Wednesday, August 3, 2016

UnBreaking Birth

I recently watched this video "UnBreaking Birth" - a lecture by Ryan McAllister. It is basically a version of the lecture I have given a couple of times as a guest lecturer undergraduate women's/sexual health classes.

"How you're born affects the rest of your life, and can affect the rest of your mother's life, too"

"There are a host of values at play beyond safety"

He says our birth care system is broken for at least 4 reasons:
  1. There isn't a sufficient amount of space and time to build an adequate relationship between the mother and the caregivers
  2. Our interventions have become routine, instead of based on the mom and baby's best interests
  3. Those interventions are often opinion-based
  4. There are conflicts of obligation within the hospital that systematically cause behavior that is out of alignment with the mom and baby's best needs

"Even when they know that practicing a different way would be better for their clients, they have some reason to practice differently. That means that there are conflicts of obligation in the hospital. At times, when the hospital's best interest is over here, and the patient's best interest would mean you behave this way, the hospital's best interest wins."



"Obstetrics has been organized around handling high-risk, emergency surgical births. and they may do this well. But treating all births this way actually derails well-birth, which is the vast majority of births. So I think we need to keep the good of this system and pair it with another approach that doesn't break well-birth."
"How could we possibly find or create highly trained experienced professionals who have evidence based practices, who work within a strong relationship wit h the mother, compassion for newborns, and don't experience conflicts of obligation with a large institution?... Those practitioners already exist. They are independent midwives."

The video does not have ALL of the information on the topic, but is a nice overview for consumers. It covers:
  • Why birth is broken (evidence that we spend more on maternity care in the U.S. but have worse outcomes; evidence that c-sections are too high and it is not caused by women being in worse health)
  • The 4 reasons he believes our maternity care system is broken 
  • A system that would work better for well-birth (certified professional midwives, birth centers)
  • What YOU can do to help improve the system
This would be a great video to share in a class, because it is only 32 minutes long.

"Being aware of and making available these other options, especially independent midwives, but also including other birth assistants such as doulas, is key to unbreaking birth in the U.S."


I like the way the UnBreaking Birth says about the indicators that we have a serious problem. It is basically a run-down of why I do what I do as a public health professional and a doula/childbirth educator:
  • there are terrible health disparities by race and socioeconomic status
  • infant and maternal mortality rates are higher than in 45 other nations
  • the maternal mortality rate has risen every year since 1995 while in most other countries it has decreased
  • only 25% of obstetric practice guidelines are based on good scientific evidence, many are overtly contra-indicated
  • common hospital policies are not in the best interest of moms and babies
  • and we spend more than any other nation on healthcare
  • Friday, July 29, 2016

    We Make Plans and Babies Don't Follow Them

    That moment when you're headed to your first doula prenatal visit with a first time mom who is 35 weeks, and she calls you and says "So, it has been an interesting day... My water broke and I'm being admitted. Do you want to make your way to the hospital instead of my house?"

    ....WHAT!?

    Luckily, despite our not having spent much time together, this mama was very calm and collected. And funny. I explained that she should do nipple stimulation to get contractions going (and avoid pitocin), I said "I know it feels weird to get sexy right now, but as they say, sometimes 'what gets baby in gets baby out'!" And she replied, "Maybe we shouldn't have had sex this morning!" And we both laughed.

    Did you know BabyCentre UK has a bunch of safe sex positions for pregnancy images? Now I do!


    I was nervous about a preterm baby, and any changes this might cause to the labor management plan, but everything turned out great. We did end up with pitocin to start contractions but mom labored with no pain meds and pushed her baby out in 6 quick hours.

    It was one of those labors where I left work, doula-ed all night, and then returned to work in the morning, with no one realizing that while they slept and went about their routine, I was having an extraordinary night!



    You learn something new every birth:

    • The doctor told the mom that she couldn't start with cervidil instead of pitocin because her membranes had ruptured. 
    • The nurse said the mom could use nitrous oxide during pushing if she wanted it (which she didn't). I've never seen it used during pushing. I feel like that would be hard to do both!
    • I've never heard a nurse so insistent on the use of drugs for stitch repair on a non-epidural mom. She said mom could use the nitrous during stitch repair, but she couldn't hold her baby. Mom declined. She then told her she could give her stadol in her IV, and didn't even tell her the pros and cons. I said "that will make her loopy, right?" the nurse finally said, "yes." Mom agreed and regretted her decision when she felt totally out of it and couldn't do anything about it for an hour. 

    Tuesday, January 19, 2016

    Disposable Vs. Reusable Diapers

    Did you know?

    In the U.S. nearly four million babies are born every year. Each of those babies is likely to use up to 8,000 throwaway diapers before they are potty trained.

    By 2012 the number of disposable diapers disposed of in landfills soared to a staggering 3,590,000 tons. It will take 500 years for these diapers to biodegrade.

    This environmental argument doesn't always impact us when we're thinking of whether we should use disposable or reusable (e.g. cloth) diapers on our babies. Most likely we think, "what will be the most efficient for me?" Time, cost, and convenience all come into play when we make decisions, especially as stressed new parents!

    Check out these informative infographics below, which cover the pros and cons, as well as some tips if you're considering giving cloth diapers a try.


    (click to enlarge)
    https://www.fix.com/blog/green-diaper-guide/


    (click to enlarge)


    https://www.fix.com/blog/green-diaper-guide/


    The environmental impact is just one factor, but one we should consider. For the children we are diapering are going to grow up into a world where there are millions of diapers not quickly biodegrading around them.



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