Monday, December 28, 2009

Almost Jan 1... Time to Induce?

Another economics-type look at births... A NY Times article from 2006 called To-Do List: Wrap Gifts. Have Baby talks about how the number of births in late December has shot up since families frequently schedule births during this time so that they can receive the year's tax incentives for having a child before the year ends.

But my favorite part of the article asks: "In addition to being an entertaining bit of trivia, the end-of-the-year baby boom also raises a legitimate policy question: just because we have the medical ability to do something, does that necessarily mean it’s such a good idea?"

Induced births and Caesarean sections are considerably more expensive than natural births on average. There are clearly cases when labor needs to be induced for a baby’s health or the mother’s. It’s much less clear, however, that the health care system should be subsidizing parents’ desire for a smaller tax bill.
The health effects of scheduled births are also murky. A big study led by a researcher at the Centers for Disease Control and Prevention found that voluntary Caesareans increase the risk of infant mortality. Another study found that weekday births are slightly more risky than weekend ones, all else equal, suggesting that a drug-induced birth can also cause health problems. The differences are small, but the stakes are big enough to take any change seriously.
“When you induce labor, you compress this long process into a few hours,” said Dr. Emmet Hirsch, the director for obstetrics at Evanston Northwestern Healthcare near Chicago. “When you do that, you can run into all sorts of problems.”
To minimize those problems, the largest medical provider in Utah, Intermountain Healthcare, now discourages women from electively inducing labor before their 39th week of pregnancy. “This is what’s best for moms and babies,” said Janie Wilson, a nurse who helps run the newborn program at Intermountain. “It just seems like a no-brainer.”

a position change or an unnecessaren?

Happy Holidays!

I've been partially following the story about Joy Szabo and her VBAC woes due to a change hospital policy which no longer allowed them, but I realized that some of you may not have heard anything about it, so I thought I'd post some info on it here.

Here's some background info:
While seven months pregnant with her fourth child, Joy Szabo was told by her local hospital that she would be required to have a repeat cesarean section rather than allow her to have the birth she wanted, a VBAC. It didn’t matter that she had already had one VBAC at this hospital, the policy had changed and VBACs were no longer permitted there.

After their discussion with their doctor, the Szabos made an appointment to speak with Page Hospital’s CEO, Sandy Haryasz. When the couple told her about their desire for a vaginal birth, they say Haryasz would not budge, even telling them she would get a court order if necessary to ensure Joy delivered via C-section.

The Szabos thought that seemed extreme and rather than succumb to the hospital’s new policy, a few weeks before her due date Joy moved into a Phoenix apartment 350 miles away from her husband and three children while she waited to go into labor. At the Phoenix hospital Joy gave birth to her fourth son Marcus Anthony in an “uncomplicated vaginal delivery.”

CNN wrote a quick-read article on it that I'd like to share, called Mom fights, gets the delivery she wants.

The article also includes some questions you should ask your doctor or midwife in the delivery room if the suggestion is made that it's time to give up on a vaginal birth and head to the operating room, which are interesting. Take a look!

I particularly like the caption on one of the photos, which says... "[so and so] was told she'd need a C-section, but a simple change in position allowed [baby] to come out vaginally."

A Simple Change in Position helped the baby come out, while the doctors were vying for a C-section.  Why didn't the doctors just suggest a change in position first, rather than dangerous, expensive, painful surgery? hmmm... Go Doula!

Wednesday, December 23, 2009

A Man Experiencing Labor!

Apparently this video went viral on Facebook a while back, but I must have missed it.

A man wonders if men truly have a higher pain threshold than women, and decides to test it by simulating labor contraction pain. Using electrodes on the abdominal muscles, a doctor and a physiotherapist simulate contractions on him. Of course its not really the same, as he has no uterine muscles, and they get him to try to change positions which really won't help at all.  Changing positions and using the ball help because it opens up a woman's pelvis and helps the baby change positions, and a man's pelvis doesn't open! It's fused together! But anyway, its kind of interesting to see how he handles the pain.



Will he make it the whole 12 hours of fake labor? haha you'll have to watch and see.

Tuesday, December 22, 2009

"Where Rock and Roll Meets Mommyhood"

Found a new blog recently - The Feminist Breeder.  The tagline is "Where Rock and Roll Meets Mommyhood." She was in a rock band and now she's a mom and wants to be a lawyer. I always wish my life were that cool! This woman's life story is really crazy interesting, and I am going to c&p her About Me info here just for fun. 

I grew up everywhere. That is a literal statement. Be definition I was homeless. My father was 14 when I was born, my mother 16, and together they couldn’t (and wouldn’t) take care of a baby.I was given to my maternal grandparents who raised me as their own. However, they were “mountain folk” who never even had a bank account, and every day was a new adventure in “Where will we be living when I wake up tomorrow?” They would often pick me up from school only to tell me we were never returning to the place I had called home until that moment. It was a transient lifestyle, one might say. I count that I went to 26 different schools between Kindergarten and 12th grade.
Despite living like a nomad, I loved school and excelled wherever I went. I also found a home in music, and played in the orchestra or sang in the choir of any school I attended. The latter earned me a 1st place award in the Illinois High School Association Choir Competitions.
Thanks to our lifestyle, and a little thing called Marijuana, I didn’t graduate high school with the rest of my 1996 class. Instead, I acted out and skipped class until I realized it was too late.
I was a musician for the first part of my adulthood. At 18, I joined a band as a singer, learned to play guitar, and went on to tour and make records for most of my 20’s. I played in a few high profile bands (“Veruca Salt”, Courtney Love’s “Bastard”, and my own band “Rockit Girl.”) I always assumed that I would stay a career musician. Then, I realized that I wanted to get my degree and do more with my life. Music wasn’t consistently paying the bills, even when I thought I was seeing some success. In 2003 I got my GED and started figuring out how to get myself back into school.
In the fall of 2004 I enrolled in the local community college. Around the same time, I started dating John, who I met through the music scene. We fell in love while touring Canada, and were engaged within 9 months. 6 months after that, a surprise pregnancy turned our plans for a September 2006 wedding into a January 2006 “shotgun” wedding, and there my life took a dramatic turn.
In February 2006, I retired my band and decided to take a break until after the baby was born. That break turned into a retirement, as I’ve never had the energy to go back to my pre-baby rocker-chick lifestyle.
In March of 2006 I got a day job, the same job I still have now, and took a break from school.
Jonas was born August 1, 2006 via cesarean section, and he (and the surgery) changed my life forever.
I have dreamed of becoming an attorney for many years. Thanks to my terrible birth experience, I am passionate about women’s issues, especially those that affect reproductive rights, childbirth rights, and children’s health. I would like to begin my law career working as a state’s attorney, then move on to advocate for women and help lobby to change laws to protect women and children.
During the pregnancy and birth of my second son (Jules – May 16, 2008), I saw just how hard a woman has to work to simply give birth naturally. Because my first son was born by, in my opinion, an unnecessary cesarean section, I sought to give birth to my second son naturally. The medical industry frowns upon natural childbirth because they are taught to see pathology where none exists, and they believe that childbirth in and of itself is a dangerous medical event. I did my research, and found that natural childbirth is far less dangerous than birth smothered by unnecessary medical interventions. In the end, in the middle of laboring my child, I had to wage a legal battle with the medical staff who wanted to perform yet another unnecessary cesarean on me because they simply didn’t want to wait around for me to have my baby. I fought off doctors who insisted that I sign papers consenting to treatments I did not want or need, and in the end I gave birth naturally to a beautiful 10 pound baby boy. No scalpel required.
After sharing my story with the birthing community, I received so many responses from women who were unable to advocate for themselves the way I did. I hope to put an end to situations where a woman would be forced to consent to unnecessary surgery and medical procedures that are forced on them by a largely misinformed medical community. The United States is far behind other developed countries in its view toward childbirth, and our maternal and fetal death rates are the second worst because of that. It is unfortunate that a woman has to know her legal rights before stepping foot in a maternity ward, but if that is what it takes, I hope I can work to keep all women and children safe.
So here are the stories, anecdotes, trials and tribulations of a rocker chick turned concerned mother, and all that may imply…… Enjoy!

Sunday, December 20, 2009

A Freakonomics look at Maternal Death during Childbirth

For a laugh, a history lesson, a puzzle that you want to know the answer to, a surprise and then a "ew gross" and "duh" moment with a laugh, read on, my friends. This story is full of interesting and true ridiculous-ness.

This post is a type-up of "The Dangers of Childbirth" from the chapter The Fix is in - And its Cheap and Simple in Super Freakonomics: Global Cooling, Patriotic Prostitutes and Why Suicide Bombers Should Buy Life Insurance by Steven D. Levitt and Stephen J. Dubner published this year.


It is a fact of life that people love to complain, particularly about how terrible the modern day is compared with the past.

They are nearly always wrong. On just about any dimension you can think of - warfare, crime, income, education, transportation, worker safety, health - the twenty-first century is far more hospitable to the average human than any other time .

Consider childbirth. In industrialized nations, the current rate of maternal death during childbirth is 9 women per 100,000 births. Just one hundred years ago, the rate was more than fifty times higher.

One of the gravest threats of childbearing was a condition known as puerperal fever, which was often fatal to both mother and child. During the 1840's some of the best hospitals in Europe - the London General Lying-in Hospital, hte Paris Maternite, the Dresden Maternity Hospital - were plagued by it. Women would arrive at the hospital to deliver a baby and then, shortly thereafter, contract a raging fever and die.

Perhaps the finest hospital at the time was the Allgemeine Krankenhaus, or General Hospital, in Vienna. Between 1841 and 1846, doctors there delivered more than 20,000 babies; nearly 2,000 of the mothers, or 1 of every 10, died. In 1847, the situation worsened: 1 of every 6 mothers died from puerperal fever.

That was the year Ignatz Semmelweis, a young Hungarian-born doctor, became assistant to the director of Vienna General's maternity clinic. Semmelweis was a sensitive man, very much attuned to the  suffering of others, and he was so distraught by the rampant loss of life that he became obsessed with stopping it.

Unlike many sensitive people, Semmelweis was able to put aside emotion and focus on the facts, known and unknown.

The first smart thing he did was acknowledge that doctors really had no idea what caused puerperal fever. They might say they knew, but the exorbitant death rate argued otherwise. A look back at the suspected causes of the fever reveals an array of wild guesses:
  • "Misconduct in the early part of pregnancy, such as tight stays and petticoat bindings, which, together with the weight of the uterus, detain the feces in the intestines, the thin putrid parts of which are taken up into the blood."
  • "An atmosphere, a miasma, or... by milk metastasis, lochial suppression, cosmo-telluric influences, personal predisposition..."
  • Foul air in the delivery wards.
  • The presence of male doctors, which perhaps "wounded the modesty of parturient mothers, leading to the pathological change."
  • "Catching a chill, errors in diet, rising in the labor room too soon after delivery in order to walk back to bed." 
(The rest after the jump)

Saturday, December 19, 2009

Delayed Cord Clamping

Found a blog called Academic OB/GYN with a really great article called Delayed Cord Clamping Should Be Standard Practice in Obstetrics written by Dr. Nicholas Fogelson.

I think that if you are a data/research oriented person you should click the link and read the entire post, as the author includes a lot of data directly from several research studies (towards the middle/end of the post), which I don't care to re-post all of here. Otherwise, you can read the parts I found most important and interesting!

There are times in our medical careers where we see a shift in thought that leads to a completely different way of doing things.   This happened with episiotomy in the last few decades.  Most recently trained physicians cannot imagine doing routine episiotomy with every delivery, yet it was not so long ago that this was common practice.
Episiotomy was supported in Medline indexed publications as early as the 1920s(1), and many publications followed in support of this procedure.  But by as early as the 1940s, publications began to appear that argued that episiotomy was not such a good thing(2).  Over the years the mix of publications changed, now the vast majority of recent publications on episiotomy focus on the problems with the procedure, and lament why older physicians are still doing them (3) (4).  And over all this time, practice began to change.

It took a long time for this change to occur, and a lot of data had to accumulate and be absorbed by young inquisitive minds before we got to where we are today, with the majority of recently trained OBs and midwives now reserving episiotomy only for rare indicated situations.

Though this change in episiotomy seems behind us, there are many changes that are ahead of us.   One of these changes, I believe, is in the way obstetricians handle the timing of cord clamping.

For the majority of my career, I routinely clamped and cut the umbilical cord as soon as it was reasonable.   Occasionally a patient would want me to wait to clamp and cut for some arbitrary amount of time, and I would wait, but in my mind this was just humoring the patient and keeping good relations.  After all, I had seen all my attendings and upper level residents clamp and cut right away, so it must be the right thing, right?
Later in my career I was exposed to enough other-thinking minds to consider that maybe this practice was not right.   And after some research I found that there was some pretty compelling evidence that indeed, early clamping is harmful for the baby.  So much evidence in fact, that I am a bit surprised that as a community, OBs in the US have not developed a culture of delayed routine cord clamping for neonatal benefit.

I think that this is a part of our culture that should change.  This evidence is compelling enough that I feel like a real effort should be made in this regard.   So to do my part in this, I am blogging about it.

Prior to the advent of medical delivery, and for all time in animals, it has been the natural way of things for a baby to stay on the umbilical cord for a significant period of time after delivery.  Depending on culture and situation, the delay in cord separation could be a few minutes or even a few hours.  In some cultures the placenta is left on for days, which of course I find excessive and gross (5).  But whatever the culture and time on cord, the absence of immediate cord clamping allows fetal blood that was previously in the placenta to transfuse back into the baby.  Studies have demonstrated that a delay of as little as thirty seconds between delivery and cord clamping can result in 20-40 ml*kg-1 of blood entering the fetus from the placenta (6).

So does this mean that early cord clamping is necessarily harmful?  Absolutely not.   But what it means is that the burden of proof is on us to prove that early cord clamping, which amounts to planned fetal phlebotomy, is a beneficial thing.  Otherwise, all things being equal we ought to give the tykes a few minutes to soak up what blood they can from the placenta before we cut’em off.

So the question is whether or not there is strong data either way.

It is easy to imagine a randomized study of immediate vs. delayed cord clamping, with quantitative analysis of fetal lab values and clinical outcomes.  So easy in fact, that it has been done many times – and in just about every study, there is a clear benefit to delaying cord clamping, even if it is just for 30 seconds after delivery.  These benefits include important outcomes such as decreased rates of intraventricular hemorrhage and necrotizing enterocolitis in preterm neonates.  Furthermore, aside from some intermittent reports of clinically insignificant polycythemia and hyperbilirubinemia in term infants, there appears to be no harm that can be linked to delayed cord clamping. It feels like being a doctor 10-15 years ago looking to see if there is any data about episiotomy, and finding that there’s a lot, and it says we’ve been doing it wrong for awhile now.

(emphasis mine.)

Friday, December 18, 2009

The Sex Knowledge of Young People

A CNN article Gaps found in young people's sex knowledge discusses a recent study just published Tuesday, and was a survey of 1,800 people age 18 to 29, conducted by the National Campaign to Prevent Teen and Unplanned Pregnancy.  It shows that "most sexually active unmarried young adults believe pregnancy should be planned, but about half do not use contraception regularly."


Hmm... could it be all the abstinence-only education?


From the article:
"Abstinence-only curriculums have gone explicitly out of their way to teach misconceptions about contraception," she said. "This generation of 20-somethings have missed many opportunities to get medically accurate and correct information."
Furthermore:
"Many of the people surveyed said they did not know much about contraception to begin with -- 63 percent said they knew little or nothing about birth control pills, and 30 percent said they had scant knowledge about condoms."
And even if they have heard about it, they don't know where to get it or how to use it.


Abstinence-only education really gets my blood boiling. Abstinence-only education has proven to be misleading and ineffective at keeping people safe and healthy.

Under the Bush Administration, federal support for “abstinence-only” education programs expanded rapidly. Abstinence-only education promotes abstinence from sexual activity without teaching basic facts about contraception. They often hold that there is no such thing as safe premarital sex. The federal government spent approximately $170 million on abstinence-only education programs in 2005, more than twice the amount spent in 2001. As a result, abstinence-only education now reaches millions of children and adolescents each year. (The Content of Federally Funded Abstinence-Only Education Programs)

In a report conducted by the U.S. House of Representatives called The Content of Federally Funded Abstinence-Only Education Programs it was found that over 80% of the abstinence curricula contain false, misleading, or distorted information about reproductive health. According to the report, the curricula present false information as proven facts. For instance, one states that condoms are not effective in preventing the contraction of HIV, which is contrary to studies done by the Center for Disease Control that show that condoms are extremely effective. Another incorrectly lists sweat and tears as dangerous in HIV transmission.


Oh and I love this little fact:
"Myths about pregnancy and sexual activity continue to permeate circles of young people. For instance, 28 percent of men incorrectly believe they will get extra protection from wearing two condoms at once, a practice that actually leads to condom breakage. At the same time, 18 percent of men wrongly believe that having sex standing up reduces the chance that they will get a female partner pregnant."
"...about four in 10 respondents said it doesn't matter whether people use birth control, believing that people get pregnant when it's their "time."


And the point that must always be addressed...


Some people believe that teaching adolescents about sex and sexuality will encourage them to be sexually active earlier. There is little evidence that teens who participate in abstinence-only programs abstain from intercourse longer than others. It is known, however that when they do become sexually active, teens who received abstinence-only education often fail to use condoms or other contraceptives. This fact, declared by Planned Parenthood, has also been proven true by a study discussed in an article in the American Journal of Psychology. Researchers found that young people who took a virginity pledge were one-third less likely to use contraception when they did become sexually active than their peers who had not pledged."Comprehensive sexuality education that advocates abstinence yet provides education for those teens that choose to become sexually active has proven practical and effective.


Abstinence-plus education, which provides a range of information and options for young people from abstinence to safer sexual behavior, does not increase sexual activity or lower the age of a young person's first sexual encounter.  It provides true and useful information.

Thursday, December 17, 2009

On my Chanukah wish list... A Birth to Attend!

Yesterday I called up the doula who is mentoring me, B, that I have been hoping to shadow at some births to see how her clients due around Christmas were doing. This turned out to be both a disappointing and fruitful discussion.

Disappointing, because she told me that her Dec 21 mom had gone into labor early (like I had hoped!) but had labored alone all night before going to the hospital. I was only going to be allowed to shadow B when she helped the mom labor at home before they went to the hospital, but since B didn't even go to the house, I didn't either :( She had talked to her on the phone all night on and off, and then when her water broke and the contractions were coming on strong with a lot of bloody show they decided to meet at the hospital. B thought the woman must for sure be at least 7 cm dilated or more, but when they checked her she was only 1 cm! But she was full effaced, and that was why she had a lot of mucus. So she was going to suggest that she go home, or go for a walk, but the woman decided to have some Stadol so they stayed. The stadol didn't really take away her pain, just sorta made her drunk, and at one point she was apparently seeing three of B.  As it turns out, she managed to go from 1 cm to fully dilated in about 4 hours and then start pushing! Which was a surprise, because even the doctor had said she probably wouldn't have the baby until the evening. So, in short, I missed it all.

The possible good news is her mom due on the 24th wants to have her baby early. This is because her previous babies were large and the doctor told her this one would be too. I'm not sure why everyone is so afraid of big babies... I was over 8lbs, my bro was 9lbs, and I've heard of plenty of moms giving birth just fine to "big" babies. Shouldn't a baby stay inside you full term? Anyway, the mom wants to be as naturally induced as possible, and doesn't want pitocin. So she is having her doctor strip her membranes*, which is supposed to help labor start within 24-48 hours. So I'm keeping my fingers crossed that she goes into labor pretty soon so I can attend it before we head out of town for the holidays! Although B told me that the client has had really short labors in the past and it may be over quickly... a bad thing in case I miss another one, a good thing if I get to go and then leave for vacation right after!

*I had to ask what this was. It is not the same as breaking the bag of waters (amniotic sac). It is done by inserting a finger between the membrane that goes around the amniotic sac and the wall of the uterus to loosen the membranes from the wall. Sometimes this stimulation of the uterine wall can help to start labor. Its not really induction, just stimulation of labor. 


I also expressed my concerns about how hard it has been to find clients for my certification births. I was hoping to get some through her or through the DC/Baltimore area yahoo groups I joined. Unfortunately, a mom interested in a low cost doula I emailed also was emailed by several other training doulas and I was shut out :( I asked B if I should make flyers and drive around town putting them up (kind of intimidating). She said I can also email local doulas/midwives/childbirth educators and ask them to give my info out to any moms looking for a low cost doula in training. 


So here's the fruitful part - I've gotten several really positive responses already! And I'm starting to look into ordering business cards and making a website (which is a lot more complicated than I thought).  The point I'm still stuck on is a clever name... that isn't already taken. I really liked EmpoweredBirth.com, but its being used :(  But, I'll be able to really throw myself into this once my application to graduate school is completely submitted - hopefully in the next week!






EDIT: sigghhhh... The first call I got this morning was from B and I was so excited that this was THE CALL! But when I picked up she said she was on her way to meet the mom.... at the hospital! siiggghhh. The other day the mom was already dilated 3-4ish centimeters even though she wasn't in true labor (you can be in pre-labor FOREVER before you're really in even early labor) and thats why she was hoping the membrane stripping would work. Turns out, she went to her doctor appointment this morning and they were like whoa, your bag of waters is bulging and you're 5-6 cm dilated and you have high blood pressure, you should go to the hospital. And when she called B to tell her she was already having to breathe through some hard contractions. So B is rushing to the hospital hoping she doesn't miss it! I'm soooo disappointed! The woman lived about 5 min away from me it would have been perfect. :(

Wednesday, December 16, 2009

Breastfeeding PSAs from Around the World

From Peaceful Parenting, here are some Breastfeeding Public Service Announcements from around the world.

from Puerto Rico:


from the United Nations:


from Canada:


from the US:

the US ones are odd...

and another from the US:


from Australia:


another from Australia:

whoa, that baby has a serious Australian accent haha

from Bulgaria:

not sure if is this really a PSA

And here is another one I found, from Spain, I'm pretty sure:

Tuesday, December 15, 2009

Placenta Sandwiches

A while back I wrote one of my first posts on eating your placenta.












I recently came across another blogger's post called "An Argument for Eating Your Placenta"

Its talks more about what I touched on - benefits of eating your placenta and so forth. I particularly liked this paragraph:

Picture this. You are living in a time before iron supplements. It is a time when the best sources of iron are found in organ meat, a time when you don’t have the luxury of saying “yuck, organ meat.” You have just given birth. Your husband is out hunting and no one knows when he will be back. All there is to eat is bread. You have lost a lot of blood and you are very hungry. Thank goodness for your placenta. Doesn’t it make sense that nature would supply a new mother with a certain form of replenishing nourishment in case of uncertain times?
This made me  have a random thought - would a vegetarian eat their own placenta?

Eating your placenta doesn't go against any of the usual arguments for vegetarianism, mainly moral consideration for animals (no animals are treated poorly or killed) and environmental destruction and distributive justice (no animals were raised in an environmentally harmful or wasteful way to create the placenta, except maybe ourselves). The health argument is a bit iffy... you could say that eating your own body part doesn't pose quite the same health risks as eating the meat of another creature, such as the other animals potential illnesses or bacteria the meat picked up before it gets to you, but you might say that eating meat at all is less healthy than eating plants and a strict vegetarian/vegan diet is simply the healthiest and that's that.. There's also the thought that if eating an animals flesh is bad eating human flesh is just cannibalism, although on the other hand, even veggie-only eating animals eat their own placenta! And the placenta provides you with iron and hormones that are produced by you and beneficial to you, so there are some health benefits right there. I suppose if you were swayed enough by the potential benefits than you might, as a vegetarian, eat your own placenta after these considerations...

Thoughts, anyone?

Monday, December 14, 2009

Doula Business

Things I need/want for my Doula business!

1. A business name! any ideas?
2. A website
3. Business cards
4. A birth ball
5. Yoga pants
6. A Doula bag
    i. rice sock or heat pad
    ii. tennis ball
    iii. massage oil
    iv. relaxing music cds
    v. rebozo
    vi. small hand-held mirror

Other things that could go in a doula bag:
- cold sources
- heat sources
- bath pillow
- more massage tools
- misting spray bottle
- a music player
- camera
- floor knee pad
- aromatherapy oils, ie peppermint, lavender, etc
- chapstick
- fan
- change purse
- extra socks
- extra hair ties
- small clipboard with pad of paper & pen
- a labor progress handbook

Sunday, December 13, 2009

Male Doulas

A movie by Vince Vaughn

No, really.

Male Doula. It will be a "high-concept" comedy written by The Wedding Date's Dana Fox.

Vince-Vaughn posted this about the project, which doesn't say much more than I wrote above. It does, however, have a comment on it that reads:
Hello! I do also enjoy the work of Vince Vaughn. I am a doula as well, so might enjoy the Male Doula movie on a personal level...
I must say, though, that while I understand there is a lot that can be poked fun of with regards to doulas and birth, I hope Mr. Vaughn sees this as a good opportunity to support the important work that doulas do, as well as gets away from the tired and innaccurate birth depictions in most movies (mom always laboring flat on her back, dad always incapable, that doulas only tell mom to "breathe", etc...I could go on and on...)
Finally I'd like to point out that there are several male doulas out there doing important work and I hope his movie is respectful of that and doesn't undermine them.
I hope that he gets an experienced doula on his staff for the making of this movie...I know lots of doulas with a sense of humor who could help...


Want to know more about real-life male doulas?
Here is an article on a 66 year-old male doula living in Colorado.  Turns out he was the first male doula certified by DONA, and you can read more about that here.

Natural Parenting









XKCD

Saturday, December 12, 2009

A Birth Story from the Man's Perspective

I found a birth story written by a man about the birth of his second son.  I have read a lot of birth stories but all from the mother's perspective, so it was fun to read this male perspective story.  There are a couple things in here that are definitely funny guy points of view.

After you read his version, you can also read that of the mother, which he links at the bottom.



The Amazing Story of Gus's Birth
In my last post, I mentioned Gus’s esophageal atresia. Well, one of the side-effects of that is that he could’t process amniotic fluid. So while most women have two pounds of amniotic fluid, Sherry had more like six or seven pounds. Like a whole extra baby’s-worth of fluid. The reason I mention that is because, despite Gus coming a week before his due date, we had been expecting him to come basically at any point in the past month. Sherry certainly looked full term, and she’d been dilated for about a month before he was born. She was 4 cm on her last appointment.
Now, my company is about to release a new version of their flagship product, the transrectal ultrasound prostate scanner. (Just for the record, “transrectal” means the device enters what is otherwise usually an exit-only area) Before we go to market, we have to do some clinical trials on live human beings. So the call went out among the employees for volunteers. For the sake of science! For the good of the company! For a cash payment!
This call went out a week before, and we weren’t getting much interest. In fact, we had had only one sign-up. So, I decided I’d sign up myself. Why not? The baby was going to come any day now, and when he or she did, I would start a week of leave. What are the odds we still wouldn’t have had a baby between now and then? I’d get credit for literally putting my ass on the line for the company, but I wouldn’t actually have to deliver. What could possibly go wrong with that?
Well. The big day rolls around and still no baby. As the morning worse on, I was really starting to get nervous. Which was making me tense. Given the procedure in question, “tense” is the last thing you want to be. For not the first time in my life I was wondering what the hell I’d gotten myself into.
I had walked by the office which they had converted into a makeshift exam room. All the equipment was in place. The performing physician was chatting with the marketing person. The machine operator was doing a final inspection. The only thing they needed was a patient.
Then, at 10:43, I had this IM exchange:
Sherry: Still feel cruddy!
Me: No good, that!
Sherry: my body is falling to pieces
Me: Not too much longer, now!
(Editor’s note: J said this a lot. But what else can you say? I’m sure in this particular instance, there was a bit more hopefulness than usual)
Sherry: OH S$&%
My water just broke!
Me: Holy crap!
Sherry: Like, no warning!!!
I think you better come home!

She didn’t have to ask me twice. I clicked my heels together, snatched up my stuff, and announced, “The water has broken! I have to go home! Enjoy the clinical trials! Sorry I won’t be here for them!” And with that, I marched out the door.
As it happened, I could probably had time to get my prostate imaged, recover a bit, and then have it done again. Most of the real action happened with me making phone calls on the way home, arranging for the other baby, Charlie, to get picked up and calling the doctor.
One of the people I called was Julie, our doula, or “birth helper-outer”. When I talked to her she was apparently heading into a birth right then. She said she had a feeling it was going to go very quickly, but just in case, she was going to call with her backup. Well, her backup was out of town, so she put us in touch with her backup backup. She seemed really nice on the phone, but we hadn’t met her. So that part wasn’t ideal, but we were sure we could work around it.
Once I got home, there really wasn’t anything for me to do. Usually the water breaks after you’ve been having contractions, but sometimes the water just breaks. That was the case here.
This was even true for Sherry. I mentioned the seven pounds of water. This is almost a gallon. It didn’t all come out at once. So most of my time after I got home involved me fetching towel after towel.
Once that settled down, I was at a total loss. Giving birth is like baseball, a few minutes of action and hours of sitting around waiting for something to happen.
So I cleaned the kitchen. Then I finished the homework assignment I was putting off until Friday night (Does this guy know how to party or what?) Then I shaved and changed shirts. I recalled that when Charlie was born, I looked like I’d been sleeping under a highway overpass for the last few days. I wanted to look good for this baby’s pictures. Or at least a bit less homeless,
So I learned something about myself: the way to make me really productive is to give me something great that will be happening in the near future that I just have to wait for. The excitement will get to me and I’ll end up doing odd tasks just to keep my mind off it.
Around 1:40, the contractions started. They were somewhere between 4 and 6 minutes apart, but extremely mild, apparently. Like I wouldn’t have known Sherry was having them if she didn’t say so. After she’d had a few, I knew what to look for, but they didn’t seem like anything I myself couldn’t handle. And I’m a total creampuff.
At 2:15 or so, we got a call from Julie. Turns out her other birth was really quick after all. She showed up about a half hour later. And, as we’d planned, Sherry’s friend Courtney also came by. She is also a doula, but she wasn’t there in a professional capacity, more just there to watch and take pictures.
We had a pretty good plan, I thought: if Sherry’s contractions got more intense or more regular, we would head to the hospital. And we’d head over regardless at 4:00, so we wouldn’t get stuck in rush hour traffic.
Well, my mom had picked up Charlie and she came over at 4 so we could say goodbye one last time. Then Sherry’s friend Mandi came over to take the dog. The dog is kind of a handful, so I walked out to the car with them. When I came back inside, something was obviously up.
Sherry and Julie disappeared into the bedroom and came out about two minutes later, saying “We need to leave. Like right now.” And then everything kind of turned into a blur.
It was about 4:55 when we got Julie, Sherry and I loaded into my car, with Courtney following in her car. The best way to get from Shrewsbury to St. John’s hospital wasn’t possible because the highway was still under construction. So I took a back road through residential Webster, up Brentwood Blvd, and onto the highway there.
I don’t know how, but we made the trip in 20 minutes. In rush hour. It seemed to be going a lot slower than that. We didn’t hit very many red lights, but ever one we did it felt like we would sit there for an hour or so. It was agony for me, and I wasn’t the one trying to hold a baby in.
Sherry thinks that if Julie wasn’t there, she would probably have given birth on the side of the highway. It takes a lot of concentration to not push when that’s all your body wants you to do, but Julie coached her through it.
I pulled into the loading zone and Courtney and Julie got Sherry into a wheelchair. Then we took off like O.J. Simpson in that old Avis ad. Or was it Hertz? In either case, we were running as fast as someone pushing a wheelchair can go, yelling at slow people in our way, until we made it to the elevator.
Sherry’s mother gave birth to Sherry’s younger sister in the elevator of the hospital. So when the door opened on the second floor and we got off, I made a nervous quip that at least we’d done better than that. Although if Labor and Delivery were on the tenth floor, it might have been a different story.
Julie had called ahead to the doctor, and the doctor had called the hopsital to arrange a room. So, after turning the wrong way once, we got ourselves into Labor 26, and a pack of nurses converged on us.
One of them said, “Sherry, we need you to get in the bed here.”
“I can’t,” she responded. “The baby’s coming.”
I think she took it as the usual prenatal hyperbole. So she said, “I understand, but you need to get into this bed.”
Sherry somehow got from the wheelchair into the bed, but she was on all fours facing the wrong way.
“We need you to turn around.”
“I can’t.”
“Well, can you at least turn on your side?”
Sherry kind of fell over, and the nurse and I then noticed the baby head that was poking out of Sherry’s woman parts. I let out a surprised expletive. The nurse noticed the cord was around the baby’s neck a bit tighter than anyone wanted, so she asked Sherry to push.
Sherry pushed one time and the baby was born, at 5:23 p.m.
I had asked not to know if we were having a boy or a girl, so the first clue I got about that was seeing the baby’s boyhood live and in person. I was happy we had a boy. As close together in age as Charlie and the next baby were going to be, I thought it would work better if they were brothers. I’m sure I would still have been happy if it was a girl, but we’ll never know for sure.
I was a bit worried that the baby seemed a bit purplish when he came out, but he wasn’t so purple any of the nurses were worried. And he turned a nice pink color a minute later.
I wandered over to the table where the nurse and physician were cleaning up the baby. The physician asked if I wanted to cut the cord. I said, “Oh, hell, no.” I’m sure some people would be honored. I’m not coordinated when I’m not feeling emotional. In this case, I would be so nervous I’d end up cutting off something I wasn’t supposed to.
Charlie had let out a loud cry the second he was out, but Gus didn’t do that. Because of his esopheal atresia, the saliva and snot and what not had no where to go. So he didn’t make any noise until the nurse cleaned out his nose, but it was still kind of faint.
Then we brought him back to Mom. She got some quality time with the very cute baby and Courtney took some pictures. But the sniffling and snortling got to be too much, so we gave him back pretty soon after that. They carted Gus down to the NICU and Courtney and I followed.
He was weighed: 6 lbs, 3 oz. Then they inserted a tube in his nose to automatically vacuum out the aforementioned saliva, etc. It was kind of sad to see, but it had to happen.
Once I was pretty sure they had that scene under control, we went back to the room. Our OB had finally arrived and he was helping the resident do stitches. Apparently he had gotten stuck in all the traffic we had lucked out of. Although if you had to choose, I’d rather he get the traffic than us. He gave me a hug and lots of congratulations.
I don’t know how long everyone was in the room, but eventually they all went their separate ways. The room looked pretty bad. I kept expecting Gary Sinese to walk in looking for clues. But they got everything cleaned up, and eventually left Sherry and I alone and in a bit of a daze at what had just happened.
And that’s the story of how Gus was born. In a hospital room. About 20 seconds after we got there.
****
Postscript: Sherry has written her own version of the story of Gus’s birth, which you can read here. In the interest of getting two different perspectives, I haven’t read it. I didn’t want to be biased at all. So her story will probably talk about different things, and we may disagree on some basic facts of the story. Although if any facts in my story cast me in a suspiciously better light than in her story, my story is still probably correct.

Friday, December 11, 2009

Two goofy videos that made me giggle

Pink Glove Dance

This video was put together with the help of over 200 employees at a Portland-based hospital to promote breast cancer awareness.


The Anthropology Song

Thursday, December 10, 2009

What Discovery Health thinks would be "Cool" for you to Know

Top 10 Things No One Tells You About Labor & Delivery from Discovery Health

"Find out what your girlfriends don't tell you about childbirth!"


Tip #10 - You can plan all you want, but sometimes the baby is in charge.
Many women commit to a drug-free birth, water birth or personally-created birth plan. Childbirth involves two living creatures, and your baby might have other ideas. The position of your baby, progression of labor and other health factors could require fast action via c-section or other changes to your plan. Remind yourself that the end result - a healthy, happy baby - is the goal, and be open to the entire experience.

Very True!  This is a great tip!

Tip #9 - You might throw up.
Wait, isn't all that supposed to be behind you? Well, vomiting during labor is actually normal. Nausea can be caused by pain, anesthesia, or the food your stomach is not digesting during labor.

And maybe poo-ing!

Tip #8 - Your teeth may chatter.
It's caused not by cold, but by incompatible fetal blood crossing into your bloodstream.

Weeiiiiirrrd! I didn't know this one!

Tip #7 - You pass gas - sometimes loudly.
There's nothing to be done here - it's caused by pressure in the birth canal. You may even have uncontrolled bowel movements. Also, epidurals can "freeze" the sphincter. Don't worry, doctors, nurses and midwives have seen and heard it all before.

Ah, here's the poo.

Tip #6 - You might rip off your clothes.
Your body is experiencing incredible hormone surges. You might yell, swear, or even rip off that nightie that's suddenly unbearably hot, itchy and uncomfortable.

Especially during Transition, which is right before the Pushing stage, and is supposed to be really tough during which you don't want ANYONE TOUCHING YOU. 

Tip #5 - You may forget everything your learned in childbirth classes.
Suddenly, all those breathing exercises and birth planning classes just go out the window. And it's very likely you won't remember a lot of details from the labor and delivery process.

That's why its essential to have a DOULA!! 

Tip #4 - You may not fall in love with your baby right away.
You've just been through an incredibly painful experience and you might need a little time to recover. Don't worry if you're not overwhelmed with joy immediately. It will come over you soon enough.

Also very true and quite common, as far as I know. Not to worry! 

Tip #3 - Your partner might be freaked out.
It's hard to watch someone you love go through violent spasms and scream with pain. In many cases, a friend or family member who's been through it before may be your best bet in the delivery room.

Doula! Doula! Doula! :D

Tip #2 - You're not done yet.
Even after you've delivered your baby, and placed him/her on your breast to begin the latching-on process, you still need to deliver the placenta. You may also need stitches, especially if you've had an episiotomy. You'll also be passing blood clots in the first hours after birth - and these may be as big as tennis balls.

As big as tennis balls?!?! No one mentioned this in my doula training...

Tip #1 - Pain doesn't end when baby arrives.
Childbirth is major surgery, and your body needs time to recover.

Oh. My. God. Childbirth is major SURGERY?! NO. Very very very bad, Discovery Health! Yes, your body needs time to recover. But normal childbirth is NOT major surgery. Unbelievable. Its only surgical if you had an unnecesarean, or if you needed stitches, or if they have to go in and get your placenta, something like that. I can't believe DH is propagating this ridiculousness as 100% fact.

Wednesday, December 9, 2009

Using Technology to Train Doctors about Labor & Delivery

Dou-la-la posted this video recently which shows a model woman being used to train doctors and nurses how to handle a woman when she's pushing her baby out. 



It makes me think of what we learned in our doula training workshop about "purple pushing" or directed pushing which the doctors and nurses always try to use - this is where the woman is sitting, curled forward and she is told to push for 10 seconds (during which she holds her breath, hence the term purple pushing) and becomes light-headed and strained. However, this is not a realistic pushing technique, because the mother can't make it a full 10 seconds without wearing herself out (my trainer says she follows the nurse's directions but counts much faster than this... 12345678910!). Though directed pushing is useful when the mother has had an epidural and can't feel her urges to push, it is just frustrating for a woman who CAN feel those urges. This is because they come several times over the course of one long contraction, and she has to just go with it when it comes, not count it out for 10 seconds whenever the doctors says to!


Here is another video about a pregnant robot who trains obgyn residents at Johns Hopkins:



A commenter on this post from Dou-la-la's blog said exactly how I feel: "Great. A whole new generation of doctors and nurses being trained to lay a woman flat on her back, open her legs, and push her knees up to her ears. Why not use a simulator to learn how to "catch" when a woman is in ALTERNATE birthing positions?"

I think training doctors and nurses for different scenarios is great, they should learn how to do births with an IV, a fetal monitor, an oxygen mask, woman on her back, however they should ALSO learn how to deal with different birthing situations. This is why we encounter nurses who are so flustered when a woman wants to have a natural birth or give birth in a squatting position out of the bed - because they are only trained for this one scenario!

Sigh. But, as Michael said after he watched these with me, "Change takes time."

Tuesday, December 8, 2009

Some Concerns as a New Doula

I have been asked a few times if it worries me that I may have trouble getting hired as a doula because
1. I'm a brand new doula with very little experience,
2. I am a young doula, and
3. I have never given birth or been a mom


One:  Yes I am a brand new doula with very little experience who is not yet certified, and I need to attend 3 births/15 hours of labor on my own to be certified. So why would someone hire me? Because I'm cheap. That's right, the #1 motivating factor! money! A doula in training is willing to take on clients for free or at an extremely reduced rate so that she can get her cert births. Other doulas may charge anywhere from $400 - $1000 (pricing depends on region).
A doula working on certification cannot attend certification births until she has been trained, so the families hiring a doula know that the doula has been trained and will be there for the laboring mother as a knowledgeable companion. Even with less experience a doula can still be compassionate, supportive, calming, give the mother ideas for easing labor and be an advocate for her choices.

Two: I am young in age to be supporting moms in labor. Well, that depends on your point of view. Yes, there are a lot of doulas out there who are older than I am, but my training workshop included one woman who was younger than I am. I have also read doula online forums about women as young as 17 getting into doula-ing, with full support from other doulas. Some women may want someone older to be a motherly support figure for them, which is fine, but some women would enjoy having someone more like themselves in age (if they're a twenty-something) helping them out. And some women don't care either way! The trick is clicking with your doula. That is why doulas emphasize interviewing several doulas to make sure you find the right match!
Furthermore, it is always possible I could take on clients who are young mothers or teen mothers, in which case I would be older to them!

Three: As my DONA trainer put it, "have you ever known someone who couldn't have children who would have made a great mother?" You don't have to have been a mom to be a motherly supportive presence during birth. And you don't have to have given birth to know what a normal birth looks like, what the usual processes with a birth are, what positions would help you find comfort or change the baby's position, and so on. There are male obstetricians aren't there? Although for a doula, I would want a female to be my birth partner. So a doula who has never given birth herself, such as myself, may still be a great support person.

Edit: Additionally, because I am brand new to this, I have nothing to un-learn, and no baggage to leave behind. The truth is, even if I had given birth, my birth experience is going to be nothing like your birth experience. This way, I go in with an open mind.

Monday, December 7, 2009

What Triggers Labor?

Oooh I love having nerdy birth-related conversations with my friends!  It brings up such good points that I then go investigate, such as this post!

Question: Does the baby induce labor?

I always assumed it was your glands producing oxytocin that induced labor, but I guess I never thought about what made your brain produce the oxytocin!

Apparently, the experts aren't sure what causes labor to begin. Some researchers now believe that the baby actually starts labor by sending a signal to the mother's body that causes labor to start.

Here are two theories:

One theory is that the baby's lungs secrete an enzyme or chemical when they are fully developed. This causes prostaglandins to be released into the mother's system. The prostaglandins then trigger changes in the cervix and contractions. Prostaglandins are sometimes used to induce labor.

Another theory is that the baby's adrenal glands send a signal to start labor. When the baby is ready to be born, the adrenal glands produce hormones. These hormones cause hormonal changes in the mother. These changes are responsible for the process that starts labor.

I couldn't find the Discovery Health show that caused the question in the first place. If I find any other information on this I'll post it!

Sunday, December 6, 2009

Re-Blog: Convincing White Women that Birth is Painless Will End 'Race Suicide'

I'm re-blogging this post from The Unnecesarean because it is really interesting and it got over 100 comments - people are really into the topic! I can't believe that women were really subjected to twilight sleep during birth, how horrible. And from some of the comments it seems that it was used as recent as 1980.

One of the comments points out something worth noting: "I think it's important to note that the "racism" here is Western (Anglo-Saxon) European vs. Eastern European." Go to the post to see more of them.

Below is the re-blog of the post:



A new method of analgesia that required constant monitoring also greatly influenced the move to the hospital. Developed in Freiburg, Germany, in 1914, “Twilight Sleep” used a combination of scopolamine, an amnesiac, and morphine, a painkiller, to remove all memory of birth. Women in Germany waxed ecstatic about this method; they reported going to sleep and awakening to find their beautiful baby lying in a bassinet. So compelling were accounts in women’s magazines that upper-class U.S. women traveled to Germany to give birth, approximately at the outbreak of World War I. Early feminists supported Twilight Sleep as promoting faster recovery from birth and thus helping to equalize the sexes in public life. Conservatives thought it was the answer to “race suicide,” the failure of Anglo-Saxon women to have enough babies to outnumber immigrants from eastern and southern Europe. If childbirth were totally painless, then Anglo-Saxon women “should” want to have large families. From about 1930 to 1960, Twilight Sleep was the preferred analgesic in U.S. hospitals.

Hospital births began to increase in frequency as more women demanded Twilight Sleep, but Twilight Sleep was being used by some to lure white women to the hospital to make more white babies? In the meantime, feminists were touting memory-free, drugged birth as healthier by saying that it got women back up on their feet again more quickly after childbirth so they could help equalize the sexes? And obstetricians launched racist and classist attacks during this time on midwives in order to protect what they felt was the dignity of obstetric arts and their only way to create a single standard was to medicalize childbirth by bringing it into the hospital?

The co-optation of birth and women’s bodies… a time-honored tradition, apparently.

Saturday, December 5, 2009

Love Robbie Davis-Floyd

Robbie Davis-Floyd is an Anthropologist whose work I love reading.  I have her book Childbirth and Authoritative Knowledge: Cross Cultural Perspectives,  because I love cross-cultural studies of childbirth! And the topic of authoritative knowledge in childbirth was introduced by Brigitte Jordan, the author of Birth in Four Cultures, the book that started it all for me!

Anyway, she has a website on which she posts several of her articles on birth and midwifery, etc, and a short one on Pregnancy had some really cool information on cultural beliefs and pregnancy. So, I shall share a few excerpts below. Enjoy!

On Pregnancy - Robbie E. Davis-Floyd, Ph.D. and Eugenia Georges, Ph.D.

The cultural variation in beliefs about pregnancy begins with beliefs about the causes of conception, which can express meanings and values central to the organization and identity of a culture. In the Basque country of France, for example, sheepherders understand conception as analogous to cheese-making: the semen of the man causes the woman's blood to curdle to form the baby, just as rennet curdles milk (Ott 1979). Behavior may mirror belief: because the Hua of New Guinea believe that conception is caused by the mixing of menstrual blood and semen, newly pregnant women have sex frequently in order to provide sufficient semen for fetal development (Meigs 1986). The Trobrianders, also of New Guinea, believe that conception results when a spirit child--formerly a Trobriander who died--enters a woman's womb and mixes with her menstrual blood. The elimination of the father's role in conception reflects the matrilineality of Trobriand society (descent is traced from mother to daughter) and the sexual freedom such a belief allows (Weiner 1993).


In many societies, the role of the woman is minimized. The Malays believe that a baby is formed in the father's brain, dropping down to his chest, where it receives human emotions, and then is thrust into the mother's womb, where, implanted, it grows like a seed--a belief which gives active agency to the man (Laderman 1983). This association of men with the creative seed, and women with nurturant soil, is common to all three of the monotheistic and male-dominant religions of the Abrahamic tradition (Judaism, Islam, and Christianity) which have informed folk theories of conception in the West and many parts of the East for millenia (Delaney 1991). Some patrilineal societies take male agency to an extreme: for example, in some Islamic societies a wife's pregnancy is the means by which the husband perpetuates his patrilineage and ensures its purity; thus women's sexuality is tightly controlled through the institution of purdah (veiling and seclusion).


Many cultures ritually proscribe the consumption of certain foods during pregnancy, and encourage that of others. According to Malay humoral beliefs, a "cool" state is ideal for pregnancy; thus foods with "heating" qualities, such as certain fruits, should be avoided (Laderman 1983:75-76). Among the Ewe of West Africa, pregnant women consume an edible clay rich in nutrients, which is comparable to the nutritional supplements prescribed in industrialized societies (Farb and Armelagos 1980:89). In rural Greece, a pregnant woman's food cravings are not to be denied: if she desires olives, for example, she must be given them, or moles shaped like olives will mark the child. Other behaviors may also be pre- or proscribed: Tanala women in Malagasy are enjoined not to touch black-eyed beans, lest their children be born with black spots; in Europe and the United States, many people believe that a mother's emotions and stress level during pregnancy will affect the psychological health of her child. Across cultures, such prescriptions and proscriptions reflect variations in cultural understandings of the symbiotic relationship between the mother and her baby, as well as the importance of their wellbeing to their society's future. Such cultural rules are far from absolute: women everywhere demonstrate a wide range of choice in their degree of compliance.


Obstetric Fistula

Here's a medical condition associated with birth that I didn't know about.  I read about it on the USAID's Maternal and Child Health site, which says the following:

During prolonged or obstructed labor, undue, extended pressure in the birth canal can lead to tissue damage. If untreated, this tissue damage results in a fistula — an abnormal opening between a woman’s vagina and bladder or rectum (or both).
An obstetric fistula permits the uncontrollable passage of urine and feces into the vagina, producing a foul odor and often leading to social isolation. Women with fistula usually feel shamed or disgraced. They are sometimes deserted by their husbands and cut off from family, friends, and daily activities. The physical and emotional stress of those suffering from an obstetric fistula is often compounded by the loss of the baby.
Because its the USAID site, it is referring mainly to women in developing countries who cannot receive emergency obstetrical care to fix the tissue damage. 

Data from the United States and the United Kingdom indicate that fistula is rare in developed countries and almost never results from obstructed or prolonged labor.

Obstructed labor occurs:

In cultures where child marriage is common and pregnancy occurs soon after menarche, obstructed labor can be common because young adolescent girls may not have achieved their maximal growth potential and thus start childbearing with an inadequate pelvis. Obstructed labor can also occur in subsequent pregnancies in which maternal nutrient deprivation may result in a distorted pelvis, or in women prone to pelvic fractures and other acquired pelvic deformities. Nutrient deficiencies such as calcium, vitamin D, folic acid, iron, and zinc deficiencies interact in combination with various biological and biosocial factors to determine the prevalence of obstructed labor. (American Journal of Clinical Nutrition)

Friday, December 4, 2009

Safety of the H1N1 vaccine for Pregnant Mother and Fetus

Oooh more controversy!

Just received an e-mail this morning with an article called Swine Flu Alert -- Shocking Vaccine Miscarriage Horror Stories.

Its true that "the package inserts for the swine flu vaccines actually say that the safety of these vaccines for pregnant women has not been established," however, pregnant women are nearly at the top of the priority list for receiving the H1N1 vaccine.  The CDC recommends that "During seasonal influenza epidemics, during previous pandemics, and with the current influenza A (H1N1) pandemic, pregnancy places otherwise healthy women at increased risk for serious complications from influenza, including death."

The above-linked article states that miscarriages by pregnant women who received the vaccine are being reported from all over the nation. Another article states, "Some might argue that miscarriages happen in 15% of pregnancies, but do they happen within hours to days after taking a vaccine?"

So, the question is, are these miscarriages really connected to the H1N1 vaccine or are they simply coincidences based on odds?

The current issue of the American Journal of Obstetrics and Gynecology has an article regarding the safety of influenza vaccines on pregnant women and their fetuses. The article notes that several studies done on past flu vaccines have shown that "maternal influenza immunization did not increase the number of stillbirths, congenital malformations, malignancies, or neurocognitive disabilities."
The authors conclude "Inactivated influenza vaccine can be safely and effectively administered during any trimester of pregnancy."

I'm interested in their making a solid determination about the safety of the H1N1 vaccine for pregnant women, because I've heard differing opinions from knowledgeable birth workers on the topic.

The Lamaze 6 Healthy Birth Practices

The Lamaze Healthy Birth Practices are a guide for creating a birth environment that lets you give birth simply and easily.

1. Let labor begin on its own
2. Walk, move around, and change positions throughout labor
3. Bring a loved one, friend, or doula for continuous support
4. Avoid interventions that are not medically necessary
5. Avoid giving birth on the back and follow the body’s urges to push
6. Keep mother and baby together – it’s best for mother, baby, and breastfeeding


1. Let labor begin on its own
 Letting your body go into labor spontaneously is almost always the best way to know that your baby is ready to be born and that your body is ready for labor. In the vast majority of pregnancies, labor will start only when all the players—your baby, your uterus, your hormones, and your placenta—are ready. Naturally, labor usually goes better and mother and baby usually end up healthier when all systems are go for birth. Every day of the last weeks of pregnancy is vital to your baby's and body's preparation for birth.
If your labor is induced (started artificially), it becomes a medical event and proceeds quite differently from spontaneous labor.  Unless you or your baby has a health problem that necessitates induction, it makes sense to wait patiently for your labor to start on its own. Even if your due date has passed and you’re longing to hold your baby, remember that nature has good reasons for the wait.

2. Walk, move around, and change positions throughout labor
Moving in labor serves two very important purposes. First, it helps you cope with increasingly strong and painful contractions, which signals your body to keep labor going. Second, it helps gently wiggle your baby into your pelvis and through your birth canal.

3. Bring a loved one, friend, or doula for continuous support
In childbirth, as in many aspects of life, we humans do better when we’re surrounded by those we trust, people who tell us we’re doing well and encourage us forward. Good labor support is not watching the clock and checking IV lines and fetal monitor printouts. It’s making sure you’re not disturbed, respecting the time that labor takes, and reminding you that you know how to birth your baby. Your helpers should spin a cocoon around you while you’re in labor—create a space where you feel safe and secure and can do the hard work of labor without worry.

4. Avoid interventions that are not medically necessary [i.e., routine interventions]
Although research shows that routine and unnecessary interference in the natural process of labor and birth is not likely to be beneficial—and may indeed be harmful—most U.S. births today are intervention-intensive. A majority of women surveyed for Listening to Mothers experienced one or more of the following interventions during labor:
Continuous electronic fetal monitoring (EFM)(93 percent)
Restrictions on eating (87 percent)
IV fluids (86 percent)
Restrictions on drinking (66 percent)
Episiotomy (35 percent)
Epidural anesthesia (63 percent)
Artificially ruptured membranes (55 percent)
Artificial oxytocin augmentation (53 percent)
Cesarean surgery (24 percent)

 5. Avoid giving birth on the back and follow the body’s urges to push
When it’s time to push your baby out, remember that instinct, tradition, and science are all on your side. Current evidence shows that letting you assume whatever position you find most comfortable, encouraging you to push in response to what you feel, and letting you push as long as you and your baby are doing well are all beneficial practices.

6. Keep mother and baby together – it’s best for mother, baby, and breastfeeding
Experts now recommend that right after birth, a healthy newborn should be placed skin-to-skin on the mother’s abdomen or chest and should be dried and covered with warm blankets. Any care that needs to be done immediately after birth can be done with your baby skin-to-skin on your chest. As midwife Ina May Gaskin says, you’re entitled to "keep your prize." 

Mother's Advocate provides free short videos and print materials (in pdf format) explaining the Lamaze Birth Practices.

Thursday, December 3, 2009

VBAC


A VBAC is a Vaginal Birth After Cesarean.  I first learned about VBACs from an article in Time magazine called The Trouble With Repeat Cesareans.

There is a great deal of controversy surrounding VBACs, and many hospitals do not give women who have had a previous c-section an option of a VBAC - its more cesareans only forever.  More than 9 out of 10 births following a C-section are now surgical deliveries.

The main risk associated with a VBAC is Uterine Rupture (because the mothers uterus has a huge cut scar running down it from her cesaren), which can be fatal to both mom and baby.

Here are the risks of Repeat Cesareans:
Heavy bleeding/hemorrhage
Increased risk of infection and infertility
Increased risk for hysterectomy and  uterine rupture in subsequent pregnancies
Increase a woman's chances of developing life-threatening placental abnormalities that can cause hemorrhaging during childbirth, such as placenta accreta (in which the placenta attaches abnormally to the uterine wall)
Here are some numbers:
1st VBAC
Chance of Successful VBAC : 63.3% (2 in 3)
Risk of Uterine Rupture : 0.87% (1 in 115)
Risk of Hysterectomy : 0.23% (1 in 435)
Risk of Blood Transfusion : 1.89% (1 in 53)
          vs.
2nd Cesarean
Risk of Hysterectomy : 0.42% (1 in 238)
Risk of Blood Transfusion : 1.53% (1 in 65)
Risk of Placenta Accreta : 0.31% (1 in 325)
Risk of Major Complications : 4.3% (1 in 23)
Risk of Dense Adhesion's : 21.6% (1 in 5)

So why do doctors push repeat cesareans instead of risking VBACs?
Malpractice Insurance.
Following a few major lawsuits stemming from VBAC cases, many insurers started jacking up the price of malpractice coverage for ob-gyns who perform such births. In a 2006 ACOG survey of 10,659 ob-gyns nationwide, 26% said they had given up on VBACs because insurance was unaffordable or unavailable; 33% said they had dropped VBACs out of fear of litigation. "It's a numbers thing," says Dr. Shelley Binkley, an ob-gyn in private practice in Colorado Springs who stopped offering VBACs in 2003. "You don't get sued for doing a C-section. You get sued for not doing a C-section."

'Weird' Birth Places

Oddee.com has a list called "10 Weirdest Places to Be Born," which I won't post the entirety of, but if you're interested you may read it here.  But the ones I found the most interesting/crazy were...

Born in a Tree

It sounds like the birth story of an ancient goddess, but it's true. Ms Cheindza was near term in 2000 when flood waters raged through her town in Mozambique. She climbed a tree to escape the crocodile-infested waters and stayed there for four days with nothing to drink or eat. Finally on the fourth day, her baby came. Soon after, helicopters arrived to winch the mother and the baby, Rosita, to safety. Her umbilical cord was still attached when she winched to safety by a South African helicopter crew. Her 26-year-old mother, torn by labour pains as she clutched the branches where she had sought refuge, was exhausted and near the end when rescuers discovered her precarious perch.



Born on a Train and Slipped through the Toilet
As if birth wasn't a hard enough way to enter the world, try surviving, then falling through a toilet and onto moving train tracks. That's the tale mother Bhuri Kalbi of Rajasthan, India, will have to tell her daughter. Kalbi was only seven monthspregnant and on a train's toilet when she gave birth early. She fainted before she realized what had happened. "My delivery was so sudden," Bhuri Kalbi told Reuters. "I did not even realize that my child had slipped from the hole in the toilet." According to Reuters, many trains in India have toilets that are just chutes which empty directly on the tracks below.

Once she awoke from her fainting spell, Kalbi told her relatives what happened. The train stopped and staff at a nearby station foundthe baby girl on the tracks, alive.
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