Maternity Care Quiz

I found this on another doula's blog. Consumer Reports Health.org has an interactive quiz about maternity care. It only takes a couple of minutes. You can test your knowledge and maybe learn something too!

Quiz: Maternity care, beware

Utah Doula Association Conference This Week!

The Utah Doula Association is having their bi-annual conference this Saturday, February 28 in Salt Lake City. I'm very excited about this conference and I'm looking forward to attending! I hope to learn a lot, and to meet other doulas and people in this business who support women's education and right to choose their birth preferences, as well as other things like natural birth and home birth.

As doulas, we support women in every setting, whatever the woman chooses is what we support her in. We attend hospital births as well as birthing centers and home births. We work together with doctors, nurses, midwives, apprentices, and birth partners (husbands, mother, etc.) in supporting the birthing mother in achieving her ideal birth. I love this work so much, and I'm really happy to be able to attend this conference. Please check out the UDA website to learn more about their group.

Non-Pharmacological Methods of Pain Relief for Childbirth

Many women are afraid of natural childbirth because they're afraid that by choosing an un-medicated birth they are choosing an incredibly painful birth. This is not necessarily the case if a woman educates and prepares herself for an un-medicated birth. I know this from experience. There are many non-pharmacological (non-medicated) methods for pain relief, and these are just a handful of examples that I thought I'd share today. Please feel free to contact me if you'd like more information.

• Moving and changing positions for labor and birth. Positioning can make all the difference in labor progress as well as in comfort during labor.
• Use of touch (handholding, stroking, patting) and Massage, and much more.
• Immersion in water during active labor (as opposed to early labor) when the water is maintained at body temperature.
• Use of Intradermal Water Blocks (subcutaneous injections of sterile water) - particularly effective for back labor, but there are many other comfort measures that can be used for back labor as well.
• Continuous Labor Support by an experienced person (who provides physical comfort, such as relaxation techniques, massage, non-clinical information and advice for the laboring woman and her partner, advise on effective position, heat or cold for pain relief, and emotional support (encouragement and reassurance).

Wonderful Doula Training!

As I've mentioned in previous posts, my DONA Doula Training was the first weekend in February. It was an absolutely amazing experience. We had a class of 5 ladies along with our instructor, and we learned so much together! A lot of the information provided was material I had already learned through my own reading and research, but there was still a lot I learned from the training. It was great to meet and interact with other doulas and talk with some like-minded people.

If you'd like to see some photos and more information from our training, please check out my doula trainer's blog: http://doulamelissa.blogspot.com/. She is planning another training in June. If you scroll down to the second post you can read a wonderful birth story.

Epidural: Procedure, Benefits, and Potential Risks

The most common form of pain medication used in childbirth in the United States is the epidural block. Despite its widespread use, I strongly feel that the majority of pregnant women in the United States are not properly educated about the use of an epidural block. Here is some information that every woman should consider when deciding whether or not she will choose an epidural in labor.

How an epidural is done:

• The drugs used in an epidural are usually a combination of an anesthetic (like bupivacaine) and a narcotic or opioid (like fentanyl). Dosage depends on the anesthesiologist performing the epidural.
  
• The mother must have an IV line to ensure adequate fluids.
• Constant monitoring of the mother's blood pressure and baby's heart rate is needed.
  
• The mother is placed on her side or sits up and leans forward to receive the epidural.
• The anesthesiologist cleans the lower back area.
• A local anesthetic is given and then a hollow epidural needle is inserted between two vertebrae into the epidural space, just before the membrane that covers the spinal cord.
• The mother usually feels pressure.
• A test dose of the medication is usually given to ensure proper placement and effectiveness of the epidural.
  
• A thin, plastic tube called an epidural catheter is threaded through the hollow needle into the epidural space and the needle is removed.
• The catheter is taped to the mother's back.
• Generally each contraction will get easier, and the mother will begin to feel pain relief in about 10 to 20 minutes. Her legs may feel warm or tingly and may feel heavy.
• The lighter the epidural dose, the more control the woman will have to move her legs and the easier it will be to change positions.

Advantages to using an epidural:

• Allows the mother to stay alert throughout labor and delivery.
• The baby is less medicated compared to if an IV narcotic is used.
• The mother can rest during a long labor.
• Can provide pain relief, particularly when labor is induced with pitocin.

Potential side-effects of an epidural:

• The woman's ability to move around or change positions may be limited. She is generally restricted to the bed.
  
• The medication may cause an erratic fetal heart rate. Local anesthetics cross through the placenta.
• Drugs can cause various degrees of maternal, fetal, and neonatal toxicity.
• May slow down labor (particularly if given before 4-5 cm dilation).
• May increase the possibility for use of pitocin.
• May make it hard for the mother to push the baby down. Some women don't feel the urge to push at all when they have an epidural. This is generally related to how strong the epidural is.
• May increase the likelihood of the use of forceps or vacuum extraction.
• May cause a fever in the mother when used for long hours.
• May make it more likely the newborn will be screened and treated for infection.
• Some mothers experience nausea, vomiting or itching when epidural narcotics are used.
• May cause short-term urinary incontinence, and a bladder catheter may be inserted into the mother. A full bladder will generally slow the progress of labor.
  
• Delayed fetal rotation and descent.
  
• Spinal headache if the epidural needle goes in too far (if it punctures the spinal space). This is usually a severe, debilitating headache that can last for a couple of weeks. A blood patch can be done to help repair the damage and alleviate the headache.
• Postpartum backache.
• Possible long-term paralysis. This is more rare than other side effects, but it can happen. I have a friend who experienced a numb spot in her leg for several months after having the epidural.
  

Click here to see photos of the epidural procedure by Patti Ramos

This information was paraphrased and compiled from An Epidural for Pain Relief: Making an Informed Choice by Nicette Jukelevics, MA, ICCE and Pregnancy, Childbirth and the Newborn by Penny Simkin, PT, CD(DONA). For more in-depth information about the risks and benefits of epidurals, please also see The Thinking Woman's Guide to a Better Birth by Henci Goer.

BOBB Newsletter, Including News from Brazil with 93% Cesarean Rate for Middle Class Women

I know I post about The Business of Being Born a lot, and it's because they are doing such wonderful things in advocating birth options and education for women. Their film is part of what has motivated me to be so active in this pursuit. They have released their most recent newsletter. To go directly to the newsletter, click HERE. There is a ton of new information, and you should take a moment to see what's going on.

The most interesting part of the newsletter for me is the report from Abby's trip to Brazil. Most industrialized countries have a c-section rate of about 30%, which is astronomical considering that only as much as 15-20% of births have a medical indication for c-section. Brazil, as a whole, is extremely baby and family-oriented, so it's incredibly surprising that in Brazil's middle and upper classes the cesarean rate is about 93%! Abby's report gives some interesting information about why this is, and contrary to popular belief it's not the doctors that are pushing for the surgeries; it's the women. Please take some time to read it, and let me know what you think!

Excellent Comprehensive Information on Pregnancy and Childbirth Care and Options

I found an incredibly informative article through another blog the other day, and I took the time to read it completely before passing it on to my readers. It's an article written by Marsden Wagner, M.D. and posted online just last month. I've seen Dr. Wagner on some of the films I've watched about childbirth, and I'm sure I've read excerpts from his books in the various works I've read on the subject. The article is entitled "Natural Birthing Options: Technology in Birth- First Do No Harm" and it's an excellent read! It's long, but gives a concise summary of the medical childbirth system that currently exists in the United States today, and the risks and benefits attributed to it. He also gives advice on what expectant parents should do to ensure they get the right information and what to do about it.

Every expecting woman should read this article. It's much shorter than any book on the subject, and gives great information. If you are interested in reading more than an online article, please check my list of Recommended Reading on the right side of this page. One book in particular that I found to be informative is Henci Goer's Thinking Woman's Guide to a Better Birth.

If you are a more visual person, I would recommend watching the documentary film, The Business of Being Born by Ricki Lake and Abby Epstein. I was able to check the DVD out from my local library, but you can also purchase a copy of the film from their online store. It's an excellent documentary that discusses the maternity care system in the United States and the effectiveness of it.

I believe that all women should be informed and know what their options are and what the risks and benefits are for all of those options. We need to make informed decisions rather than simply go along with what someone tells us is best. Empower yourself!

Here is a link to Dr. Wagner's website

Educational Childbirth Video Contest

I recently got this message from Sarah, one of my readers. I think it's a worthy endeavor, and I'm happy to spread the word:

"I work with a nonprofit that is sponsoring a contest with a $1000 prize for the best educational video about options during pregnancy and childbirth. It would be fantastic if you wanted to help us spread the word by blogging about it. Or make a movie about doulas!"

The group is called Birth Matters Virginia, and I would like to show them as much support as possible.

Contest rules are here

or you can go to the Facebook page here

Breastfeeding Support and Information Available

I am a HUGE breastfeeding advocate and I'm always looking for ways to help women breastfeed successfully. Breastfeeding.com is a great online resource for all things relating to breastfeeding. Whether you are expecting or already breastfeeding your baby, or just know someone who might appreciate some help with breastfeeding, this is a wonderful resource to turn to. In addition to online articles, there are also informational video clips you can watch. There are 57 video clips covering 10 different subjects. Please take some time to look over it!

If you enjoy reading, an excellent book on the subject is The Ultimate Breastfeeding Book of Answers by Dr. Jack Newman. I never realized there was so much to know about breastfeeding until I read that book.

Continuous Support in Labor and Childbirth

Anyone can offer continuous support to a woman in labor and childbirth, but seldom in the United States today is this available in the medical setting of a hospital. Nurses most often are attending to several patients at once and cannot devote continuous support to just one woman. Physicians are not present during labor other than occasional contact with the nursing staff or brief visits, until delivery, and then leave once the baby has been born and the mother is stitched up and settled. Even partners (husbands, family, etc.) may not be able to offer the support a woman needs. A birth doula is trained specifically in labor and birth, and specializes in offering continuous support.

According to the Cochrane Reviews, continuous support in labor and birth facilitates a better labor experience and more positive outcomes in childbirth.

"Continuous support in labour increased the chance of a spontaneous vaginal birth, had no identified adverse effects and women were more satisfied."

Original studies done on continuous support were done by having a woman simply sit in the room with the mother for the duration of the entire labor and birth. The woman did not speak or interact with the mother, but her simple constant presence in the room yielded significant results. If you are interested in reading more about these studies and about the role of doulas, please read The Doula Book by Penny Simkin (also listed on the right side of the page under Recommended Reading). It's a relatively short book and is full of important information.

Birth Doulas, of course, do much more than just sit silently in the room with a laboring woman. We are trained to provide non-medical, continous socio-emotional support through labor and birth. We come prepared with a vault of knowledge and expertise in the process of birth, as well as extensive understanding of possible complications, medical interventions, comfort measures, emotional needs and ways to address them, physiological needs and assistance, and more. We work with the mother, her partner, and the care provider and staff in helping to promote the best birth experience and positive outcome as possible.

I am eternally grateful to my doula and her irreplaceable help to me in my birth experiences. I'm so excited to offer this support to others, and most of all, to let every woman know that she can get the support she needs to have a positive birth experience!

Jessica Alba's Body After Baby Secret: A Girdle (Postpartum Belly Binding)

My post about postpartum belly binding from October has gotten more hits since I published it than the rest of my blog combined. This is a HOT topic! Women everywhere want to know the secret to a great postpartum body. Jessica Alba's secret? A girdle, or wrap! Check out the people.com story here! I think I assumed that all celebrities simply hire a personal trainer and work out like crazy to get back into shape, but Jessica claims that the workouts killed her, and she hasn't exercised since. She credits her girdle for her amazing postpartum body.

I really wish I had heard about this 10 years ago before I started having babies. I hope I can repair some of the damage done by 5 babies after this one is born, and I definitely want to try a belly binder. Please check out my earlier post for more information about the reasons for belly binding, and suggestions on some brands you can try.

I wouldn't recommend no exercise at all. If a wrap or binder can produce such amazing results, then just imagine how much better and more fit you will be if you use a girdle and moderate exercise. You will be healthier and have more energy and vitality if you exercise cautiously after giving birth. Check out my previous posts on postpartum tummy exercise and staying healthy and low-risk. Even exercise you do during pregnancy will be beneficial after pregnancy as well, and these are simple, easy exercises you can try.

Also, if you or someone you know has had experience with using a postpartum girdle, wrap or belly binder, I would love to hear about your experience. Did it make a difference for you? What brand did you use, and how did you like it? Would you recommend belly binding to other women? I have a friend who just had her third baby a few weeks ago and for the first time she is using a belly binder from the Belly Bandit. So far she loves it, and I hope to publish her story on my blog in the future.

Study: Elective C-section babies born before 39th week face risks

You learn something new every day. At least, I do, and I like it that way.

I just learned today that babies born via Cesarean Section are more likely to have respiratory problems compared to babies born vaginally. A recent study tracked more than 24,000 women who had repeat c-sections performed at 37 weeks or later. Of those women, 13,258 had elective c-sections, meaning it was simply by choice with no medical basis for the surgery. Some of the main points of the study are:

• Over one-third of women are having elective repeat Cesareans. This is a significant number.
  
• Delivery just 3 or 4 days before 39 weeks led to increased complications.
• Respiratory problems are more likely with repeat c-sections, as well as other complications, particularly when the surgery is done before 39 weeks or after 40 weeks gestation.
• Parents and Doctors should wait until the 39th week to deliver via repeat elective c-section, and no later than the 40th week.

If you'd like to read the article yourself, please click on the link in the top paragraph. I found this article through another blog.

Home Care Instructions for the Mother

I found this through a doula's blog, and I think it's very informative, whether you birth your baby in a hospital or at home. It was written by a group of midwives.

Home Care Instructions for the Mother

Years ago a woman who had just given birth was routinely kept in the hospital for over a week, in bed the whole time, not allowed to do anything for herself, for it was believed this was best for healing. We now know that moderate activity is helpful and encourages healing, but I'm sure many women struggle in finding the right balance of rest and activity to facilitate postpartum recovery.

I myself have a hard time gauging how much I should do after having a baby, especially after I've come home from the hospital. I've been reading about postpartum care and recovery, and what I've read encourages careful observation of energy levels and as much rest and time with the baby as possible. Most of the material I've read suggests having help at home with household demands to allow the mother to focus on just herself and the baby, and establish breastfeeding early on. This pdf I've linked to above seems to be pretty close to many of the other materials I've read on the subject, and I think it's very informative for any woman, wherever she chooses to birth her baby.

Click here for more on postpartum care

If you would like more information on this subject, please check out the list of Recommended Reading on the right-hand side of the page. Scroll down a bit to get to it.