Tuesday, March 30, 2010

Public Health and Breastfeeding

Breastfeeding is a Public Health Issue.


Less than one-third of infants are exclusively breastfeeding at 3 months of age, and almost 80% of infants in the United States stop breastfeeding before the recommended minimum of one year.

"Breastfeeding is the optimal form of infant nutrition. As public health leaders, it is our responsibility to protect, promote, and support breastfeeding mothers and babies. I urge you to consider ways you can be active in promoting and supporting breastfeeding in your environment, including your workplace and your community. These efforts will support a public health movement that not only provides optimal nutrition to infants, but also lessens the occurrence of infectious and chronic diseases, thereby improving the health of our nation."                  - United States Surgeon General


Societal Benefits of Breastfeeding

  • Total medical care costs for the nation are lower for fully breastfed infants than never-breastfed infants. This is because breastfed infants typically need fewer sick care visits, prescriptions, and hospitalizations.
  • Employers benefit because breastfeeding mothers do not miss as much work time caring for sick babies. Employer medical costs are also lower and employee productivity is higher.
  • Breastfeeding is better for our environment because there is less waste compared to that produced by formula cans and bottle supplies.

Breastfeeding and Public Health

Shortened or absent breastfeeding has enormous public health implications for all segments of society: children and adults, male and female. Below are some statistics:
  • Women who have never breastfed have 1.2-2.8 times the risk of pre-menopausal breast cancer.1 Breast cancer alone kills about 1,600 Massachusetts residents per year, striking about 4,400 people per year.2 About one-quarter of breast cancer deaths are in pre-menopausal women.3 (HIV, by comparison, killed 327 people in 2001).4
  • Two years of lifetime breastfeeding can dramatically lower the risk of pre-menopausal breast cancer. If a woman has two children, and breastfeeds each for a year (the recommended guideline), her risk of pre-menopausal breast cancer is lowered by 28-61%.1 Breastfeeding can lower the risk of any type of breast cancer by 4.3% for every 12 months of breastfeeding.
  • Women who have never breastfed have 1.25 times the rate of ovarian cancer,1,6 higher rates of endometrial cancer,6,7 as well as osteoporosis and hip fractures.1,8,9 Ovarian cancer kills about 400 people per year in this state.
  • Infants who were not breastfed have 7 times as much necrotizing enterocolitis (which has a 30% mortality rate);10 twice as many cases of otitis media, higher rates of hospitalization, higher rates of lower respiratory tract illness, gastrointestinal illness, meningitis; 15-18 Sudden Infant Death Syndrome (SIDS)14,19-20; and abandonment by their mothers.21 
  • Children who were not breastfed have higher rates of type 1 diabetes mellitus,11,14,22-2411,14,25 dental caries,26 dental malocclusion.27-28  leukemia and lymphoma,
  • Children and adults who were not breastfed as babies have higher rates of Crohn's disease and ulcerative colitis,11,14,29 and celiac disease.30
  • Massachusetts spends about $27 million/year to treat excessive cases of infant diarrhea, respiratory syncitial virus, and otitis media in formula fed infants.31 
  • It is estimated that an average of $331-475 in extra health care costs are incurred per child in the first year of life to treat excessive cases of lower respiratory tract infection, gastrointestinal disease, and otitis media in formula fed infants, compared to infants breastfed for as little as three months.32 
  • Nursing mothers miss less work because their children are healthier.33 
  • Maternal pre-menopausal breast cancer rates1 and rates of childhood otitis media,17,18 leukemia,25 and type 1 diabetes mellitus 22,23 all go down more with increasing duration of breastfeeding. 
  • Although the links between breastfeeding and asthma have been controversial, there remains considerable evidence that children who were not exclusively breastfed have 1.4-2.4 times the odds of having asthma.34-37 The prevalence of asthma is 10-30% among children and adolescents.39-43 Further, many children with asthma go on to have adult asthma as well. 

Monday, March 29, 2010

Prenatals and Cesarean Birth Plans

This past week I did three prenatal meetings. It was really fun to stretch my doula muscles, do some educating and (one of my my favorite things) talk about birth!

One of them wasn't quite as organized as I would have liked - I felt I could have "led" a little more because mom went off on tangents and used up a lot of our time. I'll have to cram a lot into our second prenatal now.

Another went really really well and I am so glad I took these clients on, even with my close EDD's, because they are so so sweet. I had the best prenatal with them, getting to know them and discussing their birth plan.

Here are some birth fears that came up: More pain than they can handle, Being out of control, Waking up in the middle of the dark of night in a lot of pain, Being 'late' and having to be induced, Tearing (and pain, recovery associated with that), an emergency Cesarean section.

I am a big believer in being prepared, and that is why I always bring up creating a Cesarean birth plan. Another reason is that the United States has a 32% (1 in 3) C-section rate, so it is a very real possibility that one should be prepared for.

I know that many pregnant couples do not like to think about or even mention the possibility of a Cesarean section if they are trying for a vaginal birth, especially if their pregnancy has been low-risk. They fear that simply "putting the possibility out into the universe" will somehow cause it to definitely happen. Learning as much as you can about a C-section ahead of time can only benefit you in the event that your birth reality diverges from your birth plan. Things can change in a second and you may find yourself uninformed and unprepared.

Fear is often associated with the unknown and the inability to have an effect on outcome. You DO have options when it comes to a Cesarean birth. 

I mentioned C-section birth plans in my post And KABOOM! Here's Your Baby!
Here are some options that you have for a planned or unplanned Cesarean section delivery:

Timing of Planned Cesarean: After labor begins vs scheduled before labor begins

Participation by Mother: Mother watches delivery of baby (no screen or lowered screen); anesthesiologist or OB describes events during surgery; no description or watching

Anesthesia: Regional (spinal or epidural); general anesthesia

Postoperative medications: Only at mother’s request (you can refuse sedatives); medications for anxiety, trembling, or nausea at anesthesiologists’ discretion

Presence of partner or others: More than one support person or father only; partner seated at mother’s head; partner stands and watches or photographs; partner not present

Stitching: Single vs. double suture

Environment: Soothing music and quiet talk; aromatherapy; no preference

Contact between baby and parents: Held by partner soon after birth where mother can touch and see; baby held by mother during surgical repair of incisions; baby taken to nursery for observation; if baby goes to NICU, partner goes with baby or remains with mother? A second partner stays with mother?

For more on fear associated with Cesareans, such as about anesthesia, coping and recovery, check out this post at Vita Mutari and Everything I wish I had Known Before my First C-section.

Saturday, March 27, 2010

Epidural Anesthesia Can Be a Good Thing

This post, on the Unnecesarean blog (which I will address below), reminded me of a post by Public Health Doula that she called Stages of Birth Thinking. Its a great idea-in-draft about the thoughts that people have as they learn about the birth world and birth options. I highly suggest you check it out. 

There is Pre-contemplation:
This generally means that birth education comes from mass media portrayals of pregnancy and birth, as well as personal stories from friends and family that may vary greatly, but are usually filtered through the prism of our culture's main messages about birth: Painful and pathological; done in a hospital, with doctors. You might prefer a vaginal delivery or a c-section, but there's little you can do to control the outcome, and all hospitals/doctors practice more or less the same way,
then Initial learning and Revelation:
 "Wow! Nobody ever told me that birth could be amazing, not scary! These home births are beautiful. I didn't realize that my/my friend's/my aunt's c-section could have been prevented. I didn't know about all these harmful complications of interventions - I've only heard good things. And it's so clear how once you start one intervention, you get a cascade of them. Doctors don't have the best outcomes - midwives do! Breastfeeding has benefits I didn't know about, and they are so important."
then Validation (or not) through Experience:
A year of attending births nudged me yet farther away from my starry-eyed novice doula perspective. Not all c-sections can be avoided, even if you do everything "right". Sometimes epidurals are the best tool you have. Pitocin isn't fun, but it's not the end of the world. While it might be difficult to accomplish, you actually can have a great low-intervention birth in a hospital. This tempering is slow, and less personal - it's not happening to you, and it's happening over a multitude of experiences.
 and finally Integration: 
You recognize that every situation is individual, even though there are patterns and large-scale effects that are likely, because you have a chance to see many [births].

And through these stages you may have the following thought: "I thought the epidural was the devil itself, but when I got one it was actually awesome and helped me have a vaginal birth." 

And this is what my post is about.

For some time, I was in the Initial Learning and Revelation phase, and I was causing my good friends and readers of this blog to be in it with me. But the more I read and see I am coming to the "Validation" phase, and with it, I have realized that an epidural, though it has its faults, can be awesome for some people. This was partially triggered by the post on Stand and Deliver called Epidurals, and the 67 comments that readers left discussing their experiences with an epidural and if it perhaps made they feel empowered. The response was amazing: many women said they hated the epidural and has all sorts of complications with it and would never use it again.  A few were indifferent to their experience with it. Many said they LOVED their epidural and would not birth without it. Really? Yes, these are real experiences. 

And so we get to the recent post on the Unnecesarean showing when the use of an epidural may be beneficial, and how to heighten its positive effects and decrease negative ones:

While the negative effects of epidural anesthesia are often discussed—whether they are evidence-based or experience-based—it’s important to recognize that there are occasions when an epidural is desired or needed.  Clearly, an epidural or spinal anesthetic is preferable to general anesthesia for a cesarean birth, but there are other occasions during labor when an epidural may be a wise choice.
  • When the laboring woman is exhausted and unable to rest.
  • When labor pain becomes suffering, rather than coping
  • When the mother is requesting repeated doses of IV pain medication; in this case, an epidural carries a smaller risk of causing the baby’s breathing to be depressed at birth
  • When procedures are necessary which the mother cannot tolerate without pain relief.  Examples might be manual rotation of the fetal head, maternal positions the mother cannot tolerate, or use of vacuum or forceps.
When a woman chooses to use epidural anesthesia, there are ways to minimize potential negative effects.  The most common problems with epidurals are inability to move about freely and use a variety of birth positions, and inability to push effectively.

The Strategy:
  • Administering the epidural in late labor. This carries the benefit of minimizing risk of epidural fever 1 , and allows the body to benefit from the natural surge of oxytocin and endorphins that labor brings 2 .  There are theories that suggest these hormone surges promote maternal-infant bonding, breastfeeding, and possibly some pain relief for the fetus.  Later administration of an epidural may also diminish the risk of needing an assisted vaginal delivery (forceps, vacuum) or cesarean delivery. 
  • Administering a light dose of epidural anesthesia. For women who are able to tolerate some sensation, requesting a lighter dose of anesthesia may allow them to retain more ability to move their legs and to push with contractions.  You can always request more anesthetic, but it is difficult to have sensation completely removed and then have to let the epidural wear off at the height of labor intensity in order to facilitate pushing.  Many women can work with a light epidural, not needing total numbness, but moderate pain relief.
  • Choosing a labor position that facilitates gravity. An upright position IS possible with an epidural.  Most nurses have never seen this done, but with at least two people to support the laboring woman, she can be assisted onto a birth stool place against the side of the bed or on top of the bed with the back fully raised.  Two people must remain, one on each side, at all times to ensure safety should she have difficulty supporting herself.  With a lighter epidural, this should not be a problem, although she will not be able to reliably bear her own weight.  If an upright position is not feasible, a side-lying position for  delivery is the next best option.  The upper leg may be supported by someone, or rested in a leg rest. 
  • Reducing the epidural dose during pushing. This may be helpful, but is difficult for many women to tolerate if they have not been feeling anything since the epidural was administered.  For this reason, it is optimal to have a lighter dose of epidural anesthesia, rather than starting out completely numb. 
  • Allowing the baby to '“labor down”. This may extend the second stage of labor by several hours.  Provided mother and baby are doing fine, there is no need to hurry this stage; indeed, beginning pushing before the mother feels rectal pressure can increase risk of fetal distress and need for forceps/vacuum.  Allowing baby to labor down means that either you can see the baby's head visible at the perineum with contractions, or the mother reports feeling a strong amount of pressure on the perineum, can feel when she is having a contraction, has the urge to bear down, and is able to move the baby's head with pushing

Friday, March 26, 2010

Research: Cesareans and the Pelvic Floor

Research You Can Use: March systematic review: Does cesarean delivery protect the pelvic floor?

For Childbirth Connection Enews
March 10, 2010

Nelson RL, Furner SE, Westercamp M, Farquhar C. Cesarean delivery for the prevention of anal incontinence. Cochrane Database of Systematic Reviews 2010, Issue 2. Art. No.: CD006756. DOI: 10.1002/14651858.CD006756.pub2.

Some women experience leakage of stool or gas while their perineum is healing in the postpartum period, and for some women this problem can become chronic. With age, the number of people with anal incontinence rises, and an estimated 1.4% to 11% of adults and over 50% of nursing home residents have this problem. Cesarean delivery has been proposed as a way to protect the integrity of the pelvic floor and avoid incontinence. A new systematic review explores whether cesarean section is associated with lower rates of anal incontinence than vaginal birth.

This review includes 21 observational studies that compared the odds of anal incontinence following 6,028 cesarean births with the odds of the problem following 25,170 vaginal births. No randomized controlled trials on the subject were found. The quality of the studies was assessed, and because observational studies are subject to more bias than randomized controlled trials, the authors included in their quality assessment whether the studies were prospectively designed, adjusted for maternal age, parity and delivery history, and whether incontinence was measured after 4 months postpartum when the perineum had time to heal. The studies of highest quality were also analyzed separately to see if the results differed from those of lower quality studies. No high quality studies showed any significant difference in incontinence of stool and none of the studies showed any difference in leakage of gas between women undergoing cesarean delivery and those giving birth vaginally.

The take-away:

This review shows no evidence that cesarean delivery protects a woman from future anal incontinence compared to vaginal birth. US cesarean rates have increased by 50% in the last decade and are currently at a record high of 31.8% as of 2007. Some have suggested that "maternal demand" cesarean section is contributing significantly to the rising rate of c-section, a practice associated with numerous increased risks when compared to vaginal birth. The authors of this review cite research that suggests avoiding incontinence is the main reason women with no medical indication for c-section elect to have their babies this way. Both of these suggestions are controversial. Just one mother out of 252 in the Listening to Mothers II survey reported that she had a first cesarean birth at her own request with no medical reason, and only one woman reported a cesarean delivery in the belief that it would help prevent future incontinence.

Thursday, March 25, 2010


I must be nuts! I've just taken on a FOURTH client whose estimated due date is two weeks after client #1 and SIX DAYS before client #2. Plus client #3 who is due a month later. But that makes 4 clients with EDD's within a month and a half. I've gone insane. They're all probably going to go into labor on the same day, or back to back, and I'll get absolutely no sleep! Because I am determined to attend every single one of their labor's.  I should probably e-mail my local doula group and see if anyone would be willing to be a back-up, but who knows if anyone will want to do back up and make no money from it (plus one client is almost an hour from me and possibly further from other doulas).

Four scheduled clients is my insurance that I will be able to complete my certification births by summer. Because just attending a birth for each client doesn't necessarily mean that I will be able to use every birth for my certification. Its possible I could show up too late (DONA requires I am there from the start of Active Labor) and the birth won't count. Its possible a doctor or nurse who hates doulas will refuse to sign my evaluation form and the birth won't count. So I'm hoping that with 4 births I will get at least 3!

Four clients due in a month and a half is not SO nutty... for an experienced doula. But I do not yet know how demanding these labors are going to be on my emotionally and physically. I don't know if I will take care of myself properly during a 20 hour labor (getting naps, meals, and so forth). I really think I'm going to be completely wiped out.

I can't actually tell how much I should worry. I've heard doulas say they don't even look at due dates because women RARELY go into labor when you think they're going to, so how can you really plan? And I've heard a doula say she had two clients due four weeks apart who both went into labor on the SAME DAY. So client #1 could go a week and a half late, client #2 could go half a week early, and client #3 could go a week and a half early, and that would all be the same day and I'd be screwed. Ahhh!!

So, why did I take this fourth client, whose EDD is so very close to two other's? Well, I'll tell you the truth; It was pride and excitement. She was referred to me by one of my current clients who is due a whole month later, because they are taking the same Bradley childbirth education workshop. So I was flattered that I had been recommended and agreed to an interview. Then it turned out she wanted to do this interview on Skype! So, I agreed (telling her that our prenatal meetings would have to be in person, though).

Its always odd to video chat with someone because you have nothing else to distract you while you chat (like you do on a phone or in person, while you may be multi-tasking) - you're just staring at one another the whole time! I think the chat went well and it was a good chance for the mom and husband and I to all get a feel for one another, but it definitely isn't my preferred method of interview. At other consult meetings the potential clients would get to talking freely, and I would do a lot of listening and responding. On Skype they mostly wanted to listen to me instead. It just felt like a less comfortable environment for us both. But I guess it was good enough because they hired me! Though that may just be because it costs them nothing to give me a try.

So, this week has been an extremely busy doula week.  I had the Skype interview.  Then I had my very first prenatal meeting, which was for a home birth (!) which will more than likely be my very first birth as a doula and I am ecstatic. It was a pretty simple one to count as my first prenatal, because I didn't need to teach or show much to the mom. Since this is her third birth, and her second home birth, she pretty much knows how things will go and how she wants them. She showed me around her house, showed me the homeopathy she'd like to use because I'm unfamiliar with that stuff, told me where she'd probably be laboring and told me what she'd like. I gave her some info on signs of labor (she had trouble with that last time), using a birth ball (she's interested in using mine), things her partner can do for her (I don't think he'll do any of this but I'll show him... play cards in labor?!) haha and things like that. I feel very triumphant, because though she was unsure when we spoke the first time, she is definitely going to call me! :D

This morning I went to an ultrasound appointment with a mom who isn't due for another 2 months.  Boy, technology is SO COOL. That's all I kept whispering the whole time "cool!" haha. We saw the baby's hands, feet, stomach, head and even watched its heart beating! The baby was all curled up with its hand and feet up to its head, but then it moved them and we saw its face! So clearly! And we watched its mouth move and its eyes open enough to see both top and bottom eyelids! It was awesome. Both mom and dad are so sweet.  This evening I have my first "real" prenatal - mom is giving birth in a hospital so we have their birth plan to go over. Wish me luck!

Red Raspberry Leaf Tea

from Birth Source
by Jane Palmer, Midwife, reprinted with permission from Pregnancy, Birth & Beyond
This article is for information purposes only. Please consult your health care practitioner before taking raspberry leaf.

You are probably familiar with the popular fruit, the Raspberry (Rubus idaeus). The raspberry is native to many parts of Europe and Northern America. The leaves of the raspberry plant have been used as a medicinal herb for centuries. It is thought to have many varied properties including those that are beneficial for pregnancy, childbirth and breastfeeding. It is believed that raspberry leaf, if taken regularly through pregnancy and labour can:
  • Ease the symptoms of morning sickness
  • Sooth and prevent bleeding gums which many pregnant women often experience.
  • Relax the smooth muscles of the uterus when it is contracting (Burn & Withell, 1941).
  • Assist with the birth of the baby and the placenta.
  • Calm cramping of the uterus.
  • Provide a rich source of iron, calcium, manganese and magnesium. The magnesium content is especially helpful in strengthening the uterine muscle.
  • Raspberry leaf also contains vitamins B1, B3 and E, which are valuable in pregnancy.

Raspberry leaf is also used for the following:
  • To aid fertility.
  • To promote a plentiful supply of breastmilk.
  • To help stop excess bleeding after birth.
  • To treat diarrhoea.
  • To regulate irregular menstrual cycle and decrease heavy periods.
  • To relieve sore throats.
  • To reduce fever.

It is thought that around one fifth of pregnant women take some form of raspberry leaf. Women believe that it will shorten labour and make the birth easier. The use of this herb for remedial purposes dates back to the sixth century and its benefits in childbirth have been recorded as a proven aid in maternity in the most ancient of herbal books.

Has there been any research on the effects of Raspberry Leaf?
There has been research on the effects of raspberry leaf extracts on animals and on women in the first week after birth (Burn & Withell, 1941; Whitehouse, 1941). Raspberry leaf was found to cause a relaxant effect on the uterus. It was believed that this relaxant effect caused the uterine contractions of labour to become better coordinated and more efficient, thus shortening the length of labour. It is also commonly assumed that women who take raspberry leaf throughout labour will have an improved second and third stage of labour. Consequently there is supposed to be a reduced risk of bleeding after birth.
Three midwives from Westmead Hospital in Sydney looked at the literature to try to find further research on the use of Raspberry leaf and its effects on labour. They could find no such research. These same midwives decided to do their own research. The first study they carried out was an observational study on women who were currently taking raspberry leaf in pregnancy. They compared them to women who did not take any raspberry leaf. There were 108 women in the study (57 taking raspberry leaf and 51 who did not take any). Some women started taking raspberry leaf in their pregnancy as early as 8 weeks and others started as late as 39 weeks. Most women however started taking raspberry leaf between 28 and 34 weeks in their pregnancy. The findings of the observational study suggested that the raspberry leaf herb can be consumed by women during their pregnancy for the purpose for which it is taken, that is, to shorten labour with no identified side effects for the women or their babies. An unexpected finding in this study was that the women in the raspberry leaf group were less likely to require an artificial rupture of membranes, a caesarean section, forceps or vacuum birth than the women in the control group.

Two of the three original midwives (Myra Parsons and Michele Simpson) decided that the next step was to perform a randomised controlled trial, using a larger sample, to substantiate the findings of the observational study. This second study was completed earlier this year. Parsons (2000) reports that this second study demonstrated the safety of raspberry leaf tablets (2.4gm daily) taken from 32 weeks pregnancy until the commencement of labour. There were no side effects identified for mother or baby. The analysis of the findings suggested that raspberry leaf tablets shortened the second stage of labour by an average of 10 minutes but made no difference to the length of the first stage of labour. Raspberry leaf tablets reduced the incidence of artificial rupture of membranes, forceps and ventouse births. Although the reduced incidence of these interventions did not prove to be statistically significant - the researches stated that 'these results are clinically significant'.

How is Raspberry leaf taken?
Raspberry leaf can be taken in tablet form, teabags, loose leaf tea, or as a tincture. Raspberry leaf can be purchased from many health food stores or from a health care practitioner. Due to the limited research on raspberry leaf - the ideal preparation and the ideal dosage is not known at this stage.
The following guidelines on consuming raspberry leaf during pregnancy have been taken from Parsons (1999):

Tablets - Take two 300mg or 400mg tablets with each meal (three times a day) from 32 weeks.
Teabags - 1st trimester- one cup per day -2nd trimester - two cups per day -3rd trimester - up to 4 to 5 teabag cups throughout the day.
Loose leaf tea - Bring one cup of water to the boil. Remove from heat and add one teaspoon of the herb. Stir, cover and let sit for ten minutes (do not boil the herb), strain and sip. Adding sugar or honey many improve the taste. 2 to 3 cups per day is often recommended especially after 28 weeks of pregnancy.
Tincture - A tincture is an alcoholic extract of the herb raspberry leaf. The dosage will depend on the strength of the tincture.

Raspberry Leaf has been recommended by naturopaths and herbalists as well as some midwives and obstetricians. Consult a health care provider regarding the type of preparation and what dosage to take.

When is the best time to start taking Raspberry Leaf?
Many practitioners recommend that raspberry leaf is best commenced at 32 weeks of pregnancy and continued through to the birth. Parsons (2000) found that taking raspberry leaf tablets, 2.4gm per day from 32 weeks, produced no side effects. Other practitioners recommend that Raspberry leaf can be started at the beginning of pregnancy or even prior to pregnancy. However at the present time there is no known research on the safety of taking Raspberry Leaf earlier in pregnancy. When is the ideal time for a woman to start taking raspberry leaf in pregnancy? What is the correct dosage? These are questions that need to be answered by further research.

Are there any known side effects to Raspberry Leaf?
Both recent studies on Raspberry leaf found that there were no reported side effects (Parsons 1999; Parsons 2000). Anecdotal reports say that Raspberry leaf may cause nausea, increased Braxton Hicks contractions and diarrhoea. But more research is needed involving larger numbers of women before we will truly know if there are any side effects.

The use of herbal products during pregnancy should undergo the careful consideration you would give to taking any medication during pregnancy. One of the problems with herbal preparations in general is the lack of regulation on their manufacture. Some herbal preparations have been contaminated with other substances. There has been reports of contamination of imported herbal products with drugs and animal faeces. It is for this reason that it is important to purchase a product through a reputable source.

Raspberry leaves are naturally high in tannins. Tannin can be constipating, which is something that pregnant women are already prone to. Long term safety of consumption of tannin is unknown and maybe carcinogenic. If choosing a tincture form of Raspberry leaf be aware that it is alcohol based. Some preparations are very high in alcohol. Remember that there is no safe level of alcohol established in pregnancy.
For a list of references, click link at top.

Wednesday, March 24, 2010

Foreign Language Learning with Blocks!

I've always dreamed that my children will be very worldly. From a very young age I would say, "I'm going to live somewhere on the border with 4 other countries so my kids will learn at least 5 languages!" Now I can do it with blocks!

Arabic Blocks

Hebrew Blocks

Russian Blocks

 Chinese Blocks

And a lot more at Lindenwood!!

Using a Birth Ball in Labor

 My birth ball in its brand new Birth Ball cover!

A birth ball is a physical therapy/exercise ball that is an excellent comfort tool for pregnancy, labor and postpartum. It eases labor pain and enhances progress.

Three basic positions used: 1. Sitting, 2. Kneeling and leaning forward, 3. Standing and leaning.

Reasons to Use the Birth Ball During Labor and Afterwards
from a handout, Paulina Perez

The use of the birth ball with all 3 positions provides these benefits:
1. Facilitates physiologic positions for labor
2. Allows for pelvic rocking and body movements
3. Encourages rhythmic movement
4. Can be used with both external and internal fetal monitoring
5. Encourages pelvic mobility
6. Takes advantage of gravity during and between contractions
7. Allows freedom to shift weight for comfort
8. Encourage good physiologic resting positions
9. May speed labor
10. Is beneficial with techniques for failure to progress
11. Helps contractions to be less painful and more productive

Sitting on the ball also has these additional benefits:
12. Encourages pelvic relaxation
13. Provides perineal support without undue pressure
14. Eliminates the firm external pressure of a bed, chair or rocker when sitting

Kneeling and/or standing while leaning forward on the ball also have these additional benefits:
15. Encourages fetal descent
16. Assists in rotation of the baby in the posterior position
17. Helps relieve back pain
18. Removes strain on wrists and hands that occur with the hands and knees position
19. Gives good access for back rub or back pressure
20. May enhance rotation and descent in a difficult birth
21. Helps take the pressure off the hemorrhoids (esp. kneeling over the ball)
22. In shoulder dystocia, it can support the mother who needs to be on hands and knees to facilitate rotation of the posterior shoulder.

Plus, after the birth, the ball has these benefits:
23. Sitting and bouncing on the ball while holding a fussy baby up to your shoulders is a great soother
24. The ball makes a wonderful "prop" for postpartum exercises to restore strength and flexibility.

Using the Birth Ball in Labor
from B*E*S*T Doula Service

The hands and knees position can be very comfortable for many women in labor, but your hands will become numb very quickly. If you get on your knees and rest your head and arms on the ball, there is less strain on the hands and arms and you will be able to spend more time in this relaxing position.

You can sit on the ball, with your partner or doula standing behind you and supporting you. Your legs should be about two feet apart so your feet and butt form a triangle for good balance. You should feel stable and secure. This position helps improve your posture, encourages you to rock side to side or forward and back or in circles, thereby giving the baby a better angle to enter your pelvis.

My favorite position requires two support people, usually the partner and the doula, but a mother, sister or friend would work just as well. The partner sits on the bed, facing the laboring woman sitting on the ball. The doula is behind the woman and is sitting on a stable chair (not one with wheels). During a contraction, mom leans forward and puts her head on the partner’s lap (pillows can be placed on the lap for the laboring woman’s comfort). This gives the doula great access to the woman’s lower back for massage, pressure, heat or cold packs. Between the contractions, the woman leans back against the doula and the doula gently rocks with her from side to side. This is a great opportunity for the doula to help the woman relax between contractions and prepare for the next one.

If you sit on the ball and lean forward against the bed, your partner or doula will have good access to your lower back for counter pressure or massage. Sitting on warm compresses on the ball will maximize perineal relaxation and help you avoid an episiotomy.

If you're having a long, non-progressing labor, it often means that your baby's head is turned slightly to the side and not in a good position for delivery. If this happens, you can get into the hospital bed with the foot lowered as far as it can go. Put the ball on the lowered foot of the bed and you on your knees, with your head and arms resting on the ball, so your hips are higher than your shoulders. This position will help baby to slip away from the position he or she is stuck in and to reposition for an easier birth.

The ball can be placed on the bed if you are standing and you can lean forward, resting your head and arms on the ball for a comfortable, leaning forward position to encourage pelvic swaying.

If you are standing and swaying, the ball can be placed against the wall and you can lean back against it for wonderful back support and pressure, helping you to sway from side to side and relax. Have your partner or doula hold it against the wall until you are leaning against it comfortably.

Tuesday, March 23, 2010

What does Health Care Reform mean for Childbirth?

What does Health Care Reform mean for Childbirth? 

This bill mandates Medicaid payment for the birth center facility fee in the states (and jurisdictions) where birth centers are licensed.

This bill includes major provisions for not only birth centers but women's health. These provisions include things such as:

  • 100% reimbursement of CNM services in Medicare Part B;
  • Separate payments to birth attendants "as recognized under state law as determined appropriate by the Secretary";
  • C-sections, giving birth and domestic violence can no longer be considered pre-existing conditions and used to deny insurance coverage;
  • Guaranteed coverage for pregnancy;
  • Workplace protection for nursing women;
  • Guaranteed insurance coverage of mammograms for women;
  • Screening for postpartum depression;
  • A range of other preventative services such as screening for diabetes and heart disease. 
Additionally, Section 4207, entitled Reasonable Break Time for Nursing Mothers, allows a breastfeeding mother to take a break to pump. It requires business with more than 50 employees to provide a private space to pump, that is not a bathroom.

Previously, while 44 states, Puerto Rico and the District of Columbia, protect women's rights to breastfeed in public, less than half of the states have laws on the books relating to breastfeeding in the workplace.

    Netherlands' epidural use is on the rise

    Epidural during childbirth on the increase

    A growing number of Dutch women are opting to have epidural anaesthesia during childbirth, according to a survey of teaching hospitals by free daily newspaper Spits

    With epidural pain relief, an anaesthetic is injected via a catheter into the spine. Since January 2009 all hospitals have been obliged to make the procedure available 24 hours a day – a new development in Dutch obstetrics.

    The Netherlands has one of the highest rates of home births in the developed world. Around a third of all births take place at home. A similar proportion of pregnant women plan to give birth at home if all goes well, but on the basis of the midwife’s risk assessment they transfer to hospital during labour.

    The Dutch home birth system isn’t the product of any recent move towards de-medicalisation and natural birth – it’s simply that many Dutch women still give birth at home the way their grandmothers did. Dutch midwives don’t use nitrous oxide as a painkiller as is the practice in some countries, so home births take place without pain relief.

    The Dutch midwives association argues in favour of seeing childbirth as a natural process rather than a medical condition. It points out that home births result in a much lower rate of unnecessary medical intervention, which is safer for both mother and child. However, in recent years the Dutch system has increasingly come under attack. Critics claim it is old-fashioned, and women are being denied proper access to pain relief.

    In 2008, the teaching hospital in Maastricht reported that 25 per cent of women opted to have an epidural. A year later this figure has risen to more than 30 percent. Despite the increasing numbers, the Dutch epidural rate has a long way to go before it matches that of many other countries. In some hospitals in the United States, for example, as many as 85 percent of women in labour opt for an epidural.

    Monday, March 22, 2010

    Birth in the state of Florida

    Sunday, March 21, 2010


    Since I was out of town last week on vacation I was not on my computer, I have had to catch up on a lot of blogs and birth-related news. Here is a Roundup of some interesting topics:

    Women who Pump instead of Nurse
    "I'm a huge fan of breast milk, just not of nursing"

    Time article describes the pros for moms who exclusively pumping and feeding baby breast milk for moms. There are also cons to this method, such as missing out on some of the pros to actually breastfeeding. It is an intriguing "compromise" for women who find breastfeeding difficult or undesirable.

    Jewish Midwifery
    hameyaldot ha'ivriyot

    I found a blog by a Jewish midwife who writes about Jewish custom/law and pregnancy/birth. For instance, she writes of the Jewish tradition of regarding childbirth as a dangerous passage; a life-threatening state in which other laws may be disregarded (such as breaking sabbath, fasting, and so forth).

    I find it particularly fascinating because 1. I studied Jews from an Anthropological perspective for my undergraduate honors thesis so its still of interest to me and 2. I'm Jewish myself and I find it interesting to learn new things as both an "insider" and an "outsider."

    Breastfeeding in Public
    The more something is seen, the more accepted it becomes. 

    Photos of nursing in public worldwide:

    Friday, March 12, 2010

    Breast Milk Cheese

    Would you ever taste human breast milk? Many people of talking age, both toddlers and adults, have tasted breast milk and described its taste as "sweet" almost like "ice cream" though the flavor changes frequently depending on what the mother eats. Ok, that's not so bad, right? Maybe if you had a little sip of some sweet milk, you wouldn't feel too weirded-out, because babies eat it every day right?

    What about Cheese made from human breast milk?

    A chef in New York decided to make some cheese from his wife's breast milk:

    The reactions have been interesting...

    On CNN:

    And the Today Show:

    Do you see how NO ONE wanted to try the breast milk cheese? And they all freaked out when one guy actually did?  "Gross!" "Gag!" "Ew!"

    Milk comes from human breasts to feed babies. Milk also comes from the breasts, or teats, of cows, goats, and many many other mammals. Humans drink cow milk and eat goat cheese, but if you mention consuming human breast milk by any human other than a baby, the reaction is usually shock and disgust.

    But Why? Is it because of the society we live in? Because we are so breast-phobic? Because it is from humans and it is cannibalistic (as mentioned in the video)?

    "try this…take a cup of cows milk and tell someone as you sip on it, “This is left over breastmilk I had frozen and didn’t want to see wasted.” As they turn green and gag and threaten to report you to SOMEONE who can come and lock you up to protect society from you – smile and say, “I’m just kidding….it’s just milk squeezed from a cows udder.”
    Phew….they will be relieved to hear that!" (Vita Mutari)

    If you're intrigued and would like to try some breast milk cheese yourself, the Chef includes his recipe for Mommy's Milk Cheese on his blog.

    Thursday, March 11, 2010

    Feelin' Good

    Things are really looking up. Not only because of my graduate school acceptance, but also because of my doula business!

    Back when I first spoke to my doula mentor, B, on the phone, she told me that she doesn't really need to have a website or advertise much because she gets all of her clients through word-of-mouth.  Being brand new to the birth world, I was secretly shocked by this. I thought, sure, that's because she's been doing this for more than 3 years and she's lived here awhile and she has kids so she meets a lot of moms... etc etc. All these thoughts came into my head, along with, "that is never how it will work for me, I'm going to have to work like crazy to get clients."  And this was especially reinforced by the fact that it took months to find my first clients, despite the fact that I emailed a lot of pregnant women looking for doulas!

    But now I see how word-of-mouth is entirely feasible. One of my clients is in a class with my boyfriend.... Then, she told her friend about me... Another girl overheard my boyfriend talking about doulas in class and inquired after my services... I received an email of interest from a woman who is taking a childbirth education class with my second client.... If I hadn't hooked up with the local Doula group in my area, joining email listservs and going to dinner meet-ups, I wouldn't have met the doula who called me yesterday requesting that I be her emergency back-up for a birth... And B suggested I email all the area doulas and childbirth educators and let them know I am in training and to send any moms looking for cheap doulas my way. If it weren't for that I never would have ended up on another busy doula's referral list, and never would have met the wonderful pregnant mama I met with today.

    This mom is having a home birth and her third child. She isn't sure that she needs a doula, having done this twice already without one, however is considering me because I am free anyway! She and I had a really lovely chat today, really got to know one another. She is very open and honest. She came up with several reasons (and I helped emphasize :) why having a doula there would be excellent, even with her midwife, sister and husband present. Unfortunately, she wants to leave it up in the air about "hiring" me, almost to the point where she might finally decide she needs me only once she's in labor. I emphasized the fact that I would be honored to attend her birth, because in addition to all I could help her with, it would be an incredible learning experience for me since I've never been to a home birth. Fortunately, I think she really likes me and I'm keeping my hopes up for a call next month!

    I know I shouldn't get my hopes up TOO much, but I am also really keeping my fingers crossed that all of these births work out and I can have all my certification births, and thusly my certification, completed this summer!

    Wednesday, March 10, 2010

    Graduate Acceptance!

    Dear Emily:

    Congratulations, I am pleased to inform you that you have been accepted into the Masters Program in Applied Anthropology. This year we had a high number of very competitive applications and, as always, have selected only the very best students.

    Congratulations again, we look forward to having you as part of our graduate student body.

    YAY! :D

    In the Anthro department I can choose either a Cultural or Biological track, and in the School of Public Health I will choose between either Maternal and Child Health or Global Health.

    One step closer to a PhD!!

    Formula Fed America

    Formula Fed America A Documentary

    "While commercial infant formulas are commonly perceived to be the medically recommended second choice infant food after breastfeeding, the World Health Organization (WHO) states: "The second choice is the mother's own milk expressed and given to the infant in some way. The third choice is the milk of another human mother. The fourth and last choice is artificial baby milk." 

    Movie is still in the process of filming.

    "The lack of breastfeeding in America has turned in to a public health crisis. The rising statistics of childhood illnesses preventable by the act of breastfeeding are staggering as is the price tag of healthcare that goes along with it.

    Infant Formula or Artificial Baby Milk is a relatively new invention, originally intended for babies who could not breastfeed or mothers who did not have any milk and donor human milk is not available. Why than, are we ignoring our natural biological function of breastfeeding almost completely? Why are doctors, who more often than not agree that breastmilk is far superior to infant formula, so quick to prescribe it when a mother experiences difficulty in breastfeeding? Why do we continue to sexualize the breast and stigmatize what it is actually intended for? Why aren't there more widely available human milk banks where a mother can go to get that precious liquid gold for her baby if she cannot provide instead of free cans of formula in our mailboxes? If infant feeding is a choice, why aren't we making an informed one?

    This documentary will provide an insightful look in to our culture's attitude towards the breastfeeding mother and it's acceptance of infant formula. With change we can be come a Breastfeeding America."

    Tuesday, March 9, 2010

    Assessing Labor Progress Without an Internal Exam

    A couple days ago I did a post on cervical checks during labor and today I found a fabulous post by doula in Israel called How Dilated Am I? Assessing Dilation in Labor WITHOUT an Internal Exam.

    Let's be honest... even if internal exams during labor are painful, and knowing how far along we are can't predict how long our labor is going to be, and we may even get discouraged, we still have a desire to know how we are progressing. And sometimes its useful for the medical team taking care of us to know as well.  So, from the above-linked post, here are some ways to figure it out without an internal exam:

    1. Sound. The way you talk changes from stage to stage in labor. With the first contractions, you can speak during them if you try, or if something surprises you, or if someone says something you strongly disagree with. You may be getting into breathing and moving and ignoring people – but if you really want to you can raise your head and speak in a normal voice. When the contraction disappears you can chat and laugh at people’s jokes and move about getting preparations done. During established labor, There is very little you can do to speak during a contraction. You feel like resting in between, you are not bothered what people are doing around you. As you near transition and birth, you seem to go to ‘another’ level of awareness – it’s almost like a spiritual hideaway. You may share this with someone else, staring into their eyes with each surge, or you may close them and go into yourself. In between surges you stay in this place. It is imperative for birth assistants and partners to stay quiet and support the sanctity of this space: there are no more jokes, and should be as little small talk as possible. Suddenly, the sounds start to change involuntarily: you may have been vocalizing before (moaning, talking and expressing your discomfort, singing, etc) or you may have been silent. Listen – there are deep gutteral sounds along with everything you have heard before, just slipping in there. You are about to start pushing.
    2. Smell. There is a smell to birth, that hits towards the end of dilation, during intense labor, just before birth. It is a cross between mown hay and semen and dampness. It has a fresh, yet enclosed quality, and is pervasive. The Navelgazing Midwife has also observed this scent and writes about it here.

    3. Irrationality. I love this clue – it often is a sign of transition. It always makes me smile, and I always warn women about this phenomenon so that when we hit it during labor I can remind them that what they’ve just said is irrational, and that I told her this would happen, and here it is! Relax, it means we’re nearing the end. Sometimes a mother will say she wants to go home, she is done now she’ll come back and do this later, she wants to put on her trousers and coat and go out the door. A mother who wants a natural birth and has been coping brilliantly will suddenly say she was crazy and needs pain killers right now, or that she didn’t want another baby anyways, who said they wanted a baby? Some will just curl up and say they’re going to sleep now. If she does this, that’s okay. The contractions may die down, get farther apart, and maybe she (and the baby) will get a few minutes of sleep. This slowed down transition sometimes freaks out doctors or hospital midwives and pitocin is offered – try to see if you can put them off for half an hour. Send every one out, lie on your left side propped up by pillows and have a little nap before pushing; it is such a wonderful gift.

    4. Feel. Here come some of the more fun tools that you might not have heard of before! Think about the shape of the uterus. Before labor, the muscle of the uterus is thick evenly around all sides, above, below, behind. As the cervix starts thinning and dilating, all that muscle has to go somewhere – it bunches up at that top. The top of the uterus thickens dramatically the more the cervix opens. During a contraction, at the beginning of labor, check how many fingers you can fit between the fundus (top of your bump) and the bra line – you will be able to fit 5 fingers. As the top of the fundus rises higher during labor, you will fit fewer and fewer fingers. When you can fit 3 fingers, I usually tell mothers they can think about going into hospital as they will find they are around 5cm dilated. At 1 finger, you are fully dilated. (Awesome, huh!)

    5. Look. There is something called the ‘bottom line’, which is shadow that extends from the anus up towards the back along the crease of the buttocks. It begins as 1cm and lengthens to 10cm, and it’s length correlates with cervical dilation. Why not look down there before inviting a stranger to put their fingers up inside you? It makes sense to me.

    6. Gooey Stuff. Also known as bloody show; there is usually one at around 2-3 cm dilation, and it can happen during the beginning of labor or a few days before hand. Sometimes it’s hard to know what is or isn’t a show, since during the days before labor the amount of vaginal mucus increases in preparation and this can be confusing. A show is up to a couple of tablespoons in quantity, so quite a lot. It can be clear, but is usually streaked with pink, brown, or bright blood. If there is more than a couple of tablespoons of blood then you do need to go straight into hospital to make sure the placenta is not detaching, but if there is just a bit and then it stops, then it is just show. There is a SECOND show at around 8cm dilation. This second show means that birth is near.

    7. Opening of the Back. This is just at the spot where your birth partner has been doing lower back massage, at the area above the tailbone. It is a little smaller than palm sized, rather triangular-shaped area that bulges out during pushing. At this point you’ve waited too long to go into hospital, and you need to refer to my last post, 4 rules of what to do when delivering a baby!

    8. Check yourself. Okay, so technically this one is an internal check, but it done by YOU. You don’t have to announce the results or write them down: it is not an exam. To me it’s obvious that as the owner of your body, you have more of a right than anyone else to feel comfortable with it and understand how it works. It is best to get to know what your own cervix feels like from early on in your pregnancy, if not before, and then to keep a regular check on what feels normal. If you do this through out your pregnancy you will keep your flexibility into the 9th month. This is also an excellent time to remind you to not neglect perineal massage since you’re already down there! Check out the website My Beautiful Cervix to see photos and descriptions of what a cervix should feel like. At 1 cm you can fit the tip of one finger inside. Use a ruler to practice discerning how many centimeters dilation feels like, measuring with your pointer and middle finger. NOTE: Always, always, always wash your hands thoroughly beforehand, up to the elbows, for 4 minutes at least. Do not assess your own dilation after your waters have gone.

    Sunday, March 7, 2010

    Malaysian Pregnancy Superstitions

    I found a cute Malaysian news article about Malay and Chinese superstitions that mothers pass on to their daughters.

    Some superstitions included in the article were "dry off well after showering," and "don't eat pineapple while menstruating."  Here are some of the pregnancy ones:
    The list is long and mostly not proven, but our columnist, consultant obstetrician and gynaecologist Datuk Dr Nor Ashikin Mokhtar, is no stranger to such motherly advice. “As I deal with a lot of women, usually pregnant mothers, I have heard my share of stories and pantangs (superstitions) before.
    “Understandably, they are mostly about things women can or cannot do before, during, and after pregnancy. “Usually, women want their babies to grow up pretty, so there’s this belief that by looking at beautiful pictures, their baby will also be pretty when they are born,” she said.
    Also, women would want their babies to have fair skin, said Dr Nor Ashikin. So, as they belief that taking kicap (soy sauce) will make their baby’s skin darker, they usually avoid taking it. Although this claim has not appeared in any scientific journals so far, some women will still frown at any addition of kicap to their food.
    “Malays also believe that pregnant women should not kill animals either accidentally or intentionally because their child will take up the features of the animal, while Chinese ladies believe that when they are pregnant, they must not attend funerals,” said Dr Nor Ashikin.

    Other Malay pregnancy and childbirth beliefs:

    - Pregnancy is a hot state, and women should avoid overheating. Cold foods are usually preferred. After giving birth, women are said to be cold, and drink warm drinks and eat hot foods.
    - Women may observe a period of confinement of 30-40 days. During this time they do not leave the house and may stay by a heater and dress warmly.
    - During the postpartum period (30-40 days), the woman’s abdomen may be bound. The diet is restricted to hot foods, omitting such items as fruits, vegetables and cold drinks.
    - To warm the body, postpartum women may be given a special drink jamu (herbs), made with turmeric. This practice is based on a belief that jamu may relieve cramps and prevent rheumatism.
    - If parents are Muslim, the father of the newborn may whisper the azan prayer into the infant’s right ear and the iqamat prayer into the left ear.

    Friday, March 5, 2010

    Quick Hits

    •  I LOVE FREE STUFF! Found out on the AllDoula's forum that doula's may request free product samples and informational pamphlets from pregnancy and mother related companies to hand out to clients! So far I've received lanolin ointment samples and breastfeeding information from Lansinoh/La Leche League. I've been confirmed to receive a Sleepywrap baby carrier, Mother's Milk tea from Traditional Medicinals, Preggie Pops from Three Lollies, and Buttpaste diaper cream! weee :)
    •  Lately I have been having a desire to add something more to my doula services down the line - something creative. A lot of doulas/CBE's offer photography services, either maternity photos, birth photos or photos with the baby afterwards. I'd love to get a really nice digital SLR camera and take some classes, but I have to decide if it would be worth the money for me. I also wish I was creative enough to do belly henna. Making the paste itself isn't hard and I've had henna done to me so I understand it, but I'm not artsy enough to do cool patterns on other people. Maybe one day...
    • I'm going to my first postnatal visit today! For the mom whose birth I attended weeks ago. Looking forward to it :)
    • Meeting with a home birth mom/potential client next week! Keeping fingers crossed!!
    •  ABC News article about Rising Maternal Mortality in the US, namely in California. The buzz about the California deaths rising severely has been concerned mainly with the increase in scheduled C-sections: "The latest data from the CDC shows that 31 percent of the mothers now choose to have C-sections, up 50 percent since 1996. Studies have repeatedly shown a higher rate of mortality in mothers who have a C-section delivery, especially those who have multiple C-sections."

      According to the World Health Organization, the U.S. ranks behind more than 40 other countries when it comes to maternal death rates, with 11 deaths per 100,000 pregnancies when measured in 2005. More women die in the U.S. after giving birth than die in countries including Poland, Croatia, Italy and Canada, to name a few.

      Did anyone watch The Office Baby episode? I don't watch the series but I watched the baby episode last night. Too cute! They had a lot of good info on there about birth, but the postpartum nurse was AWFUL and completely unhelpful with breastfeeding help. At least she sent the Lactation Consultant in (a male LC? interesting!)

    Thursday, March 4, 2010

    Cervical checks in Labor

    I had heard that having a pelvic exam, or cervical check, once your cervix has begun preparing itself for labor can be extremely uncomfortable.  I then saw with my own eyes the pain and discomfort it caused for a mom in labor to have the doctor's fingers inside of her. But, we think, its necessary, right? The doctor/midwife must check so we can know her progress (how many centimeters dilated, what station and effacement), true? And she was asking for it, right?

    But what if you never had your progress checked? What if you didn't ask, and the doctor or midwife never told you he/she had to? Would you never give birth? Of course you would!

    So why would you feel the need to know? If the dilation turns out to be a low number you will be disappointed, and surely your labor is going to last forever!?  If its a high number and you will feel triumphant - you think that surely this means you will be done very soon! But both of these assumptions may be false. As Stephanie writes in her post Cervical Exams: Who Needs Them?:
    Checking your cervix now does not tell us what it is going to do, it only tells us what it has done!

    Your labor could halt at 8cm and last many hours longer, or it could speed ahead from 4cm and be done as quick as can be!

    The reason we all want to know is fear - we want reassurance that our bodies "work." As Stephanie puts it:

    If you are not dilated yet, then that means you will begin doubting your body, feeling broken, doubting that this baby will “ever be born”. Please be reassured, the longest human pregnancy ever recorded was not “forever”...
    Your body has known how to conceive this baby, it has (without our assistance) been able to grow from a teeny tiny egg mixed with an even teenier sperm into an entire person!! A full grown baby with toes and hair and the cutest butt cheeks you’ll ever see!! It’s done this miraculous thing…and now, based on a stupid cervical check, you will lose a huge amount of faith in its ability to finish the job it started so perfectly? SHAME ON YOU! Your body is amazing, incredible, creating life! It deserves our utmost adoration…now is not the time to start doubting it! What has it done to deserve your skepticism of its perfection? Nothing…absolutely nothing!

    Stephanie is a midwife who writes a blog on Nurturing Hearts Birth Services and I really love the post that I have been quoting from. She also writes:

    The only time I can see the value in an internal exam is if labor doesn’t seem to be progressing in a way that we would expect, and I may want to check to see if there is an answer I can find (such as a baby’s head being crooked in there, for example). It is not to see how fast your progressing, really…as long as you are moving forward, I do NOT care how fast it is going! Take your time, have your baby in your own time…so long as everything is healthy. But for a normal labor, I don’t care how long it’s taking, I don’t care what your cervix is doing…I accept your labor is what it is and will take as long as it needs.

    So, what if mom is feeling the need to push and wants to be checked to make sure she is "allowed" to start pushing? Well, this is a tough subject.

    The "Rule of 10" that Lydi Owen writes about in Midwifery Today is a rule widely accepted by care providers that forbids women from bearing down and pushing until her cervix is completely dilated to 10 cm. Many women feel the urge to bear down and being pushing before they are fully dilated, but are told that this will swell or tear their cervix.

    Lydi asks, "Could it be that the instinctual wisdom of our bodies has become our enemy? Why would we feel the need to begin bearing down at 5–6 cm (or sooner) if it would shatter the gateway to the baby’s outer world?"

    The "Rule of Ten" came about from observations done in the 1950s of women who were drugged for childbirth. Lydi writes, "...let me say that a non medicated woman will never push so hard against her undilated cervix that it tears, because it will hurt. Pain is a natural deterrent to pushing too hard."

    Both Stephanie and Lydi emphasize that they have seen women push and successfully birth babies prior to being fully dilated and not harm their cervices at all. They also both mention what I have heard many midwives also emphasize: Listen and Respond to your internal, primal instincts, your Body is Wise, or as Ina May Gaskin puts it, "Let your Monkey do it." 
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