Childbirth Education Myths 3

February 18th, 2014

books-150x150To read the whole series, begin with Childbirth Education Myths 1.

MYTH #3: “The hospital class will be good enough.”
One of the best ways to be prepared for birth is to learn about birth. What happens in the normal, physiologic process? How do interventions (medical or non-medical) affect that process? What is the difference between the medical model and the midwifery model? Under what circumstances will each model benefit you? These are topics a hospital class will likely not tackle.

1) Limited information.
Hospitals often teach what is available at their facility. This makes sense, because hospitals are in the business of selling medicine. Their maternity department offers the medical model of care, and hospital childbirth classes reflect that. Their instructors are employed by the hospital, and the hospital has direct control over their curriculum.

The class offered at a hospital is more likely to focus on when to get to the hospital, what to do if your water breaks, protocols for epidural placement, and what to expect in a cesarean. They may cover logistics like where you go to get admitted, what happens there, and where you get moved around to. They will make sure that you are familiar with the routine protocols and procedures, which can be beneficial if you are planning to birth there.

They may or may not offer much information on non-medical pain management, the physiology of birth, doulas, or birth plans, as these are not things normally offered in hospitals.

2) Alternatives to the medical model are not offered.
Generally speaking, hospitals do not employ care providers like chiropractors, naturopaths, independent midwives, or other more holistic-minded care providers. If they do, they may not think to refer you for care from any of these areas, as they are not part of the medical model of care for birth. To learn about non-medical options, a local independent childbirth educator is going to be a wealth of resources and information for you.

3) Informed Choice vs. Informed Consent
Many hospital classes cater to the majority, who are anticipating the status quo American birth: Start labor, get epidural, have baby. While there is nothing wrong with a woman choosing that model, many hospitals operate under the assumption that this is the only model that interests women. Thus, they spend more time preparing moms for what to expect at the hospital than they do preparing them to cope with labor in whatever way seems right to her. If a mother wants something outside that model, a hospital class may not be the best fit for her, and she may feel as though she is sitting in a “How To Be Good Patient Class,” rather than a comprehensive, evidence-based, balanced childbirth class.

4) Availability of Instructor
Independent childbirth educators are often available by phone and email between classes, to help with homework, provide resources and referrals, and to answer questions. Hospital instructors may not have such ready availability. Their class sizes are usually much larger, so their ability to give one-on-one attention or instruction may be severely limited.

Questions to Ask Childbirth Educators:

  • What curriculum do you use, and what is it based on?
  • How much experience do you personally have in this hospital attending births? Do you have any experience working with the independent midwives in town to offer a balance in models of care?
  • Is this class going to teach in-depth about the physiological birth process?
  • How much time is devoted to labor coping techniques?
  • Are you a certified instructor? With whom?
  • Are you available for questions or concerns outside class? Can you refer to outside providers, and if so, whom?

In short, it’s not a bad idea to take the hospital class — just don’t let it be an exclusive source of information. There are a wealth of independent organizations that do an excellent job at preparing you for birth. There are methods like Bradley and Hypnobirthing, as well as comprehensive courses by Lamaze and CAPPA. (We’ll address method classes in this series as well, so stay tuned!)

For more on this topic, we found another excellent perspective here: 5 Reasons Not To Take Hospital Chilbirth Classes

Where did you take your childbirth classes? How did they help or hinder your understanding of birth? Did you have a good experience with the hospital?

Warmly,
Team Preparing For Birth



Childbirth Education Myths 2

February 11th, 2014

To see the first post in the series, click HERE.

books-150x150MYTH #2: “I hired a doula, so I don’t need any kind of childbirth class.”
More and more women are hearing about the benefits of having a doula on their birth team, and that is fantastic! As a doula, I would never do anything to dissuade a family from hiring a doula. However, just like her care provider, a woman’s doula should not be considered her primary source of comprehensive education. While many doulas are also childbirth educators, and are walking birth encyclopedias, there are many reasons that a birthing woman should look to a class for in-depth education.

1) Childbirth Educator is a different scope of practice and not the doula’s primary job.

A doula’s primary job is informational, emotional, and physical support throughout a woman’s pregnancy, labor, birth, and immediate postpartum period. Her scope is limited, and while some education will be a natural consequence of her relationship with her clients, it is not the primary objective. When it comes to the informational support, a doula’s primary role is to find out the individual needs of her client, then refer to resources relevant to her situation (including childbirth classes), so her client can educate herself.

2) Though a doula will spend time educating her clients, the education will not be comprehensive in nature.

Most doulas only offer two or three prenatals at about an hour each, but even if there are more than that, as well as phone and email support, it will not be enough to create a solid foundation of general birth knowledge for a client to base her decisions on. In contrast, a childbirth class is often 10 hours or more of hands-on education, creating that solid, needed base of information. Doulas build on this bedrock, tailoring their support to supplement your knowledge.

3) Even doulas who happen to be educators cannot provide all your education within framework of doula fee.

Doulas know that we can’t cover all the bases adequately within the bounds of our doula-client relationships. If our clients have taken a good comprehensive class, they benefit from being familiar with information so that in labor, they can recall that info for themselves with minor prompting from their doula. Doulas know that active labor is not the time for a 45-minute information bomb! It’s better if our clients have that information ahead of time, tucked away and ready to pull out when it’s actually needed.

Doulas who are educators often offer private or group classes at a discounted rate for this very reason.

4) Doulas know that childbirth classes are a key way to encourage active participation from the woman’s chosen birth partner, and making the birth team dynamic more effective.

Partners are more likely to be able to attend classes than they are to attend doula prenatals, and will learn more about their own place on the birth team through role-playing, relaxation exercises, labor practice, and hands-on support techniques. Doulas adjust their support to the needs of their clients, and an active, educated partner, makes the entire birth process go more smoothly, because the doula won’t have to educate on the fly during labor. She can just encourage and remind the birth partner of what they already know.

So, if you have hired a doula, fantastic! Ask her for recommendations in childbirth education, or ask if she offers classes for an additional fee. You will never regret having both a good class, and a doula.

Where did you find your childbirth classes, and how did they help you grow in your knowledge of birth, the process, and what you wanted for your birth experience? Did your doula encourage you to take classes?

Warmly,
Team Preparing For Birth



Childbirth Education Myths 1

January 27th, 2014

Over the next several weeks, Team Preparing for Birth will be debunking some common myths surrounding childbirth education classes. Check back every Monday to see the newest post.

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MYTH #1: “I’m having a homebirth, and my midwife will do all my education.”

Home birth families often see childbirth classes as an extra, rather than a valuable and necessary tool to help them have the birth they are hoping for. The most common objection they have is that they will be able to get all the education they need from their midwife. While midwives do educate their clients to some extent, this perception that they can (or should) cover everything is a myth, for several reasons.

1) Education is not a midwife’s job.

Just as obstetricians are not childbirth educators, neither are midwives. Just because midwives are more likely to do more education than an obstetrician, does not mean they give comprehensive education, and they should not be expected to. That is not their job.

Rather, a midwife’s primary job is to maintain the clinical safety and health of the mother-baby dyad. This will involve some education, yes, but only as a by-product of good midwifery care.

A good midwife will encourage her clients to be active participants in their care by reading, taking classes, and educating themselves proactively, instead of passively relying on the lack of intervention common to home birth. Midwives want clients who are thinking women, who take responsibility for their own care, and who can integrate what they learn in practical ways.

 

2) The reality of transport.

Another downside to relying solely on your midwife for childbirth education is the preparation for hospital transport. Realistically, around 10% of women and babies need something that cannot be offered at a homebirth, for whatever reason. It is not a midwife’s job to prepare you for the hospital.  Her job is to prepare you for birthing safely at home. Therefore, an expert on the hospital system is needed to prepare a birthing woman, in case of a transport. Most midwives spend very little time in the hospital, due to the low transport rate, so their expertise on local practices may be limited.

On the other hand, childbirth educators work very hard to stay up-to-date on all policy changes, protocols, and the general attitude of the staff in local hospitals. They often work (or have worked) as doulas, and have regular opportunities to interact with staff in the local hospitals that midwives simply don’t have. (This is not a criticism, merely a reality.)

While a midwife can go over what a typical transport looks like in her practice, a good childbirth education class will be able to prepare the client for what a hospital birth will look like. She can help the client to understand how to navigate the environment, and teach her how to communicate with the staff effectively.

 

3) The birth tool belt.

Midwives know that most women need a wide array of pain management techniques available to them, since an epidural is not an option at home. While a midwife will teach her clients the importance of stress management, emotional health, and relaxation, there is no substitute for a good independent childbirth course where you can actually practice tried and true techniques from all kinds of sources. This creates a solid foundation of knowledge, provides varying perspectives, and allows the birthing pair time and space to learn or review valuable tools for labor.

 

4) Prenatal appointments can only cover so much.

Even though midwifery appointments are much longer than typical obstetric appointments, it is still a very limited amount of time for a woman to learn all she needs to know about birth. Not to mention the birth partner, who may not be able to attend very many of the appointments. Childbirth education can fill in the gaps, empower a birthing pair, and provide opportunity to practice valid techniques in a real-world environment.

It is never wise to assume that your care provider will simply take care of everything, no matter who they are. Leaving the decision-making and responsibility solely in your midwife’s hands is not fair to her, to you, or to your baby. You owe it to yourself to take a proactive approach to childbirth education.

 



Dad Matters – A doula’s perspective

September 29th, 2013

Many men in our culture are fairly apprehensive about birth. Most have never seen a real birth, or talked about it outside of sex ed. They are often nervous about birth itself, seeing their partner in pain, the what-ifs, and all that may come after. They doubt their ability to support their partner in her journey, and wonder if they’ll be strong enough.

In fact, they often doubt and fear and wonder just as much as their partners do, but are often not allowed to express it, because they’re not the ones giving birth, so they feel that they don’t really matter. They may feel like they don’t have much voice in the process, and are just expected to go along for the ride, smiling and nodding whenever the experts speak.

Yet, at the same time, they are expected to know everything about birth, protect their partner, communicate her wishes, and support her physically and emotionally without pausing for breath.

Many worry that they just can’t live up to all of that. It really is an awful lot to ask of one human being, after all. Especially since history shows us that there have always been many support people surrounding a mother during birth.

Still, many men don’t realize just how much they are capable of. They don’t realize that they matter, too, and that they can enter their partner’s birthing space with confidence, ability, and strength to meet the challenges of supporting a labor and birth.

 

So, how do we help fathers to step into the birthing space with confidence?

 

We free them to be who they are, that’s how. We let go of our expectations, and help them to form their own expectations and desires for supporting the birth of their child. We help them to see that they alone can define their role in the drama and sacredness of birth.

I would suggest two important things that may help a father gain confidence and acquire tools to help him fulfill the role he wants to play during birth: 1) Independent childbirth education classes, and 2) Hiring a doula.

The more a man knows, the less he will fear birth, and taking Childbirth Classes is one of the best ways to lower anyone’s fear level in anticipation of birth. Many men appreciate information given in practical, interactive ways, and independent childbirth classes are often right up his alley. He can join with like-minded dads, ask questions, and have his concerns addressed more readily.

Information is a great, big factor in helping couples manage their stresses and fears regarding birth—as much for the father as it is for the mother. As an educator, at the beginning of a series, I usually see high levels of apprehension, which quickly fade from week to week, to be replaced by realistic expectations and informed confidence in both parents.

This is just as powerful for the father as it is for the mother. When Dad has confidence in Mom’s ability, she believes in herself all the more, and Dad begins to see that he has power to influence her for the better! Dad is able to acclimate himself more readily to the realities of birth, and begins to realize that he is an important part of her support team. Perhaps the most important part.

He feels a little more ready to step into his support role, and probably has clarified what he wants that role to look like. He will feel more confident about what he can do, and more realistic about what he might not be able to do.

 

In which case, he may begin to consider…

 

Hiring a Doula to help him fill in the gap in the support team he might not be able to fill himself. If he participates in choosing and hiring a doula, he is much more likely to have his own expectations met, as well as those of his partner. When Mom and Dad are both fully supported, Dad is far freer to just be and do what his partner needs him to be and do.

While he will likely remember a lot of what he has read and learned about, that information may become secondary to him during the birth, and take a backseat to more immediate concerns in his mind.

He may become simply focused on loving this woman who is birthing his child. And why shouldn’t he? Why should he have to remember every counter pressure technique? Every massage technique, position change, or even the water jug and bendy straw? Why shouldn’t he be the face close to hers, his eyes beaming his love, concern for, and confidence in her?

A doula allows Dad to be front and center in the support role he always wanted to fill for Mom, in whatever way makes the most sense for their individual relationship in this particular moment. If he wants to be the Expert – he ought to be equipped to do that. If he doesn’t, then he needs the space and freedom for that, too. Or anything in between.

When he is free, all his anxieties and apprehensions tend to fall away, and he finds that birth is a challenging, beautiful, amazing space to be in with his partner. He finds that he is strong to meet the challenge, just like she is. Together, they grow in strength and confidence, becoming truly ready to meet this tiny new person they have made.

Doulas help open wide the door, making the birthing space more navigable, understandable, and pleasant for fathers. This, in turn, can only benefit the mother as she is able to rest in the support of her birth team. She no longer feels concern for her partner, because he shows no reason for her to be concerned. She is able to just birth.

Then, we can just step back and watch, as he exceeds all the expectations we have laid on him, and as he steps into Fatherhood in the way that makes the most sense to him and his new family.

Tiffany Miller, CLD, CCCE



Scavenger Hunt Contest

December 3rd, 2012

Preparing for Birth is having an online scavenger hunt to ring in December.

 

You could win this cute pocket diaper.

 

Here is the scavenger hunt:

Answer:

1)      How many births has Desirre Andrews attended?

2)      Name a doula that is working through Preparing For Birth?

3)      How many on average gel capped pills can be made from a placenta?

4)      What breast pump brand does Preparing for Birth have for sale?

 

Answer these and provide a link to the source:  

5)      What is the most common risk of induction?

6)      What is an evidence based reason for induction?

7)      What is the Bishop Score used for?

8)      What are Daniel Berwick’s three principals of patient centered care?

 

Find:

9)      A picture of a child nursing in a funny position.

10)   A picture of artwork that’s at least 100 years old depicting a woman in labor.

 

Bonus Questions:

1)      What is your favorite pregnancy or childbirth related blog?

2)      What is your favorite pregnancy or childbirth related book?

Send your entry to nichole@prepforbirth.com by 9pm Wednesday December 5th.

The winner will be announced Thursday, December 6, 2012, and must be able to pick up the prize in person. Everyone who enters will get a coupon for a free birth or postpartum plan session with one of the doulas from Preparing For Birth.



An unexpected breech cesarean – A mother’s perspective

October 28th, 2012

A guest post on an unexpected breech cesarean from a mother’s perspective. From the heart. Where reality meets birth.

 

My husband and I got married roughly four years ago and wanted a baby. Our plans to conceive a baby was derailed, as I lost my job shortly after we got married. We finally began trying in 2009 and 18 months later we found out that we were expecting. I was excited to finally be pregnant. The doctor confirmed my pregnancy and we got to see our baby for the first time on October 25th, 2010. I had a dream a few nights before our sonogram that we were expecting a baby boy. During my sonogram on December 29th, we found out that we were expecting a baby boy.

 

False Labor Runs

Everything was going smoothly with the pregnancy, despite a few false labor runs. I began having false labor around 35 weeks. My contractions were coming every 5-7 minutes consistently; however, they weren’t changing my cervix. After 2 false labor runs during the middle of the night, my baby decided to wait until his due date to be delivered. A few days before my due date, things took a turn and my birthing plans were tossed out the window.

My doctor ordered an ultrasound on May 24th, the day my baby was due to check on the fluid levels since my fluid levels began dropping off after I reached my due date in a previous pregnancy. The ultrasound tech was checking the fluid levels and they were within the normal ranged. However, she discovered that my baby was now breech. He decided to turn breech over the weekend. All throughout my pregnancy, he was head down. In fact, on the previous Friday when my doctor checked me, he was head down during my exam.

My Dream Birth Was Thrown Out the Window

When the ultrasound technician found his head up in my ribs, I immediately knew that I was going to have to deliver him via c-section. I was devastated that I wasn’t going to have the labor and delivery that I had been planning in my head for months. I wanted to have a natural birth with minimal interventions. My dream labor included: freedom to get up and move around, walk the halls to help progress labor, labor in the bathtub, and less fetal monitoring. These dreams faded away quickly as my doctor scheduled my c-section.

Manual Inversion Was Too Risky

My doctor offered to attempt to manually turn the baby. If she could get him turned manually then she would proceed with inducing labor. However, she explained the risks to me and told me that I had an anterior placenta. She said the risks included: placental detachment, placental tears, and bleeding. These risks scared me to death and I felt that it was best to proceed with a C-Section.

I was so miserable and uncomfortable that I went ahead and had a c-section, but if I had the knowledge that I know now and had the money to hire a doula, I would have paid for one. A doula is a trained and experienced birth coach. They are trained to help support a mother emotionally, physically, and provide information about the choices they have to make in regards to their care. After speaking to a wonderful doula on twitter, I personally feel that I might not have been so quick to agree to a c-section. Desirre told me that there are ways to try and get the baby to turn on its own or even attempt to deliver him breech, since I had previously had successful births. But I didn’t know that when I had to make a decision about my C-Section.

Doulas Can Help Mom’s Who Have C-Sections

Doulas can even be hired for C-section births. They usually don’t participate in the actual surgery but they can provide support during the preparation and during postpartum care. A C-Section wasn’t as bad as I thought it was going to be. The hardest part was the uncontrollable shaking that I experienced as the anesthesia from my spinal block was wearing off. I felt that the spinal anesthesia kept me from enjoying those first moments of breastfeeding my baby.

 

Christy is a wife to her loving husband of 4 years and a mother to three beautiful children – Ages 15, 11, and 15 months old. I am the owner and founder of Uplifting Families. In my spare time, I enjoy blogging, spending time with my family, going to church, and playing games. I can be found on twitter at @upliftingfam



F.E.A.R.

August 30th, 2012

I have been thinking on the F.E.A.R. (False Evidence Appearing Real) acronym.  What else can it mean? Fear itself can be a positive or a negative. Fear can be a stumbling block or a motivator.

I enjoy coming up with affirmations and words that alter the view especially as it relates to pregnancy, childbirth and postpartum. I have been and know so many who have fear thrust upon them by friends, provider, family, strangers or have deep fear from previous experiences or from the unknown lurking ahead.

Take my words, come up with others and make your own acronyms to work with the FEAR surrounding you, inside you and take away its power.

 

F                      E                     A                     R

Feeling, Freedom, Fix, Fire, Fierce, Forge, Find, Fortitude, Frame, Fight, Force, Free, Forever, Forgive, Feel, Fearless

Everything, Exist, Eradicate, Excite, Envelop, Empowered, Encourage, Enhance, Expectation, Effort, Exquisite, Endearing, Encourage, Enhance, Effort, Expectation, Exquisite, Equal, Excel, Expert, Ease, Engage

Admit, And, Am, Advocate, Amplify, Armed, Above, Answer, Awareness, Act, Assist, Attitude, Ally, Appear, Admire, Ask, Alter, Apprehension, Action, Alive

Rest, Respect, Rise, Release, Rage, Rights, Ready, Resonate, Relief, Repair, Rely, Resist, Rejoice, Roar, Risk, Release, Re-frame, Rephrase, Remain

 

Please share additional words you come up with!



EMAB and Doulaparty Team Up

June 22nd, 2012

 

 

Join the #doulaparty on Twitter or follow along at DesirreAndrews.com, June 22nd 6pm PT/9pm ET to kick off summer birth work with something extra special!

 

I am very excited that Earth Mama Angel Baby is sponsoring this weeks live chat. EMAB has amazing products for all types of birth professionals and families.

 

A note from the EMAB Team:

 

Are you a midwife, doula, nurse or obstetrician looking for pure, safe products to comfort postpartum mamas and brand new babies? You’ve come to the right place! Earth Mama Angel Baby offers safe alternatives for your clients who are concerned with detergents, parabens, 1,4-Dioxane, artificial fragrance, dyes, preservatives, emulsifiers and other toxins. Earth Mama products are used in hospitals, even on the most fragile NICU babies, and they all rate a zero on the Skin Deep toxin database, the best rating a product can receive. Earth Mama only uses the highest-quality, certified-organic or organically grown herbs and oils for our teas, bath herbs, gentle handmade soaps, salves, lotions and massage oils.

Earth Mama now offers a Birth Pro Cart for wholesale pricing available for birth support professionals! Join Earth Mama Angel Baby on the #doulaparty chat Friday June 22 to talk about their new shopping cart plus answer any questions you may have. Earth Mama will be giving away Postpartum Bath Herbs and Monthly Comfort Tea, Mama Bottom Balm, Mama Bottom Spray, and a grand prize of their new Travel Birth & Baby Kit!



Doulas and Home Birth

May 29th, 2012

Is there benefit to hiring a doula for a home birth? I say YES absolutely.

As a seasoned doula who has attended home births as labor support and now an  intern midwife who clinically supports the mother, I believe that many women can keenly benefit from a doula when having a home birth.

The most simple reasoning is that the doula is there physically, emotionally and educationally specifically for the mother and family just like at the hospital or a birth center. She (he) is an integral part of the birth team.

  • The doula will likely be laboring with the mother first, providing a continuous care support framework for when the midwifery team arrives.
  • As the midwifery team sets up and prepares the space clinically, the doula is right there maintaining the comfort, peace and encouragement of the mother. Often lessening any disruption that new people in the environment can cause.
  • The doula is there SOLELY for the mother and husband (partner), step by step, eye to eye while the midwifery team is there to first and primarily clinically assess, maintain safety and be unobtrusive as possible.
  • The doula offers guidance and suggestions for position changes, physical/emotional comforts and helping to ensure the mother eats, drinks, voids and rests.
  • The doula gives the husband (partner) the opportunity to rest, have less stress, do the very best he/she can do along with enjoying the process more.
  • A doula can be present specifically to help with the other children.
  • A doula’s presence offers reduction in any interventions and cesarean.
  • A doula’s presence offers increased satisfaction with birth, bonding and breastfeeding……….

Simply put. A doula being present at a home birth is effectively the same as at a hospital or birth center, with the general exceptions that she would have to help a mother and family self advocate or navigate  institutional policies,  protocols and staff.

I again say YES to doulas at home births.

 

 



Social Media and You

October 16th, 2011

Get your pregnancy, birth or postpartum story heard!

I am looking to interview several mothers/families who have been positively changed, supported or impacted emotionally, physically, socially, educationally and/or spiritually during the perinatal (pregnancy, labor, childbirth, postpartum) and/or into the first year of mothering/processing birth outcomes through the use of/participation in social media outlets (Twitter, Facebook, Google+, Forums, Message Boards, etc.).

Purpose: Information will be used to complete a speaking session about birth and social media, as well as, material for additional writing, educational sharing opportunities.

If you are interested, please email me by October 31, 2011 with your contact information, when due if pregnant, how old your baby is if in the postpartum period and how you were affected by social media.

Contact: Desirre Andrews – Owner of Preparing For Birth LLC, birth professional, blogger, mentor, healthy birth advocate and social media enthusiast. Site: www.prepforbirth.com

Email: desirre@prepforbirth.com



Writing Your Own Birth “Plan”

October 16th, 2011

A birth plan has more than one purpose. It begins as a value clarification exercise, then becomes a communication tool with your care provider and ultimately a guide of needs and desires during labor, delivery and postpartum. Even if your birth location does not ask for birth plans, it is a good idea to write one for your own benefit.

Step 1

Clarifying your needs, wants and desires. Here are the  Birth Menu of Options and Assessing Your Feelings we use in class  to begin the value clarification process.  The birth menu is most helpful when you begin by crossing out what you are not interested in, highlighting the items you know you want and circling what you need to research. The AYF worksheet is for you and your husband/partner/non-doula labor support person to go over together to ensure you are on the same page and open up conversation. Doing this prior to 35 weeks of pregnancy gives you more time to coordinate with your care provider or birth location. If you have a doula or are taking a childbirth class, she/he can help you in this part of the process as well.

Step 2

Write down in order of labor, delivery, immediate postpartum and in case of cesarean needs and desires. Your plan really needs to be within one typed page for easy reading and digesting by care provider and staff. The only items that must be listed are care options that are outside of usual practices, protocols or standing orders. Here is the Sample Low Intervention Birth Plan we use to help you see a finished format and types of pertinent information that may be necessary to list.

Step 3

Take your written plan into your care provider. This is a conversation starter, a beginning, a partnering tool. As I encouraged above, early to mid 3rd trimester gives you more flexibility in communicating with your provider and setting your plan in motion. It also gives you opportunity to change providers or birth location if you cannot reach a comfortable agreement.

Step 4

Make any changes.Finalize.  Print out final copy.  Give one to care provider, have one in your bag for labor and birth, give one to doula (if you hired one). Though this is not a binding or legal agreement it can go a long way toward the type of care and birth you want.

Step 5

Gestate peacefully until labor begins!



Tips to finding the right “childbirth” class

October 14th, 2011

If you were my best friend, I would tell you there is not any one-size-fits-all “childbirth” class.  Education can be foundational to informed decision making and better outcomes for both mother and baby.

I encourage you to go about choosing a class series in the same way you would choose a provider or birth location. Do some investigating and even interview the educator.

In the search:

  • Get referrals from:
    •  Women who have had or wanted the type of birth you are desiring
    • From local birth groups or doulas
    • Your provider
  • Do a web search for classes in your area. There may be many offerings of differing methods and philosophies outside and within the hospital setting.
  • If  you are thinking about a hospital sponsored course, find out if it is a comprehensive series or a what happens to women once they get to our hospital class? This is otherwise known as a good patient class.
  • Check out the course website, then call or email the instructor to get a feel for her style and philosophy. Even a hospital based educator should be able to call you back or email you.

Before paying and registering:

  • How long is the series?
    • A comprehensive series is between 12 and 24 hours of instruction and a minimum of  4 class sessions up to 12 class sessions. The condensed express classes of one or two partial days are not designed for good retention or appropriate processing. It IS worth the investment of time.
  • When is the class? Day of week and time of day needs to fit into your lifestyle. Again, I encourage your investment over a period of time versus a one-day class. If you cannot find a fit, consider a private class. It is important to have classes finished by 35 or 36 weeks pregnant.
  • Where is the class held? Classes may be held in like-minded businesses (chiro office, yoga studio, doula office), in home, care provider office, birth center or hospital.
  • What organization is the instructor trained and certified with? Though certification is not required, it can be very important what training and background an educator has. If instructor is certified, check out the organization’s philosophy and beliefs.
  • What does the instructor’s experience involve?
  • What is the instructor’s philosophy and style?
  • What is the cost of the course? Classes can cost anywhere from free through a hospital to a few hundred dollars. It really can be a wide range. Find your comfort level. Though expect to invest in a good class. Free or low cost classes are often not comprehensive in nature.
  • What is the course content? A comprehensive class should include a variety of topics, such as, pregnancy basics,  common terminology, normal physiologic changes, emotional health and connection, exercise, nutrition, prenatal testing, birth plans, informed consent, communication skill building, overview of spontaneous labor and birth, labor milestones with comfort and position strategies, overview of all options in labor and birth, labor partner role,  immediate postpartum, navigating first weeks postpartum, overview of infant feeding, infant norms, medications and interventions, cesarean, unexpected events, role-playing scenarios, relaxation practice and local/online resources. It is usual to expect homework on top of class time as well.
  • What are the birth outcome statistics for class participants? It may be difficult though to get true data whether a philosophy-based or method-based class.
  • What is expected of me as a class participant?
  • What do I need to bring?
  • Who may come with me?
  • Is there a lending library?


Low Intervention Birth Plan

October 9th, 2011

A birth plan has a few real purposes. It can act as a values clarification exercise for you and your partner. Then it is a vehicle to open communication with your care provider about your needs, desires, wants for labor, birth and postpartum.  What you want and need matters.

 A brief one page plan with an opening paragraph with bullet point information specific to individualized care and desires not usually within your care provider’s standing orders or usual protocols of the birth location.

I advise you take the written birth plan to a prenatal visit at least a month prior to your given estimated due date. This gives time for conversation, to have a clear understanding of expectation and agreement.

If it becomes apparent that you and your provider are not on the same page, you then have time to seek out another provider that fits you and you fit with.

Remember it is not a legal document that your location of delivery or care provider must adhere to.

=======================================================

Birth Needs and Desires for: _______________________. 

Care Provider:_________________.

Estimated Due Date: _________________.

I am planning on a no to low-intervention labor and delivery.  I plan on being mobile, lightly snacking, drinking orally, and having ___________ present.   I understand that intermittent monitoring of me and my baby will be necessary.  I want to be fully consented for any procedure that may come up and fully participate in the medical care for myself and my baby.  I understand that there is pain management available to me, I will ask for it if I so desire.

  • I plan on wearing my own clothing. I will ask for a gown if I change my mind.
  • I would like a saline lock in lieu of a running IV.
  • Limited vaginal exams after initial assessment.
  • In the event an induction and/or augmentation is medically necessitated-
    • Ripening – Foley Catheter instead of Cytotec (misoprostol), Cervadil or Prepadil
    • Pitocin – A very gentle and slowly administered dosage increase.
    • AROM – will only consent to if an internal fetal monitor is a must.
  • Spontaneous pushing and delivery in any position I am most comfortable with.
  • External pressure and/or compresses instead of any perineal or vaginal stretching.
  • No cord traction or aggressive placental detachment, including deep uterine massage.
  • Delayed cord clamping for at least 10 minutes or until my placenta spontaneously detaches (baby can receive oxygen or other assistance while still attached to me).

Postpartum and Baby Care

  • Request that my baby is on my belly or chest for assessments and warmth (even oxygen can be given on me)
  • Delayed bathing
  • Delaying vaccinations including eye ointment and vitamin k.
  • Exclusive breastfeeding, no pacifiers, sugar water, or formula. I will hand express if necessary. I will hand express if needed to syringe feed my baby.
  • No separation from me unless absolutely medically necessary not just protocol.

Cesarean: In the event a cesarean becomes necessary and is not a true emergency requiring general anesthesia.  I would like to keep the spirit of my plan A to plan C so the delivery can be as family centered and intimate as possible.

  • Only essential conversation related to the surgery and delivery
  • Lower sterile drape or have a mirror present so I may see my baby emerge
  • Only one arm strapped down so I may touch my baby
  • Pictures
  • Aromatherapy as I desire for comfort, abate nausea and to mask surgical odors
  • Baby to stay with me continuously in OR and recovery
  • If baby must leave OR for treatment, my partner/spouse goes with baby and I would like my ____________ to stay with me so I am never alone.
  • Breastfeed in OR and/or recovery
  • Delayed immunizations
  • Delayed washing and dressing of baby
  • No separation from me except what is absolutely medically necessary
  • I am willing to hand express if baby cannot get to breast right away.

This “plan” may be copied, pasted and edited  for use by others.



Interviewing Your Home Birth Midwife

September 22nd, 2011

Interview Questions

  •  Why are you a midwife?
  •  What is your training? Are you certified? If yes, with whom and why? If no, why not?
  •  Are you licensed in the state of _____?
  •  What is your scope of practice?
  •  Are there any circumstances (physical, emotional, and/or spiritual) would you not take a woman as a patient?
  •  When would you risk out a patient?
  •  What is your style of practice (laid back, hands on, managing)?
  •  How much time will be spent with me during each appointment? Do you come to my home or do I come to your office?
  •  At what intervals will you see me during pregnancy?
  •  What can I expect at a prenatal visit?
  •  What routine tests are utilized during pregnancy? What if I decline these tests?
  •  What herbs or supplements do you like your patients taking during pregnancy?
  • At what point in labor do you normally arrive?
  • What positions are you comfortable catching in? Birth stool? Hand/Knees? Squatting? Standing? Water?
  • What does your cord clamping protocol look like?
  •  What do you do in the event a complication arises during labor or birth?
  • When would you transfer a patient?
  • What percentage of your patients do you transfer to the hospital? Cesarean rate?
  •  How are post-dates (post-42 weeks) handled in your practice?
  •  Do you ever encourage induction by pharmaceutical, herbal, AROM or other natural means? If yes, please describe.
  • What does postpartum care look like for me and my baby?
  • Do you have a midwifery student or an assistant that attends births with you? If so, what is her role?
  •  Who would attend me if you are ill, had an emergency or are at another birth?
  •  Briefly please describe the types of births you are most and least experienced with.
  • What if I hire a doula? Are there restrictions on the doula I may hire? If yes, why? What is your perception of the role of a doula at a home birth?
  • Do you have a back-up physician?
  • What do your fees cover?
  • Do you take any insurances?
  • Should I take childbirth education classes? Do you recommend any? What do you cover?

Points to ponder afterward:

  • Did you feel immediately comfortable and heard at the interview?
  • Was MW willing to answer questions in detail without being annoyed?
  • Are you comfortable with her scope of practice?
  • Are her expectations of you reasonable?
  • Are your expectations of her reasonable?
  • Are you able to take full responsibility for your decisions with this midwife?

All Rights Reserved Desirre Andrews Preparing For Birth 2011



Could this be labor?

September 21st, 2011

For first time mamas, previously induced mamas or those who have loads of prodromal labor, getting a handle on the nuances of when labor is going to start or if it is lasting labor can be really confusing. There is no way to know exactly when labor is going to start, but there are many things to look out for that can give clues and signs that onset of  labor is sooner rather than later.

Here are my favorite categories to look at and simple ways to decipher what is going on with your body at the end of pregnancy.

Remember to take a look at the whole puzzle picture not just one piece.

  • Vaginal Discharge:
    • Loss of mucous plug (after 38 weeks);
    • Steady mucousy output;
    • Thin and watery mucous;
    • Blood tinged – similar to the beginning or very end of a menstrual period. This means there is effacement and ripening of the cervix going on and even a bit of dilation happening.
  • Contraction Characteristics:
    • Longer and more intense contractions that most often find a pattern;
    • They do not stop or even increase with activity change;
    • Sudden increase or onset of regular Braxton-Hicks;
    • Low period crampiness, pelvic heaviness, off and on backache, thigh achiness.
  • Other symptoms
    • Increased nesting;
    • Insomnia or excessive tiredness;
    •  Flu-like symptoms;
    • Intuition/Instinct;
    • Loose bowels;
    • Weight Loss in the last week.
  • Testing out contractions for possible labor:
    • Change activity level – if resting get up and move, if moving sit down and rest;
    • Drink a large glass of water;
    •  Eat a snack, preferably higher protein;
    • Take a bath or shower.

After doing these things if contractions continue and increase in intensity over another hour or so likely labor is becoming established. Congratulation! As always, contact your care provider at the agreed upon time.



A Guide to Finding Your Doula

August 2nd, 2011

Building a labor support team is part of conscious preparation during pregnancy for your labor,  birth and life with the very newborn. Hiring a labor doula continues to gain in popularity for the expecting family. Your doula comes alongside you in pregnancy through labor and delivery with some additional early postpartum follow-up.  For additional after birth support, a postpartum doula is a great addition.

Step 1: Finding a Doula

  • Inquire with friends, family, local support/informational groups (for example – ICAN, LLLI, Birth Network, Birth Circle, Cloth Diaper store), childbirth educators, care providers, prenatal massage therapists, prenatal exercise instructors, lactation experts and chiropractors for referrals.
  • Use your favorite search engine and type in your city or area name with the keyword doula
  • Search training and certifying organizations such as CAPPA, DONA, ICEA ToLabor , Birth Works and Birth Arts International
  • Search general doula sites such as All Doulas, Doulas.com, About.com, Doula Match or Doula.com

Step 2: First Contact

Once you have located local area doulas, the next step is  to make contact. You will likely find that most doulas are women though occasionally you will find a male doula in your area.  After visiting any websites; phone or email only the doulas that most interest you and fit your particular needs.  Generally there is not much need to contact more than three perspective doulas.

During your initial phone conversation or in your email be sure to include:

  • Full name
  • Contact information
  • Estimated Due Date
  • General location where you live
  • Care Provider
  • Birth Location
  • Top needs and desires for birth
  • If referred, by whom
  • Any financial considerations

Step 3:  Setting up the Interview

I encourage after the phone or email contact and response, set-up in-person interviews with the doulas you found most compatible with you.

  • Unless the doula you are meeting has her own office, interviews are usually held in a public place such as a coffee house, restaurant, library, park, or shopping center. If you meet at a place where beverages or food will be ordered you can offer to pick up the tab for everyone if you desire, but it is never expected.
  • Your partner, husband or other support who will be attending the birth needs to be at in-person interview if at all possible.
  • Expect the interview to be approximately an hour and to be free of charge.

Step 4: The Interview

The interview is to gain more detailed information from the doula, as well as, share more  about yourself and what you want.  It is customary for the doula to either email ahead of time her client packet or bring it with her to the interview. It may include her professional profile, client agreement, services, and support details, as well as, additional offerings.

Suggested Interview Questions:

  • Why are you a doula?
  • What is your philosophy of childbirth?
  • Where did you get your training?
  • Are you certified? Why or why not?
  • How long have you been a doula?
  • What is your scope of practice?
  • What types of births have you participated in?
  • What types of birth locations have you been to?
  • How many births per month on average do you attend?
  • How many clients would max you out in a month?
  • Have you ever missed a birth? Please explain why.
  • Do you specialize in working with a specific type of clientele or birth plan?
  • What has been the most challenging birth you have attended? Why?
  • How do you work with my husband/partner/other support?
  • Have you worked with my provider before? If yes, please describe the experience.
  • How many prenatal visits would there be?
  • In general, what is covered in the prenatal visits?
  • Will you help me make a birth plan?
  • Please explain how your fee is structured.
  • Do you accept barter?
  • Do you have a back-up and do I meet her ahead of time?
  • When do you go on-call?
  • Do you labor at home with me?
  • What do you do if I am induced or need to schedule a cesarean?
  • When will you see me postpartum and what does it include?
  • What are your expectations of me as a client?
  • How long do I have to decide before you would contract with someone else around my EDD?

Of course that is a fairly long list of overview questions. Brainstorm some of your own. The interview is not meant to be a free prenatal visit, it is simply to find out if you and the doula are a fit personality wise and in how she practices.  Most doulas do not expect to be hired on the spot. You  need time to think and process after each interview. If a doula is pressuring you to hire on the spot because she fills so quickly, that could be a red flag and cause for you to take a pause.

Step 5: Hiring the Doula

Within 1-2 weeks,  contact the doula you would like to hire and proceed and those you did not choose to let them know you have hired someone else so they will not be holding your EDD space open any longer.

Details to be clear about when initially hiring your doula:

  • Sign and return the agreement/contract she gave you at the interview (if applicable).
  • Return any intake paperwork by mail or email.
  • Payment  – First portion of fee is usually paid upon hiring a doula.
  • Ask her usual business hours and contact preference for non-emergencies or labor related needs.
  • Let her know your contact preferences and all phone numbers to reach you and your spouse/partner or other support.
  • Set the date and time for the first prenatal appointment. Give her directions if your home is not easy to find.
  • Get clarity on what routine contact she would like from you (updates after care provider appointments, etc.)

Happy doula-ing!



Picking Your Care Provider – Interview Questions

July 28th, 2011

Being an active participant in your pregnancy and birth journey begins with choosing your provider. You can begin the search for the right provider fit prior to becoming pregnant, in early pregnancy or anytime before your baby is born. So much of how your pregnancy and birth unfold are directly related to your care provider so this is really a key element. Every provider is not the right fit for every mother and vice verse. If you already have an established provider relationship, these questions can be used as a re-interview tool.

When asking these questions, take care to really listen to the answers. If a provider will not meet with you prior to you becoming a patient, that can be a red flag.

______________________________________________________________________

Begin by expressing your overall idea of what your best pregnancy, labor and birth looks like to provider.

  • What are your core beliefs, training, experience surrounding pregnancy and birth?
  • Why did you choose this line of work?
  • What sets you apart from other maternity providers?
  • How can you help me attain my vision for pregnancy, labor and birth?
  • If I have a question, will you answer over the phone, by email or other avenue outside of prenatal appointments?
  • How much time will you spend with me during each appointment?
  • What routine tests are utilized during pregnancy? What if I decline these tests?
  • What is the average birth experience of first time mothers in your practice?
  • How do you approach the due date? What do you consider full term and when would I be considered overdue?
  • What are your patient intervention rates? (IV, AROM, continuous monitoring, episiotomy, etc.) Cesarean rate? VBAC rate? Induction rate? What induction methods are used? When are forceps/vacuum used? These numbers are tracked.
  • What positions are you comfortable catching in? Birth stool? Hand/Knees? Squatting? Standing? Water? How often do patients deliver in positions other than reclined or McRoberts positions?
  • How do you feel about me having a birth plan?
  • What if I hire a doula? Do you have an interest in who I work with or restrictions? If yes, why?
  • Do you have an opinion on the type of childbirth or breastfeeding class I take? If so, what and why?
  • Are you part of on call rotation or do you attend your own  overall? Will the back-up or on-call CP honor the requests we have agreed on?
  • Are there any protocols that are non-negotiable? If you cannot refuse – you are not consenting.
  • What if I choose to decline a recommended procedure or intervention in labor or post birth, how will that be viewed?
  • When will I see you during labor?
  • What postpartum care or support do you offer?
  • Will I be able to get questions answered or be seen before the 6 week postpartum visit?

Points to ponder afterward:

  • Did you feel immediately comfortable and respected at the interview? If already with a CP, do you feel comfortable, respected and heard at each appointment?
  • Were there red flags or white flags?
  • Was or is care provider willing to answer questions in detail without being annoyed?
  • Is choosing your care provider based on your insurance or lack of insurance?
  • What are you willing to do in order to have the birth you really desire? Birth location?
  • How much responsibility are you willing to take for the health care decisions for you and your baby?


Blessing the Mother…..

July 14th, 2011

Blessing the mother ease the period at the end of pregnancy and ease the transition into postpartum.

Ideas that bless before and after birth:

  • Freezer Meals
  • Organizing Fresh Meals for end of pregnancy through first month post birth.
  • Buy baby wearing gear for her.
  • Organize a Blessingway
  • Write down encouraging and affirming words in a beautiful card.
  • Listen to her.
  • Buy her a baby wearing, cloth diapering, breastfeeding class, etc. to her desires as a surprise.
  • Organize housecleaning party for end of pregnancy and once or twice postpartum.
  • If she has other children, have them over to give her a rest.
  • Donate toward her doula, midwife or doctor.
  • When she is postpartum, visit her and prepare a variety of snacks so she is never without food.
  • Offer to run errands after the baby is born.
  • Offer to give her time to shower.
  • Buy her a reusable water bottle so she drinks enough fluids.
  • Give her permission to phone you during odd hours after the birth if she needs support, advice.
  • Offer to dog sit or take care of any pets as needed after the birth.
  • Check in on her about 3 weeks after birth to see how she is doing emotionally and physically.

What other ideas do you have to add? Please leave me a comment.



What’s in the job?

July 6th, 2011

 

 

 

 

I wonder if most of us really know what the scopes of practice are for the providers we may choose  for pregnancy, birth, postpartum, and for the baby.  Keep reading to see if you really know what the jobs encompass.

As you go through the list I would like you to think about the language used, descriptors, and purpose of each type of provider. When we are approaching health care decisions especially who will care for us from pregnancy through birth, postpartum and for our babies, we need to make sure we are choosing the appropriate care for our individual needs and situation.

If anything strikes you or you would like me to add any provider types, please leave me a comment!

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OBSTETRICS AND GYNECOLOGY (OB/GYN)

Obstetrics and gynecology is a discipline dedicated to the broad, integrated medical and surgical care of women’s health throughout their lifespan. The combined discipline of obstetrics and gynecology requires extensive study and understanding of reproductive physiology, including the physiologic, social, cultural, environmental and genetic factors that influence disease in women. This study and understanding of the reproductive physiology of women gives obstetricians and gynecologists a unique perspective in addressing gender-specific health care issues.

Preventive counseling and health education are essential and integral parts of the practice of obstetricians and gynecologists as they advance the individual and community-based health of women of all ages.

Obstetricians and gynecologists may choose a scope of practice ranging from primary ambulatory health care to concentration in a focused area of specialization.   – from ACOG

Certified Nurse-Midwife

Midwifery as practiced by Certified Nurse-Midwives (CNMs) and Certified Midwives (CMs) encompasses primary care for women across the lifespan from adolescence beyond menopause, with a special emphasis on pregnancy, childbirth, and gynecologic and reproductive health. Midwives perform comprehensive physical exams, prescribe medications including contraceptive methods, order laboratory and other diagnostic tests, and provide health and wellness education and counseling. The scope of practice for CNMs and CMs also includes treatment of male partners for sexually transmitted infections, and care of the normal newborn during the first 28 days of life. -from ACNM

Certified Professional Midwife

Based on the MANA Core Competencies, the guiding principles of the practice of CPMs are to work with women to promote a healthy pregnancy, and provide education to help her make informed decisions about her own care. In partnership with their clients they carefully monitor the progress of the pregnancy, labor, birth, and postpartum period and recommend appropriate management if complications arise, collaborating with other health care providers when necessary. The key elements of this education, monitoring, and decision making process are based onEvidenced-Based Practice and Informed Consent. – from MANA

Direct Entry Midwife (including Licensed Midwife)

  • Not required to be nurses.
  • Multiple routes of education (apprenticeship, workshops, formal classes or programs, etc., usually a combination).
  • May or may not have a college degree.
  • May or may not be certified by a state or national organization.
  • Legal status varies according to state.
  • Licensed or regulated in 21 states.
  • In most states licensed midwives are not required to have any practice agreement with a doctor.
  • Educational background requirements and licensing requirements vary by state.
  • By and large maintain autonomous practices outside of institutions.
  • Train and practice most often in home or out-of-hospital birth center settings.

To learn more detail about all types of midwives go to Citizens For Midwifery

Nurse Practitioner

Nurse practitioners (NPs) are registered nurses who are prepared, through advanced education and clinical training, to provide a wide range of preventive and acute health care services to individuals of all ages. Today, NPs complete graduate-level education preparation that leads to a master’s degree. NPs take health histories and provide complete physical examinations; diagnose and treat many common acute and chronic problems; interpret laboratory results and X-rays; prescribe and manage medications and other therapies; provide health teaching and supportive counseling with an emphasis on prevention of illness and health maintenance; and refer patients to other health professionals as needed.

NPs are authorized to practice across the nation and have prescriptive privileges, of varying degrees, in 49 states. Nurse practitioners perform services as authorized by a state’s nurse practice act.  These nurse practice acts vary state-to-state, with some states having independent practice for NPs (not requiring any physician involvement), some with collaborative agreement required with a physician. -from ACNP

Family Practitioner

AAFP defines a family physician as, “a physician who is educated and trained in family medicine–a broadly encompassing medical specialty.”

Family physicians possess unique attitudes, skills, and knowledge which qualify them to provide continuing and comprehensive medical care, health maintenance and preventive services to each member of the family regardless of sex, age, or type of problem, be it biological, behavioral, or social. These specialists, because of their background and interactions with the family, are best qualified to serve as each patient’s advocate in all health-related matters, including the appropriate use of consultants, health services, and community resources. – from AAFP

Labor Doula

The labor doula assists the woman and her family before, during, and after birth by providing emotional, physical, and informational support. It is not within the labor doula’s scope of practice to offer medical advice or perform any medical or clinical procedure.

During pregnancy, the labor doula’s role is to assist families in preparing a birth plan, to provide information about birth options and resources, and to provide emotional support.

During labor and birth, the labor doula facilitates communication between the family and the caregivers. She supports the mother and her partner with the use of physical, emotional, and informational support.

During the postpartum period, the doula assists the mother in talking through her birth experience, answering questions about newborn care and breastfeeding within our scope of practice, and referring the family to appropriate resources as needed. – from CAPPA

Postpartum Doula

The postpartum doula provides informational and educational information to the family. Medical advice is not given; referrals to appropriate studies and published books are within the postpartum doula’s scope. The postpartum doula will determine ahead of time what duties she feels comfortable with performing for the postpartum family and she will share this information with the family prior to accepting a position with them.

CAPPA members do not perform clinical or medical care on mother or baby such as taking blood pressure or temperature, vaginal exams or postpartum clinical care. CAPPA standards and certification apply to emotional, physical and informational support only. CAPPA members who are also health care professionals may provide these services within the scope and standard of their professions but only after making it clear that they are not functioning as a labor doula, postpartum doula, or childbirth educator at the time of the care. For needs beyond the scope of the postpartum doula’s expertise, referrals are made to the appropriate resources.

CAPPA strongly recommends that members do not drive mother or baby unless there is a life-threatening emergency and an ambulance could not get to the family quick enough. – from CAPPA

Lactation Educator

Lactation educators fill an important function in educating and supporting families interested in learning about breastfeeding. This education may take place in the public, hospital, clinical or private setting. Lactation educators provide informational, emotional and practical support of breastfeeding. They may provide this service exclusively as breastfeeding educators, or may use their training to augment their support in other professions, in the cases of doulas, childbirth educators, nurses, dieticians, and postnatal or parenting educators. In addition to providing breastfeeding information, lactation educators offer encouragement, companionship, an experienced point of view, and foster confidence and a commitment to breastfeeding.

Breastfeeding education is not restricted to new families, but applies to the general public and medical staff as well. Due to the limited breastfeeding information given in standard medical and nursing training, and the rampant misinformation about breastfeeding that is so prevalent in our society, the breastfeeding educator serves as a resource for accurate, evidence-based information to the public and health care providers, as well as to childbearing families.

CAPPA does not issue Certified Lactation Consultant status, nor does the lactation educator program qualify a member to dispense medical advice, diagnose or prescribe medication. However, lactation educators provide a wealth of information about how and why to breastfeed; establishing a breastfeeding-friendly environment; basic breastfeeding anatomy and physiology; the normal process of lactation; deviations from normal; physical, emotional and sociological barriers to breastfeeding; overcoming challenges; and resources available (including medical referrals) for the breastfeeding family. They can also be a source of vital support, guidance and encouragement throughout the duration of breastfeeding. -from CAPPA

IBCLC (Lactation Consultant)

International Board Certified Lactation Consultants (IBCLCs) have demonstrated specialized knowledge and clinical expertise in breastfeeding and human lactation and are certified by the International Board of Lactation Consultant Examiners (IBLCE).

This Scope of Practice encompasses the activities for which IBCLCs are educated and in which they are authorized to engage. The aim of this Scope of Practice is to protect the public by ensuring that all IBCLCs provide safe, competent and evidence-based care. As this is an international credential, this Scope of Practice is applicable in any country or setting where IBCLCs practice.

IBCLCs have the duty to uphold the standards of the IBCLC profession by:
• working within the framework defined by the IBLCE Code of Ethics, the Clinical Competencies for IBCLC Practice, and the International Lactation Consultant Association (ILCA) Standards of Practice for IBCLCs
• integrating knowledge and evidence when providing care for breastfeeding families from the disciplines defined in the IBLCE Exam Blueprint
• working within the legal framework of the respective geopolitical regions or settings
• maintaining knowledge and skills through regular continuing education

IBCLCs have the duty to protect, promote and support breastfeeding by:
• educating women, families, health professionals and the community about breastfeeding and human lactation
• facilitating the development of policies which protect, promote and support breastfeeding
• acting as an advocate for breastfeeding as the child-feeding norm
• providing holistic, evidence-based breastfeeding support and care, from preconception to weaning, for women and their families
• using principles of adult education when teaching clients, health care providers and others in the community
• complying with the International Code of Marketing of Breast-milk Substitutes and subsequent relevant World Health Assembly resolution -from IBCLE

Pediatrician

A pediatrician is a child’s physician who provides:

  • preventive health maintenance for healthy children.
  • medical care for children who are acutely or chronically ill.

Pediatricians manage the physical, mental, and emotional well-being of their patients, in every stage of development — in good health or in illness.

Generally, pediatricians focus on babies, children, adolescents, and young adults from birth to age 21 years to:

  • reduce infant and child mortality
  • control infectious disease
  • foster healthy lifestyles
  • ease the difficulties of children and adolescents with chronic conditions

Click here for more information about the Physicians and Staff at the University of Maryland Children’s Hospital.

Pediatricians diagnose and treat:

  • infections
  • injuries
  • genetic defects
  • malignancies
  • organic diseases and dysfunctions

But, pediatricians are concerned with more than physical well-being. They also are involved with the prevention, early detection, and management of other problems that affect children and adolescents, including:

  • behavioral difficulties
  • developmental disorders
  • functional problems
  • social stresses
  • depression or anxiety disorders

Pediatrics is a collaborative specialty — pediatricians work with other medical specialists and healthcare professionals to provide for the health and emotional needs of children. – from UMM (I could find no concise scope of practice definition on the AAP website but here is their Scope of Practice Issues in the Delivery of Pediatric Health Care)

Doctors of Chiropractic

Defining Chiropractic Scope

Since human function is neurologically integrated, Doctors of Chiropractic evaluate and facilitate biomechanical and neuro-biological function and integrity through the use of appropriate conservative, diagnostic and chiropractic care procedures.

Therefore, direct access chiropractic care is integral to everyone’s health care regimen.

Defining Chiropractic Practice

A. DIAGNOSTIC

Doctors of Chiropractic, as primary contact health care providers, employ the education, knowledge, diagnostic skill, and clinical judgment necessary to determine appropriate chiropractic care and management.

Doctors of Chiropractic have access to diagnostic procedures and /or referral resources as required.

B. CASE MANAGEMENT

Doctors of Chiropractic establish a doctor/patient relationship and utilize adjustive and other clinical procedures unique to the chiropractic discipline. Doctors of Chiropractic may also use other conservative patient care procedures, and, when appropriate, collaborate with and/or refer to other health care providers.

C. HEALTH PROMOTION

Doctors of Chiropractic advise and educate patients and communities in structural and spinal hygiene and healthful living practices.

-from ACC

 



A Cesarean Plan

July 6th, 2011

Cesarean is often the last thing we want to think about during pregnancy. Most of us think it will not happen to us. Having a plan, an idea of what to ask for, to know there are ways to bridge the gap between Plan A and Plan C can be very beneficial to both mother and baby.

There is no way to make a cesarean just like a healthy vaginal birth, and frankly, that ought not be the goal. It can be however a much more family centered, family bonded, more respectful and humane experience.

Speak to your provider ahead of time about needs and desires. If you know you are having a cesarean ahead of time, meeting with the Nurse Manager and the anesthesiology department can be useful in obtaining what you want. Have the conversations, create partnerships.

Below is my latest version of a family centered cesarean plan  that can be used for a planned or unplanned cesarean delivery. All requests may not be feasible in all areas, but even small changes can be helpful.

It may be copied and pasted into your own document for personalization, however I do ask that you credit the source if you are an educator, doula or related professional using it as a sample.

——————————————————————————————————————————-

Name: Jane Doe

Estimated Due Date: January 1, 20XX

Care Provider: XXXXXX

We are seeking to make a cesarean delivery as special, low stress and family centered as possible.In the event a true emergency and general anesthesia is needed, I understand that some of my requests cannot be honored.

JUST PRIOR TO/DURING DELIVERY / RECOVERY –

  • I would like to meet each staff member in the OR by name who will be participating in the cesarean.
  • I may ask my _________ for aromatherapy to help with nausea, surgical smells and stress.
  • I ask that only essential conversation be allowed.
  • I would like to play ______ music in the OR if it won’t be a distraction to those performing surgery.
  • I would like my ______________ to take photos and/or video of the birth of my baby.  I respect that the surgeon and anesthesiologist may not want the entire surgery on video, however I would like a record of my baby being born to make it as special and personal as possible.
  • Explain all medications that will be used to me. I prefer a bolus and oral medications versus a PCA afterward.
  • Please lower the drape so I may view my baby coming out of me and hold my baby up so I can see him/her at the moment of birth.
  • Request my arms not be strapped down so I may touch my baby freely.
  • I would like my baby to remain connected to the placenta after manual extraction, as the cord will continue to pulsate for some time. I would like my ___________ to cut the cord after 10 minutes post delivery or the cord has stopped pulsating near the umbilicus.
  • I would like my baby placed skin to skin on my chest immediately with basic assessments being done while on me. My husband (partner/family member can hold baby there with a warm blanket over my baby and help maintain the sterile field.
  • I would like to breastfeed in the OR or as soon as possible in recovery.
  • I would like for my ________________ and baby to stay in the OR with me while surgery is completed and remain in recovery with me.
  • If the baby needs medical assistance requiring leaving the OR, I’d like for another person (doula, friend or family member) to attend me in the OR while my ___________________ goes with the baby, so my baby nor I will have to be alone.
  • In the event baby needs to leave the OR, I would like the wipe down towel(s) to be placed against my chest skin and baby to be pressed on me for fluid and odor transfer.
  • Asking for a delay in eye ointment and Vitamin K until after the first hour of bonding time or I am waiving all immunizations and eye ointment.
  • In the event of a hysterectomy, please do not remove my ovaries or anything else that is not medically necessary

REGARDING BABY

  • In the event the baby requires medical attention beyond that of a healthy baby, please inform me (husband/partner/family member) verbally what is needed or will be needed so I can actively participate in choices made for my baby’s care.
  • In the event of  a need for separation of my baby from me:
    • Limit the number of persons who touch or attend my baby to only those on staff as needed and my _____________.
    • Request my baby not be bathed or fully dressed until I have the opportunity to smell, touch, cuddle, etc. with my baby and I am able to participate in the bathing.
    • I plan to breastfeed exclusively, so no pacifier, formula, sugar water should be given to my baby.
  • No tests shall be performed or medications administered, etc. without my ________________ consent & prior knowledge

Thank you for honoring my requests for me and my baby.

Preparing For Birth, LLC

All Rights Reserved 2011



Lactation Training Colorado Springs – Register now.

May 5th, 2011

Transform your understanding about what breastfeeding/breastmilk really is:

• An irreplaceable relationship
• A brain developer

• An immune system
• An organ system
• A living tissue

Transform your professional skills

• Increase your doula competencies in the first hours after birth
• Hone your postpartum doula skills
• Learn unique strategies for teaching breastfeeding to families
• Explore adult learning styles
• Enhance your communication skills

Transform yourself

• Take the leap to explore new ways to work with families
• Connect with other women who love working with moms and babies
• Open your mind about new concepts surrounding breastfeeding
• Take the first step to becoming certified as a lactation
educator with CAPPA

Concepts covered over the three days include: Lactation Professionals, History
of Breastfeeding, Group Process, Learning Styles, Anatomy and Physiology of
Breastfeeding, The Importance of Breastmilk and Breastfeeding, Prenatal Support
and Breastfeeding issues, Birth’s Impact on Breastfeeding, the Hospital
Experience, Latch and the Breast Crawl, Skin To Skin, Signs of Successful
Feeding, Maternal and Infant Challenges, Medications and Breastmilk, Fathers and
Partners, and Curriculum Development.

LAST DAYS TO REGISTER!!!! Must register before 5pm, May 9th MST.

June 3-5, 2011, 8:30am-5:30pm, $425

Colorado Springs, CO at Prep for Birth

To register www.motherjourney.com

Ready to become more proficient when offering breastfeeding education? This
course is designed to improve the skill base, knowledge and perspectives on
breastfeeding and supporting both the Baby Friendly Hospital Initiative and
Mother Friendly practices.

This course satisfies the following:

*The Core Competencies in Breastfeeding Care and Services for All Health
Professionals as outlined by the United States Breastfeeding Committee (no
endorsement by the USBC is implied).

http://www.usbreastfeeding.org/Portals/0/Publications/Core-Competencies-2010-rev.pdf

*The 20 Hour World Health Organization Curriculum to support the baby Friendly
Hospital Initiative.

http://www.who.int/nutrition/topics/bfhi/en/index.html

*The CAPPA Lactation Educator certification step for workshop attendance.

http://www.cappa.net/get-certified.php?lactation-educator

Why become a certified lactation educator?

Certified Lactation Educators (CLEs) provide evidence based information to the
community, families and professionals to encourage an increase in breastfeeding
initiation, duration and support. CLEs are found teaching community and hospital
based breastfeeding classes, as peer breastfeeding counselors in hospital and
public health setting, facilitation support groups, running pump rental stations
and providing phone support.

The CAPPA CLE does not prescribe, treat, nor diagnose breastfeeding related
conditions and is trained to refer clients facing circumstances that require
this degree of intervention to a qualified professional. The CAPPA 20 Hour CLE
course is not an IBCLC exam prep course, nor does the CAPPA CLE training prepare
a student to become an IBCLC.

Your faculty:

Laurel Wilson, BS, IBCLC, CCCE, CLE, CLD, CPPFE, CPPI owns and manages
MotherJourney in Centennial, Colorado. She has her degree in Maternal and Child
Health-Lactation Consulting. With over sixteen years experience working with
women in the childbearing year, Laurel takes a creative approach to working with
the pregnant family. So is co-author of forthcoming book, The Greatest
Pregnancy Ever: The Keys to the MotherBaby Connection. Using journaling, birth
art, visualization and experiential exercises, women connect with their inner
resources to discover their true beliefs about themselves, their relationships,
and their abilities to birth and parent their children.

Laurel is certified as a lactation consultant/counselor and educator, childbirth
educator, labor doula, Prenatal Parenting Instructor, and Pre and Postpartum
fitness educator and prenatal yoga teacher. She serves as the CAPPA Executive
Director of Lactation Programs and trains Childbirth Educators and Lactation
Educators for CAPPA certification. Offering education and movement classes to
families in private and hospital settings, Laurel has created teaching
strategies that facilitate better understanding of the change processes during
the childbearing year. Laurel has been joyfully married to her husband for
almost 20 years and has two beautiful teenagers, whose difficult births led her
on a path towards helping emerging families create positive experiences. She
believes that the journey towards and into motherhood is a life changing rite of
passage that should be deeply honored and celebrated.

In light,
Laurel Wilson, BS, IBCLC, CLE, CCCE, CLD
Co-Author of forthcoming book, The Greatest Pregnancy Ever: The Keys to The
Mother-Baby Bond
MotherJourney Childbirth Services
CAPPA Executive Director and Faculty for Lactation Programs
Customer Advocate for InJoy Birth and Parenting
linfinitee@aol.com, www.motherjourney.com
720-291-9115

Connect with CAPPA:

Our website

On Facebook



Postpartum Preparation

April 19th, 2011

Planning and preparation toward the postpartum period is very important.  Sometimes it is even more important than pregnancy and birth preparation due to circumstance or birth outcome.  Too often labor, delivery and perhaps the “stuff” that goes with having a baby take priority, while the incredible change that occurs with having a new baby is seemingly ignored.

Below is a listing of important information to think about, investigate, understand and/or plan for.  Make a note of people in your immediate life that can be a resource as you go through the list.

Look carefully at class descriptions you may take in your local area, some are very thorough and others may only be introductory or without valuable content.

Here’s to postpartum preparedness!

Common Physical Changes and Needs for the Mother (first days or weeks)

  • Uterine involution, after pains and bleeding
  • Breast expectations and breastfeeding norms
  • Hormones and symptoms
  • Healing – Vaginal tears, episiotomy, cesarean, perineal soreness or swelling, hemorrhoids
  • Nutrition
  • Night sweats or urination
  • Fatigue

Common Psychological Changes

  • Mother and Father/Partner Changes
  • Processing the birth experience
  • Processing becoming a family
  • Postpartum mood disorders
  • Peer and professional support resources

Understanding Your New Baby

  • Babymoon
  • How baby’s feed
  • Attachment
  • Infant development
  • Normal sleep patterns
  • High, average or low need baby’s

New Family Dynamic

  • Coping with sleep deprivation and exhaustion
  • Managing stress
  • Grieving the changes
  • Siblings and pets
  • Knowing how to get the right support
  • Postpartum doulas and practical support

Making Your Best Decisions

  • Defining Parental Roles – Financial, Baby Care, Changing the Status Quo
  • Choosing a health care provider for your baby
  • Early Infant Health Care Decisions – Vaccinations, Circumcision, etc.
  • Parenting philosophies
  • Developing your parenting style
  • Where baby will sleep
  • Boundaries with family and friends
  • When to seek professional help

Relationship Care

  • Realistic expectations
  • Sexual intimacy
  • Practicalities of life
  • “Dating”
  • Priorities

Single Parenting

  • Arranging practical support
  • Making a community
  • Parenting needs

Unexpected Outcomes

  • Processing a difficult birth
  • Babies with medical needs, coping and advocating
  • Dealing with loss, grief, and trauma

We also offer a postpartum strategies class that goes into more detail on many of these topics.



Know Your Score – Before an Induction

March 23rd, 2011

Knowing your Bishop’s score prior to agreeing to an induction when not medically necessary or setting the stage for a medically necessary induction can make a great difference in expectations, additional interventions and understanding for the process as a whole.  Knowing your score can help you determine the type of induction or whether or not to be induced at all.
Your score is based on a vaginal exam that takes into consideration the areas listed in the chart below.


Dilation, Effacement, Consistency and Position all have to do with your cervix. Station is telling where the presenting part of baby is in relation to the ischial spines. (sitz bones).

Are you a good candidate for induction based on your score? Do you need a ripener? Are you a VBAC mother?  What other factors are working in your favor or against success?
Induction is not an easy or guaranteed process. You can see the criteria toward success is telling even without discussing the additional risks leading to additional interventions, medications and/or cesarean.

Additional links and information on induction can be found in this previous post http://prepforbirth.com/2009/08/12/preparing-for-labor-induction/.



Birth Plan Sample

February 28th, 2011

A birth plan is designed to facilitate communication between you and your provider, especially necessary if you are  birthing outside the home environment.  Secondly, it is to offer information on the individualized care you as the mother would like during labor, birth and immediately postpartum for you and your baby.

It should be brief (no more than one page) and only have the bullet point information that is specific to individualized care and desires not usually within your care provider’s standing orders or usual protocols of the birth location.

It is important to take a written birth plan to a prenatal visit at least a month prior to your given estimated due date in order to have a clear understanding of expectation and agreement. If it becomes apparent that you and your provider are not on the same page, this gives can give time to seek out another provider that fits you and you fit with. Remember it is not a legal document that your location of delivery or care provider must adhere to.

 =======================================================

Birth Needs and Desires for: _______________________. 

Care Provider:_________________.

Estimated Due Date: _________________.

 

Labor

I am planning on a no to low-intervention natural birth.  I plan on being mobile, lightly snacking, drinking orally, and having ___________ present.   I understand that intermittent monitoring of me and my baby will be necessary.  I want to be fully consented for any procedure that may come up and fully participate in the medical care for myself and my baby.  I understand that there is pain management available to me, I will ask for it if I so desire.

  • I plan on wearing my own clothing. I will ask for a gown if I change my mind.
  • I would like a saline lock in lieu of a running IV.
  • Limited vaginal exams after initial assessment.
  • In the event an induction and/or augmentation is medically necessitated-
    • Ripening – Foley Catheter instead of Cytotec (misoprostol), Cervadil or Prepadil
    • Pitocin – A very gentle and slowly administered dosage increase.
    • AROM – will only consent to if an internal fetal monitor is a must.
  • Spontaneous pushing and delivery in any position I am most comfortable with.
  • No cord traction or aggressive placental detachment, including deep uterine massage.
  • Delayed cord clamping for at least 10 minutes or until my placenta spontaneously detaches (baby can receive oxygen or other assistance while still attached to me).

Postpartum and Baby Care

  • Request that my baby is on my belly or chest for assessments and warmth (even oxygen can be given on me)
  • Delayed bathing
  • Delaying vaccinations including eye ointment and vitamin k.
  • Exclusive breastfeeding, no pacifiers, sugar water, or formula. I will hand express if necessary.
  • No separation from me unless absolutely medically necessary not just protocol.

Cesarean: In the event a cesarean becomes necessary and is not a true emergency requiring general anesthesia.  I would like to keep the spirit of my plan A to plan C so the delivery can be as family centered and intimate as possible.

  • Only essential conversation related to the surgery and delivery
  • Lower sterile drape or have a mirror present so I may see my baby emerge
  • Only one arm strapped down so I may touch my baby
  • Pictures
  • Aromatherapy as I desire for comfort, abate nausea and to mask surgical odors
  • Baby to stay with me continuously in OR and recovery
  • If baby must leave OR for treatment, my partner/spouse goes with baby and I would like my ____________ to stay with me so I am never alone.
  • Breastfeed in OR and/or recovery
  • Delayed immunizations
  • Delayed washing and dressing of baby
  • No separation from me except what is absolutely medically necessary

This “plan” may be copied, pasted and edited  for use by others.



Creating a relationship 10 minutes at a time

February 27th, 2011

It has occurred to me through my time with doula clients and students,  that many care providers serving hospital birthing mothers do not ask any questions of their pregnant patients during the 7-10 minute prenatal visits that lead to a substantive working relationship.

I have also learned that too often the pregnant “patient” does not know to tell her provider anything about what is going on in her life or pregnancy since she is not queried first.

Thinking there must be a way to better bridge this very real separation to solid patient-provider relationship building, I am drawing from my work as a midwife assistant in the making of this tip list.

Pregnant mothers your provider needs to know so much more about you and your pregnancy than blood pressure, weight, fundal height and fetal heart tones. I encourage you to freely offer the below information at every appointment to grow personalized care, advisement and support.

1) Appetite/Diet/Supplements – tell your provider if your appetite has increased or decreased between visits. Do you have food aversions? Are you taking any supplements or want to take supplements?

2) Sleep habits – tell your provider how you are or are not sleeping.  For example, are you having trouble falling asleep, falling back to sleep or staying asleep.

3) Nausea – Do you continue to have nausea? When? How often? Does it correlate with anything in particular?

4) Hemorrhoids – if you have them or not. What you are doing for them.

5) Varicose veins –  Are there veins sticking out or causing issue anywhere in your body?

6) Bowel habits – Are you experiencing normal or abnormal bowel habits?

7) Exercise – What have you been doing? Do changes need to be made?

8) Stress – Is there anything in your life that is really stressing you? Stress can impact pregnancy health. Important to discuss.

9) Related Providers – Are you going to any pregnancy related providers (such as chiropractor, acupuncturist, yoga, etc.)?

10) General  – Are you feeling well or not. Do you need more information or referrals?

There is so much more to you than a pregnant uterus. You are a holistic person who needs to be treated as such. I would venture that something much more individualized can come out of your care with simple sharing!

Here’s to whole care!





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