The following is a video of a full-term pregnant woman belly dancing with her daughter six days before the birth of her baby. Traditionally, belly dance was practiced prenatally and performed by a woman during labor and childbirth, helping the woman's body overcome the pain associated with childbirth. For more information on the subject, check out my post, Belly Dance as Traditional Birth Dance.
The video follows up six days after the birth of her son, dancing and nursing. The video is both beautiful and sweet. Enjoy!
Showing posts with label childbirth. Show all posts
Showing posts with label childbirth. Show all posts
Friday, March 2, 2012
Monday, January 3, 2011
if you are expecting...
Many expectant American mothers have little knowledge of childbirth, and some, even though they have gone through pregnancy and childbirth, remain completely ignorant of birth, its natural process and the multitude of choices that revolve around it. Unfortunately, much of that ignorance exists because of the medical community and its inability to establish and maintain doctor-patient communication and education, which often is due to the fact that obstetricians are expected by their insurance companies to see a certain number of patients in a specific amount of time, cutting down on the length of time a doctor can spend with each individual patient. Because of this, and as most women rely on their doctors to make decisions for them, many patients are not given the opportunity during their pregnancies to learn what procedures are risky or unnecessary and which options are available to them when they labor and birth.
After having a deep discussion about pregnancy with an acquaintance who already has two children, I recommended that she watch the film The Business of Being Born to better understand my philosophy of childbirth. She came back to me and exclaimed, "Why didn't anyone TELL ME this when I was pregnant?!" Like many women who are given the opportunity to rediscover childbirth in this new form, she felt an array of emotions, including shock, anger, hope and regret regarding her previous birth experiences.
But what should every pregnant woman know before she gives birth?
Educate yourself. If you are expecting, start by doing your homework. Read objective and informative resources on childbirth. Learn to make educated decisions for yourself and your baby. There are choices to make throughout pregnancy, birth, infant feeding, circumcision, vaccinations, diapering, infant sleep, parenting. Learn your options ahead of time, during the nine-month stretch before your baby arrives, and continue educating yourself along the way. Consult your doctor, midwife, and caregivers regarding important decisions, but do not rely on them to make decisions for you or because that is the procedure your caregiver regularly follows. You are an individual, and every individual/birth/child/patient is unique.
Begin by watching The Business of Being Born or by reading Ina May's Guide to Childbirth, both of which will help you explore your options in childbirth and give you a better, more realistic understanding of true natural birth. These two resources will also prove that birth does not have to be filled with fear and pain, but can actually be a beautiful, memorable transition.
Continue by learning everything you can about breastfeeding now. While breastfeeding is natural and normal, it does not mean that it is always easy. If you already know important things like how to properly latch, common comfortable positions for nursing, and how often infants infants feed, you will be well on the way to breastfeeding success. Take an afternoon to go to a local La Leche League meeting, speak with women who successfully breastfed for more than a year, watch a baby latch on to the breast and nurse--these things will be invaluable in the days following birth.
Remember, you can read every book on parenting, sleep, birth and breastfeeding. However, you will not truly get it until you are actually experiencing everything first-hand. Your baby is unique and so are you. All the information you soak up when you are pregnant will be put to the test, and you will not really get it until you are right there. In the moment. You will be thankful you did your homework, and, years down the road, your life will be richer and fuller than you ever imagined it could be.
After having a deep discussion about pregnancy with an acquaintance who already has two children, I recommended that she watch the film The Business of Being Born to better understand my philosophy of childbirth. She came back to me and exclaimed, "Why didn't anyone TELL ME this when I was pregnant?!" Like many women who are given the opportunity to rediscover childbirth in this new form, she felt an array of emotions, including shock, anger, hope and regret regarding her previous birth experiences.
But what should every pregnant woman know before she gives birth?
Educate yourself. If you are expecting, start by doing your homework. Read objective and informative resources on childbirth. Learn to make educated decisions for yourself and your baby. There are choices to make throughout pregnancy, birth, infant feeding, circumcision, vaccinations, diapering, infant sleep, parenting. Learn your options ahead of time, during the nine-month stretch before your baby arrives, and continue educating yourself along the way. Consult your doctor, midwife, and caregivers regarding important decisions, but do not rely on them to make decisions for you or because that is the procedure your caregiver regularly follows. You are an individual, and every individual/birth/child/patient is unique.
Begin by watching The Business of Being Born or by reading Ina May's Guide to Childbirth, both of which will help you explore your options in childbirth and give you a better, more realistic understanding of true natural birth. These two resources will also prove that birth does not have to be filled with fear and pain, but can actually be a beautiful, memorable transition.
Continue by learning everything you can about breastfeeding now. While breastfeeding is natural and normal, it does not mean that it is always easy. If you already know important things like how to properly latch, common comfortable positions for nursing, and how often infants infants feed, you will be well on the way to breastfeeding success. Take an afternoon to go to a local La Leche League meeting, speak with women who successfully breastfed for more than a year, watch a baby latch on to the breast and nurse--these things will be invaluable in the days following birth.
Remember, you can read every book on parenting, sleep, birth and breastfeeding. However, you will not truly get it until you are actually experiencing everything first-hand. Your baby is unique and so are you. All the information you soak up when you are pregnant will be put to the test, and you will not really get it until you are right there. In the moment. You will be thankful you did your homework, and, years down the road, your life will be richer and fuller than you ever imagined it could be.
Wednesday, August 4, 2010
the normal newborn and why breastmilk is not just food
What is a normal, term human infant supposed to do?
First of all, a human baby is supposed to be born vaginally. Yes, I know that doesn't always happen, but we're just going to talk ideal, normal for now. We are supposed to be born vaginally because we need good bacteria. Human babies are sterile, without bacteria, at birth. It's no accident that we are born near the anus, an area that has lots of bacteria, most of which are good and necessary for normal gut health and development of the immune system. And the bacteria that are there are mom's bacteria, bacteria that she can provide antibodies against if the bacteria there aren't nice.
Then the baby is born and is supposed to go to mom. Right to her chest. The chest, right in between the breasts is the natural habitat of the newborn baby. (Fun factoid: our cardiac output, how much blood we circulate in a given minute, is distributed to places that are important. Lots goes to the kidney every minute, like 10% or so, and 20% goes to your brain. In a new mom, 23% goes to her chest- more than her brain. The body thinks that place is important!)
That chest area gives heat. The baby has been using mom's body for temperature regulation for ages. Why would they stop? With all that blood flow, it's going to be warm. The baby can use mom to get warm. When I was in my residency, we would put a cold baby "under the warmer" which meant a heater thingy next to mom. Now, as I have matured, if a baby is "under the warmer," the kid is under mom. I wouldn't like that. I like the kids on top of mom, snuggled.
Now we have a brand new baby on the warmer. That child is not hungry. Bringing a hungry baby into the world is a bad plan. And really, if they were hungry, can you please explain to me why my kids sucked the life force out of me in those last few weeks of pregnancy? They better have been getting food, or well, that would have been annoying and painful for nothing.
Every species has instinctual behaviors that allow the little ones to grow up to be big ones and keep the species going. Our kids are born into the world needing protection. Protection from disease and from predators. Yes, predators. Our kids don't know they've been born into a loving family in the 21st century- for all they know it's the 2nd century and they are in a cave surrounded by tigers. Our instinctive behaviors as baby humans need to help us stay protected. Babies get both disease protection and tiger protection from being on mom's chest. Presumably, we gave the baby some good bacteria when they arrived through the birth canal. That's the first step in disease protection. The next step is getting colostrum.
A newborn baby on mom's chest will pick their head up, lick their hands, maybe nuzzle mom, lick their hands and start to slide towards the breast. The kids have a preference for contrasts between light and dark, and for circles over other shapes. Think about that...there's a dark circle not too far away.
Mom's sweat smells like amniotic fluid, and that smell is on the child's hands (because there's been no bath yet!) and the baby uses that taste on their hand to follow mom's smell. The secretions coming from the glands on the areola (that dark circle) smell familiar too and help the baby get to the breast to get the colostrum which is going to feed the good bacteria and keep them protected from infection. The kids can attach by themselves. Watch for yourself! And if you just need colostrum to feed bacteria and not yourself, well, there doesn't have to be much. And there isn't because the kids aren't hungry and because Breastmilk is not food!
We're talking normal babies. Breastfeeding is normal. It's what babies are hardwired to do. 2009 or 209, the kids would all do the same thing: try to find the breast. Breastfeeding isn't special sauce, a leg up or a magic potion. It's not "best. " It's normal. Just normal. Designed for the needs of a vulnerable human infant. And nothing else designed to replace it is normal.
Colostrum also activates things in the baby's gut that then goes on to make the thymus grow. The thymus is part of the immune system. Growing your thymus is important. Breastmilk= big thymus, good immune system. Colostrum also has a bunch of something called Secretory Immunoglobulin A (SIgA). SIgA is made in the first few days of life and is infection protection specifically from mom. Cells in mom's gut watch what's coming through and if there's an infectious cell, a special cell in mom's gut called a plasma cell heads to the breast and helps the breast make SIgA in the milk to protect the baby. If mom and baby are together, like on mom's chest, then the baby is protected from what the two of them may be exposed to. Babies should be with mom.
And the tigers. What about them? Define "tiger" however you want. But if you are baby with no skills in self-protection, staying with mom, having a grasp reflex, and a startle reflex that helps you grab onto your mom, especially if she's hairy, makes sense. Babies know the difference between a bassinette and a human chest. When infants are separated from their mothers, they have a "despair- withdrawal" response. The despair part comes when they alone, separated. The kids are vocally expressing their desire not to be tiger food. When they are picked up, they stop crying. They are protected, warm and safe. If that despair cry is not answered, they withdraw. They get cold, have massive amounts of stress hormones released, drop their heart rate and get quiet. That's not a good baby. That's one who, well, is beyond despair. Normal babies want to be held, all the time.
And when do tigers hunt? At night. It makes no sense at all for our kids to sleep at night. They may be eaten. There's nothing really all that great about kids sleeping through the night. They should wake up and find their body guard. Daytime, well, not so many threats. They sleep better during the day. (Think about our response to our tigers-- sleep problems are a huge part of stress, depression, anxiety).
And sleep... My guess is everybody sleeps with their kids- whether they choose to or not and whether they admit to it or not. It's silly of us as healthcare providers to say "don't sleep with your baby" because we all do it. Sometimes accidentally. Sometimes intentionally. The kids are snuggly, it feels right and you are tired. So, normal babies breastfeed, stay at the breast, want to be held and sleep better when they are with their parents. Seems normal to me. But there is a difference between a normal baby and one that isn't. Safe sleep means that we are sober, in bed and not a couch or a recliner, breastfeeding, not smoking...being normal. If the circumstances are not normal, then sleeping with the baby is not safe.
That chest -to -chest contact is also brain development. Our kids had as many brain cells as they were ever going to have at 28 weeks of gestation. It's a jungle of waiting -to-be- connected cells. What we do as humans is create too much and then get rid of what we aren't using. We have like 8 nipples, a tail and webbed hands in the womb. If all goes well, we don't have those at birth. Create too much- get rid of what you aren't using. So, as you are snuggling, your child is hooking up happy brain cells and hopefully getting rid of the "eeeek" brain cells. Breastfeeding, skin-to-skin, is brain wiring. Not food.
Why go on and on about this? Because more and more mothers are choosing to breastfeed. But most women don't believe that the body that created that beautiful baby is capable of feeding that same child and we are supplementing more and more with infant formulas designed to be food. Why don't we trust our bodies post-partum? I don't know. But I hear over and over that the formula is because "I am just not satisfying him." Of course you are. Babies don't need to "eat" all the time- they need to be with you all the time- that's the ultimate satisfaction.
A baby at the breast is getting their immune system developed, activating their thymus, staying warm, feeling safe from predators, having normal sleep patterns and wiring their brain, and (oh by the way) getting some food in the process. They are not "hungry" --they are obeying instinct. The instinct that allows us to survive and make more of us.
Dr. Jennifer Thomas
First of all, a human baby is supposed to be born vaginally. Yes, I know that doesn't always happen, but we're just going to talk ideal, normal for now. We are supposed to be born vaginally because we need good bacteria. Human babies are sterile, without bacteria, at birth. It's no accident that we are born near the anus, an area that has lots of bacteria, most of which are good and necessary for normal gut health and development of the immune system. And the bacteria that are there are mom's bacteria, bacteria that she can provide antibodies against if the bacteria there aren't nice.
Then the baby is born and is supposed to go to mom. Right to her chest. The chest, right in between the breasts is the natural habitat of the newborn baby. (Fun factoid: our cardiac output, how much blood we circulate in a given minute, is distributed to places that are important. Lots goes to the kidney every minute, like 10% or so, and 20% goes to your brain. In a new mom, 23% goes to her chest- more than her brain. The body thinks that place is important!)
That chest area gives heat. The baby has been using mom's body for temperature regulation for ages. Why would they stop? With all that blood flow, it's going to be warm. The baby can use mom to get warm. When I was in my residency, we would put a cold baby "under the warmer" which meant a heater thingy next to mom. Now, as I have matured, if a baby is "under the warmer," the kid is under mom. I wouldn't like that. I like the kids on top of mom, snuggled.
Now we have a brand new baby on the warmer. That child is not hungry. Bringing a hungry baby into the world is a bad plan. And really, if they were hungry, can you please explain to me why my kids sucked the life force out of me in those last few weeks of pregnancy? They better have been getting food, or well, that would have been annoying and painful for nothing.
Every species has instinctual behaviors that allow the little ones to grow up to be big ones and keep the species going. Our kids are born into the world needing protection. Protection from disease and from predators. Yes, predators. Our kids don't know they've been born into a loving family in the 21st century- for all they know it's the 2nd century and they are in a cave surrounded by tigers. Our instinctive behaviors as baby humans need to help us stay protected. Babies get both disease protection and tiger protection from being on mom's chest. Presumably, we gave the baby some good bacteria when they arrived through the birth canal. That's the first step in disease protection. The next step is getting colostrum.
A newborn baby on mom's chest will pick their head up, lick their hands, maybe nuzzle mom, lick their hands and start to slide towards the breast. The kids have a preference for contrasts between light and dark, and for circles over other shapes. Think about that...there's a dark circle not too far away.
Mom's sweat smells like amniotic fluid, and that smell is on the child's hands (because there's been no bath yet!) and the baby uses that taste on their hand to follow mom's smell. The secretions coming from the glands on the areola (that dark circle) smell familiar too and help the baby get to the breast to get the colostrum which is going to feed the good bacteria and keep them protected from infection. The kids can attach by themselves. Watch for yourself! And if you just need colostrum to feed bacteria and not yourself, well, there doesn't have to be much. And there isn't because the kids aren't hungry and because Breastmilk is not food!
We're talking normal babies. Breastfeeding is normal. It's what babies are hardwired to do. 2009 or 209, the kids would all do the same thing: try to find the breast. Breastfeeding isn't special sauce, a leg up or a magic potion. It's not "best. " It's normal. Just normal. Designed for the needs of a vulnerable human infant. And nothing else designed to replace it is normal.
Colostrum also activates things in the baby's gut that then goes on to make the thymus grow. The thymus is part of the immune system. Growing your thymus is important. Breastmilk= big thymus, good immune system. Colostrum also has a bunch of something called Secretory Immunoglobulin A (SIgA). SIgA is made in the first few days of life and is infection protection specifically from mom. Cells in mom's gut watch what's coming through and if there's an infectious cell, a special cell in mom's gut called a plasma cell heads to the breast and helps the breast make SIgA in the milk to protect the baby. If mom and baby are together, like on mom's chest, then the baby is protected from what the two of them may be exposed to. Babies should be with mom.
And the tigers. What about them? Define "tiger" however you want. But if you are baby with no skills in self-protection, staying with mom, having a grasp reflex, and a startle reflex that helps you grab onto your mom, especially if she's hairy, makes sense. Babies know the difference between a bassinette and a human chest. When infants are separated from their mothers, they have a "despair- withdrawal" response. The despair part comes when they alone, separated. The kids are vocally expressing their desire not to be tiger food. When they are picked up, they stop crying. They are protected, warm and safe. If that despair cry is not answered, they withdraw. They get cold, have massive amounts of stress hormones released, drop their heart rate and get quiet. That's not a good baby. That's one who, well, is beyond despair. Normal babies want to be held, all the time.
And when do tigers hunt? At night. It makes no sense at all for our kids to sleep at night. They may be eaten. There's nothing really all that great about kids sleeping through the night. They should wake up and find their body guard. Daytime, well, not so many threats. They sleep better during the day. (Think about our response to our tigers-- sleep problems are a huge part of stress, depression, anxiety).
And sleep... My guess is everybody sleeps with their kids- whether they choose to or not and whether they admit to it or not. It's silly of us as healthcare providers to say "don't sleep with your baby" because we all do it. Sometimes accidentally. Sometimes intentionally. The kids are snuggly, it feels right and you are tired. So, normal babies breastfeed, stay at the breast, want to be held and sleep better when they are with their parents. Seems normal to me. But there is a difference between a normal baby and one that isn't. Safe sleep means that we are sober, in bed and not a couch or a recliner, breastfeeding, not smoking...being normal. If the circumstances are not normal, then sleeping with the baby is not safe.
That chest -to -chest contact is also brain development. Our kids had as many brain cells as they were ever going to have at 28 weeks of gestation. It's a jungle of waiting -to-be- connected cells. What we do as humans is create too much and then get rid of what we aren't using. We have like 8 nipples, a tail and webbed hands in the womb. If all goes well, we don't have those at birth. Create too much- get rid of what you aren't using. So, as you are snuggling, your child is hooking up happy brain cells and hopefully getting rid of the "eeeek" brain cells. Breastfeeding, skin-to-skin, is brain wiring. Not food.
Why go on and on about this? Because more and more mothers are choosing to breastfeed. But most women don't believe that the body that created that beautiful baby is capable of feeding that same child and we are supplementing more and more with infant formulas designed to be food. Why don't we trust our bodies post-partum? I don't know. But I hear over and over that the formula is because "I am just not satisfying him." Of course you are. Babies don't need to "eat" all the time- they need to be with you all the time- that's the ultimate satisfaction.
A baby at the breast is getting their immune system developed, activating their thymus, staying warm, feeling safe from predators, having normal sleep patterns and wiring their brain, and (oh by the way) getting some food in the process. They are not "hungry" --they are obeying instinct. The instinct that allows us to survive and make more of us.
Dr. Jennifer Thomas
Friday, June 18, 2010
born in the caul
I just came across a very impowering homebirth story in pictures. The pictures are of the birth of a baby born in the caul, meaning he is born with the amniotic sac or membrane still intact around his body. The sac then balloons out around the baby at birth, covering his face and body as he emerges from the mother. When still inside the sac, a baby continues to be nourished through the umbilical cord and is not in danger of drowning and has nearly zero chance of neonatal infection. A baby born in the caul is very rare, especially in today's obstetrics, and children who are born in this way are considered, based on legend, lucky for life.
View Born in the Caul on homebirth midwife Beth Miller's website, Birthing Way to see this amazing birth.
View Born in the Caul on homebirth midwife Beth Miller's website, Birthing Way to see this amazing birth.
Tuesday, June 8, 2010
considering the cesarean section
The rates of cesarean births are increasing alarmingly each year, with over one in every three births ending in major abdominal surgery. When a cesarean is necessary, it can be a life saving technique for both mother and baby. With countless documented medical risks to the mother's health, including infections, hemorrhage, transfusion, injury to other organs, anesthesia complications, psychological complications, and a maternal mortality two to four times greater than that for a vaginal birth, it is hard to understand why cesarean births are becoming the new norm. Even the World Health Organization states that no region in the world is justified in having a cesarean rate greater than 10 to 15 percent. If we hope to do anything meaningful to decrease the rate of cesarean births, we need real culture change. However, change can only begin with understanding the barriers. This post highlights the common reasons cesarean sections are performed.
Placenta Previa This occurs when the placenta lies low in the uterus and partially or completely covers the cervix. One in every 200 pregnant women will experience placenta previa during their third trimester. The treatment involves bed rest and frequent monitoring. If a complete or partial placenta previa has been diagnosed, a cesarean is usually necessary. If a marginal placenta previa has been diagnosed, a vaginal delivery may be an option.
Since placenta previa involves pre-term bleeding, it can be a very traumatic experience for pregnant women, especially as some women believe they are miscarrying. The diagnosis can help medical practitioners rectify the problem, but the baby is usually delivered by cesarean. In this case, is definitely safer to have it by cesarean than to try to push a baby over a placenta, especially when it can detach during the birthing process. There is truly a difference between placenta previa and a low lying placenta, though in the case of true placenta previa, cesarean births are definitely worth the risk.
Placental Abruption This complication occurs when the placenta separates from the uterine lining before the baby is born. Approximately 1% of all pregnant women will experience placental abruption during the third trimester. The mother will experience bleeding from the site of the separation and pain in the uterus. This separation can interfere with oxygen getting to the baby and, depending on the severity, an emergency cesarean may be performed. There are two types of placental abruption, partial placental abruption and complete placental abruption. In the case of a partial separation, a cesarean is not necessary if the bleeding stops and the baby is not in distress. A complete separation, however, is a true medical emergency requiring immediate cesarean.
Uterine rupture In approximately 1 in every 1,500 births, the uterus tears, or ruptures, during pregnancy or labor, leading to hemorrhaging in the mother and interfering with the baby's oxygen supply. Uterine rupture is a reason for immediate cesarean as it can lead to a hysterectomy and death if it is not repaired right away. While uterine rupture can occur during any form of birth, the risk is higher for women who have had a previous cesarean birth, which in itself increases the rate of repeat cesarean birth.
Breech Position When dealing with a breech baby, a cesarean delivery is often considered by obstetricians to be the only option, especially due to the increased chances of cord prolapse and fetal distress. Even if the baby is in a breech position before the pregnancy is full-term, a cesarean may be preformed pre-term, resulting in premature delivery. Since medical schools no longer teach obstetricians how to deliver breech babies, cesareans are considered the 'safer' option for the baby. However, breech babies are commonly and safely born vaginally every year. In Canada, for instance, cesarean birth is no longer routinely performed for breech babies. Birthing position (such as squatting or hands and knees) is the key factor in order for a woman to successfully birth a breech baby vaginally. Breech birth is only a variation of normal childbirth, not necessarily something that is completely abnormal and to be feared.
Cord prolapse This situation does not occur often, but when it does, an emergency cesarean is performed. A cord prolapse is when the umbilical cord slips through the cervix and protrudes from the vagina before the baby is born (occurring, for instance, when the water breaks and there is too much space between the baby’s head and the cervix). As the uterus contracts, pressure is placed on the umbilical cord which diminishes the blood flow to the baby. Increased risk for cord prolapse occurs when the water is artificially broken. In the case of a cord prolapse, the baby must be delivered immediately, often by cesarean, so his oxygen levels do not decrease; if oxygen is cut off for too long, death or mental retardation may result.
Fetal distress The most common cause of fetal distress is lack of oxygen to the baby. If fetal monitoring detects a problem with the amount of oxygen that the baby is receiving, then an emergency cesarean may be performed. When this is correctly diagnosed, a cesarean is the best option. Unfortunately, fetal distress is often misdiagnosed in order to move labor along and get a woman to deliver faster. However, numerous tests are available to make sure the baby is not actually in fetal distress. It is common for a baby's heart rat to slow during contractions; a change of position may show that the baby is not in distress at all. If there is true fetal distress, however, changing positions will not help, and if a woman is not far enough along in her labor to speed a vaginal delivery, a cesarean may be imperative.
Failure to progress Once a woman is in labor, a failure to progress can occur when the cervix has not dilated completely, labor has slowed down or stopped, or the baby is not in an optimal delivery position. Since the first phase of labor (0-4 centimeters dilation) is almost always slow, failure to progress is diagnosed correctly only when the women is in the second phase (beyond 5 centimeters dilation). Once a woman reaches active labor (more than 4 centimeters dilation), it is commonly thought that dilation should proceed by once centimeter every hour. However, as labor is drastically different for many women, some women will open faster, some much slower.
Unless there is an actual medical emergency that requires the baby to be delivered immediately, failure to progress is not a good reason for a default cesarean, even though many medical professionals believe that some women's bodies just cannot handle labor and cannot give birth. In its natural course, labor naturally speeds up and slows down and plateaus and then speeds up again. Sometimes a laboring body needs time to rest and gain strength for the next leg of the race. If labor 'stalls,' a woman can change positions, walk around, and be active in order to get things moving again.
Repeat cesarean A cesarean section is major abdominal surgery. While the first cesarean is not necessarily considered a big deal, subsequent cesareans are particularly dangerous. Any number of complications can arise, including placenta previa, placenta accreta (abnormally deep attachment of the placenta into the middle layer of the uterine wall), uterine rupture, injury to internal organs during surgery, excessive blood loss, need for hysterectomy, and maternal death. These risks rise with each subsequent repeat cesarean delivery. However, nearly 90% of woman who have already had a cesarean birth are candidates for a vaginal birth after cesarean (VBAC) for their next birth. The biggest risk factor involved in a VBAC is uterine rupture, which is common in 0.2-1.5% VBACs. There is certain criteria a mother must meet in order to be eligible for a VBAC; women should consult their care providers in order to understand their options. The U.S. has such a low VBAC and high cesarean rate because obstetricians deliver most of our babies, and obstetricians are not primary care clinicians. In his article VBAC rates are low, but are obstetricians to blame?, Kenneth Lin, MD, explains that labor managed by family physicians and professional midwives is considerably more likely to result in a vaginal birth than labor managed by an obstetrician, especially when considering VBACs. As with labor in general, there are risks in VBAC, but the risks are far greater with a repeat cesarean.
Cephalopelvic Disproportion (CPD) A true diagnosis of CPD occurs when a baby’s head is too large or a mother pelvis is too small to allow the baby to pass through. Like failure to progress, most cases of CPD are misdiagnosed (based upon the belief that the baby is too big for the mother to sufficiently dilate in a timely, scheduled manner), especially as pelvic measurements are based upon estimations. If a woman has rickets or something else has altered her pelvic bones, CPD can be legitimately diagnosed. But for the most part, a woman's body naturally will not make a baby bigger than she can push out, especially not the 30% of women in the US who give birth via cesarean. Remaining active and maintaining mobility helps a baby to position itself for vaginal delivery and helps a mothers cervix to dilate.
Active genital herpes: If the mother has an active outbreak of genital herpes at the end of her pregnancy (diagnosed by a positive culture or actual lesions), a cesarean may be scheduled. A cesarean is necessary in this case in order to prevent the baby from being exposed to the virus while passing through the birth canal. However, if the mother does not have an active outbreak, she is perfectly able to have a vaginal delivery safely without exposing the baby to the disease.
Diabetes If a mother develops gestational diabetes during her pregnancy or is otherwise diabetic, her likelihood for having a baby larger than normal increases, as does the likelihood for other complications to arise. If the case of diabetes is uncontrolled or undiagnosed, the baby may grow too large for the mother to push out. However, diet goes a long way in controlling diabetes and baby growth; by discussing options with her care provider, a mother can control the diabetes to prevent excessive growth in the baby and successfully have a vaginal birth.
Preeclampsia Preeclampsia is a condition of high blood pressure during pregnancy, which prevents the placenta from getting the proper amount of blood and decreases oxygen flow to the baby. This condition is very severe, and, once diagnosed, a mother is closely monitored. Delivery is sometimes recommended as treatment for this condition, and most women are able to deliver vaginally, but there are rare, extremely severe cases of preeclampsia where an emergency cesarean is necessary in order to save the mother and baby.
Birth defects If a baby has been diagnosed with a birth defect, a cesarean may be performed in order to reduce the risk of any further complications during delivery. In some instances, a vaginal delivery will only complicate a particular birth defect, especially when the baby rotates and shifts during the birth process. Since this shift does not occur during cesarean birth, a cesarean is the lesser of two evils.
Multiple births As multiple births are labeled as 'high risk,' these babies are usually delivered via cesarean. However, vaginal delivery is a safe option for many multiple births given that the babies are in a favorable position (any position other than transverse). If she is pregnant with multiple babies and hopes to deliver vaginally, she should find a supportive care provider who is confident in the female body's ability to naturally birth multiples, who believes twins do not require additional interventions, and who is knowledgeable about positions that are favorable for delivering multiples.
Since placenta previa involves pre-term bleeding, it can be a very traumatic experience for pregnant women, especially as some women believe they are miscarrying. The diagnosis can help medical practitioners rectify the problem, but the baby is usually delivered by cesarean. In this case, is definitely safer to have it by cesarean than to try to push a baby over a placenta, especially when it can detach during the birthing process. There is truly a difference between placenta previa and a low lying placenta, though in the case of true placenta previa, cesarean births are definitely worth the risk.
Placental Abruption This complication occurs when the placenta separates from the uterine lining before the baby is born. Approximately 1% of all pregnant women will experience placental abruption during the third trimester. The mother will experience bleeding from the site of the separation and pain in the uterus. This separation can interfere with oxygen getting to the baby and, depending on the severity, an emergency cesarean may be performed. There are two types of placental abruption, partial placental abruption and complete placental abruption. In the case of a partial separation, a cesarean is not necessary if the bleeding stops and the baby is not in distress. A complete separation, however, is a true medical emergency requiring immediate cesarean.
Uterine rupture In approximately 1 in every 1,500 births, the uterus tears, or ruptures, during pregnancy or labor, leading to hemorrhaging in the mother and interfering with the baby's oxygen supply. Uterine rupture is a reason for immediate cesarean as it can lead to a hysterectomy and death if it is not repaired right away. While uterine rupture can occur during any form of birth, the risk is higher for women who have had a previous cesarean birth, which in itself increases the rate of repeat cesarean birth.
Breech Position When dealing with a breech baby, a cesarean delivery is often considered by obstetricians to be the only option, especially due to the increased chances of cord prolapse and fetal distress. Even if the baby is in a breech position before the pregnancy is full-term, a cesarean may be preformed pre-term, resulting in premature delivery. Since medical schools no longer teach obstetricians how to deliver breech babies, cesareans are considered the 'safer' option for the baby. However, breech babies are commonly and safely born vaginally every year. In Canada, for instance, cesarean birth is no longer routinely performed for breech babies. Birthing position (such as squatting or hands and knees) is the key factor in order for a woman to successfully birth a breech baby vaginally. Breech birth is only a variation of normal childbirth, not necessarily something that is completely abnormal and to be feared.
Cord prolapse This situation does not occur often, but when it does, an emergency cesarean is performed. A cord prolapse is when the umbilical cord slips through the cervix and protrudes from the vagina before the baby is born (occurring, for instance, when the water breaks and there is too much space between the baby’s head and the cervix). As the uterus contracts, pressure is placed on the umbilical cord which diminishes the blood flow to the baby. Increased risk for cord prolapse occurs when the water is artificially broken. In the case of a cord prolapse, the baby must be delivered immediately, often by cesarean, so his oxygen levels do not decrease; if oxygen is cut off for too long, death or mental retardation may result.
Fetal distress The most common cause of fetal distress is lack of oxygen to the baby. If fetal monitoring detects a problem with the amount of oxygen that the baby is receiving, then an emergency cesarean may be performed. When this is correctly diagnosed, a cesarean is the best option. Unfortunately, fetal distress is often misdiagnosed in order to move labor along and get a woman to deliver faster. However, numerous tests are available to make sure the baby is not actually in fetal distress. It is common for a baby's heart rat to slow during contractions; a change of position may show that the baby is not in distress at all. If there is true fetal distress, however, changing positions will not help, and if a woman is not far enough along in her labor to speed a vaginal delivery, a cesarean may be imperative.
Failure to progress Once a woman is in labor, a failure to progress can occur when the cervix has not dilated completely, labor has slowed down or stopped, or the baby is not in an optimal delivery position. Since the first phase of labor (0-4 centimeters dilation) is almost always slow, failure to progress is diagnosed correctly only when the women is in the second phase (beyond 5 centimeters dilation). Once a woman reaches active labor (more than 4 centimeters dilation), it is commonly thought that dilation should proceed by once centimeter every hour. However, as labor is drastically different for many women, some women will open faster, some much slower.
Unless there is an actual medical emergency that requires the baby to be delivered immediately, failure to progress is not a good reason for a default cesarean, even though many medical professionals believe that some women's bodies just cannot handle labor and cannot give birth. In its natural course, labor naturally speeds up and slows down and plateaus and then speeds up again. Sometimes a laboring body needs time to rest and gain strength for the next leg of the race. If labor 'stalls,' a woman can change positions, walk around, and be active in order to get things moving again.
Repeat cesarean A cesarean section is major abdominal surgery. While the first cesarean is not necessarily considered a big deal, subsequent cesareans are particularly dangerous. Any number of complications can arise, including placenta previa, placenta accreta (abnormally deep attachment of the placenta into the middle layer of the uterine wall), uterine rupture, injury to internal organs during surgery, excessive blood loss, need for hysterectomy, and maternal death. These risks rise with each subsequent repeat cesarean delivery. However, nearly 90% of woman who have already had a cesarean birth are candidates for a vaginal birth after cesarean (VBAC) for their next birth. The biggest risk factor involved in a VBAC is uterine rupture, which is common in 0.2-1.5% VBACs. There is certain criteria a mother must meet in order to be eligible for a VBAC; women should consult their care providers in order to understand their options. The U.S. has such a low VBAC and high cesarean rate because obstetricians deliver most of our babies, and obstetricians are not primary care clinicians. In his article VBAC rates are low, but are obstetricians to blame?, Kenneth Lin, MD, explains that labor managed by family physicians and professional midwives is considerably more likely to result in a vaginal birth than labor managed by an obstetrician, especially when considering VBACs. As with labor in general, there are risks in VBAC, but the risks are far greater with a repeat cesarean.
Cephalopelvic Disproportion (CPD) A true diagnosis of CPD occurs when a baby’s head is too large or a mother pelvis is too small to allow the baby to pass through. Like failure to progress, most cases of CPD are misdiagnosed (based upon the belief that the baby is too big for the mother to sufficiently dilate in a timely, scheduled manner), especially as pelvic measurements are based upon estimations. If a woman has rickets or something else has altered her pelvic bones, CPD can be legitimately diagnosed. But for the most part, a woman's body naturally will not make a baby bigger than she can push out, especially not the 30% of women in the US who give birth via cesarean. Remaining active and maintaining mobility helps a baby to position itself for vaginal delivery and helps a mothers cervix to dilate.
Active genital herpes: If the mother has an active outbreak of genital herpes at the end of her pregnancy (diagnosed by a positive culture or actual lesions), a cesarean may be scheduled. A cesarean is necessary in this case in order to prevent the baby from being exposed to the virus while passing through the birth canal. However, if the mother does not have an active outbreak, she is perfectly able to have a vaginal delivery safely without exposing the baby to the disease.
Diabetes If a mother develops gestational diabetes during her pregnancy or is otherwise diabetic, her likelihood for having a baby larger than normal increases, as does the likelihood for other complications to arise. If the case of diabetes is uncontrolled or undiagnosed, the baby may grow too large for the mother to push out. However, diet goes a long way in controlling diabetes and baby growth; by discussing options with her care provider, a mother can control the diabetes to prevent excessive growth in the baby and successfully have a vaginal birth.
Preeclampsia Preeclampsia is a condition of high blood pressure during pregnancy, which prevents the placenta from getting the proper amount of blood and decreases oxygen flow to the baby. This condition is very severe, and, once diagnosed, a mother is closely monitored. Delivery is sometimes recommended as treatment for this condition, and most women are able to deliver vaginally, but there are rare, extremely severe cases of preeclampsia where an emergency cesarean is necessary in order to save the mother and baby.
Birth defects If a baby has been diagnosed with a birth defect, a cesarean may be performed in order to reduce the risk of any further complications during delivery. In some instances, a vaginal delivery will only complicate a particular birth defect, especially when the baby rotates and shifts during the birth process. Since this shift does not occur during cesarean birth, a cesarean is the lesser of two evils.
Multiple births As multiple births are labeled as 'high risk,' these babies are usually delivered via cesarean. However, vaginal delivery is a safe option for many multiple births given that the babies are in a favorable position (any position other than transverse). If she is pregnant with multiple babies and hopes to deliver vaginally, she should find a supportive care provider who is confident in the female body's ability to naturally birth multiples, who believes twins do not require additional interventions, and who is knowledgeable about positions that are favorable for delivering multiples.
Saturday, June 5, 2010
the value and purpose of labor support
Part of labor support is empowering a mother to have confidence in her ability to birth. Having someone available for the entire length of labor provides security and confidence for the mother as practitioners are typically caring for multiple patients at a time or have other responsibilities, such as the clinical needs of the mother and the baby. Paperwork also must be completed and shift changes occur, bringing in new people to the birth environment. Having a constant throughout the entire labor process provides a sense of familiarity and safety for a laboring mother. Doulas also help the mother and father both communicate with the hospital staff or birth attendants, which is necessary in a time such as labor when the parents are usually distracted with the labor itself. While it is not the role of a doula to speak for the parents to the practitioner, she should advocate in order to help the mother or partner speak for themselves. Helping the mother and partner ask the questions appropriate to their situation and navigating the terminology used is also often helpful.
Supporting a mother emotionally during labor and birth helps the mother to believe that she can do it. Sometimes being told that she can do it is all that a mother needs to hear to keep going strong during a long labor. Understanding that laboring women are vulnerable and that the birth space should be protected is very important. Laboring women should have peace and quiet and no unnecessary interruption--and holding that space for a mother is a priority. When a doula and a partner help create a peaceful and safe environment for a laboring mother, practitioners will often follow suite and respect that space, allowing a sense of calm for the mother that helps her to maintain stamina through labor. Emotional support does not end at the birth, however. Helping a mother to process her birth experience is equally important. In unforeseen complications or unexpected situations or traumas, a mother needs the continued emotional support to facilitate healing. Being especially sensitive to these needs helps to reduce postpartum depression and negative feelings towards her birth.
Labor support also includes physical support for the laboring mother. Every woman has a different need in labor, whether it is continual touch, massage or counter pressure, while other women want very little physical touch. Women will often not know what their need will be until labor has progressed and it is important to be able to understand what the mothers needs are and at what time her needs are the greatest. Incorporating the partner into the physical aspect of labor support is often very affective as they usually already have a certain intimacy between them as a couple.
The needs of a laboring and birthing woman are very complex. Mothers deserve the continual support of a doula, someone trained in labor support. If all women had a doula present for their labor and delivery, most of them would be able to birth without medication and with little medical intervention. The cost of maternity care would decrease as a result, and there would be higher success rates in breastfeeding. Postpartum depression rates would also lower. Every woman deserves a memorable and meaningful birth experience. Every woman deserves a doula.
Artwork: Birthing in Pink by Aiyaart
Friday, June 4, 2010
profit-driven pregnancies
Our healthcare system in the United States is profit driven. By pathologizing pregnancy, by inducing and augmenting childbirth--an otherwise NORMAL condition--medical practitioners have the opportunity to drive up their profit margin. It is also why medical institutions are so against homebirth. They are so outspoken against it on the guise of it being unsafe, even though statistics show homebirth is the safest option for healthy, normal pregnancies. However, if women give birth at home, doctors, hospitals, pharmaceutical companies have no chance for profit.
The article Pathologizing pregnancy: it’s just good business from KippReport hits this concept right on the head.
The article Pathologizing pregnancy: it’s just good business from KippReport hits this concept right on the head.
Thursday, June 3, 2010
the due date epidemic
As stated above, the average length of gestation for a human female is approximately 38 weeks (266 days) from the date of conception. However, since most women do not know the day they conceived, health care providers measure the length of pregnancy from the date of the last menstrual period, which works out to 40 weeks (the two extra weeks come from the fact that the average woman ovulates around 14 days after the first day of her last period, and this is when she is assumed to have conceived).
Because pregnancy is so long, and completely unpredictable, the medical community has latched on to the concept of a due date. Of course, the estimated due date is just that: an estimate, give or take a few days or weeks. However, doctors seem to have forgotten that the estimated due date is not to be relied upon as the actual day of birth. Doctors are increasingly relying on the estimated due date as a date on which to start planning inductions, and even threatening cesareans, for going 'overdue.'
But what does this mean for the woman whose menstrual cycle is not the standard 28-day cycle? This means that her estimated due date will actually be off by as much as one to two weeks in either direction. And if she has a doctor who likes to consider induction or cesarean after the estimated due date, he may be wrong by as much as two weeks early. For this reason, there is absolutely no justification for considering induction of a healthy pregnant woman before 42 weeks of gestation. Unless the woman herself knows either the day she ovulated, or the day she conceived, her due date may be off by as much as two weeks in either direction. Two weeks is too much of a margin of error to consider taking a baby early.
For the vast majority of women, induction increases risks for them and for their babies. Induction literally leads to a cascade of interventions, meaning that once intervention begins, another intervention is followed by another, which is followed by yet another, in a repetitive cycle of intervention. Having labor induced will medicalize a mother's birth experience. Once labor is augmented, a woman will need an IV and continuous electronic fetal monitoring which will confine her to a bed for the duration of her labor. Contractions will probably be more painful, often making pain medication unavoidable. If an epidural is administered, it will help eliminate the magnified pain, but it also introduces a long list of potential problems of its own. And with nearly 50% of woman whose labors are medically induced end up having a cesarean birth, a whole new set of complications are added to the cascade, with major abdominal surgery, pain, and increased recovery time.
However, each and every day the baby spends inside his mother's uterus is valuable to his development and ability to survive of the outside of the womb. Even during late pregnancy, the baby continues to grow, his brain develops, his little body stores more fat, and his little lungs grow stronger with the passing time. A mother's body also prepares for labor by dilating a few centimeters before labor even begins. If a woman goes beyond her estimated due date, it does not mean the baby is 'overdue.' This 'post-date' pregnancy should, however, be considered beneficial for the baby--an added opportunity for the baby to grow and develop.
At the end of pregnancy, if the pregnant woman is really tired and uncomfortable, and the idea of inducing seems welcome to her, and she is truly worried about going 'overdue,' there are better ways to know what is happening in her body than simply kicking the baby out. The baby's heart rate and movements can easily be monitored by the mother and the mother should pay attention to her body's signals. There is no need to cause an emergency situation when there is not one yet. Let the mother's body and the baby tell when it’s time. When the baby is fully developed and ready to live outside the womb, labor will assuredly start on its own.
If you are interested in reading more about pregnancies that extend beyond 40 weeks, I recommend In their own sweet time: A journey into post-date pregnancy. For ideas on how to carry on after your due date, try Surviving an Overdue Pregnancy.
Monday, May 31, 2010
after the birth, what a family needs
"Let me know if I can help you in any way when the baby is born."
"Just let me know if you need a hand."
"Anything I can do, just give me a call."
Most pregnant women get these statements from friends and family but shy away from making requests when they are up to their ears in dirty laundry, unmade beds, dust bunnies and countertops crowded with dirty dishes. The myth of, “I’m fine. I’m doing great. New motherhood is wonderful. I can cope and my husband is the Rock of Gibraltar,” is pervasive in postpartum land.
If you are too shy to ask for help and make straight requests of people, I suggest sending the following list out to your friends and family. These are the things I have found to be missing in every house with a new baby. It’s actually easy and fun for outsiders to remedy these problems for the new parents but there seems to be a lot of confusion about what is actually wanted and needed.
1. Buy us toilet paper, milk and beautiful whole grain bread.
2. Buy us a new garbage can with a swing top lid and 6 pairs of black cotton underpants (women’s size____).
3. Make us a big supper salad with feta cheese, black Kalamata olives, toasted almonds, organic green crispy things and a nice homemade dressing on the side. Drop it off and leave right away. Or, buy us frozen lasagna, garlic bread, a bag of salad, a big jug of juice, and maybe some cookies to have for dessert. Drop it off and leave right away.
4. Come over about 2 in the afternoon, hold the baby while the new mother has a hot shower, put the new mother to bed with the baby and then fold all the piles of laundry that have been dumped on the couch, beds or in the room corners. If there is no laundry to fold yet, do some.
5. Come over at l0 a.m., make us eggs, toast and a 1/2 grapefruit. Clean our fridge and throw out everything you are in doubt about. Do not ask me about anything; just use your best judgment.
6. Put a sign on our door that reads, “Dear Friends and Family, Mom and baby need extra rest right now. Please come back in 7 days but phone first. All donations of casserole dinners would be most welcome. Thank you for caring about this family.”
7. Come over in your work clothes and vacuum and dust our house and then leave quietly. It is tiring for a new mother to chat and have tea with visitors but it will renew her soul to get some rest knowing she will wake up to clean, organized space.
8. Take our older kids for a really fun-filled afternoon to a park, zoo or Science World and feed them healthy food.
9. Come over and give the new father a two hour break so he can go to a coffee shop, pub, hockey rink or some other activity that will delight him. Fold more laundry.
10. Make us a giant pot of vegetable soup and clean the kitchen completely afterwards. Take a big garbage bag and empty every trash basket in the house and reline with fresh bags.
These are the kindnesses that new families remember and appreciate forever. It is easy to spend money on gifts, but the things that really make a difference are the services for the body and soul described above. Most of your friends and family members do not know what they can do that will not be an intrusion. They also cannot devote 40 hours to supporting you but they would be thrilled to devote four hours. If you let 10 people help you out for four hours each, you will have the 40 hours of rested, adult support you really need with a newborn in the house. There is magic in the little prayer, “I need help.”
"Anything I can do, just give me a call."
Most pregnant women get these statements from friends and family but shy away from making requests when they are up to their ears in dirty laundry, unmade beds, dust bunnies and countertops crowded with dirty dishes. The myth of, “I’m fine. I’m doing great. New motherhood is wonderful. I can cope and my husband is the Rock of Gibraltar,” is pervasive in postpartum land.
If you are too shy to ask for help and make straight requests of people, I suggest sending the following list out to your friends and family. These are the things I have found to be missing in every house with a new baby. It’s actually easy and fun for outsiders to remedy these problems for the new parents but there seems to be a lot of confusion about what is actually wanted and needed.
1. Buy us toilet paper, milk and beautiful whole grain bread.
2. Buy us a new garbage can with a swing top lid and 6 pairs of black cotton underpants (women’s size____).
3. Make us a big supper salad with feta cheese, black Kalamata olives, toasted almonds, organic green crispy things and a nice homemade dressing on the side. Drop it off and leave right away. Or, buy us frozen lasagna, garlic bread, a bag of salad, a big jug of juice, and maybe some cookies to have for dessert. Drop it off and leave right away.
4. Come over about 2 in the afternoon, hold the baby while the new mother has a hot shower, put the new mother to bed with the baby and then fold all the piles of laundry that have been dumped on the couch, beds or in the room corners. If there is no laundry to fold yet, do some.
5. Come over at l0 a.m., make us eggs, toast and a 1/2 grapefruit. Clean our fridge and throw out everything you are in doubt about. Do not ask me about anything; just use your best judgment.
6. Put a sign on our door that reads, “Dear Friends and Family, Mom and baby need extra rest right now. Please come back in 7 days but phone first. All donations of casserole dinners would be most welcome. Thank you for caring about this family.”
7. Come over in your work clothes and vacuum and dust our house and then leave quietly. It is tiring for a new mother to chat and have tea with visitors but it will renew her soul to get some rest knowing she will wake up to clean, organized space.
8. Take our older kids for a really fun-filled afternoon to a park, zoo or Science World and feed them healthy food.
9. Come over and give the new father a two hour break so he can go to a coffee shop, pub, hockey rink or some other activity that will delight him. Fold more laundry.
10. Make us a giant pot of vegetable soup and clean the kitchen completely afterwards. Take a big garbage bag and empty every trash basket in the house and reline with fresh bags.
These are the kindnesses that new families remember and appreciate forever. It is easy to spend money on gifts, but the things that really make a difference are the services for the body and soul described above. Most of your friends and family members do not know what they can do that will not be an intrusion. They also cannot devote 40 hours to supporting you but they would be thrilled to devote four hours. If you let 10 people help you out for four hours each, you will have the 40 hours of rested, adult support you really need with a newborn in the house. There is magic in the little prayer, “I need help.”
preparing for natural childbirth
One of the most important choices a pregnant woman will make is how she will give birth. While it is common for many birthing women to choose medications and synthetic drugs to manage pain during labor, choosing to do so brings on a greatly increased risk of birth complications and further labor intervention procedures. While childbirth may be painful, in a healthy pregnancy, a natural, drug-free childbirth is by far the best option for having a healthy delivery. A woman who trusts in her body's natural ability to labor and birth will have the most rewarding, emotional and powerful birth experience.
There are many steps you can take during your pregnancy in order to prepare for a natural birth. Make sure you keep a healthy lifestyle during your pregnancy, eating primarily nutritious, whole foods and getting plenty of easy exercise by walking, doing stretches, and yoga.
Once you decide you are serious about having a natural childbirth, hire attendants who are more likely to support your decision to birth naturally. Consider hiring a midwife rather than an OB. Midwives are autonomous practitioners and are the primary carer for the vast majority of women in both the developed and undeveloped worlds during their pregnancy. Provided a pregnancy is progressing normally, a woman need never see a doctor. According to Catherine Taylor in her book Giving Birth: A Journey into the World of Mothers and Midwives, midwives have a 19% lower rate of infant deaths and a 33% lower rate of neonatal mortality (infant death in the first month) than doctors attending comparable births, and midwives who attend hospital births have a cesarean rate that is half the national average. Additionally, midwives tend to be more open to different methods of childbirth. And, if complications do arise, midwives are assuredly knowledgeable and capable.
Whether you choose to hire a midwife or not, you may also consider hiring a doula. Essentially, a doula is a natural-childbirth coach and advocate for the birthing mother and her family. If you have a doula present at your birth, she will be able to remind you of the reasons you chose to birth naturally and gently push you to continue as you had planned when you are in the throws of labor. She will also be able to assist you with relaxation, breathing and pain-relieving techniques and help labor move along as smoothly as possible. In addition to providing emotional and physical labor support, she will advocate your wishes and can assist in communication with medical staff in a hospital setting, as well as obtain information for you to better be able to make informed decisions in regards to procedures and possible interventions.
Perhaps the most important step to preparing yourself for a natural childbirth is to educate yourself about every aspect of the birth experience. You have nine months to learn all you can about labor options, birth attendants, common procedures, possible necessary and unnecessary interventions, and the common and unique qualities of other successful natural childbirths. With the internet, there are literally countless resources at your fingertips. There are also many books that focus objectively on natural birthing options, including my favorites, Birthing from Within: An Extra-Ordinary Guide to Childbirth Preparation by Pam England and Rob Horowitz and The Birth Partner: A Complete Guide to Childbirth for Dads, Doulas, and All Other Labor Companions by Penny Simkin. When browsing birth-education reading material, be sure to choose books and sources that positively support your decision to have a healthy, aware, and natural childbirth.
Another step you can take to prepare yourself for a natural birth is to participate in childbirth education classes. While many hospitals offer basic classes for pregnant couples, there are many alternative options that actually focus on natural labor techniques. Lamaze is the most discussed method of birth education and natural pain management, teaching techniques for focused breathing. Lamaze will help you focus on making it through each contraction, though it does not necessarily prepare women for what to expect in regards to the intense pain involved in labor. Becoming increasingly popular, however, are comprehensive natural childbirth classes such as Hypnobabies, The Pink Kit, and Birth Outside the Box. These well-rounded, objective courses are comparably priced and available to you in the comfort of your own home or in small group settings, and they will provide you with options for natural pain-relief and a solid foundation on which to build your natural birth experience.
Lastly, be confident about your decision to have a natural childbirth and your body's ability to birth. For most women who choose natural childbirth, their main goal is to be lucid and alert after the delivery of their baby, to be able to immediately and peacefully see, hold and bond with their baby. Visualize this positive outcome throughout your pregnancy and be confident that this is what your want. If you expect horrible labor pain, you are more likely to actually be in pain. Confidence is actually a big step in making the labor process more bearable.
Once you educate yourself about your options and decide on birth attendants who support your decision to birth naturally, you will be able to develop a clear picture of your own expectations for a emotionally fulfilling positive birth experience. If you begin feeling discouraged at any point during your pregnancy or labor, remember this one simple thing: You were made for this.
Wednesday, April 14, 2010
modern midwifery
In the United States, less than 1% of births take place at home. It is difficult for the other 99% of Americans to make the transition from believing that technology is the benchmark for establishing worldwide leadership to the understanding that, in reality, the human body is designed to give birth. Our bodies are generous and amazing in their abilities to give birth naturally.
The rates of surgical birth and birth intervention in the US have soared beyond those of other developed countries around the world. The rate of maternal and infant mortality is not only significantly higher in the US than that of other developed nations, but also has not improved in nearly thirty years. Despite a significant improvement in the US maternal mortality ratio since the early 1900s, it still represents a substantial and frustrating burden, particularly given the fact that essentially no progress has been made in most of the US since 1982. Additionally, the Centers for Disease Control and Prevention has stated that most cases of maternal mortality are probably preventable. Among the causal deaths that could be prevented were those that involve both underlying health issues such as poor nutrition and high blood pressure as well as those that are physician-caused, including infection and hemorrhage.
There are many preventable risks of placing birth in a hospital environment. To begin with, bacteria can be introduced, first by the mother arriving in an environment where diseases are being treated, as well as from
infiltrating the natural barriers we have against infection through vaginal exams and, of course, surgical delivery. Additionally, there are higher incidences of hemorrhage from forced delivery of the placenta (when a care provider intentionally pulls on an umbilical cord). Furthermore, injuries and deaths related to the physician’s care range from the off-label use of medicine for the induction of labor as well as the sanctified use of surgical delivery, which is one of the leading causes of maternal mortality and a risk directly associated with cesareans and hospital births.
It is important to remember that pregnancy is a normal, low-risk, significant time in a woman's life. With knowledge of her body, a woman can interpret her body’s signals and maintain her own health. She can educate herself about care options and make good choices based on impartial and complete information because she knows her own body. Modern midwifery care is based on many concepts which are proven to reduce maternal and infant mortality rates and increase a mother’s joy in her birth experience.
Pregnancy effects and is effected by all aspects of a woman’s life: social, economic, professional, familial. A woman who knows about her body and how she gives birth is less likely to need medical interventions. An experienced midwife spends time with her clients. She gets to know them, teaches them and helps them think through their options to make reasoned decisions. She spends time with the client’s partner, observing the dynamics and providing holistic support. She helps identify how best to prepare the chosen space for labor and birth. Under a midwife's care, a typical prenatal visit lasts 30-60 minutes, labor accompaniment is consistent through the active labor and birth, and postnatal care includes several follow-up visits. It is estimated that midwives spend 10-15 times as many hours with a client as doctors spend--at about half the price! Midwives still do 70% of the births in the world and are experts not only at “normal” birth but at keeping infants normal around the birthing process. Midwifery care makes sense for normal pregnancies because midwives are skilled at keeping the pregnancy normal.
Women deserve knowledge to care for themselves before conceiving and during pregnancy and birth. Women gain the best birth knowledge from other women who have chosen natural childbirth with supportive birth care. Women are naturally intuitive and need not accept the negative images of labor that the media portrays. Women, their partners and their advocates can differentiate between normal birth and situations that may require medical guidance. Women want to choose important aspects of their birth experience based on credible information, not fear of litigation. The most favorable physical, mental and emotional birth outcomes for mothers and their babies are best supported by midwifery care.
Women have the right to choose a care provider and with whom and where to give birth. Every woman, and her family, must be recognized as being an individual with her own unique expectations for hers and her baby’s birth. It is a myth that women who seek a homebirth are willfully putting themselves at risk. Women are fully capable of considering their options and choosing how to care for themselves. It is not rational to say homebirth is never safe; saying so is the product of hysteria. All birth information providers must create a more personable environment for the woman to learn about birth, her body and her birth options. Protecting choice, not limiting choice, is good, no, GREAT health care.
Artwork: Music by Katie M. Berggren
The rates of surgical birth and birth intervention in the US have soared beyond those of other developed countries around the world. The rate of maternal and infant mortality is not only significantly higher in the US than that of other developed nations, but also has not improved in nearly thirty years. Despite a significant improvement in the US maternal mortality ratio since the early 1900s, it still represents a substantial and frustrating burden, particularly given the fact that essentially no progress has been made in most of the US since 1982. Additionally, the Centers for Disease Control and Prevention has stated that most cases of maternal mortality are probably preventable. Among the causal deaths that could be prevented were those that involve both underlying health issues such as poor nutrition and high blood pressure as well as those that are physician-caused, including infection and hemorrhage.There are many preventable risks of placing birth in a hospital environment. To begin with, bacteria can be introduced, first by the mother arriving in an environment where diseases are being treated, as well as from
infiltrating the natural barriers we have against infection through vaginal exams and, of course, surgical delivery. Additionally, there are higher incidences of hemorrhage from forced delivery of the placenta (when a care provider intentionally pulls on an umbilical cord). Furthermore, injuries and deaths related to the physician’s care range from the off-label use of medicine for the induction of labor as well as the sanctified use of surgical delivery, which is one of the leading causes of maternal mortality and a risk directly associated with cesareans and hospital births.
It is important to remember that pregnancy is a normal, low-risk, significant time in a woman's life. With knowledge of her body, a woman can interpret her body’s signals and maintain her own health. She can educate herself about care options and make good choices based on impartial and complete information because she knows her own body. Modern midwifery care is based on many concepts which are proven to reduce maternal and infant mortality rates and increase a mother’s joy in her birth experience.
Pregnancy effects and is effected by all aspects of a woman’s life: social, economic, professional, familial. A woman who knows about her body and how she gives birth is less likely to need medical interventions. An experienced midwife spends time with her clients. She gets to know them, teaches them and helps them think through their options to make reasoned decisions. She spends time with the client’s partner, observing the dynamics and providing holistic support. She helps identify how best to prepare the chosen space for labor and birth. Under a midwife's care, a typical prenatal visit lasts 30-60 minutes, labor accompaniment is consistent through the active labor and birth, and postnatal care includes several follow-up visits. It is estimated that midwives spend 10-15 times as many hours with a client as doctors spend--at about half the price! Midwives still do 70% of the births in the world and are experts not only at “normal” birth but at keeping infants normal around the birthing process. Midwifery care makes sense for normal pregnancies because midwives are skilled at keeping the pregnancy normal.
Women deserve knowledge to care for themselves before conceiving and during pregnancy and birth. Women gain the best birth knowledge from other women who have chosen natural childbirth with supportive birth care. Women are naturally intuitive and need not accept the negative images of labor that the media portrays. Women, their partners and their advocates can differentiate between normal birth and situations that may require medical guidance. Women want to choose important aspects of their birth experience based on credible information, not fear of litigation. The most favorable physical, mental and emotional birth outcomes for mothers and their babies are best supported by midwifery care.
Women have the right to choose a care provider and with whom and where to give birth. Every woman, and her family, must be recognized as being an individual with her own unique expectations for hers and her baby’s birth. It is a myth that women who seek a homebirth are willfully putting themselves at risk. Women are fully capable of considering their options and choosing how to care for themselves. It is not rational to say homebirth is never safe; saying so is the product of hysteria. All birth information providers must create a more personable environment for the woman to learn about birth, her body and her birth options. Protecting choice, not limiting choice, is good, no, GREAT health care.
Artwork: Music by Katie M. Berggren
Thursday, April 1, 2010
follow your instincts
When someone, usually a pregnant mama, asks me for my best parenting advice, I like to say, with complete honesty, "Follow Your Instincts." I could say many, many other things, but my mothering instincts have been strong since before I could even put a name to my parenting style. Attachment parenting, natural parenting, respectful parenting: for me, it all comes down to instinct.
I suppose the most important aspects of instinctual parenting for me started during childbirth. When both Eva and Esme were born, gently and naturally, both babies were placed directly on my abdomen, wet and warm, for optimum bonding. We had the wonderful opportunity to cuddle and touch and meet for the first time. We began our nursing relationship immediately, within the minutes following birth.
Another super necessary (for me) aspect of instinctual parenting is the family bed. When sleep-sharing, baby naturally learns and mimics mother's sleep cycle, is more likely to "sleep through the night," and is at a significantly less of a risk for Sudden Infant Death Syndrome (SIDS). Sleep-sharing also allows for a more successful nursing relationship. Additionally, it helps a mother to become familiar with her baby's cues--before the baby even needs to cry out. I was always close to my babies, was able to feed them without having to fully awake from a comfortable sleep, and I sensed everything about them.
Then there is babywearing. It has been proven countless times that carried babies fuss less and spend much more time in the awake state of quiet alertness, which is the optimum state for learning (boosting brain power). Again, like bedsharing, since your baby is close to you, you know your baby better, you become more sensitive to her needs and you can meet those needs before crying is even necessary.
There is a very fine line between each aspect of instinctual parenting, and in most cases, it is difficult to tell where one leaves off and another begins. The benefits of instinctual parenting are far too complex to fully describe. It contributes to a level of communication far beyond words. However, I could instinctively tell when my baby was hungry, needed a diaper, wanted to be put down, etc. by being close to her and learning her cues (rather than using her cry to let me know she needs something). I knew because I followed each of their silent signals and their body language, which I still know so well from years of dedicated breastfeeding, sleep-sharing, and babywearing.
Tuesday, March 2, 2010
breastfeeding and the pregnant mother
Breastfeeding is one of the most wonderful gifts a new mother and baby can share. There are countless benefits to breastfeeding, many of which you hear about on a regular basis, the most important of which are the undeniable health benefits for both mother and baby. When someone asks me, I have a ton of tips on breastfeeding. I have nursed both of my daughters for 78 months and counting, and I am a huge advocate. Unfortunately, speaking about the postpartum period is considered taboo in the United States--and speaking of some of the benefits of breastfeeding is considered taboo as well. Most pregnant mothers unfortunately do not get to hear about them, except from another mother who is not afraid of being candid and honest.
I guess my first tip regarding breastfeeding is to make sure your pediatrician and ob-gyn or midwife are advocates for breastfeeding. You want to have good resources at your fingertips if you run into problems. Unfortunately, a lot of doctors these days do not know a single thing about breastfeeding and do not know how to differentiate normal aspects of breastfeeding from potential problems, nor do they know how to resolve problems if they arise, aside from prescribing a breastmilk substitute. It is just not something they are trained in, and is unfortunately one of the biggest downfalls of maternity care in the U.S. Heck, I almost stopped breastfeeding my oldest when we were still in the hospital because none of the staff knew the answers to my questions--but I stuck with it. I met with a lactation consultant in the hospital the next day, and she had so much helpful information.
I was also lucky that my mom's cousin was supportive. She nursed her two children for a total of four years, I think, so she had a lot of experience. She was the only person I knew who did not fill my head with breastfeeding horror stories and nonsense that was really based on lack of breastfeeding knowledge. Almost everyone I knew at the time only had negative experiences to share--and the biggest problem about that was that it was extremely discouraging. It literally made me, an inexperienced young pregnant woman, feel like breastfeeding was going to be waaaay too much work. But now that I am educated about breastfeeding, I realize now that a lot of the problems these women were facing were not problems at all, but just unfortunate misunderstandings that could be solved very easily had they known someone who knew something about breastfeeding--or else, for problems taking place in the days after birth, side effects of labor pain medication or as a result of circumcision procedures on baby boys. One of the worst kept secrets about breastfeeding is that it is actually very easy--I like to think of it as the lazy mother's way of caring for a baby!
Pregnant women will find out very quickly that the one thing mothers want to share with them once they are pregnant is their bad birthing and parenting experiences. They will talk about everything that went wrong for them during their pregnancies (swollen feet, fat butt, weight gain, high blood pressure), their births (baby is too big, long drawn out painful labor, c-sections), and breastfeeding (cracked and bleeding nipples, painful latch, not enough milk). I highly recommend that pregnant women disregard everything negative that comes their way. Instead, focus on exactly what YOU want from your pregnancy, birth, and breastfeeding. Think about the wonderful things happening to you during pregnancy (shiny beautiful hair, free massages, extra cleavage), birth (right of passage, meeting the baby your body created and nurtured, naming another human being), and breastfeeding (losing the baby fat, extra money and no dishes--you don't have to pay for formula or wash bottles, no period for months or even years).
Another extremely important tip: read books that are informative and unbiased rather than books that focus on complications and things that can go wrong. I must say that, despite its mass popularity, the "What To Expect..." series is a huge culprit of feeding the belief that everything that can go wrong will go wrong. Instead, try reading something like From the Hips: A Comprehensive, Open-Minded, Uncensored, Totally Honest Guide to Pregnancy, Birth, and Becoming a Parent by R Odes and C Morris. It is a fantastic, fun, and truely cool book. While the book focuses mostly on pregnancy and childbirth, the authors have compiled some sound information on breastfeeding and a nice section on sorting through the advice that comes your way. There is also the very funny book So That's What They're For! Breastfeeding Basics by J Tamaro, which is my first recommendation for anyone to read regarding breastfeeding.
There are so many good books and resources out there--your biggest, of course, being the mothers you know who have successfully breastfed their children. Also, attend LLL meetings in the early months, especially before your baby arrives. Surround yourself with breastfeeding mothers--watch a baby latch on to the breast, notice the different ways the mother positions the baby. It can be weird at first, but to be honest, in cultures where breastfeeding is normal and children are not weaned until they are at least two years old, everyone breastfeeds, everywhere, and no one thinks anything of it. It is human nature--just another person having a snack. Hardly any women in those cultures have problems with breastfeeding because everyone knows how to do it--mothers, sisters, aunts, cousins have experienced countless babies nursing since they themselves were babies. Humans have survived for so long because of breastfeeding.
While some mothers may hit a rocky point or two at the beginning of a nursing relationship, once breastfeeding is established, given the appropriate knowledge and resources, they will hopefully realize how much breastfeeding really has to offer. Breastfeeding literally is so much more than nurturing--breastfeeding makes life with a baby easy!
I guess my first tip regarding breastfeeding is to make sure your pediatrician and ob-gyn or midwife are advocates for breastfeeding. You want to have good resources at your fingertips if you run into problems. Unfortunately, a lot of doctors these days do not know a single thing about breastfeeding and do not know how to differentiate normal aspects of breastfeeding from potential problems, nor do they know how to resolve problems if they arise, aside from prescribing a breastmilk substitute. It is just not something they are trained in, and is unfortunately one of the biggest downfalls of maternity care in the U.S. Heck, I almost stopped breastfeeding my oldest when we were still in the hospital because none of the staff knew the answers to my questions--but I stuck with it. I met with a lactation consultant in the hospital the next day, and she had so much helpful information.
I was also lucky that my mom's cousin was supportive. She nursed her two children for a total of four years, I think, so she had a lot of experience. She was the only person I knew who did not fill my head with breastfeeding horror stories and nonsense that was really based on lack of breastfeeding knowledge. Almost everyone I knew at the time only had negative experiences to share--and the biggest problem about that was that it was extremely discouraging. It literally made me, an inexperienced young pregnant woman, feel like breastfeeding was going to be waaaay too much work. But now that I am educated about breastfeeding, I realize now that a lot of the problems these women were facing were not problems at all, but just unfortunate misunderstandings that could be solved very easily had they known someone who knew something about breastfeeding--or else, for problems taking place in the days after birth, side effects of labor pain medication or as a result of circumcision procedures on baby boys. One of the worst kept secrets about breastfeeding is that it is actually very easy--I like to think of it as the lazy mother's way of caring for a baby!
Pregnant women will find out very quickly that the one thing mothers want to share with them once they are pregnant is their bad birthing and parenting experiences. They will talk about everything that went wrong for them during their pregnancies (swollen feet, fat butt, weight gain, high blood pressure), their births (baby is too big, long drawn out painful labor, c-sections), and breastfeeding (cracked and bleeding nipples, painful latch, not enough milk). I highly recommend that pregnant women disregard everything negative that comes their way. Instead, focus on exactly what YOU want from your pregnancy, birth, and breastfeeding. Think about the wonderful things happening to you during pregnancy (shiny beautiful hair, free massages, extra cleavage), birth (right of passage, meeting the baby your body created and nurtured, naming another human being), and breastfeeding (losing the baby fat, extra money and no dishes--you don't have to pay for formula or wash bottles, no period for months or even years).
Another extremely important tip: read books that are informative and unbiased rather than books that focus on complications and things that can go wrong. I must say that, despite its mass popularity, the "What To Expect..." series is a huge culprit of feeding the belief that everything that can go wrong will go wrong. Instead, try reading something like From the Hips: A Comprehensive, Open-Minded, Uncensored, Totally Honest Guide to Pregnancy, Birth, and Becoming a Parent by R Odes and C Morris. It is a fantastic, fun, and truely cool book. While the book focuses mostly on pregnancy and childbirth, the authors have compiled some sound information on breastfeeding and a nice section on sorting through the advice that comes your way. There is also the very funny book So That's What They're For! Breastfeeding Basics by J Tamaro, which is my first recommendation for anyone to read regarding breastfeeding.
There are so many good books and resources out there--your biggest, of course, being the mothers you know who have successfully breastfed their children. Also, attend LLL meetings in the early months, especially before your baby arrives. Surround yourself with breastfeeding mothers--watch a baby latch on to the breast, notice the different ways the mother positions the baby. It can be weird at first, but to be honest, in cultures where breastfeeding is normal and children are not weaned until they are at least two years old, everyone breastfeeds, everywhere, and no one thinks anything of it. It is human nature--just another person having a snack. Hardly any women in those cultures have problems with breastfeeding because everyone knows how to do it--mothers, sisters, aunts, cousins have experienced countless babies nursing since they themselves were babies. Humans have survived for so long because of breastfeeding.
While some mothers may hit a rocky point or two at the beginning of a nursing relationship, once breastfeeding is established, given the appropriate knowledge and resources, they will hopefully realize how much breastfeeding really has to offer. Breastfeeding literally is so much more than nurturing--breastfeeding makes life with a baby easy!
Tuesday, February 2, 2010
help establish a gentle birth clinic in Hati
I came across this article, Giving Life in a Land Overflowing with Pain by Damien Cave, which was published in the January 29th issue of The New York Times. It really highlights a lot of the problems Haitian mothers are facing after the disastrous earthquake.
This morning, I received the following message from Katherine Bramhall, who is in the process of establishing a maternal/child gentle birth clinic with colleague Rachael Lim in Jacmel, Haiti, which is just north of Port-au-Prince. They are in dire need of cash donations before the middle of March to purchase supplies for the clinic, which can be sent to Allies For Trauma Relief, 25 Colby Street, Barre, VT 05641. Donations are are tax deductible.
This morning, I received the following message from Katherine Bramhall, who is in the process of establishing a maternal/child gentle birth clinic with colleague Rachael Lim in Jacmel, Haiti, which is just north of Port-au-Prince. They are in dire need of cash donations before the middle of March to purchase supplies for the clinic, which can be sent to Allies For Trauma Relief, 25 Colby Street, Barre, VT 05641. Donations are are tax deductible.
Beloved Friends,
I arrived home last Thursday afternoon after nearly a month at Bumi Sehat's Bali clinic. In the time I was away, Robin and I made the decision Bumi Sehat would go to Haiti to set up a permanent clinic in Jacmel, north of Port-au-Prince, in response to the massive earthquake which devastated the country.
This decision to establish a permanent maternal/child gentle birth clinic was encouraged along by our partners Direct Relief International, our donors and a small amazing team of midwives and medics, determined to go make a difference.
In the 2 weeks since Robin and Kelly left on Team One, the earth has moved again...not in violence and destruction, but gently and steadily...ever so slowly... towards peace and health...one tiny grain of sand at a time. Our permanent clinic is quickly becoming a reality.
It has seemed impossible at times, confusing, chaotic, always overwhelming...as the conditions on the ground in Haiti are bound to be right now. Patient care is the best that can be affected for right now and so much less than what any health care provider would ever want to consider ok enough.
Sometime in the next 3 weeks I will be leaving for Haiti to join Team Two in Jacmel, north of Port-au-Prince, site of Bumi Sehat's new permanent Haiti clinic.
Between now and the end of February I need to raise $5000 to aid the immediate relief effort in our Bumi Sehat Haiti clinic.
Much is needed and in a short time.
This Sunday I am hosting a gathering at The Loft at Gentle Landing Midwifery at 2:30 (only small, nursing babies please...no children). Please see the attached poster about the event. I hope you will join me and bring all of your friends.
I invite you from the bottom of my heart to pass this email along to all you know. Then please consider coming on Sunday for moral support, updates, stories of hope...and ways you may be able to help the maternal/child effort toward safe and gentle birth in Haiti. Haiti represents a disaster of Tsunami proportions in our Western Hemisphere. The pain is so close to us. The love and hope of healing for Haiti is ours to remember.
I am attaching the freshest field report sent yesterday from Robin about the first few days on the ground. In 2 days we will have delivery of our 44 foot solid dome structure, the new home of our permanent clinic.
Yesterday we were granted a license to operate from the Haitian government. A license to care for pregnant and birthing women whose entire lives have been shattered.
18 months ago, the A Million Mothers campaign email made it across the world two times, raising $20,000 for Bumi Sehat and gentle, affordable Birth Care for women in Bali and Aceh, Indonesia. One mother at a time. One dollar at a time. www.amillionmothers.org
A Million Mothers created a miracle 18 months ago one dollar at a time. Please help a million mothers in Haiti believe in a future for their children. Please pass this email along to all you know. Please post it on social networking sites, yahoo groups...all the places we all go for support and community...
Let's shoot for the stars...A Million Mothers helping mothers and children in Haiti $10 at a time.
My blessings and deep love,
With gratitude and hope,
Katherine
________________________________________________________
If you cannot come on Sunday, or for those receiving this who live too far away, please consider donating to my non-profit organization: Allies For Trauma Relief toward the Haiti effort.
We are not on the web, but are a 501 (c) 3 and contributions can be sent to:
AFTR
25 Colby Street
Barre, VT 05641
Donations will be used to buy supplies for the new clinic and I will be posting updates and photos regularly between now and the middle of March.
If this email was forwarded to you, please email me to have your name put on the email list if you are interested in the updates.
Tax deductible receipts will be issued for all donations over $100.
Please note: All donations made to Haiti between January 12 and March 1 can be claimed for a 2009 deduction, according to a new IRS ruling.
_______________________________________________________
Katherine Bramhall
802.279.3158
katherine@gentlelanding.com
www.gentlelanding.com
Friday, December 18, 2009
what does a doula do?
Doula is a word of Greek origin meaning "woman who serves." These days, though, doulas are professionals, usually women, who provide emotional, physical and informational support to a woman and her family during the antenatal, birthing and postpartum periods. The three most common types of doulas are labor doulas, postpartum doulas, and antepartum doulas.
A labor doula attends a birthing mother and her family before, during, and just after the birth of the baby. By serving as an advocate, labor coach, and informational resource, a labor doula helps ensure a safe and satisfying birth experience. She often provides reassurance and experienced perspective, helps with relaxation techniques including massage and positioning, and makes suggestions to progress labor. Studies have found that the presence of a doula at birth results in shorter labor with fewer complications, reduces negative feelings about one's childbirth experience, reduces the need for intervention (including pitocin, forceps, vacuum extraction, and cesareans), and reduces the mother's request for pain medication and epidural. Before labor begins, a labor doula will familiarize herself with a pregnant mother's birth plan, which will include preferences regarding management options and the use of pain medication, and will assist in establishing breastfeeding after the birth of the baby.
An antepartum doula has specific and extensive training that relates to assisting pregnant women who are classified as high risk, pregnant women who may be on bedrest, or pregnant women with medical conditions necessitating additional help. Antepartum doulas provide assistance, education and physical support for a pregnant mother, sibling care, errand running, meal preparation, home care, and emotional support.
Doulas do not offer medical advice and do not perform clinical tasks (such as checking fetal heart rate, taking the mother's blood pressure, performing vaginal exams, or delivering a baby--although many are trained for such in case of emergency situations). Doulas do, however, have professional training and/or experience from the organizations that they train through and/or the births and clients they attend. Doulas are employed by pregnant and postpartum women and their families to provide physical comfort, emotional support, and to advocate. They provide their clients with unbiased information necessary to make informed, educated decisions.
If you are considering employing a birth, postpartum, or antepartum doula, it is important to get to know her first, check references, ask about her attendance and experience, and if she has birthed and breastfed a child.
Helpful Resources
Books on Natural Childbirth
The Birth Partner by Penny Simkin, PT, CD
The Birth Book by William Sears, MD, and Martha Sears, RN IBCLC
Active Birth by Janet Balaskas
Natural Childbirth the Bradley Way by Susan McCuthcheon
Easing Labor Pain by Adrienne Lieberman
Mothering the Mother: How a Doula Can Help You Have a Shorter, Easier & Healthier Birth by John H. Kennell, Phyllis H. Klaus, Marshall H. Klaus
Books on Having a Vaginal Birth after Cesarean
Natural Birth After Cesarean: A Practical Guide by Johanne C. Walters & Karis Crawford
Silent Knife: Cesarean Prevention & VBAC by Nancy Wainer Cohen & Lois Estner
Books on High-Risk Pregnancy Care
The Pregnancy Bed Rest Book by Amy E. Tracy
When Pregnancy Isn't Perfect by Laurie A. Rich
Intensive Caring by Dianne Hales & Timothy R. B. Johnson
Books on Postpartum Care
Rebounding From Childbirth: Towards Emotional Recovery by Lynn Madsen
Mothering the New Mother: Women's Feelings and Needs After Childbirth by Sally Placksin
The Year After Childbirth by Sheila Kitzinger
Sunday, December 13, 2009
babies--a new film
The upcoming film by Thomas Balmes, Babies, which will be released in April 2010, follows the story of four babies in four very different cultures through their first year of life. Babies takes a look at the uniqueness and differences of this early stage of life in Mongolia, Namibia, Tokyo, and San Fransisco.
I look forward to seeing this film, especially learning about the other cultures. It also reminds me of one of the most interesting and refreshing articles, “Breastfeeding in the Land of Genghis Khan,” published in the July-August issue of Mothering Magazine, in which Canadian-born Ruth Kamnitzer writes about Mongolians’ distinctly different attitude toward the practice of breastfeeding. Living in Mongolia while nursing her son, she soon learned she did not have to take pains to be discreet:
Kamnitzer still felt a bit out of step with cultural norms—but this time, roles were reversed. She had to learn to become comfortable with much looser standards about who should be drinking breastmilk:In Mongolia, instead of relegating me to a 'Mothers Only' section, breastfeeding in public brought me firmly to center stage. Their universal practice of breastfeeding anywhere, anytime, and the close quarters at which most Mongolians live, mean that everyone is pretty familiar with the sight of a working boob. They were happy to see I was doing things their way (which was, of course, the right way). When I breastfed in the back of taxis, drivers would give me the thumbs-up in the rear view mirror and assure me that Calum would grow up to be a great wrestler. When I walked through the market cradling my feeding son in my arms, vendors would make a space for me at their stalls and tell him to drink up. Instead of looking away, people would lean right in and kiss Calum on the cheek. If he popped off in response to the attention and left my streaming breast completely exposed, not a beat was missed. No one stared, no one looked away--they just laughed and wiped the milk off their noses.
Not only do I look forward to the segment on Mongolia, I am also very curious about birth and nursing practices in Namibia, a culture where parenting is natural and nurturing, but the risk of illness from HIV, malaria, diarrhea and pneumonia is dangerously high. Namibia already had high rates of infant death and illness due to perils like HIV, malaria, and imposed pressure of powerful corporations to artificially feed babies, even amidst the poor water conditions common in this part of the world. In this case, artificial breast milk substitutes greatly increases malnutrition and diarrhea in infants and leads to higher instances of infant death. However, when Americanized birthing styles and mass immunizations (sometimes with good intentions but outdated ingredients or 'left-overs' from the U.S.) began to be imposed on mothers/babies in Namibia, rates of morbidity and mortality started to climb even further.If weaning means never drinking breastmilk again, then Mongolians are never truly weaned—and here’s what surprised me most about breastfeeding in Mongolia. If a mother’s breasts are engorged and her baby is not at hand, she will simply go around and ask a family member, of any age or sex, if they’d like a drink. Often a woman will express a bowlful for her husband as a treat, or leave some in the fridge for anyone to help themselves.
Japan, on the other hand, currently has the fourth best rate of infant health and survival in the world, drastically different than that of the United States, which does not even compare, sitting behind 44 other countries in infant mortality and morbidity rates--and, sadly, is continuing to fall farther every year, according to the CIA infant mortality statistics. It is interesting that, even though Japan has started to adopt many of the birthing and baby care trends common in the United States, they still maintain far better rates for infant survival then we do, although their rates did fall slightly after they began adopting these trends.
Infant morbidity and mortality statistics will exist no matter what we do--it is an inescapable part of nature. However, there are varying reasons for these statistics to exist as they do. We can learn from the birthing and infant care practices of countries with the lowest infant mortality and morbidity statistics, such as Singapore, Bermuda and Sweden, and make positive changes in our own practices as a result. I look forward to seeing the film Babies, and I anticipate that it will be both delightful and insightful. In the meantime, enjoy the trailer!
Tuesday, September 29, 2009
misrepresenting homebirth
I am outraged that such a misrepresentation of birth options was presented by The Today Show, a show that I once respected and admired, in a story titled, "The Perils of Home Births," originally captioned, "Extreme Birth." While my prayers and sympathies do go out to any family who loses a child, it is important to consider that tragedies do happen in childbirth, no matter the location or attendant. Birth tragedies do not solely take place for women who choose to homebirth. It is also important to note that the United States has one of the highest infant mortality rates in the western world, after all, and one of the lowest percentages of homebirth rates.
I encourage the producers of The Today Show to air a more unbiased story of the importance of birth choice and birth options, the wonders of midwifery and homebirth, and how homebirth can be a safe alternative for many healthy, normal pregnancies and deliveries. I signed the petition Demand Accurate Reporting of ALL Birth Options. I am asking you to sign this petition to help reach the goal of 5,000 signatures. I care deeply about this cause, and I hope you will support their efforts, as well. The petition will be presented to the producers of The Today Show next week.
Here is a link to the video "The Perils of Home Births" presented by The Today Show.
I encourage the producers of The Today Show to air a more unbiased story of the importance of birth choice and birth options, the wonders of midwifery and homebirth, and how homebirth can be a safe alternative for many healthy, normal pregnancies and deliveries. I signed the petition Demand Accurate Reporting of ALL Birth Options. I am asking you to sign this petition to help reach the goal of 5,000 signatures. I care deeply about this cause, and I hope you will support their efforts, as well. The petition will be presented to the producers of The Today Show next week.
Here is a link to the video "The Perils of Home Births" presented by The Today Show.
Friday, August 14, 2009
The Birth Survey
The Birth Survey is grassroots volunteer community that is "dedicated to the promotion of advancing transparency in maternity care." The Birth Survey shares honest, objective information about birthing caregivers and settings. The survey is filled out by women who share their own personal birthing experiences and essentially rate their maternity care, their OB or midwife, and the place where they gave birth (hospital, birth center).
By viewing various reports, you can get an accurate idea of, for instance, a particular hospital's intervention rate. One of the primary goals of The Birth Survey is to help women make informed choices regarding their birthing care. The survey only takes approximately 30 minutes.
Plus, if you pass this information on, you have the opportunity to win various prizes!
Come join the weekend fun as we mark the one year anniversary of the national launch of The Birth Survey! Starting now and ending at midnight on Sunday (Eastern), we will be giving away “door” prizes and other fun things. http://www.birthactivist.cSo? What are you waiting for? Go win stuff!om/2009/08/happy-birth-day -birth-survey/
Wednesday, June 24, 2009
belly dance as traditional birth dance
In ancient times, belly dance was commonly used as prenatal conditioning for women, and was performed by a birthing mother during labor and the birthing process as a therapeutic aid. The rhythmic movements of belly dance actually mimic the physical changes a woman's body goes through during all stages of labor. Once you begin to study belly dance, the correlation between belly dance and natural stages of childbirth is evident.
During the beginning stage of labor, rhythmc movements, similar to the movements made in bellydance, help the birthing mother to relieve pain and shift tension, as well as to move the baby down the birth canal.
As labor shifts and becomes more active, the birthing mother also shifts in to a more emotional state, which employs the more spiritual aspects of bellydance. As a drummer, I always think of the Arabic rhythm, Chiftitelli, a long, slow, and dramatic rhythm, which is often reflected in long, slow, dramatic movements of the birthing mother.
When the intense transitional stage comes on, the birthing mother's abdomen, and often her entire body, begin to reflexively tremble and undulate. This movement is recreated in belly dance, and is referred to as a shimmy. While challenging to get the hang of when learning to belly dance, it is a movement the body makes when the muscles of the pelvis and abdomen are completely relaxed and loose. In childbirth, the natural shimmy that occurs indicates that it is time to push.
During my birth experiences, I remember finding undulations helpful in the beginning stages of labor, and as contractions became more intense, hip circles helped me to find a rhythm and concentrate on something other than the pain in order to progress, allowing gravity to take its course.
It is absolutely amazing to me that of childbirth is represented and recreated in such a dedicated way by the ancient art of belly dance.
The following are a list of videos that show prenatal belly dance. The first one reminds me of the rhythmic movements of the first stage of labor:
Very rhythmic and reflexive (active labor, going into transition). She makes the hip roll look easy, and it's easier to learn when you have a pregnant belly. This it to Chiftitelli:
I love*love*love American Tribal. It's so dramatic. They show the shimmy of the pregnant belly up close in this one:
During the beginning stage of labor, rhythmc movements, similar to the movements made in bellydance, help the birthing mother to relieve pain and shift tension, as well as to move the baby down the birth canal.
As labor shifts and becomes more active, the birthing mother also shifts in to a more emotional state, which employs the more spiritual aspects of bellydance. As a drummer, I always think of the Arabic rhythm, Chiftitelli, a long, slow, and dramatic rhythm, which is often reflected in long, slow, dramatic movements of the birthing mother.
When the intense transitional stage comes on, the birthing mother's abdomen, and often her entire body, begin to reflexively tremble and undulate. This movement is recreated in belly dance, and is referred to as a shimmy. While challenging to get the hang of when learning to belly dance, it is a movement the body makes when the muscles of the pelvis and abdomen are completely relaxed and loose. In childbirth, the natural shimmy that occurs indicates that it is time to push.
During my birth experiences, I remember finding undulations helpful in the beginning stages of labor, and as contractions became more intense, hip circles helped me to find a rhythm and concentrate on something other than the pain in order to progress, allowing gravity to take its course.
It is absolutely amazing to me that of childbirth is represented and recreated in such a dedicated way by the ancient art of belly dance.
The following are a list of videos that show prenatal belly dance. The first one reminds me of the rhythmic movements of the first stage of labor:
Very rhythmic and reflexive (active labor, going into transition). She makes the hip roll look easy, and it's easier to learn when you have a pregnant belly. This it to Chiftitelli:
I love*love*love American Tribal. It's so dramatic. They show the shimmy of the pregnant belly up close in this one:
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