Sunday, February 28, 2010

Midwives in Senegal

"I have shared my belief and faith that birth is a physical occurrence for a meta-physical change, and will be the best day of your life. Yes, I have sometimes doubted the process of birth but never the outcome, not even in the face of babies who were not ready to be or stay with us. I have studied everything I could get my hands on in my journey to midwifery but nothing has prepared me for what I have seen and felt here.
At Kafountine I have met women who trust birth and its outcomes without question. They trust birth because birth is. I have met and worked with the sage femmes and matrones, collectively the Sista-midwives here, who routinely manage birth complications that many U.S. home birth midwives have little experience with, except to transfer. Here, even with the grossly limited resources available and the near impossibility of transfer, these Sista-midwives do not recognize our Western distrust and “what if” of the birthing process, of birth or birth complications—they just do what they can do, always prepared for whatever outcome God and nature dictate."

The above is a quote from a midwife named Claudia, founder of Birthing Hands DC, who traveled with several midwives and midwifery students to Casamance, Senegal to work and learn in a birth clinic. I seem to have found the blog detailing her experiences just after they have returned to the States, but it is a fascinating read!

The Birth Clinic is located in Kafountine, a village in west Senegal. It has permanent residents who are Wolof, Jolla, Mandinka, Peuhl and the various regional sub-tribes of these major tribes. In addition, it has residents who have migrated, on a permanent or temporary basis, from the Gambia or Guinea Bissau.  Almost everyone understands Arabic and some French in addition to several local languages.

Here are a few quote that I pulled from the blog posts that I found particularly intriguing:

"There is a high incidence (over 20%) of fraternal twins in Senegal as elsewhere in western Africa.  The common belief that this high incidence is a result of the consumption of African yams and sweet potatoes."

Only female friends and family members support the laboring woman. No men are allowed to see or be near a birthing woman and her birth fluids.

"The women are more staunch in getting the laboring women to move and walk and work hard. Labor is hard work and the faster and harder, the sooner the baby will come. Laboring women do not make much noise; the shake their hands, tighten and beat their fists, compress their forehead, jaws and faces, hold heir lower backs; and first time mothers kneel to the ground; first time Peuhl mothers sometimes call out for their mothers."

"These Sista-midwives are not proponents of “mother the mother” and “warm fuzzies” in labor. Tough love is practiced here by the midwives and the female family members—the message is “birth is hard work!” Fundal pressure was used only once in our presence and discontinued when we remarked about it. Women birth lying flat on the delivery table with their hips resting on a large bed pan.  Also, no female family members or friends are allowed to attend the birth."

In the village of Kobar, they visited and chatted with the traditional midwives. Here are somethings they learned about their traditions and beliefs:

"Dig a hole in the ground to bury the placenta. Encircle the placenta with the umbilical cord.  Make sure the end of the umbilical cord extends above the ground, like a baby plant. Failure to do this, especially leaving the end of the cord above ground, may lead to infertility."

"It is customary not to discuss the fetus!! The fetus is not a physical being but a spirit space and only God can know what is happening there. Instead you can ask, “How is your belly?”"

How do you treat post partum hemorrhage?
  1. Many Jolla women wear bracelets made of iron which is used as a form of protection for them.
In birth there is a lot of water, meconium and blood. If there is too much blood the Jolla woman takes her bracelet and sucks on it.
  1. Also – will place a woman in a very high concentrated salt bath.
  2. Last resort – the hospital.

All photos above are from Birthing Hands DC's flickr account - check it out to see more photos of the midwives' trip!

    Saturday, February 27, 2010

    Parenting Choices

    There are a lot of things that I hadn't thought much about before getting into the birth and doula world. I have been focusing a lot on the childbirth event itself, and very little on the parenting aspect of having a baby.  Here are a few things that I've learned a lot about since getting into this world.

    Some of them may seem a little bit "hippie," but I don't think they are, really. They are seen as "Alternative Parenting" type choices, but that's because not everyone does them. It doesn't mean that someone who chooses to do one also does all the others, and not all of them are that radical.

    Each topic does have its groups of differing points of view, and sometimes even heated debate.  All of them require making your own decision about whats right for you and your family.


    The WHO estimates that as of 2006, 30% to 33% of males aged 15 or older are circumcised worldwide.

    There are a lot more people who are against circumcision than I realized, and people get very worked up about it. I am not going to formally take a side here.

    Arguments for circumcision:

    - It improves sexual function;
    - Provides some protection from HIV and penile cancer;
    - Better hygiene without a foreskin;
    - Religious aspect: Muslims and Jews traditionally circumcise their male babies for religious reasons;
    -Wanting baby to look like Dad or peers.

    Arguments against circumcision:

    - Reduces sexual function (desensitizes);
    - It is a cruel and painful procedure to do on a newborn;
    - There are risks of complication or death: infection, hemorrhage, surgical or anesthetic mishap, long-term issues with urination, etc;
    - Human Rights aspect: Seen as genital mutilation of male infants and children is just as terrible as female genital mutilation.


    Again, a lot more parents vehemently against vaccination than I knew.

    Arguments for Vaccination:
    - Decreases risk for entire population,
    - One swift, inexpensive way to prevent a disease.

    Arguments Against:
    - Religious reasons,
    - Forced immunization is about making money,
    - Safety and Side Effects related to vaccine ingredients: Mercury-based preservative thiomersal contributing to the development of autism, Aluminum, other heavy metals, animal bi-product, etc etc and long-term effects. 

    Attachment Parenting

    Attachment Parenting, or AP, is difficult to define. Wikipedia says it is
    a parenting philosophy based on the principles of the attachment theory in developmental psychology. According to attachment theory, the child forms a strong emotional bond with caregivers during childhood with lifelong consequences. Sensitive and emotionally available parenting helps the child to form a secure attachment style which fosters a child's socio-emotional development and well being. Less sensitive and emotionally available parenting or neglect of the child's needs may result in insecure forms of attachment style, which is a risk factor for many mental health problems.
    The 8 Principles of Attachment Parenting International are very broad, so that parents may interpret them in a manner that suits their lifestyle. Here are some generalizations (my take) of AP:

    1. Creating a peaceful environment for birth that promotes bonding with baby
    2. Breastfeeding, feeding baby on cue, eating healthy, weaning gently
    2. Respond with Sensitivity, or, You can't spoil your child, or Don't ignore child's needs
    3. Touch and physical affection is important, Babywearing
    4. Co-sleeping and responding to child at night as you would during the day
    5. Minimize separation and care by strangers
    6. Gentle, Positive Discipline
    7. Stay Balanced

    Cloth Diapering

    Why would you ever use cloth diapers? Isn't that so much more difficult?

    Here are some reasons:
    1. The Cost. On average, disposables cost roughly $3000 a year. Cloth diapers cost a lot up front but less overall. If you're curious about the price comparison of all the types of cloth diapering vs. disposables, this site compares the cost of buying and washing, if necessary, for every single diaper change you will probably do.
    2. The environmental impact of disposable diapers is staggering. A single disposable diaper takes 300-500 years to decompose in a landfill.  Keeping disposable diapers out of the landfills lowers your environmental footprint!
    3. Cloth diapered babies on average are potty trained almost a year earlier than babies who use disposables and have significantly less diaper rash.

    My really brief and basic description, for those of us who are only familiar with disposable diapers: There are a lot of different kinds, but I think basically you have an outer shell and absorbing inserts that both get washed in the washing machine. Solid waste gets dumped, it does not go in the machine. There are some specifics to learn about washing them and drying them, and some things to learn if you're traveling and have to carry around the dirty diapers (until you can wash them at home).

    The first post I ever read on the subject, which provides a nice summary and answers some questions, though isn't as detailed as this post, which actually describes the difference between types of cloth diapering methods, and more!
    This blog post includes the longest summary of what other bloggers have had to say about their own cloth diapering choices and I definitely didn't read through it all, but if you're interested, go for it.

    Elimination Communication
    A potty training practice in which a caregiver uses timing, signals, cues, and intuition to address an infant's need to eliminate waste. Typically the goal is to partially or completely avoid the use of diapers. EC emphasizes communication between the caregiver and child, helping them both become more attuned to the child's innate rhythms and control of urination and defecation. The term "elimination communication" was inspired by traditional practices of diaper-less baby care in less-industrialized countries and hunter-gatherer cultures. Some practitioners of EC begin soon after birth, although it can be started with babies of any age. (Wikipedia)

    I first learned about EC from this blog post where she describes what its like to do it with two children and how it works. I find it fascinating that even a young baby can signal when he or she has to eliminate waste.

    Friday, February 26, 2010

    A Birth Story

    I haven't really posted birth stories on my blog, but this one seemed special so I thought I'd share it. Its short, peaceful, includes a doula, and takes place in San Francisco.  It is from the Dear Baby, which is a blog I used to follow before I made this blog but sadly forgot about!

    Everly Veda’s Birth Story.

    I’ll start this story at the moment my water broke. It was 2:45pm on Monday afternoon and Brent was taking a shower. I’d been hounding him to make a run to the grocery store with me to stock our cabinets before Everly arrived. I’d had mild contractions all day – but nothing significant and then, in a matter minutes, I went from bouncing on my big blue birth ball while answering email, to standing in the bathroom, leggings around my knees and staring at my husband in disbelief. There was no doubting what was happening – my water had broken and the impossible wait for our daughter had come to an end.

    While Brent called our family and prepared the last items for our hospital bag, I went to work baking peanut butter cookies for the nurses in labor and delivery. He put on an old Wilson Pickett album and as music filled the house, I tried to steady my emotions. We had done so much, worked so hard, dreamed of this day and it was finally here. My contractions begin to get stronger and I was hit with a wave of emotions. I went into Everly’s nursery, leaned my head against her crib and sobbed. I said a long prayer to God and asked him to watch over Everly and I in the coming hours. I called my best friend Natasha and said “This is it. It’s really happening, I’ll call you when she’s here”

    By this time, Brent had called our doula, Lindsay who had made her way over from the East Bay. My contractions were strong, but manageable and I leaned against the kitchen counter, rocking to “Hey Jude” on the record player and trying to focus myself. It was important to me to labor in the comfort and quiet of our house as long as possible. As my contractions grew stronger and closer together, I used my hypnobabies cds to stay calm and centered. Brent and Lindsay massaged my back and hips as I breathed through them. It was about 6:30pm when I felt they were getting so intense that I couldn’t breathe through them in comfort any longer. We climbed in the car and made the 15 minute ride through the Castro and Noe Valley to St. Luke’s Hospital in the Mission. The car ride was miserable as I had to sit upright, wearing a seat belt as each contraction rolled through my body. More than anything, I just wanted to get there and get centered on the task that lay ahead of me.

    It was 7:00pm by the time I had checked in, undressed, and gotten settled in the labor and delivery room. Brent wrapped his arms around me and we swayed back and forth as I worked through each contraction. It is hard to really understand what a contraction feels like until you are in the middle of one. It isn’t like menstrual cramps, it isn’t a head to toe ache – it’s a deep, intense, active pain that rolled from my lower belly and spread through my body. Every contraction had a steady increase in strength, a peak, and then a merciful end – giving me enough time to gather my breath and courage to prepare for the next one.

    As part of our birth plan, I requested as little medical intervention as possible. No IV, intermittent fetal monitoring only and no internal exam until I requested. A lot of women have a strong desire to know exactly how far they have progressed in their labor, but for me – I didn’t want a number of centimeters dilated to effect the focus of my efforts. I was afraid that hearing I’d progressed only a few centimeters would shake my courage. With nothing connecting me to my environment, I was free to move and find a comfortable position to labor. Surprisingly, being on my hands and knees felt the most comfortable and I stayed that way for the next hour.

    By 8pm, I was asking to use the Aqua Doula tub for the remainder of my active laboring. This was the first time they checked my progress, as the hospital where I delivered does not allow you to deliver in water and they had to establish that I was not fully dilated. The midwife confirmed I was 5 cms, halfway there. I felt encouraged by that thought. As a first time mother, I knew my labor could be long – but knowing I had come so far already gave me renewed energy.

    While my doula and a nurse set the tub up, I rode each contraction up and down – on my hands in knees in the bed, my face often pushed into the pillows as I tried to stay focused on one wave at a time. Brent stayed right there next to me, rubbing my head, looking me in the eyes and encouraging me over and over again that I was doing a good job. “You are doing so good, honey. I am so proud of you” he would say – and even those few and simple words made me even more determined. I was doing this for him as much as I was doing it for myself- I focused on the image of Everly in her father’s arm and the intensity of my desire to bring his little girl into the world. He left my view only long enough to change the music from Fleet Foxes to Beirut and was back before the next wave hit me. There were times they were so strong that I would have to chant “I can do this. I can do this. I can do this” over and over again to myself. The pain had become so deep and active that I began to vocalize a loud, deep moan with every contraction – it wasn’t a sound of fear or even one of raw, physical pain – it was a sound of full and complete effort – a focused, primal sound that carried me to each wave – over the peak and down again.

    At some point, my body began to push despite my best efforts to control it. “I have to do this – I have to push” I told my midwife. It was 9pm, an hour since I was last checked, and they had just finished setting up the Aqua doula tub. She checked me again and to everyone’s disbelief – including my own, I was a full 10 cms dilated and ready to push. All the effort they had put into getting the tub ready went to waste as I couldn’t even get in. Another request in our birth plan was to let me push when I felt the need to push instead of being directed to do so. In the dim light of our room, I let go of my body and let it lead me. With each contraction I felt a deep, guttural urge to push – I couldn’t have stopped it if I wanted to. It was as if I was hooked up to electricity and each jolt pushed my body a little more. I soon began to feel Everly’s head moving out a little more with every contraction. Brent put Regina Spektor on in the background, and held my hand as I vocalized through each contraction. I was being really loud and it felt good to let the sound go with each push. My doula, worked to keep me focused on releasing after each contraction. Because I actually feel my daughter moving forward with each contraction, I found myself not wanting to release at the end of each one. I wanted to keep moving her forward – but my body needed those small breaks between waves to regroup.

    Because I had no pain relief, whatsoever, every nerve and fiber of my body was tuned into the experience. I could feel every time her head would push forward, and then slid back as the contraction finished. I experienced her journey. I knew exactly where she was at each moment and as we approached the final pushes of my labor – I found myself consumed with the need to bring her through me and into the world. Those last moments are a bit of a blur – an intense and consuming pain, an overwhelming joy – my life changed forever in one final burst of effort.

    At 10:07pm, a mere 3 hours since we’d walked into the room, she was laid, wet and pink on my chest. Her eyes blinked, her small hands clasped at my skin. She never screamed, but instead cried out for a few seconds then settled against my heart beating through my chest. Her eyes were open and she stared up at us with her small, dark eyes. Brent curled around us and the three of us laid there consumed by the new definition of who we were. New parents, a daughter, family. God, she was so beautiful. Beyond beautiful. Perfect in every way.

    No one took her away for tests. No one disturbed us. We laid there in bliss while our eyes memorized her every inch. We stayed that way for almost an hour with Regina Spektor sang “Little wet tears on your baby’s shoulder” in the background. 25 minutes after her birth, the midwife let Brent cut Everly’s umbilical cord. And eventually, when we were good and ready – they measured and weighed her. A very healthy 8 pounds, 6 ounces and 21 inches long.

    I breastfed her for the first time as I lay there recovering and an hour after that I was out of the bed and standing. My recovery has been wonderful, despite a few stitches and a sore body. Everly has been feeding non-stop since she was born and that has become one of my favorite times with her. We lay in the bed together, at some early hour of the morning, both of us sleepy and she nurses while I rub small circles on her back. She coos at me and open and closes her fingers against my breast. Nothing you do in advance can prepare your heart for those moments.

    I’ve spent the past hour writing this experience with tears flowing down my cheeks. I’ll never be the same. Not after this. To come face to face with the most intense pain, the strongest desire, the deepest love… Motherhood is a gift unlike any other.

    Shoulder Dystocia

    Shoulder Dystocia is a type of difficult childbirth in which the baby's shoulders get stuck in the pelvis after the head is delivered and additional action must be taken to get the baby out. It occurs in less than 1% of all births.

    A common strategy to deal with shoulder dystocia is the McRoberts Maneuver, in which the mother, already in a lithotomy position (on her back) legs are pushed tightly up against her stomach.  An obstetrician will also frequently cut an episiotomy to help the baby out, although it is not the perineum, but the pelvic bone, that is holding the baby back.

    Here is a video of the McRoberts Maneuver:

    Suprapubic pressure
    Pushing on the top of the pubic bone in an attempt to widen it.

    Zavanelli maneuver
    Involves pushing back the delivered head into the birth canal and then performing a Cesarean section. A study on 9 cases using this maneuver in 1988 found:
    In one of these cases, the fetal head “remained outside the vulva for twenty to twenty-five minutes before it was reinserted” and the baby was delivered by cesarean. There was one stillbirth among these nine cases, one mother suffered from sepsis and subsequent hysterectomy, one baby was born with an Apgar score of 1/4 but was reported normal at age seven, and one baby currently has some degree of mental retardation.
     Another study in 1993 found even more infant problems, and
    Maternal complications included two ruptured uteruses, three lacerations of lower uterine segments, six transfusions, and eight morbid postoperative courses. (The All-Fours Maneuver for Reducing Shoulder Dystocia During Labor)

    The Gaskin Maneuver, or the All-Fours Maneuver
    The woman turns over onto her hands and knees, which flexes and widens the pelvis.
    I introduced the all-fours maneuver in the United States in 1976, after learning about it from a Belizean midwife who had, in turn, learned it from Mayan midwives in the highlands of Guatemala.
     Out of 4452 births in the study and 82 babies with shoulder dystocia,
    Half of the eighty-two babies weighed more than 4000 grams (about 8.5 pounds); 17 or 21 percent weighed more than 4500 grams (about 8 pounds, 10 ounces); thirty of the 1-minute Apgar scores were less than or equal to 6, and two were less than or equal to 3; only one of the 5-minute Apgar scores was less than or equal to 6, which is 1.2 percent; forty-nine of the women or 60 percent delivered over an intact perineum, and there were no third- or fourth-degree lacerations; one woman had postpartum hemorrhage not requiring transfusion; and one infant had a fractured humerus.
    “The most significant observations of the study were the negative findings. No still births or neonatal deaths were reported. Not a single infant suffered Erb palsy, either transient or permanent, and no newborns experienced seizures, hemorrhage, hypoxic-ischemic encephalopathy, cerebral palsy, or fractured clavicle. No patients required any tocolytic medication during labor. No vaginal, cervical, or uterine lacerations occurred. No women required transfusions. And no cases of postpartum, ileus or pulmonary embolus were reported. Overall, the maternal complication associated with the use of the “Gaskin Maneuver” was 1.2 percent (one case of postpartum hemorrhage, transfusion not required), and the neonatal complication rate was 4.9 percent. . . None of these patients required any additional maneuvers. . . Not only was the Gaskin Maneuver instrumental in relieving shoulder impact in every instance, it is also a non-invasive procedure requiring only a change of maternal position.” The average time needed to assume the position and complete the delivery was 2-3 minutes, with the longest reported interval being 6 minutes. (The All-Fours Maneuver for Reducing Shoulder Dystocia During Labor)
    The Gaskin Maneuver may not be useful, however, if the mother has been numbed by an epidural anesthesia.  And it is not easy to do if the mother is hooked up to several monitors and an IV.

    Thursday, February 25, 2010

    Drugs and Breastfeeding

    The very last compilation of note-worthy information from my Breastfeeding Basics online learning module!

    1. There are several references that have compiled data regarding the safety of drugs given to breastfeeding mothers, including the following:
    1. LactMed: A peer reviewed and fully referenced database of drugs to which breastfeeding mothers may be exposed.
    2. Breastfeeding: A Guide for the Medical Profession 6th ed. Ruth Lawrence and Robert Lawrence. Appendix D contains a summary table of the effect of maternal medications on the breast fed infant. 
    3. The American Academy of Pediatrics Statement on Drugs and Breast Milk 
    4. Drugs in Pregnancy and Lactation 7th ed. Briggs, Freeman and Yaffe. 
    5. Medications and Mothers' Milk. 13th Ed. 2008, Thomas Hale.
    The "Physician's Desk Reference" (PDR), which is used by many people as a source of information on drugs, is not a particularly good reference for the effect of medications on lactation or on the breast fed infant. For most drugs the PDR states that the drug has not been tested in lactating women, (a true statement) and consequently should not be given to lactating women. While this is certainly a safe recommendation, it will result in many women stopping breastfeeding unnecessarily. In most cases, a physician can determine that a woman may safely continue to breastfeed while taking the prescribed medication by checking one of the references given above.

    2.  Contraception while Breastfeeding:

    - The Lactational Amenorrhea Method (LAM
    - The use of the combined estrogen/progestin oral contraceptives can cause decreased milk production in breastfeeding women. Use of the lowest dose estrogen containing pill may help minimize this effect. The effect of the pills on decreasing milk production varies among women and may be transient.
    - Progestin only forms of hormonal contraception including pills, depot medroxyprogesterone acetate (Depoprovera) and the etonogestrel implant (Implanon®) have been shown to produce no changes in breast milk composition, breast milk supply, duration of breastfeeding or infant growth.

    3. In many countries of the world, herbs or various foods are used to increase milk production. These include fenugreek, goat's rue, milk thistle, beer, papaya, and others. There is little scientific evidence of the efficacy of most of these foods on increasing breast milk production. Fenugreek, which is used as a spice and medicine in India and the Middle East has been the most widely used to increase breast milk supply. Anecdotal reports suggest some efficacy for fenugreek, however this data is very limited. Side effects can include low blood sugar in the mother, maple like odor to sweat, milk and urine, diarrhea and increased asthmatic symptoms.

    Many medications can also increase milk production, ie. domperidone, by blocking dopamine receptors and subsequently increasing prolactin levels. Domperidone is not available in the United States. However, studies performed in Canada and Italy show that when Domperidone was given to lactating mothers at a dose of 10 mg three times a day, prolactin levels and milk production increased. There were no reported side effects.

    4. Herbal teas considered safe during lactation include Chicory, Orange spice, Peppermint, Rasberry, Red bush tea and Rose hips.

     5. Pain Killers: Use of acetaminophen and ibuprofen are safe and effective in breastfeeding women. Oral codeine and hydroxycodonemay also be used by breastfeeding mothers, but mother should monitor their infants for sleepiness and other behaviors.

    6. No Illicit drugs should be used during pregnancy or breastfeeding, including alcohol and marijuana. They all pass into breast milk and affect the baby.

    Wednesday, February 24, 2010

    When it Rains, it Pours!

    If you are an aspiring doula, and haven't been told or haven't figured it out yet, I'm going to say it again: Starting a doula business and getting clients takes a long time and is slow to start.

    But after months of disappointments as far as hiring goes, things are looking up! In one week I got two potential client interests. One came from the boyfriend, who gave my card to his noticeably pregnant law school classmate. She had had a doula with her first birth and was thrilled to hear that I was offering free services since I'm in training! We met the other day and it went well, and now I have a client! The second found an ad I posted on craigslist. She went to my website and e-mailed me from there. Turns out she loves my website, and said she had the hardest time finding doulas and childbirth classes because so few people have websites. We met today and it also went well! This is her first baby and she is very sweet. Both moms are due in May.

    Both moms have been really nice and understanding of my still being in training, even offering to do anything they can for me and inviting me to their hospital tours or ultrasound visits. I feel so lucky! I also talked to another mom who is having a home birth in April. She received my name from another doula in the area - one I haven't even met yet! I don't know yet if she will hire me (I am kind of far drive from her and that seemed to concern her), but I'm keeping my fingers crossed because attending a home birth would be SO COOL!

    I can't believe they all happened within one week of one another. I'm so excited that I have two clients and one more potential one! I think having the experience of shadowing my first birth, plus offering my services for free, plus having a sweet website, business cards and professional paperwork have all really helped kick things into high gear. Hooray!

    Tuesday, February 23, 2010

    A Kardashian Birth on TV

    Keeping Up with the Kardashian's: A Reality Star is Born

    Reality TV does more for the truth about birth than fictional TV!

    Watch the videos on the page linked above - especially the second and third ones.

    Thanks to this show, I now know that when a pregnant woman's water breaks, it continues to trickle out over a period of time. I also learned that, unlike labor portrayed in movies, women have time to shave and put on makeup before they go to the hospital. So there was some actual "reality" depicted on reality TV!
    Kourtney Kardashian actually reaches down and calmly pulls her baby out and up!

    Baby Mason 

    Too frequently on television you see a woman's water break and everyone gets frantic - everything becomes a big emergency and you must rush to the hospital right away! And the mom gives birth  screaming and she certainly never catches her own baby.  This is so refreshing!

    Belly Henna and Blessing Ways

    Images found through links on

    I think Pregnant Belly Henna is so beautiful. I think photographs of your pregnant belly covered in beautiful artwork is a perfect way to keep a memory of your pregnant body.

    I like it even better than Belly Casting (what am I going to do with a giant cast of my belly? hang it on the wall forever?) even though I know some people really love belly casting.

    Here is what belly casting is: 

    One of the best things about Belly Henna is that it is often combined with a pampering party called a Blessing Way.  A Blessing Way celebrates motherhood and is a fun and spiritual women's celebration centered on the pregnant mom-to-be. It can include things like:
    painting the mom's belly;
    lighting candles and sharing prayers, poems and blessings of well-being;
    washing mom's feet and
    brushing her hair.
    The Blessing Way celebrates this important moment of life passage for a woman!

    There are a ton of belly henna photos on flickr.  See some really beautiful and detailed henna bellies here: RemarkableBlackbird

    Monday, February 22, 2010

    Donating Breast Milk or Cord Blood

    Donating Cord Blood

    I know about Cord Blood banks from reading brochures in the waiting room of my gynecologist's office. You save the blood from your baby's umbilical cord in a bank just in case those stem cells could come in handy later in life. These stem cells can be used to treat your child for almost 80 diseases, such as leukemia and lymphoma, and will be a match for someone else in your family as well. Not everyone banks their baby's cord blood; it can be expensive.

    I had not thought about cord blood donation, though, until the birth that I went to two weeks ago. Donating cord blood increases the public supply of stem cells so that people in need may be able to find a match in the registry, like you would if you were looking for an organ transplant. Donating cord blood is no different than saving it for yourself in a cord blood bank and neither choice is invasive or harmful; the doctor takes blood from the cord, not you or the baby. Its something to think about doing, as it doesn't cost you to donate and the hospital will throw it away otherwise. And you could help save someone's life!

    Donate Umbilical Cord Blood: National Marrow Donor Program
    Parents Guide to Cord Blood Foundation

    Donating Breast Milk

    In case you haven't figured it out by now from reading my blog, I am a big supporter of breastfeeding and a huge fan of breast milk. If babies are orphaned or adopted, or mom cannot make enough milk, a donation of breast milk is the best thing to give them. Over formula. Definitely over cow's milk. If a baby is premature and mom hasn't begun producing milk yet, or if a baby is ill and mom has stopped breastfeeding and therefore is no longer producing milk, donated breast milk can come to the rescue!

    There is such a thing as a Breast Milk Bank that you can donate to. They are not in every state in the U.S. but I think the interest is growing. Any nursing mother who is producing milk in excess of her own baby's needs can donate - the bank will ask you questions about your health, test your blood and test the milk. Breast milk is also pasteurized. Donation of breast milk is a great thing, especially for babies in need in developing countries. For instance, there was a big call for donated breast milk for children in Haiti after the earthquake.

    If you're interested in donating your breast milk:
    Human Milk Banking Association of North America
    International Breast Milk Project

    Sunday, February 21, 2010

    Books! Birth Partner and Jack Newman's Breastfeeding

    I recently finished The Birth Partner by Penny Simkin.  That was quite an accomplishment, because it was one of the first books I started back when I was taking my DONA workshop, and has somehow taken me this long to read.  It was so jam-packed with information, and being non-fiction it was a slow-go, so I was reading several other books at the same time. 

    But I'm not going to write a review of it here, nor am I going to suggest it for you to read. Why? Because all the knowledge is inside me now! And if you want to find out whats in it you'll just have to have me to be your birth partner! muahaha!

    I am now deep into Dr. Jack Newman's Guide to Breastfeeding, which is awesome. It is also going to be a long read because it is extremely comprehensive. My favorite chapter so far is "The Sale and Promotion of Infant Formula."  It presents information that is simply shocking! Here is a summary: In the 1970's the media revealed to the world shocking photos of dying babies in developing countries. Everyone found out that the marketing of baby formula to women in developing countries who could not afford to pay for it, didn't have access to clean water or who didn't understand that using formula would interfere with going back to breastfeeding. Babies were fed diluted formula or formula mixed with bad water and were missing out on immune protection from breastfeeding and therefore developed infections and illness.

    In response, in 1981 NGO's, UNICEF, the World Health Org, formula companies, and scientists got together and created a code of ethics on marketing infant formula and bottles. The gist of the agreement was: 1. marketing couldn't directly or indirectly target the consumer (no free samples given to pregnant women or parents at all), but advertising about formula can be given to providers (doctors and nurses); 2. Literature on infant feeding must be provided by the government, not formula companies and all donations of money or equipment by formula companies to health care providers must be done openly and without special benefits.  This code, however, is not law and the formula companies disregard it. Nestle, who owns Carnation, especially, disregards these rules in countries all over the world, and this is a big reason for the Nestle product ban. They, along with many other companies, advertise heavily to doctors and hospitals, giving money, equipment and free products. They also directly advertise to consumers through the mail and provide discharge packs for new moms leaving the hospital full of formula samples and brochures on how "formula is just as good as breast milk."

    The brochures are the most interesting part. They might say breastmilk is better, but then emphasize how tiring, restrictive, painful and difficult breastfeeding can be, and how formula is easy and healthy. Jack Newman describes the brochures' approach, which he provides pictures of in the book, as "breastfeeding mother as brazen harlot, formula-feeding mother as convent girl." I wish I could find the images for you to see online. Photos of the breastfeeding woman pray on fears of modern women to be exposed - the woman's breasts are both exposed, even the breast the baby is not feeding at. They show her squeezing her breast to express milk. Also, one image clearly shows the breastfeeding mom's left hand with an obvious lack of wedding ring on her ring finger. The formula-feeding mother, on the other hand, is dressed modestly (in a jumper, no less) and also has her left-hand clearly exposed with a very obvious wedding ring on her finger. Dr. Newman also shows two contrasting photos of dad and mom feeding baby together. In the breastfeeding photo the dad has a stank 'stache and looks a little left out of the feeding process while mom breastfeeds baby. In the formula photo, dad is feeding the baby with a bottle and the couple is clearly better looking than the breastfeeding couple. Shocking, formula companies! Simply astonishing, your stealthy manipulation!

    This is a great ad though!

    Mom says - I don't use a bottle
    - It gets dirty easily and can give my baby diarrhea
    - It diminishes my milk production
    - Teeth grow deformed and with cavities

    Baby thinks -
    My mother's milk is the best and I can take it when I want.

    Friday, February 19, 2010

    How to Find a Cheap Doula

    Part of DONA International's position is that "A Doula for Every Woman Who Wants One."

    Doulas are (or should be) an indispensable part of a woman's birthing experience - making sure that you feel like you are in control of your birth, being supported in your time of need, and that you get have a satisfying birth experience! Whether that is an un-medicated  birth, a c-section, a water birth, an induced birth with an epidural, a home birth, whatever!

    Many people's response to hearing about doulas, however, is that they must only be for people with money - those with the luxury of being able to hire an extra helper.  I want to point out that there are a lot of excellent highly trained doulas who will do pro bono work for a woman who truly cannot afford a doula but really wants one.

    Also, Doulas in Training! Like myself! Doulas working towards certification are guaranteed to offer low fee or free doula services while they try to attend the births required for certification.

    But how to find a doula in training?  Well, you can try googling it and see what comes up, but you can also just ask another Doula.  Doula's do not mind if you ask them if they know any inexpensive doulas in training, because they will understand if you do not wish to pay as much as they are asking and they also understand what it is like to be a doula looking for certification births! So they will be willing to help both sides out. And they definitely know some in training... I've been contacting tons of people to let them know I am looking for births, and I am on some area listservs where doula's put out announcements of women looking for doulas that they themselves aren't helping.  Moreover, you can ask your physician or midwife and they will most likely know of doulas in the area who can help you out with low cost doulas.

    However, if you are looking for a cheap doula in Maryland, you should just HIRE ME! :)

    Thursday, February 18, 2010

    External Version

    "If the midwife has determined in the course of the [prenatal] massage that the baby is in a breech (bottom-first) or transverse (side-lying) position, she will do an inversion, an external version of the baby in utero." - Yucutan, Mexico. Brigitte Jordan, Birth in Four Cultures

    When I first read that, for some reason my mind went to an image of a traditional midwife making a model of the baby that she would use to "symbolically" turn the baby. Ha, shows how I used to think about the efficacy of a traditional Mexican midwife's practices. yeesh. 

    An external version is actually of a turning of the baby inside the mom's tummy! How fantastic is that? 

    These days, a breech or transverse baby is usually identified by prenatal ultrasound scans.
    External cephalic version was widely performed in the U.S. until the 1950's, and is commonly employed by traditional midwives the world over, as well as by trained midwives and physicians in Europe.  In the US the standard management strategy for breech birth and other malpresentations is the Cesarean section.

    "[The Midwife] locates the baby's head and hip and by applying strong, even pressure to these parts, shifts the baby's body into the more favorable head-down position. This procedure is sometimes painful but since the perceived alternative is a Cesarean section in the hospital, the women much prefer to tolerate a few minutes' discomfort at home. [She] will do a version as often as necessary from the eigth month on, up to the time of birth."  - Yucutan, Mexico. Brigitte Jordan, Birth in Four Cultures

    Today, in the medical setting, breech external versions are done at the doctor's office. A nonstress test and ultrasound are used to assess the baby's well-being. The mother may be given an injection of terbutaline to relax her uterus. She may also be given an epidural to relax the abdominal muscles and prevent pain from the procedure, but this is time-consuming and expensive. With the guidance of an ultrasound the doctor presses on her abdomen to lift the baby out of the pelvis and turn the baby head-down. This is usually only done after 36 weeks. On the rare occasion that labor begins or the fetus or mother develops a serious problem during version, an emergency cesarean section (C-section) may be done to deliver the fetus.

    Versions are successful 60-70% of the time. 

    They are most likely to succeed when:
    • The mother has already had at least one pregnancy and childbirth.
    • The fetus, or a foot or leg, has not dropped down into the pelvis (has not engaged).
    • The fetus is surrounded by a normal amount of amniotic fluid.
    Potential Risks:
    Potential risks of version, for which the fetus and mother are closely monitored, include:
    • Twisting or squeezing of the umbilical cord, reducing blood flow and oxygen to the fetus.
    • The beginning of labor, which can be caused by rupture of the amniotic sac around the fetus (premature rupture of the membranes, or PROM).
    • Placenta abruptio, rupture of the uterus, or damage to the umbilical cord. The potential exists for such complications, but they are very rare.

    I was just informed of an alternative form of Breech version that carries fewer risks and a higher success rate - The Webster Breech Version.

    Chiropractic Care: The late Larry Webster, D.C., of the International Chiropractic Pediatric Association, developed a technique which enabled chiropractors to release stress on the pregnant woman's pelvis and cause relaxation to the uterus and surrounding ligaments. The relaxed uterus would make it easier for a breech baby to turn naturally. The technique is known as the Webster Breech Technique.

    The Journal of Manipulative and Physiological Therapeutics reported in the July/August 2002 issue that 82% of doctors using the Webster Technique reported success. Further, the results from the study suggest that it may be beneficial to perform the Webster Technique in the 8th month of pregnancy.

    To add, other than the manual manipulation of the baby there are other ways to promote the turning of a baby, such as visualization, body positions such as the pelvic tilt and knee-chest, using a rebozo, and so on!

    Wednesday, February 17, 2010

    Medical and Non-Medical Reasons for Cesarean Births

    An Elective Cesarean section is a planned C-section, as opposed to an Emergency Cesarean section which is performed during labor.

    Note: It is much better for mom and baby if a C-section is not performed until labor has begun spontaneously. This way you know for sure the baby is ready to be born and the hormones that help with birth, breastfeeding, etc have begun flowing. 

    Why Doctors and Mothers choose Elective Cesareans for Non-Medical reasons:

    1. The woman's pelvic floor will remain undamaged and this will save her from being incontinent of urine or feces.
    To assume that stretching the vagina, one of the things it is made to do, will cause permanent damage is a misleading assumption. Studies have found that by middle age, there is no difference in the rate of incontinence among women who have had cesareans, vaginal deliveries, or those who have never given birth.

    2. A desire to avoid the stresses and complications that might arise in a vaginal birth, such as long duration, exhaustion, fetal distress, the need for forceps or vacuum extractor. They perceive the potential for these risks to be more frightening than those accompanying cesarean birth.

    3. Social reasons - convenience control over timing, apparent simplicity (scheduling it and baby is born in an hour).  This is really more convenient for the doctor, who is done in an hour, than for the mother who must recover for weeks. This is based on lack of information about risks of cesarean sections and the length and hardships of recovery.

    Why Doctors and Mothers choose Elective Cesareans for Medical Reasons:

    1. Doctors suggest the fearful possibilities that the baby will be too large to deliver vaginally, a failed induction can lead to an unplanned cesarean anyway, you may have a delay in getting an epidural and have to suffer pain, your labor is overdue, or the possibility of a uterine rupture during a VBAC (if mom has had a previous Cesarean section). Even if doctor coerces the mother into choosing a cesarean for these reasons, it is written down in her paperwork as "maternal request."

    2. A breech baby (legs and/or butt first). Breech babies can be turned during pregnancy (ie, external version, I'm planning a post on this soon) or even during labor. Even un-turned breech babies can be delivered vaginally, but many doctors won't allow it and insist that if a baby is still breech at the due date than a C-section is necessary.
    Obstetricians debate whether Cesarean section is always best for Breech babies (Washington Post)

    3. Mother has a serious illness (heart disease, diabetes, preeclampsia) or injury.  Sometimes the doctor will allow the mother to attempt to labor under supervision.

    Why Elective Cesareans are Riskier than Vaginal Births, International Cesarean Awareness Network (ICAN)

    Medical Reasons for Cesarean Birth:
    Although cesareans are not always necessary in these circumstances, they are almost always considered and very often performed.

    1. Emergencies:
    - Prolapsed Cord
    - Serious hemorrhage (excessive bleeding) in the mother.

    2. Arrested Labor/Failure to Progress:
    * Note that when the doctor decides you have failed to progress may actually mean he just thinks you are taking too long, such as at the 8 hour mark, or when his shift is almost done for the day. (Recall that birth can take 24 or more hours).  Experts agree that far too many c-sections are performed for failure to wait. *
    - Abnormal presentation of baby
    - Inadequate uterine contractions
    - A poor fit between baby's head and the mother's pelvis (sometimes given as a reason ahead of time, but is difficult to measure or predict)

    3. Problems with the Fetus:
    - Fetal distress. This is indicated by what the fetal heart monitor records or by checking the amniotic fluid for meconium (when baby is stressed it poops). It is another reason that frequent unnecesareans are performed, as the monitor can be wrong or interpreted incorrectly.
    - Pre or post maturity.

    4. Problems with the mother:
    - A genital herpes sore
    - A previous cesarean section and the VBAC is not going well

         "Cesarean rates are up to 50 percent or higher in some hospitals. Doctors often feel they must do a C-section to protect themselves from a malpractice suit. And many of them seem to feel that a C-section is actually better than vaginal birth. A lot of women are being given unnecessary surgery."
         "I had a C-section, but in my case it was necessary."
         "Tell me about it."
         "Well, the baby's heart rate started to drop on the fetal monitor, and the doctor was worried that she wasn't handling labor very well. So he said a C-section was the safest thing to do."
         Its an awkward conversation to say the least. I would never want to make any woman feel bad about the birth of her child... Having been told by both a doctor and a reliable-looking and expensive piece of machinery that her baby could be in trouble, my acquaintance probably made the best decision she could make in that moment. By the time sh reached the point when that decision was made, it could, in fact -- after hours of beeping noises on the fetal monitor, the suspense of the hospital atmosphere, and loads of chemicals pumping into her body -- have been the only choice available.
         Some percentage of women who think their C-sections were necessary -- because of fluctuating heart rates, large babies, failure to progress, previous C-sections, difficult birth positions, and on --- have actually had unnecessary C-sections. I know this because the World Health Organization says that any time a country's cesarean-section rate rises above 15 percent, the dangers of C-section surgery outweigh the life-saving benefits it is supposed to provide. In the US the overall C-section rate has now reached [over] 30.2 percent. -- From Cesarean Birth in a Culture of Fear, by Wendy Pointe

    Tuesday, February 16, 2010

    Choosing Your Baby's Gender?

    You've got a 50/50 chance of conceiving a boy or a girl, right? Your X-chromosome egg will either be fertilized by the Y-chromosome sperm and make a boy (XY) or an X-chromosome sperm and make a girl (XX). But what if you could influence the outcome?

    Even though we'd love our baby no matter what gender, there are very few of us who wouldn't love to be able to choose whether we have a boy or girl.

    Wives' tales and folklore abounds on how to influence the gender of your baby.  Here are just a few examples:

    If you want a boy
    - Eat more meat — the redder the better
    - Make love standing up
    - Make love on an odd day of the month
    - Warm testicles and sperm
    - Woman sleeps on the right left side of the bed

    If you want a girl
    - Give in to your chocolate craving
    - Make love with the woman on top
    - Make love when the moon is full
    - Cool testicles and sperm
    - Woman sleeps on the right side of the bed
    - You put a wooden spoon under your bed and a pink ribbon under your pillow

    Is it truly possible to choose your baby's gender?  (I'm referring to methods that do not involve sperm selection and in-vitro fertilization) Many people believe that yes, science shows us we can.

    The Shettles Method is a popular method developed by Dr. Shettles, who based his methods around the belief that the X and Y sperm have different traits:

    X-chromosome sperms are slower swimmers than Y's but survive better in cervical mucus. Y-chromosome sperms are faster but less hardy and survive for a shorter amount of time in cervical mucus.

    Here is a summary of what he found in his study:

    1. Timing:  The closer to ovulation you have sex, the better your chances of having a boy because the Y-sperms are faster and will get to the egg first.  Having sex 3 or more days before ovulation will give you a better chance of conceiving a girl because the weak Y-sperms will die and the X-sperms will still be hanging around when your egg is released. 
    2. pH of a woman's vaginal tract: More acidic environments favor X-sperms. Y-sperms will be killed off. According to Dr. Shettles, women should try not to orgasm during sex if trying for a girl because it will make the environment more alkaline. When trying for a boy, both partners should try to orgasm at the same time.
    3. Position of intercourse and Depth of penetration: Deep penetration places the sperm closer to the egg and the quick aggressive boy sperms will get a head start. Also, shallow penetration is a more acidic environment. Shettles recommends missionary position for a girl and rear-entry (doggy style) for a boy.
    4. Sperm count: When trying for a boy, don't have sex for 3-4 days before you reach the target date (right before ovulation). For girls have sex every day until 3 days before ovulation. Men should wear loose underwear (switch to boxers!) to keep testicles cool for Y-sperms, although Shettles doesn't recommend the opposite when trying for girls.
    5. Caffeine for the man right before sex to give Y-sperms a boost.

    Is the Shettles Method scientifically sound?
    There are numerous medical articles that examine why the Shettles Method is flawed and most medical studies have not been able to replicate the numbers that Shettles himself claims to have seen. In fact, some studies have shown that those using the Shettles Method may actually have trouble conceiving.
    It seems pretty clear that many of the methods of trying for a girl, especially, would make it harder to conceive at all. The time closest to the actual period of ovulation is the time during which humans are most likely to conceive. It is incredibly hard to conceive at all - I remember learning in an Anthropology course that the human species has a very low probability of conception.  The Shettles Method recommends that if trying for a girl baby that you stop having intercourse at 3 days before ovulation, which makes you less likely to conceive overall! I also remember learning from a Psychology teacher (though this wasn't part of the curriculum, haha) that the best intercourse position to conceive in was doggy style - Shettles' recommendation for a boy!

    Many women and their partners will say that it can't hurt to try the above methods, just in case they might work! They'll mark dates on their calendar to have sex, measure the pH of cervical mucus, withhold orgasm (gasp!) and so forth.  But is this just as fruitless as "putting a wooden spoon under your bed and a pink ribbon under your pillow"?

    What do you think?

    Monday, February 15, 2010

    100th Post!

    Happy 100th post to me!

    I'm very excited to share in this 100th post that since I started keeping track of hits on my site exactly one month ago, I have had visitors from:

    The United States
    The United Kingdom
    The Phillipines
    South Korea

    Crazy cool and exciting!

    Thank you to those who have been my loyal followers from the start! And thank you to those who have stumbled upon my site and decided that you enjoy it enough to check it every now and then, and maybe even comment! I really appreciate it.

    And if there is anyone out there who has been lurking (reading but not commenting) I'd love it you would take this opportunity to de-lurk and say Hi! :)

    Sunday, February 14, 2010

    Breastfeeding Basics: Logistics

    More Breastfeeding Basics

    1. Infants should breastfeed immediately after birth

    Infants are most alert in the first hour to hour and a half of life. This is especially true if no maternal medications have been transferred to the infant during labor and delivery. Newborns should nurse at the mother's breast during this alert period. After this initial alert period, babies go through a two to six or eight hour period of time when they are much sleepier and less arousable. Breastfeeding during this period of time may be much more difficult. Mothers need to be reassured that this is normal and it will not hurt their baby to go through this period of time without a good feeding. Studies have shown that infants who nursed soon after birth had a longer duration of breastfeeding than infants who were first put to breast 3 to 6 hours after birth.

    2. It is important that the baby take as much of the areola in his or her mouth as possible, not just the nipple. This is necessary for milk let down and ejection. Basically, the baby uses its tongue, gums and jaw to stimulate and compress the milk sinuses in the areola and then milk is expelled. If the baby's mouth is only on the nipple no milk will be released and the mother will be very sore. Baby should also be tummy-to-tummy with mommy.

    3. The results of 4 studies all show that early pacifier use is associated with a shorter duration of breastfeeding. Whether early pacifier use is a cause or is only a marker for mothers who are having difficulty with breastfeeding, have decreased confidence in their ability to breastfeed, or desire a short duration of breastfeeding is unknown. Pacifier use beginning after 4 weeks of age does not seem to be associated with a shorter duration of breastfeeding. Mothers who want to breastfeed should avoid giving a pacifier to their baby until breastfeeding is well established or until the baby is about 4 weeks of age.

    4. Maternal breast milk placed on the nipples is the best treatment for dry, cracked or sore nipples.

    5. Continue breastfeeding after going back to work, or put baby on formula?

    In the United States, the cost of renting an electric breast pump has been shown to be less than the cost of formula if the infant is weaned. So continuing breastfeeding while working may provide a financial advantage as well good nutrition, immunological benefits and the other benefits of breastfeeding.

    6. Breastfeeding for a year or even longer has no detrimental effects.  Mom and baby can wean whenever they are ready.

    The American Academy of Pediatrics recommends "There is no upper limit to the duration of breastfeeding and no evidence of psychologic or developmental harm from breastfeeding into the third year of life or longer."

    Saturday, February 13, 2010

    Born in the Caul

    DID YOU KNOW?! Some babies are born and are still in their amniotic sac.

    Here's another thing that popular culture has incorrectly taught us - labor starts when your water breaks. Wrong!

    You could be in labor for hours before your water (amniotic sac) breaks. Your sac could break and you could not have contractions for a long while. Your doctor may break the sac to speed labor up (popular procedure, called AROM: Artificial Rupture of Membranes).

    Or, if your waters are never artificially ruptured or spontaneously ruptured, your baby may actually be born in the caul, as it is called when the baby's head is emerging still inside the amniotic sac. The amniotic sac cushions the baby as it works its way down through the pelvis during contractions. I've seen it in a couple birth videos.  The medical practitioner will usually go ahead and rupture the membranes once the baby's head is out so that the baby can breathe.

    Being born in the caul is not a bad thing at all, but it is very rare.  In fact, a veiled infant it is considered to be lucky or to have some sort of spiritual significance.  It does assure that the baby could not possibly have become infected. Midwives are more likely than OB's to allow a baby to be born in the caul.

    The wikipedia page on "caul" lists a lot of myths and legends associated with being a "caulbearer."

    You can view images of a baby being born in the caul at Birthing Way.

    Thursday, February 11, 2010

    My First Birth!

    I finally went to a birth! My first birth! And now I will tell you all about it :)

    B, the doula who has been trying to find me a birth to shadow her on for the past 2 months, but has been a bit flaky, finally called me and said the words I have been waiting to hear, "You know that mom I told you was due soon? She's in labor."  The crazy part - her call woke me up at 8am so we hadn't shoveled the car free from the snow that yesterday's blizzard dropped on us. So boyfriend went right out to free the car from the snow while I showered and ate and packed my bag full of extra clothes and food. Talked to B again and she told me that the mom and her husband had also freed their car from the snow and were heading to the hospital and we would all meet there. Drove on the snowy roads (had a couple mishaps, like coming to a stop at an intersection and all the snow on the top of the car sliding down onto my windshield so I couldn't see a thing and had to get out and clear it off) and survived to reach the hospital downtown. Unfortunately, B hadn't given me very many instructions on where to park/which building to look for, etc, and I completely passed the hospital parking garage and ended up in the expensive one. sigh. The roads in the city were definitely not plowed, though there were people working on it, and they all looked at me like I was crazy as I drove by. I also probably looked lost. Started tromping through the snow and around the buildings that all said the hospital name on them trying to find the Women's Health building, which I thought was the right way to go in. B had told me that she was in triage with the parents and she would let me know when they got a room. Turns out it was not the main lobby that I was in and I ended up sitting in the wrong lobby for 45 minutes. Oh well. Got a visitor pass from the gruff information desk woman, who noticed my backpack as I was walking away and said "Are you a Doula?" and was so much nicer to me after that, apologizing because she would give me a doula badge but she was out of them.

    Went up to Labor and Delivery and found the correct hospital room. Mom was already 7 cm dilated and fully effaced, and had only been in labor since 5:30 am. Her water had broken at 7am. The situation was very quiet and calm as the mom got through her contractions really well by herself. It hadn't occurred to me until I got there, though it seems like an obvious thought now, that there wasn't really much I could do or say because I had to yield to B, the more experienced doula, not wanting to overstep my bounds. Plus, this was her patient not mine, and she had her way of doing things. So, I mostly watched. I was packed and prepared to be there into the night, as this was a first-time mom, so I figured I'd be doing a lot of watching and waiting. Pretty soon her parents arrived and they were really nice and there was more to watch. Nurses and doctors were coming in and out. The mom was hooked up to an IV and the fetal heart monitor, which they kept adjusting. The main nurse was really nice, as was the doctor. The only strange moment occurred when another nurse who looked like she just wandered in because she had nothing to do came in and said "is she on an epidural?" and the main nurse said "Nope" and the other nurse said sympathetically to the laboring mother, "Oh, I know you must be in so much pain!" and B turned to her and said "She's doing very well."  I was glad the nurse just left after that and didn't go any further in her attempt to convince the mom she needed an epidural.

    After I had only been in the room for about an hour a doctor came in and checked the mom's progress. She was still at 7 cm, +1 station.  The mom groaned and said "I haven't changed at all in 3 hours? I don't think I can keep doing this. Can I have the Stadol?" And the doctor said no, when you're at 7cm we don't give stadol anymore, because if the baby were to be born soon the effects of the drug won''t have worn off yet. She said she could push the cervix back with her fingers and the mom could push through it and get the baby out now, or she could give her the Stadol and they'd wait a few hours, and until she dilates all the way, to start pushing. And the mom chose to push the baby out now, despite the discomfort of having the doctor's hands push against her cervix.  Which is amazing because I did not know you could just push through like that at only 7 cm!

    As soon as she made that decision everything went into high gear.  Nurses in scrub gear and tables full of instruments and sheets and plastic appeared in seconds to fill up the small hospital room. The bottom half of the bed disappeared and the doctor set up the whole area. I had been trying not to look between the mom's spread legs out of courtesy, but I soon realized it was going to be hard to miss. B told the mom that she should grab her thighs and pull against them to help her push, and she grabbed a leg and held the foot and thigh so the mom could push against her too. Then the doctor said "can someone else come hold this other leg?" and I jumped right in. The dad hadn't jumped up so I figured it was fine that I did. Plus, B had told me the other day that the husband was totally cool with doulas because he is from Africa and is used to birth being a Woman's thing, surrounded by other women, etc. So, I'm holding her leg and leaning into her as B is taking charge and telling her to push down down down ok breathe do it again down down down. It was really forceful pushing, and quick, because she had to push through her not fully dilated cervix as the doctor spread it apart. Then she'd breathe and relax in between contractions. That's another thing I'd like to note here: I don't know if many women realize this ahead of time, but contraction pain is not like broke-your-leg pain. If you break your leg, or cut your hand open, just as an example, you're in PAIN PAIN PAIN PAIN PAIN not stopping until the paramedics come and put you on pain drugs and then you're on them in the hospital and until you heal. With childbirth its a minute-long contraction Pain PAIN pain and then none. A few minutes go by then Pain PAIN pain none. So you get a few minutes in between to totally breathe and chill. And there's even a short period just after Transition and before Pushing called Resting stage where you could even fall asleep!

    Anyway, let me just explain in detail just how much I was at this birth. I was not just at it, I was THERE. I was all up in. I was right on the other side of the leg from the doctor. I had a front-row seat to the birth. And I have to say, it was not gross or weird at all. I watched the baby start to crown, the head pushing out and then slightly receding. The baby's head was all narrow as it got squeezed out (newborns don't look like babies they look like newborns - elongated heads and squishy faces!) and so much tinier than you'd think. Admittedly, there was a gross aspect to it - the mom did poo a little bit and that is the only thing I can't handle - the smell. I don't like poop smell. I already know its going to be a problem when I have to change my kids' diapers. But there I was, supporting and pushing against the mom's leg, right in the thick of the action, and she was kind of a large woman too so it was no piece of cake. I watched the baby come out in a split second and get placed, blue and crying, right on his mom's belly. It was so surreal.  I had watched it in videos before and then it was a foot from my face! Too cool.

    Then there was a long to-do about collecting the cord blood because the parents had wanted to donate it. Unfortunately they did a really bad job, blood squirting everywhere except in the bag, and so I don't think it was enough to donate.  Mom had pushed so hard and so fast that she had torn, so the doctor stitched her up for a long while and the baby got weighed and measured. The grandparents and the dad were taking photos like crazy. Then they gave baby back to mom and B helped her start breastfeeding. He latched on like a champ! Too cute. I congratulated her and told her she did awesome, but she said she didn't feel like she did in the end. But she really did do great - she was coping with her contractions well before she asked for stadol and then she was brave in choosing and executing the plan to go ahead and get the baby out! And I thanked her for letting me attend her birth for my training and she and the new dad both said they were glad they could help me out. They were so nice!

    The whole thing happened so fast and I'm amazed I'm there and back already.
    It all made me realize that I was thinking about Birth on the one hand and being in a Hospital on the other. Birth and Hospital were separate, even when I was thinking about births in hospitals. I know what it feels like to be a patient in a hospital, what it looks like to visit someone in their hospital room, and I've watched birth videos and read about hospital births, but I hadn't actually connected them in reality until today. I don't know if this makes sense. But when I was standing in that hospital room, it was just like being in a hospital.  I guess I kept thinking "I'll be at a birth!" and maybe my thoughts were romanticized (everything would happen fast paced, I'd be doing lots of support techniques, or it would be a special birthing-type room) instead of thinking "I'll be at a hospital!" which is just what it was. I was at a hospital.  It was just like visiting someone in the hospital. I hope that doesn't sound dumb, haha.

    Being there made me realize that there is so much that you can't know until you're doing it.  The workshops and the books do not tell you everything.  If I were on my own, I wouldn't have known where to get ice chips or chux pads from. I wouldn't have been able to tell the mom that shaking after the birth was normal. I wouldn't have been able to tell her that after she is able to get up and use the restroom by herself, whenever she is ready, they will move her and baby to the postpartum room. And so forth. Realizing this has only made me more nervous to go into a birth on my own - there will be so much I won't tell the mom! But only experience gives me experience, I suppose.

    As B and I were walking out I asked her how I did, and she said I did well. She didn't say too much about it but I believe her. :)

    Wednesday, February 10, 2010

    You shouldn't 'Try' to have a 'Natural' birth

    "Satisfaction and fulfillment in birth do not depend on an absence of medical intervention; they do depend, however, on the degree to which other essential but intangible ingredients - human values - are present."  - Penny Simkin 

    You shouldn't try to have a "natural" birth, you should prepare to have an empowered birth!

    The most important thing is not whether or not you succeed in birthing without any help or medical interventions. If you make that your most important goal for your childbirth experience, then you will feel even worse if you feel you've failed.

    Your goal should be to adequately prepare for every possibility - know how you feel about every single medical intervention or care provider rule and keep your mind open to how your feelings about them may change once you are in labor. The key is being informed.

    If you don't know your options, you don't have any.

    Ideally, one should remain flexible. It is important to realize that things don't work out how you've envisioned, whether you're a first time mother or a mother 10 times over! Each labor experience will be new and different. And no one will deny that childbirth is challenging.

    If you prepare for flexibility you will 1. be fully knowledgeable of all your options ahead of time, 2. be able to make informed decisions should some turn of events occur, 3. feel much better emotionally after the birth.

    I read in a recent post on interventions at Stand and Deliver:
    "The prominent theme in these four sets of birth stories is that the women who felt the interventions were necessary and welcome, rather than unnecessary and traumatizing, freely chose the interventions on their own--on their own request, on their own timetable, and on their own initiative. They knew it was time for assistance. They were the primary actors in their births, rather than recipients of others' agendas. They held the locus of control, even when that meant asking others to do things for or to them at some point (IV, epidural, Pitocin, or c-section)."

    This reminded me of something I learned about in my doula workshop...

    Studies on women’s long-term perceptions of birth demonstrate that the way women are treated by birth professionals determines how satisfied they are with the experience. A study by Penny Simkin, in particular, demonstrated that the women who felt in control of their situation, instead of being treated as ignorant or powerless, had the most satisfying birth experiences. Her study showed that women did indeed remember their birth experiences in detail even twenty years later, and they very much had an impact on their psychosocial health. 

    I found that if particular factors were present, women are more likely to feel long-term satisfaction... The women with positive feelings today recall being well cared for and supported by the doctor and nurse, whereas those with negative feelings today tend to recall negative interactions with staff...

    Control over what was happening to them and the decisions about their care were important factors in long-term satisfaction. Women whose doctors and nurses said and did things that they did not want still feel anger and disappointment...

    The way a woman is treated by the professionals on whom she depends may largely determine how she feels about the experience for the rest of her life. (Just Another Day in a Woman's Life? 1991)
    These are more reasons why it is great to have a doula by your side. Your doula can help you feel powerful, in control and supported. She can help you maintain this even if something unexpected comes up and you must alter your birth plan and be a little flexible.  She will have helped prepare you for all possibilities, remind you of your options, and you will feel much better for having empowered your birth experience!

    Monday, February 8, 2010

    Pain Medication Preference Scale

    by Penny Simkin, taken from "The Birth Partner"

    Explore how you feel, either as a mother or as a birth partner.

    Every number on the scale is a potential realistic feeling except the extremes (+10 and -10), which are included as reference to other numbers on the scale.
    Note: avoiding pain meds requires more preparation than using them.

    +10    Desire to feel nothing; desire for anesthesia before labor begins (this is an impossible extreme).

    +9     Fear of Pain; mother believes she cannot cope; dependence on staff for total pain relief.

    +7     Definite desire for anesthesia as soon as the doctor will allow it, or before labor becomes painful.

    +5     Desire for epidural anesthesia in active labor (at 4-5 cms dilation). Willingness to cope until then, perhaps with narcotic medications.

    +3     Preference for using medication, but as little as possible, with some sensation. Desire to use self-help comfort measures. Natural childbirth is not a goal.

    0      No opinion or preference. This attitude is rare among pregnant women, though not among birth partners or doulas.

    -3     Would like to avoid pain medications unless coping becomes difficult. Would not feel disappointed or guilty if she used medications.

    -5      Strong preference to avoid pain medications, to avoid side effects on the baby or the labor. Will accept medications for a long or difficult labor.

    -7     Very strong desire for natural childbirth, for a sense of personal gratification as well as to benefit the baby and the progress of labor. Will be disappointed if she needs to use medication.

    -9     Desire that birth partner and staff deny mother pain medication, even if she requests it.

    -10   Desire that the mother forego all medications, even for cesarean delivery (impossible).

    Sunday, February 7, 2010

    Non-Drug methods for Inducing/Speeding up Labor

    If there is a medical reason why labor must start, but you'd like to try some non-medical methods to induce labor, here are some self-induction methods (always discuss with your caregiver!). These methods also work to speed labor up!

    1. Nipple Stimulation
    Stimulating the mother's nipples causes the release of oxytocin, the hormone that contracts the uterus. Mom or partner can massage the nipples in many ways, using hands, warm towels, a breast pump, mouth, etc.  If contractions become too strong with this method you should stop.

    2. Walking!
    It is also a pleasant distraction :)

    3. Sex
    Orgasm causes the release of oxytocin (and contraction of the uterus) and may also release prostaglandins, a hormone-like substance that softens the cervix. Semen also contains prostaglandins, and sex is a more enjoyable way to deposit prostaglandins on the cervix than the methods used in the hospital! Once membranes have ruptured, however, avoid putting anything within the vagina (increased risk of infection).

    4. Acupressure or acupuncture
    Certain points on the body can be "activated" to start contractions. Make sure acupuncture is done by someone who is trained and always check with your caregiver first.

    5. Bowel stimulation with castor oil
    I've heard of this being used by cultures all over the world to stimulate labor.  I've also heard of using a raw egg to induce vomiting, but that seems like it would be gross and unsanitary! Castor oil causes powerful contraction of the bowels (and diarrhea) which can help induce uterine contractions and maybe produce prostaglandins.

    6. Homeopathic remedies
    Make sure the person prescribing these knows what they're talking about. Herbal teas and oils, such as primrose oil can speed up contractions. Proper dosage and potential side-effects should be noted.

    7. Changing Positions
    Like walking, changing positions helps loosen up the shape of the mother's pelvis, takes advantage of gravity and may encourage the baby to wiggle into a more favorable position. Open knee-chest position, pelvic rocking, the lunge, side-lying, squatting, etc.
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