3/26/09

Tomorrow

....is the first day of my Labor Support/Doula training.

This is me actually pursuing my dreams...instead of just talking about them.

It's just the beginning.
I know I have lots of learning ahead, but it feels good to have faith in a dream.

A dream to be part of something wholesome, something sacred, something magical.

A dream to be a humble servant to the mothers who feel empowered by their own bodies.

Those of you that know me, surely know that I've always been a "doubter" about everything I do. Fear of failure always haunts me.

However, this path I can walk with remarkable surety that God has called me here.

3/25/09

The Mother-Friendly Childbirth Initiative

If you are pregnant or know someone who is I highly suggest that you see if your local hospital or birth center follows these guidelines that have proven to create optimal outcomes for moms and babies.

A mother-friendly hospital, birth center, or home birth service offers all birthing mothers:
  • Provides culturally competent care -- that is, care that is sensitive and responsive to the specific beliefs, values, and customs of the mother's ethnicity and religion.
  • Provides the birthing woman with the freedom to walk, move about, and assume the positions of her choice during labor and birth (unless restriction is specifically required to correct a complication), and discourages the use of the lithotomy (flat on back with legs elevated) position.
  • Has clearly defined policies and procedures for: collaborating and consulting throughout the perinatal period with other maternity services, including communicating with the original caregiver when transfer from one birth site to another is necessary; linking the mother and baby to appropriate community resources, including prenatal and post-discharge follow-up and breastfeeding support.
  • Does not routinely employ practices and procedures that are unsupported by scientific evidence, including but not limited to the following: shaving; enemas; IVs (intravenous drip); withholding nourishment; early rupture of membranes; electronic fetal monitoring; Other interventions are limited as follows: Has an induction rate of 10% or less; Has an episiotomy rate of 20% or less, with a goal of 5% or less; Has a total cesarean rate of 10% or less in community hospitals, and 15% or less in tertiary care (high-risk) hospitals; Has a VBAC (vaginal birth after cesarean) rate of 60% or more with a goal of 75% or more.
  • Educates staff in non-drug methods of pain relief and does not promote the use of analgesic or anesthetic drugs not specifically required to correct a complication.
  • Encourages all mothers and families, including those with sick or premature newborns or infants with congenital problems, to touch, hold, breastfeed, and care for their babies to the extent compatible with their conditions.
  • Discourages non-religious circumcision of the newborn.
  • Strives to achieve the WHO-UNICEF "Ten Steps of the Baby-Friendly Hospital Initiative" to promote successful breastfeeding: Have a written breastfeeding policy that is routinely communicated to all health care staff; Train all health care staff in skills necessary to implement this policy; Inform all pregnant women about the benefits and management of breastfeeding; Help mothers initiate breastfeeding within a half-hour of birth; Show mothers how to breast feed and how to maintain lactation even if they should be separated from their infants; Give newborn infants no food or drink other than breast milk unless medically indicated; Practice rooming in: allow mothers and infants to remain together 24 hours a day; Encourage breastfeeding on demand; Give no artificial teat or pacifiers (also called dummies or soothers) to breastfeeding infants; Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from hospitals or clinics.

...Sadly, if you took the time to see if your local hospital follows these guidelines that have proven to create optimal outcomes for moms and babies, you'd find very few of them do. Why? Other factors (outlined below) besides what is best for the mother baby unit are influencing labor and birth practices in the United States.

What is the Guiding Philosophy Behind Maternity Care in the United States Today?

Birth in America is guided by the false belief that it is a fundamentally flawed process.

According to this belief, during childbirth women's bodies are inefficient, ineffective and a potential danger to the baby. Birth is only seen as normal in retrospect. This philosophy serves as the foundation for the dominant model of maternity care in America today, the technocratic medical model. As Robbie Davis-Floyd describes in her book "Birth As An American Rite of Passage," birth in this model is doctor and technology centered, only safe inside of a hospital when technology is used, restricted to arbitrary time lines that are not research supported, and the pain of labor is perceived as unproductive and unnecessary. The technocratic medical model ignores an integral part of birth, the importance of the labor and birth environment and how birthing women feel psychologically. The interventions deemed necessary and safe by this model of care are largely not supported by the medical research. Unfortunately the technocratic model of maternity care has far reaching effects. About four million women give birth each year in the United States. According to data released by the Center for Disease Control in 2003, 99% of births occurred in a hospital and 91.4% of all births were attended by a physician, who tend to employ the technocratic model of maternity care. Only 8% of births were attended by a midwife, who generally practice a more holistic, women centered approach to pregnancy and birth. The vast majority of women are being cared for by providers whose beliefs and practices are founded on the technocratic medical model of maternity care, which does not support birth as a natural, normal, healthy process.

Other factors such as convenience and fear of litigation help to explain how our system has wandered so far away from what birth really should look like:

Women making informed choices about their health, in a comfortable environment of her choice, where she is not put on a timeline as to when her baby must be born and she is not told her body isn't working well enough, she is able to move unrestricted with the birth attendants of her choosing present, soothing and guiding her emotionally and physically during the birth experience.

The Birth Experience The Listening to Mothers Survey conducted in 2002 by the Maternity Center Association surveyed 1,538 women regarding their childbirth experience. According to this survey "a majority of women reported having each of the following interventions while giving birth: electronic fetal monitoring (93%), intravenous drip (86%), epidural analgesia (63%), artificially ruptured membranes (55%), artificial oxytocin, or pitocin, to strengthen contractions (53%), bladder catheter (52%), and stitching to repair an episiotomy or a tear (52%)." [5] While these interventions are sometimes necessary and important in birth, their prevalence and the risks associated with each are alarming.

Research demonstrates the following risks:

• Continuous electronic fetal monitoring increases the risk of cesarean and has been shown to have no benefit to the baby's health. Instead, the American College of Obstetricians and Gynecologists recommend intermittent auscultation be used for healthy, low-risk women.

• "Routine IV use restricts movement (an important tool and comfort measure in natural childbirth), decreases confidence, may over-hydrate mothers, and may contribute to low blood sugar in newborns."

• Epidurals have a tendency to increase the first stage of labor, induce potentially life threatening hypo tension (low blood pressure) and fever which can't be differentiated from an infection and must be treated automatically with antibiotics, as well as the use of pitocin, which carries its own risks. Several studies have shown an increase of vacuum and forcep vaginal deliveries, again each carrying its own set of risks to the mother and baby. Epidurals may also be associated with an increase in cesarean sections.

• "An intact amniotic sac protects the baby's head and a woman's vagina during labor. Artificially rupturing the sac increases a woman's risk of infection and interventions like pitocin, EFM, IV, and cesarean."

• "There is no evidence that the prevention of prolonged labor by the liberal use of oxytocin in normal labor is beneficial." Because pitocin artificially increases the strength of contractions it puts more stress on mothers and their babies. "Pitocin use necessitates the use of an IV and continuous EFM, restricts (a mother's) mobility, and raises (the mother's) risk of epidural and cesarean. And so begins the cascade of unnecessary interventions often resulting in less optimal outcomes for mom and baby.

Keep in mind that most of the time these interventions are being used in the absence of medical necessity, thus arbitrarily introducing unnecessary health risks. More poignantly - obstetricians and midwives (obviously not practicing midwifery care) are actually introducing risk to a normal process that would work better and be more beneficial to mother and baby if left alone. Cesarean births are another major intervention with numerous risks to women that is on the rise in the United States. Our current cesarean rate of 31.1% is disturbing given that the World Health Organization (WHO) states that cesarean births should comprise no more than 10-15% of all births. Any more means less optimal health outcomes. C-section rates in the United States have increased 50% in the last 10 years.

No risk from eating during labour

I've believed this all along, but it's nice to have research on this side of the debate. It makes sense if you think about it, food gives us energy, labour takes energy, so it's better for mom and this study proves it!

http://news.bbc.co.uk/1/hi/health/7961689.stm

It is safe for most healthy women to eat during labour, research has found. The study found eating a light diet during labour has no effect on the duration of labour, the need for assisted delivery, or Cesarean rates.

Since the 1940s it has been common practice to prevent eating during labour to cut the risk of complications if surgery is required. But the King's College London study, featured online in the British Medical Journal, suggests this is too cautious.
“Denial of food can be seen as authoritarian and intimidating, which may for some women increase feelings of fear and apprehension during labour ”

Some doctors have previously advised women not to eat during labour to minimise the risk that they would breath food into their lungs should they need an emergency Cesarean under general anaesthetic - a condition known as pulmonary aspiration. But pulmonary aspiration has declined dramatically in recent years, mainly due to the increased use of local anaesthesia for Cesarean deliveries. Many doctors and midwives also argue that preventing food intake during labour can be detrimental to the mother, her baby and the progress of the delivery.However, previous research on the subject has proved inconclusive. The King's team focused on 2,426 healthy women having their first baby. Each women was either allowed small, regular amounts of food during labour, such as bread, fruit and yogurt, or water only. No differences! The natural birth rate in both groups was the same, at 44%. Average duration of labour was also similar, 597 minutes for the eating group, and 612 minutes for the water only group. The Cesarean rate was also the same - 29% for the eating group, and 30% for the water group.And in both groups around one in three women vomited during labour. There were also no differences in the condition of the babies at birth or admission to special care units.

The researchers, led by Professor Andrew Shennan, said the study showed that there was no pressing reason to deny women food during labour.

They wrote:
"Denial of food can be seen as authoritarian and intimidating, which may for some women increase feelings of fear and apprehension during labour."

"Eating and drinking may allow mothers to feel normal and healthy."

Current guidelines from the National Institute for Clinical Excellence (NICE) recommend that low risk women in normal labour may eat and drink.Dr Virginia Beckett, a consultant obstetrician and spokesperson for the Royal College of Obstetricians and Gynaecologists, said it was fine for healthy women at low risk to eat during labour. But she stressed that it was not a good idea for those who were at higher risk, such as women who were obese. Women using pethidine to reduce pain during labour, should also avoid food, as the drug relaxed the gut muscles, making problems more likely.

Dr Beckett said:
"Eating during labour is not going to make things better, but it is not going to make things worse, and it might make you feel more of a human being, and that is quite important."

Response to "The Case Against Breastfeeding"

"Hanna Rosin makes "The Case Against Breastfeeding" http://www.theatlantic.com/doc/200904/case-against-breastfeeding in the April issue of the Atlantic Monthly. The provocative title is misleading, because as Rosin explained in an interview on NBC's Today show on March 16, she isn't against breastfeeding. In fact, she kind of likes breastfeeding. Her problem is with the people who promote breastfeeding.

Here's the lead-in to her piece:In certain overachieving circles, breast-feeding is no longer a choice--it's a no-exceptions requirement, the ultimate badge of responsible parenting. Yet the actual health benefits of breast-feeding are surprisingly thin, far thinner than most popular literature indicates. Is breast-feeding right for every family? Or is it this generation's vacuum cleaner--an instrument of misery that mostly just keeps women down?

Rosin packs a lot into the article, but I would summarize her main points as:
1. American women face intense social pressure to breastfeed exclusively.
2. Advocates exaggerate the benefits of breastfeeding, which the scientific research does not support.
3. Advocates downplay the negatives about breastfeeding and fail to acknowledge that formula-feeding can be the right choice for some mothers. On a related note, Rosin depicts breastfeeding as extremely inconvenient for mothers who work outside the home.
4. Advocates have medicalized the conversation about breastfeeding, and American women are wrongly led to believe they are harming their babies if they give formula instead.

Read this article where a blogger addresses those points and more after the jump. Rosin's conflicted feelings about breastfeeding are valid, but unfortunately, she draws too many broad conclusions based on her personal experiences.
http://www.mydd.com/story/2009/3/24/19115/0339

3/12/09

Every Week of Pregnancy Counts

During the Christmas Holiday season, some hospitals see a small uptick in baby deliveries thanks to families eager to fit the blessed event in around holiday plans or in time to claim a tax deduction. Conventional wisdom has long held that inducing labor or having a Caesarean section a bit early posed little risk, since after 34 weeks gestation, all the baby has to do was grow.

But new research shows that those last weeks of pregnancy are more important than once thought for brain, lung and liver development. And there may be lasting consequences for babies born at 34 to 36 weeks, now called "late preterm."

[Why Every Week of Pregnancy Counts]
Getty Images

New research shows that the last weeks of pregnancy are more important than once thought for brain, lung and liver development.

A study in the American Journal of Obstetrics and Gynecology in October calculated that for each week a baby stayed in the womb between 32 and 39 weeks, there is a 23% decrease in problems such as respiratory distress, jaundice, seizures, temperature instability and brain hemorrhages.

A study of nearly 15,000 children in the Journal of Pediatrics in July found that those born between 32 and 36 weeks had lower reading and math scores in first grade than babies who went to full term. New research also suggests that late preterm infants are at higher risk for mild cognitive and behavioral problems and may have lower I.Q.s than those who go full term.

What's more, experts warn that a fetus's estimated age may be off by as much as two weeks either way, meaning that a baby thought to be 36 weeks along might be only 34.

The American College of Obstetricians and Gynecologists, the American Academy of Pediatrics and the March of Dimes are now urging obstetricians not to deliver babies before 39 weeks unless there is a medical reason to do so.

"It's very important for people to realize that every week counts," says Lucky E. Jain, a professor of pediatrics at Emory University School of Medicine.

It's unclear how many deliveries are performed early for nonmedical reasons. Preterm births (before 37 weeks) have risen 31% in the U.S. since 1981 -- to one in every eight births. The most serious problems are seen in the tiniest babies. But nearly 75% of preterm babies are born between 34 and 36 weeks, and much of the increase has come in C-sections, which now account for a third of all U.S. births. An additional one-fifth of all births are via induced labor, up 125% since 1989.

Many of those elective deliveries are done for medical reasons such as fetal distress or pre-eclampsia, a sudden spike in the mother's blood pressure. Those that aren't can be hard to distinguish.

"Obstetricians know the rules and they are very creative about some of their indications -- like 'impending pre-eclampsia,'" says Alan Fleischman, medical director for the March of Dimes.

Why do doctors agree to deliver a baby early when there's no medical reason? Some cite pressure from parents.

"'I'm tired of being pregnant. My fingers are swollen. My mother-in-law is coming' -- we hear that all the time," says Laura E. Riley, medical director of labor and delivery at Massachusetts General Hospital.

"But there are 25 other patients waiting, and saying 'no' can take 45 minutes, so sometimes we cave."

There's also a perception that delivering early by c-section is safer for the baby, even though it means major surgery for the mom. "The idea is that somehow, if you're in complete control of the delivery, then only good things will happen. But that's categorically wrong. The baby and the uterus know best," says F. Sessions Cole, director of newborn medicine at St. Louis Children's Hospital.

He explains that a complex series of events occurs in late pregnancy to prepare the baby to survive outside the womb: The fetus acquires fat needed to maintain body temperature; the liver matures enough to eliminate a toxin called bilirubin from the body; and the lungs get ready to exchange oxygen as soon as the umbilical cord is clamped. Disrupting any of those steps can result in brain damage and other problems. In addition, the squeezing of the uterus during labor stimulates the baby and the placenta to make steroid hormones that help this last phase of lung maturation -- and that's missed if the mother never goes into labor.

[Why Every Week of Pregnancy Counts] Gail Zuniga/WSJ

"We don't have a magic ball to predict which babies might have problems," says Dr. Cole. "But we can say that the more before 39 weeks a baby is delivered, the more likely that one or more complications will occur."

In cases where there are medical reasons to deliver a baby early, lung maturation can be determined with amniocentesis -- using a long needle to withdraw fluid from inside the uterus. But that can cause infection, bleeding or a leak or fetal distress, which could require an emergency c-section.

Trying to determine maturity by the size of the fetus can also be problematic. Babies of mothers with gestational diabetes are often very large for their age, but even less developed for their age than normal-size babies.

Growing beyond 42 weeks can also pose problems, since the placenta deteriorates and can't sustain the growing baby.

Making families aware of the risks of delivering early makes a big difference. In Utah, where 27% of elective deliveries in 1999 took place before the 39th week, a major awareness campaign has reduced that to less than 5%. At two St. Louis hospitals that send premature babies to Dr. Cole's neonatal intensive-care unit, obstetricians now ask couples who want to schedule a delivery before 39 weeks to sign a consent form acknowledging the risks. At that point, many wait for nature to take its course, says Dr. Cole.

See original article at: http://online.wsj.com/article/SB122999215427128537.html


3/6/09

If only...

all women could get to "that place" of peace during labor.

This video gives me shivers, it is so beautiful. She has 2 strong contractions during this.


3/3/09

It's hard to get off the soapbox sometimes...

I mailed in my check for my Doula training course in March, I am so excited! I have recently also become a member of DACO (Doula Association of Central Oklahoma) http://www.dacoinc.org/.

I am reading several books at the moment, taking notes, studying, trying to fill my mind with birth knowledge so that I may pass it on to pregnant women, and to be a advocate for women all over who want a better birthing experience.

We have alarmingly high Cesarean rates, we hold the 2nd highest infant mortality rates in the developed world, we lack informed consent when the"Its for the safety of the baby" Dr. based fear mongering exists to justify unnecessary interventions (I.E.: inducement, rupturing of membranes, unwarranted cesareans, the list goes on...)

I want to help educate women about their birth choices so that they don't fall victim to the system. This country's health system convinces it's pregnant women that they are sick, and the average pregnant woman is not sick! Birth is not a medical crisis!

Don't get me wrong, OB's play a very important role in delivering high risk babies, and for those situations they are skilled super surgeons trained to save lives.

I'm stepping down from my soapbox because I do want all women regardless of their birth choices to feel welcome on my blog and if you don't agree with my thoughts on birth and pregnancy, that's perfectly okay with me. :)

I want whatever is best for the the mother, regardless of her birth choices (a hospital birth vs. home birth, doctor vs. midwife, drug-free vs. epidural, vaginal vs. cesarean) I will treat her as I would anyone, with love and service in a non-judging environment.

As a woman and as a mom, I have strong opinions about these topics because I have been a first hand witness to the birth trauma and negative side effects of unnecessary birth intervention and of course I have my own personal beliefs (as we all do).

As a doula, however I have to remember it's not my place to judge the women's birth decisions, just to educate her about her birth choices and to serve her during birth/postpartum.

If you haven't seen this yet, please watch:

The Business of Being Born
http://www.thebusinessofbeingborn.com/


Homebirth Facts No One's Telling You

Author - Maryn Leister

Chances are you have never heard the truth about why homebirth is a safer choice for low-risk pregnancies. And if you're not newly pregnant, it is never to late to consider your options and give birth to your baby at home.

"The first intervention in natural childbirth is the one that a healthy woman does herself when she walks out the front door of her own home in labour."— Michael Rosenthal, OB/GYN (from Midwifery Today E-news 7:24)

1. In studies comparing home vs. hospital births. homebirths supervised by a “trained attendant” indicate fewer deaths, injuries and infections. Respiratory distress in newborns was 17 times higher in the hospital than at home. (1)

2. The US has the highest obstetrical intervention rates of any country. (1) The US is currently ranked 28th for infant mortality (that means 27 other countries have a better rate of infant survival than we do). (5, 33)

3. The superior outcomes seen in homebirths are not because the women are at lower risk or in any way special or different from women planning hospital births. (2)

4. You are very likely to have a c-section if you chose a hospital birth. The WHO concluded that there is no reason for any region of the world to have a cesarean rate of more than 10-15%. As of 2004, the US has a 29.1% c-section rate. This rate is up from 27.6% in 2003. (2, 20) (3) C-section infants also are four times more likely to die than those born vaginally. (5, 31)

5. The newest study, done in 2005 and published in the British Medical Journal showed homebirth with a CPM (Certified Professional Midwife) to be as safe as hospital birth. The rates of medical intervention at home were lower, and the study showed a high satisfaction rate for mothers. (4)

6. The vast majority of woman are 2 to 6 more times likely to die if their babies are delivered in the hospital. (5, 25)

7. If your baby is born at home with a midwife, instead of in a hospital with an OB, he is six times more likely to survive his first year. (5, 29)

8. The longer your second stage of labor, the more likely you are in to receive a c-section when at the hospital. At home, there will likely be no time limit on your pushing stage unless there is a real problem. (5, 46)

9. When your birth is attended by a midwife, your chances of hemorrhaging and/or continuing to hemorrhage are significantly reduced. (5, 58)

10. A study published in the November 2003 of The Lancet found that c-sections double the rate of stillbirth before labor begins, in women who have had a previous c-section (and most likely a hospital birth). (5, 105)

Sources:

1. From Is Homebirth for you? 6 Myths about Childbirth Exposed http://www.gentlebirth.org/format/myths.html
2. Goer, Henci. The Thinking Woman's Guide to a Better Birth.
3. ICAN (International Cesarean Awareness Network) http://www.ican-online.org/
4. http://www.mana.org/CPM2000.html
5. Doubleday, Jock. Spontaneous Creation: 101 Reasons Not to Have Your Baby In the Hospital (e-book available at spontaneouscreation.org)

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