Today on Science & Sensibility, I congratulate the Cochrane Collaboration on their 20 year anniversary and remind Lamaze International members that full access to this gold standard of evidence-based research. To read the whole post and learn how you can use the Cochrane Library for finding out current best practice, check out my post; Happy 20th Anniversary to the Cochrane Collaboration.
Archive for the ‘normal birth’ Category
This blog is a bit stagnant as I have been appointed to the Community Manager position at Lamaze International’s Science & Sensibility blog. Come on over to see what I am writing about!
Well, here I sit, in my own favorite chair, in my own living room, with my laptop balanced on my legs, and the sound of jet engines slowly fading from my ears! What a trip!
I am just back from the Lamaze International Conference in Orlando, Florida. Two days doing Disney “things” with my kids, (and trust me, two days was about 1 1/2 too many for all of us, but that is another story!) then on to the Conference.
The conference was held in the Coronado Springs Resort, in Disney. This place doubles as a million football fields all strung together! It is HUGE! HUGE! Like, if you leave something in the exhibit hall and are now in a breakout session in another room, and want to “run” back to get it, count on 20 minutes! Seriously, but enough griping!
I got to meet so many people that I have only heard about and read their material! Robin Weiss, who writes both pregnancy.about.com and many books as well as blogs over at The Birth Activist. I met Rixa Freeze, who received the Safe and Healthy Birth Media Award in recognition and appreciation of her engagement of new media and reaching childbearing women with critical messages about safe and healthy birth practices/ Her blog is on my blogroll, Stand and Deliver I met the blogger responsible for the great blog Mom’s Tinfoil Hat, who is in med school to become an OBGYN!. I looked for, but couldn’t find Amy Romano, who does the Lamaze Science and Sensibility blog. I also couldn’t find the blogger Reality Rounds, another one I love! I got to give a hug to Katy Rawlins from Idaho, who was presented the Safe and Healthy Birth Advocate Award in recognition of her promotion of safe and healthy birth and its contribution to childbearing women and their families. I got to meet Debbie Amis, who was was presented the Elisabeth Bing award in appreciation of her continued efforts to train and mentor new Lamaze childbirth educators. She also has a great blog that I love.
I got to clap really loud for my dear friend Teri Shilling who was presented the Lamaze International Award in recognition of her significant contribution to expanding the reach of Lamaze childbirth education around the world. I also met Barbara Hotelling, Ann Tumblin, Pat Predmore, Marilyn Hildreth, Ann Israel, and the list can go on and on, I probably left out many others, such a crowd of women (and a very few men!) who know that birth matters and how babies and women are treated during pregnancy and birth is important.
Another high of the conference was that I was a speaker! My session was “Working Your Magic!” The Educator’s Role in Reducing the Fear of Pain.” I had a blast and the session was received very well by the almost 90 participants! The attendees got to rock and roll during a realistic labor simulation with lots of ice! just like my clients and students do!
So many more things to say, but my head is spinning from lack of sleep! We got up at 1 AM Seattle time, in order to catch our very early plane out of Orlando!
I am renewed, encouraged, excited and proud to be a childbirth educator, doula and doula trainer! I know that what I do matters and I look forward to growing my business and improving my skills from all that I have learned this past week at the conference!
The week of September 21-28, 2009 is International Babywearing Week! Thank you to my friend Teri Shilling at Passion for Birth for bringing this to my attention and sharing some great resources!
I LOVED wearing my babies. Well, confession… my first daughter rode in a sling or other baby carrier occasionally and then a backpack frequently when she got older!. But, by the time I had my second daughter, I needed my hands free to hold my older child’s hand or push a shopping cart or carry things or….and I turned to a classic ring sling for my babywearing needs. My good friend Natalie Steiner gave me some quick lessons and I realized all I had done wrong the first time. Now, I was hooked!
I ordered a custom made sling in fabric I chose, along with a smaller matching sling for my older daughter to carry her babies in too! I was so excited and I am pleased to say that my younger daughter settled comfortably into her sling three days after birth, and neither of us ever looked back! I chose to leave the infant car seat carrier in the car, and get into the habit of taking my daughter out of the car and into the sling every time we went anywhere. No dragging that heavy, clunky, back-breaking carseat anywhere, no need to place it on the floor near all the dirt and grime and feet of the “outside world,” no need to fear all the hacking, coughing old ladies at Ballard Market who wanted to come up and touch my baby riding in her carseat on the top of my shopping cart! Oh no! My daughter was snuggled on my chest, usually fast asleep, or sometimes even nursing…safe next to my heart!
I wore out that lovely custom sling and two more additional slings (including one I made from an Elizabeth Lee Designs pattern) until they were threadbare from, from constant 18-hour/day use! The sling went on my body when I got dressed and came off when I went to bed…sounds extreme, but it worked for my family. I took my daughter to Europe for 3 weeks when she was 15 months old, with only a ring sling for carrying her and it was great!
One of my favorite parts of being a doula is meeting with my clients and their new baby for the first postpartum visit sometime between day 3-5. We cover all the important stuff like breastfeeding and mom’s recovery, but I always make sure to save some time to get their new little one into a baby carrier, (I bring a few of my own, in case one isn’t handy!)
It is especially heartwarming to see the partners so proudly wear their baby, and realize how easy, convenient and soothing it can be for both baby and parent! Way better than the teddy bear we practiced with at the prenatal visit!
If you are expecting, consider wearing your baby! It is good for your baby, good for the parents and the way it has been done for all time! If you are an experienced babywearer, comment to this post and let us know what type of carrier you like best and why, and how we can source them (weblink) and I will add that information to my resource page!
Enjoy this short but wonderful video on babywearing and celebrate International Babywearing Week by keeping your baby kiss-ably close in your arms, in a baby carrier!
More info on babywearing can be found at Babywearing International
When I am teaching childbirth classes and doula trainings, I “sing the praises” of singing or toning in labor! When a woman opens her throat and her mouth and vocalizes, sings, chants, tones or hums during labor, it helps to keep her bottom and perineum loose and relaxed. Ina May Gaskin, the famous midwife and author of several books, including my favorite “Ina May’s Guide to Childbirth,” says in her books; “loose lips, loose perineum.” I believe that whole-heartedly.
I just came across a new favorite video of a woman singing her way through transition (8-10 cm) and wanted to post it here, along with an older favorite as well! I often show these in class and everyone clearly sees the power of the song!
Watch these two clips and enjoy the power of birth as the women sing their birth song! And if a birth is in your future, consider adding song to your labor toolbox.
(and as a side note, I once had a very talented voice professional as a client, and prenatally, I suspected that vocalizing would be one of the things that would work for her as a coping technique in labor. Reality: during her unmedicated birth, there was no toning or singing! But she did state repeatedly in a very loud, vocal manner, “My ass is gonna explode,” as she powered through a very intense transition! Such a unique birth song!)
This week, The American College of Obstetricians and Gynecologists (ACOG) released “updated” recommendations for eating and drinking in labor. Recommendations Relax on Liquid Intake During Labor is the title of their newest Committee Opinion, and I fear it is already hopelessly outdated before the ink is even dry on the page!
The newest recommendations “allow” women to consume “modest amounts of clear liquids such as water, fruit juice without pulp, carbonated beverages, clear tea, black coffee, and sports drinks.” While this is certainly a big improvement from the “ICE CHIPS ONLY” policy that has been around forever, it hardly seems like the kind of nourishment one would want a laboring mama to be limited to, when she is doing the magnificant, powerful, hard work of birthing a baby!
I could go on and on about how this “new” policy makes no sense, alas, another blogger has already done a much better job than I ever could! Head over to The Family Way Publications Blog and read how a person has more of a chance of being struck by lightening TWICE in one year, than they do in dying from aspiration in labor!
There, you can also follow links to studies examining the true risks of eating and drinking in labor, find out that the American Society of Anesthesiologists (ASA) announced more than 11 years ago, that women should be allowed clear liquids in labor, and read how the American College of Nurse-Midwives (ACNM) recommends counseling women on the rare risk of complications from eating in labor, and encourages laboring moms to make a decision from a place of informed choice!
As a doula who has attended more than 130 births and a childbirth educator who has listened to probably 500 birth stories over the years at all those birth class reunions, I have always been impressed with the wisdom of women and their bodies to know when it made sense to eat and drink in labor and when they needed to cut back!
The fact is, women who are working crazy hard to have their baby, are just not asking for a cheeseburger between contractions! And, if they are, my bet is they have a ways to go before baby is earthside, and we would all benefit from making sure that she is eating and drinking to appetite and thirst.
Women who are denied adequate calories, energy and sustenance during birth often end up with longer labors, less energy and stamina as the hours drag on, and increase the risk of unwanted complications and interventions…all because they are running out of “steam” on their ice chip diet!
I encourage my clients to eat easy to digest foods (grapes, nut butters, eggs, yogurt, toast, melon, pasta, brown rice, yummy soup, strawberries, bananas…you get the idea), good quality proteins and carbs and plenty of good liquids like Recharge (a natural gator-ade product with no corn syrup or strange artificial colors), Emergen-C and my favorite, Bolthouse Perfectly Protein drink, (my fave flavor is Vanilla Chai) throughout labor, as long as they can, and to drink at least diluted juice till birth, even when they can’t eat anymore, just so they have calories going in!
I have seen eating and drinking in labor make all the difference in how the birth goes! And I have seen how quickly women fade and lose necessary energy and strength when denied nourishment! (1000ml of Lactated Ringers on your IV pole is not an adequate replacement for good quality food and drink!) If you are having a hospital birth, I encourage a dialogue with your doctor or midwife about both their philosophy around women eating in labor, as well as the policies of the birth center or hospital. Listen carefully and make your own choices about what you and your body need during your labor and birth! I deeply believe that women know what is best for themselves and their babies!
And if you have a minute, share your favorite labor/birth food and drink ideas and stories from a client or your own birth! Post your comments here!
PS: Don’t forget that partner also needs good fuel to get him/her through too! Remember that!
The United States of America, world’s largest, (financially!) most powerful country, land of opportunity, the home of the “American Dream” takes their place in line behind 48**other countries when it comes to infant mortality. Infant Mortality is defined as the death of an infant under the age of 1 year per one thousand live births. 48 other countries, including Slovenia, Cuba, and Cyprus have better infant mortality rates than the USA!
Why? We must ask why! And we must demand better from our medical system, from our government, from our social systems! Frankly, I think this situation is disgraceful!
We deserve better, our mothers and babies deserve better! Debbie Takikawa is the woman behind the project and the film, and she encourages all of us to do the following:
Send this videolink to your legislator!
Write your legislator!
Support the midwifery model of care for low risk women!
Share this on your facebook page, blog about it, Twitter!
Check out Debbie’s website and learn more. Only working together, can we as a country climb out of the big hole we are in and better out position on this very important list! Our babies depend upon us!
**Source: Population Reference Bureau
I read a great blog post today by a Certified Nurse Midwife about the usefulness (or actually, the possible emotional harm!) of vaginal exams prior to the beginning of labor. I think this is a great read and good information to take to heart, and have at times said exactly the same words to both clients and class participants. I already posted this over at the ICAN Seattle blog, ( I am the co-leader of the Seattle Chapter) but felt it was so good, I needed to get it up on my own blog too!
The question I always ask is this…. ‘Will the information gained from THIS vaginal exam change what we are going to do today?’ In your present situation, unless you are considering being induced a vaginal exam is irrelevant. What do I mean irrelevant…it does not change what we are going to do TODAY and things can literally change overnight. Because of this, I encourage you to avoid all vaginal exams until you think you are in labor and are having a labor check or you are preparing for an induction. I encourage you to let go of your current cervical change expectations and focus on getting your mind ready for labor and motherhood. You can go from closed to delivered overnight. It will happen. Don’t start to doubt and don’t start to worry. Your body and your baby know the perfect time to move to birth.
Recently I had a student in a class come to me during a break and ask me if spotting, crampiness and some contractions were normal at 33 weeks. I told her that those symptoms might be a reason to check in with her Health Care Provider, as they might want to rule out pre-term labor. She went on to tell me that she had had an appointment the day before, where a vaginal exam was done, that was fairly painful.
Ever since then, she had been feeling some contractions and cramps. When asked why the exam was done, she could not tell me, other than her HCP suggested it. I honestly did not know what to say, and wondered to myself if this woman was going to be birthing a 33 weeker because some things got stirred up when they should have left things alone. I did encourage her to check in with the provider, and am pleased to report that after another day, things settled down and she has not yet gone into labor!
Skip over to read this entire blog post by It’s Your Birth Right; Skip This Routine and think about keeping YOUR pants on if you are not in labor!
I received a call from my doula student last night, updating me on her clients! I am ever so pleased to report that this woman gave birth non-induced and non-medicated and non-intervened with to a happy, healthy baby on Saturday!
And now for for the rest of the story…the doula met up with them the evening before the scheduled induction, and was really present for their discussion and decision-making process. The doula shared The Problems and Hazards of Induction CIMS information sheet from her doula training manual. Using her wonderful, reflective listening skills, she heard the mom say that she wanted to go into labor on her own, that she did not want to be induced and felt like she might want to switch doctors, but who would “want” her, as she was past her due date. As the parents talked, they realized that they would not go in the next day for the induction and would wait for labor to start on it’s own.
The morning of the now-cancelled induction, the mom started having some contractions! It started to look more and more like active labor. Amazing how removing emotional issues can be freeing for some women and tip them into labor. Alas, the evening saw things slow down and peter out. The parents went to bed and woke up Friday morning with no sign of any labor at all. Discussions with the doula involved re-affirming that her body and her baby knew what to do and that her baby will pick it’s due date and be born when it is ready. Friday night, labor started again, and this time, kept on going, a late night trip to the hospital, several hours in the tub and a wonderful baby landed earthside! Mom gave birth in an upright position, unmedicated and oh so powerful! The doula reports that the parents are thrilled with the experience, so thankful for the support and listening ear of their doula, who helped them to clarify what was important to them.
I was proud of this new doula, and told her so! I am glad that she sought out my help when she felt she needed it, glad she was there for her client and supportive of the couple as they found their way. And oh so happy this mom got to have a wonderful, empowering birth on her own terms.
I am so lucky to have the opportunity to teach birth doulas as part of the faculty of the Simkin School for Allied Birth Professions at Seattle Midwifery School. I know I can help one family at a time as a birth doula, but I get the shivers when I think of how many families the doulas I have trained can go on to empower! I always tell my doula students, that if they ever need to bounce ideas off someone, or find themselves “stuck” and need some help, they can call me 24/7. I am always happy to help! I remember what it was like when I was starting out and was grateful for my experienced doula sisters who made themselves available to me. And now in turn, I can do the same! The circle of life continues!
I had a newer doula call me yesterday for some advice. She had been in a recent doula training class at Seattle Midwifery School and wanted to talk over a current client situation. Her client was less than a week overdue with her second child and her first baby was a vaginal birth with no complications. Her doctor told her that she needed to be induced, sooner rather than later! Like…tomorrow! And when this client inquired as to why, the reasons provided by this surgeon were: 1) most women are done being pregnant by now and just want their bodies back, 2) the baby is only getting bigger and bigger every day, and pretty soon your baby’s head will not be able to fit through your pelvis. Remember, this is a mama who has a “proven” pelvis, meaning that a baby has already found it’s way out through this very same pelvis, that now is getting more and more unable to birth her second baby by the minute! When the client asked about waiting a few more days, the doctor replied that the client could only be induced on days that the doctor was on call, even though this is one practitioner in a large, well established practice with doctors on call 24/7 for the unlikely event that a labor actually starts on it’s own.
Since this multip’s (woman who has already birthed at least one baby) cervix was already dilated and effaced, the method of induction would be pitocin or if the client preferred, they could rupture her membranes. No discussion of the benefits or risks or alternatives of any of these interventions, no discussion of the evidence based research that supports the appropriateness (or not) of these interventions, nor any reason that indicates this induction is based on a valid medical reason.
The parents were confused, scared and nervous. Maybe the obstetrician was right, maybe it was best to induce the next day! They asked for more time to discuss this privately and told the OB they would call with more questions. They called their doula, using her as a resource to help them make this decision. And the doula called me. The more I listened to the comments allegedly made by the doctor, (and I do realize I was receiving this information second-hand!) the more I could feel myself shake my head in disbelief. How is this behavior ethical? Even The American College of Obstetricians and Gynecologists, (a professional organization, mind you, not a research institution) in their own literature and patient pamphlets states what is a valid medical reason for induction! And “wanting your body back” is not on the list! No evidence of improved outcomes following induction of labour for non-diabetic women who are thought to be carrying large babies has been found that warrants an induction for macrosomia in this case.
What is up? Where is the information about informed choice, benefits and risks? Where is the truth? A great resource for anyone facing an induction for non-medically supported reasons (and even for the medically supported ones!) can use the Coalition for Improving Maternity Care Problems and Hazards of Induction as a great guide. CIMS Problems and Hazards of Induction Fact Sheet
An extremely valuable resource was published this fall by some powerhouse organizations, including Childbirth Connections that I think should be required reading for all women of childbearing age, particularly, the pregnant ones: Evidenced Based Maternity Care: What It Is and What It Can Achieve You can read a pdf on-line, or you can order copies for free! What a fantastic resource. If you are a doula, childbirth educator, or other birth professional, consider ordering some for your practice to share with clients!
As for the woman mentioned in the original paragraph, at last report, she has been in early labor since this morning, all on her own and with the support of her partner and doula, waiting for things to pick up! Maybe it was that beautiful full moon over Seattle that “induced” her baby to come! May this baby arrive safely earthside before the moon sets again!
A day just full of birth, from morning to night! First off, a postpartum visit with a mama and four day old little girl! It is so nice to help get breastfeeding off to a good start and reassure the new parents that things are going well, even if they feel all topsy-turvey, which is so normal.
Then, a PALS Doulas board meeting, with lots of exciting plans and ideas for this wonderful Seattle based doula organization, the oldest doula organization in the country!
Later this evening, it is time for ICAN Seattle to meet, and we are having a local Certified Nurse Midwife come and share some of the current issues for VBAC women that she sees in her practice and at the hospital where she works! I am a co-leader of this group, and am enjoying it very much. ICAN has a wonderful video on women who have gone on to have vaginal births after cesareans (VBAC) after they were told they had CPD (Cephalo-pelvic Disproportion), meaning no baby would fit through their vaginas. I find it so inspirational, and you should check it out![youtube=http://www.youtube.com/watch?v=roFVkDV45MM&eurl=http://www.ican-online.org/community/videos/laureen/question-cpd]
The day is full of good things, good people and birth! What could be better!
I sit on the board of REACHE, Regional Association of Childbirth Educators of Puget Sound, and we are getting ready to have our 27th annual conference, geared toward childbirth educators, labor and delivery nurses, doctors, midwives, doulas and other folks involved in maternity care.
This year’s conference is sure to be a wonderful one! Hold the date: April 17th, 2009!
Why Are We All So Afraid? Perspectives on How Fear and Risk Impact Birth
Hype or Help? The Media and Maternity Care.
Issues such as home birth, cesarean section, and maternity care in general have been getting more attention in recent months in print media, television, and film, and the amount of information accessible on the web continues to grow. How is modern childbirth being portrayed and how are mothers being portrayed? How does this affect pregnant women’s knowledge and attitudes toward birth? Is the information age helping women make more informed choices or making them ore fearful?
Balancing Fear and Faith: Risk Estimation in Modern Obstetrics.
Dr. Kotaska’s presentation will include: What is “normal” birth and why is it important to define? The language and the culture of risk. Overestimating obstetrical risk. Industrial versus normal birth. Fear versus faith in modern obstetrics. An interactive question and answer session.
The Courage to Birth: Reducing Fear and Enhancing Confidence
Fear is a stumbling block to many women who are trying to achieve a normal birth. Learn how it affects labor progress and birth outcomes, and discover specific strategies to help clients reduce fears and develop the confidence needed to have a positive, satisfying birth experience.
The Effects of Fear and Risk on Obstetric Practice
Dr. Dawn Russell, MD, OB/GYN at Evergreen Women’s Care in Kirkland, Washington will cover the life experience, education and training processes for a practicing OB/GYN. She’ll explain how these processes influence her practice and decision making.
Check out the REACHE website to register, or for more information!
See you there!