Feeds:
Posts
Comments

So, I wish I wrote this about the cesarean rate. And I wish I made all the great graphics to go with it. But, even though I didn’t write it myself, I’m in love with this piece. It’s really helpful for answering the question I get all the time, “So, why do you think the cesarean rate is so high?” I can talk, talk, talk about all the reasons, but this piece just quickly runs through the reasons and more importantly gets to WHAT WE CAN DO actually.

Let’s get to it!

http://www.toprntobsn.com/bringing-birth-back/

Childbirth Classes: Necessity or Luxury? Redundant in the Internet Age?

Hello pregnant women!

Fewer of us than ever before are signing up for traditional childbirth education classes. You know, those old-fashioned classes that meet in person. With a teacher. And maybe a textbook. Perhaps “class” reminds you of high school. Or college. And you do not want to be in SCHOOL any longer.

Besides, everything you need to know about birth is on youtube. Right? OK, well, then. Maybe it’s on Parenting.com? Or Childbirth.org? Or the American Pregnancy Association? Or WhatToExpect.com?

Oh, dear. There’s a lot of websites that offer “childbirth information.” And the information they offer conflicts. A lot. More importantly, the information is not well-tailored to your unique situation.

No, problem, says the modern mama-to-be. I know how to get information tailored for me! I will jump into some chat rooms or join a website and ask my specific, individualized questions. Then the magic of the Internet will quickly provide me with the answers I need.

This is, indeed, how the majority of American women are preparing for childbirth. But childbirth is a very different process than researching what car to buy or whether or not to cut bangs this week (Michelle says, “Yes!”). Preparing for childbirth on-line is sort of like preparing for a triathalon on-line. There are good tips out there, but we all know that the REAL preparation is occuring off-line in what I would call “real life.”

Childbirth is a unique life event and probably nothing you have ever done in your life (except give birth previously!) can serve as a good model for how to prepare. I don’t know of any other event that requires the combination of social (how to interact with hospital staff and birthing professionals well), emotional, relational (negotiating the needs/wants of partners and parents and siblings), intellectual, and physical that birth requires. Many people compare birth to endurance sports events like marathons, but the fact is that few marathoners have to negotiate important medical decisions with doctors while they are running.

So, what you get in childbirth education classes that you CANNOT get on-line is the opportunity to practice in the presence of an experienced guide. When you READ information, it does not stick with you nearly the way it does when you have practiced what that information tells you to do. As Yogi Berra said, “In theory there is no difference between theory and practice. In practice there is.“

You learn SO much by getting to ask a question and having a personal INTERACTION about your question. You get to practice — try out — different ideas in this safe place that is not yet your labor or your baby’s birth. In this place, you get to practice thinking and feeling and relating different ways. You have a teacher, who has probably been at a number of births and seen some of those ways play out in real life, who can guide you in your thinking and feeling and relating.

Childbirth education classes are not really about information. The “facts” are readily available on-line. It is the practice of trying this idea and then this one or, hey, maybe this one that makes this information useful for you. When you are in labor you do not need theoretical knowledge. You need very, very practical knowledge.

I ran across this article on holisticmamas.com today. It feels great when other doulas write about advice in my book. Doulas collectively have a lot of birth wisdom that is really about how to help mothers achieve the births they want… which is a very different skill set than that of a doctor, midwife, or nurse. Their job is not focused on the mother’s birth experience in quite the same way. Here’s what Patricia Madden had to say:

A Doula’s Advice: “Routine Interventions” vs. “Medical Solutions”
Posted on April 3, 2012 by Mare
Patricia Madden, Doula
Guest post by Patricia Madden, DONA-Certified Birth Doula

“Routine interventions versus medical solutions.” I heard this phrase many years ago, and I’m pretty sure it came from Pam England of “Birthing from Within” fame. In my 14 years of experience, I’ve noticed that this is the kind of phrase that relaxes couples and doctors alike.

Most of my clients are very dedicated to having a natural birth, but as we talk more they come to understand that what they really want to avoid is routine interventions that can snowball into surgery. When a birth mother puts that simple sentence in a birth plan, she lets the hospital staff know that she is not against technology at any cost; she just does not want the normal routine things that most laboring moms get when they DON’T state a preference. The birth mother then also does not feel like she failed if she ends up saying, “You know, I’ve been laboring on and off for 3 days, and now I’ve been in active labor for 12 hours, I’ve had almost zero sleep for 3-4 days, and I’m still at 4cm. Maybe the next best thing might be an epidural.” (This was also from Pam England.) :-)

Stating a preference: ah, that brings me to another thought I got from the new book by Cynthia Gabriel, Natural Hospital Birth. Her advice to doulas like me: “I have learned over the years that you must say what you want or the [hospital] staff will think that what they routinely do will be fine. In every job, people have routines. Routines make life easier for us. The more your client talks about what she wants and doesn’t want, the more the [hospital staff] will help her achieve her goal, because they know she is serious. At every prenatal your client should talk about her preferences …over and over, and the fact that it is not medical solutions that solve a unforeseen problem that she wants to avoid, but the routine interventions that could eventually cause the problem that she wants to avoid.”

Just thought I’d share an effective wording for your birth plan to swing things in your direction, if you’re of a mindset to try your best for a natural hospital birth, but yet are open to medical solutions in case anything should go wrong. – Patricia

Waves

Surfing the waves of contractions, photo by Folkert Gorter

Active labor.  Contractions are hard and occasionally whipping up higher than expected. Massage and hip squeezing isn’t working. The birthing mother’s voice is getting higher and tighter.

As a doula, sometimes in these situations I reach for a visualization. And for active labor, there is no better metaphor than waves. There are so many ways to use this metaphor. Here’s an outline you can use and embellish as you like on the spot.

Here comes the wave… Take a deep breath… Now dive under this wave and through it and through it…. and now you’re coming out on the other side… swim up… Take a breath… Let it go

It’s OK if there are moments of silence in between your words or sentences. You don’t have to be talking the whole time. Speak slowly and use a low, calming voice. If she follows your lead, her own imagination will be filling in most of the details. You are just there to give her a bit of guidance. By focusing on this image of a wave, she can more easily let go of other thoughts that might have been causing anxiety (like, “How much longer will this go on?” and “I’m afraid of the next one.”) Our minds will fill with thoughts if we don’t give them something to focus on.

If you’ve never talked someone through a visualization, it can feel strange to do it the first time. I think we fear that everyone will look at us strangely and wonder why we have started talking in a sing-song voice about waves. In reality, my experience is that everyone in the room is usually happy that there is something besides pain and, often, the blips of machines on which to focus. Often the birth partner and nurses in the room will quietly take part in visualizations and, if it appears to calm down or help the birthing woman, they will even take it up, adding their own voices to the visualization. You may feel funny at first, but if you give it a real try, I guarantee you will be pulling this trick out in a lot of births.

What’s your favorite visualization?

 

What do doulas need in their stockings or in their Hanukah packages? Hmmm, I thought I would dream about good gifts for doulas. I am VERY practical gift-giver. I like gifts to be useful and not anything that will add to clutter. I suppose some will think “thank you notes” could add to clutter, but I think they also add to a nicer world, so they remain on the list. Cheers!

I am reposting this list from a few years ago, but it’s all still true!

1. A  rolling pin from Palumba (http://www.palumba.com/full-size-wooden-pastry-rolling-pin.html)

I always carry one in my doula bag in case a laboring mom wants back pressure during contractions. After about an hour, I can’t do hip squeezes anymore. My wrists give out. But I can run a rolling pin over a mom’s lower back for 20 hours. I know. I’ve done it! If I use the rolling pin during labor (probably about 1/4 of the time I do), I give it to the parents as a baby gift along with a cookie recipe at my first prenatal visit. It usually gets a smile.

2. Beautiful Thank you notes, maybe with her name embossed on them?

Always a good idea to have a package of thank you notes in your doula bag for nurses, doctors, midwives, lactation consultants. For anyone who is helpful in any way at the birth. Helps spread the love for doulas a little bit further.

3. Essential oils

I get my essential oils at a great local shop called Indigo Forest. Beth will ship to you and consult by phone about your essential oil needs. She convinced me this year to carry frankincense with me and I am glad she did. It’s such a useful essential oil! You can google its many uses (or call Beth and ask her. She’ll convince you, too!) Of course, the moms you attend may or may not be into essential oils, but even if the mom I am attending does not want to use them, I use them on myself! I always, always have lavender for calming myself down. It works in an instant. It’s like deep breath in a bottle. If the mom I am working with does not like scents or finds aromatherapy too “out there”, I am careful, of course. I just smell my bottle, I don’t put any on my skin. And if she is allergic, then, sadly, I don’t use them at all. (Indigo Forest is http://visitindigo.com and phone (734) 807-9909)

4. Honey Sticks

I get these at our local farmer’s market. If someone bought me a package for Christmas, I would be thrilled. I always have to make sure my kids (aged 10 and 7) haven’t gotten into my stash before I attend a birth. They are so great for an energy burst (for mom-to-be or me or, in one case, the tired doctor).

5. A donation to a birth-related cause on kickstarter or another crowd-funding website

There are a FEW birth-related projects out there looking for funding. 

What do doulas need in their stockings or in their Hanukah packages? Hmmm, I thought I would dream about good gifts for doulas. I am VERY practical gift-giver. I like gifts to be useful and not anything that will add to clutter. I suppose some will think “thank you notes” could add to clutter, but I think they also add to a nicer world, so they remain on the list. Cheers!

1. A child-size rolling pin from Palumba (http://www.palumba.com/product/298/)

I always carry one in my doula bag in case a laboring mom wants back pressure during contractions. After about an hour, I can’t do hip squeezes anymore. My wrists give out. But I can run a rolling pin over a mom’s lower back for 20 hours. I know. I’ve done it! If I use the rolling pin during labor (probably about 1/4 of the time I do), I give it to the parents as a baby gift along with a cookie recipe at my first prenatal visit. It usually gets a smile.

2. Beautiful Thank you notes, maybe with her name embossed on them?

Always a good idea to have a package of thank you notes in your doula bag for nurses, doctors, midwives, lactation consultants. For anyone who is helpful in any way at the birth. Helps spread the love for doulas a little bit further.

3. Essential oils

I get my essential oils at a great local shop called Indigo Forest. Beth will ship to you and consult by phone about your essential oil needs. She convinced me this year to carry frankincense with me and I am glad she did. It’s such a useful essential oil! You can google its many uses (or call Beth and ask her. She’ll convince you, too!) Of course, the moms you attend may or may not be into essential oils, but even if the mom I am attending does not want to use them, I use them on myself! I always, always have lavender for calming myself down. It works in an instant. It’s like deep breath in a bottle. If the mom I am working with does not like scents or finds aromatherapy too “out there”, I am careful, of course. I just smell my bottle, I don’t put any on my skin. And if she is allergic, then, sadly, I don’t use them at all. (Indigo Forest is http://visitindigo.com and phone (734) 807-9909)

4. Honey Sticks

I get these at our local farmer’s market. If someone bought me a package for Christmas, I would be thrilled. I always have to make sure my kids (aged 10 and 7) haven’t gotten into my stash before I attend a birth. They are so great for an energy burst (for mom-to-be or me or, in one case, the tired doctor).

5. A donation to a birth-related cause on rockethub or another crowd-funding website

There are a FEW birth-related projects out there looking for funding. Here’s one that looks awesome to me: http://www.kickstarter.com/projects/1180845187/the-4th-trimester-bodies-project?ref=live

6. An extra few hours of sleep

If anyone knows where I can find this this December, please let me know. We are fresh out of this hot commodity in Ann Arbor. I’m hoping a new shipment comes in soon!

6. An extra few hours of sleep

If anyone knows where I can find this this December, please let me know. We are fresh out of this hot commodity in Ann Arbor. I’m hoping a new shipment comes in soon!

Russia Breastfeeding article

This looks like strikethrough text, but click on it! It is the link to my article about breastfeeding and “low milk supply” in Russia. We are so used to our own cultural context that we can forget that we ALL see pregnancy, birth, breastfeeding, and parenting through our own particular culture. As a breastfeeding conference is underway in my favorite city (Toronto!), I thought I would share this article I wrote a while ago about my experiences in Russia.

Things have changed in Russia since I did fieldwork there in 2000-2001, but I still think it is valuable to understand how others in the world think (or thought) about women’s reproductive bodies.
You can also get to this article by clicking on the words ‘Related articles” below. That brings up the Google link!
by C Gabriel – ‎2003 – ‎Cited by 2 – ‎Related articles

THE EFFECTS OF PERCEIVING “WEAK HEALTH” IN RUSSIA: THE CASE OF.BREASTFEEDINGCynthia Gabriel. The state of Russian health has declined.

A group called The Unnecesarean pointed out today that anesthesiologists, themselves, are aware that WALKING in labor (“ambulating” in medical terms) reduces cesarean rates. Though I am an advocate of natural hospital birth, I share the goal of reducing unnecessary cesareans. It seems to me that if “walking epidurals” are known to reduce the risk of cesarean in women who want epidural anesthesia, we should be offering these more often. (Please know that I say that with the belief that no woman should be offered anesthesia in labor that she does not want. Women who want a natural birth deserve FULL support for this!) As “The Unnecessarean” points out, the anesthesiologist quoted in this article is blunt in admitting that it is “easier” to manage laboring women in bed. But labor is not about ease. It is about birthing the next generation. It is worth the hard work of women AND hospital staff!

Here are some excerpts and a link to the article. Thank you to The Unnecesarean for pointing this out.

Most notably, only four of the patients who received a walking epidural experienced hypotension compared with 44 patients in the nonambulatory group. Only 113 in the walking group required bladder catheterization compared with 187 in the nonambulatory group. Motor block was seen far less frequently in the ambulatory group (14 vs. 145 patients in the nonambulatory group), and cesarean delivery was less common as well (53 vs. 65, respectively).

On the other hand, patients who received walking epidurals reported more pruritus and required more interventions, as demonstrated by higher total PCA volume and use of rescue doses of ropivacaine. The duration of labor was unaffected.

“Even with the benefits to the patient, walking epidurals are not used very often because they are more time-consuming in terms of patient management,” said study leader Shaul Cohen, MD, professor of anesthesiology at UMDNJ, in New Brunswick. “It’s much easier to keep them in bed with a Foley catheter. And it’s an insurance issue. Insurance companies pay for care not quality of care, and they won’t pay for the additional time and staff required by walking epidural.”

Dr. Cohen added that the increased use of cesarean delivery—nearly 45% of laboring women in New Jersey now undergo the surgery, he said—makes it more difficult, if not impossible, for obstetric anesthesiologists to offer patients the walking epidural approach.

Others in the field have a more tempered view of its benefits, however. “There is no ‘ideal’ epidural infusion regimen for labor analgesia,” said David Wlody, MD, chief of anesthesiology at the State University of New York-Downstate Medical Center, in New York City, and a specialist in obstetric anesthesiology. “Different patients, anesthesiologists and obstetric providers will have different expectations regarding pain relief in labor,” said Dr. Wlody, a member of the editorial board of Anesthesiology News, who was not involved in the latest research.

“Some patients may be willing to tolerate a greater amount of discomfort if it means enhanced ability to ambulate, while others will desire more pain relief at the expense of increased motor block,” Dr. Wlody added. “It is the responsibility of the anesthesiologist to balance these often conflicting goals in order to provide the best outcomes and the highest degree of patient satisfaction.”

http://www.anesthesiologynews.com/ViewArticle.aspx?d=Clinical%2BAnesthesiology&d_id=1&i=May+2013&i_id=956&a_id=23112#.UaSyPv1c7Q0.facebook

Follow

Get every new post delivered to your Inbox.

Join 1,491 other followers