Archive for the ‘Intervention’ Category

That Pesky Due Date

Friday, September 10th, 2010

Women and babies are not made with a pop out button like some Thanksgiving turkeys indicating being done. That pesky due date becomes such great topic of debate. It can lead to unnecessary interventions (such as induction, provider change because of regulations or cesarean), emotional unease (I am broken, this baby is never coming, I am LATE one minute past 40 weeks), physical distress by way of decreased pregnancy change tolerance, and mess with a woman’s work schedule (when to start maternity leave or return to work date).

Prior to home pregnancy tests and ultrasound dating, the due date was much more of a due month. Now it seems everyone has bought into this mysterious due date being something very hard fact and unfailing.

Henci Goer wrote a tremendously helpful article called “When is that baby due? ” several years back that sheds light on this very issue. She states: “When it comes to determining your due date, “things,” as the Gilbert and Sullivan ditty goes, “are seldom what they seem.” The methods of calculation are far from exact, common assumptions about the average length of pregnancy are wrong and calling it a “due date” is misleading. Understanding these uncertainties may help to curb your natural impatience to know exactly when labor will begin.”

The most common way women are finding out the due date of their baby is by using an online calculator such as this:

However, this even from the federal website does not take into consideration ovulation, only length of cycle (which is an improvement over straight up LMP dating).

So how do women handle this notion of a due date? I asked the question and here are some responses.

  • KZ –    “Last time, I told everyone my due date, and when E had other plans, I got the, “Have you had that baby, YET?? How long are they gonna make you go?” *cringe* This time, I’m wising up and saying Spring. That’s it. Spring.”
  • SL – “I used a “due season”. I told my three year old that the leaves would change on the tree and we would probably have Thanksgiving dinner and she would be here sometime after that. :)”
  • KMC-M -“I love the Ish… december-ish”
  • CLM -“I always give very generic answers to avoid the annoying “aren’t you due yet???” comments. I’ve also written on Christmas cards … “baby #3, due Spring 20??”. Once I was due at the very end of July. My well meaning neighbor was asking … “are you STILL pregnant?” on July 4th. Ugh.”
  • LE – “Whenever someone asked my due date I always said, “he’ll come when he’s ready” or “when God decides he’s ready”
  • SC – “Mid to late month was the closest I’d get.”

Seems these particular women either have previously gotten bitten by the pesky due date or learned in the first pregnancy not to put too much stock in an arbitrarily determined date. I say good for them!

As a midwife assistant, I now participate in the baby assessments. Some of these post birth assessments gestationally date baby. Often the dates are different than the due date assumption. Some earlier and some later.  This happens even with women who knew exactly when the last menstrual period, ovulation, and conception occurred along with cycle length.

Only the baby (and God according to my belief) knows the due date aka when he or she will press start.

Early is not one day prior to 40 weeks EDD just as late is not 40 weeks and 1 day over EDD. Full term pregnancy is defined as 37 weeks-42 weeks gestation.

I think it is high time “we” layoff pressuring mamas and their babies. “We” must stop trying to evict them earlier than they desire without a true medical reason. One day to any adult is nothing, but even a day to an unborn baby coming earthside can mean the difference between alive and thriving.

Technology and the Prenatal “Diet”

Wednesday, February 17th, 2010

In westernized countries, television and the internet have almost completely replaced the generational teaching and learning found in the “circles” of the past. Women would gather over sewing, quilting, canning, and life events including pregnancy and childbirth. They offered support, told their stories, spoke of family life, shared their everyday knowledge, wisdom and expertise while the children played at their feet.

At first glance it seems that through these technologies women are able to gain vast amounts of incredible knowledge regarding childbirth.  There are very popular websites, message boards and forums to meet and greet other women who are expecting the very same month.  Any topic is available to explore. Excellent places for a sense of community and belonging. The information is so prevalent that some women even eschew childbirth classes because they feel well enough prepared from all the exposure. Fantastic to be sure, at first glance.

Upon a deeper look  with a critical eye at the most popular shows and on-line communities, it becomes pretty obvious that overwhelmingly the messages and scenes actually have little to do with real encouragement and instilling confidence in a woman’s design and inherent ability to birth.

Let’s start with the satellite/cable television shows on the learning and health channels. Stop for a moment and think of what occurred during the last episode you viewed.  Did you see a spontaneous labor from entry to hospital to birth without augmentation, epidural, or any other intervention except for intermittent monitoring and perhaps a saline lock (IV port) placed? Was it an induction with an epidural? Was it a cesarean or a vaginal delivery? Did she have adequate support? Was her background given in any detail? Who made the decisions? What about informed consent? Was the laboring woman paid attention too or were the machines heeded more? What sort of comfort measures did she employ? Was she ever out of bed? Who delivered the baby?  What response to her baby did the mother have? Who saw her baby first? With that clear memory in mind, how did you feel after viewing it? What thoughts came to your mind? Now consider that essentially all of the births shown take place in a hospital. In fact any birth that does not, is often touted as extreme or some other like descriptive.

Let’s move on for a moment.

Now let’s take a look at the most popular pregnancy websites, message boards and forums where women connect with one another.  The “conversations” and threads are filled with all things related to the impending birth. Chatter about baby showers, maternity leave, body changes, vaccinations, previous experiences, breastfeeding, nursery preparations and so much more. Really anything under the prenatal sun. Inspecting further though, there seems to be an inordinate amount of discussion regarding the need for scheduled inductions and cesareans and very little conversation or even support for natural or spontaneous labor and birth.

With intervention appearing to be the ruling majority within the technological communities and filling the television, how is a pregnant woman feeding her eyes, heart, and mind on this type of diet supposed to feel confident, uplifted and excited about her upcoming birth? I am uncertain that she can with the seeds of inadequacy, fear, brokenness, helplessness, and lack of options being sewn into her being at such an alarming ratio.  Sometimes yes interventions are needed, however, in practice it isn’t a need for many women and babies.

These shows and internet locales are like junk food. Like all junk food they are not to be an integral part of a healthy prenatal “diet” that will be encouraging, expand useful knowledge, grow confidence, spark self-advocacy, promote self-awareness, ignite excitement, and offer joy to the expecting mother.

How can an expecting mother improve her “diet” regardless of the type of birth she is planning? What are the better places to “shop”?

  • Turning off the TV
  • Check out and attend local groups and support meetings. Educational sessions and workshops are often free of charge. For example: Doula Groups, ICAN, Midwifery Groups, Birth Network, Birth Circles, and similar.
  • Try some different message boards, forums and sites. See Blog Roll and Resources listed on this site.
  • Seek out positive free videos to watch on You Tube.  http://prepforbirth.com/2009/07/30/birth-videos/
  • Talk to women who have birthed in the hospital, birth center and at home. Get a variety of positive stories.
  • Try some different reading on for size. http://prepforbirth.com/books-videos-and-more/
  • Rent or borrow movies from Netflix, a doula or childbirth educator, such as, Business of Being Born, Pregnant in America, or Orgasmic Birth to name a few.
  • Take the challenge to learn about and be open to the variety of birthing techniques, locations, options and provider types that women are utilizing.

Bottom line, the most prevalent “food group” in a diet is going to positively or negatively affect the parts and the whole of the journey to having a babe in arms.  No matter what the mother and baby live with the outcomes from the birth. Enriching the prenatal “diet” is not a guarantee of outcome or path to the birth. It does however give much more possibility and opportunity for both mother and baby to have a better birth and start together.

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.