Some Links!

 It is finals time in grad school, so this week you get a link round-up! :)


Call for Submissions - Positive C-Section Stories
Danielle, blogger at Momotics, is looking for submissions to a blog carnival of positive stories of medically necessary c-sections! If you have one of these, please share!

How Toy Ad Vocabulary Reinforces Gender Stereotypes
Check out these word clouds of words used in commercials for toys geared towards either boys or girls. The results, while not shocking, are interesting to see.

The Smarter You Are the Stupider You Look 
Annie at PhD in Parenting posted a really in-depth analysis of the study that was going around about how images of breastfeeding moms were perceived as being less-competent than non-breastfeeding mothers.

Epidural Use Tied to Length of Prenatal Care?
A study by the National Center for Health Statistics found that the more prenatal care you had, the more likely you are to use epidural anesthesia.Why would this be?

Support Global Mother's Health
Christy Turlington's new documentary No Woman, No Cry is heading around the country, and it looks excellent. Has anyone seen it? Check out the trailer at Dou-la-la's blog, and read about how buying a CD at Starbucks can help support global mother's health.

...and I thought this XKCD comic was cute! Someone should try this with the L&D nurses when they ask this question :)

More Reading than You'll Know What to Do With

Hello! Happy March!

I know that there are many followers of this blog who follow the blog itself, some who follow facebook only, and some who follow me only on twitter. I also realize that there are various combinations of the three; for instance, following the blog and facebook but not twitter, or just facebook and twitter, etc. I do different combinations of following of blog content, myself! But I just thought I'd let all my google friend/RSS reader followers what happens over on facebook in case you don't overlap.

Facebook is great because even though with a busy grad schedule I can still post interesting things and have discussions, even if I don't have time to write a whole blog update!

We had a great conversation on the facebook page about whether or not, and how, anthropologists should or can be Activists/Advocates.


Link Roundup: Wrapping up February Edition
Here are some great links that I shared recently, but didn't blog about, that are worth checking out (in chronological order):

Too Many Babies are Delivered Too Early - Hospitals Should Just say No via Time Healthland

The LeapFrog group recently released info on elective deliveries have soared 40% and more and more babies are being born TOO EARLY. The March of Dimes is working on a campaign to stop hospitals and doctors from ordering/performing inductions/c-sections prior to 39 weeks if not MEDICALLY INDICATED.

This is because babies are being born too early when elective deliveries are performed before 39 weeks. Inaccurate measures of gestational age is common, with ultrasound estimations done in the last trimester being off by up to 3 weeks.

Babies who are born before mom goes into labor naturally have more health problems: Risk having immature lungs and respiratory problems, cannot suck and swallow adequately, and are less alert (especially if born by c-section). They spend more time on ventilators and in NICU. If the baby is delivered at 37 weeks and it turns out the baby was actually only 35 weeks gestational age, the baby will have all these problems and more, such as birth defects, autism, learning disabilities, chronic health problems.... They are also more likely to die.

They also cost more. Even born at 37-38 weeks, premature infants cost 10 times more than a full-term newborn. Reducing early deliveries to under 2% could save close to $1 billion in health care each year.

J D Kleinke on Defensive Medicine, Obstetrics, and Women's Health

Fascinating post on the Health Care Blog on "Cultural norm-ing of Defensive Medicine."  Its pretty long, so the Unnecesarean has given us a few quick paragraphs of the main idea... But definitely read the full article if you can!

 The Doula's First Time Mama Advice Kit

Written by the Public Health Doula, this is an AWESOME MUST-READ. She has included everything in this advice kit!

 Is Breastfeeding Advocacy Anti Feminist? An essay by Katherine A Dettwyler

Anthropologist Katherine Dettwyler studies biocultural anth and breastfeeding and dicusses them in this article, and feminism!

The Blonsky Apparatus for Facilitating the Birth of a Child  via Unnecesarean

My boyfriend found these images of the Centrifugal force machine mentioned in the book "Pushed" and I was going to post them to my blog this week, but The Unnecesarean beat me to it! Check this crazyness out!

Pain, Suffering, and Trauma in Labor and Subsequent Post-Traumatic Stress Disorder: First of Two Posts by Penny Simkin  and
Part Two: Pain, Suffering, and Trauma in Labor and Subsequent Post-Traumatic Stress Disorder: Practical Suggestions to Prevent PTSD After Childbirth

The Fabulous and Famous Penny Simkin on Pain vs Suffering (important distinction!) and Birth Trauma and PTSD on Science and Sensibility blog.

Evolution and C-sections

I think it could happen over time, but I don't think its happened already. There are other factors contributing to the current small increases in birth weights. Wouldn't that be a scary thought, though - every single future birth ending in a cesarean section because everyone evolved to have cephalopelvic disproportion??

 Continuous Support for Women During Childbirth - Cochrane Systematic Review

Check out the new Cochrane Review on Continuous Labor Support "The good news about doulas just got better! Fewer cesareans, fewer instrumental vaginal births, less need for pain medicine, less dissatisfaction with birth and better Apgar scores for baby." Via Childbirth Connection

Anthropology Without Doctorates

More and more graduate students in anthropology are not completing their PhD and are working outside of academia. What happens to terminal MA's in anthropology?

Making the Case for Delayed Umbilical Cord Clamping: A Grand Rounds Lecture by Dr. Nicholas Fogelson

50 minute video lecture of Dr. Fogelson speaking to his peers about why umbilical cord clamping should be delayed.

Women in Control of Epidural in Labor Use 30% Less Anesthesia

Important find! If women could be in control of their anesthesia, they'd feel more in control of the whole experience! And if they end up using less anesthesia, all the side effects would be less. I think it would be a blessing for those who want an epidural but fear the potential side effects, like a groggy newborn or too much numbness.

 Incredibly Moving Birth Photography of a Home Water Birth


I hope this isn't too much reading... it definitely covers a whole range of potential interests!

If for some reason this is just not enough to satiate your appetite (if you're like me, ha), I do re-tweet even more interesting articles on Twitter. I also sometimes use Twitter to talk about being a doula or with other doulas. To get involved I encourage you to join in on #doulaparty every Friday and some Sunday afternoons, or simply search the #doulaparty hashtag and read up!

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).

Narcotics given during Childbirth

Think about it.

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

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

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

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

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


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

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

Pain in Childbirth Pt. 2

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

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

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

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

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

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

 

Pain in Childbirth Pt. 1

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


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

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

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

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

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

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

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

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