Childbirth Preparation: Prenatal Ponderings

Today pregnant women need to be consumers and self-advocates. Many childbirth classes are teaching strategies to better these skills. This is not by chance, but rather by the often one-size-fits all packaging and management from pregnancy onset to labor through immediate postpartum in the care provider offices and hospitals of today.

Many routine tests are done prenatally. Though prenatal care and these tests can help further healthy outcomes for moms and babies, too often women can be funnelled into a cycle of unnecessary fear, stress and choice limitation while in reality still healthy and maintaining normal pregnancy.

Below is a listing of common prenatal tests and practices for you to question (what is it for, what does it improve upon, what can it lead to in other tests or interventions, is it for low-risk moms and babies, what will I do with the information), research and decide on are:

• pregnancy test by urine dip or blood work
  
• ultrasound to date the pregnancy
  
• blood pressure reading each visit
  
• weight measure each visit
  
• urine test - check for protein in the urine
  
• fundal height measurement as pregnancy furthers
  
• gestational diabetes testing
  
• triple screen testing (AFP)
  
• just because ultrasounds
  
• ultrasound for fetal size
  
• routine ultrasound for fluid level as "due date" approaches
  
• biophysical profile(s) as "due date" approaches or passes
  
• membrane sweeping
  

It is vitally important that you are equipped and aware of your care provider's philosophy and usual practices.

What are you willing to do? What are you willing to bypass? How responsible for your pregnancy and birth are you willing to assume? At the end of the day you are ultimately the one who has to live with the choices you or your provider make.

Be a driver - you are more likely to arrive at the destination you desire.

Upcoming Childbirth Classes, Trainings, and Childbirth Tips

Visit http://www.birthingtouch.com/ for upcoming childbirth classes serving the Colorado Springs area and for CAPPA childbirth educator trainings in Colorado, Missouri, and Utah.

• Proper support is important for childbirth - builds confidence in mom, builds safety in mom, lowers complications, interventions, medications and cesareans.
• Induction is only for medical reasons - big baby, past "due date", tired of being pregnant, care provider preference, upcoming holidays... all put mom and baby at risk for complications, interventions and cesarean.
• Cesarean only for medical reasons - cord prolapse, placenta previa, pre-eclampsia or HELLP syndrome where induction fails, true fetal distress, some breech positions, placental abruption, uterine rupture (there are other less common reasons as well - notice previous cesarean, non-medical reason, large baby, gestational diabetes, obesity, convenience are not on the list)
• Unrestricted movement in labor -
• Pushing in gravity prone positions - only use reclined or lithotomy of mom desires it.
• No separation of mom and baby unless there is a complication.
• Drinking and eating in labor - the uterus is a muscle it needs to be watered and fed.
• Intermittent monitoring of mom and baby - only high risk moms and babies need continuous monitoring.
• No routine medications or interventions - pain management should not be pushed on a mother, episiotomies should not be routine, augmentation of labor should only be done AFTER non-medical methods are tried and patience is used, naturally occurring rupture of membranes, etc.
• Unrestricted breastfeeding access.
• Informed consent and refusal need to be utilized.

Check out http://www.cappa.net/, http://www.independentchildbirth.com/, http://www.lamaze.org/ for resources outside of Colorado Springs, CO (classes, doulas, other related professionals).

So what might a cesarean get you? More than a baby!

Having a cesarean section will likely get you a baby, but generally much more than you bargained for.

Let me count the ways in no particular order:

• A scar that in no way makes a bikini look better. Sometimes described as a shelf or a pouch.
• The feeling of failure, guilt or less than deserving of motherhood.
• The struggle of living with the huge dichotomy of loving your baby and hating the birth.
• Higher probability of losing your ability to have more children either through physiologic secondary infertility, pregnancy complications, self-induced secondary infertility, hysterectomy or lack of sexual intimacy in relationship.
• Higher probability of difficulty in breastfeeding.
• Postpartum depression or PTSD, especially in an unwanted cesarean.
• The feeling of failure as a wife or partner.
• Having others discount your feelings and needs. After all you "just" had a baby. Really you just had MAJOR surgery, perhaps by coercion, or completely from interventions and medications.
• Living with the idea that you failed to pass induction, you failed to push out your baby, you failed because _________ (fill in the blank).
• Obtaining your records to find what you were told and what was written are different. Could your trusted care provider have lied and cheated you?
• Simply finding out that no one told you and you didn't do the research, that being induced, getting the epidural, allowing AROM, not getting out of bed, etc. is why you had the cesarean. Is maternal ignorance and fear enough to quell what you feel and make it ok?
• How can you trust yourself as a mother when you ignored your maternal intuition and kept saying yes, because the nurse, midwife or doctor told you to?
• The way your marriage or partnership takes a turn toward hell.
• Living with dread when a hungry hand sweeps over your scar. Being sexual can be extremely difficult physically and emotionally.

For all of these - there a stories layered and interwoven for too many women. Every thirty seconds a woman is surgically having her baby delivered. Light her a candle. Offer her a meal. Let her speak. Listen to her intently. Send her to ICAN. http://www.ican-online.org/.

Push! Bringing Baby Forth During Childbirth.

"Pushing felt good." "The urge to push was unstoppable." "I felt like I was going to split apart." "It hurt so much more than I thought it would." "I didn't want to push." "Why did I have to hold my breath and tuck my chin?" "Why were people yelling at me?" "All I wanted to do was breathe and not push." "What is the deal? I was told I couldn't get a baby out on my side, squatting, hand and knees or when I arched my back and threw my head back." "If I would have pushed in another position would I have torn so much?" "Would I have avoided a cesarean pushing in another position?"

The myths surrounding pushing in our culture are widespread. Over and over women are told unless they push in the "C-position" or reclined position with tucking chin and holding breath "purple pushing" there is no way they can effectively push out a baby. Interestingly, when not coached, most women choose to squat, stand and lean or use a variation on hand and knees to deliver their babies.

So why are we told there is only one way to effectively deliver a baby and expected only to do that?

Here a few reasons I have come up with:

• 98% of babies in USA are born in the hospital versus at home or birth centers with midwives.
• Most OB's are not trained to catch in any other position, are trained to see with their eyes for one orientation, and do not know how to "see" with their hands.
• In hospitals, nearly ALL women - in some areas close to 100% are medicated with narcotics or more likely with epidural anesthesia.
• Beds are almost used 100% for hospital deliveries versus a birth chair, birth stool, toileting, squat bar, standing or leaning.

Using alternate positions in pushing (unless you are a small percentage of women who prefer the "C-position"), can reduce trauma to the perineum, shorten pushing time, allow for movement of tailbone thus opening the pelvis more, can lessen stress on the baby, and give mom more sense of control over the birth.

Using alternative breathing techniques other than holding the breath as in directed pushing to a count of ten or more can allow for baby to get more adequate oxygenation and be a more gentle process for both parties. A mom may spontaneously push while breathing non-specifically, she may grunt and growl, she may hold her breath for a moment and then exhale several times during a pushing episode, she may do a slow-exhalation with mouth relaxed and slightly open (open-glottis) while pushing, breath slowly/rhythmically and not push actively allowing for passive dissent of baby through contractions.

Most un-medicated or lightly medicated women will choose a position and breathing style that works for her in the event she is allowed to trust her body, trust the process and feels supported. We don't really need to do anything.

I urge you to have deeper conversations about pushing and delivery with your care provider BEFORE you go into labor.

• Find out what positions your provider is comfortable or willing to catch in.
• Ask about use of compresses and perineal massage
• Ask about only using coached pushing if really needed
• Ask about percentage of women under provider care "require" an episiotomy
• Ask how long pushing will be tolerated
• Ask your provider what his or her philosophy about pushing and delivery is.
• Ask for evidence to support practices. Actual studies not just verbal.
• When you arrive at the hospital, speak to the nurse about what you want to do and the what you and your care provider have agreed upon.

Here's to pushing with confidence, using your instincts and following your body!

Childbirth in the hospital - Navigational Tips

There are many reasons why a woman chooses to birth in the hospital. Women have the right to choose where and with whom she will birth regardless of what another would choose.

Women need the tools to navigate the hospital setting. She and her baby ARE unique. They are human beings. Laboring women are often placed under one-size-fits-all standing orders and protocols. Because of this, pregnant women need to be very careful regarding the books read, the types of birthing shows viewed, the care provider chosen and the childbirth class taken prior to entering the hospital to birth.

Here are some tips for a truly healthier and safer experience:

• Take the hospital tour - ask lots of questions - induction rate, induction medications and/or procedures routinely used, average cesarean rate for first time moms, VBAC rate, pitocin use rate, epidural rate, use of non-medical pain relief, natural childbirth rate, IV use versus heplock, percentage of moms who utilize doulas, is pain management highly suggested to every laboring mom, monitoring norms, availability of tub or shower for labor, standard protocol on eating and drinking in labor, use of non-supine pushing positions, mobility in labor, are the labor and delivery nurses open to anything goes in labor, what is protocol on immediate postpartum baby care, is there a lactation staff available....
• Read the pre-admit paperwork. If you are not sure what it says, ask a paralegal or lawyer to look at it. Be certain that you agree with what you are signing. Do not sign epidural consent form or cesarean consent form at pre-registration. You want to be fully consented during true decision making time. Be sure though to be familiar with benefits, risks and consequences of everything ahead of time.
• Take a non-hospital childbirth class.
• Only agree to induction for a true medical reason - (suspected big baby, pre-pre-eclampsia, being tired of pregnancy, care provider going on vacation, relative will be in town, being past your "due date", just because you can - are not medical reasons)
• When induction is necessary - choose a foley catheter to ripen the cervix over misoprostol (cytotec, miso, or the little pill) and if labor establishes upon cervical ripening - decline pitocin or ask to keep it very low over a longer period of time.
• Keep your "water" (amniotic sac) intact until it breaks on its own. This can keep infection probability much lower, lessen risk of cord prolapse, and lessen the discomfort of contractions among many other things.
• As long as a mom and baby are low-risk - wait until well into active labor to arrive at the hospital - contractions 3 minutes apart and lasting a minute or more. Shortening the time in the labor and delivery room usually keeps interventions and medications to a minimum.
• Any birth and immediate postpartum preferences need to be discussed PRIOR to labor with your care provider. A concise birth preference plan can be given to the nurse upon arrival.
• In the event a cesarean is necessary (hopefully not created by interventions and medications in labor), discuss with your care provider prior to labor what you would like to have occur (partner in OR, no separation of baby from mom, pictures taken, etc. - for a complete list, please email me).
• Make postpartum baby care decisions prior to arriving at the hospital. You do not need to have a pediatrician or family practitioner picked out ahead, as the floor doctor will oversee your baby's care. If you are unsure of what you want, it is always acceptable to delay any immunization, vitamin K injection, eye ointment, etc. until you have the opprtunity to investigate further. As a parent you have the right to say yes or no to anything.

The key thing to remember is that as a consumer, you are paying your care provider for a service, for the hospital staff to attend you respectfully, and for the use of the room you are renting. You do have rights. Protocols and practices are not laws. You can say yes or no to anything or everything.

As a woman you are making parenting decisions throughout labor, delivery and early postpartum that should be respected, honored and can have lasting consequences. There is no do-over.

Remember to be a driver - not a passenger!

Cesarean Awareness Month

April is Cesarean Awareness Month http://www.ican-online.org/

What is Cesarean Awareness Month?

An internationally recognized month of awareness about the impact of cesarean sections on mothers, babies, and families worldwide. It’s about educating yourself to the pros and cons of major abdominal surgery and the possibilities for healthy birth afterwards as well as educating yourself for prevention of cesarean section. Cesarean awareness is for mothers who are expecting or who might choose to be in the future. It’s for daughters who don’t realize what choices are being taken away from them. It’s for scientists studying the effects of cesareans and how birth impacts our lives. It’s for grandmothers who won’t be having more children but are questioning the abdominal pains and adhesions causing damage 30 years after their cesareans.CESAREANS are serious. There is no need for a ‘catchy phrase’ to tell us that this is a mainstream problem. It affects everyone. One in three American women every year have surgery to bring their babies into the world. These women have lifelong health effects, impacting the families that are helping them in their healing, impacting other families through healthcare costs and policies, and bringing back those same lifelong health effects to the children they bring into this world.

Be aware. Read. Learn. Ask questions. Get informed consent. Be your own advocate for the information you need to know.

Visit your local ICAN chapter or go to http://www.ican-online.org/

ICAN's response to ACOG and AABC statements

Redondo Beach, CA, February 7, 2008: The International Cesarean Awareness Network (www.ican-online.org) would like to publicly condemn both the AABC (American Association of Birth Centers) and the ACOG (The American College of Obstetricians and Gynecologists) for their statements* this week that limit not only women's choices in birth but imply that birth is a fashion trend rather than a safety concern.

Since VBAC is the biological normal outcome of a pregnancy after cesarean, ICAN encourages women to get all of the facts about vaginal birth and elective cesarean before making a choice. This decision should not include weighing the choices of your doctor's malpractice payments but only be a concern of the mother, her baby and their health and safety.

Since some mothers will make the choice to give birth outside of the hospital, we encourage the AABC to not cave into ACOG's demands that all women give birth in a hospital facility with a surgical specialist, but instead allow women to make their own choices about care providers, birth settings and risk factors. ICAN respects the intelligence of modern women and accepts that the amount of information available about VBAC and elective repeat cesarean should serve as informed consent.

ICAN further encourages the governments of individual states to look closely at their cesarean rates (31.1% national cesarean rate as of 2006) and the informed consent laws that apply and help women to reach a standard of care that lowers the risks of major surgery and the risks of elective or coerced cesarean without medical indication. Women and children should not bear the brunt of malpractice risks being conveyed into physical, mental, emotional and spiritual health risks in order to protect their physicians.

Mission statement: ICAN is a nonprofit organization whose mission is to improve maternal-child health by preventing unnecessary cesareans through education, providing support for cesarean recovery and promoting vaginal birth after cesarean. There are more than 94 ICAN Chapters across North America, which hold educational and support meetings for people interested in cesarean prevention and recovery.

* AABC statement: http://www.birthcenters.org/files/file.php?id=2&file=file&file_type=file_type
ACOG statement: http://www.acog.org/from_home/publications/press_releases/nr02-06-08-2.cfm