6/30/10

Happy Birth Day Owen!

Birth Notes from the Doula’s Perspective
Pictures posted with permission

It was April 22ndth and you were 40 weeks and 2 days pregnant. This birth would be a planned homebirth. You called me around 9:30am to let me know contractions had started a few hours earlier and were about 5 minutes apart and mild. You decide to try and rest a bit because you weren’t sure that you were in active labor. You’d thought maybe you had been having contractions the night before but you thought it may have been a dream so you went back to sleep. It wasn’t long before your husband called me at 10:30am to let me know that contractions were getting closer and he said that you were focusing through them; I assured you I would be at your home shortly. I arrive at your home at about 11:00am and the homebirth midwife arrives shortly after. I come in the house to see you standing in the bathroom; your face rosy and warm as you close your eyes during contractions. You mention that you don’t know what is going on with your body, that you were not expecting labor to progress this quickly. I hug you and remind you that no matter how much we prepare, we still have to be open to the unique labor we are given. I also remind you how amazing you are doing! Shortly after, you are assessed by the midwife and found to be 7-8cm! You can’t believe it! Your body naturally relaxes with each contraction and you rest in the bed for several contractions. Your family arrives and your daughter  greets the room with love and curiosity when she asks “What’s mommy doing?” I smile and say “She’s having a baby!”

As the birth pool is being filled with water, you walk around the house for a few contractions. You rotate between rocking your hips and leaning on me. You breathe with purpose; each breath is long and smooth as you take in plenty of oxygen for your baby.  Because you hadn’t had much to eat you snack on some orange jello and water. Upon entering the birth pool you quickly respond with “Why didn’t I get in here sooner?” and we all giggle because we had been encouraging you to try the tub for a while. You were able to relax even deeper in the birth pool, allowing your body’s natural painkillers to do their job. Your husband and I take turns sitting behind you supporting your arms; I get you cold washcloths for your forehead and massage your hand.

You mention more pressure and start bearing down a bit, pushing softly with contractions. You aren’t sure that you really have the urge to push so you decide to relax for several contractions to see if the pressure intensifies. An hour or so later, the midwife encourages you to stand for a while and let gravity help you, you do that and then you sit on the birth stool to push on a few contractions. You start a feel a little doubt creep in; you say “It feels like I am not doing something right?” The midwife and I assure you that you are doing everything right because you are listening to your body! You push for a while longer and get back in the birth pool on your knees leaning over the edge, where your water breaks. Immediately, you feel a stronger urge to push and within a few contractions your baby emerges into the water as you reach down to catch your baby on your own.

You put your baby on your chest and say with the proudest joy “I did!” With your husband at your side, both of you overwhelmed with joyful tears, you both can’t take your eyes of your baby. You didn’t know if you were having a boy or a girl (although your daughter Orianna seemed to think it was a boy) So you reach down and look to see, and you both say with delight “It’s a boy!”  Owen weighed 10lbs 4oz!

“Happy Birth Day Owen!”

This birth was filled with so much faith and strength! Congratulations! You did amazing! I'm sure I left something out, as birth brings so many magical moments. The official birth story belongs to you.  Thank you for inviting me to be part of something so sacred.

With love,
Taryn Goodwin, CD(DONA)




6/24/10

What does a placenta look like?

See the video below for pictures of the human placenta. Please don't watch if you don't want to see it or feel you will be "grossed out". Video created by: http://confidentbeginnings.com/


For more information on placenta encapsulation visit my website at: www.spiriteddoula.com

6/17/10

Is foreskin a birth defect?




I am used to treading very softly around this topic because I know that some of my dear friends and clients choose to circumcise their boys. This is not an article directed at you.  I know that my clients and friends will make decisions that I wouldn't make and visa versa, that doesn't mean I don't support them wholeheartedly, rest assured that I do.


It is my hope that this post helps someone who wants to learn about the history of circumcision and some of the common myths surrounding it. 


I will also show what the procedure looks like so that parents looking for information will have the chance to make a informed decision.


First, lets dispel the common myths behind circumcision by looking at a fact sheet adapted from a presentation of the Pennsylvania chapter of The National Organization of Circumcision Information Resource Centers.


Myth #1: Circumcision is recommended by doctors and medical organizations
Fact: Circumcision is not recommended by any national medical association in the world. Fifteen national and international medical associations have extensively studied infant circumcision and its effects and found no significant evidence to support this practice.  In March 1999, the American Academy of Pediatrics (AAP) concluded that infant circumcision is not recommended as a routine procedure.1  The circumcision policy statements of the American Medical Association (AMA) and the American Academy of Family Physicians have concurred with this position.2-3  The AMA calls infant circumcision “non-therapeutic.” 


Myth #2: It’s just a little piece of skin, he won’t miss it. 
Fact: The prepuce (foreskin) makes up as much as half of the skin system of the penis.4  It is an extension of the shaft skin that folds over onto itself, completely covering and protecting the glans (an internal organ) and provides the mobility of the shaft skin necessary for frictionless intercourse and masturbation.  The foreskin has three known functions: protective, immunological, and sexual.  It contains about 10,000 highly specialized nerve endings and several feet of blood vessels.  An adult male foreskin, if unfolded and spread out, would be about the size of index card (3 x 5 inches), much more than a “little piece of skin.” Many sexually active men circumcised in adulthood report a significant decrease in sexual pleasure and comfort because of the loss of sensitive nerve endings, skin mobility and natural lubrication.


Myth #3: The care of a circumcised penis is easier than an intact penis. 
Fact: For the care of an intact penis, the AAP recommends, “Leave it alone.” 5  No special care is required – an intact child should have the external surface of his penis (and the rest of his body) washed regularly to keep clean.  When a male is older and can retract his foreskin (which typically occurs by puberty), a simple rinsing is all that is necessary. 6  Other cultural myths about special cleaning procedures are just that – myth.


Myth #4: Circumcision protects males from urinary tract infections.   
Fact: Overall, urinary tract infections (UTI) occur at about the same rate in male and female infants during the first six months of life.7  Regardless of circumcision status, infants who present with their first UTI at 6 months (or less) are likely to have an underlying genitouninary abnormality.  In children with a normal underlying anatomy, a study found as many circumcised infants with a UTI as those who retained their foreskin.8  The appropriate treatment for UTI, in males as well as females, is antibiotics, not prophylactic excision of the prepuce.  According to the AAP, “Urinary tract infections are usually not life threatening and are easily treated in most cases.”  Breastfeeding provides some measure of protection against UTI during the first six months of life.9


Myth #5: Circumcision is effective in the prevention of penile cancer.
Fact: "The American Cancer Society does not consider routine circumcision to be a valid or effective measure to prevent such cancers... Penile cancer is an extremely rare condition, affecting one in 200,000 men... Perpetrating the mistaken belief that circumcision prevents cancer is inappropriate.'' 10 The American Medical Association, in a July 2000 report, states, “… because this disease [penile cancer] is rare and occurs later in life, the use of circumcision as a preventive practice is not justified.” 2


Myth #6: Almost everyone is circumcised…I don’t want my son to be teased in the locker room.   
Fact:  The circumcision rate for males worldwide is about 15%.  Even in the US, the only country that circumcises a majority of its male newborns for non-religious reasons, the circumcision rate is decreasing.  According the National Center for Health Statistics, the US circumcision rate is approximately 60% (varies widely by region) and slowly decreasing. According to many intact males, the “teasing” concern is vastly overstated.  For many boys, genital status is neither an important issue nor one that is discussed.  In the unlikely event of concerns later in life, at least the person can make his own decision about an irreversible body alteration that has no medical justification. 


Myth #7: Circumcision is a simple and painless procedure… it only takes a few minutes.
Fact:  While circumcision is a relatively quick procedure, it is extremely painful for the infant.  The initial part of the process involves a forced separation of the foreskin, which is fused to the glans (head) in much the same way as a fingernail is joined to the finger.  The AAP says the following about EMLA cream, one of the most common pain relief methods, “The analgesic effect is limited during the phases associated with extensive tissue trauma…1   Which means that the EMLA cream that babies get to numb the penis isn't effective at relieving all the pain, not to mention the baby is urinating on a open wound for several weeks. Although they cannot remember the pain as adults, circumcised male infants have increased pain response in vaccinations 4 to 6 months later.11  Circumcision appears to lower the pain threshold. 


Myth #8: Circumcision makes the penis cleaner and more hygienic. 
Fact:  Eyes without eyelids would not be cleaner; neither would a penis without its foreskin. The artificially externalized glans of the circumcised penis are constantly exposed to abrasion and dirt, making the circumcised penis, in fact, more unclean. The loss of the protective foreskin leaves the urinary tract vulnerable to invasion by bacterial and viral pathogens. Circumcision removes the protective portion of mobile shaft skin, which is intended to cover the glans (head) of the penis.  The glans is the internal portion of genitalia (for both genders).  Circumcision artificially exposes and denudes this highly sensitive tissue, resulting in a buildup of keratin and a dry, desensitized part of the penis.  And contrary to popular myth, more sensation does not lead to control problems.  Based on reports from men circumcised as adults, just the opposite is true.  With more sensation, a man has better feedback and can better determine his proximity to the “orgasmic threshold.”   


Myth #9: Circumcision prevents AIDS and other sexually transmitted diseases (STDs). 
Fact:  Some studies show that circumcision has a slight preventive effect for AIDS and some STDs; however, other studies show an insignificant or opposite effect, especially for chlamydia.  The bottom line: sexual practices have a much greater effect on the chance of becoming infected than circumcision status.  If someone acts on the misconception that circumcision alone will protect them, they are taking unwise chances.  


Myth #10: The history of non-religious circumcision is based on disease prevention.
Fact:  Non-ritual circumcision evolved from a misunderstanding of bodily function by physicians of the late-19th century.12  Many doctors of that era believed that a normal foreskin could cause disease and lead to increased incidence of “self-abuse.”  John Harvey Kellogg, of cereal fame, was a proponent of genital cutting as a cure for this “horrible practice.”  He recommended performing circumcision “without administering an anesthetic, as the pain attending the operation will have a salutary [health-giving] effect upon the mind, especially if connected with the idea of punishment.”     


References:
1.  American Academy of Pediatrics, Circumcision Policy Statement  - March 1, 1999
2.  American Medical Association, Report 10 of the Council on Scientific Affairs (I-99), July 6, 2000
3.  American Academy of Family Physicians, Position Paper on Neonatal Circumcision, February 14, 2002
4.  Cold CJ, Taylor J. The prepuce. BJU Int 1999; 83:34-44
5.  American Academy of Pediatrics pamphlet. Newborns: Care of the Uncircumcised Penis – Guidelines for Parents. 1990
6. CIRP: Normal development of the prepuce: Birth through age 18.www.cirp.org/library/normal/
7. Marild S, Jodal U.  Incidence rate of symptomatic urinary tract infection in children under 6 years of age.  Acta Paediatrica 1998;87:549-52
8. Mueller E, Steinhardt G, Naseer S.  The Incidence of Genitourinary Abnormalities in Circumcised and Uncircumcised Boys Presenting with an Initial Urinary Tract Infection by 6 Months of Age.  Pediatrics 1997;100(supplement):580
9. Pisacane A, Graziano L, Mazzarella G, Scarpellino B, Zona G.  Breast-feeding and urinary tract infection.  Pediatrics 1992;120:87-89
10.  Letter from the American Cancer Society (National Home Office) to the American Academy of Pediatrics, 16 Feb 1996
11. Taddio A, Katz J, Ilersich A, Koren G. Effect of Neonatal Circumcision on Pain Response During Subsequent Routine Vaccination. Lancet 1997;349:599-603.
12. Gollaher D. Circumcision: A History of the World’s Most Controversial Surgery, New York, Basic Books, 2000


Next, I encourage you to look at the history of circumcision. 


Also, for anyone interested here is a great forum for mothers who regret their decision to circumcise their son(s).

Lastly, I will leave you with a few videos. Everyone who wants to circumcise should see what the procedure looks like before they consent...

Another video:


6/2/10

Doulas are only for those “crunchy granola eating, birkenstock wearing mamas” and other myths!



I am often surprised when I talk to people about doulas. It seems that there are several misconceptions about what a doula's role is in the birth. Hopefully, todays blog post will help debunk some of those myths! 


Myth: A doula will "take over" the role of the partner.
Truth: A doula is there to enhance the relationships between the hospital staff, the laboring couple and others present. Often times the partner will become more involved with a doula present.  As Penny Simkin, P.T. states "While the doula probably knows more than the partner about birth, hospitals and maternity care, the partner knows more about the woman's personality, likes and dislikes, and needs. Moreover, he or she loves the woman more than anyone else there. A good doula will reinforce the fact that this is your birth, not hers.  She will strengthen the pair bond by instilling confidence in the partner and facilitating open communication between the couple and others present.

Myth: Doulas are only for those “crunchy granola eating, Birkenstock wearing mamas” that want natural childbirth and she wouldn’t support me if I choose medication. 
Truth: A doula recognizes that this is YOUR birth. She works for you. Her job is to ensure a satisfying birth experience as YOU define that. She is there to help you achieve the experience you desire. A doula will not make medical decisions for the laboring couple.  A doula will not judge a couple's decision to have pain relief.

Myth: A doula will leave if the mother gets an epidural.
Truth: There seems to be an urban legend of sorts about the doula who left as soon as the mom got an epidural. This is not usual. A doula is there to support the laboring woman with any decisions she makes. She still needs continuous support even with an epidural. The doula can give dad/partner a break to go get something to eat or to take a nap if it's been a particularly long labor. She can take pictures, get ice-chips, do hand massage or just sit quietly while the woman rests.

Myth: A doula has a negative opinion about a hospital setting.
Truth: A doula has the utmost respect for the lifesaving technology available for unexpected circumstances in a hospital.  While doulas have a strong belief in a woman's ability to birth her baby and always strive to ensure that the birthing process remains normal, doulas appreciate the judicious use of life saving technology when the situation becomes abnormal or complex.

Myth: Doulas only attend home births.
Truth: Doulas attend births at home, at the hospital and at birth centers. She will remain at home with the laboring woman until it is time to go to the hospital/birth center (where applicable). This can be very helpful as most women labor at home for several hours before going to the hospital. The fact is that the vast majority of women living in the United States birth in a hospital setting and therefore most of the births a doula attends are in the hospital.

Myth:
 A doula has her own 'birth agenda' and strives to make the couple follow it.
Truth: A good doula will help you formulate your own birth plan and then bend over backwards to follow it.

Myth: I don't need a doula, that’s what the nurse is for.
Truth: The reality is that the typical labor and delivery nurse in the hospital has multiple patients. She is required to keep extensive records on all of her patients at the same time. In fact, one study showed that only about 10% of the nurse's time was spent supporting the laboring woman with her physical or emotional needs. Doulas do not work in shifts or have multiple patients. They care for the individual needs of the mother and stay with her until the baby is born. Not only that, but the birth doula is not a stranger to the mother and therefore she can act as a familiar guide through the long and often challenging hours of labor. A doula does not perform clinical skills, is not encumbered by hospital procedures, and is not overwhelmed by caring for several women at the same time. She is the only member of the maternity care team who is focused completely on the mother's well being and will remain with the woman constantly from the beginning of labor to the end. 

Myth
: If you've met one doula, you've met them all.
Truth: Maybe you've met one doula and didn't click, or you found that her birth philosophy wasn't in line with yours. Even though every certified doula abides by the certifying body's 'scope of practice', each doula is unique. It is important to interview several doulas to find someone whose philosophy, personality and areas of specialty most closely meet your needs. 

Myth: I have a midwife, I won’t need a doula too. 
Truth: Midwives do provide wonderful, personalized care, but they sometimes have to be more involved with the clinical aspect of your delivery and may sometimes have to leave your side. Having a doula as well, ensures that you will have personalized care on the clinical, physical aspects of delivery, and personalized care from a doula who’s sole focus is on your well being and feelings about what is happening.

Myth: A doula will intrude on this intimate, private family moment.
Truth: Labor and delivery rooms can become very chaotic places with many people you don’t know running in and out. Doulas are often called "guardians of the space". A doula can can act as a guard on your privacy and facilitating communication between you and your caregivers so there is less need to check in on you unnecessarily. She can help you maintain a private, soothing atmosphere. A doula can also preserve your memories of these intimate moments by documenting them for you by taking photographs and/or birth notes.

Myth: We’ve been to a childbirth class, we’ve practiced our breathing, I know what to do.
Truth: 
When labor actually gets going it is very hard to remember everything you learned in class. Things may happen that you don’t understand. A doula understands the physiology of childbirth, she knows medical lingo and she knows ways to make labor easier and shorter. Having a doula with you is like taking your childbirth educator to the delivery room!

Myth: A doula is a stranger, I won’t be able to relax and be myself in front of her.
Truth: Doulas take the time to get to know their clients personally before labor ever begins. By meeting you in your home and answering questions, as well as providing loving touches in her prenatal care, a doula ensures that by the time you arrive in the delivery room, she will be the most familiar, comforting face you’ll see there.

Myth: The medical staff will automatically respect all my wishes. 
Truth: Unlike a doula, they don’t work solely for you. There are many factors and routines that shape the medical care you receive in a hospital. Many times it is simpler for your hospital to follow standard procedure than to work with each individual birthing mom on their preferences regarding her options for childbirth.

Myth: A doula will interfere with medical advice.
Truth: A doula will not interfere with medical advice. She facilitates communication between all involved and encourages the couple to ask relevant questions so they can make informed choices. Doulas do not make decisions for their clients and doulas DO NOT offer medical advice. 

Myth: I have already had a baby, I know what to expect. 
Truth: Each pregnancy and childbirth comes with its own set of unique circumstances and issues. A mom who has already been through the process would especially benefit from the help of a doula because she knows from experience what she wants or doesn’t want this time and a doula can help her accomplish her goals. (This can be especially helpful if mom is having a VBAC (Vaginal Birth After C-section).

Myth: I can’t afford a doula. 
Truth: Doulas fees vary from area to area and based on experience, may vary from doula to doula. With a little research and questioning you can find a doula in your price range. Also, many doulas in training offer their services for very little. If you have asked around and price is still a problem, many doulas can help you file for reimbursement through your insurance company. With the rising popularity of doula assisted births and the amazing statistics on how doulas can actually lower the cost of your childbirth, many insurance companies are getting on board. If you are still having trouble affording your doula, talk with her. In the spirit of encouraging doula supported birth most doulas will work out a financial plan with you that works best for everyone.

Myth
: A doula shows up for the labor and birth then leaves.
Truth: Doulas strive to provide "continuity of care".  This means the doula forms a relationship with the mother and her partner during pregnancy, cares for the couple during labor and birth, then provides follow up care to ensure that the mother, father and baby have adjusted to their new roles and their new environment.  Part of the doula's responsibility is to the facilitate uninterrupted bonding time between baby and parents and to ensure that if a mother intends to breastfeed that she is able to do so. Additionally, most doulas offer at least one postpartum visit.

Despite the numerous studies in the last 25 years that have clearly demonstrated the value of a birth doula during the process of childbirth, there is still some negativity surrounding this profession. Help me spread the truth! Doula care is about  helping to empower the woman to have a safe and satisfying birth experience as she defines it.

Some of the evidence has even shown that fewer mothers ask for 
medication or require medical intervention such as the use of pitocin to induce or speed up labor. Mothers who use doulas are more likely to have shorter labors and fewer cesareans compared to mothers who did not have a doula. Mothers also tend to breastfeed their babies longer and have a more satisfying birth experience if they have used a doula. In fact, a recent survey indicated that mothers gave the doulas the "highest rating" for the best supportive care over any other member of the birth team including nurses, doctors and nurse-midwives.




Some myths adapted from: 
http://www.mother-care.ca/doula_myths.htm
http://www.savannahdoula.com/Doula_Myths.html
http://birthing-options.suite101.com/article.cfm/top_reasons_to_hire_a_doula

Search This Blog