Sunday, November 29, 2009

C-section Rate Rises in U.S.

The CDC’s National Center for Health Statistics reported its findings of its analysis of nearly 99 percent of all birth records reported by 50 states, the District of Columbia, and U.S. territories.

Of the record 4,317,119 babies born in 2007, 1,372,844 were delivered via Cesarean section. 

The c-section rate rose 2 percent in 2007, to 31.8 percent, marking the 11th consecutive year of increase and another record high for the United States according to the CDC.


Births: Preliminary Data for 2007


Thursday, November 26, 2009

Breast Milk Contains Stem Cells!

“We already know how breast milk provides for the baby’s nutritional needs, but we are only just beginning to understand that it probably performs many other functions,” says Dr Cregan, a molecular biologist at The University of Western Australia.

Read the article here: Breast Milk Contains Stem Cells

Wednesday, November 25, 2009

Narcotics given during Childbirth

Think about it.

An Epidural is actually a mixture of anesthetic medications (like lidocaine or chloroprocaine) and narcotics (like Demerol or morphine). An epidural is administered through a catheter. This catheter is inserted in your back into the space surrounding the outside membrane of your spine.

Like the epidural, the Spinal block is a mixture of anesthetic medications and narcotics. It is administered during the active stages of labor or just prior to a C-section. The spinal block works immediately to relieve pain as the medication is injected directly into the fluid in your spinal column.

Demerol is a popular choice for pain relief during labor. Demerol alters how you recognize the pain you are experiencing by binding to the receptors found in your central nervous system. Demerol can cause drowsiness, nausea, vomiting, respiratory depression, and maternal hypertension (low blood pressure). If injected within five hours of delivery, Demerol has been found to cause breathing difficulties in babies.

Stadol has been found to relieve pain when given in the first stage of labor. This narcotic is also considered more potent than morphine and Demerol. It is usually given intravenously in small doses, usually 1 to 2 mg. Stadol can cause the mother to have respiratory depression and a dysphoric reaction (a state of feeling well and unhappy).

Fentanyl is a synthetic narcotic similar to Morphine or Demerol and provides moderate to mild sedation.  Intrathecal Fentanyl is the placement of fentanyl, into the fluid surrounding the spinal cord. This is different from an epidural in which medication is placed into the epidural space. Intrathecal Fentanyl is a one-time injection into the spinal column similar to an epidural.


 --> Narcotics dull pain.  Think about if you injure yourself while you're drunk, the pain will be dulled, but like alcohol, can make you loopy, out-of-it, nauseated, and even cause hallucinations.

--> You spend your entire pregnancy not putting anything even minorly possibly dangerous into your body for fear of harming your child, and then in the final hours preceding the child's birth you pump yourself up with NARCOTIC DRUGS?! think about it.

Tuesday, November 24, 2009

The Same Hormones are present in a woman during

orgasm

birth


breastfeeding

Monday, November 23, 2009

Ring of Fire

The Ring of Fire, also called the Rim of Fire, occurs when the baby's head is coming out of the vaginal opening and does not recede (Crowning stage).  During this stage the perineal tissue is stretching the most. This stage is characterized by an intense burning sensation known as the ring of fire.

At this point women are anxious to keep pushing and "just get the baby out," but the best course of action would be to allow the tissue to stretch and expand slowly, in an attempt to prevent too much tearing.

Other methods of coping with the rim of fire are any type of perineum stretching during pregnancy, such as perineal massage or the EPI-NO.

Some women feel this with every birth and some have it at one birth but not another. Some women don’t feel it at all.  To be prepared, one can learn to relax through the stretching/pressure/burning of the moment by preparing with the above-noted methods.


Kathy at Woman to Woman Childbirth Education describes how it feels:
"Open your mouth as wide as you can and hold it. Now, put your fingers in the corners of your mouth and pull your mouth wider until you feel stretching or burning. Now, imagine that at your vaginal opening. That is similar to what you might feel when your baby is born."

Pain in Childbirth Pt. 2

The Most Common Causes of Pain in Childbirth 
from The Epidural Express by Nancy Griffin, M.A., AAHCC

 
     Pain occurs during a normal vaginal birth for basically three reasons. It can happen during transition, which is simply the most cervical dilation in the shortest period of time. Nature, however, makes the most painful period also the shortest. A typical transition rarely lasts more than about 15 minutes. If the labouring mother is told that she is in transition, and knows that she is almost through, she may be able to continue with out an epidural. If she were to have an epidural during transition, she would have to remain curled up on her side with a needle in her back, without moving, and would not receive any pain relief for transition itself, as an epidural takes 20 to 30 minutes to become effective. She would then have the added risk during second-stage Labor of not being able to push as effectively. Most doctors will recommend against having an epidural this late in Labor for that very reason. The key to dealing with the pain of transition is to know it doesn't last for long, and to choose one position that feels right; to relax completely, surrendering to and trusting in the process. 

     Another reason for pain in a normal childbirth is back Labor. Most women experience contractions low and in the front, similar to a menstrual cramp. But when the baby is in a posterior presenting position (the baby is facing the mother's pubic bone), pressure can be more intense on the mother's lower back and even tailbone during contractions (however, this is not always the case). By getting on her hands and knees, which pulls the baby away from her back, and having her coach give her counter-pressure (an intense circular pressure with the fist into the painful spot), the birthing mother can effectively minimise back Labor. Also, walking and changing positions can help to rotate the baby out of the posterior position, relieving back Labor completely. 

     Crowning -- the point at which the baby emerges from the vagina during secondstage Labor -- can also cause pain. During this time, the mother's perineum (the skin and muscles between the rectum and vagina) are being stretched to their maximum. Again, nature makes the most difficult moments the shortest. Crowning rarely lasts longer than one to three pushes in an unmedicated birth. By choosing her own birthing position and avoiding the traditional hospital pushing positions, the mother can make crowning far less painful. Squatting widens the pelvic outlet by up to 28 percent in a pregnant woman and utilises gravity to assist the birth. By using effective pushing techniques learned in a good childbirth class, staying in good physical condition, doing Kegel exercises during pregnancy, and having her healthcare provider perform perineal massage or support during the birth, the mother can minimise the pain of crowning. 

     Other reasons for pain during childbirth are the result of abnormal Labor and birth complications. It is during these circumstances that we can be truly thankful for medical technology.

     Once women are educated about epidurals it becomes clear that avoiding one during childbirth may be well worth it to both mother and baby. Truly needing one, or deciding to have one as an informed choice at the time of the birth, on the other hand, need not leave the new mother feeling guilty.

 

Sunday, November 22, 2009

Pain in Childbirth Pt. 1

What causes pain in a normal childbirth?
from The Epidural Express by Nancy Griffin, M.A., AAHCC


    The main cause of pain in a normal childbirth is what Dr. Grantly DickRead (the "father" of modern natural childbirth) called the "Fear-Tension-Pain-Syndrome." Relaxation is the key to pregnancy, Labor, birthing, and breastfeeding. 

    Despite the fact that we have technology at our disposal, our biology provides us with powerful instincts during birth. The first is the need to feel safe and protected. All mammals will instinctively seek out a dark, secluded, quiet, and most of all, safe place in which to give birth. While birthing, mammals give the appearance of sleep and closed eyes to fool would-be predators, and they breathe normally. Some (those who don't perspire) will pant in order to cool down, but humans will most easily achieve a relaxed state through closed eyes and abdominal breathing. This relaxation slows down the birthing mother's brain waves into what is called an alpha state, a state in which it is virtually impossible to release adrenaline, the "fright-flight" hormone. Physical comfort becomes critical, along with the need to have a "nest" ready for the baby. Hospital environments often unintentionally disrupt the birthing atmosphere by introducing bright lights, lots of people, noise, and fear-inducing exams and machines. Put it all together and you have fear, and therefore stress, and stress causes pain. 

     The uterine muscles are beautifully designed to deal quite effectively with danger, fear, and stress in Labor. The uterus is the only muscle in the body that contains within itself two, opposing muscle groups one to induce and continue Labor and another to stop Labor if the birthing mother is in danger or afraid. Emotional or physical stress will automatically signal danger to a birthing mammal. Her Labor will slow down or stop completely so that she can run to safety. In modern times, this goes haywire. We can't run from our fears -- which may include the "horror story" our best friend told us about her birth -- or even from our hospital or physician. Instead, we may release adrenaline, which causes the short, circular muscle fibres in the lower third of the uterus to contract. These muscles are responsible for stopping Labor by closing and tightening the cervix. The result is that we literally "stew" in our own adrenaline. At the same time that the long, straight muscle fibres of the uterus are contracting to efface and dilate the cervix, the short, circular muscle fibres of the lower uterus are also contracting to keep the cervix closed and "fight" the Labor. The result? The very real pain of two powerful muscles pulling in opposite directions each time the birthing mother has a contraction. 

    Anything causing fear in the birthing mother will increase her pain, a pain often described later as "Labor from hell." The constant presence of a loving, supportive, and trained Labor coach; effective education about the birthing process; and a physician and birthing environment the birthing mother can trust can make all the difference in the world. By learning to deeply relax mentally, physically, and emotionally; actively dealing with fears about birth; and choosing a birthing environment that feels safe and protective, birthing women will not have to experience the traumatic pain caused by the "Fear-Tension-Pain-Syndrome." In such a positive mental, physical, and emotional environment, Labor can feel very, very different. 

    Unnecessary or preventable pain can also be caused during Labor by simple things such as prohibiting the labouring mother from walking, changing positions, or moving around freely according to her instincts. Freedom of movement literally supports rotation and alignment, the process by which the baby turns and moves down through the pelvic inlet and outlet. Time-honoured traditions in birthing have always included walking, changing positions, rocking, and even floating in water. Anything that assists the rotation and alignment of the baby during Labor will automatically improve the efficiency of contractions, thereby shortening Labor and decreasing pain.

     Avoiding unnecessary medical interventions during Labor will decrease pain because these interventions (such as breaking the water, or using Pitocen) actually cause pain themselves, leading to routine epidurals. The use of these regular interventions interferes with the natural process of birth, which is inherently safe and effective. When the natural process is interfered with, pain is the result. How is it possible to know whether medical interventions are unnecessary? The answer is surprisingly simple. If both mother and baby are doing fine during Labor, they're unnecessary. 

    Proper and adequate nutrition during pregnancy and eating and drinking to appetite during Labor can also dramatically decrease pain. A uterus that did not receive adequate nutrients for growth to full-term size can be weak and ineffective during Labor. A weak uterine muscle working far beyond its capacity will result in painful contractions. Inadequate consumption of complex carbohydrates and water during Labor can result in dehydration and low blood sugar, both of which cause more painful and less effective contractions similar to the way a marathon runner "hits the wall." And yet, often hospitals or physicians order routine IVs and "nothing by mouth" once a labouring woman is admitted to the hospital, whether she is at risk or not. If the mother and baby are both healthy and low-risk and are doing well during birth, the mother may experience a less painful Labor by eating and drinking lightly, guided by her appetite and thirst. 

    A safe and effective exercise program during pregnancy should include aerobic conditioning, to provide the mother with needed endurance during Labor, as well as pregnancy-specific exercises to prepare her body physically for Labor. When the mother's body is strong and prepared, pain is decreased. She will have the strength and endurance for pushing in second-stage Labor, perhaps decreasing the length of the pushing stage, and thereby decreasing pain. Pregnancy-specific exercises include pelvic rocking, Kegel exercises, squatting for Labor, "tailor" sitting (sitting "Indian style" on the floor), and abductor-strengthening (legs apart) exercises. These exercises are taught in good prenatal exercise and childbirth classes and should be done every day during pregnancy.

Saturday, November 21, 2009

What an Induction Looks like


A portion of the original post Re-Blogged from Public Health Doula:
"I think the impression many women of an induction is that it's similar to regular labor, but you just get to pick your day. Let me be one of many doulas who can tell you: this is not the case!
When you start regular labor at term, it's because a complex set of signals and changes in your body say "This baby is ready; let's get it out." (One way to measure whether the body has begun preparing for labor is a Bishop's score.) When inducing labor, medical staff try to replace those natural signals and changes with manufactured ones: promoting cervical softening and dilation using prostaglandin gels or misoprostol (Cytotec), inducing contractions with artificial oxytocin (Pitocin).

As this cervical ripening and early dilation is generally the longest part of labor anyway, and is much less efficiently done by medications than by normal physiological processes, all of this takes a long time. Often by the time a woman in spontaneous labor would be showing up at the hospital (4-5 cms) you have already been in the hospital 12-24 hours, and still have a ways to go. You're also likely to experience a more intense, painful labor because induced contractions are different from natural contractions, so you're more likely to need pain medications."

True Reasons to Induce Labor:

1. Pre-Existing Maternal Health Conditions
2. Pre-Existing Baby Health Conditions

Friday, November 20, 2009

Cultural Beliefs about Pregnancy and Birth

Different cultures have varying beliefs about pregnancy, childbirth and women as mothers. I think the differences are fascinating, and I think what I'd love to do is compile all the cultural traditions together, like a Birth and Culture book for Doulas/Midwives/OBs/Birth Workers in general. Here is a smattering of a few interesting cultural pregnancy and birth traditions that I've been perusing online:

Turkish:
During Pregnancy -  
  • Not looking at bears, monkeys, and camels,
  • Not eating fish, rabbit, trotters or sheep’s’ heads, and not chewing gum,
  • Not attend funerals or looking at the deceased,
  • Not secretly taking and eating anything.  
  • Looking at the moon,
  • Looking at beautiful people,
  • Smelling roses,
  • Eating quinces, apples, green plums and grapes. 
During Birth -
  • Unfastening the woman’s hair,
  • Opening locked doors, chests and windows,
  • Feeding birds,
  • A woman who had earlier had an easy labor would rub the back of the pregnant woman,
  • Shooting in the air,
  • Putting the woman on someone’s back and shaking her,
  • Making the woman jump down from a high place,
  • Making the woman lie down on a piece of cloth and rocking her. 


Japanese:
During Pregnancy -
  • A diet of fish, tofu, soup, and fresh vegetables  
  • positive thinking, images, and music
During Birth -
  • Foods rich in protein and carbohydrates such as mochi and eggs 
  • Very little noise is to be made


Chinese:
During Pregnancy:
  • Working with glue or other adhesives may cause birthing complications and hammering nails is thought to cause deformity in the fetus
  • the use of foul language must be avoided as this may cause the baby to be cursed. So may torturing, striking or killing an animal
  • ‘sharp’ foods such as pineapple and some other fruits avoided as they may cause miscarriage. 
  • Eating squid and crab are discouraged: the former is believed to cause the uterus to ‘stick’ during delivery, the latter to result in a mischievous child 
After Birth -
  • Praise should never be given to or applied to a new-born Chinese baby as this may invite the attention of demons and ghosts: the baby, instead should be referred to with unfavourable terms and words! 
  • Mother is confined; she is not allowed to eat food considered ‘cold’ or have cold baths


 Orthodox Jewish:
 During Pregnancy -
  • Many women do not prepare for their babies or reveal the baby's name in advance for fear of tempting the angel of death
During Birth -
  • Women in labor are considered to be in mortal danger and is considered to be in this risk state up to 3 days after the baby is born
  • As soon as there is bloody discharge from the vagina the husband may not physically touch his wife until 7 days after all bleeding as stopped
  • the husband is not allowed to see the woman's genital area and will not watch the birth and he cannot touch the mother even once the baby is born, until she has ritually cleansed herself


Hispanic/Latino:
During Pregnancy -
  • unsatisfied pregnancy cravings cause birth marks; 
  • milk is avoided because it causes large babies and difficult births;
  • drinking chamomile tea is thought to assure effective labor; 
  • exposure of pregnant women to an eclipse will cause their infants to have a cleft lip or palate
  • some women wear a red string around their abdomen to prevent a cleft lip or palate
Birth -
  • inactivity will result in loss of amniotic fluid, causing fetus to stick to the uterus
  • new mothers are discouraged from taking showers for several days


Many of these are "folk beliefs," as in not everyone of this culture may follow all these traditions and customs, but they're still fun to read about!

EPI NO!

This is so cool. In our childbirth education workshop we learned about a new product that can help reduce the need for an episiotomy by preparing the pelvic floor/perineum for stretching when a baby is born - the EPI NO. Perineum massage is done with the hands and already has shown to help reduce tearing of the perineum during childbirth or the need for an episiotomy. 

Created by a German company, the EPI NO has been around in Europe for several years. It is now finally working its way into the US from Canada. Here is what the website has to say:
The EPI·NO birth training exercises are designed to gradually and gently stretch the vaginal muscles, increasing their elasticity, thus allowing the baby to pass with greater ease
You begin using the EPI-NO three weeks before your due date. You do daily 20 minute sessions with a small balloon that is inserted into the vagina. Then you gently inflate it with a hand pump, gradually increasing pressure over time.

According to the site:

EPI·NO is clinically proven to:

  • Reduce the incidence of an episiotomy or perineal tear from natural birth
  • Increase apgar score (rating for the health of a newborn)
  • Decrease the need for drugs during birth
  • Reduce the parturition phase of birth (resulting in less stress for the baby)
  • Reduce anxiety in the mother-to-be for a more enjoyable birth experience

In addition to the German doctors study, there was also an Australian study that confirmed results with the EPI NO.




There are numerous testimonials on the website, and I found a forum where women posted their experiences with it and liked some of the things they noted. One woman said it was difficult to learn to use at first, as her muscles kept squeezing it out on their own and she had to learn to breathe, but she said, "But I would highly recommend getting one. To get used to sensations, have an idea of what things will feel like, and to train my mind and body."


So even if its not perfect on reducing tearing, an EPI NO, or simply perineum massage, can help you prepare for the sensations that you will feel during childbirth. And hopefully once you recognize the sensations, you will be prepared to relax your body rather than tense up.



In case anyone reading is unaware, an episiotomy is a cut that the doctor or midwife makes in the perineum from the vaginal opening towards the rectum to enlarge the opening for the baby. This is painful, often unnecessary, takes longer to heal than a tear, and causes future problems such as incontinence. Additionally, I would like to note that if you tear with your first birth you are likely going to tear with subsequent births.

Thursday, November 19, 2009

Epidural with a Harrington Rod

Apparently, I probably couldn't have an epidural or a spinal during labor even if I wanted one!

This is because of the Harrington Rod I had fused to my spine when I was 14.

I was reading this post on The Unnecesarean and the woman's story included the fact that she had had a Harrington rod in her back for a severe spinal S curve and her OB wanted to make sure to induce her on a day that the anesthesiologist was in so he could numb her in case of any pain.

I remember when I was 14 and my mom asked my doctor if I would have any complications having children, and he said no. I remember thinking it was interesting that she asked, because at 14 I was so far from thinking about pregnancy and childbirth that it wouldn't have occurred to me until... well right now!

Anyway, I looked up harrington rods and childbirth and most people seem to say that, exactly as my doctor said, there are no problems with pregnancy or childbirth as a result of spinal fusion.
However, it is apparently quite difficult to place an epidural into the space near your spine where it needs to go because the epidural space may be gone completely.

It is not always entirely unsuccessful, as the doctors can maybe look at an X-ray of my back and view where they may be able to place it, or simply place it in certain locations that they know might work even with a rod in. The down side, if did decide to try for one, is that they may have to try several different locations along my spine, which sounds like an absolutely horrible and painful experience that I think I'd rather just avoid.

The second down side is that if I have to have an emergency C-section I would have to be under general anesthesia (instead of the anesthesia in the epidural which only numbs your lower half), and thusly would have to be asleep while my child was born and wait to nurse until the anesthesia left my system :-(

Tuesday, November 17, 2009

Doula Workshop: Preparation for Labor Support

Day 2:

Introduction to Labor Support
Prenatal Contact
Comfort Measures for Labor - Pt 1
DONA and the Professional Role of the Doula
Communication Skills with Clients and Caregivers
Emotional Support in First Stage of Labor
Emotional Support in Second Stage of Labor


Day 3:

Working with Difficult Labors
Cesarean and VBAC issues
Comfort Measures - Pt 2
Video of Laboring Mothers assisted by Doulas
Grief and Loss
Postnatal Visits and Postpartum Depression
Practice Situations for Doulas


I've been learning A LOT. More updates when its over!

Sunday, November 15, 2009

Doula Training Workshop begins tomorrow!

My Doula workshop begins tomorrow!

My first day will include only the people who have no professional background in the childbirth field, such as labor/delivery nursing, childbirth education or midwifery. It fulfills my Childbirth Education series requirement for certification. 

This is what I will be learning tomorrow!

Day One - Introductory Workshop:

Anatomy and Physiology of Pregnancy
Fetal Development during Pregnancy
Stages of Labor
Medical Interventions
Medications used in Labor
Basic Coping Techniques for Pain Management
Postpartum Adjustment

What is a Doula?

A Doula is a labor companion or birth partner.

The word "doula" comes from the ancient Greek meaning "a woman who serves" and is now used to refer to a trained and experienced professional who provides continuous physical, emotional and informational support to the mother before, during and just after birth.

A doula is with the laboring woman for the entire labor and delivery of her child.  The doula's expertise is in helping reduce anxiety, discomfort, and pain for the mother in labor.  She is there as much or as little as the laboring woman needs. She is there to help the mother stick to her desired Birth Plan, whatever that may entail, so that the woman may have the type of experience she wants.  She is an advocate of the mother's wishes and helps her stay informed of ongoing medical procedures.

A doula is not a doctor, nurse or midwife and is not trained to make any medical decisions. A doula's training helps her explain to the parents what happens during labor and delivery and helps relieve some of their uncertainties and anxieties. 

"Continuous support from a doula during labor provides physical and emotional benefits for mothers and health bonuses for their babies. With less medical interventions, fewer complications, and shorter hospital stays, there may be financial savings as well."(Harvard Health Letter)


There are long-term benefits of Doula support. A number of studies show that a doula's care can produce important benefits.
Doula's have been shown to improve a mother's ability to cope with the pain of labor and avoid pain medication or even reduce the length of labor, her postpartum emotional state, the way she perceives the health and attitude of her new baby, her success with breastfeeding, and perception of pain at twenty-four hours after birth. (Klaus, Kennell and Klaus)

A doula also meets the needs of fathers during labor and delivery.  A father may have the desire to help, participate and feel useful and important for the mother. It is difficult, at times, for a father to remain continuously calm and objective when he fears for the well-being of his loved-one. The father also has little experience with the birth process. A Doula helps the father to be less anxious and more helpful to the woman in labor. He is able to be there at his own comfort level. The birth of the baby should be a rewarding experience for the father as well as the mother.

Thursday, November 12, 2009

Home Birth vs. Birth Center

Last night Ren and I were chatting a little about hospital vs. home birth vs. birth center.  We were wondering if a birth center was a bit better than birthing at home but meant we didn't have to birth in a hospital either.

Rixa at Stand and Deliver wrote a post in response to a woman's query regarding the possibility of a birth center being built right across the street from a hospital. I liked her response so I'm reposting it below:

For me, a birth center is a less appealing option to me than a home birth. There isn't any inherent safety advantage of a freestanding birth center over a home birth, since the same equipment will usually be present in each setting (Doppler for intermittent monitoring, O2, IVs for dehydration/hemorrhage, antihemorrhagic meds, adult and neonatal resuscitation equipment, etc.) I'd much rather be in my own turf, rather than be at the mercy of an institution's rules, restrictions, or protocols. Of course birth center rules/protocols aren't anything like a hospital's, but still, it's not your house and you are the guest in someone else's territory. If I am going to get into a car and go somewhere else during labor, there better be a darn good reason for it--i.e., I need medical attention in a hospital setting.

On the other hand, someone else might choose a birth center over a home birth for a number of different reasons. Perhaps they just feel safer birthing in an institution/going somewhere to give birth, rather than staying in their own house. Perhaps they don't have a nice or safe home environment and the birth center is really awesome and luxurious and has a great labor tub. Perhaps they live too far away from their backup hospital for their own personal comfort (for some women, this might be 30 minutes, for others, 1 hour) but the birth center is right across the street from the hospital (her ideal scenario, which I definitely can see the appeal of; I mean, if you're literally across the street from the hospital, you can't really argue from a safety perspective).
So, is a Birth Center the best of both worlds? Rixa argues no, and her blogpost addresses many of the issues that Ren and I brought up. From a previous post she wrote this:

Freestanding Birth Centers offer no technological or pharmacological advantages over home births. Midwives in both settings carry nearly identical equipment. It might vary slightly from midwife to midwife, of course, but there is no additional technology available in FSBC's compared to midwife-attended home births. In both settings, women will likely have access to:
- anti-hemorrhagic treatments and equipment (ranging from herbal tinctures to Pitocin, Methergine, Cytotec, IVs to replace fluid loss and/or stablize in case of transport)
- maternal and neonatal resuscitation equipment and skills (bag & masks, oxygen tanks, suctioning equipment, possibly meds & intubation supplies)
- suturing equipment and local anesthetic
- fetoscopes/dopplers for listening to baby's heart beat during labor
- other equipment for monitoring vital signs (BP cuff, stethoscope, thermometer, etc)

Women in both settings will need to transfer to a hospital for interventions such as:
- operative deliveries (vacuum extraction, forceps, cesarean section)
- analgesia (except in rare cases where some birth centers supply IM narcotics)
- anesthesia (spinal, epidural, etc)
- continuous Electronic Fetal Monitoring (external or internal)
- blood banks if a transfusion is needed

There are valid reasons to go with a Birth Center instead of a home birth, which she touched on above... for instance I wouldn't want to give birth in my apartment building if that were my pregnancy situation. Also, you may not want to rent your own birthing tub or worry about covering your bed or floor with plastic. Of course if you decided to go with a birth center instead of a hospital or at home you'd have to make sure you do your research well, just as you would when picking a hospital, OB, or midwife, because Birth Centers have their own policies just like hospitals do. You may not agree with their philosophies or rules. Its a lot to think about!


I'd also like to point out that we are very lucky and should be thankful that we even have the opportunity to choose our birth setting.  Many poor women do not have the luxury of learning their options or giving birth in an ideal setting. Many women end up having un-wanted home births in a home that is messy, loud, crowded, stressful and not at all cozy because they cannot afford medical care or cannot arrange travel to a hospital. Many give birth in a hospital where they have to go along with whatever the doctors want instead of in a comfortable setting such as a birth center where they are fully supported.

I think we're all wishing for a middle ground, but you really have to choose whats best for you. I really liked this comment posted on Rixa's above-mentioned post:
And speaking as someone recently enlightened and trying to "deprogram" and trust birth, if I were planning where to give birth, I wouldn't consider a homebirth, because I'm just not mentally ready yet. And if a mom who didn't trust birth and trust herself fully was guilted into a homebirth, that could be just as impeding as the "discomforts" of a hospital or FSBC for a woman on the other side.

This is getting long, but I'd also like to note that there is such a thing as an in-hospital birth center.  Sometimes these will have different policies regarding drugs and interventions than the L&D ward since it is in a separate part of the hospital, and may have comfy beds, tubs and showers, and so on.

Wednesday, November 11, 2009

Children's Book about Home Birth

Re-Blog from Radical Doula

I got an email from Kelly Mochel, the author of this new children’s book called “We’re Having a Homebirth!!”

She says she decided to create the book when they were planning for their homebirth and couldn’t find any literature for their 2 year old to read about the process. She self-published the book, which is available for purchase on her website.

I only saw the sample pages here, but I appreciate the frankness with which she talks about the issues at hand. For an example see this page about breastfeeding after the jump.

Breastfeeding page

________________________________________________
Ok, "the new baby sucks milk from Mommy's BOOBIES?!"  Come on now, children are intelligent, we don't have to use goofy sounding words for them to understand. They can learn the word proper word for breasts.

Anthropology Talk on NPR

An Anthro post! Kojo Nnamdi's show on NPR is usually pretty boring, but today he was interviewing an anthropologist who had a lot of interesting things to say.

Cultures on the Brink of Extinction with Wade Davis

"The great revelation of anthropology is that the world in which youre born is just one model of reality. And these other peoples aren't failed attempts at being you, they're unique answers to a fundamental question 'what does it mean to be human, alive?'"

"It's so important to emphasize that anthropology never calls for the elimination of judgment, it calls for the suspension of judgment so that the judgments we're obliged to make can be informed ones."

Breastfeeding with Comfort and Joy

Kathy at Woman-to-Woman Childbirth Education is hosting a giveaway of Breastfeeding with Comfort and Joy available at www.TheBreastfeedingBook.com! 

Haven't read it yet, and unfortunately it isn't on my DONA book list, but the reviews are good!



First Prenatal Visit!

This morning I went with the doula I am shadowing, B, to visit a client's home for the first time. B came and picked me up since she was 25 minutes from me, and the woman's home was 35 minutes further from me. B had agreed to be this woman's doula pro bono because the woman was going through a hard time financially, and B is a really big doula advocate in general and thought it was important that she have a doula. They had communicated several times by e-mail so B already had her background and medical history and situation known.  We'll call the pregnant woman Marie.

Marie is pregnant with twins and already has a 3 year old girl. The twins will be delivered by C-section. This is frequently, though not always, the case with twins because they must both be in the right positioning to be safely delivered vaginally. Also, they're almost always pre-term because come on, there's just not enough room in there to bring both babies to their full gestational size! Marie's tummy was huge and really quite wide and she is very uncomfortable. She had a C-section with her first child so she knows basically what to expect, but she didnt have an ideal situation in the hospital because they gave her baby a lot of vaccinations and procedures that she did NOT want done and did end up causing complications. Also, she didn't see her baby for several hours and they gave her a bottle which made breastfeeding difficult and frustrating.
Her current doctor has been pushing a lot of unnecessary tests and shots on her that she is a bit unhappy with, but she's having her husband stay with the twins from the minute they are born so they can make sure they don't have any needles near them.

Today's visit was an opportunity to meet face to face before the birth and let the woman know how her C-section procedure with twins is going to go. B was very knowledgeable, as she had witnessed cesareans and twin births before, and had gone to this particular hospital many many times and knew the doctors and the rooms and everything. I mostly sat back and listened both to what B told Marie and how Marie described her experience. It was an opportunity for them both to ask questions of each other about how it was all going to go. It was very laid back and informative.

I can't attend the birth because of the hospital's flu season visitor policy, but I may go to her postpartum visit (as long as I'm not away for Thanksgiving). Also, there is a Jewish woman in the next town over who is due in December who has said to B that it is all right if I am there for her home labor. Again, I won't be able to go to the hospital and see the actual pushing part, but its still pretty good!

Does anyone know why an Orthodox Jewish man may not even look at his wife without her clothes on while she is in childbirth? I understand why no touching, but why no seeing either?
A caveat to last night's post: I'm not saying that you should completely stay away from hospital births entirely. That was not a push for home birth with a midwife only scenarios allowed. Many obstetricians are very good, talented doctors who are thankfully there for when emergencies do arise, and C-sections are necessary. Many genuinely believe that their way is the best way, and it does get the job done... My concern is that each woman have exactly the kind of childbirth experience they desire and come out feeling strong, proud and content.
I think that hospital births are great if you're nervous about complications or if its necessary as a result of your or the baby's medical history. Honestly, I may end up wanting my first birth in a hospital myself, as it will be my first experience with my own childbirth and I won't know how I do in such a situation! But I'll definitely be having a doula :)

Tuesday, November 10, 2009

A Dangerous Birth?

This evening I was thinking about fear of childbirth as a result of almost all of us grow up "knowing" that birth is dangerous and that doctors were required to get women through it.

Why is it we think that birth is inherently dangerous?

Well, for starters, we learn, from the media and stories we hear even as children, that women give birth in hospitals. While this may not be true for all women, the majority of little girls are not exposed to home births. And hospitals make us think of a patient who is ill or a person suffering from a health condition. At the hospital, the woman can be "cured" or kept "safe" in case they get worse by someone we think of as a health professional. (This makes me think of authoritative knowledge surrounding birth culture, but I can get into that at another time)

Furthermore, we are all taught that many women, historically, used to die of childbirth left and right. So, clearly, childbirth is a disaster waiting to happen and the woman needs to be monitored in a hospital by a doctor because something probably WILL go wrong.

I looked up exactly it was that caused women to die of childbirth and found that the main complications were infection caused by unsanitary tools and conditions and hemorrhaging. In modern times we understand infection and take precautions against this easily.  Postpartum hemorrhaging is caused by the failure of the uterus to contract strongly enough after the baby and the placenta are both expelled. But this is rare, as it most likely would have been in the past, except now we are better equipped to treat it.

Other complications for mothers historically, and still today in impoverished countries, are malnourishment, ill health, or giving birth at a very young age.
Birthing mothers chances are greatly improved simply by proper diet and exercise during pregnancy.


The point is, childbirth is not as scary and dangerous as many of us grow up believing, and we can have it our own way, not just how a doctor tells us we must.
A hospital can save the lives of mothers and babies who would have died a hundred years ago, and thank goodness. But birth is a natural process that a woman's body is completely prepared to handle and does not require constant interventions to speed it up or slow it down. A woman knows when to push without a doctor telling her to.  Women can labor completely alone and be perfectly fine.

The trouble is we aren't taught much at all about childbirth growing up, and that's why its important to learn as much as possible about what is happening to us!


A Truly Dangerous Birth:

Pitocin to induce labor - can cause uterine contractions that are so strong that they stress the baby and cause fetal distress.
Intravenous drugs affect the baby so strongly that the baby may not breathe at birth
Epidurals for pain - decrease the mother's ability to use her legs to walk around or squat; can lower the mother's blood pressure so that the baby isn't getting enough oxygen through the placenta; this can cause fetal distress and the need for an emergency c-section to rescue the baby
Episiotomy to increase the vaginal opening - tearing in the rectal sphincter, incontinence, longer recovery period.
Separation of the mother and child at birth, which makes initial breastfeeding difficult.


I feel like I could go on but I won't!

Monday, November 9, 2009

OB/GYN office says 'your desires don't matter here!'

Last week the blogosphere was going crazy about this sign:
Because the Physicians at Aspen Women’s Center care about the quality of their patient’s deliveries and are very concerned about the welfare and health of your unborn child, we will not participate in a “Birth Contract”, a Doulah Assisted, or a Bradley Method delivery. For those patients who are interested in such methods, please notify the nurse so we many arrange transfer of your care.

To read more on the discussion:

Says Stand and Deliver: "Still, even if there's a back story and the docs aren't really that bad, they certainly could have come up with a better sign! Like actually spell "doula" right for starters..."

Cold Calling

So, I'm not sure how other new doula's do it exactly, but today I began my cold calling of local doulas in my area in order to find someone who would take me on as an apprentice doula. I found a whole bunch of people and websites, and today I managed to call three. Only one woman picked up, and when I asked her if she would allow me to shadow her for my first few certification births, she basically said, "sure, why not?"

She was really really nice and full of information. She talked to me for about a half an hour! She said she'd see if her clients wouldn't mind me tagging along and get back to me. Its a bit complicated for two reasons: 1. its holiday time and I'll be out of town several times over the next two months and
2. Hospitals putting counter-pressure on Doulas/all visitors during Flu Season. Women giving birth in certain hospitals may have to choose between their spouse, doula, family members, other children, and so on.
In all Women’s Units (including Labor and Delivery, Family-Centered Care and Post-Partum) the following restrictions apply:
Visitors to women in OB units are limited to one person, who must be either a spouse or significant other (boyfriend/girlfriend). If the patient has neither a spouse nor a significant other, a designated “support person” may visit instead. The visiting hours spelled out above do not apply to this spouse/significant other/support person. In addition, all maternity and pre-surgical tours have been cancelled during flu season.
 Now, not all her cases are hospital births (some are home or birth clinic cases), and not all hospitals are following this policy, AND she said that she usually encourages her clients to labor as long as possible at home (frequently all the way up to 10 centimeters dilation) before going to the hospital. So, if the timing is right I may be able to attend some births before the end of the year!

And since I only called 3 people off a list of about 15, I could always find some more people to shadow and births to attend!
And my workshop begins one week from today! EXCITED!

My doula reading list

In order to be certified through DONA International I have to read 5 books and an article.  The first two of the books are required reading, and for the other three I may pick from several choices.


So far I have completed only one:
1. Klaus, Kennell & Klaus, The Doula Book, 2nd edition, 2002



And begun two others:
2. Simkin, The Birth Partner: A Complete Guide to Childbirth for Dads, Doulas, and All Other Labor Companions, 3rd edition, 2008



3. Simkin, Whalley & Keppler, Pregnancy, Childbirth and the Newborn: the Complete Guide, revised, 2001




 For my fourth book I have chosen but not yet started:
4. Ina May Gaskin’s Guide to Childbirth, 2004






I still need to pick one on breastfeeding but I haven't yet researched all the choices on my list:
• Mohrbacher, Stock & Newton, The Breastfeeding Answer Book, 3rd edition
• Mohrbacher & Kendall-Tackett, Breastfeeding Made Simple, 2005 (Available in the U.S. and Canada)
• Newman & Pitman, The Ultimate Breastfeeding Book of Answers, 2000 (Available in the U.S.)
• Newman & Pitman, Dr. Jack Newman’s Guide to Breastfeeding, 2000 (Available in Canada)
• Huggins & Lawrence, The Nursing Mother’s Companion, 5th edition, 2005

Sunday, November 8, 2009

To Eat your Placenta or not to Eat your Placenta...

Thank goodness now that you're done with the baby birthing and newborn adjustment you can finally think about what fun things you can do with your placenta!

Interestingly, this is a big decision for a lot of women. Many women like to freeze their placenta in order to keep it safe for what they can do with it next. Some women make placenta prints which usually end up looking like trees.

Another idea is to bury it under a tree. Or you could have a Lotus birth - leave the baby attached to the placenta until the cord dries up and falls off on its own.

And yet another popular option is to EAT IT a.k.a. placentophagia. Many animals eat their own placenta, for various reasons, including the fact that it contains oxytocin (happy-feeling drugs), which, among other things, make you happy about your new baby!
Supposedly placentophagia also helps prevent postpartum depression and contract the uterus after the birth.

An alternative to placenta lasagna or placenta smoothie is Encapsulation - the placenta is dried, ground, and encapsulated so that you can ingest it like vitamins. You can take them for as long as you need them, and then even save them for menopause if you like!

I'm not sure how I feel about this. I think burying the placenta under a tree is nice - circle of life and so forth - but I don't know if I could take a pill and not think about the fact that it was once my own organ. Thoughts?

Saturday, November 7, 2009

Re-Blog: My Hopes

I want to re-blog part of a post from Public Health Doula that says a lot that I would like to express here!

"What I DO care about:

- I care that you know enough about birth, and your choices (and RIGHTS) in birth, to make educated decisions and know what your priorities and values are. This is the biggie. I hope you never think "I wish I had known..." or "If only someone had told me..." If I am ever pushy with information, it is with this goal in mind.

- I care that with what you learn about pregnancy, birth, and breastfeeding, you resist the misinformation out there, and refuse to spread it yourself. If one of my friends says, "Once a child's old enough to ask for it, he's too old to breastfeed" ...well, let's just say we'll have to talk.

I also have some hopes - things I cross my fingers that my blog posts are teaching you more about:

- I hope you know that you have many options and variations in terms of maternity care. How one individual care provider practices is not necessarily the gold standard that you cannot question.

- I hope for you not to be frightened of birth, and I want to balance out the voices that might be feeding you fear.

- I hope for you to feel supported in whatever choices you need to make for your health (mental and physical) and your baby's health (mental and physical).

- I hope for you to feel happy and at peace with whatever happens at your birth, and if you don't I am there if you want to process your feelings or want help finding more information. But I never want you to feel like I am playing the "If Only" game with your birth unless you have specifically asked me how I think things could have been different.

So again: no matter what happens during your pregnancy, birth, and parenting - I want you to NEVER EVER feel judged by me for any of the choices you make and if you do, call me on it."

A Fun Start

Some funny names my friend came up with for me when I was trying to think of a clever name for my new doula blog:

This is How We Doula, Chat Womb, Zip-a-dee Doula, Ma Doula's Oblong - Ata!, Hula Doula, My Doula is Coola, Doula 4 You-la, Doulivery, Ovu-late than never, Doula Tallulah, Say I dou-la, Let's gOvary, No Maybes Just Babies, Cervixen, Dilate to Annihilate, Womb Raider, Putting the "you" back in Uterus

First Post

Hello!

I am an aspiring Doula and future medical anthropologist. The purpose of this blog is to share the information I discover on pregnancy, childbirth, mothering, breastfeeding and so forth, on my journey to becoming a doula.

I am passionate about helping women be fully informed about the entire pregnancy/birth/mother process so that they may have the most ideal possible experience throughout their pregnancy, birth, and motherhood!

I am right at the start of my Doula certification process, and would like to document as fully as possible my experience with learning and training. After I decided to go ahead and register for the training workshop that would begin my certification process, I tried to find blogs on the beginning doula training experience of others. Unfortunately, I had no luck! Thusly,  with this blog I am hoping to help myself, and eventually others, on the doula path.

I realized that I was posting a great deal of birth related articles on my old blog, and thought it might be time to find a separate location for all of those thoughts.  A lot of what I learn is all new to me, so I will be simply expressing my thoughts and impressions on it all.  Enjoy!
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