June Class Series - Prepared Childbirth

Healthy Mama Childbirth is pleased to present a June 2011 Prepared Childbirth Course.

The course will begin Tuesday June 7 and run each consecutive Tuesday of the month of June (June 7, 14, 21, 28) from 6pm - 9 pm at Perrow Presbyterian Church in Cross Lanes, WV.

Class topics:
...Class 1: The Third Trimester
Class 2: Regular Course of Labor
Class 3: Variations of Labor and Common Procedures
Class 4: New Baby Care and Postpartum Adjustment

This course is regularly offered for 120.00, but the June series is offered at half price! A 20.00 deposit is due at registration. Please contact healthymamachildbirth AT gmail.com for registration.

More information:
The Prepared Childbirth course is a full four week course designed for women and couples in the latter half of pregnancy. The course is suitable for women and couples in a first pregnancy, as well as those needing a refresher course.

The course focuses on presenting pregnancy, labor, and birth as normal parts of life rather than as times of illness or caution. Because of this, "typical" labor is presenting as a baseline for all other discussions of labor and birthing. However, participants will still become competent in the variations of labor.

Additionally, hospital procedures and interventions will be discussed in terms of benefits and risks, particularly in how they may affect the course of labor. High-risk mothers will also benefit from this focus on "typical" labor in light of how their experience may differ. Birth center and homebirth clients will also see how their choices affect what they can expect during labor.

Class content is presented in a variety of ways in order to meet the needs of adult learners. Participants can expect lecture, handouts, group discussions, guest speakers, displays, role play, physical models, rehearsal, demonstrations, relaxation, and review games.

Class Goals:

* to facilitate an appreciation that birth is a normal and healthy event
* to enhance communication between families and caregivers
* to provide means for partners to support birthing women
* to assist in creating a positive birth environment beginning in pregnancy
* to assist families in achieving a healthy pregnancy and birth
* to facilitate informed consent
* to enhance communication between the woman and her partner
* to assist individual values clarification, regarding your needs and wants for pregnancy, labor, birth, and postpartum

A little late, but better than never: A short analysis of the BMJ exclusive breastfeeding attack

Yes, it's late. But I recently needed to look at studies and analyze them, and this was one I looked at (turned out I needed something else, but that's beside the point.) 

The article is here for reference: http://www.bmj.com/content/342/bmj.c5955.full

I will refer to the full-text of the article, which is free. I will also refer to the citations used by the authors.

The article starts off with an odd statistic. It states that although the WHO recommendation is six months of exclusive breastfeeding, that 65% of all European Union states and the United States "elected not to follow this recommendation fully." This appears to sound as though those nations disagreed with the recommendation; however, the citation for the claim is simply an article on breastfeeding rates rather than policy. For the record, the American Academy of Pediatrics agrees with WHO and recommends six months exclusive breastfeeding. While the nation may agree it is best, and many women may try to follow the recommendation (initial breastfeeding rates are high), actual six months exclusive rates are low.

The article continues by attempting to discount the systematic review the WHO recommendation is based on - "the review included 16 eligible studies, seven of which were developing countries." This seems to be a primary point throughout the article (and many others that attempt to discount exclusive breastfeeding through six months) that while breastfeeding exclusively for six months is best in poor developing countries, it is not so for developed countries (because we have scientifically engineered stuff that is supposedly better than natural).

Breastfeeding adequacy is questioned later, as the authors cit a study by Wells and Reilly and state that "many mothers who exclusively breastfeed would not support their infant's energy requirements to six months." Unfortunately, no further information backing this up is given (unfortunately for them!). The study cited is actually only a hypothesis proposed for developing countries and the authors Wells and Reilly would like further studies to see if this hypothesis is true.

Later in the article, low iron levels are looked at. The authors cite a study that found lower iron levels in United States infants breastfeed exclusively for six months as opposed to four to five months. However, when I looked up this citation, the study also found that the differences were "statistically insignificant." The other studies cited here are ones linking iron deficiency to low cognitive performance and development; a valid point if the difference in iron levels had been significant and of concern.

The article then addresses food allergies, citing a study that found introducing gluten prior to three months and after six months increased the risk of gluten allergy. The authors claim this justifies introducing solids between three and six months. Unfortunately (for them), when i looked at this citation, the study only included infants deemed "at risk" for such an allergy, rather than infants as a whole. The authors the article then state that exclusive breastfeeding to six months is directly challenged by this evidence of higher risk for celiac disease. 

The article's purpose is to demonstrate the need for randomized trials regarding breastfeeding rather than the current observational studies. Some may argue this is unethical, particularly in light of the author's own statement that early feeding practices directly influence the rest of a child's life. 

Of particular interest, the article ends by addressing competing interests. While none of the four authors received "external funding in connection with the preparation of this manuscript," three of the four "have performed consultancy work and/or received research funding" from infant food and formula companies in the last three years. I think that is particularly telling in light of the article's flaws.

Thoughts on the birth battle

Recently I have been becoming more and more disgusted watching the arguments in the birthing world. I'm sad part of me is less "green" about it all, because I certainly like the hopeful, optimistic me. 

Part of this stems from my entering nursing school (well almost - I'll know by April if I'm accepted) in an effort to continue down my path to helping birthing women while trying to support my family. I feel like a spy in my classes with nursing majors, like I'm trying to figure out how the brain works to so blindly trust the medical model at the expense of common sense, mamas, babies, and families.

My conclusion: In many ways we're all guilty of the same blindness.

Both sides of the birth war use the same methods of guilt and anger, the same self-righteous attitude. 

Before I get hate mail, let me be clear that I am certainly on the homebirth, breastfeeding, unassisted if you want it side. 

But we're not free from the negatives - the failure to see some options as appealing to others even we will feel they're dangerous (so hard!). And to be honest, I don't know what we do about it - if anything.

It is absolutely true that we often make women feel guilty for not breastfeeding.

Mothers should feel guilty about not breastfeeding - just as they should feel guilty about giving a child a Coca-cola and a donut instead of milk and a banana.

But how do we prevent that guilt from turning into defensive rationalization and inability/refusal to change? How do we communicate with love, empathy, and understanding?

I think we have to start with these assumptions - we do not know all the reasons a mother may choose to do "X" and she is not at the same place we are.

The second assumption, to me, is the hardest and the most important. We can talk until we're blue in the face about the risks of not breastfeeding (which as a note is proven more effective than presenting it as the benefits of breastfeeding - study) but without long-term cultural change we are not going to get there with everyone.

I hate this.

The idealist in me wishes I could help everyone, save every mama and baby from a bad birth, but I can't. No one can. We can try our damnedest and then we just have to hope. Things may not change now, but down the road these seeds may sprout and bloom. We just have to keep planting and watering and weeding. 

Breastfeeding Misinformation begins with Doctors and Nurses

As some of you may know, I have recently gone back to school. I've applied to a local RN Associate Degree program and am working on related coursework. One of my courses this semester is Nutrition and Diet Therapy, and as part of the course requirements, we're presenting group projects. Yes, pregnancy nutrition was taken by the time I got to sign up, but I managed to snag breastfeeding.

I started by scanning my textbook (which is required as we're primarily presenting the text information and supplying research to compliment). I came across this gem: "The adjustments [of breastfeeding comfortably] are easier if supplemental formula feedings are not introduced until breastfeeding is well established, after at least 3 to 4 weeks. Then it is fine if a supplemental bottle or two of infant formula per day is needed." [Contemporary Nutrition: A Functional Approach]

I had a few choice words and then set out to find the research to disprove it. I'm presenting that here.

First - The statement goes directly against current breastfeeding recommendations. WHO states that "exclusive breastfeeding is recommended up to 6 months of age, with continued breastfeeding with appropriate complementary foods up to two years of age or beyond" (Citation) American Academy of Pediatrics goes this far: Supplements (water, glucose water, formula, and other fluids) should not be given to breastfeeding newborn infants unless ordered by a physician when a medical indication exists.” and “Pediatricians and other health care professionals should recommend human milk for all infants in whom breastfeeding is not specifically contraindicated and provide parents with complete, current information on the benefits and techniques of breastfeeding to ensure that their feeding decision is a fully informed one.  When direct breastfeeding is not possible, expressed human milk should be provided." (Citation) Healthy People 2020 Targets are exclusively breastfeeding through 3 months - 46.2% and exclusively through 6 months - 25.5% (Citation)

Second: Formula Supplementation has been linked to early breastfeeding cessation: “Partial breast-feeding (supplementing more than one bottle of formula per day, measured at 1 month postpartum) was associated with shorter breast-feeding duration. This latter effect was minimized by frequent nursing (seven or more times per day), despite formula supplementation.” (citation) 

And finally: “Clinicians who recommended formula supplementation or who do not think their advice about how long to breastfeed is very important may be sending signals that exclusive breastfeeding is not something that mothers should value highly. In addition, our results indicate that many clinicians do not feel confident in their skills to support breastfeeding and may have limited time to address the issue during preventive visits. As for mothers, experiencing problems with the infant latching on or sucking seems to be a risk factor for not exclusively breastfeeding.” (Citation - I found the full article through Ebscohost and cannot link it directly. You can comment/email me for the file and I will be happy to supply it.)

I'm excited to use the information I've found to disprove such a fallacy and educate other nurses. Let's hope they listen...

Modern Medical Birth Control - Risks

 Sometimes people wonder why I go through all the trouble of charting to avoid pregnancy when women have so many other birth control options. 

I just wonder why they put themselves through medical birth control methods. 

Let's look at the risks of some of the modern methods. By the way - It concerns me that I had to do extensive searches on each website to find this information. Some even hide the full side effects from the FAQs portion of their site.

Hormonal birth control pills and patches

Taken from the pdf file (download here) for OrthoTriCyclen - "The use of oral contraceptives is associated with increased risks of several serious conditions including myocardial infarction, thromboembolism, stroke, hepatic neoplasia, and gallbladder disease, although the risk of serious morbidity or mortality is very small in healthy women without underlying risk factors. The risk of morbidity and mortality increases significantly in the presence of other underlying risk factors such as hypertension, hyperlipidemias, obesity and diabetes."

OthroEvra (the patch) contains almost identical wording. 

Seasonique (the three-month no-period pills) -  "Vascular risks: Stop Seasonique if a thrombotic event occurs. Stop Seasonique at least 4 weeks before and through 2 weeks after major surgery. Start Seasonique no earlier than 4 weeks after delivery, in women who are not breastfeeding. (5.1)
• Liver disease: Discontinue Seasonique if jaundice occurs. (5.3)
• High blood pressure: Do not prescribe Seasonique for women with uncontrolled hypertension or hypertension with vascular disease. (5.4)
• Carbohydrate and lipid metabolic effects: Monitor prediabetic and diabetic women taking Seasonique. Consider an alternate contraceptive method for women with uncontrolled dyslipidemias. (5.6)
• Headache: Evaluate significant change in headaches and discontinue Seasonique if indicated. (5.7)
• Uterine bleeding: Evaluate irregular bleeding or amenorrhea."

Depo-Provera Shots - "Thromboembolic Disorders: Discontinue Depo-Provera CI in patients who develop thrombosis (5.2)

Cancer Risks: Monitor women with breast nodules or a strong family history of breast cancer carefully. (5.3)

Ectopic Pregnancy: Consider ectopic pregnancy if a woman using Depo-Provera CI becomes pregnant or complains of severe abdominal pain. (5.4)

Anaphylaxis and Anaphylactoid Reactions: Provide emergency medical treatment. (5.5)

Liver Function: Discontinue Depo-Provera CI if jaundice or disturbances of liver function develop (5.6)

Carbohydrate Metabolism: Monitor diabetic patients carefully. (5.11)
----------------------------------ADVERSE REACTIONS---------------------------
Most common adverse reactions (incidence >5%) are: menstrual irregularities
(bleeding or spotting) 57% at 12 months, 32% at 24 months, abdominal
pain/discomfort 11%, weight gain > 10 lbs at 24 months 38%, dizziness 6%,
headache 17%, nervousness 11%, decreased libido 6%. (6.1)

To ensure the patient is not pregnant at the time of the first injection, the first injection should be given ONLY during the first 5 days of a normal menstrual period; ONLY within the first 5-days postpartum if not breast-feeding; and if exclusively breast-feeding, ONLY at the sixth postpartum week."

Mirena (IUD device) (This was by far the most difficult to find information on. While others listed their "prescription inserts" with a bit of searching, Mirena asks that you talk to your health care provider for a full list of possible side effects) - "Call your healthcare provider right away if you think you
are pregnant. If you get pregnant while using Mirena, you may have an ectopic pregnancy. This means that the pregnancy is not in the uterus. Unusual vaginal bleeding or abdominal pain may be a sign of ectopic pregnancy.
Ectopic pregnancy is a medical emergency that often requires surgery. Ectopic pregnancy can cause internal bleeding, infertility, and even death.
There are also risks if you get pregnant while using Mirena and the pregnancy is in the uterus. Severe infection, miscarriage, premature delivery, and even death can occur with pregnancies that continue with an intrauterine device (IUD). Because of this, your healthcare provider may try to remove Mirena, even though removing it may cause a miscarriage. If Mirena cannot be removed, talk with your healthcare provider about the benefits and risks of continuing the pregnancy. 

Life-threatening infection can occur within the first few days after Mirena is placed. Mirena may become attached to the uterine wall. If embedment happens, Mirena may no longer prevent pregnancy and you may need surgery to have it removed. Mirena may go through the uterus. If your uterus is perforated, Mirena may no longer prevent pregnancy. It may move outside
the uterus and can cause internal scarring, infection, or damage to other organs, and you may need surgery to have Mirena removed.
Common side effects of Mirena include: Pain, bleeding or dizziness during and after placement. If these symptoms do not stop 30 minutes after placement,
Mirena may not have been placed correctly. Your healthcare provider will examine you to see if Mirena needs to be removed or replaced."

 

Essure - permanent placement of coils within the tubes - "The most frequent adverse events and side e ffects reported as a result of the hysteroscopic procedure to place the Essure micro-inserts were as follows: cramping (29.6%), pain (12.9%), nausea/vomiting (10.8%), dizziness/lightheadedness (8.8%), and bleeding/spotting (6.8%). Hypervolemia occurred in <1% of cases. During the rst year of reliance on the Essure micro-inserts for contraception (approximately 15 months after micro-insert placement), the following episodes were reported as at least possibly related to the Essure micro-inserts: back pain (9.0%), abdominal pain (3.8%), dyspareunia (3.6%). All other events occurred in less than 3% of women." A number of women had to undergo a second surgery because the initial surgery failed to properly place the devices or they became dislodged."

Tubal Ligation - difficult to find direct information since this is not a device or pill, but a procedure. Some general information may be found at webmd - "Minor complications include infection and wound separation. These affect about 11% of women after mini-laparotomy, and 6% of women after laparoscopy.³ Major complications include heavy blood loss, general anesthesia problems, organ injury during surgery, and need for a larger laparotomy incision during surgery. These affect 1.5% of women after mini-laparotomy, and 0.9% of women after laparoscopy. Although fewer complications occur with laparoscopy than with other kinds of tubal ligation surgery, these complications can be more serious. For example, on rare occasions, the bowel or bladder is injured when the laparoscope is inserted. The general risks of surgery are greater if you have diabetes, are overweight, smoke, or have a heart condition."

I encourage women to embrace their fertility. I wonder why so many doctors (and women) feel that loosing a period - and therefore fertility - is a fine or even good thing (think about those "unnecessary period" commercials). Fertility has long been feared by some men and now by some women.

I've heard it said that bottles were invented by men to separate the woman from her child. Don't allow men to separate you from your fertility.

Where do we stop with the "high-risk" designations?

The other day as I was scanning new books at my local library, I noticed one about high-risk pregnancy. I picked it up and glanced through it.

To be perfectly honest, I stopped when I saw the list of factors that may put you in a high-risk pregnancy.

I honestly think it would put more than 50% of the birthing population as high-risk.

Some are, to be certain, legitimate. Placenta previa, where the placenta covers all or part of the cervix, is more complicated than regular pregnancy and requires education and cesarean birth in almost all cases. I can understand the worries with existing diabetes (particularly if poorly controlled) or high blood pressure, even previous birth defects or preterm births.

But some of the others had me flabbergasted at the level of fear present in obstetrics today.

Pregnancy at less than 18 years old or more than 35 years old.

Low-socio economic status

Being underweight or overweight

Fertility treatments

Having a previous pregnancy loss (yes, singular loss. It's estimated that 10-20% of pregnancies end in miscarriage, but many may feel they have had a late, heavy period).

Having five or more pregnancies

ETC.

The list was quite long.

Why is there such fear? I'm afraid - BRUTAL HONESTY FOLLOWS - that our culture has gone so far away from death being a part of life that we are fearful from the point of conception that someone might die. We are willing to do anything to prolong life. Mothers, in particular, are pushed to self-sacrifice in order to give life to children (I am not talking abortion here. I am talking general pregnancy).

I had a miscarriage before I had my son. It was devastating and took a long time to work through. I still cry thinking about my lost little one; hearing of another's loss provokes the same pain. I lost a child and will always mourn that.

However, I fully feel there was a reason my little one should not have been born. It was his time in life to go. I won't speculate as to what the reason was (that leads down a dark path). It doesn't make it any easier to accept his death, but it is what it is.

I certainly agree that obstetrics has saved some lives that would have otherwise been lost. However, we cannot use that nor the fear of death as an excuse for the mistreatment women, babies, and families currently deal with in the system. In many cases. when presented with an unknown, watching and waiting is less deadly than the "well, we must do SOMETHING ANYTHING" attitude so prevalent in modern medicine. (Certainly we've all heard the scares regarding the current radiation levels we're subjected to with unnecessary ct scans and x-rays? I've been x-rayed for a stomach virus and high fever before. Also, think of the current MRSA superbugs in hospitals due to over-prescribing antibiotics, and the chicken-pox vaccine leading to increased shingles cases. It's got to stop somewhere soon)

We need to stop being so fearful and take back our health. For the vast majority of women, pregnancy and birth are times of health. Your best bet - see a care provider who believes this to be true rather than a care provider who believes pregnancy and birth are times where something could go wrong at any time and you need careful monitoring. Ask your WHY? questions and get second opinions. Loose the "all that matters is a healthy baby" mantra.

New book - look out for similar titles!

Just came across a new book in our local library titled The Birth Partner Handbook.

Do not be confused!!!!

This is not The Birth Partner!

I highly recommend The Birth Partner. This new one (by a different author), not so much at all. Very much in the vein of whatever the doctor says must be right.

Educate yourself and get The Birth Partner instead!