I have been aware for a while that more and more hospitals were allowing women to hold their babies skin to skin on their chests. This promotes bonding and breastfeeding while the surgery is going on.
Recently, I came across a video on "family centered Cesarean birth". It incorporates the skin to skin aspect while in the OR, and more. The video can be seen at www.SeeBaby.org I would encourage the viewer to enlarge the video instead of trying to watch the smaller version.
Dr. Brad Bootstaylor is trained as an OB and a perinatologist. He is a strong advocate for women being fully informed about their options and encouraging them to choose where and how they want to delivery their babies. His works respectfully with midwives and provides hospital backup when they need to transport a mother they are attending at a home birth. He bases his practice on research evidence. He also provides consults to other OBs in difficult cases, due to his specialty in perinatology. There is a very interesting article about him, published originally in Midwifery Today. To read it click Midwifery Today article.
After reading this article and seeing the C-section video, I wish every woman had access to a Dr. Bootstaylor and his team.
This medical practice also promotes 3D and 4D sonographic imaging during pregnancy, thus the "SeeBaby" name. I am still a bit wary of many sonograms being done during pregnancy while the baby's brain is developing so rapidly. I would encourage women to do an online search of the pros and cons of routine and repeated sonography during pregnancy before having repeated photos of the baby as it grows.
Dr. Bootstaylor is based in Atlanta, Georgia. Kudos to him and his staff for making C-sections more special for women and their partners, for being willing to be a back up hospital based physician for women who are planning a home birth or birth center birth, and for respecting women enough to provide them with the information they need to make informed decisions about their birth experiences.
With facts, stories, Scripture, and sometimes humor, a pastor's wife, RN, certified lactation consultant, and childbirth educator presents breastfeeding and birth from a Christian perspective. Occasionally I will drift into another topic which MIGHT be related to birth and breastfeeding. "1 Peter 2:2-3" examines the beautiful picture of why Jesus chose mother's milk to describe the Word of God.
Pages
- Required "Cookies Alert"
- Pure Milk Blog Posts (formerly "Sincere Milk")
- The Big Picture
- 1 Peter 2:2-3 -- Desire the Pure Milk of the Word
- How to Use the Blog to Learn about Breastfeeding and Childbirth
- Having a Baby? Quick Guide for Success in the First Few Days -- For C-section Moms, Too.
- A List of Risks of Formula Feeding
- Links to Helpful Web Sites
- Do You Speak At Women's Events?
Friday, January 31, 2014
Considering a Home Birth? You Can Breathe a Sigh of Relief.
If you have read an earlier post on this blog entitled "But What If?", you will know the story of why my mother did not breastfeed her first child beyond 3 months, and why she did not breastfeed my other brother or me. However, when it came to giving birth, she stuck by her beliefs, that for her, giving birth at home was better than giving birth in the hospital. At that time, women were given "twilight" sleep and tied to their beds, anesthetized at the time of delivery, and often delivered by forceps accompanied by a large episiotomy (cut made at the base of the vagina to enlarge the space).
Home birth was not as much of an issue when my brothers were born, but it was when I was born. Her doctor expected her to go to the hospital. That was not her plan. My aunt was an RN. When Mom went into labor with me, she called Aunt Sara to come over. When Aunt Sara felt that birth was getting close, she called Dr. Lamb and told him that my mother was in labor, but that it was too late to go to the hospital. He rushed over to the house and delivered me. My father experienced seeing me born -- a rarity for men at that time. He always treasured that experience and our bond was tight.
The incidence of planned home births dropped to single digit percentage points in the US during the 60s and beyond. Certified and "granny" midwives still attended births in outlying areas, usually associated with public health department programs. But by far, most women gave birth in hospitals.
Midwives almost became extinct via pressure on legislators from physician and hospital professional organizations. Finally, some women started demanding safe alternatives to what they saw as practically barbaric practices with hospital birth. Lamaze, Bradley and other childbirth methods became popular. Pressure was put on hospitals to allow fathers to be present at hospital births because women would go to physicians and hospitals which allowed it. As we all know, money talks.
With the "all things natural" movement emerging in the 60's and 70's, more women wanted to avoid medications, episiotomies, and forceps deliveries. They questioned the use of continuous electronic fetal heart monitoring which forced them to stay relatively still and in the bed. They noticed that the C-section rate was increasing since EHMs were being used.
So, they started looking for someone to assist them with home birth. A few licensed and also granny midwives were still in practice, but their numbers were dwindling. As more women began to demand home birth as an option, more physicians agreed to provide back up. As the statistics began to show that a planned home birth for a low risk woman and her low risk baby was safe AND less expensive, the government allowed for the training and practice of more certified nurse midwives (CNMs) to care for the more economically stressed women. Even though women from lower socio-economic backgrounds tended to have a poorer nutritional status, their birth outcomes were impressively good. Women from all socioeconomic levels began searching for the services of midwives, either for hospital births or for home births.
More and more studies have been done as the home birth movement has been growing. Rikki Lake, an actress and former talk show host, experienced the now almost typical induced labor, epidural tract hospital birth with her first child. She states that she felt something was not right, and that there was something more to giving birth than what she had experienced. Lake found a midwife for an at home delivery and a physician who was willing to provide hospital care in case it was needed. Her birth experience was not easy, but one she found very fulfilling. After that, she, along with a producer, made the documentary film "The Business of Being Born" (see last post).
Over the past few decades, more and more studies have been done on the safety of home birth in the United States. Some studies had serious flaws because they included "accidental" births at home. Many of these were premature babies. Sometimes statistics would show that more babies died from home birth, but they were often related to unattended rapid preterm births or birth not attended by a professionally trained midwife. However some studies did a better job of examining only birth which were planned and attended by a trained midwife or even physician.
This latest study covers 16,924 home births in the US. The births were attended by certified nurse midwives. The results are impressive.
To read a synopsis article on the study, click on the following: Home Birth Study Synopsis Article.
For those who enjoy reading the published study itself, click on this link: Outcomes of 16,924 Planned Home Births in the United States
Giving birth at home is not for everyone. It certainly is not for women or babies who have conditions which put them more at risk for complications which can be helped by medical intervention. Many women prefer to have access to epidurals and other medications to help with the pain of labor. Some women will find a hospital birth "perfect" while others may look for alternative with a subsequent pregnancy.
Some women have carefully studied both options. Of these, some will deliver in a hospital and some will begin planning a home birth attended by a certified midwife with a physician available to meet them at the hospital should complications arise which require a transfer. Obstetrical emergencies are very rare with planned home deliveries because the midwife will notice signs which will cause her to call for transport before an emergency arises.
Finally, there are no guarantees either way. I think personal philosophy comes into the mix. In the DVD "More of the Business of Being Born" (last post), the women discussed risks of induction and C-sections. Ina Mae Gaskins said more than once "a mother's children need her to be around to raise them". From statements like this one, I got the sense that she, and other midwives, felt that risks associated with common medical interventions increased the chance -- still very rare -- of maternal demise around the time of childbirth. A baby might be lost, again rarely, if the mother does not deliver in a hospital, which might have been saved if it had been delivered in the hospital. However, there are those in the maternal infant health care field who believe that statistics also indicate that a few women and a few babies die because of the effects of some somewhat "routine" interventions.
Deciding where to give birth is not always an easy decision. Hospitals have physicians and midwives who differ in their approach to obstetrical care. Some are teaching hospitals where interventions are sometimes advised to allow students to practice doing amniotomies, inserting fetal scalp electrodes, and so on. Some offer birth centers, which support minimal intervention. Some physicians will serve as backup for a home deliveries. Many will not. If a woman chooses to have a home birth but needs some assistance from the hospital, she may be meet with some derision.
This happened to a friend of mine. She delivered each of two children at home. Part of the reason was financial, part was personal preference. Each time she sustained a laceration large enough to require a physician to examine it and then suture it. I met her in her second pregnancy. After the baby was born and she nursed it, she went to the hospital for the repair work. My friend told me the physician was unkind and berated her for having the baby at home. It was a little surprising to my friend because the physician was a woman. My friend was very upset at the way she was treated and decided to write a letter to the administrator.
I think it is good for well done studies to continue on many aspects of maternal health care. Such research has led to change over the years. No longer are women subjected to an enema and shaving off all hair at the site of birth. Neither are low risk mothers and babies required to be tethered to the electronic fetal monitor throughout the entire labor. The use of episiotomies has dropped significantly. But, there are still interventions which studies have indicated are unnecessary or which carry risks significant to alter the course and outcome of normal labor.
Home birth or hospital birth? I once read "If you don't know your options, you don't have any". Studies like this one helps women to better know their options. If you would like to see what a planned home birth with professional assistance can be like, you can watch a short video. The mother's modesty is protected overall in the video. However, breastfeeding for the first time after birth does go better without any fabrics between mother and baby.
The environment was calm. The mother was free to move around as she desired. She birthed on her hands and knees which is a comfortable position for many women. It allows the tail bone to swing out of the way and the pelvis to spread a little more to make it easier for baby to pass through the pelvis. Baby gets oxygen via the umbilical cord during the birth. It clears any amniotic fluid and water by itself in most cases.
One can see why some women prefer this type of birth to one in a typical labor and delivery unit. Again, sometimes a birth like this can be done in a hospital setting if the support is there. One friend had her first babies at home, using the birth pool. When she went to China, she delivered in the hospital using a pool. She was the first woman to do so at that large hospital. Her doctor and the nurses were so impressed, they started offering the option to other women. Even her doctor became pregnant and planned a natural birth using the birth pool.
To see the video of a planned home birth, click on
http://www.pinterest.com/pin/104427285083441199/
Home birth was not as much of an issue when my brothers were born, but it was when I was born. Her doctor expected her to go to the hospital. That was not her plan. My aunt was an RN. When Mom went into labor with me, she called Aunt Sara to come over. When Aunt Sara felt that birth was getting close, she called Dr. Lamb and told him that my mother was in labor, but that it was too late to go to the hospital. He rushed over to the house and delivered me. My father experienced seeing me born -- a rarity for men at that time. He always treasured that experience and our bond was tight.
The incidence of planned home births dropped to single digit percentage points in the US during the 60s and beyond. Certified and "granny" midwives still attended births in outlying areas, usually associated with public health department programs. But by far, most women gave birth in hospitals.
Midwives almost became extinct via pressure on legislators from physician and hospital professional organizations. Finally, some women started demanding safe alternatives to what they saw as practically barbaric practices with hospital birth. Lamaze, Bradley and other childbirth methods became popular. Pressure was put on hospitals to allow fathers to be present at hospital births because women would go to physicians and hospitals which allowed it. As we all know, money talks.
With the "all things natural" movement emerging in the 60's and 70's, more women wanted to avoid medications, episiotomies, and forceps deliveries. They questioned the use of continuous electronic fetal heart monitoring which forced them to stay relatively still and in the bed. They noticed that the C-section rate was increasing since EHMs were being used.
So, they started looking for someone to assist them with home birth. A few licensed and also granny midwives were still in practice, but their numbers were dwindling. As more women began to demand home birth as an option, more physicians agreed to provide back up. As the statistics began to show that a planned home birth for a low risk woman and her low risk baby was safe AND less expensive, the government allowed for the training and practice of more certified nurse midwives (CNMs) to care for the more economically stressed women. Even though women from lower socio-economic backgrounds tended to have a poorer nutritional status, their birth outcomes were impressively good. Women from all socioeconomic levels began searching for the services of midwives, either for hospital births or for home births.
More and more studies have been done as the home birth movement has been growing. Rikki Lake, an actress and former talk show host, experienced the now almost typical induced labor, epidural tract hospital birth with her first child. She states that she felt something was not right, and that there was something more to giving birth than what she had experienced. Lake found a midwife for an at home delivery and a physician who was willing to provide hospital care in case it was needed. Her birth experience was not easy, but one she found very fulfilling. After that, she, along with a producer, made the documentary film "The Business of Being Born" (see last post).
Over the past few decades, more and more studies have been done on the safety of home birth in the United States. Some studies had serious flaws because they included "accidental" births at home. Many of these were premature babies. Sometimes statistics would show that more babies died from home birth, but they were often related to unattended rapid preterm births or birth not attended by a professionally trained midwife. However some studies did a better job of examining only birth which were planned and attended by a trained midwife or even physician.
This latest study covers 16,924 home births in the US. The births were attended by certified nurse midwives. The results are impressive.
To read a synopsis article on the study, click on the following: Home Birth Study Synopsis Article.
For those who enjoy reading the published study itself, click on this link: Outcomes of 16,924 Planned Home Births in the United States
Giving birth at home is not for everyone. It certainly is not for women or babies who have conditions which put them more at risk for complications which can be helped by medical intervention. Many women prefer to have access to epidurals and other medications to help with the pain of labor. Some women will find a hospital birth "perfect" while others may look for alternative with a subsequent pregnancy.
Some women have carefully studied both options. Of these, some will deliver in a hospital and some will begin planning a home birth attended by a certified midwife with a physician available to meet them at the hospital should complications arise which require a transfer. Obstetrical emergencies are very rare with planned home deliveries because the midwife will notice signs which will cause her to call for transport before an emergency arises.
Finally, there are no guarantees either way. I think personal philosophy comes into the mix. In the DVD "More of the Business of Being Born" (last post), the women discussed risks of induction and C-sections. Ina Mae Gaskins said more than once "a mother's children need her to be around to raise them". From statements like this one, I got the sense that she, and other midwives, felt that risks associated with common medical interventions increased the chance -- still very rare -- of maternal demise around the time of childbirth. A baby might be lost, again rarely, if the mother does not deliver in a hospital, which might have been saved if it had been delivered in the hospital. However, there are those in the maternal infant health care field who believe that statistics also indicate that a few women and a few babies die because of the effects of some somewhat "routine" interventions.
Deciding where to give birth is not always an easy decision. Hospitals have physicians and midwives who differ in their approach to obstetrical care. Some are teaching hospitals where interventions are sometimes advised to allow students to practice doing amniotomies, inserting fetal scalp electrodes, and so on. Some offer birth centers, which support minimal intervention. Some physicians will serve as backup for a home deliveries. Many will not. If a woman chooses to have a home birth but needs some assistance from the hospital, she may be meet with some derision.
This happened to a friend of mine. She delivered each of two children at home. Part of the reason was financial, part was personal preference. Each time she sustained a laceration large enough to require a physician to examine it and then suture it. I met her in her second pregnancy. After the baby was born and she nursed it, she went to the hospital for the repair work. My friend told me the physician was unkind and berated her for having the baby at home. It was a little surprising to my friend because the physician was a woman. My friend was very upset at the way she was treated and decided to write a letter to the administrator.
I think it is good for well done studies to continue on many aspects of maternal health care. Such research has led to change over the years. No longer are women subjected to an enema and shaving off all hair at the site of birth. Neither are low risk mothers and babies required to be tethered to the electronic fetal monitor throughout the entire labor. The use of episiotomies has dropped significantly. But, there are still interventions which studies have indicated are unnecessary or which carry risks significant to alter the course and outcome of normal labor.
Home birth or hospital birth? I once read "If you don't know your options, you don't have any". Studies like this one helps women to better know their options. If you would like to see what a planned home birth with professional assistance can be like, you can watch a short video. The mother's modesty is protected overall in the video. However, breastfeeding for the first time after birth does go better without any fabrics between mother and baby.
The environment was calm. The mother was free to move around as she desired. She birthed on her hands and knees which is a comfortable position for many women. It allows the tail bone to swing out of the way and the pelvis to spread a little more to make it easier for baby to pass through the pelvis. Baby gets oxygen via the umbilical cord during the birth. It clears any amniotic fluid and water by itself in most cases.
One can see why some women prefer this type of birth to one in a typical labor and delivery unit. Again, sometimes a birth like this can be done in a hospital setting if the support is there. One friend had her first babies at home, using the birth pool. When she went to China, she delivered in the hospital using a pool. She was the first woman to do so at that large hospital. Her doctor and the nurses were so impressed, they started offering the option to other women. Even her doctor became pregnant and planned a natural birth using the birth pool.
To see the video of a planned home birth, click on
http://www.pinterest.com/pin/104427285083441199/
Wednesday, January 29, 2014
More of the Business of Being Born -- A Video
Many women have seen the first video by Rikki Lake and Abby Epstein, "The Business of Being Born". Tonight I watched the sequel, "More of the Business of Being Born" by the same producers. It contained a fascinating interview with Ina Mae Gaskins (who wrote the books Spiritual Midwifery, Ina Mae's Guide to Childbirth, and Ina Mae's Guide to Breastfeeding) and some other midwives. Ina Mae knows birth. She has been a careful student of the natural process of birth and does an excellent job of explaining why certain things happen the way the do. She discusses the "due date" and what this really means. She also raises some questions as to how routine medical interventions affect both mother and baby during and after the birth process. She questions the effects of Pitocin and other drugs on the mother and baby, rushing the pushing stage, delivering the placenta before it is ready to be delivered, and limiting labor to a certain number of hours before doing a C-section. She also talks about some of the more common reasons for maternal deaths -- including repeat C-sections and the use of the drug Cytotec to induce labor, which, on occasion, seems to result in amniotic fluid embolus. While Ina Mae does not mention this in the video, it is important for women to know that Cytotec has not been approved by the FDA for use in pregnant women.
The statistics Gaskins quotes are impressive and should cause women and care providers to stop and think more carefully about how to approach labor for the low risk mother and low risk baby.
The midwives on "The Farm", a commune in Tennessee, have attended approximately 2800 deliveries. They have back up at a local hospital and will transport when "red flags" occur, although this is a rare occurrence. Their C-section rate is 1.7%, almost 20 times lower than the current US rate. They have no cases of babies born who were later diagnosed with autism. While many babies were past due, only a handful had the actual signs related to being truly post mature.
Reasons for the explosion in medical interventions are discussed. These include loss of skills due to the type of training physicians receive in medical schools, and influence from insurance companies. Gaskins points out that even with all the new technologies, the maternal death rate has doubled in the past 20 or so years in this country. She is an avid reader of research material and has learned to read German in order to read medical studies written in that language.
I am about to become a grandmother again, and I will be recommending this video and others in this series to my grand baby's parents. My daughter in law, like all women, deserves to know as much as possible and/or as much as she desires to know about her choices. I will NOT be recommending a home birth and I will NOT be recommending a hospital birth. That decision is hers to make after she explores all the options. She is a smart woman, and I can trust she will do what is best for her and her baby.
My other daughter in law has had three hospital births. She and my son have stated that if they have baby number 4, they are considering a home birth. Again, they are intelligent people and should baby number 4 be conceived, they will make the decision right for them.
I know this video can be found on Netflix. It is also available via http://www.thebusinessofbeingborn.com
It can be a challenge to trust the natural birth process God created. After all, we live in a fallen world. Still, the more we learn about it, and the more we learn about interventions which can change the course of labor for better or worse, we can see that when women are able to trust His design and work WITH it, the process itself has fewer complications and the outcomes are better overall. I do not know Ina Mae's relationship with Jesus Christ. Like many people with her background, she would probably say that she was "spiritual". It is clear that her years of working with women in pregnancy and birth has lead her to acknowledge and even reverences the beauty and dynamics of birth, as evidenced by this quote:
The statistics Gaskins quotes are impressive and should cause women and care providers to stop and think more carefully about how to approach labor for the low risk mother and low risk baby.
The midwives on "The Farm", a commune in Tennessee, have attended approximately 2800 deliveries. They have back up at a local hospital and will transport when "red flags" occur, although this is a rare occurrence. Their C-section rate is 1.7%, almost 20 times lower than the current US rate. They have no cases of babies born who were later diagnosed with autism. While many babies were past due, only a handful had the actual signs related to being truly post mature.
Reasons for the explosion in medical interventions are discussed. These include loss of skills due to the type of training physicians receive in medical schools, and influence from insurance companies. Gaskins points out that even with all the new technologies, the maternal death rate has doubled in the past 20 or so years in this country. She is an avid reader of research material and has learned to read German in order to read medical studies written in that language.
I am about to become a grandmother again, and I will be recommending this video and others in this series to my grand baby's parents. My daughter in law, like all women, deserves to know as much as possible and/or as much as she desires to know about her choices. I will NOT be recommending a home birth and I will NOT be recommending a hospital birth. That decision is hers to make after she explores all the options. She is a smart woman, and I can trust she will do what is best for her and her baby.
My other daughter in law has had three hospital births. She and my son have stated that if they have baby number 4, they are considering a home birth. Again, they are intelligent people and should baby number 4 be conceived, they will make the decision right for them.
I know this video can be found on Netflix. It is also available via http://www.thebusinessofbeingborn.com
It can be a challenge to trust the natural birth process God created. After all, we live in a fallen world. Still, the more we learn about it, and the more we learn about interventions which can change the course of labor for better or worse, we can see that when women are able to trust His design and work WITH it, the process itself has fewer complications and the outcomes are better overall. I do not know Ina Mae's relationship with Jesus Christ. Like many people with her background, she would probably say that she was "spiritual". It is clear that her years of working with women in pregnancy and birth has lead her to acknowledge and even reverences the beauty and dynamics of birth, as evidenced by this quote:
Friday, January 10, 2014
Peanut Balls, Labor, Epidurals and Breastfeeding
No, I am not talking about those little, delicious, homemade peanut butter balls. You might have thought I was going to say that eating them would help nourish a woman in labor and help her breast milk production.
Nope. They don't do that and I'm not going to say that. The peanut ball I am talking about is used in labor. A study of it's use at an Arizona hospital found that it decreased the length of the first stage of labor by NINETY minutes for moms who had an epidural. It decreased the pushing stage by twenty three minutes, on average, for these same moms. 200 mothers who received epidural anesthesia were assigned to one of two groups. The mothers received their epidurals at around 4 - 5 cms. dilation. Labors for the mothers who used the peanut balls were faster, as described above. For every one centimeter beyond the 4.7 average centimeters the women were dilated when they entered the study, the length of labor was reduced by 35 minutes.
The study also found that the "peanut ball moms" were less likely to need vacuum extraction. The Cesarean rate for these moms was 13 percentage points less than for the moms who did not have the peanut ball.
The study concluded that using the peanut ball for women who had an epidural in labor significantly reduced the length of labor without adverse outcomes for the babies.
The ball was placed between the laboring mothers' legs when they were lying on their sides. One source of information suggested that one leg remain resting on the ball while the other leg was lying on the bed in a "butterfly" position. This should open the pelvis to one side. The mother can change to the opposite side or to another position every 20 to 30 minutes.
The ball worked by opening up the pelvis and allowing the baby to make the maneuvers required to descend through the pelvis and after that, the birth canal.
So, how does this affect breastfeeding? It's pretty simple. Lactation consultants have reported for years there is a correlation between the use of epidurals and problems with breastfeeding. Some problems are related to the use of IVs fluids required when an epidural is given. Edema of the breast and fluid overload of the baby can lead to latching or sucking problems. Pitocin is sometimes needed if epidural anesthesia leads to a slowdown of labor contractions. This medication is associated with greater pressure on the infant's head and cord. This can lead to issues with the cranial nerves which control the baby's ability to suck. Pitocin is also associated with increased jaundice, which can result in poor infant feeding. A cascading result is that the mother's breasts are not stimulated properly. Lactogenesis III can be delayed (the mature milk starts "coming in"). Use of the peanut ball helps prevent labor slowing down to the point where Pitocin is given.
The side effects of an epidural, or the additional interventions which it may lead to, can increase need for a Cesarean section. Women who have a Cesarean section are more likely to experience a delay in their transitional/mature milk coming in. This, along with the postpartum pain which goes with a C-section, is more likely to lead to supplementation. In turn, supplementation increases the chance the mother will stop breastfeeding because of problems with latching and/or milk supply. Furthermore, because antibiotics are given with the C-section, women are more likely to develop thrush and the accompanying pain. Many of these women give up without seeking the help of a lactation consultant. If the use of the peanut ball if the mother has an epidural minimizes the use of Cesarean section, then C-section related breastfeeding problems are avoided.
Therefore, the use of peanut balls for women with epidurals in labor should increase the chance of successful breastfeeding among these same women -- at least that is a reasonable conclusion. I would expect a study, if done, would confirm this.
Women who do not have an epidural should be able to benefit from the ball also. Some blogs by doulas or midwives attest to this. While these women tend to move about more, which is beneficial for the baby's descent, they also need to rest from time to time. The ball can be used for a variety of positions when the woman is active, and can be placed between her legs when she is in the bed resting -- just as is done with the epidural moms.
The use of peanut balls in labor is very new to many hospitals. Some nurses are not aware of it. Others are not aware of the study done on it. Because of this, it is possible that some nurses will discourage its use. Some may fear injury to the mother if her leg slips off onto the bed. In cases like this, the mother, her labor partner, and the nurse might work out a plan to minimize mother's leg slipping off the peanut ball. The partner can sit or stand near the mother, or simply be vigilant to her movements and intervene if the leg starts to slip.
There must be a balance between the benefits and the risks of any intervention (this includes using the epidural itself). Nothing is always perfectly safe -- including doing nothing. First of all, there were no reports in this study of any problems with the mothers' leg slipping off the peanut ball, or of any injuries to mother or baby with its use. Secondly, as one care provider suggested in an article, a towel or pillow could be rolled up and placed behind the mother's back, and also in a place which would prevent the ball from moving.
So, let's review: the use of the peanut ball has been shown to decrease the time of labor, the need for forceps delivery, and the need for C-sections -- all associated with potential, a sometimes serious, complications. There is no report of evidence that somehow a mother's leg could be injured. This chance would be further reduced by telling someone who is with the mother to stay nearby and, if her leg begins to slip, to stabilize the leg and contact the nurse for assistance with repositioning the mother and the ball. So, any theoretical chance of injury is further reduced. Finally, the mother can be told of the benefits and any potential risks, real or theoretical, of the use of the peanut ball, and then she can make an informed decision. This is done all day long and every day by patients and their care providers in the hospital setting.
A sturdy peanut ball that is not likely to leak or burst will cost around $50. A width of approximately 55 centimeters or approximately 20 inches was recommended for most women. Many hospitals do not have them yet, so you will probably need to bring your own. This $50 investment can be recouped many times over in a lower hospital bill and also by not having to switch to formula - - as long as no other problems arise which require a C-section or which lead to breastfeeding cessation. You can watch a YouTube video on how to use the peanut ball at
http://www.youtube.com/watch?v=hSn_BWjL1nw
Saturday, January 4, 2014
Are Common Hospital Childbirth and Breastfeeding Practices Based on Research Evidence?
Note: To go directly to the Evidence Based Birth website, click here
If you have been around for a few decades, as I have, you have probably heard the "Ham Recipe" story. It goes like this (borrowed from http://able2know.org/topic/4965-1, and revised a little):
The family was gathered for a special dinner. The youngest newly married daughter was preparing her first family dinner. As she was about to put the large ham in the oven to begin baking, her mother stopped her and said "You have to cut three inches off the ham before you bake it." Puzzled, the daughter asked her mother why? "Because that's the way my mother taught me to do it," said the mother. Still puzzled, the daughter went to find her grandmother.
"Grammy," she asked, "Mom says you have to cut 3 inches off of the ham before putting it in the oven to bake. Why?" "Well, that's how my mother taught me to do it, and it's the way I've always done it," replied the grandmother.
The next day, the daughter went to visit her great grandmother, who was in assisted living.
"GiGi," he asked, "Grandma says you taught her to cut 3 inches off of the ham before putting it in the over. I'm puzzled. Why is that necessary?"
"Well, dear, when I was a new bride, just starting out, I baked my first ham for Easter dinner. The ham was 20 inches long. The largest roasting pan I had was 17 inches long, so I had to cut three inches off of the ham to make it fit the pan."
Some medical practices are not entirely unlike this story. The first research paper I was required to do in my BSN program was to write a paper on Dr. Teresa Christy, a nurse who practiced in the mid-1900s. She was curious enough to ask "Why". When she was learning to care for patients who had had pelvic surgery, she was told to NEVER, EVER take a rectal temperature. When she asked "Why" she was told of the potential for excessive bleeding or damage to the nearby surgical area. When she did further research, she found that many years earlier, the bulb on thermometers where much, much larger. They were so large that they could put too much pressure on surgical sites. But, thermometers had evolved and the bulbs were much smaller and posed no threat to the surgical wound. Therefore, it was safe to take a rectal temperature, which, in some cases would provide the most accurate reading and possibly catch signs of infection earlier.
That story stuck with me. As a childbirth educator, I often come across medical practices which have been the standard for a long time. Some were based on the way things were decades before. However, evolving medical practices, or better research has shown that those practices are unnecessary. In some cases, they increase the risk of other problems for the patient.
It is important to remember that everything in the medical realm has its benefits and its risks . . . and that includes doing nothing. Health care consumers help themselves when they search out the known benefits and risks of any upcoming procedure.
I recently found a web site which does a superb job in putting forth the evidence on a number of obstetrical and breastfeeding practices common in today's hospital system. The writer is Rebecca Dekker, PhD, RN, APRN. She has done an amazing job of studying the research, and answering common questions based on it. Her material is reviewed by two physicians and a midwife. She updates the site regularly.
I strongly recommend every expectant mother, every obstetrician, every pediatrician, every family practice physician who cares for babies, every women's health nurse, every childbirth educator, every lactation consultant, every midwife, and anyone else who might be providing education, support, or health care to pregnant women and new mothers to read it. When health care professionals read it, they will find solid rationale to consider making some changes in their practice -- or least to support their patients who desire to approach labor, birth, and breastfeeding in a way that is different from the providers' typical practice. Expectant mothers will find solid support for approaches to labor which are based on solid research, but are not necessarily practiced in the hospital setting.
Click on the following link to visit this wonderful site, but come back here to read some additional important information. Bookmark the site while you are there so you can go back over and over again.
Evidence Based Birth
If you are expecting a baby, please read the various topics. If you decide, based on the research evidence to incorporate a certain approach to labor into your birth plan, print the handout which relates to that approach. For example, if you desire to labor without IV fluids, print "IV Fluids in Labor".
One issue I see coming from this are care providers who say "We practice according to the policies or recommendations of the professional organizations associated with our area of practice." This does provide some legal protection for the practitioners. However, all professional organizations do not put forth recommendations based on the entire body of research, or the most up to date research. The recommendations can be dated, waiting revision. Sadly, they can be influenced by contributions or remuneration from companies with a vested interest in what those organizations say or do.
For example, even though the American Academy of Pediatrics strongly supports breast milk as the species appropriate, natural, and best food for babies, it has recently agreed to have it's logo printed on "gift bags" distributed by Mead Johnson, a formula company. When women see the AAP's logo, it sends them a message that pediatricians approve of that formula over another. It also sends a message that formula is an approved, healthful baby milk, somewhat in the same league as breast milk.
Women often continue using the same formula they find in the bag their care providers gave them. Not surprisingly, Mead Johnson, and other companies, put in their more expensive types of formula. As result, families spend hundreds, and possibly more than a thousand dollars a year on the more expensive formula -- without evidence that it is any better than other types.
So, when a physician, or other health care provider, says he or she bases his or her practice on the recommendations of "this" or "that" professional organization, it does not mean that those recommendations are based on the total of available evidence, or on the latest best studies, or even in the best interest of the health care consumers.
Preparing for childbirth and for breastfeeding in most hospital settings REQUIRES that the mother do her own research. Yes, she should talk with her care providers. They will provide information which is helpful. But, in some cases, that information may not be totally up to date. One example is basing how well a woman is progressing through labor on "Freidman's Curve", a long outdated graph of what is "normal". This was plotted in the 1950's when women were sedated and often restrained in the bed and on the delivery table during labor. The normal time frames for each part of labor is different now, and this can be further affected by how the mother copes with pain (medicate or not), her positions, and so on.
Information from any individual care provider may be partially based on personal experiences or preferences, rather than current research. Therefore, getting good information from a reputable, objective source gives the mother a better picture of the pros and cons of her choices and options.
Proverbs 11:14 tells us there is safety in a multitude of counselors. This website (Evidence Based Birth), in my opinion, falls into the category of a great "counselor."
If you have been around for a few decades, as I have, you have probably heard the "Ham Recipe" story. It goes like this (borrowed from http://able2know.org/topic/4965-1, and revised a little):
The family was gathered for a special dinner. The youngest newly married daughter was preparing her first family dinner. As she was about to put the large ham in the oven to begin baking, her mother stopped her and said "You have to cut three inches off the ham before you bake it." Puzzled, the daughter asked her mother why? "Because that's the way my mother taught me to do it," said the mother. Still puzzled, the daughter went to find her grandmother.
"Grammy," she asked, "Mom says you have to cut 3 inches off of the ham before putting it in the oven to bake. Why?" "Well, that's how my mother taught me to do it, and it's the way I've always done it," replied the grandmother.
The next day, the daughter went to visit her great grandmother, who was in assisted living.
"GiGi," he asked, "Grandma says you taught her to cut 3 inches off of the ham before putting it in the over. I'm puzzled. Why is that necessary?"
"Well, dear, when I was a new bride, just starting out, I baked my first ham for Easter dinner. The ham was 20 inches long. The largest roasting pan I had was 17 inches long, so I had to cut three inches off of the ham to make it fit the pan."
Some medical practices are not entirely unlike this story. The first research paper I was required to do in my BSN program was to write a paper on Dr. Teresa Christy, a nurse who practiced in the mid-1900s. She was curious enough to ask "Why". When she was learning to care for patients who had had pelvic surgery, she was told to NEVER, EVER take a rectal temperature. When she asked "Why" she was told of the potential for excessive bleeding or damage to the nearby surgical area. When she did further research, she found that many years earlier, the bulb on thermometers where much, much larger. They were so large that they could put too much pressure on surgical sites. But, thermometers had evolved and the bulbs were much smaller and posed no threat to the surgical wound. Therefore, it was safe to take a rectal temperature, which, in some cases would provide the most accurate reading and possibly catch signs of infection earlier.
That story stuck with me. As a childbirth educator, I often come across medical practices which have been the standard for a long time. Some were based on the way things were decades before. However, evolving medical practices, or better research has shown that those practices are unnecessary. In some cases, they increase the risk of other problems for the patient.
It is important to remember that everything in the medical realm has its benefits and its risks . . . and that includes doing nothing. Health care consumers help themselves when they search out the known benefits and risks of any upcoming procedure.
I recently found a web site which does a superb job in putting forth the evidence on a number of obstetrical and breastfeeding practices common in today's hospital system. The writer is Rebecca Dekker, PhD, RN, APRN. She has done an amazing job of studying the research, and answering common questions based on it. Her material is reviewed by two physicians and a midwife. She updates the site regularly.
I strongly recommend every expectant mother, every obstetrician, every pediatrician, every family practice physician who cares for babies, every women's health nurse, every childbirth educator, every lactation consultant, every midwife, and anyone else who might be providing education, support, or health care to pregnant women and new mothers to read it. When health care professionals read it, they will find solid rationale to consider making some changes in their practice -- or least to support their patients who desire to approach labor, birth, and breastfeeding in a way that is different from the providers' typical practice. Expectant mothers will find solid support for approaches to labor which are based on solid research, but are not necessarily practiced in the hospital setting.
Click on the following link to visit this wonderful site, but come back here to read some additional important information. Bookmark the site while you are there so you can go back over and over again.
Evidence Based Birth
If you are expecting a baby, please read the various topics. If you decide, based on the research evidence to incorporate a certain approach to labor into your birth plan, print the handout which relates to that approach. For example, if you desire to labor without IV fluids, print "IV Fluids in Labor".
One issue I see coming from this are care providers who say "We practice according to the policies or recommendations of the professional organizations associated with our area of practice." This does provide some legal protection for the practitioners. However, all professional organizations do not put forth recommendations based on the entire body of research, or the most up to date research. The recommendations can be dated, waiting revision. Sadly, they can be influenced by contributions or remuneration from companies with a vested interest in what those organizations say or do.
For example, even though the American Academy of Pediatrics strongly supports breast milk as the species appropriate, natural, and best food for babies, it has recently agreed to have it's logo printed on "gift bags" distributed by Mead Johnson, a formula company. When women see the AAP's logo, it sends them a message that pediatricians approve of that formula over another. It also sends a message that formula is an approved, healthful baby milk, somewhat in the same league as breast milk.
Women often continue using the same formula they find in the bag their care providers gave them. Not surprisingly, Mead Johnson, and other companies, put in their more expensive types of formula. As result, families spend hundreds, and possibly more than a thousand dollars a year on the more expensive formula -- without evidence that it is any better than other types.
So, when a physician, or other health care provider, says he or she bases his or her practice on the recommendations of "this" or "that" professional organization, it does not mean that those recommendations are based on the total of available evidence, or on the latest best studies, or even in the best interest of the health care consumers.
Preparing for childbirth and for breastfeeding in most hospital settings REQUIRES that the mother do her own research. Yes, she should talk with her care providers. They will provide information which is helpful. But, in some cases, that information may not be totally up to date. One example is basing how well a woman is progressing through labor on "Freidman's Curve", a long outdated graph of what is "normal". This was plotted in the 1950's when women were sedated and often restrained in the bed and on the delivery table during labor. The normal time frames for each part of labor is different now, and this can be further affected by how the mother copes with pain (medicate or not), her positions, and so on.
Information from any individual care provider may be partially based on personal experiences or preferences, rather than current research. Therefore, getting good information from a reputable, objective source gives the mother a better picture of the pros and cons of her choices and options.
Proverbs 11:14 tells us there is safety in a multitude of counselors. This website (Evidence Based Birth), in my opinion, falls into the category of a great "counselor."
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