pathogens are re-stimulated. These B cells then migrate to the mother's breasts where they produce just those antibodies that the baby needs!" (1)

We talk a lot about breastmilk, and about how it conveys antibodies to the infant and helps to prevent illness. However, the antibodies that the mother has made to the germs around her while pregnant convey little help to the infant. It is the germs in the infant's environment at present, the ones he is in contact with right now which he needs protection from. Kissing the baby is a very important activity beyond it's obvious pleasurable and attachment-promoting value.

So mothers, kiss away on those babies!

(1) Sompayrac, Lauren. (1999). How the Immune System Works. Malden, MA:
Blackwell Science, Inc. p. 71.

This is from The Online Childbirth Class Center For Unhindered Living

11/15/09

Formula Fed America

The United States has one of the worst breastfeeding records out of all the countries and formula is a 4 billion a year industry. This and more are discussed in the new film: Formula Fed America. See the trailer below. I emailed them requesting information about hosting a screening in our area.

Get more information here.

10/29/09

The Apparatus for Facilitating the Birth of a Child by Centrifugal Force


"The Apparatus for Facilitating the Birth of a Child by Centrifugal Force, may not end the age-old debate of whether or not centrifugal force actually exists, but it sure will take a pregnant woman’s mind off the business at hand during childbirth!

The device, which was patented on November 9, 1965, is a complicated machine consisting, basically, of a concrete slab with an elaborate motor mounted onto it, a table, metal straps, which the inventors, George and Charlotte Blonsky recommend, but do not insist, be made of iron to hold the victim — I mean, mother-to-be — in place, a rotary that looks something like a huge scythe, and a vaginal basket for catching the expulsed infant. Of course, the Blonskys were likely to encounter some problems from the outset. Namely, a hospital’s cost for acquiring and maintaining such a large-scale piece of equipment, not to mention the amount of dedicated floor space needed to house such a behemoth. Trickier however, is confronting and changing the way women and doctors envision the whole birthing process.

In simple terms, a woman in labor is strapped into the “Apparatus” and spun around at a speed that create[s] a gentle, evenly distributed, properly directed, precision-controlled force, that acts in unison with and supplements [mother’s] efforts. In everyday language: it’s as close as women have gotten to a passive delivery system since we all agreed that doping mothers as they are giving birth might not be the best thing for baby. The result? The baby is safely, well hopefully, expelled into the warm, expectant embrace of a woven basket! That’s right. A baby’s first tactile experience is not that of a doctor’s gentle touch, but rather, the impersonal sensation of an artificially constructed womb. (I guess the better to prepare the baby for the cold, impersonal world it is likely to encounter in the years ahead!) Although the very thought of all this is likely to diminish any TLC visions we might have of delivery rooms abuzz with joyful anticipation, the Blonskys’ were interested, mainly, in accelerating the childbirth process."
- via Colitz.com


Like all inventors, the Blonskys sought to address a problem, namely the long, laborious process of giving birth. Never having had any children of their own, the inspiration for the Apparatus for Facilitating the Birth of a Child by Centrifugal Force came from observing a pregnant elephant in labor. The elephant, alone at the Bronz zoo was spinning during labor. The Blonsky's though this was Centrifugal Force in action and failed to realize that in the wild, when in labor an elephant is surrounded by it's herd until the labor is over. This captive elephant was just alone, and making do. The Blonsky's even went on to win a Nobel Prize.


Sound crazy?



Well, some of the women polled after the device was patented said "If I was full term and sick of being pregnant, I'd give it a go."


Kind of makes you think twice about what else we do to our bodies when we induce, augment, or interfere with normal birth. Instead of making devices and drugs to speed up labor why can't we accept the beauty in the slow process that nature has requested?



Don't get me wrong, I appreciate medical interventions when they are truly needed. However, in low risk births why must society try to improve upon something that when left undisturbed tends to create the best outcomes for mom and baby?



And what about the elephant spinning at the Bronx Zoo? It makes me think of women in hospitals, left without the support of the continuous care of a midwife or doula, left to deal with these naturally primal urges and sensations in "captivity" so to speak.



Like the elephants in the wild, birthing women need the full support of the herd. I think all women should carefully consider who will be the "herd" or team of birth professionals at their birth.






10/8/09

Its in the mail!

I mailed my doula certification packet yesterday! It could be 2 months before I know so keep your fingers crossed!

10/1/09

The Importance of Skin to Skin Contact

The Importance of Skin to Skin Contact, 2009
Written and revised (under other names) by Jack Newman, MD, FRCPC, 1995-2005 and Revised by Jack Newman MD, FRCPC and Edith Kernerman, IBCLC, 2008, 2009



There are now a multitude of studies that show that mothers and babies should be together, skin to skin (baby naked, not wrapped in a blanket) immediately after birth, as well as later. The baby is happier, the baby’s temperature is more stable and more normal, the baby’s heart and breathing rates are more stable and more normal, and the baby’s blood sugar is more elevated. Not only that, skin to skin contact immediately after birth allows the baby to be colonized by the same bacteria as the mother. This, plus breastfeeding, are thought to be important in the prevention of allergic diseases. When a baby is put into an incubator, his skin and gut are often colonized by bacteria different from his mother’s.

We now know that this is true not only for the baby born at term and in good health, but also even for the premature baby. Skin to skin contact and Kangaroo Mother Care can contribute much to the care of the premature baby. Even babies on oxygen can be cared for skin to skin, and this helps reduce their need for extra oxygen, and keeps them more stable in other ways as well (See www.kangaroomothercare.com) (See the information sheet Breastfeeding the Premature Baby).

"To appreciate the importance of keeping mother and baby skin to skin for as long as possible in these first few weeks of life (not just at feedings) it might help to understand that a human baby, like any mammal, has a natural habitat: in close contact with the mother (or father). When a baby or any mammal is taken out of this natural habitat, it shows all the physiologic signs of being under significant stress. A baby not in close contact with his mother (or father) by distance (under a heat lamp or in an incubator) or swaddled in a blanket, may become too sleepy or lethargic or becomes disassociated altogether or cry and protest in despair. When a baby is swaddled it cannot interact with his mother, the way nature intended. With skin to skin contact, the mother and the baby exchange sensory information that stimulates and elicits “baby” behaviour: rooting and searching the breast, staying calm, breathing more naturally, staying warm, maintaining his body temperature and maintaining his blood sugar."


From the point of view of breastfeeding, babies who are kept skin to skin with the mother immediately after birth for at least an hour, are more likely to latch on without any help and they are more likely to latch on well, especially if the mother did not receive medication during the labour or birth. As mentioned in the information sheet Breastfeeding—Starting out Right, a baby who latches on well gets milk more easily than a baby who latches on less well. See the video clips of young babies (less than 48 hours old) breastfeeding at the website nbci.ca. When a baby latches on well, the mother is less likely to be sore. When a mother’s milk is abundant, the baby can take the breast poorly and still get lots of milk, though the feedings may then be long or frequent or both, and the mother is more prone to develop problems such as blocked ducts and mastitis. In the first few days, however, the mother does have enough milk, but because it is not abundant, as nature intended, the baby needs a good latch in order to get that milk. Yes, the milk is there even if someone has proved to you with the big pump that there isn’t any. How much does or does not come out in the pump proves nothing—it is irrelevant. Many mothers with abundant milk supplies have difficulty expressing or pumping more than a small amount of milk. Also note, you can’t tell by squeezing the breast whether there is enough milk in there or not. And a good latch is important to help the baby get the milk that is available. If the baby does not latch on well, the mother may be sore, and if the baby does not get milk well, the baby will want to be on the breast for long periods of time worsening the soreness.

To recap, skin to skin contact immediately after birth, which lasts for at least an hour (and should continue for as many hours as possible throughout the day and night for the first number of weeks) has the following positive effects. The baby:
  • Is more likely to latch on
  • Is more likely to latch on well
  • Maintains his body temperature normal better even than in an incubator
  • Maintains his heart rate, respiratory rate and blood pressure normal
  • Has higher blood sugar
  • Is less likely to cry
  • Is more likely to breastfeed exclusively and breastfeed longer
  • Will indicate to his mother when he is ready to feed
There is no reason that the vast majority of babies cannot be skin to skin with the mother immediately after birth for at least an hour. Hospital routines, such as weighing the baby, should not take precedence.

The baby should be dried off and put on the mother. Nobody should be pushing the baby to do anything; nobody should be trying to help the baby latch on during this time. The baby may be placed vertically on the mother’s abdomen and chest and be left to find his way to the breast, while mother supports him if necessary. The mother, of course, may make some attempts to help the baby, and this should not be discouraged. This is baby’s first journey in the outside world and the mother and baby should just be left in peace to enjoy each other’s company. (The mother and baby should not be left alone, however, especially if the mother has received medication, and it is important that not only the mother’s partner, but also a nurse, midwife, doula or physician stay with them—occasionally, some babies do need medical help and someone qualified should be there “just in case”). The eye drops and the injection of vitamin K can wait a couple of hours. By the way, immediate skin to skin contact can also be done after cæsarean section, even while the mother is getting stitched up, unless there are medical reasons which prevent it.

Studies have shown that even premature babies, as small as 1200 g (2 lb 10 oz) are more stable metabolically (including the level of their blood sugars) and breathe better if they are skin to skin immediately after birth. Skin to skin contact is quite compatible with other measures taken to keep the baby healthy. Of course, if the baby is quite sick, the baby’s health must not be compromised, but any premature baby who is not suffering from respiratory distress syndrome can be skin to skin with the mother immediately after birth. Indeed, in the premature baby, as in the full term baby, skin to skin contact may decrease rapid breathing into the normal range.

Even if the baby does not latch on during the first hour or two, skin to skin contact is important for the baby and the mother for all the other reasons mentioned.

If the baby does not take the breast right away, do not panic. There is almost never any rush, especially in the full term healthy baby. One of the most harmful approaches to feeding the newborn has been the bizarre notion that babies must feed every three hours. Babies should feed when they show signs of being ready, and keeping a baby next to his mother will make it obvious to her when the baby is ready. There is actually not a stitch of proof that babies must feed every three hours or by any schedule, but based on such a notion, many babies are being pushed into the breast simply because three hours have passed. The baby who is not yet interested in feeding may object strenuously, and thus is pushed even more, resulting, in many cases, in baby refusing the breast because we want to make sure they take the breast. And it gets worse. If the baby keeps objecting to being pushed into the breast and gets more and more upset, then the “obvious next step” is to give a supplement. And it is obvious where we are headed (see the information sheet When a Baby Has Not Yet Latched).

Questions? First look at the website www.nbci.ca or www.drjacknewman.com.


9/29/09

Mass Media Childbirth vs. The Real Thing

When you see birth displayed in the media it usually shows a women in unbearable amounts of pain, flailing about like she was dying, only to have her baby instantly upon arriving to the hospital. Far from the peaceful and sacred births I have witnessed!

Those "reality" shows like A Baby Story & Birth Day and others just make it worse by capitalizing on the drama. I can't even watch them anymore without wanting to scream at the television. In fact, I have started suggesting that my clients don't watch those shows at all! I believe that the Hypnobabies Instructors also suggest their students avoid any shows like that.

I came across this new film: Laboring under an Illusion Check out the trailer below! It will help people see difference between Mass media childbirth and the real thing!

I hope to get the DVD so I can show this to clients!

9/14/09

Economics of A Doula's Fees


Economics of A Doula's Fees (Adapted with permission from www.Gentlebirth.org)

Question: How do you set your fees?

Answer: The economics of professional labor support work are a mystery to many people; I offer this information so that you'll have a better idea of what you're paying for:

Hours - Couples having a first baby may imagine that I'll only be spending a few hours with them during the labor and birth. In reality, an eight-hour labor would be considered pretty zippy; most first labors last longer than 16 hours. The average time that I've spent with a woman for her labor and birth is about 16 hours. I spend at least another 9 hours in prenatal and postpartum meetings, and another hour or two in phone calls and email communication.

Clients per Week - When I make a commitment to be available to attend you in labor, I have to limit the number of clients I put on my calendar so as to avoid birth conflicts and to ensure that I am reasonably rested when you go into labor. The rule of thumb for birth professionals providing in-home services is that one client per week is a full schedule. However, because I am working to balance family and doula work carefully, I actually try and only take 2 clients a month.

Clients per Year - When I put your due date on my calendar, I commit to being available one week beforehand and 1 week after that date. This means that when I schedule a two-week vacation, I have to add another four weeks during which I cannot accept clients. There are some weeks where I have to turn clients away and then there are other weeks where I have no births on the calendar.

Consultant Factor - The rule of thumb is that a self-employed professionals income is only half of what they earn, after deductions for vacation and sick time, self-employment taxes, health insurance, continued education and business expenses. I also have routine professional and transportation expenses. In addition, I bring labor support tools to your birth as part of providing doula care.

Putting It All Together - The annual income of someone providing labor support services 
with a responsible client load and a strong commitment to being available for your birth is 1/2 the number of clients per year times their fee per client. So if I take 24 clients a year, this is about 12 times the fee per client, and, yes, that's before taxes, including extra self-employment taxes. Although I am dedicated to this work, being on-call all the time requires a very high level of personal sacrifice, including a willingness to be beeped awake after half an hour of sleep to go attend a labor for the next however many hours.

Bottom Line - Nobody's getting rich doing labor support work. I wish I could offer my services for free, but that would require that I make even greater financial sacrifices than I am already making to do this work. I am a self-supporting professional, I want to earn a living wage working with birth so I can provide for my family while doing what I love. There are people offering doula services at significantly reduced prices. They are either offering significantly reduced services, are still in training, or are basically offering charity. If you need charity, I encourage you to get labor support however you can; and I do offer pro-bono work when a client can't afford my standard rate. However, if you can afford doula care and you looking for "a free doula" you are doing future birthing women a disservice by making labor support an underpaid profession that cannot attract or keep talented, skilled individuals. If you end up selecting a doula who is undercharging for her services, I strongly encourage you to pay her more than she is asking; otherwise, she may not be around to help you with your next child.

Advocacy Suggestions - Doula's have been granted a health insurance billing code which means I can help you bill your insurance for possible reimbursement. You can talk with your Human Resources representatives to ask them to lobby to include all doula services as a covered option in your plan. Additionally, you could talk with your midwife or doctor to encourage them to offer universal doula care to their clients. By hiring several doulas to be on-call for their clients, they could substantially reduce the cost per birth, although the doula might be someone you've never met before. You could also advocate for the hospital to provide universal doula care, so that it would be covered in the same way as their in-house lactation consultants are covered.

8/13/09

"Bonjour Nicolas!"

These are birth notes from the last birth I attended from my perspective. The official birth story belongs to this couple. I'm sure I left something out, as birth brings so many magical moments.

It was 4:47pm and mom called, to tell me she had been having contractions all day, and they were 5-6 minutes apart and seemed manageable. We spoke for a few minutes and I told her that when I woke up this morning I thought to myself "I better get the birth ball and my doula bag in the jeep, I think today is the day." Mom was 40 weeks and 6 days, and this was to be a VBAC attempt after a traumatizing c-section experience with her 1st son.

Mom decided to call the midwives and see when they wanted her to come in. At 5:00pm mom called me back to tell me that the contractions were building and only 4-5 minutes apart and that the midwives wanted her to go into the hospital. I assure mom I will meet her there shortly.

Around 6:30 I meet mom and dad in the hall of OB triage, where we greet each other and get mom checked in to triage. The nurses get mom hooked up to the monitor, and check mom to find that she is 1-2cm, 50% effaced. Mom is discouraged by this and quickly I remind her that her body is working hard to get her baby out. I encourage her to trust that her cervix is doing what it is supposed to while I softly help mom to imagine her cervix like a rose, blossoming into each contraction.
"Remember, your cervix is like a rose, you can't stop a rose from blossoming. Let it go, give yourself permission to open"
After an hour in triage, at about 7:30 the nurse suggests that mom walks around for 1-2 hours to "get things going". Mom and dad hadn't eaten dinner because they had planned to order pizza at home before labor intensified. We go to the cafeteria and get some food.

We walk, and each contraction builds like a soft wave. She is leaning on the chair or dad while breathing deeply during contractions. We walk, at a snails pace...through the noisy hospital corridors as the janitors wax the floor. As we walk mom handles her contractions so well, I wasn't sure at this point that she was progressing.

9:03 pm, mom wants to stop the walk to go back to triage, contractions are more intense, she is feeling a little nauseous and starts to tremble a little. We get back to the room and as mom is checked the nurse reveals mom is a 4-5, 80% effaced!!! Mom says "So, does that mean I can stay?" Nurse: "Oh, yes! You're having a baby!"

Soon after, mom started stripping clothes (good labor sign!) and she was feeling flashes of hot and cold (another good labor sign!) Mom had not slept much the night before so she laid on her side to rest. She loved the warm rice sock on her back and dad stayed close by moms head, keeping her space full of love. Dad stayed very involved and never took his eyes off mom.

10:30 we get settled in the birthing suite, mom labors leaning on the back of the bed on her knees. I plug the Ipod Player in, dad puts his Ipod on and a Joni Mitchell song is playing. I dim the lights and put out my flame less candle to help create a peaceful space for mom.

"Oh, here one comes..."
"Take a deep breath in, breathe for your baby...that's it, just like that."
"I don't know if I can do this..."

"You are doing this! Remember each contraction is bringing you closer to meeting your baby."

Mom's bag of water broke at 11:20 pm. After being checked at 11:30 mom is 7-8cm almost 100% effaced, shaking in the knees, cold washcloth on forehead, fan blowing, mom is doing awesome. I remind mom that this part is transition, usually the shortest part, but the most intense.

"I'm feeling a lot of pressure!"

Mom knew in advance she might want the epidural, and dad & I supported mom with massage and reassuring words while she labored waiting on the anesthesiologist to arrive. The midwife said that by the time the epidural was placed, mom was complete and ready to push. It was 12:30am.

Mom dug to the deepest, most sacred parts of herself to push strong and hard to birth her baby. Baby Nicholas was born with his eyes open at 2:10 am. As mom looked at her son she whispered "We did it, we did it!" What a glorious moment! This moment of empowerment brought tears to my eyes!

What a beautiful baby that latched on instantly.

Dad's primary language is french, so as he held Nicholas for the first time he said "Bonjour Nicholas!"

This beautiful embrace brought tears to my eyes...again.

8/4/09

"Over here, Mr. President"


Pushed author Jennifer Block recently wrote a new blog about health care reform and why maternity care should be included in the reform work. In this recent piece she says "Over here, Mr. President" if you want to cut health care costs just look at maternity care. Block says:

"Childbirth, in fact, costs the United States more in hospital charges than any other health condition -- $86 billion in 2006, almost half paid for by taxpayers,"
And here's the worst part:

"Yet we have among the worst outcomes: high rates of preterm birth, infant mortality, and maternal mortality, with huge disparities by race."
On the BOLD blog, here is a great piece about Jennifers article:

It's a no-brainer that maternity care needs reform, but ironically as Block points out the women's health community has never fully embraced this cause. Why? One word: abortion. Reproductive rights advocates need ACOG (American College of Obstetricians and Gyns) on their side. You lose them and you could jeopardize women's access to abortions. This, Block asserts, is the reason reproductive rights advocates haven't been knocking doors down to complain that one in three women are c-sectioned in the United States, that mothers who had C-sections are being denied vaginal birth as an option in at least half of the hospitals in the US.Hearing all of this is painful and tragic.

And, women's health advocates aside, there's more worrying feedback mothers are getting about their maternity care. Block attended Childbirth Connection's symposium on maternity care and..."An executive from Geisinger Health System made a startling admission:

"There are many healthcare organizations across the country [that] have become, unfortunately, dependent upon NICU [Neonatal Intensive Care Unit] volumes to fund many of their other services."
In other words, our for-profit system not only rewards the overuse of intervention even if it leads to more sick babies; in some cases, it depends on it.

These are hard words to swallow, especially if you're pregnant today. But do not despair. BOLDness is out there! As Block points out, midwives are offering outstanding care for low risk mothers. And if 10 percent (instead of the current 1%) of the population in the US used midwives we'd save $9.1 billion in healthcare. It just makes CENTS!!!

To read Jennifer Block's full piece click here.

7/28/09

Placentophagia



Over the last several weeks I have been reading about Placentas, and the encapsulation process to possibly offer as a new service to my clients. I have been reading about various training programs, and DIY avenues. Regardless of my path to providing this service I am committed to helping moms see the benefits of their Placenta. :)

I don't think it is"Medical Waste", as it is labeled in the hospital. It can be mom's gateway to wellness postpartum as it contains high levels of various vitamins, such as B6, which can help curb postpartum depression. Eating the placenta gives mom back all those nutrients she was providing for her unborn baby. Eating the placenta also increases a mother's blood levels of a hormone known as CRH (corticotropin-releasing hormone), a known stress-reducer. This hormone is normally secreted by the hypothalamus. Studies have also shown that eating the placenta can also increase milk production, and slow postpartum hemorrhage.

Eating the Placenta is common practice in many parts of the world. However, in Western cultures, eating the placenta is often viewed as gross or weird, but with the information about the surprising benefits and modern encapsulation techniques, it doesn't have to be taboo!

I think that it is time now to set aside our societal prejudice, and embrace the placenta for what it truly is - an art form of wellness.

According to a study performed by the National Institutes of Health (NIH):

"During the last trimester of pregnancy, the placenta secretes so much CRH that the levels in the bloodstream increase threefold. However, it was also discovered that postpartum women have lower than average levels of CRH, triggering depressive symptoms. They concluded that the placenta secreted so much CRH that the hypothalamus stopped producing it."

"After childbirth, the hypothalamus doesn't immediately receive the signal to begin producing CRH again, which can lead to postpartum depression. Eating the placenta will raise a mother's CRH levels therefore, reducing postpartum depression."

-http://placentabenefits.info/medicinal.asp

You don't have to eat it raw! The placenta can be dried, ground, and encapsulated. The capsules can then be taken daily for a number of weeks. And when you have recovered from birth you can freeze and save some for menopause. One placenta can produce 100-200 capsules. You reap all of the healthful benefits of placenta quickly, easily and discreetly, and the capsules will last indefinitely (for years).

7/17/09

Keep baby with you after birth

This video is for anyone planning a hospital birth. This video explains why skin to skin contact is so beneficial after birth. See more videos about birth here.

6/25/09

Avoiding Induced Labor


I have been trying to find clear, informative information on induction as I see so many moms opting for early or unwarranted inductions because they are impatient or uncomfortable.

It makes it that much harder for moms when we live in this "fast food nation" where doctors are suggesting inductions for convenience, not properly informing of the risks and insurance companies are also to blame for still paying for voluntary inductions. If insurance companies stopped paying for them that would only be half the battle, because you'd still have some doctors who would say "baby is too big" or "your past due" to get the induction funded. I loathe the ways our maternity system mis-educates by fear mongering.

I do think that Inductions DO save lives when used in high risk situations.

Below are very informative quotes and excepts on the FACTS of induction from an article published by Medical News Today. You can find the original here.

Throughout pregnancy, many women eagerly anticipate the day they finally will meet their new baby. This is especially true in the last few weeks of pregnancy when, as a baby grows larger, an expectant mother becomes increasingly uncomfortable and impatient to finish out her pregnancy.

Despite the anticipation, research shows that allowing labor to start naturally, rather than induce, is more beneficial to both mom and baby. Labor induction, or artificially initiating labor through the use of medicine, is performed for a variety of reasons. Today, one of the more common reasons for induction is "convenience." Hospitals can staff extra nurses, physicians can schedule births for times that are most convenient for them, and expectant parents can make work and family arrangements in advance according to their scheduled induction date. At first glance, labor induction may seem more convenient; however, it's important to recognize that induction may lead to a longer labor and overall hospital stay, more medical interventions, higher costs, risk of potential for litigation, and adverse outcome for a mother or baby.

In the last weeks of pregnancy, a woman's body and her baby perform crucial functions to prepare for birth. The baby's lungs mature and he or she develops a protective layer of fat. In addition, the baby drops down into the pelvis, the cervix tilts forward and softens, and irregular contractions help the cervix thin and begin to dilate. In most cases, a woman's body goes into labor only when her body and her baby are ready.


"Research at The University of Texas Southwestern Medical School suggests that it is a signal from the baby that starts the process of labor," says Debby Amis, RN, BSN, CD(DONA), LCCE, FACCE.

"The best way for a mother to know that her baby is fully mature and ready to be born is to allow labor to begin on its own."

"By avoiding induction, women are less likely to encounter other medical interventions," says Lamaze International President Allison J. Walsh, IBCLC, LCCE, FACCE.

"Experiencing natural contractions and laboring without unnecessary medical interventions increases a woman's freedom to respond to contractions by moving and changing positions, both of which facilitate the process of labor and birth."

Lamaze International recommends that a woman allows her body to go into labor on its own, unless there is a true medical reason to induce. Allowing labor to start on its own reduces the possibility of complications, including a vacuum or forceps-assisted birth, fetal heart rate changes, babies with low birth weight or jaundice, and cesarean surgery. Studies consistently show that inducing labor almost doubles a woman's chance of having cesarean surgery.

Avoiding induction also decreases the likelihood of a premature birth. Because neither doctors nor mothers can determine a baby's due date with 100 percent accuracy, babies may be induced accidentally before they reach full term (at least 37 completed weeks). A scheduled induction at 39 weeks could result in giving birth to a preterm baby who is only 36 weeks gestation. Preterm babies miss critical stages of development that take place during the last weeks of pregnancy and are at risk are for several postnatal complications. A study published in The Journal of the American Medical Association examined 4.5 million births in the United States and Canada and concluded that babies born only a few weeks early-at 34 weeks through 36 weeks-were nearly 3 times more likely to die in their first year of life than full-term infants. When medically necessary, inducing labor can be a life saving procedure.

The American College of Obstetricians and Gynecologists states that labor may be induced if it is more risky for a woman's baby to remain inside her body than to be born. Medical reasons for induction include, a woman's water has broken and labor has not begun for several hours; her pregnancy is post term (more than 42 weeks); she has pregnancy-induced high blood pressure; she has health problems that could affect her baby, like diabetes; there is an infection in her uterus; or her baby is growing too slowly.

First-time mothers are most vulnerable to the risks of inductions. Contrary to what many believe, suspecting a large baby is not a medical reason for induction. It is very difficult for a doctor or midwife to determine the size of a woman's baby before birth with accuracy, even with the use of ultrasound. Studies consistently show that inducing for a suspected large baby increases, rather than decreases, the incidence of cesarean birth.

Lamaze International has developed a care practice paper entitled "Labor Begins on its Own," which presents the research surrounding labor induction and tips for avoiding induced labor .

Childbirth education classes, such as Lamaze, provide women with the tools and information they need to make educated choices during labor and birth. To find a Lamaze class in your area, visit http://www.lamaze.org/.

6/18/09

Beautiful Home Birth

Click here to view a incredible slide show of a great home birth!

I wish more moms knew how wonderful birth could be!

6/16/09

TENS for labor



Medical News Today recently published a press release citing a 2009 review by the Cochrane Collaboration that concluded that women should have the option of using transcutaneous electrical nerve stimulation (TENS) as a non-pharmacological method of pain management in labor.

The full report can be found on the Cochrane Collaboration’s website. The summary reads:


“TENS is a device which emits low voltage currents which has been used for pain relief in labour. The way that TENS acts to relieve pain is not well understood. The electrical pulses are thought to stimulate nerve pathways in the spinal cord which block the transmission of pain. In labour, the electrodes from the TENS machine are usually attached to the lower back (and women themselves control the electrical currents using a hand-held device) but TENS can also be applied to acupuncture points or directly to the head. The purpose of the review was to see whether TENS is effective in relieving pain in labour. The review includes 19 studies with a total of 1671 women. Fifteen studies examined TENS applied to the back, two to acupuncture points and two to the cranium (head). Results show that pain scores were similar in women using TENS and in control groups. There was some evidence that women using TENS were less likely to rate their pain as severe but results were not consistent. Many women said they would be willing to use TENS again in a future labour. TENS did not seem have an effect on the length of labour, interventions in labour, or the wellbeing of mothers and babies. It is not known whether TENS would help women to manage pain at home in early labour. Although it is not clear that it reduces pain, women should have the choice of using TENS in labour if they think it will be helpful.”

I like that the TENS unit can increase a mother’s feeling of control during her labor, it doesn't have any risks of harming mom and baby, and its non-pharmacological! It's win win!

How it works:

  • TENS is a small battery-operated electrical current generator that provides input to your central nervous system. The TENS unit is small and portable-the size of a pager-so you can walk around or be up with it while using it in labor. TENS is a safe method of pain control. It has no side effects and is controlled by you. And, while TENS does not eliminate pain, many women have found it to be extremely effective in helping them work with their contractions and feel more in control.
  • The TENS unit sends an electrical "signal" through your skin to the nerves. This signal feels like a warm, comfortable tingling sensation which helps block out some of the other pain stimuli that is also reaching your central nervous system.
  • Four electrode pads are placed along your spine.
  • Electrode wires are inserted into the pads and plugged into the TENS unit. The unit is turned on to the level of feeling a mild sensation.
  • With each contraction you dial up the intensity of the current with the contraction and turn it down to a mild sensation in between.
I am trained on using the TENS in labor and I am offering my unit to doula clients as requested. If you are interested in using a TENS unit for pain management in labor please contact me.

Advanced Doula Training


Last weekend I had the pleasure of attending a workshop taught by Penny Simkin, PT. Penny is a internationally revered physical therapist who has specialized in childbirth education and doula work since 1968. She is one of DONA’s founders and has written several books on birth and labor support. I just had to have Penny sign my doula bible (Labor Progess Handbook). Yay!

I was so grateful to attend this workshop! I learned so much! Below is an outline of what we learned.

Day 1
  • When Survivors Give Birth: Understanding and Healing the Effects of Early Sexual Abuse on Childbearing Women
Day 2
  • Non-Pharmacological Methods of Pain Relief in Labor
  • When pain becomes suffering
  • TENS Training (transcutaneous electrical nerve stimulation)
  • The OP (Occiput Posterior) fetus: How little we know
  • Postpartum: The Neglected Phase of Childbearing.

I am looking forward to using the knowledge I learned to better support moms in labor!

5/27/09

A different consent form!!!

This was written by a woman who wants a VBAC and is frustrated by the lack of support she is getting, so she decided to write a consent for OBs.

If they read, they would see how wrong they are!

Check it out below or at the original site.


I, the undersigned physician, have, in violation of the Consumer Bill of Rights and Responsibilities, the Emergency Medical Treatment and Active Labor Act, the Patient Self Determination Act, the ethical guidelines of the American Medical Association and the American College of Obstetricians and Gynecologists, Constitutional Law (the right to privacy and self determination protected by the 1st and 14th amendments), international tort law, and case law (of particular interest "In re A.C.", 1987, "In re Fetus Brown, 689 N.E.2d 397, 400 (Ill. App. Ct. 1997)", and "In re Baby Boy Doe, 632 N.E.2d 326 (Ill. App. Ct. 1994)") and the Patient Rights as determined by this institution, deprived my client,________________, of her right to self determination and her right to bodily integrity by ignoring her repeated refusal for delivery by repeat cesarean section. I acknowledge that by refusing to honor my client's denial of consent, I have not only violated the above laws, but I also affirm that I have used unwarranted and unethical pressure including emotional threats to my client's and her unborn child's life and safety, in my attempts to obtain such consent. I further affirm that I have stressed the risks of vaginal birth after cesarean, but neglected to inform my patient of the risks of delivery by repeat cesarean section.

I further affirm that I understand, that should I resort to physical force, including but not limited to physical or chemical restraints to compel my client's cooperation, I will be guilty of criminal battery, which is defined as "any form of non-consensual touching or treatment that occurs in a medical setting".

In compensation for the above violations of my client's rights, I hereby guarantee the following:

a healthy baby, born in perfect condition, with no physical, mental or developmental defects whatsoever, whether arising from surgery or any other cause no complications for the infant, including but not limited to:

persistent pulmonary hypertension, transient tachypnea of the newborn, respiratory distress syndrome, iatrogenic prematurity, lacerations, or hematomaa speedy, uncomplicated post-operative recovery for my client.

Specifically, I guarantee that my client shall not experience nerve damage, organ damage, hemorrhage (whether sufficient to require transfusion or not), disability or disfigurement, intraoperative or postoperative infection of the wound or surrounding skin and tissues, post partum depression and post partum post traumatic stress disorder (PTSD), and other conditions not listed here.

Signed,

_______________

5/18/09

Sign a Petition to Support Midwives

Please read and sign the petition to support all midwives as care providers. Women need choices when choosing care providers!

Dear Friends-

A recently revised Position Statement from the American College of Nurse Midwives (ACNM) seeks to limit recognition of midwifery providers to those who have received their training through government accredited programs. The North American Registry of Midwives (NARM) oversees the credentialing of midwives who have received their training through time honored and evidenced based systems that emphasize clinical competency over all other criteria (Certified Professional Midwives-CPMs).

NARM has posted an online petition in an effort to organize our voices and convince the ACNM to reconsider its position on apprentice trained midwives. This letter seeks to unite US Midwifery under the common goal of providing women with access to the provider and setting of their choice for birth.

There are many great opportunities mounting to move midwifery forward on both the state and national level. We must stand together as a community of midwives if we are going to have a real voice for change in maternity care. Whether you are a CPM, CNM, a midwifery consumer, advocate, or none of the above, please click here to read more details about this issue and sign the petition to make your voice heard.

Respectfully,

The NARM Board of Directors

5/12/09

Ignorance Meets Knowledge (extended breastfeeding)

As a proud breastfeeding mom to my 13 month old, this video brought tears to my eyes.

Thank you Tori for this wonderful video! :)

5/7/09

When choosing a Obstetrician...



Adapted from: Your birth your way blog
If you are thinking of choosing an Obstetrician as your care provider for pregnancy and birth, it is essential that you choose someone who is the right fit for you. You will remember your childbirthing experience for your entire life.

Interviewing at least 3 OB's is vital in discovering whether that person will respect your wishes for the birth you want. You might form a really good opinion of OB #1, but when you interview #2 you may discover that the first was really not on the ball with current evidence-based care.

Be informed of what is acceptable and safe obstetric practice before you begin interviewing, otherwise you won't know if what you're hearing is myth or reality. Unfortunately there are many OB's who would rather do a cesarean for their own convenience than wait and give you time to birth your baby naturally. However there are also some fantastic OB's who will not rush in to perform un-necessary surgery, and will give the birthing mother the respect, time and support to birth the way she wants to.

But, how do you work out who is good and who should be avoided?

Firstly, work out what you want your birth to be and why you want that. Do you want a completely natural, drug free birth? Do you want a natural birth, but are open to the idea of drugs if you decide to use them? Do you want every drug under the sun? Do you want a cesarean? Do you want to be able to move around & eat & drink during labor? Are you basing these decisions on what is best for you and your baby, or are you making decisions based on fear? Have you considered and researched all the options for maternity care? Don’t forget that although some women may need obstetric care, for the vast majority of women the very best maternity care you can receive is from a midwife.

Secondly, take responsibility for your birth. It is not the OB's responsibility to make the decisions and tell you what to do. It is your responsibility to accept this birth as yours, and make wise well thought through decisions about what you want, and then tell your OB what will be done. If they try and push you to do things a certain way that is against what you want, then they are not the right one for you, and you should take your business elsewhere. Do not forget that you are the client, you have the business they want, and they need to be respectful.

Thirdly, inform and prepare yourself well. Read the good books, not the ones written just for a laugh.
My birth recommended reading list:
  • Ina May's Guide to Childbirth
    by Ina May Gaskin

  • The Thinking Woman's Guide to a Better Birth
    by Henci Goer

  • Childbirth Without Fear
    by Dr Grantly Dick-Read

  • The Birth Book
    by William Sears

Remember that knowledge is power, and if you are well informed you will make wise decisions. Speak to people who can help you find answers to your questions, not just your your mom or girlfriends, as helpful as they may be. Talk to midwives and Doula's. Even if you would never consider home birth, talk to the independent midwives, they are highly trained, experienced and a wealth of knowledge, they will offer a different perspective which can only ever be helpful in giving you a more well rounded understanding of birth.

Fourthly, hire a Doula to support you and your partner throughout your entire labour and birth. Doula’s, unlike hospital based midwives and obstetricians, will stay with you throughout your entire labour and birth. Having that continuity of care makes an enormous difference to your ability to cope with labour and both mother and baby’s well-being.

Write down all your questions, so that you won’t forget them at your appointments. It’s all too easy to get distracted by listening to baby’s heartbeat and the myriad of other checks, and forget the questions you’ve been waiting all week to ask.

Here are some Interview questions for Obstetricians.
Under what circumstances do you consider Induction necessary?
If my waters break but I do not go into labor immediately, how long would I have before you would want to intervene?
What is your policy on breaking the waters, epidurals, episiotomies?
What is your episiotomy rate?
What is your policy regarding monitoring of the baby?
What is your policy on eating and drinking during labour?
What is your policy on Vaginal Breech Birth and Water Birth?
What is your caesarean rate for first time mothers?
What is your VBAC (Vaginal Birth after Caesarean) rate?
Under what circumstances would you consider doing a caesarean?
How do you try to avoid the need for a caesarean?

If an Obstetrician is very vague and dismissive of your questions, or if they patronise, ridicule or try to use scare tactics to convince you of their reasons, go somewhere else. It is better to choose a new care provider than to try to fight for what you want while giving birth. It is never too late to change care-providers. I know of women who felt unsupported by their Obstetricians, and they changed care-providers and had the wonderful births they wanted.

Remember this is your birth and your baby, and you deserve to be supported and cared for in the way YOU require.

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