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Thanks!
Tuesday, November 30, 2010
Wednesday, November 10, 2010
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.
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.
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.
Monday, November 8, 2010
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.
Wednesday, October 27, 2010
Maternal Satisfaction and Pain
If I were to do a poll about labor concerns, most people would say what they fear(ed) most about childbirth was the pain. What’s more, when most people just think of a word they associate with childbirth, the first to come to mind is pain.
(As a side note: how sad is it that joy, family, or wonder are not the first words. Instead it is pain, epidural, loss of control…)
I digress – pain and its management are very central in childbirth education models (especially in Western thought). There are many different theories of pain – all worth studying.
But the research that surprised me the most indicated that pain is not chief when it comes to satisfaction in childbirth.
Are you surprised too?
Then, of course, since its good research, it didn’t surprise me so much and it even began to make a lot of sense.
It didn’t matter so much as far as pain and its management. Women with epidurals were just as likely as women without medical pain management (drugs) to feel dissatisfied with their birth over these points – information provided, concerns recognized, and support received.
Let me break that down again – women with epidurals were dissatisfied with their birth if they felt the doctor and nurses didn’t give them enough information, didn’t address their concerns, and/or didn’t give enough support.
In fact, research seems to indicate that patients are more likely to sue if they feel they are not being communicated with and included in decision making. (see below for citation)
Can we all collectively say “Wow”?
This totally knocks the old “all that matters is a healthy baby” out of the picture. Also out the door is the idea that an epidural is the “Cadillac” of pain management.
Insurance companies, doctors, nurses, hospitals, clinics, politicians, feminists, women, and men should all be jumping all over this.
Why is it not happening?
Because this model of care in addressing all concerns, providing all information, and giving all levels of support requires a lot of time. If I were better with numbers, I’d run them to see if it confirms my suspicions – it’s cheaper to pay high malpractice premiums than it is to take fewer clients in order to spend more time with each one.
I’ve said it before, but it bears repeating – OBs (and some midwives as well as general practitioners for regular health matters) do not spend enough time counseling patients on preventative medicine and healthy lifestyle choices. How many of us were asked about our eating during our pregnancy, unless we were “gaining too much weight”? How many heard that exercise could be continued but to take it easy, without regard for our current level of fitness?
I’m getting off track – pain, however central in our minds before labor, appears to take a lower position of importance during labor.
Yes, it’s still painful.
Yes, we still want to know how to deal with it – either with coping techniques or drugs.
But for women with or without epidurals, even those with absence or pain or sensation, still have a greater need for this – information and the support it gives.
Once we recognize that and true informed consent happens, it will change everything about birthing in America.
The article that is the main focus of this: http://www.ajog.org/article/S0002-9378%2802%2970189-0/abstract Results: Four factors—personal expectations, the amount of support from caregivers, the quality of the caregiver-patient relationship, and involvement in decision making—appear to be so important that they override the influences of age, socioeconomic status, ethnicity, childbirth preparation, the physical birth environment, pain, immobility, medical interventions, and continuity of care, when women evaluate their childbirth experiences. Conclusion: The influences of pain, pain relief, and intrapartum medical interventions on subsequent satisfaction are neither as obvious, as direct, nor as powerful as the influences of the attitudes and behaviors of the caregivers.
Article concerning likelihood of lawsuit: Communication gaffes: the root cause of malpractice claims. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1201002/
Another article regarding pain management and maternal satisfaction:
Abstract – Maternal Satisfaction and Pain Control in Women Electing Natural Birth – I think this one comes to the wrong conclusion that “survey results suggest that concerns about epidurals and their effect on the baby, greater than anticipated labor pain, perceived failure of requesting an epidural, and longer duration of labor may have accounted for these findings [of being less satisfied with birth].” I think further study is needed, but that it is good to point out what the study did certainly find: “88% of women who requested an epidural for pain reported being less satisfied with their childbirth experience than those who did not, despite lower pain intensity.” http://journals.lww.com/rapm/Abstract/2001/09000/Maternal_Satisfaction_and_Pain_Control_in_Women.14.aspx
(As a side note: how sad is it that joy, family, or wonder are not the first words. Instead it is pain, epidural, loss of control…)
I digress – pain and its management are very central in childbirth education models (especially in Western thought). There are many different theories of pain – all worth studying.
But the research that surprised me the most indicated that pain is not chief when it comes to satisfaction in childbirth.
Are you surprised too?
Then, of course, since its good research, it didn’t surprise me so much and it even began to make a lot of sense.
It didn’t matter so much as far as pain and its management. Women with epidurals were just as likely as women without medical pain management (drugs) to feel dissatisfied with their birth over these points – information provided, concerns recognized, and support received.
Let me break that down again – women with epidurals were dissatisfied with their birth if they felt the doctor and nurses didn’t give them enough information, didn’t address their concerns, and/or didn’t give enough support.
In fact, research seems to indicate that patients are more likely to sue if they feel they are not being communicated with and included in decision making. (see below for citation)
Can we all collectively say “Wow”?
This totally knocks the old “all that matters is a healthy baby” out of the picture. Also out the door is the idea that an epidural is the “Cadillac” of pain management.
Insurance companies, doctors, nurses, hospitals, clinics, politicians, feminists, women, and men should all be jumping all over this.
Why is it not happening?
Because this model of care in addressing all concerns, providing all information, and giving all levels of support requires a lot of time. If I were better with numbers, I’d run them to see if it confirms my suspicions – it’s cheaper to pay high malpractice premiums than it is to take fewer clients in order to spend more time with each one.
I’ve said it before, but it bears repeating – OBs (and some midwives as well as general practitioners for regular health matters) do not spend enough time counseling patients on preventative medicine and healthy lifestyle choices. How many of us were asked about our eating during our pregnancy, unless we were “gaining too much weight”? How many heard that exercise could be continued but to take it easy, without regard for our current level of fitness?
I’m getting off track – pain, however central in our minds before labor, appears to take a lower position of importance during labor.
Yes, it’s still painful.
Yes, we still want to know how to deal with it – either with coping techniques or drugs.
But for women with or without epidurals, even those with absence or pain or sensation, still have a greater need for this – information and the support it gives.
Once we recognize that and true informed consent happens, it will change everything about birthing in America.
The article that is the main focus of this: http://www.ajog.org/article/S0002-9378%2802%2970189-0/abstract Results: Four factors—personal expectations, the amount of support from caregivers, the quality of the caregiver-patient relationship, and involvement in decision making—appear to be so important that they override the influences of age, socioeconomic status, ethnicity, childbirth preparation, the physical birth environment, pain, immobility, medical interventions, and continuity of care, when women evaluate their childbirth experiences. Conclusion: The influences of pain, pain relief, and intrapartum medical interventions on subsequent satisfaction are neither as obvious, as direct, nor as powerful as the influences of the attitudes and behaviors of the caregivers.
Article concerning likelihood of lawsuit: Communication gaffes: the root cause of malpractice claims. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1201002/
Another article regarding pain management and maternal satisfaction:
Abstract – Maternal Satisfaction and Pain Control in Women Electing Natural Birth – I think this one comes to the wrong conclusion that “survey results suggest that concerns about epidurals and their effect on the baby, greater than anticipated labor pain, perceived failure of requesting an epidural, and longer duration of labor may have accounted for these findings [of being less satisfied with birth].” I think further study is needed, but that it is good to point out what the study did certainly find: “88% of women who requested an epidural for pain reported being less satisfied with their childbirth experience than those who did not, despite lower pain intensity.” http://journals.lww.com/rapm/Abstract/2001/09000/Maternal_Satisfaction_and_Pain_Control_in_Women.14.aspx
Monday, October 25, 2010
Breech Birth?
What options do you really have for breech birth? And will your doctor tell you about them?
I consider myself educated about birth and research-based practices. I studied all I could before I was pregnant and while I was pregnant.
So why did I agree to an elective c-section?
I thought I had no other option.
It frustrates me, angers me, saddens me to learn now what options I did have, but at the time had no way of finding out.
I feel lied to, mislead, coerced even.
It hurts that I feel so taken advantage of.
The situation: I made my doctor very aware throughout my pregnancy of my intention for a drug-free natural birth. This was usually met with a well-meaning but slightly condescending comment that I “really had no idea of how my labor might go, that it might be as long as 12 hours and I may change my mind.”
This should have been my first clue – a doctor should always support any healthy practice. This includes encouragement and even giving further resources. A doctor should never discourage a healthy practice. (How many of us would go to a doctor who told us starting an exercise program or diet was really hard and that we might want to change our mind once we started?!)
Late in pregnancy when he was stubbornly breech, I wish my doctor would have given me other options rather than a scheduled cesarean before my due date. Yes, I should have looked into options on my own as well. However, ethically, a doctor should give you all information. Period.
What could these options have been?
I consider myself educated about birth and research-based practices. I studied all I could before I was pregnant and while I was pregnant.
So why did I agree to an elective c-section?
I thought I had no other option.
It frustrates me, angers me, saddens me to learn now what options I did have, but at the time had no way of finding out.
I feel lied to, mislead, coerced even.
It hurts that I feel so taken advantage of.
The situation: I made my doctor very aware throughout my pregnancy of my intention for a drug-free natural birth. This was usually met with a well-meaning but slightly condescending comment that I “really had no idea of how my labor might go, that it might be as long as 12 hours and I may change my mind.”
This should have been my first clue – a doctor should always support any healthy practice. This includes encouragement and even giving further resources. A doctor should never discourage a healthy practice. (How many of us would go to a doctor who told us starting an exercise program or diet was really hard and that we might want to change our mind once we started?!)
Late in pregnancy when he was stubbornly breech, I wish my doctor would have given me other options rather than a scheduled cesarean before my due date. Yes, I should have looked into options on my own as well. However, ethically, a doctor should give you all information. Period.
What could these options have been?
- Switch to a practitioner trained in vaginal breech birth. There is at least one in the area (I know this now and with I had known then). Research says that vaginal breech birth is just as safe as cesarean breech for the baby and presents fewer complications for the mother. I believe it is unethical not to provide this information.
- Wait until I went into labor to do a cesarean. It seems that we are so focused on the pain of labor (next post will discuss a bit of this) that we forget that labor is beneficial for both mother and baby. Babies benefit from the contractions of labor; they help push fluid from the lungs in preparation for breathing. Both mother and baby benefit from the natural hormonal cocktail (which is very different from the unnatural Pitocin many get) – lactation is facilitated and the baby is better prepared for the sudden environment change. Bonding is initiated. These benefits cannot be overlooked or ignored – they equate fewer NICU stays and better lactation success. Additionally, there is some, however slim, chance that a breech baby may turn during labor. Again, it is unethical for a practitioner to neglect to mention these facts.
I’m starting very much to question going back to my current OB/GYN for future pregnancies – even though I have heard he will attend VBACs. I feel he neglected to tell me so much that I wonder what he might leave out of his VBAC “standard of care.”
I’m always looking for VBAC and breech birth information in the area, and would love to hear about VBAC and breech supportive providers – even homebirth midwives. (which, judging from the research I found for my last post, is looking to be more and more of an option)
A little end note: I would love to get my hands on this film – A Breech in the System.
I’m always looking for VBAC and breech birth information in the area, and would love to hear about VBAC and breech supportive providers – even homebirth midwives. (which, judging from the research I found for my last post, is looking to be more and more of an option)
A little end note: I would love to get my hands on this film – A Breech in the System.
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