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Dear Family and Friends of Expectant Mom,

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     We know that you are anxious to hear news about your loved one going into labor and giving birth. And we know that you really do care.     

     If you really want what is best for this woman-in-waiting, you might consider leaving her alone for now. We promise, someone will let you know when anything important occurs.       

     We also know that you have a wealth of knowledge and experience. But sharing that right now is not going to make the baby come any sooner. And it just may cause your loved one some fear and stress. Now, we all know, those two emotions are not good for momma or baby.     

     We know that you are acting out of love and concern. It is for that reason we ask that you give her the most important gifts…faith, trust, love, patience, and plenty of space.       

     We know she is dealing with her own thoughts, discomforts, impatience. Please do not give her yours, too.      

     Thank you so much for understanding and not having hurt feelings. Do not worry, your new, wee baby will be here exactly when the time is right.      

Respectfully,  

Triad Birth Doula, 

Doula of a 40+ week momma-in-waiting

 

VBAC

VBAC Momma

 

 

 

 

 

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Baby Belly Bazaar March 2015

bbb 4x6 card front (2)It is almost time for the Baby Belly Bazaar and the excitement is growing!!!

Fifty vendors are expected and several talented artists are prepared to decorate your baby belly!

on line sponsors

Our sponsors alone indicate what a wide range of information, education and fun that will be available to you!

And there are many more vendors!

Don’t miss this exciting event that is just for you and your baby!!!

Saturday; March 21st; 11am-3pm;  Greensboro Cultural Center

The Squat Bar

The squat bar can be an awesome tool to use when you are pushing your baby into this world. But it can be very confusing as to how to use it…and feel strange. I will try to give you a feel for it with the pictures and comments below. Unfortunately, it is rare to have an opportunity to actually practice with a bar.

3cbd034e9e27cd1efe410ff6801cc37b.wix_mp_1024 This is how the bar and the bed are positioned. You sit right on edge of raised portion until a contraction comes. Then with a contraction, you squat so your bottom is not touching bed, and you push.

khkhjymjjkujPushing like this at first can feel a little insecure because all of your weight is on that lowered portion of the bed. It will help you to know that your support person is right there with you.
It may also help to have entire bed lower to the ground so you do not feel like you might fall off a cliff.

hNote how the bar is tilted towards the foot of the bed and all of your weight is on lowered portion.

 

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Between contractions, you can try to rest the weight of your body back onto the higher portion of the bed.

 

index (2)Then, with a contraction go into a deep squat, supporting yourself with the bar.

squatting bar on hospital bedRemember, your support people are right there for you and will help steady you. And having the entire bed lower to the floor will also help you to feel more secure in this position. Everyone else will accommodate your position.

a4128bd43637fbfa63d5aa40946a1e19.wix_mp_1024This is an awesome way to use the squat bar and “tug-of-war” position. Please note how she is not on her bottom; how she is really in a squat but on her side. Very useful with an epidural. “Tug-of-war” position is usually used for pushing; not labor.

maxresdefaultI’m not sure about this kind of position because while it simulates a squat, it leaves her sitting on her butt. It does, however, allow for that “tug-of-war” position.

fThis position allows you to be asymmetrical while being able to take some weight off of the lower body by leaning on the bar. If possible, spread your legs as wide as you can.

 

Most of these positions can also be good for labor. It is considered best to use the bar for a deep squat during a contraction. Sit back and rest in between. You want to be sure that when you are in that deep squat, you are NOT PUSHING until your cervix is ready.

If your hospital does not have squat bars…start asking for them. This is how change can occur!

Tools for Birth

When you are ready to give birth, you will have an arsenal full of tools you wish to use during this most important and exciting experience.  <<   

You will have all of your recent education, your birth wishes, your doula, your midwife. You will <have your birth ball, your birth pool, your willingness to do what you need to do.

Your desired ambiance will be created through lighting, music and aromatherapy. <And most important…you will have your open mind.

If things might not go as you originally hoped they would…you will have another set of tools that some call interventions. And you will know in your heart that there is a time and place for every intervention that man has created. <And so your tools will have grown to include pitocin, pain medication, epidural, and if need be, a cesarean.

And in the end, you will have your new baby in your arms. <Your dream of many days and weeks will be complete.< Perhaps not exactly as you had hoped and planned. And for that you may need to grieve. And that grieving will be good.

But you will forever know that you had prepared, and used,  your tools. And you had prepared, and used, your open mind. <And then, and for always, you will have your baby; your family.

 

Hypnobabies®

Hypnobabies® says…
“Enjoy your baby’s birth in comfort, joy and love…”

And that is exactly what I witnessed!

But this type of birth is only going to work for you if you believe and if you invest yourself…also known as practice and prepare.

Hypnobabies® was not the only thing going on with this birth.

There was just so much love in this room…between mom and dad and son and parents. It was perfect the way dad read the script while son performed the touching. And, of course, when there is this much love you know that the oxytocin levels are unbelievable. Then add the soothing effect of the warm waters of a birth pool…well, no wonder this labor did not go on for hours on end.

And just to make this birth even more special…a well known doctor, Dr. Stringer of Central Carolina OB/GYN in Greensboro, NC, was the one who had the privilege of guiding this baby to her momma’s waiting arms.

A week or so later and it was finally my turn…

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     I love my work!!! Thank you, Mom & Dad!!!

https://www.hypnobabies.com/

100 and Counting!!!

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It gives me a great deal of pleasure to introduce you to my 100th Baby and Family!!!

Congratulations to all!!!

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What Impact Can IV Fluids Have on Mother, Baby and Breastfeeding?

 A Quick Look.

images (4)Written by guest author, Jacqueline Levine

Having IV fluids is a medical procedure. It’s meant to restore normal body fluid balance when there’s blood loss or dehydration, but the Listening to Mother’s Survey1 reports that 83% of women have IV in labor. Having a routine IV , as so many do, isn’t risk-free.2 An excess of IV fluid can dilute red blood cells and other components of the blood like clotting factors, so that less oxygen gets to the uterus and less to the fetus, increasing the possibility of post partum anemia or hemorrhage3,4.
Too much fluid can overcome normal pressure in blood vessels, and fluid goes where it shouldn’t. The mother’s and/or baby’s lungs can become “wet”5. Large amounts of fluid given quickly (a bolus) can interfere with the activity of the uterus.6 The type of IV fluids given can have unhappy effects as well, such as hyponatremia which can cause seizures, and symptomatic hypoglycemia in the baby7,8,9. Plastic IV lines may “off-gas” phthalates and other chemicals that are harmful. This list is brief. There are lots of studies that show harms from routine use of IV. Even the safety of “normal saline” has come under scrutiny.10 And the effect of IV administration lasts well into the days after the mother is disconnected from her hanging bag of fluids.
Fluid has weight, of course; haven’t you heard that helpful little reminder, “a pint’s a pound the world around”? If a laboring mother gets bag after bag of IV fluids, odds are that her baby will be born with an inflated birth weight. Breastfeeding success is often measured by how quickly the baby regains its birth weight after the normal weight loss in the first week or so. What exactly might that baby’s normal birth weight have been? What does it mean to the motherbaby pair when of them both are full of extra fluids? Water moves everywhere in the mother’s body and aside from ankles and wrists and fingers and toes that can be swollen like sausages, breasts and nipples hold water as well. A swollen breast with taut skin makes latching difficult. This scenario is often the beginning of early nursing troubles10: the transition from colostrum to mature milk may be delayed in a water-swollen breast, and a newborn may not able to achieve a deep latch so he can’t get sufficient food and cannot stimulate the breast well. Supplementation comes next. We know it and the studies show it. There are remedies to those situations…good support for mother and baby… but best-evidence, optimal maternity care is the answer.
Supplementation frequently comes next. We know it and the studies show it. There surely are remedies to the problem of swollen breasts, like Reverse Pressure Softening, and methods to build up milk supply, and ways to support better positioning for a baby who is having latch difficulties..
But the overarching answer is for mothers to be aware of best-evidence, optimal maternity care, and to understand their rights as patients to refuse routine interventions. By avoiding IV fluids except for compelling medical reasons, mothers will be able to avoid the negative consequences of fluid overload to their babies and themselves, and give themselves a chance at better breastfeeding beginnings.

Jacqueline (Jackie) Levine, LCCE, FACCE, CD(DONA), CLC is committed to providing a continuum of care for underserved women at PlannedJackie-Levine Parenthood, on Long Island, NY, where she has provided free Lamaze education, birth and breastfeeding support to all the women in her classes for the last 9 years. She is a guest lecturer on Childbirth in the US at CW Post, has worked for CIMS, contributed to the Lamaze e-newsletter Building Confidence Week-by-Week , all after her 30-year career as a designer in the garment center. Jackie is a recipient of the Lamaze Community Outreach Award, mother of three and Grandmother of five.” Science & Sensibility

 
References:
1-DeClerq E, Sakala C, Corry MP, et al. Listening to Mothers ll: Report of the Second National US Survey of Women’s Childbearing Experiences. New York: Childbirth Connection
2-Wasserfstrum N. Issues in fluid management during labor; general considerations. Clin Obstet Gynecol 1992;35(3):505-13
3-Carvalho JC, Mathias RS, Intravenous Hydration in obstetrics. Intl Anesthesiol Clin 1994:32(2):103-15
4- Carvalho JC, Mathias RS,Senra WG et al. Hemoglobin concentration variation and blood volume expansion during epidural anesthesia for cesarean section. Reg Anesth1991;16(1S):73
5-Gonik B., Cotton DB.,Peripartum colloid osmotic changes; influence of intravenous hydration. American Journal Obstet Gynecol1984;150(1):99-100
6-Cheek, T.G., Samuels, P.,Miller, F., Tobin, M., Gutshe, B.B. Iv load decreases uterine activity in active labor. Journal of Anaesthesia 1996;77:632-635
7-Stratton JF, Stronge J, Boylan PC. Hyponatremia and non-electrolyte solutions in laboring primigravida. Eur J Obstet Gynecol Reprod Biol 1995;59(2):149-151
8-west CR, Harding JE. Maternal water intoxication as a cause of neonatal seizures. J Pediatr Child Health 2004;40(12):709-10
9-Nordstrom L, Arulkumaran S, et al. Continuous maternal glucose infusion during labor; effects on maternal and fetal glucose and lactate levels. Am J Perina. Am J Perinatol;1995;12(5);357-62
10-http://www.modernmedicine.com/modernmedicine/Modern+Medicine+Now/Normal-saline-is-not-normal-may-be-harmful/ArticleNewsFeed/Article/detail/776186?ref=25
11-Chantry CJ, Nommsen-Rivers LA, Peerson JM et al. Excess Weight Loss in First-Born Breastfed Newborns Relates to Maternal Intrapartum Fluid Balance. Pediatrics 2010

Obstetricians Study Themselves

It is my privilege to share another thought provoking article by Jacqueline Levine, LCCE, FACCE, CD(DONA), CLC

Your obstetrician is afraid of being sued.

imsssagesShould that fear guide the way you’re treated during your pregnancy, labor, and the birth of your baby? Should fears of litigation have a direct effect on the rate of cesarean section in our country, and should your risk of having a c-section depend on your OB’s personality?

How about best-evidence optimal maternity care? Do you believe that the maternity protocols in use by OBs reflect the best science, using “Level A” evidence-based protocols and practices? And if there’s a proven, effective training program that takes just two days and lowers c-section and morbidity rates, shouldn’t that training be in use in every hospital and everywhere women have their babies? Common sense and our general understanding of ethical behavior make us want to answer those questions with confidence, just as you think they should be answered.

The dismal truth, however, is that those questions must be answered in just the unequivocal opposite of what your good sense tells you.
The cesarean rate in the US seems to have stopped rising and has leveled off, as reported last year by the Center for Disease Control and Prevention (CDC). The information came from the National Center for Health Statistics, and it says, in sum: “After 12 years of consecutive increases [1998 to 2009], the preliminary cesarean delivery rate among singleton births was unchanged from 2009 to 2011”; the report cites the current rate as 31.3%. That the rate has stopped rising is good news. And that the rate is too high is not in dispute. The World Health Organization (WHO) and other orgs that promote and support optimal maternity care have been making that case for a good while.
Now, famously, ACOG has come out with a position paper, a report entitled “Safe Prevention of the Primary Cesarean Delivery”, with guidelines meant to prevent a first-time c-section; the study calls for “revisiting” the list of the “common indications” for cesarean. Those various rationales for section have held sway in maternity care for years. We understand that the new guidelines are a hard admission that the rate of surgical birth is indeed far too high, and that current practices do not promote the general health of women and babies. ACOG wants to “prevent overuse” of c-section. (See Obstetric Care Consensus Number 1, March 2014, entitled “Safe Prevention of the Primary Care Delivery”, from the American College of Obstetricians and Gynecologist, along with the Society for Maternal-Fetal Medicine.)
We should understand that the forces driving maternity care are not totally about optimizing the health of mothers and babies, but rather respond to other imperatives. Examples follow.
At the 57th Annual Clinical Meeting of the American Congress of Obstetricians and Gynecologists (as reported in Medscape Today; Medscape Medical News, May 12, 2009), there was discussion of an article entitled “Liability Fears May Be Linked to Rise in Cesarean Rates”. I’ll just quote it directly so that you can have the very words of the study as reported (bold emphasis is mine):
PhysiciansBenefitCopingSupport“It has been suggested that medical-legal pressures are a factor in the high number of cesarean deliveries. A number of studies have borne this out. Localio and colleagues (JAMA. 1993; 269:366-673) found a positive association between medical malpractice claims risk and the rate of cesarean delivery. Murthy and colleagues (Obstetrics & Gynecology 2007; 110:1264-1269) found an association between professional liability premiums and rate of cesarean delivery — for every $10,000 increase in insurance premium there was a 15% increase in the rate of cesarean (s)delivery. Dr. Barnhart said “First of all, I applaud the abstract, in that it quantifies a perceived problem,” “We all anticipated that defensive medicine might be a reaction to litigation, and this paper demonstrates that that is indeed the case,” “So don’t just blame the doctor for doing a C-section, recognize that there’s probably a reason that [he or she is] doing it. And that fear of litigation is the reason,” Dr. Barnhart concluded.”
This article is really a confession. It’s a way to say “You see, it’s not our fault that we have to do all these c-sections. We’re just human and fear is making us do unnecessary surgeries, just in case we get sued” and puts the OB in the role of victim. It’s “defensive” medicine…and where might this kind of medicine be taught in the medical curriculum? It’s an admission that what is being done in the way of care may be for the welfare of the OB, and not for the welfare of the women in his care. Do docs acknowledge the possible effect of malpractice insurance on birth options?
We assume that the most fundamental tenet of care is that what a doctor does is for our benefit, and not for her or his well-being, convenience or safety. We are right to feel that any doctor who picks up a scalpel and performs surgery for these “defensive” reasons is behaving in a way that is the antithesis of ethical behavior, a betrayal of our trust in the doctor-patient relationship. It’s easy for the OB to use cesarean delivery as an answer to all potential problems, to say that something might be wrong, do the surgery, and when of course everything turns out fine, mother and family are just relieved.
But should you have to give up your right to be treated according to your genuine health status, and have to risk the many documented hazards of c-section for both you and your baby, and perhaps compromise your future reproductive health to protect the personal welfare of your doc? So yes: your OB may treating you to promote his or her own personal, financial interest, since that study shows a willingness to admit that one of the reasons for the high cesarean rate is fear of litigation.
Another example: does your risk of c-section depend on your OB’s personality? Again, the answer is yes. A disturbing article, called “Women’s Risk of Having C-section May Depend on Her Obstetrician’s Personality”, discusses a study published in the Journal of Obstetrics and Gynecology in 2008. (Here is the citation: Allcock, C., Griffiths, A., & Penketh, R., The effects of the attending obstetrician’s anxiety trait and the corresponding obstetric intervention rates. Journal of Obstetrics and Gynecology, 28(4), 390-393. [Abstract]). “Trait anxiety” is an integral and unchanging part of the human personality and is very different from “‘state anxiety’” which happens in response to a particular situation
The results of the study are very concise, and as before, quoting directly makes things abundantly clear: The obstetricians with the least anxiety had the lowest emergency cesarean rates. imagesThe obstetricians with the most anxiety had the highest rates.”
Statistical analysis revealed that the doctor’s trait anxiety levels were highly correlated with cesarean rates. It’s unlikely that the human condition and the pantheon of measureable personality traits has changed much since ’08. It’s likely that there are still discernible anxiety levels among OBs, that might cause them to react to those anxious feelings and perform sections for that anxiety.
These studies document just two of the many factors that affect a birthing mother’s chances of having a cesarean, and how many of those factors have to do with a mother’s or baby’s actual health status? Of course there’s literature that proposes other reasons for the high c-section rate, but the studies discussed here expose a side of obstetric practice that is particularly damning. Each doctor makes a choice either to treat ethically, or alternately, with regard for his/her own interests and inclinations.
Here’s some mixed news from the industry. It’s the publication of the study entitled: “Scientific Evidence Underlying the American College of Obstetricians and Gynecologists Practice Bulletins (Wright, Jason D. MD; Pawar, Neha MD; Gonzalez, Julie S. R. MD., et al), published in Obstetrics and Gynecology in 2011”. This study examines the protocols and guidelines used in obstetric care as to their basis in good science. We can only applaud OB’s decision to examine their own guidelines and protocols, no? This quote comes from the Abstract of the study: “We examined the quality of evidence that underlies the recommendations made by the American College of Obstetricians and Gynecologists (the College)”. So far, so good
But the words that cause that frisson of anxiety are in the conclusion of the study: “One third of the recommendations put forth by the College in its practice bulletins are based on good and consistent scientific evidence.” That evidence is called “Level A”. That can only mean that the remaining two-thirds are not. That’s 70% of the care protocols used on birthing women are not based on the best science! Doctor #1What does this mean to each birthing woman? Must she be on the lookout for practices based on anecdotes, opinions, traditions and other poorly supported evidence? How will she know? And why should she ever even have to worry?
Making that point even more painfully is this study from the Society for Maternal-Fetal Medicine’s 34th Annual Meeting, presented February 6, 2014, with this title Training Reduces Cesarean Delivery and Neonatal Morbidity, and published online in Medscape Medical News © 2014 Feb 07, 2014. This important study needs to be quoted:
“A multifaceted intervention program for health professionals aimed at reducing the rate of cesarean delivery succeeded in doing just that, according to a new multihospital study…. “Our hypothesis was that intervention at the right time would provide the chance to improve the quality of obstetrical care and reduce morbidity. “… ” The program involved a 2-day on-site training workshop for health professionals that focused on the best clinical practices for intrapartum care…. and that did significantly reduce neonatal major morbidity (OR, 0.81; P = .028) and effect minor morbidity (OR, 0.88; P < .001). …
“This study of more than 100,000 women shows that an interventional program can not only reduce the chance of cesarean delivery, but can also reduce neonatal morbidity, noted William Grobman, MD, professor of obstetrics and gynecology-maternal fetal medicine at the Northwestern University Feinberg School of Medicine in Chicago.
“The important thing is that this did not involve new therapies or methods. This was totally about the delivery of health services,” Dr. Grobman told Medscape Medical News. “We often focus on new treatments, but sometimes it’s the relatively simple things — education, quality improvements, quality control, and feedback — that can substantially affect maternal and child health.”
Shall we assume that nurses and docs just don’t know “best clinical practices’ without this extra training, or forgot them, or find it inconvenient to use them? If it takes only two days of training to correct bad practices, what can we think?
Is the problem not clear? Bad practices based on less-than scientific evidence and unethical behavior and personal character traits and fear of litigation and ignorance…the “ignoring” of best clinical practices, can guide maternity care. If only a third of maternity protocols…for both mother and newborn…are based on best-evidence science, what about the rest of the care woman and their babies receive? And if that unscientific behavior can be remedied by a mere two-day course that reminds docs and nurses how to observe optimal care practices and can fix the huge problem of high c-section rates and other insults to the health of mother and baby, how can a mother make her way through this system without coming to some kind of harm? We have the words of the maternity caregivers themselves to read and ponder.
OBs are ducking questions about the morality of performing cesareans for defensive reasons, and ducking patient’s questions about best-evidence care, but somehow we have to make them face this reality: “Approximately one-third to one-half of maternal deaths can be attributed to the cesarean procedure itself.” And: “There are no well-documented prospective trials demonstrating benefit to the fetus or to the mother that would justify the extent of the increase in the primary cesarean rate.” These quotes are from Obstetrics: Normal & Problem Pregnancies, 3rd Ed. Gabbe et al. p634).
There are many caring and dedicated practicioners who stay current and give only best-evidence care. We admire the ethical caregivers who do not rely on routine interventions and who use surgery only to save the lives or health of babies and mothers, and not for their own welfare, but the high section rate illustrates the fact that they may just be a minority.

ifffmagesWe have only that one day, that one chance for each baby we birth,

so when deciding on a caregiver, it’s our responsibility to get familiar with best-evidence, optimal maternity care and question our health care provider about his/her practices. We need to learn the facts about normal, healthy birth, and conservative reasons for c-section based on real health status as well. Recommendations for OBs, hospitals and midwifery care from women across the United States can be found at the non-profit, all volunteer website www.thebirthsurvey.com Your prospective OB knows that best-evidence information is out there for you to see, so question him/her closely about his/her c-section rate, induction rate, episiotomy rate, and other routine and common practices that may not confer best-evidence care upon mother and baby. If you sense a defensive posture about his stats, or an air of reluctance to tell you what you want to know, politely say your thank-you’s, and head for the door.

Jackie-Levine“Jacqueline (Jackie) Levine, LCCE, FACCE, CD(DONA), CLC is committed to providing a continuum of care for underserved women at Planned Parenthood, on Long Island, NY, where she has provided free Lamaze education, birth and breastfeeding support to all the women in her classes for the last 9 years. She is a guest lecturer on Childbirth in the US at CW Post, has worked for CIMS, contributed to the Lamaze e-newsletter Building Confidence Week-by-Week , all after her 30-year career as a designer in the garment center. Jackie is a recipient of the Lamaze Community Outreach Award, mother of three and Grandmother of five.” Science & Sensibility

Please feel free to send comments/questions to Jackie: birthlink@optonline.net

 

The Use of Lubricant During Childbirth

 

     When a woman is pushing her baby into this world, the care provider will more than likely use a lubricant to help make the crowning process, and then birth, easier and hopefully result in less tearing. * And no, our bodies usually will not create enough natural lubrication at this point in birth.BirthBowl.2jpg

     At the hospital where I most often attend births, this lubricant is soapy. I use to laugh and say the baby was getting his/her first shampoo.

     The other day, a nurse told me as she was watching this process that she noticed the newborn squinting, blinking, having a difficult time keeping his/her eyes open. And then it struck her, there was soap in his/her eyes! For all these years and births, they have been putting soap in the infant’s eyes. And we all know how that feels.

     The solution appears easy enough…do not use a lubricant that is soapy. Okay…but then what should be used? It must be something that is sterile and water-soluble so as not to harm mother or baby…right?

     I thought perhaps mineral oil. Someone else suggested vitamin E oil. Why not baby shampoo? If it is safe for a baby, with “no more tears”, would it be safe for a newborn?

     Whatever suggestions you may come up with, please, please, discuss with the experts before using. I am not an expert. I am just a doula who wonders about that soap in the newborn’s eyes.

*No lubricant is used in a waterbirth.