I recently was involved with putting together a conference entitled "Birth Really Matters: Optimizing Maternal and Neonatal Outcomes". We had a couple of physicians, half dozen midwives, several RNs, several doulas, several lactation consultants, and a few childbirth educators attend. A certified nurse midwife from VCU Centering Pregnancy was a speaker. She showed a video (link to be displayed at the end of this post) on the rights of childbearing women.
As a childbirth educator, I am often asked "Will they let me . . .?". To this I usually respond, "What you want to say it 'My plan is to . . .', or, 'I will be doing . . . '. Avoid asking if something is OK. A nurse or physician could be having a bad day, and you can get a "no" when that should not be the case."
At the conference, a midwife in the audience talked to us about the power of "no". If a nurse says, "I need to take your baby to weigh and bathe it", you can say "No. I want to hold my baby and let her breastfeed for a while longer. I do not plan to for my baby to have a bath today." If a physician says "You have to have IV fluids", you can say "No. I will be taking in fluids orally. I do not want to be connected to IV fluids".
So, what if you have signed all kinds of consent to treat forms? "No" trumps these. No matter what you have consented to allow to be done, or to do, at any time you can invoke the power of "No". At this point, without a court order, no one can force you to do anything.
My advice? Use your power wisely. If necessary, ask questions, and use your BRAIN (benefits, risks, alternatives, intuition, and "no" or "not now" if applicable). Christian women have a great resource: prayer. Ask for wisdom in making your decision (James 1:5).
Do not be intimidated. It is your body. It is your birth experience. To the care provider, it is just another day at the office. You will remember this experience -- and deal with any effects -- for the rest of your life. And, most importantly, it is YOUR baby.
http://www.youtube.com/watch?v=K105F9o3HtU
http://childbirthconnection.org/article.asp?ck=10084&ClickedLink=0&area=27
Monday, October 13, 2014
Friday, July 11, 2014
So What Do Doulas Do? Watch This Video!
This will be a short
post. There is a 50 minute video on how doulas support women in labor.
Benefits include less need for pain meds and reduced chance of having a
C-section.
Click on this link to watch the trailer, to rent or to purchase the video. The trailer is free, and prices are reasonable for either option.
http://muvi.es/w3219/283382
Disclosure: The organization which put out this video has a system where the person who provides a link will receive a small fee for sharing if the movie is rented or purchased. I have not idea what that fee is, but it is probably very minimal. My goal is to inform women of the fantastic benefits of having a doula.
Click on this link to watch the trailer, to rent or to purchase the video. The trailer is free, and prices are reasonable for either option.
http://muvi.es/w3219/283382
Disclosure: The organization which put out this video has a system where the person who provides a link will receive a small fee for sharing if the movie is rented or purchased. I have not idea what that fee is, but it is probably very minimal. My goal is to inform women of the fantastic benefits of having a doula.
Thursday, July 3, 2014
Noise Making: Friend of the Woman Giving Birth
One of the Power Point slides in my class shows three names: Grantly Dick-Read, Fernand Lamaze, and Robert Bradley. By each name are a few sentences describing the philosophy of their approach to birth. Somewhere in each of those descriptions are the words "relaxation", "breathing", and "painless". I explain that these physicians were known for developing a way of approaching childbirth in the previous century, with Dick-Read's work in the 1930's, Lamaze's work in the 1950's and 60's, and Robert Bradley's in the 60s and 70s. I then ask the class to see if they find common themes, or simply anything common among the physicians as they read the blurbs.
Most of the time, members will identify the three words noted above. And, in most cases, they notice that the physicians were all men. "This is why they think birth can be painless if you can only relax enough. They have NOT given birth", is my response, which typically brings about some laughter. I also point out that they deserved some kudos for trying to make birth easier for women, and in some ways, they did.
However, these men were probably very uncomfortable with women making noise in labor! Why? In the context of the culture from which these physicians came, men did not want to hear women crying. They typically wanted to "rescue" women in distress. It naturally followed that they would look for a way to keep the women they cared for in childbirth from making noise because crying, moaning, etc. meant the problem of pain and her response to it was not fixed.
The patterned breathing and the relaxation techniques were supposed to help a woman CONTROL her response to pain, but it also lessened or eliminated any noise she might make during contractions. This is not a natural thing for women to do. Therefore, "natural childbirth" practiced this way, is not really natural. Even women who manage to "hee" and "hoo" their way through most of labor often make the hard "aaehhhh" sounds of work when pushing. Finally, women who are feeling their contractions seem to emit an almost primal scream as the baby is exiting her body.
Tears, too, are a natural part of many natural birth experiences. Years ago, a young woman, around 18 years old came to my childbirth class. Her mother was her "coach". They wrote back that during labor, K., young woman, sat on the toilet to use the bathroom. She found it comfortable and stayed there. Her mother brought a pillow and placed it on the floor in front of her daughter. She knelt down, and her daughter leaned against her during contractions. At one point, K. began crying quietly, releasing tears. The nurse came in, saw the tears, and said "Oh no! Don't cry!". K. told the nurse "I -- i-- it's al --- right. (Sniff.) I'm O -- oK" and continued coping the way she was. K. ended up delivering without any pain meds and was thrilled she reached her personal goal of a natural childbirth.
A friend something to me. She told me how she tripped on her friend's deck, and hit her elbow. She said, "All I could do what hold my elbow, rock back and forth, and moan.". My response was "Somewhat like a woman in active labor".
I am convinced that women in labor naturally make noise (along with rhythmic movements) as a method of coping with pain -- and SHOULD be allowed, even encouraged, to do so. I am not talking about screaming with fists clenched and back arched. I am talking about tension releasing noises like moaning, or staccato sounds like "oh, oh, oh, oh, oh" vocalized in a tension releasing way. A good cry during advanced labor helps to release tension, also. Crying is part of the Master's design for tension release.
I also think that many nurses and physicians in today's hospital setting are uncomfortable with noise women make as a way of coping with contractions. Nurses are trained to ask about and document their patient's level of pain based on the "faces" pain scale where "1" is a happy face and "10" shows an agonized countenance. Then, they are trained to "fix" the patient's problem by medication until she can give a lower number when asked to rate her pain once again. Our normal reaction is to want to help the woman "not to suffer", so drugs, or breathing techniques are offered, sometimes with intense pressure to comply.
In order to really help a woman prepare for her labor, she needs to be encouraged to surrender to it. Learning to relax or "let go" at will is also important. She needs to be told it is OK to cry (real tears) and to make tension releasing noise.
It is especially hard for the woman's husband or other support person, unless that person is a doula or someone who understands natural birth, to listen to his loved one "suffering". But, it really is not suffering when the woman is not crying out for help. It is coping, and needs to be supported and not discouraged.
This does not mean that you should not learn breathing techniques. You might find them, particularly Bradley's show abdominal breathing, to be helpful, especially in the earlier phases of labor. But don't feel like you have to stay with them when your body is "telling" you to make noise.
If you are planning to have a natural childbirth, you might need to write something in your birth plan along the lines of "I plan to use vocalization as part of my coping techniques. Please encourage tension releasing noises instead of returning to more artificial breathing techniques if I am finding vocalization to be helpful."
I have a feeling that Dr. Lamaze, especially, would abandon his "hee-hee-hoo"s for some "ohhhhhhhhhhhhhhhhh"s moans if he actually labored and gave birth.
Most of the time, members will identify the three words noted above. And, in most cases, they notice that the physicians were all men. "This is why they think birth can be painless if you can only relax enough. They have NOT given birth", is my response, which typically brings about some laughter. I also point out that they deserved some kudos for trying to make birth easier for women, and in some ways, they did.
However, these men were probably very uncomfortable with women making noise in labor! Why? In the context of the culture from which these physicians came, men did not want to hear women crying. They typically wanted to "rescue" women in distress. It naturally followed that they would look for a way to keep the women they cared for in childbirth from making noise because crying, moaning, etc. meant the problem of pain and her response to it was not fixed.
The patterned breathing and the relaxation techniques were supposed to help a woman CONTROL her response to pain, but it also lessened or eliminated any noise she might make during contractions. This is not a natural thing for women to do. Therefore, "natural childbirth" practiced this way, is not really natural. Even women who manage to "hee" and "hoo" their way through most of labor often make the hard "aaehhhh" sounds of work when pushing. Finally, women who are feeling their contractions seem to emit an almost primal scream as the baby is exiting her body.
Tears, too, are a natural part of many natural birth experiences. Years ago, a young woman, around 18 years old came to my childbirth class. Her mother was her "coach". They wrote back that during labor, K., young woman, sat on the toilet to use the bathroom. She found it comfortable and stayed there. Her mother brought a pillow and placed it on the floor in front of her daughter. She knelt down, and her daughter leaned against her during contractions. At one point, K. began crying quietly, releasing tears. The nurse came in, saw the tears, and said "Oh no! Don't cry!". K. told the nurse "I -- i-- it's al --- right. (Sniff.) I'm O -- oK" and continued coping the way she was. K. ended up delivering without any pain meds and was thrilled she reached her personal goal of a natural childbirth.
A friend something to me. She told me how she tripped on her friend's deck, and hit her elbow. She said, "All I could do what hold my elbow, rock back and forth, and moan.". My response was "Somewhat like a woman in active labor".
I am convinced that women in labor naturally make noise (along with rhythmic movements) as a method of coping with pain -- and SHOULD be allowed, even encouraged, to do so. I am not talking about screaming with fists clenched and back arched. I am talking about tension releasing noises like moaning, or staccato sounds like "oh, oh, oh, oh, oh" vocalized in a tension releasing way. A good cry during advanced labor helps to release tension, also. Crying is part of the Master's design for tension release.
I also think that many nurses and physicians in today's hospital setting are uncomfortable with noise women make as a way of coping with contractions. Nurses are trained to ask about and document their patient's level of pain based on the "faces" pain scale where "1" is a happy face and "10" shows an agonized countenance. Then, they are trained to "fix" the patient's problem by medication until she can give a lower number when asked to rate her pain once again. Our normal reaction is to want to help the woman "not to suffer", so drugs, or breathing techniques are offered, sometimes with intense pressure to comply.
In order to really help a woman prepare for her labor, she needs to be encouraged to surrender to it. Learning to relax or "let go" at will is also important. She needs to be told it is OK to cry (real tears) and to make tension releasing noise.
It is especially hard for the woman's husband or other support person, unless that person is a doula or someone who understands natural birth, to listen to his loved one "suffering". But, it really is not suffering when the woman is not crying out for help. It is coping, and needs to be supported and not discouraged.
This does not mean that you should not learn breathing techniques. You might find them, particularly Bradley's show abdominal breathing, to be helpful, especially in the earlier phases of labor. But don't feel like you have to stay with them when your body is "telling" you to make noise.
If you are planning to have a natural childbirth, you might need to write something in your birth plan along the lines of "I plan to use vocalization as part of my coping techniques. Please encourage tension releasing noises instead of returning to more artificial breathing techniques if I am finding vocalization to be helpful."
I have a feeling that Dr. Lamaze, especially, would abandon his "hee-hee-hoo"s for some "ohhhhhhhhhhhhhhhhh"s moans if he actually labored and gave birth.
Monday, May 5, 2014
"I am SO Happy!"
I heard these words repeated over and over during the first thirty minutes following the delivery of her baby girl via natural childbirth. Well, almost natural. Here is the rest of the story, with the permission of the mother.
She was induced at 40 weeks and 3 days due to "oligohydramios" (decreased fluid found upon testing) and "several dips" in the baby's heart rate. I am not going to do into these finding or what may have caused them. Some experts say that this is common with late "post date" pregnancies, and when mother has been confined to bed, on her back during the testing. The situation was this: I received a call at 2:45 a.m., with this mother in tears. I assured her that God was in control and that I was on my way to serve as her doula.
I arrived around 4 a.m. "A." was upset because the midwife on call at the military hospital had challenged A about her "too detailed" birth birth plan (it was only one page in length) and told A. that she needed to give up some control. Then the midwife tossed the birth plan at the nurse as she left the room.
I set up the room with flameless candles, essentials oils on cotton balls for aroma therapy, and Scriptures A. had selected from those I had printed out. Actually, she and her husband decided where they wanted each verse posted, and he placed them around the room and bathroom.
I then went to introduce myself to the nurses, who were very kind. One apologized about the midwife right away. I asked who would be on duty at 7 a.m. and they assured me that it would be an OB who was easier to work with. They were right, as we came to learn. Before leaving the nurses' station, I explained that this was a very strong and capable woman, and having a natural childbirth was very important to her. She would let us know if she wanted meds, but as stated on her birth plan, did not want anyone suggesting pain meds or discussing them before she inquired. This turned out to be the only request which was ignored a few times.
A. was started on Pitocin (synthetic oxytocin) to jump start her labor. She had done a lot of reading and told the nurse she did not want any increases for at least an hour. The nurse agreed to check with the doctor. Dr. Lee came in to visit, birth plan in hand, and the first thing she said, "I think we can do everything you want to do as long as the labor allows", and discussed most items. This allowed A. to clarify one. Everyone was now on the same page.
We finally got A. to lie down around 6:15 a.m. to try to sleep a little. After a while, her nurse came in to give her oxygen since her baby's heart rate kept dropping a little. A. told her she was not surprised because she had asthma and it had been hard breathing while trying to sleep. After a bit more napping, A. got out of bed after the nurse removed the oxygen, and we walked around the unit several times. The hospital had a wireless electronic fetal heart monitoring, which made it possible to do so with mom on Pitocin. ALL hospitals need this for their patients. The literature is clear regarding the benefits of walking and upright positions for labor.
A. was still 1 centimeter dilated after this and her OB suggested inserting a Foley catheter into her cervix to stretch it a bit. She told A it would fall out when the cervix reached 3 to 4 centimeters. A. was unsure, so, as her doula, I asked the OB to list for A the benefits and risks of the procedure. A. considered the information and decided to try the Foley. We walked some more, the nurse increased the Pitocin, and A. began having stronger contractions. She went to use the bathroom and found sitting on the toilet comfortable. I brought in a pillow, some flameless flickering candles, and some lavender essential oil on a cotton ball. A. rested her head on the pillow behind her, and stayed on in this position for about an hour. 30 minutes into this "toilet time" she placed her legs over my thighs to elevate her feet, which had started swelling a little from the fluids and the Pit.
She managed her contractions by intentional relaxation, deep breathing, and "blowing out the pain", sometimes with moaning. I would gently support her finger tips with mine to assess her relaxation and to let her know when she was beginning to tense up so she could consciously relax.
A. had been at 1 centimeter for some time and I was a bit worried the induction would not work and that A. would end up with a C-section. I texted my husband, her pastor, to ask him to pray that A. would dilate more quickly. At the end of the hour, A. was checked and the balloon was still not ready to come out. We went over to the bed and soon she felt it slip a bit. The OB came in and gave it a tug and it came out. A. was declared to be "3".
We did some 'stomp, stomp, squats" around that time, and periodically during labor. A. got into the bed, and leaned over a peanut ball (a large exercise ball shaped like a peanut), on her hands and knees and rested. I used two weighted soft exercise balls as counter pressure for her back, as she directed from the choices. The room was dim, lighted by flameless candles and the scented with lavender and jasmine essential oils. The nurse loved coming into the room because of the scent and atmosphere. I put a little peppermint oil on A's back and inner thighs to help with pain. After an hour, with contractions increasing in intensity, the nurse checked her and declared A. was "6".
As I had promised A., we got her into the shower for the expected, most intense phase of stage one of labor -- transition. At this point her nurse came in to check on her and told A., that she had been conservative with her last exam -- A. was really a 7. This news encouraged all of us. However, from A.'s first contraction in the shower, it was clear she WAS in transition because of her emotional response to it and her sleepiness between the rapidly occurring contractions.
With A. sitting on the shower bench (well, leaning back a little against a pillow, with her legs stretched out with feet on a nursing stool) I sprayed warm water over her chest and tummy while her husband encouraged her with loving words.
Let me digress a bit here. At some point with each one of the above comfort measures and positions A. had used in her labor, her nurse would come in to teach. In early labor, A. listened to the dangers of sucking on lollipops (increased saliva and stomach contents in case a C-section was needed). I asked the nurse -- for A.'s benefit of hearing the answer -- how often they used general anesthesia for C-sections (VERY rare). Since spinals and epidurals practically eliminate the risk of aspiration syndrome (vomiting stomach contents into the lungs) A. ignored the "caution" and sucked on her lollipop. The research does not support having a woman fast during labor. In fact, doing so can interfere with normal labor and a woman's ability to complete it without additional intervention.
Since A. had reminded her nurse (who really was an excellent nurse) that she did not want to hear about the epidural, her nurse talked with her husband about it other pain meds. She cautioned him that if A. did not take something soon, it would be too late. She did just outside the bathroom door, and within A's. earshot. A.'s husband re-stated A.'s desire NOT to be offered medication. Once the nurse could see that A. was as determined as she was, and that what we were doing was working to keep labor progressing (thanks again, honey for praying for A.!), and that A. was coping -- albeit loudly at times-- the nurse did not mention the "E" word, or systemic meds, again.
During the hour we spent in the shower, A. experienced all the normal signs of transition: nausea, drowsiness between contractions, slurred, slow speech, shaking, and near the end of transition "I want this to STOP! I don't want to do this anymore!". A. went from praying "Thank you, Lord for helping me. Help me finish this labor!" to fussing about the pain, and back again. Acceptance of a woman's powerful and volatile emotions in transition is crucial for her to let go and do this incredibly demanding work.
Again, the nurse wanted A. go get into the bed to be checked and A. quickly and without reservation told her "You must be out of your mind!. I am not moving". I smiled and said, "I don't think she's ready to leave the shower yet". So, I redirected the water while the nurse checked to see if A's water had broken. It had. There was no need to check for a cord prolapse. Baby's heart rate was thumping along just fine. Thankfully, the waterproof transducers on A's belly, along with the wireless monitor allowed her to enjoy the shower during her labor on Pitocin. ALL hospitals should have this equipment!
A. had been complaining of feeling like she had to push for well over an hour, even before getting into the shower, but she was able to "blow" through them. I knew she was not yet ready, even though she voiced her frustration a little of not being allowed to push.
A few minutes after the nurse checked for SROM (spontaneous rupture of the membranes", A. said she felt like she was about to pass out. Her husband helped her onto her hands and knees (to prevent her falling and hitting her head) while I ran for the honey and a straw in my doula bag. I shoved the straw into the honey, pulled it out, and told A. to suck all the honey out of the straw -- NO ARGUMENT. She did so. In seconds, she revived, and on the next contraction "cow bellowed," "I HAVE TO PUSH!" Once again, I told her to blow (air out of her mouth) through the urge, but this time she told me, "YOU DON"T UNDERSTAND! It won't let me!" Those are the words I was waiting to hear. A. "blew out the candle" anyway, between little fusses. Strong woman!
Once the contraction was over, I turned off the shower, had her husband help me get her up, toweled her off, threw a blanket over her, and headed for the bed. The nurse came, checked A., and declared A. had dilated to "10" and she could being pushing.
A. had stated on her birth plan that she wanted to push on her hands and knees. Her OB was comfortable with this. A. rested her upper body over the same peanut ball she had used earlier to rest, and grabbed the mattress at the head of the bed. She managed to keep pulling it away from the frame, loosing her leverage. Her husband secured her arms with his hands as she pushed. What beautiful teamwork. No class taught him that.
By the way, her husband was amazing! They had attended my childbirth class and comfort measures classes, plus one held by her hospital. Earlier in her pregnancy, they read a book I had loaned them, and continued reading many other other books and articles, so he was well aware of what to expect . . . to a point. I had taken a few moments earlier in labor to remind him that he would see his wife in a lot of pain, but that God had also provided pain relief and naps between the contractions (via God-designed "morphine" known as endorphin). I gave him a list of things to say to encourage his wife, with "I love you" and "You are amazing" at the top of the list. He provided her with the "emotional medication" that often works as well as pharmaceutical meds in helping labor progress and helping women cope with the contractions. Now, he was helping his wife do what she needed to do in order to push effectively.
A. started her pushing, as most women do, a little uncoordinated while trying to figure out what her body was doing. The nurse, per her training, was wanting A. to hold her breath for a count of ten before pushing again. This can be necessary when a woman does not feel her urges to push, as happens with most epidurals. However, studies had shown that when the mother is allowed to follow her urges, she will hold her breath, if she does hold it, for about 6 to 7 seconds when she pushes. The benefit to this natural pushing is that the baby's heart rate does not dip as low, and recovers more quickly than with directed pushing. Also, when a woman is told to push out of rhythm of the urges, they experience more pain while the work is less effective. Holding to someone else's count to "10" easily gets the woman out of HER OWN rhythm of pushing with her body's urges.
I told the nurse "Let's watch A. for about 15 minutes and see how she does before we direct her". The nurse sweetly agreed (which spoke well of her because almost everything she had been suggesting throughout the labor was declined). Soon, A. was pushing in harmony with her body, taking deep breaths to oxygenate her baby between urges to bear down, and when she was resting between pushes.
Dr. Lee was lying on her side across the bed, watching the baby's descent and figuring out the maneuvers for a delivery 180 degrees opposite from a typical birth. She had done hands and knees births before, but not recently. A's nurse, Janine, was on her knees on the floor beside the bed to hold the monitor on A's upside down belly to record the baby's heart rate. What dedication! This was clearly not a typical birth scene for that military hospital. Yet, the OB and the nurse were smiling at each other at one point and agreed "this is cool!". ALL hospitals need medical and nursing staff like the ones on duty for this birth! (I still scratch my head at the midwife's attitude, though. It's so untypical for a midwife.)
In less than one hour, little Isabelle was born. Well, not really little. A. had delivered a 9 pound 14 ounce, 22 inches long baby without vacuum extraction, forceps, or C-section, so "little" is not the right word. As A. requested, no episiotomy was done.
By the way, the baby's heart rate was wonderful throughout all of the labor, even with the Pitocin, with the exception of when A. was lying straight in the bed. There IS something to getting mom off her back when checking fetal heart tones! Perhaps the induction wasn't really necessary, perhaps it was. But, this was how God wanted this labor to occur, and He used it to bless A.
Back to the birth sequence. The OB directed us how to help A. turn over on her back to receive her baby while maneuvering among the IV/Pitocin lines. Earlier during the pushing stage, she had asked how we were going to figure this out. I suggested she call the shots since she had to best view of everything. I was impressed by her attitude of teamwork vs. the "I am in charge of everything" personality exhibited by some OBs. Her approach to A.'s care had a major impact on how her labor was allowed to progress, and on all the positive results A. and her husband enjoyed. All hospitals need physicians like this!
The photo above shows the triumph A. felt. once Isabelle was in her mother's arms. After greeting her baby, her first words to all of us in the room were "I AM SO HAPPY!", followed by "Thank you, Lord!" not as an exclamation but as a prayer.
In a few minutes, still on her post natural birth oxytocin high, A. said, with a huge smile, "I am AWESOME! I did this without pain meds AND on Pitocin". Was she bragging? No. She was enjoying the empowerment God gives as a special gift to many women whose labor occurs in this manner. She was not better than other mothers, she was simply experiencing a special feeling the Lord provides many women who have accomplished this work. Oxytocin is a powerful hormone, which is released in increasing amounts during labor.
Pain medications diminish the normal release of oxytocin, so 85% of women in this country do not experience the intense feeling God planned for them to enjoy. Remember, pain meds have not been around for all of history. While women, due to the curse resulting from the Fall of Man, experience pain in childbirth, our loving God also provides something comforting during labor and very uplifting immediately after the birth. A. was blessed to enjoy this gift.
As Dr. Lee repaired a tear from the birth, A. allowed Isabelle to progress through the steps God designed babies to be able to do to finally self latch and nurse. Again the nurse tried to assist, but I explained that, as a lactation consultant, I too want to "help". However, studies showed that if we leave healthy, alert babies alone, they will progress through certain, consistent steps and latch better than if we we jump straight to attaching baby to breast. Again she nodded and let Isabelle continue without help. Sure enough, in about 30 minutes, Isabelle accomplished those steps to latch beautifully and suckle away. I showed her dad how a good latch looked so he could help assess with later feeds.
After an hour, A. gave the baby to her husband, who took it to the warmer where she was wiped down an little more, weighed, and measured. Dad got to put on her first diaper, and then held his daughter for some skin to skin time.
What did A. and her husband think about their decision to have a doula? I received a Facebook message from A. several hours after I went home from the birth.
" . . . I don't know if we could've done this without you. Knowing and having someone there to guide us and empower us through our labor was the BEST decision we have ever made together (besides getting married, choosing to have Heavenly Father as our families foundation, and having babies of course :-)) Thank you so much for the amazing experience you were able to give us. We love you!!!"
In her opinion, having a doula was the 4th best decision they had made in their lives. Since it followed what it followed in her list, you can get an idea of how much support women discover that a doula can provide to help them achieve their goals for birth and breastfeeding initiation.
Even though A. had planned her way, God directed her steps (Prov. 16:9). She found, that with God's help, she was capable of more than she imagined. She found Him to be faithful, to comfort, to strengthen, and to bless in ways she had never before experienced. Yes, she had support from her husband, her doctor, her nurse, her doula, and for early labor, three amazing women: her mother, grandmother, and mother-in-law (all who had birthed without meds, including the mother-in-law who gave birth to a 13 pound baby, who happened to become A.'s husband!).
However, and most importantly, she had her GOD, the one Who created her, Who loves her -- Who gave her second birth -- to carry her through this labor which threw her into the depths of pain, and for a few moments, despair, before elevating her to heights of a type of joy she had never experienced.
Her husband learned that he, with God's help, could provide the necessary emotional support and physical comfort measures to help his wife birth their first
child.
As their doula, I was blessed, once again, to witness the partnership of a man and his wife during her labor, and the birth of a man and a woman into parents, holding the one they had come to love, but never had seen before that special day.
Thank you, A. and T. for this precious experience. I, too, "am SO happy!"
 |
| The face of a mother high on oxytocin following a pain med free, or "natural" childbirth. |
I arrived around 4 a.m. "A." was upset because the midwife on call at the military hospital had challenged A about her "too detailed" birth birth plan (it was only one page in length) and told A. that she needed to give up some control. Then the midwife tossed the birth plan at the nurse as she left the room.
I set up the room with flameless candles, essentials oils on cotton balls for aroma therapy, and Scriptures A. had selected from those I had printed out. Actually, she and her husband decided where they wanted each verse posted, and he placed them around the room and bathroom.
I then went to introduce myself to the nurses, who were very kind. One apologized about the midwife right away. I asked who would be on duty at 7 a.m. and they assured me that it would be an OB who was easier to work with. They were right, as we came to learn. Before leaving the nurses' station, I explained that this was a very strong and capable woman, and having a natural childbirth was very important to her. She would let us know if she wanted meds, but as stated on her birth plan, did not want anyone suggesting pain meds or discussing them before she inquired. This turned out to be the only request which was ignored a few times.
A. was started on Pitocin (synthetic oxytocin) to jump start her labor. She had done a lot of reading and told the nurse she did not want any increases for at least an hour. The nurse agreed to check with the doctor. Dr. Lee came in to visit, birth plan in hand, and the first thing she said, "I think we can do everything you want to do as long as the labor allows", and discussed most items. This allowed A. to clarify one. Everyone was now on the same page.
We finally got A. to lie down around 6:15 a.m. to try to sleep a little. After a while, her nurse came in to give her oxygen since her baby's heart rate kept dropping a little. A. told her she was not surprised because she had asthma and it had been hard breathing while trying to sleep. After a bit more napping, A. got out of bed after the nurse removed the oxygen, and we walked around the unit several times. The hospital had a wireless electronic fetal heart monitoring, which made it possible to do so with mom on Pitocin. ALL hospitals need this for their patients. The literature is clear regarding the benefits of walking and upright positions for labor.
A. was still 1 centimeter dilated after this and her OB suggested inserting a Foley catheter into her cervix to stretch it a bit. She told A it would fall out when the cervix reached 3 to 4 centimeters. A. was unsure, so, as her doula, I asked the OB to list for A the benefits and risks of the procedure. A. considered the information and decided to try the Foley. We walked some more, the nurse increased the Pitocin, and A. began having stronger contractions. She went to use the bathroom and found sitting on the toilet comfortable. I brought in a pillow, some flameless flickering candles, and some lavender essential oil on a cotton ball. A. rested her head on the pillow behind her, and stayed on in this position for about an hour. 30 minutes into this "toilet time" she placed her legs over my thighs to elevate her feet, which had started swelling a little from the fluids and the Pit.
She managed her contractions by intentional relaxation, deep breathing, and "blowing out the pain", sometimes with moaning. I would gently support her finger tips with mine to assess her relaxation and to let her know when she was beginning to tense up so she could consciously relax.
A. had been at 1 centimeter for some time and I was a bit worried the induction would not work and that A. would end up with a C-section. I texted my husband, her pastor, to ask him to pray that A. would dilate more quickly. At the end of the hour, A. was checked and the balloon was still not ready to come out. We went over to the bed and soon she felt it slip a bit. The OB came in and gave it a tug and it came out. A. was declared to be "3".
We did some 'stomp, stomp, squats" around that time, and periodically during labor. A. got into the bed, and leaned over a peanut ball (a large exercise ball shaped like a peanut), on her hands and knees and rested. I used two weighted soft exercise balls as counter pressure for her back, as she directed from the choices. The room was dim, lighted by flameless candles and the scented with lavender and jasmine essential oils. The nurse loved coming into the room because of the scent and atmosphere. I put a little peppermint oil on A's back and inner thighs to help with pain. After an hour, with contractions increasing in intensity, the nurse checked her and declared A. was "6".
As I had promised A., we got her into the shower for the expected, most intense phase of stage one of labor -- transition. At this point her nurse came in to check on her and told A., that she had been conservative with her last exam -- A. was really a 7. This news encouraged all of us. However, from A.'s first contraction in the shower, it was clear she WAS in transition because of her emotional response to it and her sleepiness between the rapidly occurring contractions.
With A. sitting on the shower bench (well, leaning back a little against a pillow, with her legs stretched out with feet on a nursing stool) I sprayed warm water over her chest and tummy while her husband encouraged her with loving words.
Let me digress a bit here. At some point with each one of the above comfort measures and positions A. had used in her labor, her nurse would come in to teach. In early labor, A. listened to the dangers of sucking on lollipops (increased saliva and stomach contents in case a C-section was needed). I asked the nurse -- for A.'s benefit of hearing the answer -- how often they used general anesthesia for C-sections (VERY rare). Since spinals and epidurals practically eliminate the risk of aspiration syndrome (vomiting stomach contents into the lungs) A. ignored the "caution" and sucked on her lollipop. The research does not support having a woman fast during labor. In fact, doing so can interfere with normal labor and a woman's ability to complete it without additional intervention.
Since A. had reminded her nurse (who really was an excellent nurse) that she did not want to hear about the epidural, her nurse talked with her husband about it other pain meds. She cautioned him that if A. did not take something soon, it would be too late. She did just outside the bathroom door, and within A's. earshot. A.'s husband re-stated A.'s desire NOT to be offered medication. Once the nurse could see that A. was as determined as she was, and that what we were doing was working to keep labor progressing (thanks again, honey for praying for A.!), and that A. was coping -- albeit loudly at times-- the nurse did not mention the "E" word, or systemic meds, again.
During the hour we spent in the shower, A. experienced all the normal signs of transition: nausea, drowsiness between contractions, slurred, slow speech, shaking, and near the end of transition "I want this to STOP! I don't want to do this anymore!". A. went from praying "Thank you, Lord for helping me. Help me finish this labor!" to fussing about the pain, and back again. Acceptance of a woman's powerful and volatile emotions in transition is crucial for her to let go and do this incredibly demanding work.
Again, the nurse wanted A. go get into the bed to be checked and A. quickly and without reservation told her "You must be out of your mind!. I am not moving". I smiled and said, "I don't think she's ready to leave the shower yet". So, I redirected the water while the nurse checked to see if A's water had broken. It had. There was no need to check for a cord prolapse. Baby's heart rate was thumping along just fine. Thankfully, the waterproof transducers on A's belly, along with the wireless monitor allowed her to enjoy the shower during her labor on Pitocin. ALL hospitals should have this equipment!
A. had been complaining of feeling like she had to push for well over an hour, even before getting into the shower, but she was able to "blow" through them. I knew she was not yet ready, even though she voiced her frustration a little of not being allowed to push.
A few minutes after the nurse checked for SROM (spontaneous rupture of the membranes", A. said she felt like she was about to pass out. Her husband helped her onto her hands and knees (to prevent her falling and hitting her head) while I ran for the honey and a straw in my doula bag. I shoved the straw into the honey, pulled it out, and told A. to suck all the honey out of the straw -- NO ARGUMENT. She did so. In seconds, she revived, and on the next contraction "cow bellowed," "I HAVE TO PUSH!" Once again, I told her to blow (air out of her mouth) through the urge, but this time she told me, "YOU DON"T UNDERSTAND! It won't let me!" Those are the words I was waiting to hear. A. "blew out the candle" anyway, between little fusses. Strong woman!
Once the contraction was over, I turned off the shower, had her husband help me get her up, toweled her off, threw a blanket over her, and headed for the bed. The nurse came, checked A., and declared A. had dilated to "10" and she could being pushing.
A. had stated on her birth plan that she wanted to push on her hands and knees. Her OB was comfortable with this. A. rested her upper body over the same peanut ball she had used earlier to rest, and grabbed the mattress at the head of the bed. She managed to keep pulling it away from the frame, loosing her leverage. Her husband secured her arms with his hands as she pushed. What beautiful teamwork. No class taught him that.
By the way, her husband was amazing! They had attended my childbirth class and comfort measures classes, plus one held by her hospital. Earlier in her pregnancy, they read a book I had loaned them, and continued reading many other other books and articles, so he was well aware of what to expect . . . to a point. I had taken a few moments earlier in labor to remind him that he would see his wife in a lot of pain, but that God had also provided pain relief and naps between the contractions (via God-designed "morphine" known as endorphin). I gave him a list of things to say to encourage his wife, with "I love you" and "You are amazing" at the top of the list. He provided her with the "emotional medication" that often works as well as pharmaceutical meds in helping labor progress and helping women cope with the contractions. Now, he was helping his wife do what she needed to do in order to push effectively.
A. started her pushing, as most women do, a little uncoordinated while trying to figure out what her body was doing. The nurse, per her training, was wanting A. to hold her breath for a count of ten before pushing again. This can be necessary when a woman does not feel her urges to push, as happens with most epidurals. However, studies had shown that when the mother is allowed to follow her urges, she will hold her breath, if she does hold it, for about 6 to 7 seconds when she pushes. The benefit to this natural pushing is that the baby's heart rate does not dip as low, and recovers more quickly than with directed pushing. Also, when a woman is told to push out of rhythm of the urges, they experience more pain while the work is less effective. Holding to someone else's count to "10" easily gets the woman out of HER OWN rhythm of pushing with her body's urges.
I told the nurse "Let's watch A. for about 15 minutes and see how she does before we direct her". The nurse sweetly agreed (which spoke well of her because almost everything she had been suggesting throughout the labor was declined). Soon, A. was pushing in harmony with her body, taking deep breaths to oxygenate her baby between urges to bear down, and when she was resting between pushes.
Dr. Lee was lying on her side across the bed, watching the baby's descent and figuring out the maneuvers for a delivery 180 degrees opposite from a typical birth. She had done hands and knees births before, but not recently. A's nurse, Janine, was on her knees on the floor beside the bed to hold the monitor on A's upside down belly to record the baby's heart rate. What dedication! This was clearly not a typical birth scene for that military hospital. Yet, the OB and the nurse were smiling at each other at one point and agreed "this is cool!". ALL hospitals need medical and nursing staff like the ones on duty for this birth! (I still scratch my head at the midwife's attitude, though. It's so untypical for a midwife.)
In less than one hour, little Isabelle was born. Well, not really little. A. had delivered a 9 pound 14 ounce, 22 inches long baby without vacuum extraction, forceps, or C-section, so "little" is not the right word. As A. requested, no episiotomy was done.
By the way, the baby's heart rate was wonderful throughout all of the labor, even with the Pitocin, with the exception of when A. was lying straight in the bed. There IS something to getting mom off her back when checking fetal heart tones! Perhaps the induction wasn't really necessary, perhaps it was. But, this was how God wanted this labor to occur, and He used it to bless A.
Back to the birth sequence. The OB directed us how to help A. turn over on her back to receive her baby while maneuvering among the IV/Pitocin lines. Earlier during the pushing stage, she had asked how we were going to figure this out. I suggested she call the shots since she had to best view of everything. I was impressed by her attitude of teamwork vs. the "I am in charge of everything" personality exhibited by some OBs. Her approach to A.'s care had a major impact on how her labor was allowed to progress, and on all the positive results A. and her husband enjoyed. All hospitals need physicians like this!
The photo above shows the triumph A. felt. once Isabelle was in her mother's arms. After greeting her baby, her first words to all of us in the room were "I AM SO HAPPY!", followed by "Thank you, Lord!" not as an exclamation but as a prayer.
In a few minutes, still on her post natural birth oxytocin high, A. said, with a huge smile, "I am AWESOME! I did this without pain meds AND on Pitocin". Was she bragging? No. She was enjoying the empowerment God gives as a special gift to many women whose labor occurs in this manner. She was not better than other mothers, she was simply experiencing a special feeling the Lord provides many women who have accomplished this work. Oxytocin is a powerful hormone, which is released in increasing amounts during labor.
Pain medications diminish the normal release of oxytocin, so 85% of women in this country do not experience the intense feeling God planned for them to enjoy. Remember, pain meds have not been around for all of history. While women, due to the curse resulting from the Fall of Man, experience pain in childbirth, our loving God also provides something comforting during labor and very uplifting immediately after the birth. A. was blessed to enjoy this gift.
As Dr. Lee repaired a tear from the birth, A. allowed Isabelle to progress through the steps God designed babies to be able to do to finally self latch and nurse. Again the nurse tried to assist, but I explained that, as a lactation consultant, I too want to "help". However, studies showed that if we leave healthy, alert babies alone, they will progress through certain, consistent steps and latch better than if we we jump straight to attaching baby to breast. Again she nodded and let Isabelle continue without help. Sure enough, in about 30 minutes, Isabelle accomplished those steps to latch beautifully and suckle away. I showed her dad how a good latch looked so he could help assess with later feeds.
After an hour, A. gave the baby to her husband, who took it to the warmer where she was wiped down an little more, weighed, and measured. Dad got to put on her first diaper, and then held his daughter for some skin to skin time.
 |
| A father falls in love with a beautiful girl. |
What did A. and her husband think about their decision to have a doula? I received a Facebook message from A. several hours after I went home from the birth.
" . . . I don't know if we could've done this without you. Knowing and having someone there to guide us and empower us through our labor was the BEST decision we have ever made together (besides getting married, choosing to have Heavenly Father as our families foundation, and having babies of course :-)) Thank you so much for the amazing experience you were able to give us. We love you!!!"
In her opinion, having a doula was the 4th best decision they had made in their lives. Since it followed what it followed in her list, you can get an idea of how much support women discover that a doula can provide to help them achieve their goals for birth and breastfeeding initiation.
Even though A. had planned her way, God directed her steps (Prov. 16:9). She found, that with God's help, she was capable of more than she imagined. She found Him to be faithful, to comfort, to strengthen, and to bless in ways she had never before experienced. Yes, she had support from her husband, her doctor, her nurse, her doula, and for early labor, three amazing women: her mother, grandmother, and mother-in-law (all who had birthed without meds, including the mother-in-law who gave birth to a 13 pound baby, who happened to become A.'s husband!).
However, and most importantly, she had her GOD, the one Who created her, Who loves her -- Who gave her second birth -- to carry her through this labor which threw her into the depths of pain, and for a few moments, despair, before elevating her to heights of a type of joy she had never experienced.
Her husband learned that he, with God's help, could provide the necessary emotional support and physical comfort measures to help his wife birth their first
child.
As their doula, I was blessed, once again, to witness the partnership of a man and his wife during her labor, and the birth of a man and a woman into parents, holding the one they had come to love, but never had seen before that special day.
Thank you, A. and T. for this precious experience. I, too, "am SO happy!"
Saturday, April 26, 2014
Formula Marketing Hits a New Low -- as in "Lower in a Key Nutrient for Brain Growth"
While attending a perinatal conference recently, I picked up some formula company literature. I had noted that FCs were marketing a "gentle" formula for babies who were having trouble tolerating formula (not surprising as babies were not designed to tolerate well anything other the human milk). Mead Johnson had removed 70% of the lactose, Similac had removed 80%, and Gerber had removed 98%!
Why is this significant? Well the primary carbohydrate in human milk is lactose. Lactose is critical for brain development in babies.
I asked one of the reps if there were any studies of the effect of removing this vital brain growing nutrient from this product. She could not think of any, but will look and if she finds any, will send me copies. I could genuinely thank her for doing this for me.
I asked if her (or any company) put a warning on the packaging about this. If a mother was having a problem with a fussy baby, and was tempted to change to this lactose lacking formula, she might reconsider if she could read a caution on the packaging.
Of course, this was a rhetorical question. Formula companies do not list risks of their product on their packaging. They only tell consumers how close formula is to breast milk, or that it contains all the nutrients required for a healthy baby. They even proclaim how (algae derived -- NOT disclosed) DHA, probiotics, choline, and other additives support brain growth similar to breast milk. They do NOT list how using their product increases baby's risk of asthma, diabetes, leukemia, lymphoma, GI diseases, etc. They do not discuss how their product decreases the baby's IQ when compared to breastfed infants, or that the brain is actually less developed as seen on MRI studies.
In addition to the "gentle" formula, the FCs now advertise a "supplemental formula" for breastfed babies.
When asked by the rep my opinion of their packaging, I told her that I felt it was deceptive. I have no trouble with formula companies marketing their product. There was a place for it. However, I did not like incomplete disclosure or misleading phrases they consistently use in their marketing. I explained that many mothers would see this "supplemental" formula for breastfed babies as "something close to breast milk, unlike the other formulas". In reality, it is very similar to the other formulas. Only a few ingredients were slightly tweaked.
At this point, the rep told me that her company was the last to market both the "gentle" (dumb down?) formula AND the supplemental (for breastfed babies) formula because of their commitment to integrity in marketing (What?). She stated they finally had to do something to prevent some of an increasingly limited market share going to those competitors. Really? THAT is the reason for a formula company adding something "new" and "improved" and "designed" for certain babies, even though, by doing so, they actually are removing a vital, brain growing, nutrient?
Moms, if you chose to, or have to use formula, think twice about giving your baby a "gentle" formula deficient in lactose. I may be wrong, but I would not be surprised if we see ten years down the road a population of "gently fed" kid struggling with school work because their brains were starved of an essential nutrient. We might be seeing this now.
Many babies have been given plant based formula for years because they were "allergic" to milk based formulas. But, risking future brain capacity because baby is fussy? Try to stick it out for a few weeks in order to support your baby's brain, as best as formula can, for life long benefits.
If you are breastfeeding, and think that this new "supplemental" formula can make breastfeeding easier while giving your baby the same nutrition as your milk without harming your baby's immune system, think long and hard. Don't be fooled by pretty packaging, carefully contrived words, and smart marketing on social media and elsewhere. It's really the same old stuff. Even their latest study on DHA, which they say "proves" babies had higher intelligent scores as children, compared formula fed babies to formula fed babies.
If you are using formula, save your money. The FDA requires a certain standard in artificial baby milk manufacturing. "Supplemental", "DHA/AA", "Gentle" and other formula types are typically more expensive than standard formula with little to no proven benefits.
Finally, ask yourself if decreasing the amount of crying over a few weeks of time is worth the risk of giving your baby a formula which lacks so much lactose.
Why is this significant? Well the primary carbohydrate in human milk is lactose. Lactose is critical for brain development in babies.
I asked one of the reps if there were any studies of the effect of removing this vital brain growing nutrient from this product. She could not think of any, but will look and if she finds any, will send me copies. I could genuinely thank her for doing this for me.
I asked if her (or any company) put a warning on the packaging about this. If a mother was having a problem with a fussy baby, and was tempted to change to this lactose lacking formula, she might reconsider if she could read a caution on the packaging.
Of course, this was a rhetorical question. Formula companies do not list risks of their product on their packaging. They only tell consumers how close formula is to breast milk, or that it contains all the nutrients required for a healthy baby. They even proclaim how (algae derived -- NOT disclosed) DHA, probiotics, choline, and other additives support brain growth similar to breast milk. They do NOT list how using their product increases baby's risk of asthma, diabetes, leukemia, lymphoma, GI diseases, etc. They do not discuss how their product decreases the baby's IQ when compared to breastfed infants, or that the brain is actually less developed as seen on MRI studies.
In addition to the "gentle" formula, the FCs now advertise a "supplemental formula" for breastfed babies.
When asked by the rep my opinion of their packaging, I told her that I felt it was deceptive. I have no trouble with formula companies marketing their product. There was a place for it. However, I did not like incomplete disclosure or misleading phrases they consistently use in their marketing. I explained that many mothers would see this "supplemental" formula for breastfed babies as "something close to breast milk, unlike the other formulas". In reality, it is very similar to the other formulas. Only a few ingredients were slightly tweaked.
At this point, the rep told me that her company was the last to market both the "gentle" (dumb down?) formula AND the supplemental (for breastfed babies) formula because of their commitment to integrity in marketing (What?). She stated they finally had to do something to prevent some of an increasingly limited market share going to those competitors. Really? THAT is the reason for a formula company adding something "new" and "improved" and "designed" for certain babies, even though, by doing so, they actually are removing a vital, brain growing, nutrient?
Moms, if you chose to, or have to use formula, think twice about giving your baby a "gentle" formula deficient in lactose. I may be wrong, but I would not be surprised if we see ten years down the road a population of "gently fed" kid struggling with school work because their brains were starved of an essential nutrient. We might be seeing this now.
Many babies have been given plant based formula for years because they were "allergic" to milk based formulas. But, risking future brain capacity because baby is fussy? Try to stick it out for a few weeks in order to support your baby's brain, as best as formula can, for life long benefits.
If you are breastfeeding, and think that this new "supplemental" formula can make breastfeeding easier while giving your baby the same nutrition as your milk without harming your baby's immune system, think long and hard. Don't be fooled by pretty packaging, carefully contrived words, and smart marketing on social media and elsewhere. It's really the same old stuff. Even their latest study on DHA, which they say "proves" babies had higher intelligent scores as children, compared formula fed babies to formula fed babies.
If you are using formula, save your money. The FDA requires a certain standard in artificial baby milk manufacturing. "Supplemental", "DHA/AA", "Gentle" and other formula types are typically more expensive than standard formula with little to no proven benefits.
Finally, ask yourself if decreasing the amount of crying over a few weeks of time is worth the risk of giving your baby a formula which lacks so much lactose.
Friday, April 25, 2014
Reflections on a Conference
Yesterday, I attended an all day perinatal conference. As an RN, continuing education is required for relicensure. I listened to information on retinopathy or prematurity, screening for cardiac conditions newborns, the variety of newborn screenings available in my state, genetic markers for certain cancers in women, and something called "Mindfulness Meditation", which managed to let me take a little cap nap.
However, there was one topic which elicited a wide array of responses as the presenter spoke: nods (a few), rolled eyes, whispered comments to a next seat neighbor, expressions of "really?" on faces, and so on.
In my seat, as the only childbirth educator in the room, I was nodding and inwardly saying "Yes!" Once or twice I gave a hidden fist and elbow jerk -- you know, the once athletes do when they score points, or what someone does when something good happens and they say "That's what I'm talking about".
As a childbirth educator, I am required to teach according to the evidence, a.k.a. "evidence based practice". As you know from earlier posts, and probably some personal experience or reading, this is not always the case in the medical profession, especially in maternity care.
What got me so excited?
The speaker was a certified nurse midwife who was the director of a department and practice at a large medical center in Richmond, Va. Their c-section rate is only 6%. Most women labor without medication. Most of the women who receive epidurals receive a very light dose of the medication so they can still assume some positions of comfort, and cooperate with their bodies to push out their babies.
Women can choose where they want to give birth (the bed, the shower, the toilet, the couch, etc.). They can choose the position in which they give birth. They can catch their own babies if they desire. Babies are not bulb suctioned, bathed (just wiped off while on mom's abdomen), or subjected to any newborn procedures until after completion of the first breastfeeding. Episiotomies are not done, preserving the integrity of the pelvis floor for the mother's lifespan.
When babies are born via C-section, they are handed to the mother via a "sterile pathway" so that she is the first contact the baby makes with an unsterile object. This allows baby to be innoculated with the organisms of her skin vs those in a hospital warmer, etc. They even swipe the fluids from the mom's vagina and perineum with a sterile gauze and then wipe the baby's mouth and body with it so the baby receives the organisms it would have picked up during normal vaginal birth. These last two practices help protect the establishment of a normal microbiome in the baby's gut and respiratory tract. An abnormal microbiome increases the chance of asthma, diabetes, and a weaker immune system, among other health issues.
When the speaker asked the group why they would do such a thing, this lone childbirth educator was the only one who raised her hand to answer. When the speaker asked if anyone knew what microbiome meant, no other hands went up.
This does not mean I am smarter than the average bear. It meant that in a room where most of the nurses worked in a hospital with a highly medicalized approach to birth, they had had little exposure to normal birth and the evidence, based on research, which supported the procedures (or lack thereof), the speaker was presenting.
One nurse suggested that this approach needed to start with the OBs. The speaker noted that at their medical center, the residents taking a rotation at the birth center so they could learn how normal (and optimal) birth was handled -- or in many cases, NOT handled. She told us that the hardest thing for the residents was learning to stand by and watch. They would want to do vaginal exams to check progress, but were told they were not necessary for most of labor and only increased the chance of infection or desire to speed labor up by mechanical or medicinal means.
The speaker also responded to the nurse's comment by pointing out that changes in maternity practice often starts with the mothers. When women wanted husbands to be present during the labor and birth back in the 1960's and 70's, they used the services of the doctors and hospitals which supported this. Loosing market share, others had to follow suite. The same thing is happening now. The speaker reported that women were coming to their practice from as far away as two to three hours drive, passing hospital after hospital, in order to have more control of how they give birth, yet doing so in an environment in which they feel safe.
At the end of the session, during Q and A, I asked the group if they had heard of "birth circles" where women get together and share birth stories -- and their opinions of care providers and hospitals in the area. None had. I explained there were more than one (actually three) in our area and then shared how this can impact a hospitals bottom line, plus employee's paychecks and job security. Many hospitals depend on government issued reimbursement checks for patients on Medicaid. Many hospitals have a high volume of patients enrolled in this program. But cuts in what the program will allow to be paid can affect a hospitals bottom line. If private pay, or private insurance pay (at least as long a private insurance is allowed to exist) customers go to places two and three hours away in order to have the birth experiences they want, and in order to avoid unnecessary interventions which carry risks and side effects the women don't want, hospitals will loose market share. At some point, like in the 1960's and '70s, the light bulb will come on and changes will be made.
Needless to say, I was thrilled that the nurses were exposed to this information. I know many of them and they are a passionate and caring and bright bunch of professionals. Still some will (and did) scoff at what they heard -- but a lot listened and accepted the evidence. The photos of the smiles on women's faces moments after giving birth said it all. Many were not in a bed, and were holding their newborns, cord/placenta connection still intact, against their chests. The incredible joy empowerment they felt was visible in their expressions.
I am looking forward to knowing that those I teach in class will be walking into a labor and delivery environment where the nurses are more familiar with what the mothers are wanting. I am sure many of them will be even more supportive of "the magical hour", mother's request that the baby NOT be suctioned at birth as a routine, and so on. They will more strongly advocate for the mothers' desires. They will have opportunity to share what they learned with the physicians as they explain why the mothers want what they want. Information will slowly, but surely, continue to "trickle up" because of the efforts of the patients and their nurses. One day, more hospitals in our area will be offering, as standard care, the type of approach to labor and birth offered by the Centering Pregnancy group in Richmond, VA.
http://www.obgyn.vcu.edu/pregnancy/index.html
Friday, April 18, 2014
Hope Springs Eternal -- in Canada, and MAYBE, Here in the US
It seems to me that breech babies are not God's "oops" babies. Too many babies have been born breech over man's time on Earth. But, for a while, C-sections became the "safe" way to deliver breech babies. Finally, someone (really several professionals) decides to evaluate the literature without the lens of a court and a judge being used. Guess what? The literature does not establish that safety of C-section for all breech babies over vaginal birth! Surprised? I'm not. Most babies in the breech and the vertex (head down) position can be safely born vaginally.
Medical professionals (maybe some midwives included?) in Canada are going to start teaching physicians how to perform breech deliveries. One purpose is TO GIVE WOMEN A CHOICE. Another is to decrease the complications which accompany many C-sections for both mom and baby.
Will American OBs begin doing the same? I hope so. I heard recently from a doula friend that EVMS in Norfolk VA was beginning to train OB residents in non surgical breech delivery. That would be wonderful -- for the moms and their babies who want to enter this world feet or bottom first!
http://m.theglobeandmail.com/life/parenting/pregnancy/delivery/c-section-not-best-option-for-breech-birth/article1186104/?service=mobile
Medical professionals (maybe some midwives included?) in Canada are going to start teaching physicians how to perform breech deliveries. One purpose is TO GIVE WOMEN A CHOICE. Another is to decrease the complications which accompany many C-sections for both mom and baby.
Will American OBs begin doing the same? I hope so. I heard recently from a doula friend that EVMS in Norfolk VA was beginning to train OB residents in non surgical breech delivery. That would be wonderful -- for the moms and their babies who want to enter this world feet or bottom first!
http://m.theglobeandmail.com/life/parenting/pregnancy/delivery/c-section-not-best-option-for-breech-birth/article1186104/?service=mobile
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