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CHECK YOUR HOSPITAL BILL

male-teenagersI suppose this is something that we all know that we should do but here are reasons from women like you…

CHECK YOUR HOSPITAL BILL!

Shared from a Triad Birth Doula Facebook post on October 7 & 8, 2016:

Yesterday I posted an article from CBS, “Dad says hospital charged $39 to hold newborn baby”, and a mama shared something VERY IMPORTANT!!!

Mama: Just FYI for patients at women’s. I asked for an itemized bill, and they charged me for numerous things I declined. Eye drops, sugar drops, numerous visits with lactation that didn’t actually occur. When I called they said “oh you must be self pay. Pat…See More

Triad Birth Doula: Are you kidding me??? May I make separate post of this?

Mama: Of course, and no I’m not kidding. The only reason I asked for an itemized statement, was because when I declined the sugar drops, the nurse went ahead and scanned them anyways. Didn’t even open them. I wanted to check on that. That’s when I saw the eye drops, that were not given, and all the lactation visits.

Triad Birth Doula: Thank you! Women need to know this! What are the sugar drops? Haven’t heard of that.

Mama: When they draw blood, for the blood test kit they give it to babies as a distraction. Just a couple drops of sugar water, no big deal. I don’t know the proper term. In my survey I included a whole letter, about all this, plus I called and spoke with an administrator, (who made the statement above) also told me the lactation charges are automatically billed. So basically, if they walk in your room, you are billed $50, even if you say no thank you and they leave and do nothing. It’s not about the money, But to get a bill, and see $250 worth of charges that I declined and did not receive is disgusting. After this experience, I request an itemized bill for everything!!

Triad Birth Doula: Wow! Again…thank you for sharing!!!

2nd Mama: This happened to me as well. I had to ask for an itemized bill for my AFLAC plan, and when I saw a few things and was curious, I started googling things. Discovered I was charged for at least $300 worth of supplies/services that weren’t used. They charged for a standard IV as well as a Pitocin IV which I specifically declined both. They charged a lot of random things for the baby as well – like a nebulizer that she didn’t use/need at all.
I asked my friend who is an L&D charge nurse, and she said they scan things that are checked in to the room as a precaution. But that they also have to chart everything that happens to and is given to the patient, so if you disputed it, they would be able to take it off the bill because they’ll see it’s not in the actual chart/files.
I’m with (1st Mama) – will always ask for itemized bills from now on!!

Triad Birth Doula: Exactly!!! May I share your comment?

2nd Mama: Yes – anything to help make this stop.

If this has happened to you, please share your story on https://www.facebook.com/TriadBirthDoula/

 

 

 

PROM AT TERM… Some Evidence

index-14PROM AT TERM… Some Evidence  

written by Jackie Levine

 

Many define PROM as any release of waters before labor has actually begun…. whether at 32 or 42 weeks. There are recommendations about the management of PROM, but there’ is no definitive proclamation from the CDC or anywhere else  about what one “must” do to a woman after a certain number of hours have gone by without some contrax, especially at “term”.  The statistics about PROM pretty much don’t change….around the world the same % of women will go into labor and will birth  after 12-24 hours,  the same % after 48 hours, then 72 hours, etc, with the same low per centage of mothers and babies sustaining infection. 

It seems that the whole establishment is not convinced about exactly how to handle PROM, and the studies continue. You can find  ACOG practice bulletins on this at least since 2000.  The studies don’t all study things the same way….yes to pelvic exams?  No exams?  Expectant management with testing for fever or other signs of infection?  When and how?  Many mothers are really in early early labor, water breaks but there are no discernible contrax, yet the cervix is slowly slowly beginning to change.  Do these women as qualify as PROM and should they be put in the 24-hour queue? Or should they br  “classified” as being in labor, however early, which takes the “P” out of PROM…

The latest info on this is from the Cochrane, 2014. Here’s the “Background” and the “Conclusion”, followed by the citation.  This information may help mothers-to-be to make the  decision about whether to be treated according to routine, cookie-cutter care  that her OB applies to all clients with PROM at term, or to make sure that  a truly genuine  assessment of her  and her baby’s individual, actual health status is made.

BACKGROUND:

Prelabor rupture of the membranes (PROM) at or near term (defined in this review as 36 weeks’ gestation or beyond) increases the risk of infection for the woman and her baby. The routine use of antibiotics for women at the time of term PROM may reduce this risk. However, due to increasing problems with bacterial resistance and the risk of maternal anaphylaxis with antibiotic use, it is important to assess the evidence addressing risks and benefits in order to ensure judicious use of antibiotics. This review was undertaken to assess the balance of risks and benefits to the mother and infant of antibiotic prophylaxis for PROM at or near term.

AUTHORS’ CONCLUSIONS:

This updated review demonstrates no convincing evidence of benefit for mothers or neonates from the routine use of antibiotics for PROM at or near term. We are unable to adequately assess the risk of short- and long-term harms from the use of antibiotics due to the unavailability of data. Given the unmeasured potential adverse effects of antibiotic use, the potential for the development of resistant organisms, and the low risk of maternal infection in the control group, the routine use of antibiotics for PROM at or near term in the absence of confirmed maternal infection should be avoided.

Cochrane Database Syst Rev. 2014 Oct 29;10:CD001807. doi: 10.1002/14651858.CD001807.pub2.Antibiotics for prelabour rupture of membranes at or near term.Wojcieszek AM1Stock OMFlenady V.

Here’s another concise recent piece of information: JUNE 18, 2015/BCAYLEY Summary: For women with pre-labor rupture of membranes occurring after 36 weeks’ gestation (who do not have a confirmed infection), use of antibiotics does not appear to reduce the risks of endometritis, early-onset neonatal sepsis, maternal infectious morbidity, stillbirth, or neonatal mortality; but use of antibiotics in this situation may be associated with increased rates of cesarean delivery and maternal length of stay in hospital, and potentially could be associated with adverse medication side effects from antibiotic use and the potential for the development of resistant organisms. (In other words, avoiding antibiotic use for prelabor rupture of membranes after 36 weeks’ gestation unless there is a confirmed maternal infection, may be associated with lower risks adverse antibiotic effects, lower rates of cesarean delivery, and shorter maternal stay in hospital; without increasing the risks of any neonatal or maternal morbidity or mortality.)

http://www.ncbi.nlm.nih.gov/m/pubmed/25352443/

 

 

Thank you, Jackie! You know I, Triad Birth Doula, always enjoy sharing your articles.
Interesting thing…in my experience here in NC, I have only had antibiotics offered once for PROM, which mother refused much to the doctor’s distress.
I have had a couple of mothers become sick after 24+ hours and were then given antibiotics as soon as fever appeared. But no wonder with all of the vaginal exams, catheter and internal monitor due to pitocin & epidural.
I have a theory about avoiding PROM….
Around here, and with my clients, I feel that a sudden drop of barometric pressure is all too often the culprit of PROM. So I suggest that when we know this type of weather is going to occur, drink extra water and if safe get in bath tub. If not safe (lightening) lie down so at least gravity is taken out of the picture.
Some may laugh at me but I believe in this.

 

 

 

Active Management of Third Stage of Labor & Birth

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Jacqueline Levine, Childbirth Educator/Lactation Consultant, has taken a hard look at the Third Stage of Labor and Birth.
If this stage is “managed” or not may have an impact on your breastfeeding.
Take a look at what this long time professional has to say…..

Prophylactic pit is just  part of that package of “Active Management of Thirds  Stage of Labor” (AMTSL) and there’s  a really great analysis of that concept  and its consequences  in “Optimal Care in Childbirth” Romano and Goer’s  great book.  They contend, and studies agree,  that the medical model of birth…induction and pit to augment labor and other protocols…are modifiable causes of PPH (Post Partum Hemorrhage),  and all woman do not just bleed to death after birthing their babies.   

We know that docs think that medical intervention is always the answer to a problem… never the cause.   I quote from the Goer/Romano book “…research fails to provide ANY evidence that universal application of AMTSL   results in clinically important improvements in maternal outcomes in developed countries, while documenting that it introduces harms”  (p379).     

 In 2010, Cochrane reviewers raised many issues about the trade-offs between the benefits and harms of managing third stage, including worries about prophylactic pit for all women regardless of their risk profile. The key phrase for looking at PPH is, I think, “developed” countries.   99% of deaths due to hemorrhage are in undeveloped and developing countries (says the WHO) , and pit has had  great success in the prevention and treatment of PPH in low-resource countries.

 But here in the US and  in other  high-resource settings, AMTSL “ conferred no benefit other than a small absolute reduction in transfusion rates, but findings show that transfusion rates are not an objective measure”, (Goer/Romano p379), because of the biases found in decisions about  the administration of transfusion and the lack of standardization as to when to treat.   Here, where we have the best medical resources (badly used and badly distributed, no doubt), a pit shot for every woman is overkill, unnecessary for the healthy mother, takes the place of her own highest-ever levels of natural oxytocin, upsets the beneficent cocktail of post birth hormones  the high levels  that nature provides for the most successful and joyous first minutes and hours with her newborn.  

During a c-section,  the mother may lose as much as 1000ml of blood, and that’s not enough to make docs call for a transfusion, but the standard for vaginal birth is only 500ml, and one wonders how they can tell how much blood loss there really is, when much of what a woman loses may be absorbed in the chux pads under and around her.

The Cochrane  says” Women should be given information on the benefits and harms of both methods to support informed choice. Given the concerns about early cord clamping and the potential adverse effects of some uterotonics, it is critical now to look at the individual components of third-stage management.”

Active versus expectant management for women in the third stage of labour. Cochrane Database Syst Rev. 2011; 11:CD007412 (ISSN: 1469-493X) Begley CM ; Gyte GM ; Devane D ; McGuire W ; Weeks A
School of Nursing and Midwifery, Trinity College Dublin, 24, D’Olier Street, Dublin, Ireland, Dublin 2.

 

Premature Rupture of Membranes (PROM)

severe-ne-5jun16

We, of the NC Triad, may just get some severe weather this evening, along with the rest of the east coast.

Why do I mention this?
Because rapidly falling barometric pressure could potentially break your bag of fluids if you are close to 40 weeks.

If your baby and your body are not ready for labor, this is called Premature Rupture of Membranes (PROM).

And this sets you up for a difficult and long labor.
So??? What to do???
I suggest drink, drink, drink that water.
If it is not dangerous, get into water where the pressure can be equalized.
At very least, lie down so that you are taking gravity out of the picture.

And if your water breaks…then you take it one step at the time.

This is a great article about PROM from Rebecca Dekker of Evidence Based Birth

http://evidencebasedbirth.com/evidence-inducing-labor-water-breaks-term/

 

 

 

Dear Family and Friends of Expectant Mom,

images

     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

 

YOU must make it happen!

When you give birth, you can have a quiet, peaceful, private environment…even in the hospital but YOU must make this happen.

It will be YOUR responsibility to share your wishes with your care provider.
It will be YOUR responsibility to share with the hospital staff that this is what you want.
YOU will need to tell them that you want dim lights, soft voices, minimum interruptions, no spectators (students/trainees).

You can accomplish this by discussing this with your care provider, by including it in your Birth Plan/Wishes, by telling the staff when you first arrive, by reminding your care provider, and by having your partner remind everyone as needed as labor progresses.

The environment you establish can be very important to your, and your baby’s, experience.
But YOU must make it happen.

VBAC

VBAC Momma

 

 

 

 

 

Click on picture

When a woman is first administered an epidural…she needs her doula.

indexWhen a woman is first administered an epidural…she needs her doula. In fact, she and her partner need, and want, their doula* very, very, much!

 
In most cases when a doula is present, this woman has just given up her dream to have a natural birth. This is difficult for her. And that is not even mentioning the pain she is dealing with at the time. She hurts; she is upset; she is scared. She may even feel that imaagesshe has just been forced down a path she did not want. She knows that this is a turning point in her labor and takes her closer to the possibility to major surgery. And all of this has a huge impact on her partner.

 
It is obvious…they both need the woman they have come to know and trust over the past several months. They jwant the woman they have handpicked to be with them throughout this journey of childbirth. They want that one consistent and ever present woman. They want their doula.

 
And why shouldn’t their doula remain with them? Around these parts, the anesthesiologist do not mind. There is plenty of space in the room. And the doula knows to stay out of the way. She is beneficial because imageksshe knows how to calm the woman so that she is not moving about during this precise procedure. She knows how to keep a watchful eye on the partner. She offers a sense of peace and calm for this couple with whom she has spent so many hours, as no one else in the room can offer.

 
imagesThen there are those first delicate moments immediately following the administration of the drugs. The woman’s blood pressure may drop; the baby may not react well; etc. Again…this is the time to have the soothing presence of the doula. This is the very important time for both mother and partner to be assured by this woman they trust so much.

 


The doula knows that the medical team must do what they need to do at such an intense time and is prepared to remind this couple of what is occurring, as she has already reviewed the possibilities weeks ago. She is also prepared to remind the mother of her options, her choices, with all the pros and cons. She is able to explain to the couple what might be occurring, even while the mother and baby are being cared for by the medical team.

 
kWhen an epidural is administered, which is a turning point in a woman’s labor, the woman and her partner need and want their doula.

 
It is very simple…the doula gives them what no one else can.

 

*For the purpose of this article, when I refer to a doula I am referring to a certified doula, or one in the process of certification, who abides by a set Code of Ethics and Standard of Practice.

They Get It…Why Can’t We?

 

As some of you may know, I have just returned from an awesome vacation in Belize.S6304091 While visiting a friend in Corozal Town, we passed a park at the water edge called Mother’s Park.
In the center of this park, for all to see, every single day, S6304087in color no less, is a statue of a mother breastfeeding her baby.
PERFECT! JUST PERFECT!

S6304089
As my picture was being taken, this little girl wanted to stand with me. With her mother’s permission, we posed.
In the second picture, she S6304090wanted us to say “cheese”. Who am I to deny such an adorable child?
Our country is so advanced compared S6304088to this small country. How can we be so delinquent in something that is so very natural?

 

Happy Holidays!

May you and your family

have a most wonderful

holiday season!!!

Hugs!!!  Kenny