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Great Expectations: Liz @ 28 Weeks

October 30, 2010 By Liz Abbene 2 Comments

One of the most valuable tools a mother (and mother-to-be) has is her instinct. This instinct will help her make smart choices during pregnancy, trust her body throughout birth, and guide her in caring for her child.  This week has given me the opportunity to witness this instinct in both my own life and others.

Just over a week ago, I had an appointment to see my midwife.  My gut instinct told me that I was probably slated to take the gestational diabetes test and that I should call her to remind me of the proper preparations for the screening. Instead, I didn’t, and subsequently failed the test. I then had to wait two nerve-wracking days to take the 3-hour test, which my instinct told me was going to be a waste of time and leave me looking like a human pin cushion after all of the blood draws. Guess what? My instinct was right–turns out I should have just called my provider in the first place and I don’t have gestational diabetes.

In yoga class yesterday, (which for the record, I believe is the best mental, physical, and spiritual preparation for birth) I started to think about how I might incorporate yoga into my upcoming birth.  I looked briefly around the room at the other beautiful mamas in their poses, and wondered the same thing about them.  Even when yoga is led by an instructor, the purpose is for each individual to follow their instinct, look deeply within for wisdom, and move in ways that feel right for them.  I can think of nothing else that translates so well into birth.

Then, early this morning, I joined a beautiful laboring mama and her partner as their doula.  After an entire day of early labor and a long, intense active stage of labor due to a malpositioned baby, this wonderful mama easily pushed out an incredible baby boy with little guidance. How?  Her instinct, of course.

So mamas, trust your instinct!!  It’s right!!

P.S. My instinct told me that this year the family should go as the “Pac Family.”  Here I am with “Blinky!”

Filed Under Birth, Exercise, Featured Story, Great Expectations, Health and well-being, Pregnancy, Working with a doula Tagged With Great Expectations

Are You an “Ideal” Candidate for VBAC? What Are Your Choices if Not?

October 28, 2010 By Cara Terreri Leave a Comment

This article is part of A Woman’s Guide to VBAC: Navigating the NIH Consensus Recommendations, a collection of resources that address the most common and pressing questions women may have about their birth choices. View all sections in the guide, including a link to the authors, on theindex page.

By Desirre Andrews

For a woman with a previous cesarean, answering these questions is a critical step to deciding between a repeat cesarean (RCS) and a vaginal birth after cesarean (VBAC).

According to the NIH VBAC Consensus Statement, an estimated 74% of women that plan a VBAC will have a successful VBAC. The success rates vary between 54%-94% depending on a several factors, including induction or augmentation of labor, pregnancy length, vaginal birth history, reason for prior cesarean, cervical readiness, race and ethnicity, health of the mother, socioeconomic status, region, marital status and type of hospital.

The following factors are based upon current evidence and point to higher rates of successful VBAC*:

Before labor:

  • A previous vaginal delivery (before or after a cesarean delivery)
  • Nonrecurring reason for cesarean delivery (such as malposition, breech, multiples, fetal distress, placenta previa)
  • Previous delivery of a baby weighing less than 4000 grams (8 lb and 13 oz)

Start of and during labor:

  • Spontaneous labor (no induction or augmentation)
  • Pregnancy length of 40 weeks or less
  • Greater cervical dilation at admission
  • Greater cervical dilation at rupture of membranes
  • Cervical effacement that reaches 75-90% upon admission
  • A single, vertex position baby (head down)
  • The baby’s head being engaged or lower in the pelvis
  • A higher Bishop score (a scoring system to estimate the success of induction)

While the medical factors listed above define an “ideal” candidate, you do not need to fit into all the areas to be a good candidate, and most women do not fit into all the categories.

Non-medical factors that can greatly influence success regardless of medical factors:

  • Care provider perception and tolerance of risk
  • Care provider preference
  • Patient preference
  • Patient perception of safety
  • How informed consent is given
  • Location and number of births per year at hospital
  • Hospital policy regarding VBAC
  • Health insurance status
  • Professional association guidelines

These non-medical factors often have the greatest impact on whether or not you are considered a good candidate and in fact give birth vaginally. Before or during labor, non-medical factors are often used to persuade a woman she is not a good candidate, even if she does fit many of the medical criteria for VBAC.

In addition to considering who is likely to have a vaginal birth, looking at uterine rupture risk also plays a part in identifying candidacy for a VBAC. These factors may lower the risk of uterine rupture:

  • A prior vaginal delivery
  • Allowing for spontaneous labor
  • A low transverse uterine scar type
  • 18 months or greater between pregnancies
  • A woman in a healthy weight range
  • A hospital that has a medium to high number of births each year

Avoiding induction is a key component in preventing uterine rupture and achieving successful VBAC.

There is no way to be certain whether or not someone will have a successful VBAC. The NIH Statement could not define the ideal candidate for VBAC because all the evidence is based on large groups of women and should not be used to predict an individual’s chance of successful VBAC. Based on the evidence, the NIH Statement concluded that a planned VBAC is a reasonable option for many pregnant women with one prior low transverse uterine incision. Vaginal birth after multiple cesareans (VBAmC) and other special situations were not addressed in this consensus statement, but there is some evidence, albeit weaker quality evidence, that shows VBAC in these situations may be a safe choice for most women as well. A subsequent Practice Bulletin from the American Congress of Obstetricians and Gynecologists states that none of the following factors, in and of itself, indicates that a woman is a poor candidate for VBAC:

  • history of two or more prior low-transverse incision cesareans
  • twins in the current pregnancy
  • gestation beyond 40 weeks
  • suspected macrosomia (big baby)
  • prior low vertical incision
  • unknown prior scar, unless there is a high suspicion that the prior scar is a classical incision.

There may be other factors specific to your own situation that, combined with one of these factors, changes whether you are a good candidate for planned VBAC.

Providing complete and easily understood informed consent for both VBAC and RCS, lowering barriers to VBAC access, increasing care provider risk tolerance and perception of safety, using a shared decision making process and, whenever possible, honoring the woman’s preference will make a marked difference in whether or not any individual will have a VBAC.

To maximize your chances of a successful VBAC, it is vital that you are assessed individually and not compared to a large group of women. To the best of your ability, use a care provider willing to partner with you, and choose a birth setting that offers individualized care. Ultimately your desire for a VBAC and your care provider’s desire to support you fully weigh heavily on your chance of success.

*The available evidence stated is only for planned VBACs taking place in hospitals and does not include out of hospital VBACs.

Filed Under A Woman's Guide to VBAC, Birth, Choosing a care provider, Complications and high risk pregnancies, Featured Story, Pregnancy, Preparing for VBAC Tagged With A Woman's Guide to VBAC

A Tale of Two Homebirths

October 26, 2010 By Amy Romano 6 Comments

I have two kids, and they were both born at home.  My births were almost carbon copies of each other.  My daughter and son were both born at 39 weeks and 4 days, labor started with water breaking, contractions followed about 30 minutes later, and then labor progressed very quickly.  I had a second degree tear both times in the same spot (ouch), and experienced urinary retention and required a straight catheter both times (double ouch). It’s weird, I know – most women don’t have two kids with such similar births.

There was one major difference, though. At my second birth, my midwives could have been arrested just for being there. They were Certified Professional Midwives (CPMs) with a combined 30+ years of experience but the state I lived in at the time didn’t recognize this national credential.  Neither do 22 other states. Some states actively criminalize home birth midwifery while others have outdated statutes that simply don’t recognize CPMs. But the impact is the same: it marginalizes midwives from the very system that optimizes the safety of home birth: the care providers and facilities that can intervene when complications develop.

I was fortunate that I didn’t need this safety net. But had I encountered problems in my first birth, the procedure was clear: My midwife would have called the obstetrician she worked with, who I had already met during a routine 36 week visit, and she would have accompanied me to the hospital, freely sharing the information in my medical record, giving a verbal report to the doctor, and staying by my side to provide continuous emotional support and comfort. My prenatal record and labs would already have been at the hospital and the doctor would prepare whatever resources and staff were necessary based on the report she got by phone from my midwife – whether that was an epidural for pain relief or a crash c-section.

Had the same complication arisen in my second birth, I honestly don’t know exactly what would have happened. I was lucky that the doctor who backed-up the birth center practice where I worked at the time was willing to do a “special favor” and be my back-up doctor for my own birth. He didn’t do this for other women planning home births. There were a few other doctors in the surrounding areas who would provide “parallel care” to women having home births, which would have meant going to double the number of prenatal visits even though I was healthy, had a toddler at home, and a full-time job. And I’d have to travel a good 30-45 minutes for those prenatal consults, since those doctors weren’t right in my community. I probably would have declined to bother with this since, given my history of rapid labors, I knew it was unlikely that I’d even make it to a hospital 30 or 45 minutes away, and would end up going through an ER closer to home for my care. As for my midwife, she may or may not have been able to transparently share the records from care up to the point of transfer, and she may or may not have been able to stay by my side. It probably would depend on the circumstances of the transfer and whether the receiving hospital was hostile toward or accepting of home birth midwives. After all, she could end up in jail just for bringing me there, even if by doing so she saved my life or my baby’s life.

If ever there was a disincentive to provide safe care, this is it: the fear that by securing access to proper treatments, the midwife faces the possibility of incarceration, loss of livelihood, and financial ruin. And the irony is that in many of the cases where midwives get into trouble, the baby and the mother turned out healthy. In other words, the midwife initiated a transfer appropriately and in a timely manner and the system – as fragmented as it is – actually worked to achieve a good outcome. But all it takes is one person to lodge a complaint, even if the woman herself is happy with her care, and the house of cards comes tumbling down.

Who benefits from this way of doing things?  We’ve already seen that women, babies, and midwives don’t. I don’t really believe that doctors or hospitals benefit, either. Instead of having an orderly system for receiving referrals, staff have to piece together the bits of information in the moment, while caring for a patient who probably doesn’t want to be there and has just been separated from the care provider with whom she has built up nine months worth of trust. The state doesn’t benefit, either. When my son was born safely at home, my husband signed the birth certificate. In other words, the state can’t track the outcomes of practicing home birth midwives, but is called on to investigate when a member of the public makes a complaint.

Many women, I presume, approach the situation the way I did: ignorance is bliss. I didn’t really want to hear the answers to the hard “what if” questions, so I didn’t dwell on them. Besides, I didn’t really have any other options. The only other midwifery practice in my community was the one I worked at, and I preferred to keep my personal and professional lives separate, and I knew enough about the hospital in my community to know that I didn’t want to give birth there unless it was the only safe place to be. I assumed because I was healthy and had already given birth at home, everything would probably turn out fine. I knew my midwives were competent and caring and would do everything possible to keep me out of harm’s way. But I didn’t really know how my care would unfold if I needed urgent help that was outside of my midwives’ scope of practice or skill set. I put trust in a system that couldn’t have been more dysfunctional, and I was lucky that, in the end, I didn’t need to rely on it.

This post is part of a blog carnival to raise awareness about Dr. Agnes Gereb, a Hungarian gynecologist and midwife who was jailed for attending a precipitous birth at her birth center in Budapest, despite apparently providing proper care and exhibiting swift judgment.

Filed Under All Recent Articles, Birth, Birth stories, Blog Carnival, Choosing a care provider, Homebirth, Pregnancy, Working with a midwife

Lamaze Breathing: What You Need To Know

October 25, 2010 By Cara Terreri 12 Comments

Once upon a time, the hallmark of Lamaze chidbirth education was “breathing” (hee, hoo, hee, hoo). Over the years, Lamaze has evolved into a comprehensive approach to childbirth, part of which are comfort measures for labor; breathing is one of the suggested comfort measures. So what does it mean to “breathe?” Here’s a little on what you should know (excerpted from The Official Lamaze Guide: Giving Birth with Confidence by Judith A. Lothian and Charlotte DeVries):

 

Breathing in Pregnancy:  A Daily Check-in
Finding the time, energy, and peace to face your fears—or do anything that requires mental focus—is a challenge in our culture. One pregnant woman shared that after years of working at her office, she’d tuned out the sounds of phones ringing and computers clicking. She didn’t even notice how noisy her office was until an older coworker looked at her across the bank of desks and said, “You’re bringing this child into a world of sounds my babies never heard.”

It’s true: In just a decade or two, technology has changed the world dramatically. From cell phones to ATMs, from microwave ovens to Facebook friends, from high-definition DVDs to iPods, technology fills our days with vivid images and messages. It’s a noisy, busy world that can crowd out the peace we need to connect with ourselves.

Connecting with yourself is an important task during your pregnancy.  It’s a big job to pay attention to all the physical, emotional, and spiritual changes you’re experiencing. It takes concentration to envision a future that includes a new role and a new person. Finding a place of stillness for a few moments each day can help you do this crucial work.

Even if your space and your schedule are crowded, you can find a place and time to keep a daily appointment with yourself. Perhaps you can retreat to the corner of your bedroom, the bathroom, a closet, or an empty room at your workplace. Perhaps you can sneak a moment before others wake up, after they’ve gone to bed, before you get in the shower, or during your lunch break. You might want to “check in” at the same time each day so you treat this appointment with yourself as the important time it is.

Your daily check-in may be a few moments of silence, meditation, or prayer. You can use this time to get in touch with not only your feelings, but also your body and the little one who is taking up more and more of it. Close your eyes for a moment and listen to your breathing, then take an inventory of yourself: Are there any tense areas in your body—neck, shoulders, throat, hands, back? Is anything nagging at your mind? Doing a full-body and -mind check will help you identify what needs to be released, relaxed, or dealt with.

 

Breathing Benefits from Yoga Practice
Yoga, an ancient form of exercise that includes breath control, meditation, and body postures, has become popular among pregnant women. It’s easy to understand why: Many yoga exercises include movements that open the pelvis. Yoga also teaches rhythmic breathing, concentration, stamina building, and relaxation. Some women who do yoga report improved physical coordination and more balanced emotions.

 

Lamaze Classes and Breathing
Lamaze classes prepare women for a safe, healthy birth by providing the most current, evidence-based information about birth, simplifying birth, and helping women navigate the maze of modern obstetrics. Be wary of “Lamaze” classes that spend a lot of time practicing relaxation and breathing and little or no time building your confidence or discussing how to keep things simple and how to have the safe, healthy birth you want in the birth setting you have chosen.


Breathing: Finding Comfort in Labor
When allowed and encouraged to, a woman will naturally move, moan, sway, change her breathing pattern, and rock to cope with contractions, eventually finding the right rhythm for her unique needs. Such active comfort-seeking helps her baby rotate and descend and helps prevent her labor from stalling. As her contractions get stronger, her body releases endorphins—nature’s narcotic—to ease her pain.

Conscious Breathing
Conscious breathing (especially slow breathing) reduces heart rate, anxiety, and pain perception. It works in part because when breathing becomes a focus, other sensations (such as labor pain) move to the edge of your awareness.

Conscious breathing is an especially useful labor tool because it not only keeps you and your baby well oxygenated, it’s also easy to learn and use. It’s naturally rhythmic and easy to incorporate into a ritual. And best of all, breathing is the one coping strategy that can’t be taken away from you—even if you’re stuck in bed attached to an electronic fetal monitor and intravenous fluids.

Conscious (or patterned) breathing used to be the hallmark of Lamaze childbirth education. For many women, it’s still an important way to stay relaxed and stay on top of their contractions. It’s true that conscious breathing can help you relax and feel less pain during contractions.  There’s no “right” way to breathe in labor, despite what others may tell you. Slow, deep breathing helps most women manage the pain of contractions. But the right way for you to breathe is whatever feels right to you. Issues like your number of breaths per minute, breathing through your nose or your mouth, or making sounds (like hee-hee) with your breaths are only important if they make a difference for you.

It may help you to have a visual focus to accompany your conscious breathing. You can recall an image with your eyes closed, focus on a picture or special object from home, keep your eyes on your partner, or simply stare at a spot on the wall. You may also find that as labor progresses, faster, shallower breathing—like a dog gently panting—feels better. You’ll figure out what works best for you. And what works best will probably change as you move through labor.

Many women “practice” breathing during pregnancy by using conscious breathing when everyday life presents stressful situations, like being caught in traffic, running late for an important meeting, or worrying about any number of things.

Find Your Rhythm
At some point in labor, you’ll “find your rhythm” or “get in a groove,” much like a marathon runner does. You’ll be living in the moment, doing without thinking.  To others you’ll appear to be in another world. Your movements will be rhythmic; you’ll relax between contractions; you’ll respond to contractions in the same way over and over again, perhaps shaking your arms, rolling your head, breathing slowly, chanting, or praying.

You’ll be totally focused, but you won’t necessarily look comfortable. You’ll look like you’re working very, very hard—which you are. When this happens, you’ll know endorphins are working their magic—dulling your pain and helping you ride your contractions intuitively. You’ll be doing exactly what you need to do. You won’t need to be rescued; in fact, the worst thing that could happen to you at this point is to be disturbed or interrupted. A healthy dose of encouragement, support, and respect are all you’ll need from your support team.

Do you have experience with conscious/patterned breathing during labor? How did it affect your birth experience?

Filed Under Birth, Childbirth education, Coping with pain, Featured Story, Healthy Birth Practice, Labor, Pregnancy

The Waiting Game: Why Baby Knows Best

October 22, 2010 By admin 11 Comments

 

By Debby Amis, RN, BSN, CD(DONA), LCCE, FACCE

Patience is truly a virtue after 9 long months, especially when you’re a few weeks or days from your due date. The swollen feet, extra pounds and late-night bathroom trips can take their toll. Wouldn’t it be easier to just schedule your baby’s birth and get the show on the road?

Elective induction offers the satisfaction of knowing your baby’s birth date in advance, but it might not go as planned. Sometimes women scheduled for induction are bumped from the hospital agenda because the staff is busy. Plus, induction doubles your risk of cesarean birth. The major risk of elective induction is that your baby may not be ready to be born. Experts agree that a normal pregnancy lasts between 38 and 42 weeks, and research indicates that the baby actually initiates the labor process. Once his lungs are fully mature, he releases a protein that tells his mother’s body that it’s time. A baby born even a few weeks early is at an increased risk for breathing problems, admission to special-care nurseries and breastfeeding difficulties.

Inductions & Interventions
An induction usually requires more interventions than a naturally starting birth. You will need IV fluids and continuous electronic fetal monitoring, making you less mobile. Also, artificial contractions may peak sooner and be more intense than natural ones. You are therefore more likely to request an epidural, which increases your chances of needing forceps or vacuum assistance, developing a fever and/or requiring a cesarean section. Plus, the most common medication used for induction (Pitocin) interferes with the release of hormones that promote birth happening normally and breastfeeding.  

Because of these risks, some hospitals do not offer or limit elective inductions. “It seems that, if we are too cavalier about inducing labor for the convenience of either the mother or the provider, we are ignoring the baby’s essential contribution and asking him to participate even when he is not ready,” says Biddy Fein, CNM, who attends births at Brigham and Women’s Hospital in Boston. “We accept this as necessary when the risks of continuing pregnancy outweigh the benefits. But in all other circumstances, we should be respectful of nature’s plan for the initiation of labor and the exquisite interplay between mother and baby.”

Baby Makes the Date
If there are valid medical reasons for labor induction, your health-care provider will weigh the benefits of immediate delivery versus continuing the pregnancy for the health of your baby. But if you are like the majority of women who have a healthy pregnancy, the safest option for you and your baby is to wait for labor to begin on its own. Your baby may decide to come on his due date (although less than 10 percent of babies do), but you may want to plan for a later date in case your pregnancy does extend to 42 weeks.  

If your pregnancy lasts longer than expected, try not to worry. Continue normal activities and remember that you are giving your baby the best start by allowing him to decide when he is ready to make his grand entrance into the world.

This article was reprinted with permission from Lamaze International and is available on the Lamaze parent resource Web site along with many more helpful tips and advice for pregnancy, birth and parenting.

Filed Under All Recent Articles, Birth, Birth plans, Breastfeeding, Healthy Birth Practice, Labor Tagged With Healthy Birth Practices, labor induction

How Pregnancy Taught Me to Trust (and Like) My Body

October 20, 2010 By Cara Terreri 3 Comments

 

The following is a guest post from Christine Krauth, a certified Traditional Authentic Pilates instructor and Prenatal and Postnatal Specialist certified by The Center for Women’s Fitness, who practices at The Pilates Loft in Newnan, Georgia. To find a certified prenatal Pilates instructor near you, visit  www.thecenterforwomensfitness.com.

 

When I found out I was expecting a baby in the fall of 2008, I remember feeling so thrilled and terrified at the same time. I was beginning the Traditional Authentic Pilates (TAP) certification program and was now faced with a difficult and unique set of problems: How would I complete such a physically and mentally intensive program with a pregnancy? How would I stay connected to my own body enough to dictate movements to clients? I remember confiding in my boss, Mary Ann, telling her “Please don’t be upset with me…I’m pregnant.” She looked at me as if I had two heads and said “Why on earth would I be upset with you?” She listened as I proceeded to tell her my fear of not being able to get certified and then she gave me some wonderful advice. She said to be patient and learn about how my body would change so I could work with my body rather than against it.

As I thought about what Mary Ann said, I began to realize that pregnancy for me was going to not only be a huge physical change but an enormous mental one as well. I had spent the better part of my life trying to work against my body; trying to lose weight here, to trim this, get rid of that, to look better there. To be honest, my body and I weren’t the best of friends. In fact, it is safe to say we were enemies.

Pregnancy forced me to embrace changes in my body I never would have condoned before. As I watched my belly grow, my hips widen and my feet swell, I continued to teach and practice Pilates. We modified and created movements to accommodate my body. I learned that strengthening my pelvic floor was an investment in the future…especially if I wanted to laugh uncontrollably or jump rope again! Although my abdominal muscles had opened laterally across my belly to make room for the life inside me, I could still do things to strengthen my oblique abdominals. I strengthened my arms, my inner thighs, my behind, and practiced walking without pronating. All the while I was still getting bigger (and bigger) and for the first time in my life I was able to embrace it! Gaining weight didn’t make me want to cut the calories, instead it made me smile and think about how my baby must be eating really well.

After I had my baby girl, I began exercising slowly. Once I received permission from my doctor, I started strengthening my abdominals gradually with the tiniest movements. Then I began taking a class at my studio again. I will never forget my first class back. It was one of our beginner classes and I thought I would breeze through it… man, was I wrong. Needless to say, I was humbled. But I stuck with it, and before I knew it, I was back to where I started before my pregnancy and felt even better than I had before. I completed my certification in the spring of 2010, nine months after I had Grace.

The thing is, I learned that my body was capable of something amazing. I gained respect for what I was naturally given and learned to embrace change that I couldn’t control. I learned that to be “connected” could be taken literally in the sense that you “connect” your abs while you do your Hundreds (a Pilates practice), but also figuratively in my daily life. I believe the lesson of working with your body rather than against it is perhaps the most important thing to remember while practicing Pilates, and applies equally to pregnancy and birth. I feel so fortunate to have had the tandem experience of pregnancy and Pilates because it taught me something priceless: work with what you have to make your body healthy and strong. Now my body and I are close. I might even call my body my best friend. Unless I eat too much cheese…then, unfortunately, we are at odds.

With all we are going through in the world, we need to remember some very important qualities of life. We are given one body, one brain, one heart, one soul. It is our job to take care of it. If we neglect our body, we are not true to our inner self. The SELF that makes us… us. Be true to you, take care of you and connect your mind to your body.

Filed Under All Recent Articles, Health and well-being, Pregnancy Tagged With exercise during pregnancy, pilates

Finding Mother-Friendly Care – Some Questions to Ask

October 18, 2010 By Cara Terreri 4 Comments

This article has been excerpted from the publication Having a Baby? 10 Questions to Ask by the Coalition for Improving Maternity Services (CIMS).

 

Birthing care that is better and healthier for mothers and babies is called “mother-friendly.” Some birth places or settings are more mother-friendly than others.

A group of experts in birthing care came up with a list of 10 things to look for and ask about, all of which are supported by medical research and are also the best ways to be mother-friendly. Following are three of those questions.

  

Ask, “What happens during a normal labor and birth in your setting?”

If they give mother-friendly care, they will tell you how they handle every part of the birthing process. For example, how often do they give the mother a drug to speed up the birth? Or do they let labor and birth usually happen on its own timing? They will also tell you how often they do certain procedures. For example, they will have a record of the percentage of C-sections (Cesarean births) they do every year. If the number is too high, you’ll want to consider having your baby in another place or with another doctor or midwife.

Here are numbers we recommend you ask about.

  • They should not use oxytocin (a drug) to start labor for more than 1 in 10 women (10%).
  •  They should not do an episiotomy on more than 1 in 5 women (20%). They should be trying to bring that number down. (An episiotomy is a cut in the opening to the vagina to make it larger for birth. It is not necessary most of the time.)
  • They should not do C-sections on more than 1 in 10 women (10%) if it’s a community hospital. The rate should be 15% or less in hospitals that care for many high-risk mothers and babies. A C-section is a major operation in which a doctor cuts through the mother’s stomach into her womb and removes the baby through the opening. Mothers who have had a C-section can often have future babies normally. Look for a birth place in which 6 out of 10 women (60%) or more of the mothers who have had C-sections go on to have their other babies through the birth canal (VBAC).

 

Ask, “Can I walk and move around during labor? What position do you suggest for birth?”

In mother-friendly settings, you can walk around and move about as you choose during labor. You can choose the positions that are most comfortable and work best for you during labor and birth. (There may be a medical reason for you to be in a certain position.) Mother-friendly settings almost never put a woman flat on her back with her legs up in stirrups for the birth.

 

Ask, “How do you help mothers stay as comfortable as they can be? Besides drugs, how do you help mothers relieve the pain of labor?”

The people who care for you should know how to help you cope with labor. They should know about ways of dealing with your pain that don’t use drugs. They should suggest such things as changing your position, relaxing in a warm bath, having a massage and using music. These are called comfort measures.

Comfort measures help you handle your labor more easily and help you feel more in control. The people who care for you should not try to persuade you to use a drug for pain unless you need it to take care of a special medical problem. All drugs cross the placenta and reach the baby and can affect the baby.

Read the remaining 7 questions in the full publication by CIMS.

Have you given birth in a mother-friendly hospital or birth center? What was it like? What was the best part about your care?

Filed Under All Recent Articles, Birth, Birth plans, Choosing a care provider, Health and well-being, Healthy Birth Practice, Pregnancy Tagged With care provider, Healthy Birth Practices, hospital birth, mother-friendly care

Great Expectations: Liz @ 26 Weeks

October 15, 2010 By Liz Abbene Leave a Comment

After logging over 3000 miles of drive time in the last two weeks, this pregnant mama is ready for a break.  My first trip was to the Lamaze/ICEA conference in Milwaukee–basically a mecca for birth junkies like myself. It was incredible to be in the presence of so many amazing birth professionals.  My growing nugget had the pleasure of making a guest appearance, as Gail Tully of Spinning Babies used him/her for a live belly mapping and painting demonstration once again.  There were definitely a lot more “oohs” and “ahhs” with that crowd, compared with the gawkers at the Minnesota State Fair.

Last week marked the third installment of “The Abbene Family Road Trip,” this time to Virginia for a wedding.  I found the tree trunks formally known as my legs almost comical and even broke down and took a couple of baths in the hotel tubs to help with the swelling.  I found swimming to be positively weightless bliss and am now scoping out local pools to enjoy during the last trimester.  I was relieved that my bladder held out, at least for part of the trip. However, all that sitting in the car got this baby moving and squirming so much that by the time we were on the way home, I had to stop and pee more than all of my children combined.

Now that I’m home, I’m not planning on going anywhere for a good, long while.  I’m quite content to enjoy home-cooked food, sleep in my own bed, and watch my little nugget’s hiccups from the comfort of my couch.

PS: Go vote for this blog on FitPregnancy… today is the last day!

Filed Under All Recent Articles, Great Expectations, Pregnancy Tagged With Great Expectations

Help Us Move to #1 – Go Vote!

October 14, 2010 By Cara Terreri Leave a Comment

Giving Birth with Confidence is currently in 2nd place on the FitPregancy Best of the Web poll. Help us move to #1… go vote today (lots and lots of times!) and tomorrow–polls close tomorrow, Friday October 15.

 

Click here to vote!

 

 

Filed Under All Recent Articles

Birthing Breast Cancer

October 13, 2010 By Walker Karraa, MFA, MA, CD(DONA) Leave a Comment

This blog space is a gift. I don’t want to waste it just telling my story…that isn’t helpful to anyone. Adding to the fear that already exists about breast cancer during this pink-ribbon month is the last thing I want to do. Fear shuts down our birth, and our courage.  I want to use the gift of this space on this wonderful site to encourage all birthing and postpartum women and their partners to NOT be afraid. Be informed. 

I was 36. I got breast cancer. I found it myself. I knew there was an increased risk, as my mom had had it. I had been doing self-examinations for several years, and knew to look for signs. This time, I just knew it felt different. I listened to my body and called my OB/GYN. A few days later, a well-meaning, well-trained breast-cancer specialist walked into a waiting room, told my husband I had breast cancer, and that I would be getting a mastectomy and simultaneous reconstruction. “Call the office. Buy my book. Goodnight.” My husband had to tell me I had cancer, and then take me home to our 3 year old son and 7 month old baby daughter.

The words “you have breast cancer” forever changed me. There is the initial disbelief and then the profound, down-to-the-bones knowledge that life is utterly beyond our control, and at times, sucks. I had a toddler and an infant and breast cancer. There are no words.

Much like my experience with postpartum depression, and my work as a birth doula, breast cancer gave me the opportunity to learn a great deal about the need to advocate for myself, and transform the difficulty to help others.  Not to take care of women in an all-knowing, dare I say patriarchal way that suggests I know your experience. I can’t tell a woman what it feels like to birth; I can’t tell you what it feels like to have breast cancer when you are lactating. So, rather than grow more fear of the unknown with this entry, I want to plant seeds of power in anyone who reads it with some words of encouragement:

Look. Look at your body, your amazingly capable, ever-changing body. Look with awe at its ability to create, heal, and give us direct information about what it needs. Look to your changing body with courage to see its signals. Get in there and do your self-examinations. The answers about what to do will come. Then do it. Go have a trained professional look at your body and help you with it. Our bodies never lie.

Listen. Listen to what your care providers say. Carefully. Write it down. Have your partner write it down. Listen carefully to what they don’t say. Lots of answers come from spaces in between medical science and your life. Listen to your intuition, write that down, too. When my surgeon told me I was going to have reconstruction through a method that would require me to not pick up my baby for 6-10weeks, and sounded positively medieval, my instinct said, “You are going to what???”  Even though he posed it as a positive “I will give you a nice tummy-tuck and new boobs” my instinct told me to learn more. Quickly.

Learn. Learn about it. Learn what the language means. What are those terms? What is that procedure they are telling you they are going to do? Don’t just Google it—not good enough. Go to reputable sources of evidence-based information. Universities with research programs are a good place to start, search PubMed, or Wiley Science with your words. Ask someone to do it with you. With my cancer, I assumed what my surgeon was telling me about reconstruction was part of the treatment. Then, like learning the terms and philosophies of childbirth, I learned the language of reconstruction and breast cancer– and discovered that my surgeons’ reconstruction procedure was elective. He assumed I would want to do it.  Multiple surgeries, chance of necrosis, not lifting anything heavy for 6-10 weeks just to have boobs was not my choice. I was determined to hold my baby and my son as soon as possible. Plus, the thought of having skin grafted from my labia to create “nipples” was all I needed to re-think the whole thing, okay?

I remember sitting on the porch when I called my OB/GYN, who had just delivered my daughter, and had walked me fearlessly through postpartum depression with my son, and asked, “Do I HAVE to do that?”  No.  She assured me my surgeon would be supportive. She was right. Reconstruction, with an infant and a toddler, didn’t work for me. So off they went, and the convenient all in one tummy-tuck never happened! (What am I, anyway, Jiffy Lube?)

Lean in. Once you learn what you are facing, my deepest heartfelt advice is to lean in to it, and lean on strong things that can really hold you up. Just as I ask my clients about who can really, really hang in there in the operating room if there is a need for a C-section…I suggest finding those who can face breast cancer with you, and lean on them. With every wave of fear, or doubt, lean on those supports. Don’t white knuckle it; don’t rob yourself of the help and support you deserve, and quite frankly, will need. Lean on partner, lean on others who have been through it. Lean on your spirituality or religion if you have one. And when in doubt, lean on yourself. Leaning in doesn’t mean giving up, it means surrendering to the experience with the knowledge that you will come out the other side with grace, and grit.

Laugh Out Loud. Let yourself laugh at the absurdity what your body comes up with, and what the universe brings you in the form of care-providers’ quirks. I remember my surgeon showing me and my husband how flexible he was—and he was serious! He kicked off his man-clogs right there in the exam room and practically went into full down-dog. And another time he made a muscle like Popeye and insisted I feel his bicep. So bizarre it was hysterical. Speaking of down-dog, I couldn’t help but laugh out loud when I tried wearing prosthetics to yoga and one fell out on my mat. Plop! Let yourself laugh. It is okay. Realizing you will never wear a tube top in public again is not necessarily a bad thing when you are pushing 40. I’m just saying…

Let it go.
Let your life change. Don’t expect it to stay the same. Your friends will change. Some will stop calling, some will send a card and then not include you in girl’s night anymore. It is hard, and sad. Let it go. Those who don’t know how to love you through a life changing event feel horrible. They wish they could make eye contact with you at Starbucks, and they know in their hearts they hurt you because they fell out of your life when you needed them. Their loss. Let them go. You will be there for them when they need you.

Family members…those who should know better and still fail miserably– let them go, too. Neither my mother nor father attended my births, or my mastectomies. For a long time I tried to pretend I was okay with it. I wasn’t. I am not. They should have been there for all of it–physically there to hold my hand, my babies, and my fear. If this happens for you, I am so sorry. Know that they don’t mean harm–they just have lost the ability to know they are important agents for healing in the world. Sad, really. And if you are a family member, go be with her. It counts.

Let your body change—It isn’t pretty, but opening to its changes will bring you tremendous relief and insight: you are not your body. I had one mastectomy at a university hospital and the other at a local hospital. If I were my body, more specifically my breasts, where am I now? Would I exist in two different hospitals? How could my children still love me if I didn’t exist? Letting go of the wrong view that I was somehow the same as the breast tissue was probably the most healing part of recovery.

“When we meet our children, when we hear we have cancer–reality dissolves; we stare mortality itself in the face, and fully dilate at the awesome fragility of life”. 

These words are true for birthing our babies, and birthing our cancer. Lean into yourself; learn the lingo; look without fear at what your body gives you, and let yourself change. Our lives are fragile and funny, our bodies are stunningly obvious, our spirits surpass any medical procedure. 

And as we survive it all, tell your women to do the same.

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