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!

How do you know when to go to the hospital/birth center in labor? An observation.

Last night as I was waiting in the ER with my dad (minor surgical complication; he's fine), I observed the strangest thing - three women entered and were directed to the OB admission area. The strange part - none appeared to be in active labor. One in particular (only 37 weeks) sat for at least 10 minutes nearby without even a peep or a squirm. The other two (both 38 weeks) talked with nurses easily, filled out admission paperwork, and climbed into wheelchairs.

The thought in my head - Why are they here yet?!

In pregnancy, among the labor and delivery horror stories, I also often heard about the women who went in too early - "Oh don't worry, I got sent home 'x' times before they kept me."

Did no one bother to tell them that they can (and should) stay at home as long as possible?

I tell women (even those planning an epidural) that in normal labor, you should look for 4-1-1 before heading in. This helps reduce the interventions you may "need" and gets you to the hospital at the point when labor is more likely to keep going rather than stall. Getting to the hospital earlier may even get you there at a point when you can't yet have an epidural (depending on your hospital and anesthesiologist).

With 4-1-1, contractions are about 4 minutes apart, last about 1 minute each, and have been doing so for about 1 hour.


Disclaimer #1: Follow 4-1-1 unless you have another reason to go to the hospital ASAP - bleeding, foul smell with vaginal leaking, feeling something through the cervix/vagina, if you feel that labor is going too quickly, or if you are not yet 38 weeks. I'm not a doctor and don't pretend to be one :)

Disclaimer #2: Don't go to the hospital at all if you can help it! Find a good midwife and birthing center or a good homebirth midwife if you're low-risk in pregnancy. It's not just a "fad"; it's good medicine.

Traumatic Birth – or why some women may prefer cesarean birth

Lately, I’ve found myself wondering why some women feel cesarean birth is better than vaginal birth. It’s been something I questioned before I was pregnant and was particularly confusing when I was confronted with my own cesarean.

For me, I always wanted a natural, med-free, intervention-free birth. It was devastating for me to be confronted with a cesarean. The recovery was particularly difficult, and the couple of times I “overdid it” really were painful and debilitating.

I’m looking at future pregnancies with fear, as complications during pregnancy are more common after cesarean – placental issues, tubal pregnancies, secondary infertility. The VBAC fight was never one I wanted to be faced with, but here I am.

So how could someone be not just satisfied, but even pleased, with this? I’m slowly beginning to understand.

Recently, I read an article about post traumatic stress disorder following birth; it’s on the rise. As a medical system, we need to acknowledge that in an age where 1 in 10 women suffer from postpartum depression, much less PTSD, that it is apparently not about “just a healthy baby.”

Women need to have the opportunity to mourn the births they have lost. The ideal birth, whatever it is for that particular woman, needs to be acknowledged, and if at all possible, pursued. For me – I lost my first birth to major abdominal surgery. For some, it’s losing the ideal of pain management when a planned epidural doesn’t work, or just being able to go into labor before the pressure of induction begins.

Many women see the cesarean as what saved them – whether it did or not. Maybe it saved them from another traumatic induction lasting 48 hours or more. Maybe it was a way of attempting to control the unknown. Maybe the recovery temporarily saved them from additional childcare and household responsibilities.

As a birth professional, I’ll be honest that I’m a little biased about the solution. But fortunately there are studies and guidelines to back me up. (I’ll list them at the end.)

Childbirth education should be expanded, encouraged, and absolutely available to all. It needs to involved couples working through both their fears and expectations. It must involve current research about normal labor processes and when interventions are medically necessary as opposed to simply routine. It should provide an opportunity for couples to build relationships with others in the childbearing year, expanding their network of support.

Doula care needs to be covered by Medicaid and private insurance. Having a labor doula can decrease the need for cesarean by up to 50%. Postpartum doulas can fill the role once done by the extended family – helping the new family adjust with each child added to the family.

Midwifery care should be more widely available, particularly in rural areas where OB presence is minimal. Low-risk women should be seen first by midwives and referred to OBs as necessary.

Women with negative birth experience should report these to their care providers with the intent that questions are answered and care is altered. It wasn’t too long ago that women and families decided it was unacceptable for fathers to be in the waiting room during the birth of their own children, or that women shouldn’t be forced to undergo “Twilight Sleep” and not be mentally and emotionally present at their own birthing.

It should be no different now that we refuse to accept the parts of the system that make us uncomfortable and that are not supported by rigorous research. What we’re comfortable with may be different woman to woman – med-free, highly managed, etc – but it’s time for individualized care again.

No woman should have to feel that major abdominal surgery was an easier and more acceptable solution that the birth route her body was made and designed for.


Studies and Resources:
Expecting Trouble – written by an obstetrician who feels 80-90% of women should have midwifery prenatal care and at least 70-80% should deliver with a midwife.

The Doula Book – numerous studies about the benefits of a doula – from childbirth satisfaction to birth outcomes.

Healthy People 2020 Guidelines - reduce cesareans, among many others

Post Traumatic Stress Disorder After Childbirth - particularly look at Ten Questions to Ask

Traumatic Birth News Article

Website Relaunch!

Just relaunched my webpage. Please check it out and let me know what you think!

http://sites.google.com/site/healthymamachildbirth

Thanks!

FAQs about Doula Services with Healthy Mama Childbirth

What is a doula?
A doula is a trained labor professional who provides support during labor and birthing. The word doula comes from the Greek, meaning “with woman.”

What help do you give as a labor doula?
I provide emotional, physical, and informational care throughout the entire course of labor. I can give you information about labor and birth to help you make informed choices, reminding you of what you have learned in classes and of your desires for labor and birthing. I provide emotional support in the form of encouragement and constant presence. I can give you suggestions to help your individual labor progress well and help you have a healthy birth. I support you physically with comfort techniques, such massage and counter pressure. I also support your partner, giving him suggestions and help for taking an active role in your labor support, allowing him to take breaks, and giving him informational and emotional reassurance regarding the birthing process. I will help you labor at home if you desire. I may also help you know when to go to the hospital or birthing center, or when to call the midwife.

What support do you not give as a labor doula?
A doula never provides medical care. I am however trained in medical interventions and can explain how they work as well as the pros and cons.
I do not replace your partner; instead I support the couple.  I will help as much or as little as the couple desires. Your partner has emotional investment in you; a doula usually does not. This is both a pro and a con. Your partner’s emotional investment in you allows him to truly understand you and provide care. A doula’s lack of emotional ties allows her to be objective and unbiased in your care.

What are the benefits of having a doula? From The Doula Book  (Klaus, Kennell, Klaus).
“In studies of over 5000 women involving comparisons of outcomes with and without such support [as a doula], we have seen a major reduction in the length of labor, a greater than 50 percent drop in cesarean sections, [and] a remarkable drop in the mothers’ need for pain medication.”

Why can’t I just rely on my doctor for everything?
You can, and you should, rely on your doctor for medical advice.

Unfortunately, many doctors don’t seem to have the time necessary for support. Are your prenatal visits less than 30 minutes? Do you have long wait times to see the doctor? If these are YES, then you probably have unanswered questions. Most simply don’t have the time to address basic needs such as what you eat, how you manage stress, or how you plan to arrange life post-partum.

Many women find that their doctor is not present during labor. Most doctors do not come until the pushing stage.  Your doctor may not be on-call when you go into labor, and someone you may never have met may be catching your baby.

A doula is the only trained professional who will be present with you throughout your labor, birthing, and early postpartum period.

Aren’t the nurses there to help me? What about my husband/partner?
Yes, the nurses are there to help you, but the help they may be able to provide might not be what you need or expect. Nurses are responsible for a number of patients, limiting their time to spend individually with you. Additionally, their responsibilities also include a variety of clinical tasks and paperwork. A nurse will certainly help you when she is able, but you will likely find you need information, comfort, and support “NOW” rather than when the nurse is finished with another laboring mother.

As for husbands and partners – while many men feel confident before labor begins, they often find this confidence wanes as labor progresses. They may resent the fact that they have to put aside their own needs and fears to support a laboring woman. Additionally, most men lack the experience and training necessary to continually provide comfort, support, and coping techniques required for a laboring woman. Many men, no matter how well trained in childbirth education classes, find recall and actual practice of techniques more difficult than they imagined.

It is normal for men to feel this way, and doulas are there to both validate the partner’s feelings and give him the support to in turn support his partner, the laboring mother. A doula can offer the informational and emotional support the partner needs. Some partners become overwhelmed just when the laboring mother needs to most support; a doula can allow him to take a quick break while still meeting the laboring mother’s needs.

What if I want an epidural? Are you going to try to make me feel bad or talk down to me?
No! I firmly believe that each woman (and couple) needs to make the choices they are most comfortable with at the present time. I feel my job is to help you make an informed choice – I want you to know and understand all the benefits and risks “common” procedures (such as epidurals and IVs) have.

I do support natural, unmedicated childbirth, and I feel that every woman is more than capable of having that kind of birth. But I won’t think you’re a failure if you don’t have an unmedicated birth. The thing I believe is most important is a safe, satisfying, healthy birth. Some women have it with epidurals, some don’t. Some women have it with natural childbirth, some don’t.

How do you feel about hospital birth? Do you think all women should have home births?
I operate fully under ICEA’s motto of “freedom of choice based on knowledge of alternatives.” Therefore, I fully support women and families in the choices they make in childbirth from elective cesarean to home birth, whether I would personally make the same decision or not.

I fully support home birth. I also fully support each family as they make the decision of birthing location based on both the knowledge of facts and personal needs and comfort levels. Many women in the United States choose to birth in a hospital or birthing center.

Is doula support covered by insurance?
Usually no. However, some families have been able to use funds from their health savings accounts for doula services. Most families find that doula services are worth the price.

I offer payment plans for my services. I also offer some services at an add-on price. However, all basic doula services – prenatal visits, on-call period, labor and birthing support, postpartum visit, and phone/email consultation – are included in the basic price.

Also, because I am currently in the process of certification through ICEA, I offer my services at a lower price than a certified doula.

FAQs about Childbirth Education with Healthy Mama Childbirth

Why can’t I just take a hospital class?
By and large, hospital classes are not designed to give you all the coping strategies I will. Hospital classes operate under this statistic – more than 80% of women get epidurals. Hospital-based childbirth educators may not be allowed to tell you that “routine” procedures such as IVs may be politely refused or modified (in this example, a heparin lock may be placed for access without compromising mobility).

Additionally, hospital classes are usually much larger than independent classes. Smaller classes allow for discussion and addressing individual concerns and needs.

A true prepared childbirth course should present you with all options. This is allows you to give true informed consent, particularly in situations when you may choose to have an IV or epidural, for example. This component of true informed choice makes an independent childbirth education class your best option.

Why are your prepared childbirth courses six weeks?
I believe that part of the reason we fear childbirth is because we don’t understand it. Our great-grandmothers learned pregnancy, birth, and breastfeeding from their mothers. Women understood that labor and birthing were skills to be learned. They learned from observation.

We’re beginning to understand that these skills still need to be learned. These skills take time, and learning such as this can’t be rushed. Rushing the information results in more difficult recall and less ease of use during birthing.

Besides information, my classes are designed to allow ample practice time as a place to simply “try out” a variety of techniques. I also aim to give each couple the time to discover your needs and beliefs surrounding birthing – time you may not have otherwise set aside.

Why can’t I just rely on my doctor for everything?
You can, and you should, rely on your doctor for medical advice.

Unfortunately, many doctors don’t seem to have the time necessary for routine questions. Are your prenatal visits less than 30 minutes? Do you have long wait times to see the doctor? If these are YES, then you probably have unanswered questions. Most simply don’t have the time to address basic needs such as what you eat, how you manage stress, or how you plan to arrange life post-partum.

Childbirth education gives you the skills necessary to communicate your needs and concerns in an effective manner during your prenatal visits. It also gives you the skills to find additional information outside the doctor’s office (not “Dr. Google” either!)

When you are an informed consumer, you are better able to ask questions during office visits. Childbirth education empowers you and allows you to have a better relationship with your doctor.

Aren’t the nurses there to help me during labor? What about my husband/partner?
Yes, the nurses are there to help you, but the help they may be able to provide might not be what you need or expect. Nurses are responsible for a number of patients, limiting their time to spend individually with you. Additionally, their responsibilities also include a variety of clinical tasks and paperwork. A nurse will certainly help you when she is able, but you will likely find you need information, comfort, and support “NOW” rather than when the nurse is finished with another laboring mother.

As for husbands and partners – while many men feel confident before labor begins, they often find this confidence wanes as labor progresses. They may resent the fact that they have to put aside their own needs and fears to support a laboring woman. Additionally, most men lack the experience and training necessary to continually provide comfort, support, and coping techniques required for a laboring woman. Many men, no matter how well trained in childbirth education classes, find recall and actual practice of techniques more difficult than they imagined.

Childbirth education prepares you for this reality ahead of the game. This gives you time to consider how you will deal with labor and to practice techniques that you can use. It also gives you information about normal labor and possible variations ahead of time so you are better prepared for what you encounter.

What if I want an epidural? Are you going to try to make me feel bad or talk down to me?
No! I firmly believe that each woman (and couple) needs to make the choices they are most comfortable with at the present time. I feel my job is to help you make an informed choice – I want you to know and understand all the benefits and risks “common” procedures (such as epidurals and IVs) have.

I do support natural, unmedicated childbirth, and I feel that every woman is more than capable of having that kind of birth. But I won’t think you’re a failure if you don’t have an unmedicated birth. The thing I believe is most important is a safe, satisfying, healthy birth. Some women have it with epidurals, some don’t. Some women have it with natural childbirth, some don’t.

Some women find that childbirth education allows them to “compromise,” delaying an epidural when they originally hadn’t thought that to be an option. It also gives them more options to try in the event the epidural “doesn’t take all the way,” a phenomenon that occurs sometimes when using this method of pain management.

Am I going to look stupid doing some kind of crazy breathing that my friend says didn’t help her?
Nope! I do believe that breathing patterns and techniques help with labor, but again it’s about comfort level. Personally, I can’t currently do proper yoga breathing; it’s too slow for me. Instead, I slow my breathing down to a comfortable, relaxing level. This works for me, and it’s the point of the breathing in yoga.

We will discuss your comfort level and current ways of managing stress. Your current methods can then be adapted for labor, and we can build on these with others that may work for you.

How do you feel about hospital birth? Do you think all women should have home births?
I operate fully under ICEA’s motto of “freedom of choice based on knowledge of alternatives.” Therefore, I fully support women and families in the choices they make in childbirth from elective cesarean to home birth, whether I would personally make the same decision or not.

I fully support home birth. I also fully support each family as they make the decision of birthing location based on both the knowledge of facts and personal needs and comfort levels. Many women in the United States choose to birth in a hospital or birthing center.

Is independent childbirth education covered by insurance?
Usually no. However, some families have been able to use funds from their health savings accounts for childbirth education. However, most families find that it is are worth the price. I offer a variety of classes, including customized private classes. Also, because I am currently in the process of certification through ICEA, I offer my services at a lower price than a certified childbirth educator.



Another Care Provider in Pregnancy - Chiropractor

I was unfortunate enough this weekend to pull out my back again (and follow that up with church nursery), so I was at the chiropractor's today. It reminded me of when I pulled my back out during pregnancy, so I thought I'd share.

I feel there is no reason a pregnant woman should have to deal with "regular" backaches during pregnancy. We all act like this is totally normal, but it isn't. 

Backache during pregnancy is easily treated (or at least managed) by a chiropractor. I pulled my back during the second trimester. Once it was remedied with a few trips to the chiropractor, I had no more back pain the rest of the pregnancy - even putting on those fifty pounds. (And reminder, I'm only 5'2"!)

Chiropractic care in pregnancy will help return your body to proper alignment. A good chiropractor will also help you with posture and sleeping positions that will help your body to stay pain free. The adjustments aren't painful.

At the start of the injury, you may find yourself at the chiropractor's office a few times the first couple of weeks. This is pretty normal as your body takes the time to settle into the new alignment. The chiropractor will then start to spread your visits out more. After my back was feeling great, I saw the chiropractor once a month as a check-up and slight adjustment. 

I recommend pregnant women not wait until the injury is severe, or even until there is an "injury." Back pain should be looked into immediately if possible to lessen the number of adjustments needed for health.

See a good chiropractor that you feel you can trust. It's preferable (in my opinion) that you see one who has an in-house massage therapist or two; massage helps the adjustments settle in and take hold rather than moving back into the painful position. 

Also, see a chiropractor who is experienced with pregnant patients. A good chiropractor will tell you if they are or not. When I was going to have the Webster technique (a chiropractic technique to assist in turning a breech baby), my chiropractor told me that while he was trained in it and comfortable seeing pregnant women for other therapies and adjustments, he hadn't done the Webster technique since college. He helped me find someone in the area who was trained and experienced in the technique - and I respect him greatly for being honest with me and helping me. 

You might be surprised that your insurance will usually cover chiropractic care. My current insurance, as well as the insurance I had while pregnant, cover up 20 visits a year with my co-pay. You may want to check with your insurance to see if these visits need to be preauthorized, or ask the chiropractor's office staff when you call to make an appointment.

Please feel free to contact me if you'd like to see a chiropractor in the Charleston, WV area. I've seen a few and am happy to recommend them! I have no affiliation with any offices other than being a satisfied client.