Childbirth Today From Birthsource.com

More Business of Being Born Trailer!

2012-02-01T13:23:00.001-08:00

Remember Ricki Lake and the Business of Being Born? Well, there is MORE!

Debunking the myth: Birth is dangerous

2012-01-30T07:25:00.001-08:00

Debunking myths about midwifery care

2012-01-30T07:23:00.001-08:00

Debunking the myths around home birth

2012-01-30T07:20:00.001-08:00

A Woman-Centered Cesarean Birth

2012-01-24T12:27:00.000-08:00

What a beautiful blend of obstetrics and midwifery to provide a woman-centered cesarean experience!

QR Codes ~ what they are and why you may need one

2012-01-19T10:25:00.000-08:00

Marketing is vital to birth professionals of all kinds, whether you are a doula, childbirth educator, lactation consultant, massage therapist - no matter what you do! But marketing today is different than it was just five years ago.

When you hand out print materials (business cards, informational postcards or flyers - even posters), you want to entice the reader to visit your website or blog. You want them to learn more about your philosophy, services and how to reach you. The newest form of marketing to include on cards, postcards and flyers is called a QR Code.

A QR Code is a Quick Response Code or two dimensional code first introduced in Japan (Toyota). The code consists of black modules arranged in a square pattern on a white background. Previously used to track auto parts, these Codes are now used in magazines, signs or city buses to drive visitors to URLs or Uniform Resource Locators, commonly called web addresses.

Now, if a person has a smart phone, they can download a QR Code Reader app and have access to the information encoded in the QR Code.

At this point, you may feel overwhelmed. But if you can type in a web address and click your mouse, you are just a few moments away from creating your own QR Code! And once you create it, you can put it on t-shirts, hats, bags and yes, even chocolates!

First, decide the URL that you are going to make into a QR Code. Second, go to www.quikqr.com to make your Code. Input the URL in the space provided. Then you can either have it emailed to you OR you can right mouse click and open the image in any program that will transfer the image to a JPG or photo image (named after the group who created it: Joint Photographic Experts Group), such as the program Paint which is available on most PCs. A JPG is nearly a universal photo image for use on computers, websites, etc.

Then, once you have saved your QR Code as a JPG, you are ready to insert it as a photo image on a variety of marketing items...want to give away chocolates with your Code on them? Go to www.qrchocolates.com! Need them on stickers or decals? Go to http://www.dezignwithaz.com/modern-wall-stickers-objects/code-wall-decals-p-2371.html. How about a skin for your laptop, so the next time you are working at Starbucks, you can still be marketing? Go to http://www.zazzle.com/laptop+skins+gifts. And for business cards/postcards: www.vistaprint.com and for shirts and other imprinting www.4imprint.com.

I hope this has helped you with marketing your business. Questions? Email me at info@birthsource.com!

Comfort Measures ~ a vital role in childbirth education!

2012-01-18T13:03:00.000-08:00

* You can find more articles like this at www.birthsource.com!

As you learn more and more about labor and the birth process, you will be fascinated by the number of comfort measures available to you. Each comfort measure is unique and designed to support you either physically or emotionally. You may not find complete information about all comfort measures in one place, however many of the most reliable measures are listed here.

Faith in the process, faith in the providers of care, and faith in your ability to make informed decisions about your care
Just as a marathon runner would not wait until the last moment to prepare for a major run, expectant parents should not wait either to be as prepared as possible. Emotional and physical preparation takes time and with time, comes faith in the knowledge and information you have received. You have the ability to make informed decisions based on the knowledge you have of alternatives. And carefully choosing care providers also enables you to trust in critical moments.

Active relaxation
There is definitely a difference between relaxation and sleeping. You can be tense and still fall asleep. Relaxation is a combination of rhythmic breathing and allowing tension to go out of your muscles. For some, relaxation techniques are not enough to get them to fully relax. Music therapy, massage and guided imagery may also be useful to get the expectant mother to relax.
Why is relaxation so important? More oxygen travels to both the laboring uterus and to the baby when a mother is relaxed. Also, the tension hormone, adrenaline, has the ability to slow or stop labor - depending on its level in the body. Reducing the tension in Mom can reduce the adrenaline, therefore enhancing labor!

Breathing techniques
Techniques vary based on the education and training from a childbirth instructor. Basically, breathing techniques keep you focused, maintain oxygen to both you and your baby, and give you something to concentrate on rather than the discomfort generated by the contractions. There is no one perfect set of techniques - rather it is the basic philosophy that works!
Education
Whether you take childbirth classes, do extensive reading, watch a variety of birth videos or obtain information from your care provider or, ideally, a combination of all, you should become educated as to the labor and birth process. Many mothers say that they are extremely frightened of the birth process, but that their fear and anxiety was greatly reduced with information!

Using a Trained Labor Support Person
Childbirth assistants or doulas can bring to your birth many emotional and physical advantages. These advantages include more comfort measures for your specific needs, a familiar face that stays beyond shift changes, comfort from a woman who has experienced childbirth ~ someone who can anticipate you and your coach's needs before you realize they are your needs. These women never take the place of the coach unless an expectant woman has no coach. Before choosing a doula, interview them and ask them about their experience and their philosophy of birth.

Using Gravity to Enhance Labor
Try these helpful positions to keep labor moving right along!

upright positions
walking
hands and knees
using a Birthing Ball
squatting
supported lunge
swaying or dancing with partner
pelvic rocking
sitting in a rocking chair

Hot and Cold Therapy
Warm rice socks or ice pack can make lower abdominal or back labor more comfortable.

Music Therapy
Soft and quite relaxation CD's and tapes enhance relaxation at home and when you go to the hospital. Take along a CD player if one is not provided by the hospital.

Frequent urination
Emptying the bladder often reduces the discomfort of a full bladder and also reduces the blockage of the birth canal often made as the bladder increases in fluid.

Counter pressure
To help with the discomforts associated with true back labor, counter pressure is often the comfort measure of choice. Your childbirth educator or doula can help you with the specific positions for counter pressure and some interesting alternatives to just pressing with the palm of the hand!

Massage
Since the touch fibers in our bodies are larger than the pain fibers, messages travel faster from the area being touched to our brains. And since our brains can only process so much information, massage can help reduce the amount of pain our brain senses. How can this be? What happens when you stub your toe? You instinctively massage it and the pain magically becomes managable. This same principle can be used during labor. Massage is also a great way of reducing the tension in the body during labor.

Aromatherapy
Fresh cut grass reminds me of Saturday afternoons as a child; certain perfumes remind us of certain people. Pick a scent that will trigger pleasant thoughts and help you maintain relaxation during labor. Lavender and Chamomile are two scents that many expectant mothers prefer.

Water Therapies
Shower and the Labor Tub make use of heat therapy. And the Labor Tub uses hydrostatic pressure to reduce the feelings of discomfort brought about by increasingly intense contraction and the movement of the baby down into the pelvis. This increases relaxation and facilitates labor!

Focusing
A focal point: stuffed animal, photo, coach's face etc can help you keep focused on labor and relaxation, especially if you've practiced with it for months. Then it becomes a conditioned response to relax when looking at this object.

Guided Visual Imagery
Have someone read a very descriptive paragraph or story to you that could help you relax. Oddly enough, television is a form of guided imagery in that it takes us mentally from the place we are and transports us to different places. However, television does end and has commercials and this tends to break concentration.

References:

Bobak, I., Jensen, M. Maternity & Gynecologic Care: The Nurse and the Family. (1989) St. Louis: Mosby Publishers.
Nichols, F., Humenick, S. Childbirth Education: Practice, Research & Theory (2000) Saunders & Co.
Livingston, C. The Birth Ball Source Book. 4th edition. 2011. Perinatal Education Associates.
Reeder, S., Martin, L., and Koniak-Griffin, D. Maternity Nursing: Family, Newborn, and Women's Health Care. (1997) Philadelphia: J.B. Lippincott Company.
Sprague, A. Water Labour., Water Birth. 4th Edition. 2011. Amazon & Kindle Editions.
Simkin and Ancheta. The Labor Progress Handbook: Early Interventions to Prevent and Treat Dystocia. 2nd Edition 2011. Wiley-Blackwell Publishers. Amazon/Kindle Editions.

Learning Lamaze: Back to Basics!

2012-01-12T07:48:00.000-08:00

You have been practicing the basics of Lamaze probably your whole life. Surprised? Let me explain…

Lamaze is built on the basic principle that you have the power to raise your pain tolerance through various comforting techniques. Lamaze, learning from the research of two specialists who published extensively in the 1960s, created techniques that challenged the body’s gating system. This gating system works on the principle that our pain fibers are smaller and the pain stimulation travels slower than touch. Our touch fibers are larger and thus the touch stimulation travels faster to the brain. If given a painful stimulus (stubbing one’s toe) and then rubbing the toe, the touch sensation travels to the brain faster and in greater quantity than the pain, thus closing the gate to the pain stimuli – as the brain can only take so much stimulation at one time. In turn, this enables the laboring mother to raise her pain tolerance (the variable degree of pain a person can endure) while acknowledging her pain threshold (the rising degree of pain from a particular source).

Lamaze also drew some of his knowledge from two Russian researchers who encouraged expectant mothers to practice certain techniques prenatally so that the techniques would seem almost automatic when they went into labor. These techniques included structured breathing patterns, focusing on an external source, and a relaxing touch technique call effleurage.

Breathing

All breathing begins with a Deep Cleansing Breath

Inhale-through the nose (if possible), keeping shoulders relaxed

Exhale-through the mouth, letting go of all the tension in your body

SLOW-PACED BREATHING

Rate is approximately half the number of breaths you normally take per minute; not less than 3 or 4 breaths per minute;aids relaxation and provides optimum oxygenation.

When doing the more advanced breathing techniques, return to slow-paced breathing when able.

Procedure:

Deep Cleansing Breath

Inhale (through nose if possible) to a count of 4 - In two, three, four

Exhale through mouth to a count of 4 - out two, three, four

Repeat the inhale/exhale throughout the contraction

When contraction ends, Deep Cleansing Breath

MODIFIED-PACED BREATHING

Rate is slightly faster than your normal breathing rate; not exceeding twice your resting rate; allows you to be more focused and alert.

Procedure:

Deep Cleansing Breath

Inhale through nose to a count of 2 - In two

Exhale through mouth to a count of 2 - Out two

Repeat the inhale/exhale throughout the contraction

When contraction ends, Deep Cleansing Breath

PANT-BLOW BREATHING

Same rate as modified-paced breathing

Blowing softly at regular intervals creates a rhythmic pattern

The pant is an in breath and an out breath (touching the tip of your tongue to the roof of your mouth will help keep your mouth moist)

Patterns may vary: pant - 2 -3 - 4 - blow, or pant - 2 - 3 - blow

Procedure:

Deep Cleansing Breath

Take upper chest, shallow breaths follow by relaxed exhales

At regular intervals, add a slightly emphasized exhalation (a sigh)

The importance is to keep facial muscles relaxed

When contraction ends, Deep Cleansing Breath

Focusing

A focal point is an object, such as a photo, stuffed animal or even a cross stitch piece that will help you to focus on something other than the contractions and the time that labor is taking. The focal point also helps to stimulate certain positive feelings…for example if you plan on giving the stuffed animal to the baby after the birth, there may be feelings of nurturing and love and motherhood attached to the stuffed animal. If the focal point is a photo of a place you have been, there may be feelings of calmness and serenity evoked when looking at the photo. If you choose to use your husband/partner’s eyes during labor as a focal point, this can be particularly empowering as you work together and a powerful team to being this new family! Knowing and drawing strength from your partner can energize a woman even in the closing hours of a long birth!

Effleurage

Effleurage is a rhythmic stroking motion on the larger portions of the body (long bones of the legs, back, abdomen) in circular or back-and-forth movements.

In the classical sense of Lamaze, the emphasis has been on carefully designed, learned and practiced breathing techniques, abdominal massage (effleurage), choosing a "focal point" to look at during uterine contractions, counting during contractions and understanding standard hospital procedures. Dr. Lamaze believed that distractions from pain reduces the perception of pain. Therefore, most women could labor and give birth awake, aware and under their own power if they mastered his techniques in order to avoid being overwhelmed by the intensity of labor. As mentioned previously, the Gate Control Theory or Gating Theory uses touch and effleurage as a key piece for raising pain tolerance.

While these tools and techniques cannot make labor painless, it can make labor less painful by showing you just how much power you have over the pain of the contractions!

Reference:

The Lamaze Guide: Giving Birth With Confidence, 2nd Edition Judy Lothian/Charlotte Dvries, 2010

Gisele Bundchen's New "Birth Around the World" Project

2012-01-10T12:08:00.000-08:00

Here is the first video introducing Gisele's idea!

Update on Ingestion of Food and Fluids During Labor

2012-01-06T07:32:00.000-08:00

Since C.L. Mendelson's report in 1946 (Mendelson C.L. The aspiration of stomach contents into the lungs during obstetric anesthesia. Am J Obstet Gynecol 1946; 52: 191-205.), most anesthesiologists assumed a very conservative stance used with obstetrical surgical patients with a "nil per os" (Latin for nothing by mouth or "NPO") for maximum safety. Is a slowing of the contraction pattern due to dehydration and no food/fuel? If so, does this also contribute to a slowed labor pattern and ultimately augmentation? More importantly, does having nothing in the stomach lower gastric acidity enough to protect the esophagus from corrosion should aspiration occur? Does being NPO eliminate Mendelson’s Syndrome?

Conversely, midwives and some physicians will allow fluids, soups, crackers, etc. during the early and active phases of labor. Can fluids or food during labor, along with IV fluids lower gastric acidity by giving the acid something to break down and facilitate the contraction pattern, possibly avoiding some interventions such as augmentation? And statistically, what is the likelihood of Mendelson's Syndrome or death from pneumonia due to aspiration?

According to Joy Hawkins, M.D. of the University of Colorado Health Sciences Center, scant key scientific data exists to show that laboring women who are kept NPO are less likely to die due to aspiration than women who had some sort of food or fluids. Without food, a laboring woman's body enters into ketosis. Starvation ketosis occurs when the pregnant body is starved, especially of carbohydrates. With starvation ketosis, tissues begin to breakdown and the byproducts of this ketabolism are called ketones, which actually aggravate nausea and possibly vomiting. So does keeping a woman NPO actually potentiate Mendelson's Syndrome? Additionally during pregnancy, women experience reflux due to delay emptying of stomach contents thought to be due to higher levels of progesterone, decreased motilin levels and the growing uterus applying pressure to the digestive system including the stomach valve. Do these hormonal influences along with NPO ketosis make things worse?

Dr. Robert Galser, M.D. of the University of Pennsylvania Medical Center says that we cannot afford to speculate as aspiration is a very real problem, especially for the mother who has general anesthesia with a cesarean section. Although Mendelson's research was mainly on rats and rabbits, it is suggested that IV's help to prevent ketosis while keeping stomach contents at a minimum. Currently, there is no evidence that moderate levels of ketosis are harmful to the fetus. Penny Simkin found that of several stressors in labor, being NPO was minimally stressful compared to not being active in labor.

In 2009, Maharaj (European Journal of Obstetrics, Gynecology and Reproductive Biology, September) stated that while the incidence of aspiration pneumonitis is rare, “it is the fear of the birth-attendant to bear full responsibility if a patient inhales gastric contents when giving in to demands for liberal fluid and food regimes during labor that governs practice. While the bulk of evidence supports fluid intake in labor, there are insufficient published studies to draw conclusions about the relationship between fasting times and the risk of pulmonary aspiration during labor.”

Singata, Tranmer and Gyte wrote in a 2010 Cochrane Database Systematic Review of restricting oral and fluid intake during labor (five studies and 3130 women), that the evidence “shows no benefits or harms” and that there “is no justification for the restriction of the fluids and food in labour for women at low risk for complications.

So is restricting food and fluids during labor a technocratic ritual or based on research? Since the basis for the restriction had the foundation of research in the 1940's when general anesthesia was the standard for cesarean sections, have we not progressed from there to the point where a significantly fewer number of women are exposed to general anesthesia for childbirth, with an even significantly fewer number of women aspirating acidic vomitus during anesthesia? Is this another case of "this is how we've always done it?"

Pushing ~ What you need to know...

2012-01-05T10:33:00.000-08:00

For most of labor, women feel like an observer instead of a participant. This feeling changes dramatically when the cervix reaches 10 centimeters dilated and 100% effaced. At this point the cervix is said to be “complete” and pushing can begin without fear of causing the cervix to swell or bruise (which can happen if pushing begins BEFORE the cervix is completely dilated or effaced).

The dynamics of pushing can be divided into 3 parts: position, breathing and effort.

Positions:

Techniques such as pushing while on a toilet, relaxes the perineal muscles while supporting the long bones of the upper legs. Psychologically, moms relax their bottoms when on the toilet and this become important during the Second Stage.

Many mothers will sit at a 30-40 degree angle or C-Position in the birthing bed. Any farther back or even a lying down position will work against gravity and often prolong the pushing part of labor.

Squatting either at the side of the bed or with the aid of a squatting bar encourages rapid descent, requires less physical effort and increases the diameter of the pelvis. Some moms may even do early squat pushing on egg-shaped birth balls. You work with gravity in a squat.

The hands-and-knees position is good for trying to turn a posterior baby, helps with fetal distress and takes the pressure off of the perineum. Many midwives say that this position is the best when there is suspected shoulder dystocia.

During a rapid birth, you may be instructed to side-lie, with your partner or assistant supporting the leg on top. This position slows descent somewhat, lowers the need for episiotomy and helps maintain good oxygen to the baby.

Breathing:

Continuous Breath Holding, also known as purple pushing refers to holding the breath so long and with such force that the small capillaries in the cheeks and face burst. Purple pushing produces Valsalva's Maneuver. Valsalva's Maneuver occurs with prolonged breath-holding ~ longer than 6 clock seconds. With prolonged breath-holding, there is an increase in the heart rate and the blood pressure. Immediately, a reflex of slower heart rate occurs. All of this disrupts the blood flow to the uterus and ultimately to the baby. This disruption in blood flow indicates a disruption in oxygen flow, which ultimately shows up on the fetal heart monitor as fetal distress. There is no clear evidence that closed glottis pushing (Valsalva's Maneuver) shortens second stage, decreases fatigue or minimizes pain. It has otherwise been suggested that bearing down for a prolonged period with a closed glottis alters the effectiveness of the contractions, leading to inefficient contractions and failure to progress.

Click here for more of this article...

Beyond Beyoncè: Five lies the media tells you about birth

2012-01-04T09:13:00.000-08:00

As a birth journalist, I receive hundreds of pregnancy, birth and breastfeeding news alerts each day. About 85% of them are about celebrity pregnancies. That leaves approximately 15% new stories, read by both parents and professionals, that contain some modicum of truth. Or do they?

What both parents and professionals see in the media (news, podcasts, internet, television shows and movies), to some degree, take away from the natural body instincts for birth and parenting. Here are some examples:

Childbirth is a dangerous event. Studies from across the globe confirm that childbirth is inherently safe. The WHO indicates that there may be only 10-15% of birth events in need of cesarean birth to maintain safety.
Babies will drown during a waterbirth. If you carefully examine the physiology of this event (water birth), you will see that since the baby is going from one water environment to another, and the umbilical cord is still attached there is no chance for drowning. However, should the baby be brought up from the water and air is touch the face, this helps to initiate breathing and yes, if the baby is put fully back down in the water, that may cause a problem.
The pain of childbirth is excruciating. That actually depends on the situation. Many times, pain is exacerbated by other situations: fear of the unknown, being alone, tension, reduced food and fluid intake, and sometimes just a simple low tolerance to pain. In all of these cases, knowledge gained through childbirth education classes will help – not cure – the experience of pain in childbirth.
Interventions during childbirth, including epidural anesthesia, are bad. Again, knowledge is power. With any medical procedure, from starting an IV to performing an episiotomy, there is risk. However, the risks (all of them) must be weighed against the benefits (all of them) and vice versa. This takes a birth team of skilled and knowledgeable people! Another point to add here is that if the medical staff only know one way to handle a birthing situation, then all women in that birthing situation will be handled that one way. It is how the staff are taught. It is ingrained in then that THIS way is the BEST way….which may or may not be accurate.
Because you are birthing in the US, you can be assured of accuracy, safety and a better birth outcome that most countries. We Americans still have a LONG way to go in terms of the maternity care field. While we don’t have the highest cesarean rate in the world, it is still over 33%. Our maternal/infant mortality and morbidity statistics rank us lower and lower each year amongst other countries, sometimes as low as 51^st place.

Regardless of whether you are a parent expecting a baby, or a birth professional, you need to know the facts, physiology and truth about pregnancy, birth and breastfeeding. Read and read and learn, ask questions! Go beyond Beyoncè to get the facts!

Waterbirth in a Hospital ~ yes you can!

2011-12-29T09:26:00.000-08:00

Here is a visual of how you can have a waterbirth in a hospital setting. The most difficult obstacle is often the uninformed hospital staff. They typically don't teach about waterbirth in nursing or medical school.

Hospitals and Waterbirths

2011-12-29T09:22:00.001-08:00

Hear from waterbirth expert Barbara Harper.

One World Birth ~ the next great birth film

2011-12-29T09:13:00.000-08:00

In case you've not been following the progress of this amazing film maker, check out the launch video!

Physiologic Birth Is Front and Center in the Media!

2011-12-12T07:40:00.000-08:00

The end of 2011 and the beginning of 2012 spark excitement in the birth world! Two separate organizations honor two women who daily, stand up for physiologic birth and women/baby centered maternity care: Ina May Gaskin and Robin Lim.

For those of you who may not have seen Ina May Gaskin receive the Rightlivlihood Award earlier, here is the video.

And if you missed Robin Lim receiving her award at the CNN 2011 Hero(es) of the Year Ceremony, the link to that segment is not available for embedding at this time but is available by clicking here.

These awards and videos are important to share on any and every social media. Expectant parents are constantly being bombarded by information about alternative means of giving birth and raising a baby. We must, as birth professionals, share in the duty and honor of dispelling myths and sharing the truth.

Just the facts: The Home Birth/Hospital Birth Conundrum Part 2

2011-12-01T08:59:00.000-08:00

In Part 1, we took a look at the Home Birth Summit from October of 2011.

But a question still begs to be answered: If there was consensus amongst organizations, why is there still a conundrum? Conflicting stories based on equally conflicting studies published in journals continue to flood the news.

“A new study (published in the BMJ) in England shows little difference in complications among the babies of women with low-risk pregnancies who delivered in hospitals versus those who gave birth with midwives at home or in birthing centers.”

“A study published in the BMJ, which was conducted by researchers from Oxford University has revealed that first time expecting mothers who opt to have home deliveries are at greater risk than those who opt for obstetric or midwifery unit.”

Ironically, they are talking about the same study in the same journal. Why the difference?

It leads us to the five basic reasons for the conundrum:

Media Influence
Media spin has a damning effect on childbirth, here in the US and world wide. Documented in her video Laboring Under an Illusion, Vicki Elson exposes the drama-seeking Hollywoodism and stretching of the truth in our every day viewing. Seeing this, and not being exposed to the truth, leads to accustomization ~ where we begin to believe what we see because we are accustomed to seeing it!

Education Gap in Professional Training
A second reason for the conundrum is Statement 9 in the Home Birth Summit Consensus document: “We recognize and affirm the value of physiologic birth for women, babies, families and society and the value of appropriate interventions based on the best available evidence to achieve optimal outcomes for mothers and babies”. In reality, this is not done in our major universities, medical schools and nursing schools. If it was embraced and taught, then all of the things that certified childbirth educators teach their classes or the information discussed by doulas would not be new information to nurses, physicians, and yes, even some midwives.

Fear of the Unknown
Childbirth is not a foreign event for women. However, since we are such a mobile society, we are not routinely exposed to family and friends having babies. Hence we have lost the ability to tap into the inner wisdom. Dr. Amali Lokugamage discusses finding the inner wisdom in her book The Heart in the Womb. She states that “fear of childbirth really does prevent women from discovering their inner wisdom.” Women with this fear (fear of the unknown, fear of pain, fear of disaster, etc) look to others to “solve” their problem. To the rescue is modern medicine, and the discouragement of childbirth education classes or doula services. It is viewed that with information and an informed support person, labors will be more difficult for the medical staff. It boils down to whose birth is it anyway?

Incongruent ways of reading research
As demonstrated by the Summer of 2010’s Wax home birth meta-analysis , definitions make or break a study and the efficacy of the information in the study. For example, as Amy Romano pointed out the definition of neonatal death was different. In the Wax study of 9,811 homebirths, neonatal death was defined as death of a live-born infant between 0 and 28 days. In the Ank de Jonge study of 321,307 homebirths, the definition was the death of a live-born infant between 0 and 7 days. The latter is also the definition used by the World Health Organization. Wax also had no requirement for home birth eligibility. The Dutch study defined who was eligible based on national guidelines – to ensure that homebirths are healthy and at very low risk for complications.

Professional Obstacles
I really didn’t know how else to phrase this contributor to the conundrum but there are professionals who are, either informed or uninformed, against homebirth. Period. No discussion. Heidi Anne Deurr, MPH said in her recent article for OBGYN.net titled “Home Birth Consensus Summit: Much Ado About Nothing?”:

While the intentions and words involved in the statement might be well-meaning, the merit of the summit and its consensus statements is questionable. For one thing, ACOG has come out against home births.

Legal liability certainly has a hand in this last contributor to the conundrum. As pointed out in Statement 7 of the Home Birth Summit Consensus, the legal system needs repair and there needs to be adequate access to homebirth and birth center births within an integrated health care system.

In reviewing the above five conundrum contributors, the bottom line, in my humble opinion, is consistency in research and education about the research. We must talk the same language with the same numerical values and the same definitions. If studies and research varies so greatly, no congruent statement can be made about any issue. Second, practitioners of all kinds should be educated about this research and work together for healthy mothers and babies. To do otherwise, is to ignore “First Do No Harm.”

Just the facts: The Home Birth/Hospital Birth Conundrum Part 1

2011-12-01T07:42:00.000-08:00

There has always been a separation between ideals in the conversation between home birth advocates and hospital birth advocates. Lately, the separation has become wider and more volatile. It is vital that the facts surrounding both this summit and homebirth/hospital birth be clear.

The summit was held October 20 & 21, 2011 in Warrenton VA and present were birth professionals and leaders. These professionals and leaders included representatives from the following prestigious organizations: MANA, LAMAZE, ACNM, AWHHON, ACOG, AAP, ICTC, NACPM, AABC, and Our Bodies Ourselves with collaboration from Childbirth Connection, The White Ribbon Alliance, JPhiego, ICM, NARM, and the Farm. These organizations along with representatives from hospitals and universities, examined the current research regarding the entire topic of birth and the impact of where birth happens.

With passion and dedication, nine common ground statements were achieved:

STATEMENT 1

We uphold the autonomy of all childbearing women. All childbearing women, in all maternity care settings, should receive respectful, woman-centered care. This care should include opportunities for a shared decision-making process to help each woman make the choices that are right for her. Shared decision making includes mutual sharing of information about benefits and harms of the range of care options, respect for the woman’s autonomy to make decisions in accordance with her values and preferences, and freedom from coercion or punishment for her choices.

STATEMENT 2

We believe that collaboration within an integrated maternity care system is essential for optimal mother-baby outcomes. All women and families planning a home or birth center birth have a right to respectful, safe, and seamless consultation, referral, transport and transfer of care when necessary. When ongoing inter-professional dialogue and cooperation occur, everyone benefits.

STATEMENT 3

We are committed to an equitable maternity care system without disparities in access, delivery of care, or outcomes. This system provides culturally appropriate and affordable care in all settings, in a manner that is acceptable to all communities. We are committed to an equitable educational system without disparities in access to affordable, culturally appropriate, and acceptable maternity care provider education for all communities.

STATEMENT 4

It is our goal that all health professionals who provide maternity care in home and birth center settings have a license that is based on national certification that includes defined competencies and standards for education and practice.

We believe that guidelines should:

allow for independent practice
facilitate communication between providers and across care settings
encourage professional responsibility and accountability, and
include mechanisms for risk assessment.

STATEMENT 5

We believe that increased participation by consumers in multi-stakeholder initiatives is essential to improving maternity care, including the development of high quality home birth services within an integrated maternity care system.

STATEMENT 6

Effective communication and collaboration across all disciplines caring for mothers and babies are essential for optimal outcomes across all settings. To achieve this, we believe that all health professional students and practitioners who are involved in maternity and newborn care must learn about each other’s disciplines, and about maternity and health care in all settings.

STATEMENT 7

We are committed to improving the current medical liability system, which fails to justly serve society, families, and health care providers and contributes to:

inadequate resources to support birth injured children and mothers;
unsustainable healthcare and litigation costs paid by all;
a hostile healthcare work environment;
inadequate access to home birth and birth center birth within an integrated health care system, and;
restricted choices in pregnancy and birth.

STATEMENT 8

We envision a compulsory process for the collection of patient (individual) level data on key process and outcome measures in all birth settings. These data would be linked to other data systems, used to inform quality improvement, and would thus enhance the evidence basis for care.

STATEMENT 9

We recognize and affirm the value of physiologic birth for women, babies, families and society and the value of appropriate interventions based on the best available evidence to achieve optimal outcomes for mothers and babies.

A full list of delegates who endorsed these statements is available at the Home Birth Consensus Summit website.

Private Childbirth Classes Cost What???????????????

2011-11-07T06:11:00.000-08:00

With a heightened buzz about childbirth education classes lately, one of the biggest questions I receive as a private educator is "why do private childbirth classes cost so much and what is the difference between them and the hospital"? Whether you are a consumer (currently pregnant) or a professional, I hope this will give insight!

Hospital Based Childbirth Education Classes:
Looking at the average cost of hospital based childbirth education classes, here's what I found: the average hospital based childbirth education class is 8 hours in length (either 4 weeknights of 2 hours each or a weekend class) and cost approximately $65. These classes have 6-15 couples (or 12 - 30 people) and include hospital policies and procedures and a tour. Generally, hospital based childbirth education classes are taught by nurses with a knowledge of labor and delivery but who may or may not be certified by national childbirth education organizations. (important note: nursing schools do not included how to be a teacher in the curriculum).

Private or Community Based Childbirth Education Classes:
The nationwide average of private childbirth education classes is 10-12 hours in length, usually at the scheduling option of the consumer and cost approximately $200. These classes have 1-2 couples (2-4 people) and include a wide variety of evidence-based information. Private/community classes are taught by certified childbirth educators who may or may not be nurses.

Based on the above information, here are some quick facts:

Either type of class may be taught by someone who is OR is not certified. It is up to to the consumer to research this.

Hospital classes generally talk about the procedures done at that facility, not the options that the laboring mother has.

Cost ~ those who teach childbirth education in either hospitals or privately make the same amount of money per hour. Even though hospitals charge $65 per hour (65/8 = $8.12), no nurse is going to teach for nearly minimum age. Her salary (approx. $25-$32/hour) is subsidized by the hospital and all of her teaching supplies are purchased by the hospital as well. The educator who teaches privately and charges $200 (200/12 = $16.66) received over $16 per hour but must also purchase any and all of her teaching supplies herself.

Private or community based classes can share the latest national statistics, research and updated information about a variety of topics important to the consumer. Some hospital educators are actually told to not share evidence based research or statistics if that goes against current hospital policy or procedure. Such information can include information about risks/benefits of epidural anesthesia, cesarean sections, or the benefits of continuous skin-to-skin contact after birth with mother/baby or the benefits of delayed cord clamping.

What I am NOT saying here is that you will get a better education if you attend a private or community based childbirth education class. I am also NOT saying that you will receive a tainted or substandard education from a hospital class. What I AM saying is that you as the consumer need to research the childbirth education options in your community and find out what best suits your needs. Do you need more information on how to choose childbirth education classes? Click to this link for a great article with more information!

Dystocia: is there a gene for that?

2011-10-17T10:18:00.000-07:00

On every birth professional's reading list should be Penny Simkin and Ruth Ancheta's updated and 3rd edition of The Labor Progress Handbook.

This new edition comes with even more information on the simplicity of birth, and common sense non-invasive methods to prevent or facilitate dystocia. Heavily referenced (new references have been added and others have been updated), this edition is a must have for childbirth educators who practice in the community or in a hospital setting! Retaining the hallmark features of previous editions and meeting the needs of all types of learners, this book uses charts and illustrations showing position, movements, and techniques and is logically organized to facilitate ease of use. Two new chapters are included in this 3^rd edition and include research based information on third and fourth stage labor facilitation, including low-technology interventions, a complete analysis of directed versus spontaneous pushing, and additional information on massage techniques. Information on delayed cord clamping, the Gaskin Maneuver and so much more.

And new research indicates that dystocia may be in a woman's genes.

In a new study just published (Indentification of a Myometrial Molecular Profile for Dystocic Labor BMC Pregnancy and Childbirth 2011 11:74), researchers Brennan et al suggest an underlying molecular basis for dystocia in nulliparous women in spontaneous labor. Myometrial biopsies were obtained from the upper incisional margins of nulliparous women undergoing lower segment cesareans for dystocia. These women were in spontaneous (non-induced) labor but had received intrapartum oxytocin to accelerate labor.

This new finding suggest an important role for the immune response in dystocic labor and could provide indicators for new diagnosis and therapies for helping with dystocia.

In light of this new study, we need to be as prepared as possible to assist women with any event that needs assistance during labor and birth. The Labor Progress Handbook is one important tool to have!

A Few Reasons Why Occupying a Hospital Won't Change Policies & Procedures

2011-10-11T06:19:00.000-07:00

Several days ago I posted this on my Facebook page:

"What if we 'occupied' hospital parking lots? Would that facilitate policy and procedure change?"

Several people, within just a few minutes, were ready to paint signs and begin the sit-in. I was very surprised at the response, yet have since realized that it is through the frustration of years of "telling the truth" that this must have been a visceral response.

Occupying any location in a hospital or near a hospital for the purpose of facilitating policy and procedural change would be folly. Why? If you have ever worked in any type of business and tried to facilitate change, then you already know that change does not happen because someone is protesting or beating the door while yelling "you must change because we said so".

As with most change, it happens sssslllooowwwlllyyy. It happens because more and more become educated that the "way we've always done it" is no longer desirable, gets the desired responses or is no longer useful. It is difficult because we are creatures of habit and typically multitask - so habit enables multitaking.

Change also happens from the top of the pile. Hospitally speaking, it happens when nurse managers, directors of nurses, administrators and the finance people all realize that this change will impact their numbers. Yes, it is a numbers issue. And who impacts the numbers most of all? THE CONSUMER.

But unlike when this happened back in the 1970s, the consumer cannot take the larger responsibility of informing the professional that excessive intervention rates and unfathomable cesarean rates hurt mothers and babies rather than help them. Exposing the facts from the CDC and World Health Organization about the maternal morbidity/mortality rates and infant morbidity/mortality rates is paramount in bringing about change. Getting this information to the top, to those nurse managers, directors of nurses, administrators and yes, even the finance people is paramount. While the the finance people may see early preterm births as revenue from the added intervention (cost) and admission into the NICU (cost) as a benefit, we need to also inform the consumer that professional who pay the bills on the very backs of the healthy consumers must be informed and educated. And ultimately, stopped.

In a state of economy as this country (the US) is currently experiencing, all are conscious about keeping their jobs. L/D nurses and childbirth educators are not excluded. But it is beyond my personal thinking that especially these two groups of which I am a part of both, can continue to protect their jobs and not tell the absolute truth about the hazards of induction/medication for labor and the risks/benefits about intervention (especially cesareans). This is called teaching informed consent and I thought it was the foundation of every childbirth education certification program.

But perhaps, as childbirth educators and nurses, need to go back and look at why we chose this profession? At least for myself as a nurse, I chose nursing to take care of people and get them (in obstetrics) from one state of health to the next. As a childbirth educator, the choice was similar but instead of me caring for them, I wanted them to become active in their own health care and make the choices that are best for them.

So what is the answer? If we advocate for change from the "top" (directors/administrators) as well as from the "bottom" (parents), just as we did in the 70s, then there will be an educational squeeze play and change will occur. Rational behavior with a side order of evidence based information, referenced to the hilt is the order of the day. Every professional organization should talk about it. We must insist that The Joint Commission and Magnet Recognition change/add to their definitions of quality by insisting on evidence-based best practice.

And as childbirth educators, we need to present information in the complete risk/benefit style that we all know is best practice. We need to be bold, be true and be educated ourselves. Our classes can still be exciting and enriching without being overly humorous (portraying to parents that childbirth is something funny) or aggressive.

This is serious business. And we are only contributing to the statistical nightmare if we don't ramp up best practice now.

Dear Dr. Lisa, Thank you for helping!

2011-10-06T09:05:00.000-07:00

After viewing the segment on waterbirth with Barbara Harper yesterday on the daytime talk show The Doctors, I just want to say thank you to Dr. Lisa!

The Doctors asked Barbara on their show to talk about waterbirth. After all, she is the expert and travels world-wide to educate professionals as well as parents about the gentleness and benefits and the precautions surrounding waterbirth. She has written books. She has created DVDs. She has an evidence-based website with all of the evidence-based research data. As Barbara said in a text message to me on 10/5/11 about the show: "They edited it so much and moved things around. The taping was far worse and longer. I actually think it was good for our side. The truth prevails!!"

And Dr. Lisa made a great point (and I am paraphrasing): please read ACOG's opinions and then go to Barbara's website to see the research evidence from medical journals and then let the parents make the decision. Brilliant.

It was clearly evident by her excessive body language and voice inflection/argumentative tone, that Dr. Lisa felt very threatened by Barbara's presence and the evidence which Barbara brought to the show....or tried to even over the posturing and yelling of Dr. Lisa. This is, in fact, typical behavior when a person feels as if their territory has been invaded.

However, and let me be historically accurate, it was the midwife or sage femme who began assisting mothers with birth...back in the day...when we all wore fig leaves and lived in caves. It was the midwife/sage femme who continued to care for the family when other children came along. Physicians became insanely valuable during difficult births and because they are trained surgeons, when a cesarean became necessary. However seeing that becoming a mainstay in maternity care meant more financial stability, some physicians formed a trade union called ACOG - the American College of Obstetricians and Gynecologists - and began a movement to move in on and ultimately deter midwifery care. And more damning is that in a June 2011 story on MSN, this statement appeared:

Less than a third of the recommendations from the American College of Obstetricians and Gynecologists (ACOG) are based on gold-standard scientific experiments, researchers found.

The rest are based on anecdotal evidence or expert opinion, which is subject to personal biases, they reported.

So if ACOG and obstetricians in general are operating on less than 33% evidence, is it any wonder why Dr. Lisa had to resort to carnival stunts by showing a dirty aquarium with a baby doll sunk in the water? She simply does not know the evidence.

Oh, wait, this isn't the first time that they have formed a movement against wellness in maternity care. In the early 1980's, physicians/hospitals co-opted childbirth education from the community to the hospital ("The Politics of Co-optation: strategies for childbirth educators" by Dr. Eugene Declerq. Birth 1983 Fall 167-172) . As epidurals, inductions and the rising cesarean rate became evident, obstetricians often tell their expectant patients that childbirth education is not necessary. In other words, don't go. Hospitals loose revenue, and reduce childbirth education down to a one day, 4 hour class or worse yet, no classes offered at all. And too, an informed patient/client asks questions, which take time and may cause a deviation away from the set and managed practice guidelines.

In her 2004 book, The Medical Delivery Business, author Barbara Bridgman Perkins states that academia and industry (aka the pharmaceutical company) worked together to develop management of labor - not only an expectant mother's labor but the labor work force in a hospital. An Upjohn-funded study in Britain concluded that labor induction could save hospitals money by enhancing staffing and efficiencies in their labor and delivery units.

More inductions --> more interventions --> more cesareans = more $$. And according to Perkins, bowing to (1994) contemporary practice, ACOG softened its stance against elective induction for logistic reasons.

"Production costs" do not allow for nature to be involved. Long labors cost man-hours, with no added benefit (revenue from induction, interventions such as continuous EFM, epidurals, cesareans). The one-workday labor is a major incentive for managed care. Nature not invited.

Dr. Lisa may have very well ignited (or fanned the flames) of re-forming maternity care by reformation. Similar to what the International Childbirth Education Association published in 1972, Doris Haire's The Cultural Warping of Childbirth (where she documented the inadequate evidence supporting much of the routine technological intervention practiced in birth during the late 60's and 70's). Sound familiar?

There should be a second edition of The Cultural Warping of Childbirth published. The re-forming of care, the true identification of best practice, and putting the well-being of mothers and babies above increasing revenue should be paramount. There needs to be a ROBUST conversation about the state of maternity care.

The question is: can we come TOGETHER to actually have that ROBUST conversation?

I believe the answer is YES!

So yes, thank you Dr. Lisa for reminding us about all of these things!

Remember the Psychology of Daytime Television: Contact Information

2011-10-03T06:39:00.001-07:00

.......and should you be moved to response to the program directly, here is contact information from our friend Jeanne Batacan:

It should prove to be a very interesting program - and according to the guest Barbara Harper may just move you to contact the website:

http://thedoctorstv.com/main/ask_our_doctors

or contact the Associate Producer justin.winters@cbs.com

or write to the program:

The Doctors
5555 Melrose Ave.
Mae West Building, Second floor
Los Angeles, CA 90038

Remember the Psychology of Daytime Television: The Young and the Childbearing!

2011-10-03T06:27:00.000-07:00

This Wednesday, October 5 2011, birth advocate and friend Barbara Harper will be on the US daytime talk show, The Doctors. Filmed a few weeks ago, we have anxiously been waiting on this segment.

As we prepare to gather before our televisions on that day, please try to remember that this show is on daytime television! Daytime television is the home of ridiculous game shows, shows where half of the US population do not know actual paternity, people dress up like chickens to win prizes and residents of imaginary towns flaunt their dirty laundry. (Wait, am I sure I am talking about DAYTIME television?)

According to Wikipedia, daytime television is usually designed to be viewed by audiences such as stay-at-home mothers and fathers, and secondarily those viewers who might not usually carry a job, such as the unemployed, senior citizens and in some select cases, college students. For all intents and purposes however the traditional target of daytime television has been demographically 18-49 women, and as such daytime programming is hosted by women and usually pertains to women's issues and other subjects such as child care, minor health care and other issues within a home setting.

I suppose by that definition and judging from the kind of drivel they put on Daytime Television, programming must be mindless and ridiculous for this demographics to be attracted to it. Keeping with that thought, then, does that imply that The Doctors falls into the category of drivel.

If you are following this logic train, then to be upset with the reception that Barbara is going to receive OR did receive on this daytime television show is also drivel. However, if you look more closely at the demographics of 18-49 women, these are childbearing women! This is also OUR target market! Hence, we cannot ignore this drivel.

So, I propose that the entire cyber birth community begin today to flood the net even more with evidence of best practice of maternity care - statistics, quotes, videos etc. Yes, even more than normal.

In this way, when The Doctors airs on Wednesday, and stays then forever on You Tube, all will see it as............just drivel.

More on Delay Cord Clamping ~ Got Evidence? Parts 3 & 4

2011-09-13T08:05:00.000-07:00

(if you are viewing this blog on Facebook, please go to www.childbirth today.blogspot.com to view the video)

Need evidence about delay cord clamping? This is from Dr. Nick Fogelson, the Academic OBGYN on delay cord clamping - he talks the evidence. This is Part 3 & 4 of grand rounds.

More on Delay Cord Clamping ~ Got Evidence? Part 2

2011-09-13T08:00:00.000-07:00

(if you are viewing this blog on Facebook, please go to www.childbirth today.blogspot.com to view the video)

Need evidence about delay cord clamping? This is from Dr. Nick Fogelson, the Academic OBGYN on delay cord clamping - he talks the evidence. This is Part 2 of grand rounds.

More on Delay Cord Clamping ~ Got Evidence? Part 1

2011-09-13T07:59:00.000-07:00

Delayed Cord Clamping ~ Not just a fad

2011-09-13T07:42:00.000-07:00

(if you are viewing this blog on Facebook, please go to www.childbirth today.blogspot.com to view the video)

A review of current medical literature (2005-2010) finds overwhelming recommendations that late cord clamping can be advantageous for newborns by improving iron status and does not increase the risk of postpartum hemorrhage (Cochrane Database Syst Review. 2008 Apr 16;(2):CD004074.). A 2007 article in the Journal of the American Medical Association found that delay clamping in full term babies is beneficial to the newborn and the increase in polycythemia was benign. (Journal of the American Medical Association 2007 Mar 21;297(11):1241-52. Hutton EK, Hassan ES “Late vs early clamping of the umbilical cord in full-term neonates: systematic review and meta-analysis of controlled trials”.)

When looking at the effect of placentofetal transfusion on cerebral oxygenation in preterm infants, delayed clamping of the umbilical cord actually improved cerebral oxygenation in these infants in the first 24 hours. (Pediatrics. 2007 Mar;119(3):455-9).

Finally, an article in the British Medical Journal addressed concerns that delayed cord clamping could not only increase polycythemia but also cause hyperbilirubinaemia (abnormally high levels of red blood cells and bile pigments in the bloodstream, often leading to jaundice). However, trials show this is not the case. (British Medical Journal 2007, August 17 18;335(7615):312-3. Weeks, A. “Umbilical Cord Clamping After Birth”).

If you want to show your clients this same video, download it to your laptop or notebook by using Real Player. Or if you do not wish to do that, use your fetal doll model with cord and placenta to show them a live demonstration of the same. What a tremendous learning opportunity!

Maternity Care vs. the way a woman's body labors

2011-09-05T17:37:00.000-07:00

For years, perhaps decades, I have been saying and in some instances SCREAMING that the US Maternity Care system does not practice evidence-based care. That's right, it doesn't. Look at the CDC statistics, the 34% cesarean rate or the fact that nearly 45 other countries have better statistical data than the US when it comes to maternal and infant morbidity and mortality.

However, and this was a HUGE aha moment, when I was watching the live webcast of the play BIRTH on 9/5/11.....I discovered that there is a GIGANTIC disconnect not only between US maternity care and the evidence BUT US maternity care and the way women are built to labor and birth their babies!

It all became clear. Suddenly. Like a bolt out of the blue. A woman's body is wanting to labor and birth the baby one way, and we/US maternity care is demanding that the labor and birth happen in a different way. As if to say that a woman's body is wrong and maternity care is right. That the woman's body should accommodate the maternity care and NOT THE OTHER WAY AROUND.

Once I actually said it outloud and then put it on paper, it seemed so simple. Such a simple concept.

So while it is horrific that our maternity care is not evidence based, it is even more horrific that we do not honor and respect the work that a woman's body is trying to do, albeit as individual as we all are. That our maternity care system is not flexible enough or educated enough to learn about all of the possible variables of normal.

But that our maternity care system is at odds with a woman's body during labor.

One World Birth ~ the next great birth film

2011-09-01T14:41:00.000-07:00

We have come to a pivotal point in US maternity care. A revolution has been brewing for some time now and the actual beginnings started as a buzz at the various midwifery, birth and breastfeeding conferences and to some degree online, for example on blogs. Now, just as this newborn bird incrementally tears open the restrictive interventionist shell of the maternity care egg, we see that there is a light of truth being shown on this US maternity care….a care system that exudes mediocrity.

With staggering statistics of 34% cesarean rate and humiliating maternal/infant morbidity and mortality rates as the costars of this tumultuous reality show, today’s birth celebrities (Ina May Gaskin, Michel Odent, Sheila Kitzinger, Elizabeth Davis, to name a few) venture into view to call the plays like they see them ~ "if we get birth right, we get the world right". (www.oneworldbirth.net)

The marriage of evidence-based maternity care with modern medicine is dismal at this moment. With uncomplicated pregnancies turning into complicated births, one only has to look at the factors surrounding the birth to see a path of interventionism and iatrogenic dystocia. These women then take their experiences back into the community and in trying to validate their non-informed decision making, instill fear into future laboring women. Compounding this is the impact of the media, who sensationalizes childbirth to the extreme so that the lines are truly blurred between fact and fiction.

In the 1970s, those of us who were in the birth professional spoke louder than now, literally and figuratively, regarding the policies and routines that interfered with the birth process, including the cooptation of childbirth education classes into the hospital setting. Parents must once again realize that all childbirth education classes are NOT created equally and they will not receive cookie-cutter classes regardless of where they attend classes. While it would be very unfair of me to say that all hospital childbirth education classes were guilty of the sin of omission in many details of information (mainly because I have worked for at least one hospital who didn’t have such stringent ties on their childbirth educators), I can say that for the vast majority of childbirth educators who teach in a hospital setting, an evidence-based curriculum is challenged by obstetricians and anesthesiologist who have little if any training in physiologic birth. And basically because the childbirth education department in such a hospital is NOT the huge money maker department, sins of omission occur. The whole truth is not told. Parents essentially do not get the full story.

When identified as a “patient”, a human begins to feel a certain vulnerability, a need to be cared for and a need to trust. And so an expectant mother and her partner begins to put their trust into care providers that may or may not fully understand the emotional, hormonal or spiritual piece that the expectant parents assume they know. Let’s be clear, how many women have either thought this scenario or verbalized it:

When I am ready to give birth to my child, I want the baby to come early so it can be admitted into the NICU and out of my touch for hours or days. To obtain this end, I want to have my membranes stripped in that painful procedure, be given a synthetic hormone to speed my labor and shuts down my body to make its own natural hormone. I definitely want to lay as still as I can on my back, so labor slows, the baby does not complete the cardinal movements easily and the weight of the baby and the uterine contents puts tremendous strain on the vena cava. In the presence of the resulting fetal distress, I will push and hold my breath and deprive my uterus and baby of more oxygen, thus making the fetal distress worse. At this point, my care provider will perform abdominal surgery on me to deliver my child so I can have a recovery period so much longer than with a vaginal birth and thus, my baby will go to the NICU.

Absurd? Yes. But this same scenario happens every hour of every day of every week of every month of every year. And our species is not thriving. One only has to look at the CDC statistics to see that the US is behind such countries as Qatar. It is not supposed to be that way. We are the leaders of the world. We are more innovative and smarter than that. We must do better. We must consider the expectant mother as whole being not a uterus and vagina. We need to make the scenario of the “patient” in a hospital less frightening as the power of fear and the impact of fear and the hormones surrounding fear are revealed. If that interaction was honored for what it is, and respected, and if women were supported by educated care providers who knew how to care for women regardless of their choices, AND if expectant parents were fully educated about all of the options and possible scenarios, birth would be a better beginning.

If you have not viewed the video clips available from www.oneworldbirth.net, I urge you to do so. See what is being said and take part in the conversation/ revolution.

It is right time; the right place.

September is BOLD and BIRTHY

2011-09-01T09:25:00.000-07:00

I have been waiting for September. Why you may ask? Because of the One World Birth videos today and the BOLD play on Monday. To give you a taste of OWB, here is one of the videos that are FREE!

Maternity Thought Process Swings Toward Health

2011-08-15T07:51:00.000-07:00

It has been brewing for several years.
It has been spoken about in professional journals and at childbirth conferences.
And now, it is finally here.

The maternity thought process in the media and in established care facilities such as WIC and hospitals is changing and gratefully, the media is reporting it. Jumping on the bandwagon (literally) of the Big Pink Bus for breastfeeding awareness, local communities, LLLI and WIC offices promoted World Breastfeeding Week and then Breastfeeding Month (August).

More and more hospitals are realizing that the increase in NICU admissions is NOT a good thing for fiscal management and that they are a BAD thing for society. From coast to coast, hospitals are banning - yes, banning - early elective cesareans and early elective inductions. To say that early elective inductions and cesareans rates had gotten out of hand is a small statement. With the CDC confirming the US cesarean rate of 34% and also the US slipping further in maternal/infant morbidity and mortality was a clear indicator that the increase in interventions were NOT saving lives - if nothing else, contributing to the catastrophic morbidity and mortality rates.

Of course, we need quanitifying data to show us what we and Mother Nature have known since the beginning of time: vaginal birth has extensive benefits for mother and baby. In a 2006 published report in Clinical Obstetrics and Gynecology (Buhimschi et al Advantages of Vaginal Delivery CLINICAL OBSTETRICS AND GYNECOLOGY Volume 49, Number 1, 167–183), the authors finally admit it: Despite an impressive amount of effort and extensive research, our knowledge of parturition remains limited. Scientists have exhaustively investigated ‘‘the timing of birth’’; yet, we still have a limited understanding of the biologic mechanisms that control the events initiating delivery, and consequently, we lack tools to prevent these mechanisms from acting inappropriately.

Further the state:

Thus, it is not surprising to see that the overall rate of labor induction

overall rate of labor induction has doubled

as part of our efforts to ‘‘save life.’’
Although there is compelling evidence to suggest elective induction of labor signiﬁcantly
increases the risk of cesarean delivery
the concept of elective primary cesarean section is not anymore a ‘‘myth.’’

While it is abundantly clear that for most care providers the ultimate goal is a safe and healthy mother/baby dyad, it is also clear that humans really do not have as firm a grip on the power of the mother's body during labor and birth NOR do we have an extensive knowledge base of the impact of the birth process on the newborn and ultimately breastfeeding. For if we did, our statistical data would be reflective of it.

The authors' final statement does give hope to those of us who've championed evidence-based maternity care and education:

Therefore, we all have to rely on high-quality studies that can guide our
decision-making and make obstetric practice safer for both the short- and the longterm future. We believe that establishment of clinical protocols aimed at identifying cases appropriate for vaginal delivery or for cesareans should become a clear objective of each department, and that consistent implementation of these guidelines would signiﬁcantly improve maternal and infant outcomes.

Amen!

Your body, your baby, the Hormonal Orchestration

2011-08-10T11:58:00.000-07:00

(If you are viewing this through Facebook, please go to www.childbirthtoday.blogspot.com for easier viewing of the video!)

During one of my presentations, "The Hormonal Orchestration of Birth" I reference the Fight or Flight Hormones (catecholamines/adrenaline) and Ina May Gaskin's work on sphincters. Professionals get it. Now, in childbirth classes, I ask the support partners if they could have a bowel movement in the middle of Times Square on New Year's Eve? The answer is "NO".

This video is a great illustration!

What The Big Latch-On Is......and Isn't

2011-08-03T10:27:00.000-07:00

This is World Breastfeeding Week - a week where we focus on the benefits of breastfeeding for babies and moms. Those benefits are NUMEROUS. And I appreciate all of the publicity, don't get me wrong.

The negative hoopla around World Breastfeeding Week and the Big Latch On is what concerns me. So let me set the record straight and give you references to combat the bad press.

What the Big Latch On Is............
According to La Leche League, the first record for one location for simultaneous breastfeeding was from Berkeley California in 2002 where over 1000 mothers participated. In 2006, an international record for one location was set in the Philippines where over 3700 mothers participated. From there, the Philippines have partnered each year with other countries and in October 2010, recorded 9,826 mothers in 325 sites in 16 countries.

On Saturday, August 6 at 10:30 am local time, for one minute, women nation wide will be breastfeeding. Information about registering your local event and the how-tos of signing up for participation in this very special event are on the La Leche League website. Click here for the specific page. There are also a "Rules" page and a section where forms for registering your event are located. Want to know where in your state the events are occurring so far? Scroll down a little farther on that page and events are divided by state and are in a table format.

Additionally on the La Leche League website, you can find a "Kit" to use to help you celebrate World Breastfeeding Week. This kit includes professionally designed brochures to print off, planning tips, publicity tips.......if it is too late for you this year, this is a good website to bookmark for next year!

What the Big Latch-On is NOT............

The Big Latch-On is NOT going to be a distraction to any public location in which it is held. It is not a lewd or obscene event. It is only 60 seconds of feeding other human beings. There will be women (of all ages) breastfeeding their children (of all ages), in an effort to reverse the public view of breastfeeding: all too often breastfeeding is the underdog of feeding babies. The Big Latch-On strives to set the record straight - breastfeeding is the Gold Standard.

So go get your LATCH ON on August 6.

If you are not breastfeeding a child, go and support those who will be on that day. Don't hesitate!

And be sure to check out the Milk For Thought Pink Bus coming to a town near you!
Look at the 2011 Breastfeeding Report Card.

And look for the United States Breastfeeding Committee to announce on August 6, that August will be declared National Breastfeeding Month!

Happy World Breastfeeding Week 2011!

2011-08-01T15:13:00.001-07:00

Happy World Breastfeeding Week!

US Cesarean Rate Now 34% ~ Healthgrades

2011-07-20T10:33:00.000-07:00

On July 19th, 2011, HealthGrades Obstetrics and Gynecology in American Hospitals (an independent source of physician information and hospital quality outcomes) released a study of U.S. hospital outcomes between 2002 and 2009. States included in the study where data are publically available: Arizona, California, Colorado, Florida, Iowa, Maine, Maryland, Massachusetts, Nevada, New Jersey, New York, Oregon, Pennsylvania, Rhode Island, Texas, Utah, Virginia, Washington and Wisconsin.

In the report, there were several key findings significant to nurses, midwives, physicians, doulas and childbirth educators:

In those states studied, 7% of women undergoing single live born deliveries experience an inhospital complication. If all hospitals performed at the level of 5-Star rated hospital in maternity care, 32% of these complications (141,869) could have been potentially prevented.

The highest rate of C-section was found in Florida (38.6%) and New Jersey (38.0%). The lowest rate was found in Utah (22.4%).

As they see it, quoting a 2011 Yale School of Medicine study, the rise in cesarean sections are associated with factors including:

Common labor practices that can lead to cesareans such as inductions or epidurals in early labor.
Timing convenience for provider or mother.
Increase maternal risk factors such as age, obesity and diabetes.
Increased multiple births.
Increasing willingness of physicians to perform cesareans.
Limited understanding by the mother of the potential complications of cesarean births.
Maternal request for cesarean.
Physician fear of malpractice claims if they do not perform a cesarean.
Established physician practice patterns.

It becomes alarmingly clear after reading the entire report, that 7 of the 9 indications can be eliminated through education....dynamic and evidence-based education of mothers and their partners and simultaneous dynamic and evidence-based education of physicians, midwives and nurses. Yet, providers continue to discourage evidence-based childbirth education either by directly discouraging expectant parents to attend such classes or assert their influence over childbirth education class materials, if the classes are in the hospital setting.

According to "Understanding the Dangers of Cesarean Birth" by Nicette Jukelevics, "women have few standards by which to choose quality coverage for maternity care. The National Committee for Quality Assurance (NCQA) is a private, not-for-profit organization that sets standards for quality of care and service for health plans. In its 2005 report on the state of health care quality, the NCQA found that 'consumers do not yet have access to the kind of objective information they need to make informed decisions about their care...They need to know which practices, hospitals, and health plans have systems in place to improve quality and safety and which ones make themselves publicly accountable and they need to know how to find their way to high performance providers.'"

The Listening to Mothers II Survey, a survey of over 1600 mothers, found that US women were poorly informed about the risks of cesareans despite their belief that they should be told about those risks. The survey went on to point out that support in pregnancy, a healthy life event, for physiologic birth is very limited. Large proportions of the contributors reported numerous interventions with various degrees of invasiveness and risk. The survey goes on to state that "There were signs of failure to implement standards of informed consent, and many women did not have the childbirth choices or knowledge they wanted. Most who had experienced specific consequential interventions lacked an accurate understanding of associated side effects. In open-ended comments, many mothers described indignities and treatment that expressly violated their wishes. Far too many indicated that they felt overwhelmed, frightened or week during this pivotal event."

The United States of America is not a third world country and our mothers should not be treated with little dignity, little education and little respect. The invasive procedure, including cesarean sections, not only interfere with a woman's body and healing postpartum but also breastfeeding. Breastfeeding is interfered with by separation and supplements. It becomes clear with each passing second, with each new study or press release that United States maternity care is letting down its citizens, mothers and babies. Families who do want less interventions and more mother-friendly evidence-based care experience policies and trends or "habits" in the health care system that are diametrically opposite of best practice.

This, along with the 20% rise in homebirths (as released by the Center for Disease Control), this is a strong and loud wake-up call for hospitals and providers. We women, both childbearing and birth professionals, can and will seize this opportunity to shine an even large light on the non-evidence-based practice given to the citizens in the United States.

"The rising cesarean rate is a matter of deep concern for every childbearing woman today and in the future. Even a mother with previous vaginal births is at risk for a surgical delivery. The rising cesarean rate is a warning siren that every childbearing woman is at risk for a surgical delivery outcome. The rising cesarean rate is not a niche issue with over 1.4 million surgical deliveries being performed in 2009. Every childbearing woman needs to be proactive in her care toward surgical prevention," says ICAN President Desirre Andrews.

I challenge you to print off the HealthGrades 2011 Obstetrics & Gynecology in American Hospitals Report and give to at least five maternity care providers. If it only changes the practice of one, that is one more than yesterday who will practice evidence-based medicine.

Prescription Milk

2011-07-17T16:11:00.001-07:00

You may have seen this trailer before. But you may want to see it again!
(if you are looking at this on Facebook, please go to www.childbirthtoday.blogspot.com to see the complete video.)

Guest Blogger: Jodi Hitchcock MSW

2011-07-16T14:29:00.001-07:00

Perinatal Mood Disorders: Who Should Screen?

By Jodi K. Hitchcock, MSW

I am often asked whose responsibility it is to screen a pregnant or postpartum woman for a mood disorder (or a PMD). This seemingly simple question has a complex answer. I can reply with whom should be screening, or with whom is actually screening, or there is even whom I think needs to be doing it. Unfortunately, these three are rarely one and the same and that leaves many women at risk for never receiving a proper diagnosis or treatment.

Lets begin with whom should be screening. In an ideal world, all obstetricians and midwives would include a standard PMD assessment during all perinatal visits. Unfortunately, this rarely happens and when it is addressed, a clinical diagnostic tool is often not used. The doctors and midwives that I have discussed this with have explained a variety of reasons why they do not routinely screen their patients. The most common reason that has been given is that they do not know what to do with a patient whose scores indicate a high probability for a PMD. In the area that I live, there are very few resources readily available for doctors and midwives to refer patients should they be experiencing a PMD. Women who are on Medicaid have the most difficulty finding specialized treatment, which leaves these women particularly vulnerable to more significant problems.

Through my experience researching and working with the perinatal population, I have discovered that there is an “underground society” of professionals providing these services, but they are not well known and are rarely publicized. I have many theories behind why I believe this is the case, but I will save those for a future post! The bottom line is that physicians are often times at a loss for what the next treatment step should be so they skip the clinical diagnostic assessment entirely. I am not placing blame on obstetricians or midwives, this is a much broader concern where changes need to be made at every level.

Although most hospitals now include some form of PMD education or screening as part of the discharge process, this is only a minor first step in accurate diagnosis and treatment. The majority of women will experience some form of postpartum blues in the first 2 weeks postpartum. If the symptoms become worse or are not getting any better at 3 weeks postpartum, it is likely that she may be experiencing a PMD and this could not be determined at discharge from the hospital. Although a 6-week postpartum visit with a doctor is generally a standard practice, for women going through depression, anxiety, panic, etc., this can feel like a very long time to wait. This is one of the main reasons that I feel the optimum place for a new mother to be screened is at the pediatrician office. New babies are often seen a couple of times in the first month after birth to do weight checks (especially if they are breastfed). A standard diagnostic test (such as the Edinburgh Postnatal Depression Scale) could be administered to the mother at each of these visits and referrals made to see a specialist or even see their own doctor (sooner than the usual 6-week visit). In addition to diagnosis occurring sooner, having multiple assessments done in one location allows the medical professional the ability to monitor the symptoms to see if the woman is improving with time or getting worse. The sooner a mom receives treatment for a PMD, the least amount will be needed for a shorter amount of time. Therefore, early detection is beneficial to mom, baby and the family unit and pediatricians play a key role in this success!

About the Author:

Jodi K. Hitchcock, MSW is a mother of 4 amazing children (ages 10, 9, 6 and 21 months) and the stepmother to a wonderful 14 year old. She currently works 24 hours a day as a stay-at-home mom to those lovely children. In addition, Jodi works as an independent consultant providing perinatal support, education and outreach to mothers, couples and families experiencing PMD’s. In addition, she conducts training seminars and provides outreach education to other perinatal professionals. After experiencing a variety of PMD’s during and after her pregnancies, Jodi is able to provide a unique combination of personal and professional knowledge to the people she works with. Jodi especially loves to work with pregnant women who are experiencing or are at risk to experience a PMD so that she may empower them through education and prevention techniques so that they may have the best possible birth experience! To read more about Jodi and her personal experiences, visit her website @ www.mypostpartumlife.com

The 43 Year Active Management of Labor Project: What have we learned?

2011-06-29T12:19:00.000-07:00

The concept of active management of labor is familiar to most maternity care professionals. This concept was first demonstrated at the National Maternity Hospital in Dublin Ireland in the late 1960s.

Defined, active management of labor includes two major components. The first component is the Organizational Component, which many have stated is the most critical of the two. The Organizational Component includes prenatal education (which includes patient/family education about the birth process and working with labor), daily physician assessment (assessing labor progress, supportive to patient throughout labor and during the postpartum period), bedside support (emotional and educational support at the bedside by staff), and peer reviews of outcomes (evaluate the effectiveness of the approach and possible process improvement). The other component, the Medical Component, includes a rigid inclusion criteria (ensure only term, umcomplicated nulliparas are actively managed), strict diagnosis of labor (prevent hospital admission in early labor, decrease cesarean rate), early amniotomy (to assess volume and presence of meconium), frequent cervical exams (detect early dystocia and adequate process), and high-dose oxytocin (to correct dystocia with more effective contractions). All of this with twelve hours believed to be the maximum safe duration of spontaneous labor.

Interestingly, epidural anesthesia is not a component of the active management of labor routine. To compound this, there is some conflicting research as to the effect of epidural anesthesia on length of labor, depending on the source. Over all, it is well known in the literature that women who have inductions have longer labors and higher cesarean rates.

Taking a look at the state of US maternity care today, with pregnancy outcomes (specifically maternal morbidity/mortality and infant morbidity/mortality) not improving (in fact worsening) and the cesarean rate rising significantly since 1968, it is important to assess use of active management of labor prior to its efficacy. Many birthing facilities and care providers use some of the components of active management of labor, however several items tend to be overlooked or forgotten in the implementation of the process ~ specifically, prenatal education, bedside emotional and physical support and rigid inclusion criteria. Therefore, with these vital components not being included, any assessment of the efficacy of active management of labor would be incongruent. Thus, active management of labor may be misunderstood by care providers and misapplied.

One only has to look as far as the Cochrane Database to obtain a summary of RCTs and evidence-based care. No longer do we have an excuse that evidence-based maternity care continuing education opportunities are beyond reach. And in this case, ignorance is not bliss. Nor is it professional. Expectant parents look to care providers to do just that ~ give care. Our organizations charge us with providing best practice and quality care. Conversations, albeit heated ones, exist about the best practice vs best price conundrum. How dare we, as a society or as a country, put currency before the health of our women and children. How can our conscience survive knowing that we compromise care, blaming it on "that's the way we've always done it", "that's what our policy says" or more acidic comments such as "if you don't do this, your baby will die" (when in fact, the baby will not die).

Our maternity care practices in the past 43 years have not yielded better results. The outcry of those pleading for revolutionary change in maternity care are not those who are aggressive, uneducated radicals uncomfortable with 43 years of rituals. Many are, in fact, physicians, midwives, nurses, childbirth educators and doulas. They are authors, speakers, researchers, university professors.

And they all are asking the same question: What have we learned?

Resources:

Listening to Mothers I & II

Boylan, P.C. Active management of labor: results in Dublin, Houston, London, New Brunswick, Singapore and Valparaiso. Birth 1989 16: 114-9.

Declercq, E. Macdorman M., Menacker F. Recent trends and patterns in cesarean and vaginal birth after cesarean (VBAC) Deliveries in the US. Clinical Perinatology 2011 June 38(2) 179-92.

Declercq, E. Macdorman M. Zhang J. Obstetrical intervention and the singleton preterm birth rate in the US 1991-2006. American Journal of Public Health 2010 Nov 100(11) 2241-7.

Declercq, E. Macdorman M., Menacker F. Neonatal mortality risk for repeat cesarean compared to VBAC in the US 1998-2002 birth cohorts. Maternal and Child Health Journal 2010 Mar 14(2) 147-54.

Florence DJ, Palmer, D. "Therapeutic choices for discomforts of labor" Journal of Perinatal and Neonatal Nursing 2003 Oct-Nov 17(4) 238-49

Impey L. Boylan P. Active management of labor revisited. British Journal of Obstetrics and Gynecology. 1999 106:183-7.

James D.C. "Routine obstetrical interventions: research agenda for the next decade." Journal of Perinatal and Neonatal Nursing. 2011 Apr-Jun 25(2): 148-52

Nil Nocere

2011-06-22T07:33:00.000-07:00

This post is actually a quote from Dutch professor of obstetrics G. Kloosterman:

Spontaneous labour in a normal woman is an event marked by a number of processes so complicated and so perfectly attuned to each other that any interference will only detract from the optimal character. The only thing required from the bystanders is that they show respect for this awe-inspiring process by complying with the first rule of medicine - nil nocere [do no harm].

Kloosterman, G. (1982) "The universal aspects of childbirth: Human birth as a socio-psychosomatic paradigm" Journal of Psychosomatic Obstetrics and Gynecology 1(1) 35-41 page 40.

Free New App for Breastfeeding

2011-06-20T13:10:00.000-07:00

Hot off the press is the new LactMed App for iPhones and Androids.

LactMed, part of the National Library of Medicine's (NLM) Toxicology Data Network (TOXNET®), is a database of drugs and other chemicals to which breastfeeding mothers may be exposed. It includes information on the levels of such substances in breast milk and infant blood, and the possible adverse effects in the nursing infant. Suggested therapeutic alternatives are provided to those drugs where appropriate.

All data are derived from the scientific literature and fully referenced. Data are organized into substance-specific records, which provide a summary of the pertinent reported information.

To download this App, go to the iTunes App Store or scan the QR code here below to learn more.

Apple Dumplings ~ from a UK Midwife!

2011-06-15T08:05:00.000-07:00

Perhaps the first music video about breastfeeding!

What if......we substituted Childbirth Educator for the word Anesthesiologist?

2011-06-14T12:51:00.000-07:00

There was an article that was written recently about the disparity in understanding between maternity health care providers, focusing on anesthesiologist. In playing with the word anesthesiologist, I wondered what the article would look like if I substituted the word childbirth educator or education. Here's how it turned out. What are your thoughts?

********************************************************************

"Childbirth educators are pivotal in so many areas of the hospital, yet their work and expertise are not well understood, especially in labour and delivery settings," said Dr. XXXXXX, XXX Fellow at XXXX Centre and resident physician at the University of XXXX and lead investigator of the study. "This study is the first-of-its-kind that explores specifically how childbirth educators and their labour and delivery colleagues perceive the childbirth educators role, and the potential impact of these perceptions on interprofessional dynamics and team collaboration in labour and delivery."

The study, co-supervised by Dr. xxx, vice-president of education at St. xxxas Hospital, and Dr. XXXXXXXXXXX with the XXXXXX Institute of xxxxx Hospital and The xxxx Centre, was recently presented at the first International Conference on Faculty Development in the Health Professions in (city) at xxxxx Hospital.

Health providers in the labour and delivery units at two urban teaching hospitals in Toronto were interviewed. Participants (ranging from midwives, nurses and obstetricians, as well as childbirth educators, all with different levels of experience) were asked a series of in-depth questions to determine their understanding of the childbirth educators's role during labour and delivery, the childbirth educators process, and the type and amount of education and training they had received around childbirth education management.

On analysis of the data, a number of important themes emerged:

Lack of understanding of the complexity of the childbirth education process during labour and delivery. While midwives, nurses and obstetricians appreciated the role of their childbirth educator colleagues, particularly in the provision of labour pain relief and anesthetics for C-sections, many reported that their understanding of the actual process of childbirth education was limited.
Lack of training about childbirth education: Many nurses and midwives received little formal training about the childbirth education process in school or during their clinical placements. Similarly, most obstetricians had very little postgraduate exposure to formal childbirth education training. The study also revealed that opportunities for structured communication between all labour and delivery health professionals (ex. to discuss cases or to debrief after an adverse event) were infrequent and therefore, a missed opportunity for team learning and quality improvement.
Childbirth educators’ membership in the labour and delivery 'team': Nurses, midwives, obstetricians and other members of the obstetrical team spend countless hours with the patient throughout the entire labouring process. In comparison, the study found that the childbirth educators had less involvement in decision-making processes, even when they could have had useful and important input into a patient's care. The study found that this misunderstanding and the often peripheral position of the childbirth educators on the team, led to isolation of the childbirth education s in their work, which had implications for effective communication, collaboration and the safe delivery of care.
Imbalances and tensions between health professionals: The study found that some engrained stereotypes and historical tensions were present between different health professions. Instances of hesitation to question other professionals about decisions related to patient care were sometimes borne out of fear, or were due to inadequate training and knowledge.
"This study tells us that as health professionals, we have an immense amount of work to do in order to build a culture of true interprofessional teamwork and to provide the necessary training and supports to ensure that we deliver the best possible patient care, " .

World Breastfeeding Week 2011!

2011-06-14T05:17:00.000-07:00

The theme of this year's World Breastfeeding Week is "Talk to Me! Breastfeeding a 3D Experience". When we look at breastfeeding support, we tend to see it in two-dimensions: time (from pre-pregnancy to weaning) and place (the home, community, health care system, etc). But neither has much impact without a THIRD dimension – communication!

Every year, breastfeeding advocates and parents celebrate world wide Breastfeeding Week during August 1-7!
Even with global exclusive breastfeeding rates on the rise, the momentum to promote and continue to promote breastfeeding is a wise decision!

Read more.......

Healthy Babies Are Worth the Wait! New from March of Dimes

2011-06-13T16:19:00.000-07:00

Another great resource for childbirth educators and doulas: the first educational stop on the pregnancy journey!

The March of Dimes' new campaign, Healthy Babies are Worth the Wait, informs health professionals and the public about the complications and health risks related to inducing a pregnant woman before 39 weeks gestation.

Through this new campaign, the March of Dimes aims to raise awareness among women and medical providers of the importance of having a full-term birth and allowing for natural labor, if possible.

For more information and resources related the MOD’s 39 weeks campaign, visit: http://www.marchofdimes.com/pregnancy/getready_atleast39weeks.html.

Food Guide Pyramid --> My Plate!

2011-06-13T10:27:00.000-07:00

If you are viewing this on Facebook, please go to www.childbirthtoday.blogspot.com to see complete blog post.

Out with the old Food Guide Pyramid and in with the new My Plate!

The USDA has created a more user friendly and easier to comprehend way of looking at our nutrition and have replaced the Food Guide Pyramid with the new My Plate graphic. Designed to help everyone eat better and be healthier, the USDA have also added some great resources to add to your childbirth education class materials or doula client information!

Check it out ~

Daily Food Plan for Moms
Daily Food Planner/Tracker
Moms with Special Nutritional Needs: Allergies, etc.

While not as Baby Friendly as the Surgeon General would like, there is info on nutrition and breastfeeding:

Breastfeeding Nutrition

What about food safety? Click here

Need more info about nutrition and pregnancy and breastfeeding? They have great resources too!

Remember, it is NEVER too late to talk to your expectant clients about the impact of dietary changes on the development of their baby(s)! Even if you begin interacting in the closing weeks of the third trimester, share the My Plate with them. It may make a world of difference!

Follow up: FDA oks Birth Pools

2011-06-13T10:15:00.000-07:00

The FDA has released birth pools from "detention" and will continue their investigation. For right now, they are NOT classifying them as Medical Devices, which is best for midwifery community and all women seeking a non-medicated birth.

~ Waterbirth Solutions

10 Simple Truths About Childbirth ~ #5

2011-06-13T10:07:00.000-07:00

If you are viewing this on Facebook, please go to www.childbirthtoday.blogspot.com to see entire post. Thanks!

Many people are followers and few are leaders. This is true both in childbirth related organizations and society as a whole. Not only does it apply to "politics" but also how birth is viewed.

Birth is an organic, normal, natural and physiologic process. Like other body functions, birth typically does not need intervention. However, occasionally, like other body functions, intervention is beneficial...in fact necessary for positive outcomes.

Whatever your role in the birthing community ~ care provider or care receiver ~ think twice about being a sheeple....that is, following the crowd. Doing what has always been done because it appears ok. The reality is, at the end of the day...or at the cliff's edge, it may appear ok, but it may not be ok!

Oh, and another thought. Be careful whom you do follow.

Birth Pool Accessibility Now in Question

2011-05-26T13:27:00.000-07:00

If you are a birth professional, you will know how quickly the news about the FDA making accessibility to birth pools in the U.S. harder went viral today (5/26/11) . The following is information from long time expert and waterbirth advocate Barbara Harper:

"In my personal conversations with a woman(Patricia Jahnes) in the "Office of Compliance- Center for Devices and Radiological Health" (that's where they put us) I was told in no uncertain terms that pregnancy is classified as an "illness" and "birth is a medical event" and therefore ANYTHING that is used during this time is considered a "device" and therefore needs approval by the FDA". ! BH

There is a flaw here in their (the Office of Compliance) reasoning. A huge flaw. So if one arm of the U.S. government believes that pregnancy is an illness and birth is a medical event and anything that is used during this time is considered a device that needs to be approved by the FDA, then what about Foley catheters used for Foley Inductions rather than for urinary flow? What about Cytotec that is used frequently but not approved for use during pregnancy and birth? And what about the inconvenient truth that both the electronic fetal monitors and the Apgar scoring system were never intended to be used in the manner that they are today?

I realize that these may be the difficult and unpopular questions. However, I also realize that many of a woman's options and choices in pregnancy and childbirth are under attack.

And therefore since one arm of the U.S. government believes that pregnancy is an illness and birth is a medical event and anything that is used during this time is considered a device that needs to be approved by the FDA, what is the next option/choice to go?

10 Simple Truths About Childbirth ~ #4

2011-05-24T05:23:00.000-07:00

‎"Men fear most what they cannot see" ~ perhaps that is why they fear childbirth? But all they really have to do is....look.

Fear is by far one of the driving forces behind the increase in medical intervention in childbirth. "Men" meaning humankind, fear what they cannot see. And since a good visual is not available for what is happening in the uterus and in the most dangerous 4 inches in an infant's life - the journey through the birth canal - then fear takes over.

Yet as much as we intervene in childbirth in the U.S., research continues to show with the rise in intervention rates, the rate of maternal morbidity and mortality/infant morbidity and mortality is still extremely poor. In fact, 40 other countries have better statistics than the US in spite of the fact that the US spends more money on maternity health care.

But as the quotation says, perhaps all one has to do is to look and they can "read" a laboring women.

I am not talking about EFMs or vaginal exams.

I am talking about physical presence, verbal cues and emotional signals from women in labor.

Study how she moves - left alone, a labor woman moves in perfect syncrony with her body to promote the cardinal movements of the baby: those miraculous movements that the baby initiates as the journey of birth begins. Not signaled by the mother or caregiver, the baby instinctually knows how to move, bend and extend in order to fit through the tight spaces of the pelvis. The mother will also move, bend and extend, crouch, squat, stand, sit, kneel, sway, lean and walk as if listening to a birth song...dancing to this song to bring her baby into the world.

Likewise, she may also "sing" along with this birth song...verbalizing as best as she can the effort going into this work. It may be in the form of talking, moaning, singing, yelling, groaning, or talking in soft, loud or angry tones. With each phase/stage of labor, her verbalizing changes, signalling the change from one phase to another. Her verbalizing tries to match the intensity of the contractions and the work her body does.

As her verbalizing changes in intensity, so do her emotions. From calm and expecting, to intense and working, to fierce and with effort, a laboring woman's emotions also change to match the work she does. As the contractions become stronger in an effort to push the baby from the uterus to the loving arms on the outside, the emotions (and endorphins) match this strength. With the protective fierceness that exists down deep in all mothers, a laboring woman expresses her emotions verbally, on her face, in the tone of her words and in her physical actions.

If we as caregivers take the time (albeit precious) to be fully present at a birth and watch with careful eyes the emotions, movement and verbal cues given by laboring mothers, then as we learn what is normal (and what isn't), birth will no longer be a fearful experience. But we absolutely must know the normal before we can truly deal with the abnormal. Then our morbidity and mortality statistics will be more reflective of the maternity care we all want to achieve.

While this has spoken more about the fear that caregivers have of birth, I will soon write Simple Truth #4a - about the fear that pregnant women have surrounding birth. That also must be addressed.

The New Birthsource Lamaze Childbirth Educator Program!

2011-05-06T06:19:00.000-07:00

In the spring of 1979, my husband and I sat in a Lamaze Childbirth Education Class in Lompoc, California. While I was a nurse, normal and natural childbirth was something new to me. We were taught about crisis intervention and all of the modern technology of the day, but this was totally new. I was incredibly inspired by our educator, Linda Richardson (I believe that was her last name). The spark of childbirth education had been ignited.

During the birth of our first daughter in April of '79, I experienced the Lamaze techniques and some of the same feelings we saw in the birth film (reel to reel ~ LOL) "Nan's Class". As I held my beautiful daughter in my arms, counted her fingers and toes like all new parents, I knew my destiny. I wanted to be an educator!

Several month later, I called Linda only to find that ALL of the Lamaze Educators in the local area were leaving, as their husbands were all military and it was time for new assignments. They all helped me complete the educator program, including my own Seminar taught by Harriet Palmer in Fresno. In August of 1980, I taught my first Lamaze childbirth education class, under the observation of one of the other educators. I was hooked! I soon became an LCCE and then a charter FACCE.

When our second daughter arrived in 1986 at Cape Canaveral Hospital in Florida, I had been teaching for seven years and really got an opportunity to "practice what I preached". Her amazing birth reinforced that normal, natural childbirth was possible, even in a hospital setting; that there were care providers who believed in the power of women and the normalcy of birth! Her birth strengthened my focus and further dedicated me to education.

During the 31 years since certification, I have taught in many states (as my husband was also in the Air Force), locations (adult schools, colleges, military hospitals, civilian hospitals, churches, and privately). As I checked the mail yesterday, that same thrill came to me as I opened the envelope from Lamaze International containing the welcome letter and certificate for the new Birthsource Lamaze Childbirth Education Program!

While to many it may just be a natural progression - the sage femme becomes the educators' educator - to me it is an honor and privilege to be an active part of such a respected and prestigious organization that has stood for education, advocacy and maternity reform for so many years.

I guess now I too can say.....Thank you Dr. Lamaze.
And thank you to my daughters, who unknowingly played such an important part of my career!
And to my husband, who stood by me, cheering all the way.

10 Simple Truths About Childbirth ~ #3

2011-04-28T10:24:00.000-07:00

I have begun the series "10 Simple Truths About Birth". You can respond on Facebook, or directly on my blog at www.childbirthtoday.blogspot.com.

Truth #3: Many of today’s expectant women are passive, uninformed and fearful

In a discussion several days ago with another seasoned birth professional, we came upon the theory that the reason why so many women present in childbirth class passive, uninformed and fearful is because they may not have had the same type of role models as in the past.

Rather than strong family members giving birth and being empowered parents, expectant mothers of today are influenced by the media, and the half truths, misinformation and sometimes, out right lies that are told.

When it comes to books, many women are familiar with the main stream books that are trendy and hip but contain, again, misinformation and half truths. Rather than look for the evidence-based information, they are relying on celebrities and even some of my own maternity/obstetrical colleagues to provide a non-biased view of birth. Unfortunately, expectant women who rely on these sources lose in the long run.

Likewise, if expectant parents rely on television, they will also lose. Few if any televised shows about childbirth/breastfeeding present unbiased and/or evidence-based information. Case in point:

Please also view this:

And finally, this opinion:

Thank you to American Baby and "Better" for helping to promote the importance of childbirth education classes. Where do the majority of the expectant parents you know get their information?

10 Simple Truths About Childbirth ~ #2

2011-04-26T12:48:00.000-07:00

Today I begin the series "10 Simple Truths About Birth". You can respond on Facebook, or directly on my blog at www.childbirthtoday.blogspot.com.

Truth #2: US maternity care does not practice evidence based care.

The US Maternity Health Care system does, in fact, not practice evidence based care. A close look at the statistical data on maternal morbidity and mortality/infant morbidity and mortality shows a very bleak picture of our outcomes based on an interventive based care plan. In fact, in their new initiative, Childbirth Connection states that “the largely healthy and low-risk population of childbearing women and newborns experiences 6 of the 10 most common hospital procedures. One out of three babies is born via cesarean section, the most common operating room procedure in the United States. Best evidence supports more judicious, restrictive use of maternity care procedures, and suggests that overuse is contributing to significant excess harm and costs.´

There is obviously a disparity between evidence based care and the care practices in the US. But, as Childbirth Connection also asks, how can you make a change if you don’t know what you are aiming for?” Exactly!

The scope of change will never happen with birth professionals standing at the hospital doors, banging, and yelling “You must change because we say so and because it is right”. As stated in another “Truth”, hospitals are indeed companies or businesses wanting to make a profit. Change will not happen necessarily because the literature says that is the thing to do….especially if “what we’ve always done” is working….mirroring the old adage: If it ain’t broke don’t fix it.

It is broken. Research is beginning to come to the surface about our broken system. A report issued by the California Pregnancy-Related and Pregnancy Associated Mortality Review shows that deaths from pregnancy-related causes, usually occurring at the time of birth, have risen dramatically in the U.S., in spite of the increased use of technology and the increase in cesarean section rates. In fact, the study that was released on April 26, 2011 stated that the increase in cesarean sections were a major contributor to the increase in deaths from pregnancy-related causes.

But again, what does evidence based maternity care look like? What is staffing, what services? Is there a comprehensive childbirth education program and if so, what do those classes look like, certification? What about a hospital based doula program? Again, the Childbirth Connection asks for an essential package to answer these questions and many more.

I especially like Childbirth Connection’s call for a revival and broaden reach of childbirth education through expanded models and innovative teaching modalities.

This in turn, will foster and promote a true cultural shift in attitudes toward childbearing.

10 Simple Truths About Childbirth ~ #1

2011-04-19T05:46:00.000-07:00

Today I begin the series "10 Simple Truths About Birth". You can respond on Facebook, or directly on my blog at www.childbirthtoday.blogspot.com.

Truth #1: Birth is healthy and normal, complications are the exception.

Mother nature says it. The World Health Organization says it. Many maternity health care professionals such as physicians, midwives, nurses, childbirth educators and doulas say it.

Birth is healthy and normal.

Anyone can find proof. See abstracts of journal articles at the website for the US National Library of Medicine/National Institutes of Health or the Cochrane Database. Read about it in books such as The Official Lamaze Guide: Giving Birth With Confidence, 2^nd Edition.

Interfering with the normal physiological process of labor and birth in the absence of medical necessity increases the risk of complications for mother and baby. So why is nature seen as abnormal and interventions seen as “normal”? One educator shared on Facebook that it was the media and cultural brainwashing. Some believe it is the process of accustomization – where we are slowly and methodically lead to believe that intervention is beneficial and good – see my previous blog and video spot from the US television show, "The Doctors". Sadness was the emotion that came to me as I viewed this. This was not an instance of misinformation or omit evidence. What they did on that show was lie about the risks of the use of epidural anesthesia. How sad.

It is vital that we continue (and in some cases, begin) to teach from a risk/benefit view…evidence-based information…best practice. The Joint Commission requests this practice.

How to do that? Lamaze has established the Six Health Birth Practices: avoiding medically unnecessary induction of labor, allowing freedom of movement for the laboring woman, providing continuous labor support, avoiding routine interventions and restrictions, encouraging spontaneous pushing in nonsupine positions, and keeping mothers and babies together after birth without restrictions on breastfeeding ~ skin to skin. Well established documentation of the evidence accompanies these Birth Practices. Lamaze has partnered with Injoy Video Productions to make professional quality handouts and free videos available to everyone.

Many birth professionals who receive formal training such as physicians and nurses may have never thought of birth as anything else than a crisis waiting to happen. That concept is not taught in the medical schools and nursing schools of the U.S.

Do not be afraid of speaking the truth. The paradigm shift needs another a kick start.

Questions to Ponder

2011-04-18T06:00:00.000-07:00

These are questions I've been wondering about for a while....actually quite a while.

If birth is natural and normal, then why isn't intervention of any kind (with the exception of emergent cesarean) seen as the non-norm?

Why are those who seek natural, healthy, normal birth seen as "odd" or labeled with everything from "crazy" to "granola crunchers"?

If, as the research demonstrates, all medication crosses the placenta and affects the baby, then why are women more fearful of THAT than the few minutes of pain/hour of labor?

The female breasts are put there to nourish a newborn. Why is these seen as the non-norm?

Why are those who breastfeed their babies seen as "odd" or labeled with everything from "crazy" to "granola crunchers"?

If, as the research demonstrates, breastmilk is THE perfect source of nutrition for babies, then why are women more fearful of THAT than the additives in formula?

Mmm, I see a pattern here. Do you?

View this...then read that.

2011-04-06T13:30:00.000-07:00

View this segment from U.S. television:

Then read this:

http://www.scienceandsensibility.org/?p=2379#respond

Thanks to Kimmelin Hull for a brilliant rebuttal. Also read some of the comments if you would like to write the Doctor's TV Show.

Revised US Guides on GBS

2011-03-28T10:28:00.000-07:00

In the April 2011 issue of Obstetrics and Gynecology, the American College of Obstetricians and Gynecologists will share the revised guidelines for the prevention/treatment of GBS or Group B Streptococcal Disease.

GBS is a relatively common, asymptomatic bacteria carried by women (approx. 10-30% of expectant mothers) in the vagina or rectum. If transmitted to newborns (approx 2% of newborns infected), it can cause infections such as sepsis (blood), lungs, brain, or spinal cord. Nearly 5% of those infected newborns tragically die. It is important to note that when the guidelines were published in 1996, there has been between 70-80% decrease int he rate of early onset GBS disease.

Summarizing the new CDC (U.S. Centers for Disease Control) guides for GBS, the ACOG Committee Opinion #485 acknowledges the screening between 35-37 weeks of pregnancy and the antibiotic treatment for women with preterm labor or premature rupture of membranes (water breaking). Updated guides include antibiotic treatment for women plus regimens for women with penicillin allergy, and updated management plans for newborns at risk.

To see the CDC Guidelines or download them as a PDF, click here.

The College of Midwives of Manitoba (Canada) recently updated their Guidelines for Management of Group B Strep. Click here to see their Guidelines.

Speaking the Truth Often Unpopular But the Right Thing To Do!

2011-03-21T11:40:00.000-07:00

I have been a Lamaze Certified Childbirth Educator a long time. A very long time. Since 1980.

I have always prided myself in giving the most recent, evidence-based information to my clients, even before it was in vogue and "evidence-based" was a popular term. My clients had all of their options before them, ready to make choices made with full, unbiased information. I watched my voice inflection and body language to not give away my (few) biases. I didn't want to sway them. It was their birth.

Because I gave the most current, evidence-based information, I was not popular with some. Mainly because what I spoke was sometimes contrary to "the way we've always done it" or contrary to "our policy". Even when I would show the professionals telling me those things that the evidence was in their own journals, it didn't seem to matter. I cannot teach what isn't accurate. I have to tell the truth.

I have a binder in my office with evidence-based articles. I have two websites full of the evidence-based information. I still believe that providing my clients with the current research, evidence-based information and letting them make their informed decisions is the right thing to do.

And I hope I continue to teach and share the research for another 30+ years!

Our History is our Strength!

2011-03-15T13:29:00.000-07:00

March is National Women's History Month.

Now you have to admit, few other professions have as many women involved as the birth profession.

Who are the women in birth that have inspired you...captivated you...motivated you...encouraged you?

Please list them below..and I'll give a tally at the end of the month!

Remember, if you are reading this on my Facebook page, please go to www.childbirthtoday.blogspot.com

to reply.

The Essential Ingredient: Doula

2011-03-09T13:06:00.001-08:00

(If you are seeing this on Facebook, please go to www.childbirthtoday.blogspot.com to view the video!)

In case you still have not seen this new video from DONA International, here it is again. What a great video to download to your laptop and show in childbirth education class, when you are talking to care providers/hospitals about doulas and to your own doula clients! It is only 14 minutes in length but says so much!

Congrats DONA International!

What If.......

2011-03-08T10:23:00.000-08:00

What if instead of "natural childbirth" being unmedicated and no interventions, they called medicated and interventive birth (what most women see in the hospital setting) "unnatural".

Just askin'.

What Do The Jolly Green Giant and Human Babies Have in Common?

2011-03-02T07:28:00.000-08:00

I was struck by a commercial on television last night.

It was for Green Giant vegetables.

Green Giant says that we don't determine when veggies are ready, they do.

Why can't the same be said for babies?

Why are more and more babies being born too early, in spite of the research to the contrary?

Why are more babies being induced before their "due date"?

Why are more babies being born by cesarean, again, in spite of the research?

This is by far an epidemic. If there was one iconic person leading a media blitz to cause this harm to babies, I am relatively certain he would be hunted down and charged with some crime.

But this hit me like a lightening bolt last night. Obviously we care more about vegetables than our own children.

When you really sit back and let the impact of this set in, I am sure you will be as nauseated as I am.

We are intelligent humans. We can do better. We must do better. Now.

The Evidence Says: 10 Things to Unlearn About Pregnancy

2011-02-23T09:17:00.000-08:00

As a veteran childbirth educator, I am still surprised by the beliefs of both maternity professionals and expectant parents...about birth!

There are certain beliefs that people have regarding birth. The following is a list of the top 10 beliefs, written in the positive, rather than the negative. The true belief is written in italics after the reference.

1) Pregnancy is a condition of health, not an illness. (World Health Organization Fortelezea Declaration, 1985) Pregnancy and birth are crises waiting to happen.

2) Expectant mothers and their partners will be asked to make decisions regarding their birth; hence childbirth education classes and reading quality books is essential to making informed decisions. (Healthy People 2020)
You don't need childbirth classes; your doctor or nurse can tell you everything you need to know.

3) Labor should begin on its own; induction should be used carefully and judiciously. (See references at the end of this Care Practice) Induction of labor is ok and eliminates that "fat" feeling during late pregnancy.

4) Interventions such as electronic fetal monitoring may not have positively impacted birth outcomes. (Seminars in Fetal and Neonatal Medicine). Interventions such as monitoring can keep your baby safe. Medications do not cross the placenta and are safe to use during labor.

5) Doula support does make a difference in labor and birth. (20+ years of research and this Cochrane Data)
You don't need a doula. Your doctor or nurse will be with you the whole time.

6) Upright and gravity positive positions facilitate labor and birth. (Multiple references)

7) The position a woman assumes to give birth should be dictated by her and include gravity (Cochrane Data)
Lay back with your feet in these stirrups so the doctor has a better visual of the birth.

8) What happens during the birth process has a direct impact on breastfeeding. (Impact of Birthing Practices on Breastfeeding by Linda Smith) Birth has nothing to do with breastfeeding.

9) Skin to skin truly helps the newborn adjust to the outside world and enhances breastfeeding. Almost all newborn tests and exams can be done while baby is on mother's chest. (Multiple references) We have to take the baby to the nursery for tests and exams.

10) Evidence-based maternity care is essential to better outcomes: maternal morbidity/mortality and infant morbidity/mortality. (Evidence Based Maternity Care: Turning Aha Moments into Dynamic Practice; WHO booklet.) We have always done it this way.

The Not-So-Silent Revolt: The "Push Back"

2011-02-16T09:59:00.000-08:00

Has anyone noticed the Not So Silent Revolt in the news lately? Standing eye to eye and nose to nose with those that tout a 71.2% cesarean rate or banning public breastfeeding are stories of women ~ world wide ~ searching for alternatives in childbirth and pushing back about their right to breastfeed.

From Czech news, comes reports in-hospital outpatient childbirth and home childbirth choices, this due to physicians leaving. While "authorities" are concerned that there won't be enough beds for the newborns, have they considered the mothers' arms? We are seeing more stories about Nurse-ins, in support of breastfeeding in public vs. taking a young baby to the restroom for their meal.

I have said for years (now probably decades) that policies will NOT change while health care professionals are advocating for that change.

The only time change will happen is when the consumer pushes back. Just like in the 60's and 70's.

Here we go again!

Teaching Childbirth Education Seminars

2011-02-08T14:11:00.000-08:00

If you are reading this blog on Facebook, you may not be able to see the embedded video. Please go to www.childbirthtoday.blogspot.com to view. Thanks!

One of the professional gifts I have been given is the opportunity to train individuals to become childbirth educators. Having worked for several childbirth education organizations, and now finalizing the opportunity to work with Lamaze International, I have had the opportunity to update my curriculum. Part of that updating is adding new slants on certain topics.

The topic of "how to reach the learners in your class" is one that usually takes a lot of time as it is vital to understand the learning techniques of the vast majority of people attending. Childbirth education is NOT cookie cutter education. You simply cannot be handed a curriculum and be expected to teach effectively. Teaching is part education and part entertainment. Simply sitting in a class won't make you educated, just like sitting in a garage will not make you a car.

So how does one reach the learners in your class. First, a thorough understanding of how the brain works is essential. Not for the squeamish, this video "How It Feels To Have A Stroke" by Jill Bolte Taylor demonstrates the vastness of the functionality of the brain.

Thanks to my friend/colleague, Amy Chavez LMT, STRP, BD, CCE, for showing this at a recent Red Tent Event (which she facilitated) and introducing it to me!

Aromatherapy Basics ~ Setting a Mood

2011-02-02T12:53:00.000-08:00

When considering using aromatherapy for labor and birth...or even to talk about in childbirth education classes, it is best to take a class from an aromatherapist who knows specifically about the right aromatherapy to use during this special time!

Aromatherapy oils can not only be used as inhalants but they can also be massaged into the skin. The essential oils used in aromatherapy are concentrated extracts taken from the roots, leaves, or blossoms of plants. Each essential oil contains its own mix of active ingredients, and this mix determines the healing properties of the oil. Some oils promote physical healing-for example, some are able to relieve swelling. Others are used for their emotional value, such as lavender, as they may encourage relaxation or make a room smell nice. The essential oil derived from orange blossom, for example, contains a large amount of ester, an active ingredient thought to induce a calming effect.

Single essential oils are often the best for early labor, however some blends can be beneficial too. If you are wanting a relaxing mood for Early or (early) Active labor, try Lavender essential oil. Please note that direct administration of Lavender on the skin is generally safe for most people, however, some may have an allergic reaction. Lavender is one of the few oils that can be used directly on the skin. You can also obtain a battery operated pocket diffuser or use a cotton ball for periodic whiffs. If you are considering blends for early labor, you might explore any Lavender based blend ~ remember the desire is to promote relaxation!

Chamomile is also a very relaxing essential oil and may be preferred by expectant parents. A blend of Chamomile and Lavender is very calming. Bergamot can be added for a refreshing feeling.

Rosemary can be used either alone or in a blend for that time in labor where concentration is needed, such as mid-late active phase or transition. During this time also, it may be time to pull the laboring mother from the relaxed and dreamy state of early labor to a more invigorated state - a blend of any essential oil that is citrus based (such as Neroli, Grapefruit, Tangerine or Sweet Orange) can achieve this. Marry the citrus oils with Rosemary and you have a winning combination for Transition or even Stage 2. After all, citrus oils are stimulating - that is why they are used in morning shower gels and lotions!

Blends can give you the benefit of distraction also - the expectant mother enjoys identifying the different scents in the blend. Ideal carrier oils to mix blends with are Grapeseed and Apricot Oils! Not sure how to blend essential oils? Try these two brands ~ Cappriccio Aromatics and Aura Cacia! From blends, to single essential oils to smelling salts, we have the perfect oils and blends for every laboring mother!

ACOG Weighs in on Homebirth

2011-01-26T12:37:00.000-08:00

ACOG issued a statement on homebirth on January 25, 2011.

Here is our "response". Please feel free to give yours!

ACOG says: "It's important to remember that home births don't always go well, and the risk is higher if they are attended by inadequately trained attendants or in poorly selected patients with serious high-risk medical conditions such as hypertension, breech presentation, or prior cesarean deliveries."

Childbirth Today: No, homebirths don't always go well but then neither do hospital or birth center births. To think that location guarantees safety is not supported by the literature. We do agree that high risk women should be attended by equally adequate providers.

ACOG says: absolute risk of planned home births is low.

Childbirth Today: True!

ACOG says: published medical evidence shows it does carry a two- to three-fold increase in the risk of newborn death compared with planned hospital births.

Childbirth Today: please cite the references.

ACOG says: A review of the data also found that planned home births among low risk women are associated with fewer medical interventions than planned hospital births.

Childbirth Today: True.

ACOG says: Although The College does not support planned home births given the published medical data, it emphasizes that women who decide to deliver at home should be offered standard components of prenatal care.

Childbirth Today: There will ALWAYS be the population who will decided, through informed decision making that home birth is an option for them. We hope that instead of putting up more roadblocks for these families, ACOG will work together with other care providers to create an educational and informational highway for families devoid of statements like this one, that could be construed as not presenting the entire picture plus discouraging families from seeking childbirth education, which strengthens their educational foundation.

ACOG says: It also is important for women thinking about a planned home birth to consider whether they are healthy and considered low-risk and to work with a Certified Nurse Midwife, Certified Midwife, or physician that practices in an integrated and regulated health system; have ready access to consultation; and have a plan for safe and quick transportation to a nearby hospital in the event of an emergency.

Childbirth Today: Research shows that in countries with more midwifery care, maternal mortality/morbidity and infant morbidity/mortality rates are much lower, while our statistics grow worse in spite of rising intervention on births. Have you read this 2005 study in the BMJ? What about Licensed Midwives or Certified Professional Midwives? Why leave them out?

ACOG Says: the risk is higher if they are attended by inadequately trained attendants or in poorly selected patients with serious high-risk medical conditions.

Childbirth Today: women should choose their care providers carefully and wisely, whether they are midwives or physicians. Women should also choose their location to give birth wisely as well. The Birth Survey can help!

While statements or opinions such as Committee Opinion #476, "Planned Home Birth," is published in the February 2011 issue of Obstetrics & Gynecology is perfectly fine as an opinion, the reader must be aware that it is only an opinion and only based on limited references...which are not given. For expectant parents to make full use of informed consent, they should hear other opinions, read CDC statistics and make their own decisions. After all, childbirth is not an illness. It is a state of health. And statistically speaking, few women actually need the care of an obstetrician (who is also a surgeon). There are some that do and that is why we have obstetric care and hospitals.

The bottom line (no pun intended...well, ok maybe) is that the war between physician/midwife and hospital birth/home birth is not likely to end soon. And this is one example of why.

The Evidence says: Education is the Key ~ Breast is Best

2011-01-25T06:53:00.000-08:00

The US Surgeon General held a press conference last week (January 20,2011) announcing a Call to Action for the American public for more education, access and acceptance of breastfeeding.

In her Call to Action, Dr. Regina Benjamin detailed the plans of her "Call to Action to Support Breastfeeding," which includes greater cultural support of nursing at work, at home, and in the community.

"One of the most highly effective preventive measures a mother can take to protect her child and her own health is to breastfeed," Benjamin said during the briefing.

Mother's milk has been shown to reduce diarrhea, ear infections, pneumonia, and asthma and protect against obesity in babies, while it diminishes the risk of breast and ovarian cancer in moms, Benjamin said.

In a report accompanying the announcement, Department of Health and Human Services Secretary Kathleen Sebelius said that "for much of the last century, America's mothers were given poor advice and were discouraged from breastfeeding, to the point that [it] became an unusual choice in this country."

In her document, Dr. Benjamin presents irrefutable evidence about the benefits of breastfeeding including health benefits, psychosocial benefits, plus economic and environmental benefits. Following surgeon generals before her, Benjamin endorsed a federal policy on breastfeeding.

The American Academy of Pediatrics recommends that Moms begin breastfeeding as soon as possible following the baby's birth. Newborns should be nursed on demand or whenever they show signs of hunger including mouthing, sucking or rooting behaviors or increased awake/alert states. Crying is considered a late hunger cue. Newborns typically need to nurse between 8 to 12 times a day, until satisfied. There are growth spurts at 2 weeks, 6 weeks, 3 months where Baby may nurse more vigorously and more often. This is not a sign that milk production is decreasing. Nursing infants should not be given any supplements (water, glucose water, formula, etc.) unless there is a medical indication. Supplements are rarely needed when breastfeeding is properly accomplished. Pacifiers and bottles should be avoided -- at least until breastfeeding is well established to avoid nipple/flow confusion.

As birth professionals, regardless of if you are a physician, midwife, nurse, childbirth educator, doula or related professional, it is our duty to present the facts about breastfeeding. Plus, in the event that a new mother absolutely wishes to breastfeed, she must be given adequate instruction for the safety of her baby. Benjamin acknowledged that research indicates that the marketing of substitutes for breast milk has a negative effect on breastfeeding practices, noting that women who receive commercial discharge packs that include formula are less likely to be breastfeeding exclusively at 10 weeks postpartum than are women who do not receive them.

We encourage you to print out the Surgeon General’s Press Release, Fact Sheet and the entire Report, via the direct links below. These documents will be further evidence that education about the benefits of breastfeeding will increase the numbers of American babies who are breastfed, and this will unequivocally benefits our society as a whole.

Read the Surgeon General’s Press Release Click here

Read/print the Fact Sheet

Download the entire Surgeon General’s Report

Guest Blogger: Donna Walls RN, IBCLC

2011-01-21T14:01:00.000-08:00

Our Second Guest Blogger of 2011 is Donna Walls RN, IBCLC. She has had many years of experience helping mothers and babies breastfeed. She lives in Dayton Ohio and works as a nurse and Lactation Consultant. If you would like to be a Guest Blogger at Childbirth Today, email us at info@birthsource.com!

Many new mothers worry about their milk supply. Do I have enough milk for my baby? In the first days after birth¸ it’s the number one question mothers ask. In reality for the vast majority of women, the answer is yes. There is only a very small, less than 1% chance, that a woman’s breasts lack enough glandular tissue to provide adequate breast milk for her infant.

There are some issues that can create concerns; early introduction of contraceptive hormones or some anti-depressants, unnecessary supplementation in the first days of life, infant suck problems such as tongue-tie, and exposures to environmental endocrine disruptors such as plastics and pesticides.

So what can we do to ensure a good milk supply?

Nurse your baby as soon as possible after birth, preferably within the first 60 to 90 minutes after birth and make sure the latch is comfortable, feeling only a tugging, pulling sensation on the nipple. If you feel the latch is not good ask your nurse or lactation consultant for assistance.

Keep your baby with you in the hospital and spend as much time as you can skin to skin. Babies love the calming closeness of skin to skin and smelling the milk in your breasts can encourage early feedings.

Nurse your newborn on demand¸ whenever they show signs of hunger such as mouthing motions, restlessness, fussing sounds. Offer the breast- if they are hungry they will eat and if not, they won‘t! Forcing feedings in the first 24-28 hours is not necessary and may interfere with the natural rhythm of breastfeeding. Colostrum is very concentrated and provides the newborn with all the nutrients they need in fewer feedings.

Most newborns will have some shorter “snacking” feedings and some longer “meals”. They commonly eat in clusters of feeds, usually followed by a stretch of sleep. This cluster or feeding frenzy period is normal and not a sign that the mother doesn’t have enough milk- no supplementation is necessary. Establishing this request and supply system of communication between mother and baby sets the stage for a good milk supply.

What if I notice my milk supply diminishing after it is well established?

First go back to the basics. Make sure you are nursing, pumping or hand expressing at least 8-10 times a day, remember milk production is request and supply, so the more you ask you breasts to do, the more they produce!

Many foods and herbs have also been shown to enhance milk supply. Many mothers notice an increase in supply with a daily bowl of oatmeal or adding brewer’s yeast tablets to food. Traditional cultures have used barley, anise, garlic, dill, caraway and alfalfa to assist mothers in making milk for their babies.

Herbal medicines taken as teas, tinctures or capsules have also been used successfully for increasing milk supply. Some of the most common herbs used are: fenugreek, fennel, blessed thistle, goat’s rue, hops, marshmallow and nutritive herbs such as nettle, spirulina or kelp.

The drug Reglan can be prescribed for increasing supply. This drug was originally used for gastrointestinal upset but has been shown to improve lactation.

Illinois Hospital Bans Elective Deliveries Before 39 Weeks

2011-01-17T13:28:00.000-08:00

Edward Hospital in Naperville is one of six Illinois medical centers chosen to be part of a March of Dimes pilot program calling for a halt to elective deliveries before 39 weeks of pregnancy.

According to hospital officials, a critical part of the success of this program is patient education. In the article that appeared in the Beacon News on January 15, "As our culture shifted toward a more relaxed attitude about delivering early, it was apparent education was needed by both patients and medical staffs."

The obvious solution to the patient education need is childbirth education! However, the education for medical staff may be a little more tricky. Due to the limited OB curricula in nursing schools and residency programs, few nurses or physicians are trained (and therefore skilled in) the art of supporting women through what is known as physiologic birth. Physiologic birth, formerly known as natural childbirth or normal birth, involves honoring the mechanics and hormonal responses of the body for birth, limiting interventions and medications, and enhancing the physiologic/mind/spiritual link between mother and baby. Even though the number of interventions in childbirth has increased exponentially in the past decade in the U.S., the U.S. maternal and infant mobidity/mortality has NOT improved; rather those statistics have gotten progressively worse. It becomes clear that an increase in intervention during childbirth does NOT improve outcomes.

Some call this hands off method of childbirth the midwifery model of care. Rather than label it and cause a riff in the maternity profession, call it what it is....physiologic birth. Stop quibbling. And honor physiologic birth for reducing the admissions of near-term/preterm infants into the NICUs.

The article goes on to make these points:

"Based on data, hospitals participating in the 2011 March of Dimes project can expect to reduce pre-term births and admissions to the NICU by 15 to 20 percent, Crouse said. That is significant from both a health and cost perspective. The typical hospital bill for a full-term baby is about $2,000, he added. That can be 10 times higher when a baby is in the NICU."

We applaud all of the hospitals who are joining with the March of Dimes in this endeavor! Seventeen Illinois hospitals applied to be part of the March of Dimes program. Others that were selected are Decatur Memorial Hospital, St. Elizabeth’s Hospital in Belleville, St. Joseph Hospital in Breese, Katherine Shaw Bethea Hospital in Dixon and the University of Illinois Hospital at Chicago. Also participating are five hospitals in California, Texas, New York and Florida.

Guest Blogger: Jodi Hitchcock

2011-01-10T08:34:00.000-08:00

We welcome Jodi Hitchcock, MSW as our first Guest Blogger of 2011! If you would like to be a Guest Blogger in 2011, email us at info@birthsource.com!

Living in the North East, the passage into a new year is often a bittersweet one. After the hustle and bustle of the holiday shopping, eating, visiting and overall merriment, we enter into the dreaded long months of winter in its fullest. Although we have had a substantial amount of snow and cold for several weeks now, it does not seem as foreboding when you are in the midst of the holiday cheer. Come January 1^st, winter feels as though it will never end.

This feeling was never more intense for me than the first winter after I had given birth. My first birth experience, my daughter who was born in October 2000 at 36 weeks gestation and after a very traumatic delivery, left me feeling a range of physical and emotional pain I had never felt before. At that time, given what I had been through, my family, friends and doctors all dismissed what I was experiencing as “normal” and “to be expected”. As a 23-year-old first time mom, who was I to question all of these wise and worldly individuals? They told me it was normal… so it must be normal! It was ok that I cried constantly, that I felt overwhelmed by the needs of my new premature baby and that I could not sleep without horrible dreams of her delivery (yet all I longed to do was sleep). It was “normal” that I was absolutely terrified to walk down the stairs with my baby because I was certain my arms would go limp and she would tumble down the stairs. I was living a nightmare… that I was assured was “normal”. I wanted desperately to feel the sun on my skin and to breathe fresh air. Unfortunately, where I live, sun is MIA for about 6 months of the year… and I was right at the start of that 6 months. Bundling up my new baby for a crisp walk was not an option since she was considered to have a weakened immune system and she had difficulty maintaining her body temperature. So in we stayed… a prisoner in my own home is how I felt. I loved my baby, I think, but I also resented how her birth had left me feeling.

At that point in my life, I had vaguely heard of postpartum depression (in news reports of Andrea Yates-the mother who killed her 5 children *). I knew that I was not capable of harming my baby, so the thought that I could be experiencing the same thing that she had never crossed my mind. My doctors never mentioned it or screened for it… so it all must be normal, right? WRONG!! After 2 more children… and each postpartum period worse than the others… I finally got what I had desperately needed in the beginning; answers, a diagnosis, acknowledgement that what I was feeling was not normal and most importantly, treatment.

As a social worker, I have been able to use my horrific personal experiences by dedicating my career to the perinatal population. I have spent the past 6 years researching, studying and working with women and families who have experienced perinatal mood disorders (PMD’s). My goal is to help eliminate the shame, the judgment and the fear of those suffering from PMD’s and to help educate the perinatal professional community so that women are able to receive help as soon as possible. I am excited to spend 2011 as a guest blogger on the Child Birth Today site and I hope to offer some insight, both personally and professionally, on perinatal mood disorders.

*I now know that Andrea Yates did not have postpartum depression, but did have postpartum psychosis. This is a much more severe mental illness that can lead to infanticide and/or suicide and is extremely rare.

About the Author:

Jodi K. Hitchcock, MSW is a mother of 4 amazing children (ages 10, 8, 6 and 16 months) and the stepmother to a wonderful 14 year old. She currently works 24 hours a day as a stay-at-home mom to those lovely children. In addition, Jodi works as an independent consultant providing perinatal support, education and outreach to mothers, couples and families experiencing PMD’s. In addition, she conducts training seminars and provides outreach education to other perinatal professionals. After experiencing a variety of PMD’s during and after her pregnancies, Jodi is able to provide a unique combination of personal and professional knowledge to the people she works with. Jodi especially loves to work with pregnant women who are experiencing or are at risk to experience a PMD so that she may empower them through education and prevention techniques so that they may have the best possible birth experience!

The Evidence Says: Friedman’s Curve Essential to Reducing Cesarean Rate

2011-01-04T11:06:00.000-08:00

For nearly 60 years, the (Dr. Emanuel) Friedman’s curve has been the gold standard by which maternity care givers have managed a woman’s labor. It is one of the very first things that physicians and nurses learn in school.

The curve, depicted in graph form, shows the progress of labor where cervical dilation and fetal descent are plotted on a vertical axis. Along the horizontal axis is the element of time. Like a mathematical graph, the Friedman’s curve is divided into stages and phases of labor. When there is a disparity in the slope of the curves, labor is termed dysfunctional.

Studies done during the first decade of this century demonstrate that the parameters to determine if labor is progressing need to be expanded. The reasons for expansion may be the increase in medical technology, specifically the rise in epidural anesthesia and subsequent inactivity during labor which can prolong the labor. A study published in 2004 in the Journal of Obstetrics, Gynecology and Neonatal Nursing (Cesario, S. Reevaluation of Friedman’s Labor Curve: a pilot study. 2004 Nov-Dec; 33(6):713-22) suggested “With the availability of technology to assess maternal and fetal well-being, labor should be allowed to progress past the rigid 2-hour time limit for the second stage of labor artificially imposed on women in some childbirth settings. More emphasis should be placed on the nursing assessment techniques used to reassure the family and health care practitioners that labor is progressing safely and the nursing interventions that may have an impact on the length of each stage of labor.”

From an article on Birthsource.com, current definitions of labor protraction and arrest may be too stringent, Dr. Jun Zhang of the National Institute of Child Health and Human Development, in Bethesda, Maryland said at the 2002 annual meeting of the Society for Maternal-Fetal Medicine. "And the long-accepted Friedman curve may not be an accurate description of normal labor progression, according to a new analysis of data from 1,329 nulliparous women aged 18-34 undergoing singleton, vertex presentation deliveries following spontaneous labor," said Dr. Zhang.

Based on the speed of overall labor progression and current cervical dilation, Dr. Zhang and his colleagues calculated the expected traverse time for the cervix to reach the next centimeter and the expected rate of cervical dilation at each phase of labor. "Our curve is very different," Dr. Zhang said, pointing out that on his curve the average was 5.5 hours for progression from 4 cm to 10 cm, compared with 2.5 hours on the Friedman curve.

"We also didn't see a deceleration phase," he said, noting that in 1978 Friedman modified his curve, but the distinctive sharp upturn remained, as did the deceleration phase. "Our data suggest that most women enter active labor at different times, mostly between 3 cm and 5 cm dilation, and even in the active phase the speed of progression varies from person to person," he further explained. The median time for cervical dilation to progress from 4 cm to 5 cm in the present study is 1.7 hours. And for fetal descent, it could take 3 hours to progress from station +1 to +2, and an additional half hour from station +2 to delivery, he added. "Therefore, the definition of protracted descent or arrested descent appears to be too stringent in current practice," according to Dr. Zhang. Read more…

Dr. Zhang again calls into question the use of the Friedman’s curve in 2006 and refines insight into labor progress, the diagnostic criteria for labor protraction and arrest disorders.

And in December of 2010, Zhang again questions existing practice by the study gathering data from over 62,000 birthing women. Their conclusions were as follows:

"Judging whether a woman is having labor protraction and arrest should not be based on a research definition of an average starting point or average duration of labor," the researchers write. Instead, an upper limit of what is considered 'normal labor' should be used in patient management. "As long as the labor is within a normal range and other maternal and fetal conditions are reassuring, a woman should be allowed to continue the labor process."

The differences they observed could be due to the fact that women giving birth are older and heavier, on average, than they were when Dr. Friedman's labor curves were developed, the researchers note; "these factors are known to affect labor progress and duration."

Therefore, based on several large studies and over a decade of research, the evidence says that the rate of cervical dilation accelerated after 6 cm, and progress from 4 cm to 6 cm was far slower than previously described. Allowing labor to continue for a longer period before 6 cm of cervical dilation may reduce the rate of intrapartum and subsequent repeat cesarean deliveries in the United States. Clinging to the original Friedman’s Curve may “cause” an increase in cesarean section.

Referenced:

"The Length of Active Labor in Normal Pregnancies," by Leah I. Alberts,CNM,PhD: Melissa Schiff, MD; and Julie G. Gorwoda, CNM,MSN. Obsterics & Gynecology. 87(3):355.359, March 1996.

“Contemporary patterns of spontaneous labor with normal neonatal outcomes” by Jun Zhang MD and others. Obstetrics & Gynecology. 2010 Dec;116(6):1281-7.

The Evidence says: Childbirth Education Is A Vital Part of Maternity Care

2011-01-03T08:38:00.000-08:00

The Healthy People 2020 initiative for Maternal Child Health is supported by clinical recommendations from the US Preventive Services Task Force (USPSTF). The USPSTF is an independent panel of non-Federal experts in prevention and evidence-based medicine and is composed of primary care providers (such as internists, pediatricians, family physicians, gynecologists/obstetricians, nurses, and health behavior specialists).

The USPSTF conducts scientific evidence reviews of a broad range of clinical preventive health care services (such as screening, counseling, and preventive medications) and develops recommendations for primary care clinicians and health systems. These recommendations are published in the form of "Recommendation Statements."

In reading through the Healthy People 2020 initiatives, it is plain to see that many of the initiatives could be accomplished with comprehensive childbirth education classes, taught by certified childbirth educators, and enthusiastically and positively promoted by physicians and midwives early in the pregnancy of every woman.

The very fact that Healthy People 2020 initiative MICH-12 calls for an increase in the proportion of pregnant women who attend a series of prepared childbirth classes is proof enough that childbirth education classes are important. Numerous studies (available with abstracts) are listed on the US National Library of Medicine/National Institutes of Health website www.ncbi.nlm.nih.gov, extolling the virtues of childbirth education classes in improving maternity care. However, not all providers of childbirth education classes devote curriculum to the dissemination of evidence-based information.

The U.S. maternity care system, with the escalating cesarean section rate, increase in near term newborns from an increase in elective inductions, and a standard of maternity care that is intervention based rather than health based, is truly at a cross roads. We can no longer sit back and debate whether maternity care is evidence-based. We have seen that over and over again, in most cases, it is not.

Judith Lothian wrote in the winter 2009 issue of the Journal of Perinatal Education, “It is a challenge to present the “best evidence” when hospitals provide care that is decidedly not evidence-based. Childbirth educators and nurses too often feel pressured to encourage women to comply with hospital policies and routines or are pressured to withhold information or present information in ways that do not challenge women's prior thinking. Our mandate to assist women in making informed decisions, including making them aware of their right to informed refusal, creates never-ending dilemmas for many childbirth educators (as well as many nurses, midwives, and physicians). It is extremely difficult to move from principles to practice!”

What can be done to “fix” this seemingly impossible situation?

We need only to take a brief visit back to the 1960s and 1970s when maternity care faced similar challenges.

1) Childbirth education must be taken back by certified childbirth educators (either nurses or non-nurses). Not all nurses have the qualities to be an educator; conversely, not all educators need to be nurses. Medical schools and nursing schools prepare the students for crisis intervention and rarely prepare students to work with the laboring female body in a physiologic manner. To this end, those who teach childbirth education absolutely must be trained and certified by organizations who will give them the knowledge of physiologic birth.

2) Childbirth education must be community based so that the freedom of sharing unbiased, evidence-based information is preserved. Fear of job loss is evident in areas where childbirth education is taught by hospital employees. Failure to conform to non-evidence based mandates ultimately result in sanctions or job loss.

3) Childbirth education must be taught with a standard of credibility, excellence and adherence to the evidence, regardless of the organization of certification.

4) Childbirth education must have at its core the right of every pregnant women to base her decision-making during pregnancy, birth and parenting on informed consent. With journals dedicating entire issues to informed consent, numerous conference devoting speakers to teach about informed consent and federal acts/professional practice guidelines defining and mandating informed consent, the inconvenient truth is that not every American woman has the opportunity to exercise this right during childbearing.

5) Childbirth education must strongly advocate for women as it did in the 1960s and 1970s. Childbirth education must NOT be adversarial. We must use a variety of marketing strategies to campaign for healthier mothers and babies through evidence based maternity care. We must shine the light of truth on the fact that U.S. maternity care is not evidence based; that it is based on old information, convenience and intervention.

Contact your certifying organization and ask them what their Strategic Plan for 2011 entails. This is the best way to know if your organization is working toward this goal. Then, take these five “musts” and see how you can incorporate them into your community.

The Evidence Says...Returns!

2011-01-02T18:28:00.000-08:00

Early in 2010, I began a series of blogs called "The Evidence Says". It examined several widely known practices and the differences between the practices and the evidence.

Several readers have asked me to do the series again this year...with different topics. So in the next few weeks, we will take a look at some of the Healthy People 2020 initiatives and how they will impact hospital practices. We'll also look at the facts surrounding both the initiatives AND the practices ~ how do the current practices differ from the research?

It will be interesting to read...and research!

Happy New Year all!

Questions about Birth & Christmas.....

2010-12-23T05:33:00.000-08:00

If you are reading my blog via Facebook, please go to www.childbirthtoday.blogspot.com to view the video.

What really was Mary's EDD?

Did she feel contractions? Did she have back labor?

Did Joseph help her with her breathing?

How long was the Second Stage of Labor?

Did they have a lotus birth?

What would've been Jesus's Apgar score?

Did Jesus latch on right away?

And finally, have you viewed The Social Network Christmas? Merry Christmas to all !

Follow Up to Previous Article

2010-12-22T12:01:00.000-08:00

Several subscribers have asked for more information about the test to determine if a cesarean is necessary - a blog I posted earlier today.

I went to the Obstecare website and found this information, along with their reference page:

http://www.obstecare.com/Clinicalsolution.htm

Hope this helps!

New Test to Determine If Cesarean is Necessary

2010-12-22T06:45:00.000-08:00

Just as the CDC issued the 2009 Cesarean Section Statics ~ we are now at 32.9%, up from 32.3%, a Swedish company, Obstecare, has developed a test that measures the amount of lactic acid in the amniotic fluid.

In a press release issued today (Dec 22,2010) by a New Jersey Law Firm, "if high levels of lactic acid are present, it is doubtful that the mother will be able to deliver the baby vaginally, as lactic acid at certain levels begins to inhibit contractions. The test could help end difficult labors earlier by indicating that a C-section is necessary." The press release also said "For the mothers that endure prolonged hours of labor only to have a Cesarean section (C-section) in the end, a new test performed at the early stages of labor could indicate that a C-section should be performed."

Could this become standard for all obstetricians to use before labor and delivery?

Seasonal Emoticons

2010-12-21T12:01:00.000-08:00

It is true. This blog entry has nothing to do with childbirth. BUT it has everything to do with those really cool emoticon trees, snowmen and other art done with your computer key board.

Wanna make a snowman?

__[-]__
.. (*>*)
. (.. : .. )
.( .. : . . )

Or perhaps a Christmas tree?

…………(¯`O´¯)
…………*./ | \ .*
…………..*♫*.
………, • '*♥* ' • ,
……. '*• ♫♫♫•*'
….. ' *, • '♫ ' • ,* '
….' * • ♫*♥*♫• * '
… * , • Merry' • , * '
…* ' •♫♫*♥*♫♫ • ' * '
' ' • Christmas . • ' ' '
' ' • ♫♫♫*♥*♫♫♫• * ' '
…………..x♥x
…………….♥

For ALL of the cool designs and secrets, visit

http://facebook-emoticons-symbols.blogspot.com/2009/04/basic-symbols-key-alt.html

Unsuspecting Doulas

2010-12-15T05:02:00.000-08:00

If you are aware of randomized control trials or the Cochrane Review, then you already know the years...no, decades of research documenting the profound benefits of doula care before, during and after labor/birth.

Take a moment, however, to examine the very simple and amazing impact of doulas ~ companionship.

Mankind was never meant to experience life alone. From the very beginnings, we were given friends, companions, helpmates, mates...the list goes on. Why? Because sometimes life is difficult. Life is a challenge or series of challenges and really, who wants to experience those challenges alone? Often a challenge not only stretches us physically, but emotionally and spiritually as well! And when those challenges approach the "overwhelming" point, there is definitely strength in numbers!

But if you have ever breathed, you have already experienced doula care in some form or another. Here are some examples of doulas in our every day life:

When you were about 2 and wanted your mom or dad to be with you in the bathroom, especially when you flushed.

On the play ground when you were 5. It was funner to have a playmate than play alone.

In 4th grade, it was nice to have a buddy to go to run errands for the teacher in school than walk through those scary halls alone.

Sleep-overs in middle school and high school.

In football, it is wonderful to have someone block for you!

The first time you put gas into a car.

Freeways have signs that say HOV ~ high occupancy vehicles.

Even a friend who proof-reads a paper for you.

While these are just a few of the "go with me", "help me" moments in life, I am certain you have some of your own. We live in towns and communities. We are meant to be in contact and friendship with others. They help us and we help them.

So yes, there is evidence-based proof that doula care is beneficial for positive outcomes in labor and birth. But deep down in your heart, you know that having a compassionate companion with you during an exceptional life experience makes that life experience easier.

You know that investing in another not only brings joy and calm to that person but to you too.

Your life is richer and so is theirs.

So is it really any wonder why doulas make a difference?

Congratulations to DONA ~ the new introductory video!

2010-12-14T08:35:00.000-08:00

If you are viewing this on Facebook, please go to my blog, www.childbirthtoday.blogspot.com! And if you have RealPlayer on your computer, you can easily download this video for future use.

The 3 1/2 Minute Cheer For Your

2010-12-01T17:39:00.000-08:00

For all of the childbirth educators and doulas I have trained in the past 14 years or so....I can't always be there to cheer you on. And if I didn't lead your seminar or workshop, you also may need some support! I have found that many people need this, especially in the winter time...when the sun is not out as much and when we cannot go out as much to clear our heads and our hearts.

I found this video on You Tube and found it very encouraging - so I thought I would share it with you. If you see this blog notification on Facebook, please go to my blog at http://www.childbirthtoday.blogspot.com/ to see the video!

Childbirth Today From Birthsource.com

More Business of Being Born Trailer!

Debunking the myth: Birth is dangerous

Debunking myths about midwifery care

Debunking the myths around home birth

A Woman-Centered Cesarean Birth

QR Codes ~ what they are and why you may need one

Comfort Measures ~ a vital role in childbirth education!

Learning Lamaze: Back to Basics!

Gisele Bundchen's New "Birth Around the World" Project

Update on Ingestion of Food and Fluids During Labor

Pushing ~ What you need to know...

Beyond Beyoncè: Five lies the media tells you about birth

Waterbirth in a Hospital ~ yes you can!

Hospitals and Waterbirths

One World Birth ~ the next great birth film

Physiologic Birth Is Front and Center in the Media!

Just the facts: The Home Birth/Hospital Birth Conundrum Part 2

Just the facts: The Home Birth/Hospital Birth Conundrum Part 1

Private Childbirth Classes Cost What???????????????

Dystocia: is there a gene for that?

A Few Reasons Why Occupying a Hospital Won't Change Policies & Procedures

Dear Dr. Lisa, Thank you for helping!

Remember the Psychology of Daytime Television: Contact Information

Remember the Psychology of Daytime Television: The Young and the Childbearing!

Top 10 Topics for Childbirth Education Classes ~ Part 2

Top 10 Topics for Childbirth Education Classes ~ Part 1

More on Delay Cord Clamping ~ Got Evidence? Parts 3 & 4

More on Delay Cord Clamping ~ Got Evidence? Part 2

More on Delay Cord Clamping ~ Got Evidence? Part 1

Delayed Cord Clamping ~ Not just a fad

Maternity Care vs. the way a woman's body labors

One World Birth ~ the next great birth film

September is BOLD and BIRTHY

Maternity Thought Process Swings Toward Health

Your body, your baby, the Hormonal Orchestration

What The Big Latch-On Is......and Isn't

Happy World Breastfeeding Week 2011!

US Cesarean Rate Now 34% ~ Healthgrades

Prescription Milk

Guest Blogger: Jodi Hitchcock MSW

The 43 Year Active Management of Labor Project: What have we learned?

Nil Nocere

Free New App for Breastfeeding

Apple Dumplings ~ from a UK Midwife!

What if......we substituted Childbirth Educator for the word Anesthesiologist?

World Breastfeeding Week 2011!

Healthy Babies Are Worth the Wait! New from March of Dimes

Food Guide Pyramid --> My Plate!

Follow up: FDA oks Birth Pools

10 Simple Truths About Childbirth ~ #5

Birth Pool Accessibility Now in Question

10 Simple Truths About Childbirth ~ #4

The New Birthsource Lamaze Childbirth Educator Program!

10 Simple Truths About Childbirth ~ #3

10 Simple Truths About Childbirth ~ #2

10 Simple Truths About Childbirth ~ #1

Questions to Ponder

View this...then read that.

Revised US Guides on GBS

Speaking the Truth Often Unpopular But the Right Thing To Do!

Our History is our Strength!

The Essential Ingredient: Doula

What If.......

What Do The Jolly Green Giant and Human Babies Have in Common?

The Evidence Says: 10 Things to Unlearn About Pregnancy

The Not-So-Silent Revolt: The "Push Back"

Teaching Childbirth Education Seminars

Aromatherapy Basics ~ Setting a Mood

ACOG Weighs in on Homebirth

The Evidence says: Education is the Key ~ Breast is Best

Guest Blogger: Donna Walls RN, IBCLC

Illinois Hospital Bans Elective Deliveries Before 39 Weeks

Guest Blogger: Jodi Hitchcock

The Evidence Says: Friedman’s Curve Essential to Reducing Cesarean Rate

The Evidence says: Childbirth Education Is A Vital Part of Maternity Care

The Evidence Says...Returns!

Questions about Birth & Christmas.....

Follow Up to Previous Article

New Test to Determine If Cesarean is Necessary