Archive for the ‘c-section’ Category

An unexpected breech cesarean – A mother’s perspective

Sunday, 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

EMAB and Doulaparty Team Up

Friday, 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!

A Cesarean Plan

Wednesday, 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

Family Centered Cesarean Plan

Saturday, October 16th, 2010

Below is my version of a family centered cesarean plan – can be used for a planned or unplanned cesarean delivery.

Sample Cesarean Plan PDF

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

We are trying to make a cesarean delivery as special and intimate as possible for us even though we did not have the desired vaginal birth.

DURING DELIVERY / RECOVERYIn the event a general anesthesia needs to be performed, I understand that some of my requests cannot be honored.

  • I would like to meet each staff member in the OR who will be participating in the cesarean.
  • I may use aromatherapy to help with nausea, surgical smells and stress.
  • I would like to play ______ music in the OR if it won’t be a distraction to those performing surgery.
  • Explain all medications that will be used to me. I prefer a bolus and oral medications versus a PCA afterward.
  • I would like for my husband (partner/family member) 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 husband (partner/family member) goes with the baby so I won’t have to be alone.
  • I would like to take photos and 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.
  • Please lower the curtain 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 after basic assessments while in the OR. My husband (partner/family member can hold baby there with a warm blanket over my baby.
  • In the event of a hysterectomy, please do not remove my ovaries or anything else that isn’t medically necessary.
  • I would like to breastfeed my baby as soon as possible in recovery.

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.
  • Limit the number of persons who touch or attend my baby to only those on staff as needed and my husband (partner/family member).
  • 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.
  • Delaying immunizations, even eye ointment and vitamin K.
  • 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 (husband/partner/family member) consent & prior knowledge

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

A woman’s voice birthed into fullness

Wednesday, April 7th, 2010

This is a personal post written 10 years to the day of my third son being born. I was also birthed that day into my fullness of voice as a woman and as a full throated advocate for mothers and babies.  You see my son was a CBAC (cesarean birth after cesarean) after a failed natural VBAC (vaginal birth after cesarean).

I had a VBAC with my second son, though by other peoples standards might not be said to be wonderful because at the very end of a totally natural, spontaneous labor after arriving at the hospital at 9cm’s with waters having broken on the way in the car,  forceps were used by an impatient on call doc after merely an hour of pushing. I was thrilled though it was ultimately less than ideal with a baby overnight in the NICU. I was not broken. An impatient doc who gave me an awful episiotomy could not take it away from me. But I digress. We can talk heinous episiotomy at another time.

Of course when I became pregnant with my third some 14 months later I assumed of course I would have another VBAC this time with no forceps. Of course I didn’t have to think about another cesarean I already disproved the need. There is a piece  of information that I was missing though………

My pregnancy goes well. I am terrifically healthy though more fluffy than I should have been. You see  my dear husband was laid off during pregnancy and well, I clearly didn’t exercise and eat properly the second half of the pregnancy.  A very dear friend and her children were flying in from out of state near my due date.  She arrived and I was contracting already. I must have been waiting for her to arrive to round out the support team.  She has clinical skills so I ask her to check me and allow her to sweep my membranes (okay stop groaning at me I was already in the beginnings of early labor). I was a few centimeters dilated and well effaced. She wasn’t sure of baby position though.

The membrane sweeping helped move labor along. I was 5 centimeters before very much time once contractions became nicely regular. My husband had gotten a job two weeks prior and was scheduled for work so off he went though I knew I would be calling him before too long. Sure enough contractions picked up very nicely and I could no longer tend to any of the children.  I decided to call my husband home.

Around this time I was about 6 cm’s dilated… good news right? WRONG! I also began having severe back labor. I had this with my first and he had an acynclitic head ending in cesarean after 4 hours of pushing. After my husband got home it was so much worse. You see I am a natural birther but this caused a panic stricken heart. I really freaked out. Not from the pain, but thinking OH no not another cesarean. How could this be happening? I was screaming inside my head. Sheer terror actually. I had not prepared at all for a malpositioned baby – I mean I had gotten him to turn vertex at 37 weeks from frank breech on my own. OP how could this be? In my panic I insisted that we go to the hospital though my dear friend and husband thought we should stay home longer. I was about 7 cm’s at this time. My friend now suspected an OP baby but didn’t tell me. Why did they not insist we stay home? I mean I was in no condition to drive myself the 15 minutes to the hospital. I don’t know.

We arrive at the hospital, I am indeed about 7 cm’s and yes baby is OP. No one worries though that I am a VBAC again. Basic monitoring, no saline lock, all is well in l&d land (so it would seem). In my head I am still in sheer terror though from the outside apparently it was not visible. That is still tough for me to comprehend. I was screaming through my eyeballs but I made no noise at all from what I am told.

I tried many positions to get him to turn, and probably would have but……..

At some point during a vaginal exam, my water was broken without my consent. This my dear readers is what caused the downhill slide to a repeat unexpected cesarean. I have since learned I have an android pelvis and without intact waters rotating a poorly positioned baby is near impossible if possible at all.  Back to the story.

I cannot say how much time went on for sure, a couple of hours I believe. Somehow in this room filled with two nurses, my dear friend and husband, a complete breakdown of emotional care took place. I felt totally and utterly unsafe, scared, terrified, and without hope. My husband too was overwhelmed and felt displaced in the situation though he admits he allowed it to occur. I did blame him and to some degree my dear friend in the beginning, but I do not now. I didn’t prepare well. I assumed. I didn’t define the roles of support between my husband and dear friend. I was a Pollyanna.

I was now complete and still trying everything possible to get baby to rotate. Nothing worked. I was desperate. By the way, I was unmedicated and only on intermittent monitoring for most of the time. So cannot blame the epidural or being strapped down.

I pushed for over three and a half hours in varying positions. During pushing (I am pretty sure of timing) an internal monitor was put on my son and a scalp sample was taken to check his stress level. Oh, the SAME on call doc that was impatient and used forceps on me during the last birth was my attending. That very much did not make for a safer, happier birth space.  At the end of the hours of pushing, she again pulled out forceps to see if she could rotate him or help me deliver him, but my dear friend discouraged it highly since he was still higher up (forgive me the station escapes me without my records in front of me).   I was then told the scalp sample came back showing my baby was becoming acidodic, which means he was getting very stressed. His FHT’s were fluctuating quite a bit as well.

At this point I could hardly keep my eyes open. I was in despair, heart broken, and becoming very angry. The doctor presented me with a cesarean consent form. I refused to sign it. I said I wouldn’t sign it but my husband had a power of attorney. I made him do it. I could not do it. I could not agree to another cesarean. Somehow having my husband sign it helped me face it better. Perhaps because then it was out of my control.

So another cesarean for a “stuck” and this time fetal distressed baby. So I was told. I was taken to the OR where the anesthesiologist would eventually place the epidural. I begged and begged and begged for a dose of terbutalin to slow the contractions as I still had the uncontrollable urge to push.  He essentially told me I was being a baby. To man up. He would get my epidural in soon enough. He was mean. He was verbally hostile. In between intense contractions, I actually thought over and over as I sat on the metal table with feet dangling of how I could take a swing at him without falling and hurting my son. I wanted to make this anesthesiologist feel pain. Punching him in his condescending, smug face would have been extraordinarily satisfying. I was so angry at how I was being treated. I will never know if he was punishing me for being a natural birther or a failed VBAC mother.  Maybe both.  He still is in practice and no I cannot be in the room if a client of mine gets an epidural with him as the anesthesiologist. My response is still visceral to his mere presence.

It seemed like a very long interval of time before the I.V was put in, the epidural was placed, the OR team was fully assembled and my husband was at my side. After reading my records it was a long interval. My husband signed the consent form and my son was not surgically born until more than 45 minutes later. Was he REALLY fetal distressed with that long of a wait in between? 45 minutes when the OR was open and available? I was IN there with the anesthesiologist the whole time. That is not an emergency or even emergent. Plainly he wasn’t coming. Yes he was OP.

I was laying on the table, armed strapped down, husband standing next to me watching the cesarean take place. I have no memory of what the epidural felt like. My eyes were closed out of exhaustion, grief and anger. My son was delivered at 535am.  His APGAR’s were decent not that of a highly distressed baby. I wonder if during the long wait and the rest period, he normalized. I may have been crying but not for the good reasons. My son was waved by my face. I do not remember seeing him. My husband was heading to the nursery with him. I screamed after him at the nurse, “If you give my baby formula, I will sue you.” It seems the woman who wouldn’t send back a wrong order at a restaurant was forever changed. Like a light switch my voice was established.

While I was being repaired. I decide to talk to the doctor (at this point I had no idea she broke my water without consent and had falsified my medical records in a few areas), so I tell her I want another baby. I then asked her if my uterus was good for another VBAC. She said sure you can have another VBAC if you want. No problem. My uterus looked beautiful. Wow, I should have felt wonderful that I am such an amazing healer from previous surgery.  I didn’t. Sigh. I wanted to die except my baby would want to nurse. Oh yes, my baby J.

Once out of recovery and into my room my husband came and gave me report on J. He was being observed, seemed very well. No they didn’t feed him anything. M had to go home and check on our other children who were just 4 and 23 months.  He swapped off with my dear friend who had gone to check on her children. I still hadn’t held my baby. I had no idea what he looked like. I was distraught but no one knew it. I would make a heckuva poker player I think.

Five hours post op and I want my baby. I want him NOW. He must be hungry. He must be wondering where I was.  The thoughts ran through my head. I called my nurse and asked her to bring me my son or take me to the nursery to feed him. She said no to both requests stating various reasons. This did not suit the new me at all. I asked her again. She again said no.  This did go on for a few minutes where we were actually raising our voices back and forth. Finally I noticed the wheel chair by the door, I looked the nurse in the eye (who by the way was no more than 6 inches from my face), and I said “Fine you want me to get up and walk across the room to the wheel chair then you will take me?” She said, “Yes” in a non-believing tone. HM she didn’t know me at all. THAT my dear readers was a dare in her voice. I called her bluff. I took a deep breath, held my belly, stood up and walked right over to the wheel chair on my own.  Needless to say she took me to the nursery to see my son.

My voice was completely in full bloom. Never to go back.

As she wheeled me around my son’s bassinet I grabbed his chart much to everyone’s dismay and horror. Why were they worried, well they had performed several tests, admitted him to the nursery for a minimum of 24 hours, started I.V. antibiotics and put in a central line ALL without consent. All done under implied consent which does not exist once the cord is severed and baby is his own patient. I thoroughly read his chart (no reasons given for the battery of tests), made certain they hadn’t him or given him I.V. fluids to curb his hunger, then I held my precious, sad little boy. Almost 8 pounds. Gorgeous. Very hungry. He nursed beautifully. I was elated and even more stricken. I stayed with him until he fell asleep then instructed them to call me at ANY sign of hunger.

I went back to my room and within another hour I was walking myself back and forth alone to the nursery. They had to ask me to come back for vitals to be taken and implored me to rest. He was MY baby not theirs. Mine to care for, nurse, be with….. Sigh.

When evening rounds took place the I asked the pediatrician to come to my room so we could discuss getting my son out of the nursery and into my room. He went through his whole chart with me and told me exactly what needed to happen for him to be released at 7 a.m.  Yes I noted it all.  He wrote it in the chart everything he told me.

During one of my evening trips to the nursery, the truly decent and kind night nurse informed me that my son never needed to be admitted to the nursery and she was better equipped to take care of in need babies. My son was fine. She said sure he needed to be observed for an hour or two but never should the tests been done or a central line placed for that matter. She encouraged me to stay as long as I wanted but it was good for me to go and sleep to heal best too.

In the morning I was there before the floor pediatrician was doing rounds. You probably guessed it, my son was in my room by 8 a.m. I can be very persuasive. The funny part about the scenario was that immediately when the doctor walked away the nurse implored me to help her get all the leads off and my son unhooked from everything quickly. Why? Because she had never seen a doctor release a baby like that and feared the doc would change her mind.

I finally had my son with me. Finally. I was hurting physically. I didn’t rest enough. I was his mother after all, that is what we do. Had I not done exactly what I had he would have still been in the nursery and breastfeeding could have been a disaster. More ibuprofen please. I do not even remember my husband bringing the other boys to the hospital. I do not remember anything but advocating for me and my son.

By 48 hours post cesarean I was desperate to go home. As I put it not so delicately to the doctor who didn’t want to release me so early after surgery, “I can sit on my own damn couch and I have better cable than you do here.” Seriously the full throated voice was speaking. Yes, she released me though against medical advice. I assured her I knew what infection looked like and I would be back if I needed to be.

My husband was there shortly thereafter with car seat and our other sons in tow. I was traumatized and shell shocked BUT I had well spoken up for the two of us when all was said and done.

Just like the Grinch who’s heart grew in size, I powerfully came into my own as a woman, as a mother and as an advocate.  For this and this alone I am tearfully grateful for my CBAC and though much was lost so very much more was gained.

“Elective” Cesarean – If you had one…..

Friday, February 5th, 2010

There is much in the news and in community talk how women are signing up for cesareans electively. I am very intrigued by this assumption and believe there is much misinformation regarding the topic out in the public for consumption. I am seeking to shed some more light on this topic.

Though this is not a scientific survey, I believe your experiences can help others in understanding why women are making this choice, as well as, potentially aiding other women in informed decision making.

If you have had or are planning an “elective” cesarean, I appreciate you answering this informal survey.  Answers can be submitted via confidential email to desirre@prepforbirth.com. By responding you are agreeing to allow me to use the information anonymously in a future blog, writing or other educational medium.

  1. Was your “elective cesarean for a medical reason?  If so, what?
  2. Was your “elective” cesarean for a non-medical reason?  If so, what?
  3. How were you given informed consent?
  4. What information were you given in the cesarean consent for benefits, risks, consequences, and alternative for you and your baby?
  5. Were any words such as: Easier, safer, painless, no big deal, not risky, saves vagina or less pain used to describe potential experience?
  6. Were you told your cesarean was necessary and found out later it was coded as elective?
  7. Did you ever feel pressured or led by care provider to choose cesarean?
  8. After your cesarean, did you feel you were consented fully enough prior to the surgery?
  9. Did the cesarean “do” or live up to what you were told for you and your baby?  How so?  How not?
  10. Would you make the same choice again or would you “go for” a VBAC?
  11. What country do you reside?

Thank you very much for answering these questions. I am so grateful for input on this subject.

If you would like any information shared and attributed to you as a quote,  please indicate in your email to me.  As stated above, otherwise your identity will be kept completely anonymous and confidential.

Rethinking the nature of intervention in childbirth

Saturday, January 16th, 2010

There is much awareness and conversation of what the routine interventions are that can occur during the labor and birth process within the hospital environment.  These interventions can include induction, augmentation with Pitocin, epidural, or cesarean. In all my professional and personal roles, I am privy to a great amount of pregnancy and birth stories. Within these experiences there are many “silent” yet obvious interventions that are hidden in plain sight under the guise of protocol, practice and societal expectation.

My current list of hidden in plain sight interventions in no particular order that can make a difference on how a woman labors and ultimately delivers her baby is below.

  • The uniform -Asking and expecting the mother to give up her clothes for the hospital gown.
  • Who’s on first? – If care provider is part of a large practice or on-call group a woman may have never met or have any knowledge of the person who’s practice style and philosophy is helping to guide and steer her labor and delivery. On-call CP may or may not adhere to the birth plan the laboring woman worked out with her own CP.
  • On a short leash – Continuous monitoring even if she is not high risk, medicated, or being induced/augmented.
  • The big drag around – Requiring IV running with absence of medical need.
  • Staying put – Asking or requiring the laboring woman to stay in bed for ease of staff without medical need.
  • Ice chips and Jello – Disallowing snacks and sometimes even actual water even though labor is hard work.
  • The marketing tool – Disallowing the laboring woman to get into the touted tubs or showers since it isn’t convenient for staff and she will not want to get out.
  • One is enough – Limiting the amount or type of support persons a woman is allowed to have with her.
  • I know more than you – Treating the laboring woman as if she knows nothing or shouldn’t know anything.
  • If you don’t… – Instead of giving informed consent and refusal, telling only what bad could, maybe happen.
  • Attitude and atmosphere – Negative, non-listening, lacking compassion, leaving the door open, ignoring requests, and the like when a woman is laboring.
  • Only if you ask – Though some wonderful practices are in place, they are only offered if a laboring woman or postpartum mother ask/insist on it.
  • Bait and switch – The official tour of labor and delivery and the reality of labor and delivery don’t fit together.
  • New with bells and whistles – The pretty with all the fancy bells and whistles like wi-fi, flat screen tv’s, etc. have to be paid for somehow. Because of this investigate the intervention rates there.
  • Routine vaginal exams – By and large VE’s are very subjective and can vary greatly between one person to the next on how they score a VE. This variation can deeply affect the course of a woman’s labor and delivery.  Women birthing in the hospital really only “need” a VE upon entrance for assessment of where she is in labor, if she desires an epidural/IV narcotics, if she is having a very prolonged labor, or if she feels pushy.
  • Pushing the epidural – When a woman is moving, moaning, making noise or just doing her thing in labor and it causes the staff discomfort or worry.  It could even be that anesthesiologist is going in to surgery and it can only happen now.

Simply because a societal norm is birthing at the hospital, as well as, what routinely goes on there, doesn’t mean the hidden in plain sight interventions are wise or harmless.

My goal here is to give pause and broader thinking to what intervention means for labor and delivery as another tool in planning and preparing for childbirth with eyes wide open.

Sisterhood of the Scar Revisited

Sunday, January 3rd, 2010

Many years ago I wrote this piece after attending my very first ICAN conference in San Diego in 2005. I read this and part of me weeps for her, for the me I was and for the women who are becoming part of this sisterhood willingly, wittingly or not.  My pain has been transformed into outstretched hands and heart. It has given me a sensitivity and awareness of the birth world I would probably have never achieved on my own had my births been perfect, idyllic and without this trauma.

I love you dear sisters and my life would be far less without each of you.

Seems a long distance the ivory tower to the ground.  The surprise in finding the thorny bushes with burrs that dig deep and puncture again at will? Well meaning onlookers say “Well a hundred years ago you both would have died?”  And the farce begins.  Stuff it down because it is crazy not to be grateful for the surgeon’s hand.  Smile and pretend all the twisted darkness inside doesn’t really exist.  The oft daily chore mixed with joy of caring for a baby whom we are unsure is truly our own.   The continuing assault during lovemaking when a cringe comes from the depths when a loving and hungry hand brushes the incision site.  “How can he think I am beautiful?  How can he possibly want this?”  Another thing of beauty and perfection quashed underneath the burden of the surgeon’s handprint.  Oh no say it hasn’t already been a year.  The birthday.  THE birthday sounds so exciting but terror strikes.  Preparation to be happy, preparation to feel joy.  Preparation not to shortchange our amazing gift of a child under the pain of the surgeon’s knife print.

The anticipated day meant to birth us into motherhood and my child into my waiting hands to my craving breasts, I was birthed into the Sisterhood of the Scar forever.

How real is active phase arrest of labor?

Thursday, September 17th, 2009

Preparing For Birth: 35+ and Pregnant

Wednesday, September 16th, 2009

Hourglass

The disturbing trend in treating ALL  “advanced maternal age”  mothers (over 35 at the time of impending birth) high risk continues to grow despite lack of evidence to do so.

My original post from 3.5 years ago still rings true today.

They are being subject to weekly Biophysical profiles or Fetal Non-stress tests tests that are normally reserved only for high-risk mothers and babies from as early as 32 weeks in pregnancy.  On top of the scans, these mothers are often pressured to agree to an early delivery of their babies by means of labor induction or cesarean even without other risk associations.  This is growing more and more prevalent especially for women over 35 who are first time mothers.

I have heard even from women that at their first OB appointment they are being told they will be induced at 39 weeks as a standard of practice and expectation for signing on with said provider.  The seed of fear and worry is being planted that their growing baby will die if the pregnancy goes to 40 weeks or longer.  What a way to start out a provider/mother relationship.  I would call that a red flag of immense proportion.

So what really is the big deal with “old” mothers?  This study Advanced Maternal Age Morbidity and Mortality correlates various medical issues with “AMA” mothers though the biggest hot button is an elevated yet unknown cause of perinatal death.  This statement alone has caused a huge shift in the way these mothers are viewed regardless of  overall pregnancy health and absence of any known risk associations. ACOG’s February 2009  Managing Stillbirths maintains there is a risk to older mothers with no explanation as to why there is a risk, what the percentage of  risk increase is or any prevention protocols.  Seems dodgy since the other groups noted in the bulletin have all the data included.

There are some serious problems with any practitioner taking this study and applying it across the board to “AMA” women.  The study even says so much, “It is important to note that the findings of this study may not be generalized to every advanced-maternal-age obstetric patient in the United States. Although the FASTER trial patient population was unselected, meaning that patients were not excluded based on any confounding factors such as race, parity, BMI, education, marital status, smoking, pre-existing medical conditions, previous adverse pregnancy outcomes, and use of assisted reproductive care, there may have been significant patient or provider self-selection.” So the population could have been skewed from the get go by provider or patient selection, along with the fact that it seems the only point of homogeneity is present in that most of the women were Caucasian.  Throw all these women in a pot and see what happens?  Next step is to make protocols and change practice style upon weak findings?

The study also shows an increased risk for cesarean by “AMA” mothers.  “As with prior literature, this study demonstrated that women aged 40 years and older are at increased risk for cesarean delivery. Older women may be at increased risk for abnormalities of the course of labor, perhaps secondary to the physiology of aging. It is possible that decreased myometrial efficiency occurs with aging. Nonetheless, maternal age alone may be a factor influencing physician decision making. It is uncertain whether the increased rates of cesarean delivery are due to a real increase in the prevalence of obstetric complications or whether there is a component of iatrogenic intervention secondary to both physician and patient attitudes toward pregnancy in this older patient population.” Very interesting. So “old” women are perceived as being unable or problematic so they have less successful vaginal birth outcomes. Now that is a self-fulfilling practice style with a huge dose of ageism thrown in.  I also wonder what the cesarean rate in this age grouping is going to be due to these protocols.

Let’s get to the perinatal and neonatal death risks.  The study says: “Studies regarding an increased risk for perinatal mortality in women of advanced maternal age have been controversial. In this study, the increased risk of perinatal mortality was not statistically significant for patients aged 35–39 years (adjOR 1.1). Age 40 years and older was associated with a statistically significant increased risk of perinatal loss (adjOR 2.2). There were only 119 stillbirths and 37 neonatal demises in total. As a result, we could not draw any meaningful conclusions about the etiology or timing of perinatal mortality in women of advancing maternal age. The reason that advanced-maternal-age patients may be at increased risk of perinatal mortality is unknown. The failure of uterine vasculature to adapt to the increased hemodynamic demands of pregnancy as women age is a proposed explanation. So in conclusion, we have no idea why this might occur and have no way of counseling “AMA” mothers to lower the risk especially those over 40. Another noteworthy thought is that this study had 79% under 34 year old women, 17% 35-39 year old women, and only 4% women over aged 40.  So with such a small grouping ALL women considered “AMA” are being put under very heavy handed protocols to delivery their babies in the 39th week of gestation.

In closing, I find it difficult to believe that anyone who reads this study would change practice style because of it and move pregnant patients who are otherwise maintaining a healthy pregnancy without risk associations to a high risk model of care. Amazingly the study itself says the same thing, “In summary, the majority of women of advanced maternal age deliver at term without maternal or perinatal adverse outcomes.” And, “The role of routine antenatal surveillance in women aged 40 years and older requires further investigation because these women seem to be at increased risk for perinatal mortality, including stillbirth. Although the likelihood of adverse outcomes increases along with maternal age, patients and obstetric care providers can be reassured that overall maternal and fetal outcomes are favorable in this patient population.”

Couldn’t have said it better myself.

Since the original posting – - – instead of women being told they must be induced in the 39th week they are now being “offered” non-medical, cesareans as a first course of action.  This sort of pressure is not evidence-based or even medically ethical in my opinion.

Preparing For Birth – Common Pregnancy and Childbirth Terms

Tuesday, August 25th, 2009

Below is a compilation of common terms and acronyms that women often will come across during pregnancy, labor, and delivery.  Check back as more will be added from time to time.

  • AROM – Artificial Rupture of Membranes – using a finger or tool to open the amniotic sac to to allow the fluid to release.
  • PROM – Premature Rupture of Membranes – when the amniotic fluids releases before labor starts.
  • SROM – Spontaneous Rupture of Membranes during labor.
  • ROM – Rupture of Membranes
  • Miso – Misoprostol is the pharmacological name for Cytotec a drug used for cervical ripening and induction though a controversial, off and against label used ulcer Medication
  • VBAC – Vaginal Birth After Cesarean
  • HBAC – Home Birth After Cesarean
  • WBAC – Water Birth After Cesarean
  • UBAC – Unattended Birth After Cesarean
  • CBAC – Cesarean Birth After Cesarean – This is a repeat cesarean after a woman desires and tries to have a vaginal birth after cesarean.
  • ERCS – Elective Repeat Cesarean
  • RCS – Repeat Cesarean
  • Natural Birth – Labor and vaginal delivery free from intervention except for intermittent fetal monitoring. In the hospital only a saline lock and intermittent monitoring.
  • Vaginal Birth – Baby born vaginally with or without medication and intervention.
  • First Stage – Early, Active, and Transition. This encompasses the effacement to 100%, dilation to 10 centimeters/complete, position movement of cervix from posterior to forward as contractions begin while staying longer, strong and closer together prior to pushing and delivery.
  • Second Stage – Pushing phase after cervix is completely dilated to delivery of baby.
  • Third Stage – Delivery of baby to delivery of placenta.
  • Fourth Stage – First hours after placenta is delivered.
  • Oxytocin – A hormone made in the brain that plays a role in childbirth and lactation by causing muscles to contract in the uterus (womb) and the mammary glands in the breast. It also plays a role in bonding with mate, child, and socially.
  • Pitocin (oxytocin injection, USP) is a sterile, clear, colorless aqueous solution of synthetic oxytocin, for intravenous infusion or intramuscular injection.
  • Prostaglandin – Any of a group of hormone like fatty acids found throughout the body, esp. in semen, that affect blood pressure, metabolism, body temperature, and other important body processes such as cervical ripening.
  • Uterus -The muscular organ in which a fertilized egg implants and matures through pregnancy. During menstruation, the uterus sheds the inner lining.
  • Cervix -The lower portion of the uterus that provides an opening between the uterus and the vagina. Also known as the neck of the uterus that softens, effaces, dilates and changes position during labor.
  • Vagina – A muscular canal between the uterus and the outside of the body. Also known as the birth canal.
  • Perineum – The area between the anus and the vulva (the labial opening to the vagina).
  • Pelvis -The basin like cavity formed by the ring of bones of the pelvic girdle in the posterior part of the trunk in many vertebrates: in humans, it is formed by the ilium, ischium, pubis, coccyx, and sacrum, supporting the spinal column and resting upon the legs.
  • Pelvic Floor Muscles -The sphincter mechanism of the lower urinary tract, the upper and lower vaginal supports, and the internal and external anal sphincters. It is a network of muscles, ligaments, and other tissues that hold up the pelvic organs.  Includes bladder, rectum, vagina and uterus.
  • Fundus -  Top of the uterus. During labor contractions the fundus thickens and gets more firm as the strength of contractions increase and dilation increases.
  • Placenta -The organ that develops during pregnancy that transports nutrients to the fetus and waste away from the fetus. The placenta is attached to the uterus and is connected to the fetus by the umbilical cord.
  • Umbilical cord – The cord that transports blood, oxygen and nutrients to the baby from the placenta.
  • Bloody Show – Mucous and blood mixed together as dilation and effacement occurs.  Starts off as blood tinged mucous and becomes heavier as labor progresses.
  • Stripping membranes -  Pressing the amniotic sac away from the inside of the cervix.
  • Mucous plug - The mucous that blocks off the non-dilated and non-ripened cervix for protection.
  • Lochia – Post birth bleeding that though a wound site from the placenta detaching from the uterine wall, it mimics a heavy and long menstrual period.
  • Cesarean – Baby born via a surgical incision made through the abdomen into the uterus.
  • Obstetrician – Is the surgical specialty dealing with the care of women and their children during pregnancy, childbirth and the immediate post birth time.
  • Midwife – Is a person usually a woman who is trained to assist women during pregnancy,  during childbirth, and postpartum as well as the newborn post birth.  There are many types of midwives – some work in the home, at birth centers or in the hospital.
  • Doula – Is an assistant who provides various forms of non-medical and non-midwifery support (physical and emotional) in the childbirth process. Based on a particular doula’s training and background, the doula may offer support during prenatal care, during childbirth and/or during the postpartum period. A birth doula provides support during labor. A labor doula may attend a home birth or might attend the laboring at home and continue while in transport and then complete supporting the birth at a hospital or a birth center. A postpartum doula typically begins providing care in the home after the birth. Such care might include cooking for the mother, breastfeeding support, newborn care assistance, errands, light housekeeping, etc. Such care is provided from the day after the birth, providing services through the first six weeks postpartum. In some cases, doula care can last several months or even to a year postpartum – especially in cases when mothers are suffering from postpartum depression, children with special needs require longer care, or there are multiple infants.
  • Birth Center – Free standing location usually run by one or more certified nurse midwife. True birth centers are almost always independently run. They are not overseen by a hospital or in a hospital. May be near a hospital. Often set-up like a home birth space and epidurals or other pain medications are not available.   Hospital “birth centers” are labor and delivery floors not birth centers in the true sense of the term.
  • Intervention – Anything that does not exist in a naturally occuring labor and delivery that is done.
  • Saline Lock/Buffalo Cap/ Hep Lock – Is the apparatus that the IV line hooks into.  It is silicone tubing that is lightweight with a plastic needle that stays under the skin to allow easy vein access.
  • Foley – A foley catheter is used to release the bladder if a woman unable to urinate due to an epidural, post surgery, or with a swollen urethra post birth.  It can also be used for successful cervical ripening in lieu of cytotec.
  • Induction – To attempt to artificially start labor usually by pitocin, artificial rupture of membranes with or without cervical ripening (Cytotec or Foley Catheter).
  • Epidural - A medical method of giving pain relief during labor. A catheter is inserted through the lower back into a space near the spinal cord. Anesthesia is given through this catheter, and results in decreased sensation from the abdomen to the feet.
  • Contraction – Tightening and loosening of your uterus. Productive contractions are often felt at the bottom of the uterus, start out like period cramps and progressively grow stronger, longer in length, and closer together.
  • Braxton-Hicks – Practice contractions that do not dilate or efface the cervix often felt at the top of the uterus versus the bottom.
  • Episiotomy – A surgical procedure to widen the outlet of the birth canal to facilitate delivery of the baby and avoid a jagged rip of the perineum. (Natural abrading or tearing is preferred and episiotomies are not evidence-based to be used except under specific circumstances).
  • Ina May’s Sphincter Law -Tapping into the concept that if one sphincter is open and relaxed, the others will also open, relax and be able to handle, quite adequately, the task at hand. This also includes the aspect of birth requiring privacy, sacredness, and honor as well so a woman feels safe, unwatched and supported.
  • Kegel Exercises – Named after Dr. Arnold Kegel, consists of contracting and relaxing the muscles that form part of the pelvic floor (sometimes called the “Kegel muscles”).

Preparing for a medically necessary labor induction

Wednesday, August 12th, 2009

Labor induction is increasingly on the rise, however, even ACOG has a limited statement on what is a defines medically necessitated labor induction.  This is generally defined as gestation or chronic hypertension, preeclampsia, eclampsia, diabetes, premature rupture of membranes, severe fetal growth restriction, and postterm pregnancy (postterm dates are defined generally after 42 weeks gestation though protocols and practice style is often after 41 weeks).  There are varying opinions in the birth world of what is truly medically necessary so always research your options and need.

Induction is not a panacea, it only sometimes works, is more challenging than naturally occurring labor and is often long.  I hope my suggestions and information can help you be more well equipped when it is the best solution for you and your baby.

So you do need to be medically induced, how can you prepare?  Do you need cervical ripening prior to the induction as well ?

Start with the type of induction you need.

Ripening is for a cervix that is not ready for using pitocin for induction purposes (see Bishop’s score below). Ask your care provider what your score is.  If he or she does not use the Bishop scoring ask for the particulars of each of the five categories then you can use the table yourself.  The position category denotes the position of your cervix.

Are you a good candidate for induction? Do you need ripening too?

Are you a good candidate for induction? Do you need ripening too?

If you need a ripener prior to the induction, you have two common options (Cytotec or Foley Catheter) though there are more available (Cervidil or Prepadil), they are not widely used any longer.

Foley Catheter ripening is a mechanical ripening method that requires no medicine therefore has very little negative consequence related to the usage. The catheter is inserted in the cervix, then filled with saline to fill the end of the bulb and mechanically opens the cervix up to approximately 4 cm’s while the foley is in place. The mother will go home until the catheter falls out or will remain in the hospital overnight.  The pressure from the foley catheter promotes continual prostaglandin release that encourages the effacement and works in conjunction with the mechanical dilation to open the cervix.  When the catheter falls out, unless it prematurely dislodges the cervix is ripe and ready for induction (pitocin usage). Sometimes the mother is already in early labor and may not require pitocin or require less.   For more information and studies regarding foley cather ripening view my blog page http://prepforbirth.com/2009/07/20/foley-catheter-ripening-versus-medication-studies.html.

The most common yet riskier method of cervial ripening is the use of Cytotec (Misoprostol).  Cytotec is used in an off label manner for ripening the cervix. ACOG has this to say in the revised new guidelines that include seven recommendations based on “good and consistent scientific evidence” — considered the highest evidence level — including one that sanctions 25 mcg of misoprostol as “the initial dose for cervical ripening and labor induction.” The recommended frequency is “not more than every 3-6 hours.”  Though this drug has been shown to be successful for ripening it is not without concern, consequence, risk or controversy.  Please do your research ahead of time prior to allowing this drug to be used on you and your baby.

Here are some helpful links:

http://www.aafp.org/afp/20060201/fpin.html

http://www.petitiononline.com/cytotec/petition.html

http://www.medscape.com/viewarticle/458959

http://www.thefreelibrary.com/Making+an+informed+choice:+Cytotec%5BR%5D+for+induction-a0128063329

Your cervix is ripe for induction

The most common next step is the use of Pitocin to induce labor contractions. What to expect: an IV with fluids running, continuous monitoring, and limited mobility. The increased pain and stronger than usual contractions over a longer period of time associated with Pitocin use often leads women to ask for epidural anesthesia. There are varying protocols, but the low-dose protocol is most often used today.  Induction is not fail safe, you may or may not respond to “tricking” your body into labor.  Your baby also may not respond favorably.  In the event the induction fails or causes maternal or fetal distress or host of other complications, a cesarean delivery is the next step.

Here are some helpful links regarding Pitocin.

http://www.rxlist.com/pitocin-drug.htm

http://www.corninghospital.com/Educate/Pit.htm

http://pregnancy.about.com/od/induction/a/pitocindiffers.htm

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=4975#section-4

Rethink how you pack your birth bag

Considering the length of time that you will be at the hospital  considering adding the following items to your birth bag.

  • Movies (make sure your hospital provides DVD players or you will want to bring one of your own)
  • Puzzles of all types
  • Cards
  • Games
  • Books
  • Laptop Computer
  • Extra changes of clothing
  • Extra food for husband, partner or labor support
  • Extra cash
  • Ear plugs and eye covering to make sleeping easier
  • More comforts from home to be soothing

Points to think about

  • You are having a baby and need to do the work of labor completely at the hospital. ONLY allow those who can help you keep the chaos and interruption to a minimum.  This is not a party.
  • Turn of cell phones.
  • Keep room comfortable, peaceful,  and stress-free.
  • Having your water broken artificially does not mimic it naturally breaking.
  • Use the space provided and get on the birth ball, stand near the bed and sway, use rocking chair, have equipment moved closer to bathroom so you may sit on the toilet, use as many positions as possible to help baby negotiate and to help dissuade a mal-position.
  • Induction increases the risk of a cesarean delivery becoming necessary whether from the induction failing (fooling a body into labor isn’t as easy as it sounds), maternal/fetal distress or another complication may arise.  Here is a sample cesarean delivery plan in the event it becomes necessary.  sample-cesarean-plan

My closing thought to you is take a deep breath and know when medically necessary an induction is a reasonable step.

My hope is for you to be well informed, be confident to ask questions, be strong to make your own decisions, and thrive to a successful birth even when Plan A isn’t an option anymore.

Radio Interview on Whole Mother show – Cesareans, VBAC & Prevention

Wednesday, August 5th, 2009

Here is the radio interview I did with Debbie Hull of the Whole Mother Radio show.  We talked about the current percentage of cesareans, VBAC availability, where to obtain support, ways to prevent an unnecessary cesarean and much more!

http://archive.kpft.org/mp3/090803_063001wholemother.MP3

Increasing your opportunity for a vaginal birth in a cesarean stricken culture.

Tuesday, August 4th, 2009

Today the cesarean rate is an alarming 31.8% (CDC 2007 preliminary data).  Only a maximum of 15%  of birthing women should be having cesarean deliveries in order to keep mortality (death) and morbidity (poor outcomes) to the healthiest levels according to the World Health Organization. With the staggering discrepancy in what should be and what is, you NEED to care about this topic.  You could have a questionable cesarean like so many others.

It is important that you the childbearing woman understand how to have the healthiest birth for you and your baby which is most often a no-to-low intervention vaginal birth.

When a cesarean occurs for a truly medical and/or life saving reason it is necessary and the benefits far outweigh the consequences for mom and baby.  The cesareans that occur for other than truly medical and/or life saving reasons are often not necessary or became necessary due to external influence that skewed the labor and delivery outcome (routine induction, epidural,  impatience by provider, mal-position of baby, staying in bed during labor, routine continuous monitoring, pushing in one position, lack of food and water during labor, routine augmentation of labor, lack of support, etc.)

Below is a list of ways to promote having a vaginal birth even if you have already had a baby this information needs to be known.

  • Take the ICAN webinar on cesarean prevention.
  • Interview before choosing your care provider – you are doing the hiring! Know his or her statistics.  If you do not get a clear answer, that is a RED flag.  You need individualized care. ou and your baby deserve no less.
  • Interview both midwives and OB’s.
  • Research your chosen birth location well.  There are other options outside of the hospital – home and birth center.
  • Hire a doula who shares your philosophy and is comfortable with the type of birth you desire. Some searchable places for a doula are: www.cappa.net, www.dona.org, and www.alldoulas.com.
  • Without medical reason standing in the way, labor at home into active labor if traveling to a hospital or birth center.  Well established labor upon arrival to the hospital or birth center decreases the opportunity for interventions, medications, and cesareans.
  • Get educated! Take a childbirth class that promotes confidence, consumer awareness (knowing rights and responsibilities), and evidence-based practices. A “good patient” class is not what you want to take.  READ books that share positive stories and good information.  A few of the searchable sites are: www.cappa.net, www.independentchildbirth.com, www.lamaze.org, and www.ican-online.org.
  • Turn off your TV – stop watching the dramatic birth shows.  They are not real.
  • Use mobility in labor.
  • Drink and snack in labor.
  • Say NO to routine interventions – meaning interventions or medications without a true medical reason. These can include, IV with fluid running, artificial rupture of membranes, continuous monitoring, wearing of hospital gown, and vaginal exams.
  • Say no the the epidural completely or at the earliest at 6 cm’s dilated.
  • Push and deliver in positions other than the reclined or “C” position unless that feels good and baby is coming well that way.
  • Only have those around you who will support what you need and desire in labor and birth. When you close your eyes who is there with you in your labor “cave”? Who doesn’t fit well there?
  • Study yourself for what comforts, assures, and adds to your feeling of safety.
  • Eat healthy and exercise during pregnancy.
  • Read What Every Woman Needs to Know About Cesarean Section – http://www.childbirthconnection.org/article.asp?ck=10164
  • For more information on Cesarean recovery and support, VBAC education and support, and Cesarean prevention go to www.ican-online.org.
  • Bottom line – take your money and walk if you are not being listened to and treated as a partner in your care.

What might a cesarean get you? Often more than is bargained for.

Tuesday, July 28th, 2009

This is a  slight re-do from a popular blog post from early 2008. The information is vital and pertinent to the near 1.5 million women (based on previous CDC data) who will have a cesarean surgery this year.

Having a cesarean section will almost always  get you a baby.  Generally there is much more to it and anyone could bargain for or anticipate even in the best of recoveries.

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 perhaps 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, a true medical indication, 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 think it would happen to you. 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 okay?
  • 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 or in the least a divided place.
  • Living with dread when a hungry hand sweeps over your scar. Being sexual can be extremely difficult physically and emotionally.
  • Having great fear of becoming pregnant again.
  • Having great fear of going for a VBAC and ending up in the OR at the end.
  • Not being understood and having others say to your face how lucky you are that you got to take the easy way out.
  • Pain.
  • Difficulty moving, walking, getting up, rolling over, coughing, laughing, tending to personal cleaning…. You get the idea. It is surgery.

Though not every woman will experience what is on the list, many do.  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. Don’t judge her. Send her to ICAN. http://www.ican-online.org/.

Preparing for Post Birth –

Saturday, July 25th, 2009

Putting effort into the initial postpartum period is in my opinion equally as important as preparing for pregnancy and birth.  Sometimes it is even more important due to circumstance or birth outcome.  Too many focus solely on the labor, delivery and perhaps the “stuff” that goes with having a baby while completely forgetting to look at all incredible change that occurs with having a new baby 24 hours a day, 7 days per week.

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 do not go into information you need in detail.

Here’s to postpartum preparedness!

Common Physical Changes for the Mother

Uterine Change and Bleeding

Breast Expectations and Breastfeeding Norms

Hormones and Symptoms

Recovery Requiring Attention

Vaginal Tearing, Episiotomy, Cesarean, Extreme Soreness or Swelling, Hemorrhoids

Nutrition

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

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

I offer a Postpartum Strategies class privately in the Colorado Springs area that goes into more detail on many of these topics.  My Bookstore lists several helpful books as well.

Cesarean vs. VBAC: A dramatic Difference

Wednesday, July 22nd, 2009

I have been invited to share with you an intimate and challenging (and graphic) journey of a mother from an unexpected primary cesarean, physician decided repeat cesarean and a home water birth after those two cesareans.

Before you watch it, take a deep breath and have an open mind. A box of tissues may be in order as well.

Cesarean vs. VBAC: A Dramatic Difference from Alexandra Orchard on Vimeo.

Watch how a baby is delivered in a cesarean birth and see the dramatic difference of what both the mother and baby experience in a home water birth after cesarean.



Thank you Alex for allowing me to share your story!  Many blessings to you and yours.

For more information on cesarean recovery, support, prevention and VBAC information go to www.ican-online.org.

ACOG refines guidelines for fetal monitoring in labor

Wednesday, July 22nd, 2009

ACOG recently updated guidelines for fetal monitoring in labor.  They call it a refinement.  Very interesting.

Directly from the press release “Since 1980, the use of EFM has grown dramatically, from being used on 45% of pregnant women in labor to 85% in 2002,” says George A. Macones, MD, who headed the development of the ACOG document. “Although EFM is the most common obstetric procedure today, unfortunately it hasn’t reduced perinatal mortality or the risk of cerebral palsy. In fact, the rate of cerebral palsy has essentially remained the same since World War II despite fetal monitoring and all of our advancements in treatments and interventions.” That is an increase in use by 89% with what benefit to mothers and babies? More cesarean?  More interventions and managed labors? Perinatal mortality hasn’t decreased.  Shocking really.   So for the needs and most likely benefit of the truly high-risk moms and babies all women have been subjected to more and more electronic monitoring in labor resulting in more morbidity for mothers and babies.

Apparently a big issue is that there are huge discrepancies in interpretation when assessing the FHT strips by physicians. There was a group of 4 physicians who initially assessed 50 FHT tracings and only agreed 22% of the time. Then two months later the same 4 physicians were asked to re-assess the same 50 tracings and their own evaluations varied nearly 1 in 5.   I have heard this over and over anecdotally from labor and delivery nurses through the years.  That no one can agree.  That the variance is so great.  Better to treat just in case whether by interventions or a cesarean.  I have been told that even a 40 hour course on FHT assessment leaves one without any clear advancement of skill or knowledge. The training actually left one individual less inclined to trust assessment.  So how does this comfort the expecting woman? Knowing that the machine that rules so much of labor and delivery in combination with the human element is so fallible.  Now that is non-reassuring in real life application.

So what can be done?  Unless there is a real high-risk situation that needs to be addressed, ask for intermittent auscultation with a handheld doppler or even better with a fetascope.  When a nurse, midwife or doctor actually listens personally to a baby with a fetascope there is no machine interpreting sound. It is with their own ear and skill assessing your baby.

The other thing to remember is keeping away from routine use of  induction, narcotic use, and epidural use in labor can greatly improve the opportunity to remain low-risk and healthy.  Thus not requiring continuous fetal monitoring.

I only touched on a few aspects of the new guidelines.  For a more complete breakdown of the refined guidelines, the NY Times did a nice piece.

ACOG revises labor induction guidelines

Tuesday, July 21st, 2009

uterobaby

(Originally posted July 2009. Information still relevant.)

ACOG released a press release today regarding a new practice bulletin revising labor induction guidelines.  Though the practice bulletin is not available on the ACOG site, a detailed review is available by Medpage today.  I hope to soon have the full copy to share.

Some high points I found in the explanation and review of the revision:

  • Misoprostol (Cytotec) should not be used to induce any woman with a previous uterine surgery or cesarean due to the increased risk of uterine rupture.
  • The Foley catheter is a reasonable and effective alternative for cervical ripening and inducing labor (as stated in my blog earlier this week).
  • The recommendation for fetal demise is for induction rather than cesarean unless unusual circumstances present as it is associated with maternal morbidity without fetal benefit.
  • ACOG also states that the assessment of “gestational age and consideration of any potential risks to the mother or fetus are of paramount importance for appropriate evaluation and counseling before initiating cervical ripening or labor induction.”
  • Admitting to this fact – At the same time, there have been a number of reports linking the induction of labor with increased risk of adverse events including uterine rupture and meconium-stained amniotic fluid.
  • “A physician capable of performing a cesarean should be readily available any time induction is used in the event that the induction isn’t successful in producing a vaginal delivery,” notes Dr. Ramin. Although rare, there are potential complications with some methods of labor induction. (perhaps less inductions that are for lack of medical reason will be done if a physician must induction sit?)
  • Post cervical ripening whether by medication or mechanical once the cervix is dilated, labor can be induced with oxytocin, membrane stripping, rupture of the amniotic membrane, or nipple stimulation. (using an alternative like nipple stim interesting)

 

 

Some low points I found in the explanation and review in the revision:

  • The new guidelines include seven recommendations based on “good and consistent scientific evidence” — considered the highest evidence level — including one that sanctions 25 mcg of misoprostol as “the initial dose for cervical ripening and labor induction.” The recommended frequency is “not more than every 3-6 hours.” (I want to see these studies)
  • ACOG said that the data on the safety of high-dose misoprostol (50 mcg every six hours) were “limited or inconsistent,” making its recommendation on high-dose misoprostol an evidence level “B” recommendation. (again studies please)
  • The practice of inducing labor has become more common. More than 22% of pregnant women undergo labor induction, ACOG says, and the overall rate doubled from 1999 to 2006. (once again – only 22% – this one I need to research)
  • Rapid delivery or lack of access to good care at home as a potential reason to induce labor in rural areas.

More possible low points:

  • Low- or high-dose oxytocin regimens are appropriate for women in whom induction of labor is indicated. (Pit to distress with high doses?)
 

 

So even ACOG says that induction needs to be taken seriously as there are risks and consequences associated.  Definitely I am in agreement with that. It IS a very big deal and the risks to not having your baby immediately must outweigh the benefits of baby staying put a little longer.


Molly Ringwald births twins – Congratulations!

Monday, July 13th, 2009

It has been reported that Molly Ringwald naturally birthed her twins (son Roman and daughter Adele) on July 10th, 2009.  Her babies arrived within minutes of each other.  No other details were given.

She had previously spoken publicly in a Fit Pregnancy interview about her desire for a vaginal birth.  Also that she would not schedule a cesarean due to expecting twins alone.  This is no small feat in today’s maternity world.  Women today nearly always deliver twins and other multiples via planned cesarean without labor (unless both babies are head down and the mother agrees to a tethered labor).

Something else stands out to me.  She appears to have bucked the trend of advanced maternal age obstetrics based on this study ama study.  You see Molly Ringwald is a gorgeous, healthy 41 year old!

Though Molly Ringwald is a celebrity, she is like all the rest of us, a  childbearing woman.   If she can do it, so can you!

Congratulations to Molly and her family.

Pitocin – Be aware!

Saturday, July 11th, 2009

In recent days there has been much chatter in the birth and consumer worlds about the use or rather misuse of the synthetic oxytocin drug Pitocin (ICAN, unnecesarean, nursingbirth, daytondailynews).

Pitocin is used very commonly in the United States before labor to induce, during labor to augment the process and post birth for the purpose of eliminating or preventing  hemorrhage. Women are told that it is just like the oxytocin she produces, it is a way to mimic natural labor, it is no big deal, etc.  Clearly that is not the case.  Unfortunately women are rarely if at all informed of the manufacturer’s protocol’s for use or the documented risks and  consequences to her and her baby as seen here – pitocinKingPharmPamphlet.

For a drug this powerful to be used routinely for  non-medically indicated induction and unnecessary labor augmentation is frankly terrifying and unethical.  How many complications go unreported or under reported that are directly attributed to such liberal Pitocin use? The thought is staggering.  My heart aches and sobs as there are thousands of women and babies suffering needlessly every minute, every hour, every day and every year.  The advocate in me raises a fist and grabs a bullhorn. Please spread the truth.

The many women who come out of birth terrified and traumatized.  They say how painful, how out of control, how trapped in bed, how unable to cope without pain medication, how they fear for another labor, how they don’t ever want to go through that again and so on.  Next time you hear that ask her if she was induced or augmented with Pitocin.  I think you will be astounded by how many will say yes and how many will give an account of the cascade of interventions that came with it.

Women I believe overall say yes to induction and augmentation because they have no idea of the true risk involved, and of the deep held ideal that no care provider or staff would recommend or allow any procedure (yes it is a procedure) that could harm a woman and a baby unless the benefit greatly outweighed the risk.  I do not believe that a care provider or staff member is trying to do harm, but more the realistic function that there is another medication to fix it, a protocol to manage it or the go to cesarean option to handle the pit-to-distress syndrome.

Every pregnant woman must find out how her care provider uses Pitocin with his or her patients.  She needs to inquire with the birth facility as to normal protocols surrounding this medication.

Be aware.  Be informed.  A decision only can be made well when the playing field is leveled.

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

Thursday, April 10th, 2008

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/.



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