Pregnancy, Birth & Postpartum Resolutions

New Year’s resolutions may take on more meaning if you’re preparing for the birth of a child in 2013. This year, perhaps for the first time, “join the gym and lose 10 pounds” isn’t on the list. At the same time, many of the resolutions you make for a healthy pregnancy look a lot like those you would make for a healthy lifestyle, pregnant or not. For example:

  • eat fruit and vegetables daily
  • get 8 hours of sleep
  • exercise 30 minutes a day
  • carve out time for yourself
  • ask for help when you need it

For a healthy pregnancy, birth, and postpartum period, we’ve compiled a few significant resolutions for you to consider adding to your list this year.

 

Pregnancy

Listen to your body. If it’s telling you to slow down, do all that you can to make it happen. Cereal for dinner? Why not. Nap at 6 p.m.? Yep. On the other hand, if you’re feeling great, don’t let pregnancy slow you down — continue your exercise regimen, meet up with friends for dinner, enjoy life!

Learn about evidence-based maternity care. You can’t always count on your care provider to give you the best, most up-t0-date care. How will you know if you’re not receiving the best care? Learn how to navigate the maternity care system and how you can get the best care.

 

Labor & Birth

Plan for the best support. Who will attend your birth? Do they support your wishes? Will they provide positive energy? Think carefully about your birth support team. Look into hiring a doula. Share your birth plan with everyone well before labor begins.

Take labor one step at a time. Humans seem to be hardwired to think about what’s going to happen next. With labor, it helps to only think about what’s happening now. If you can take each contraction, each stage, each moment as it’s happening, you’ll be better able to put complete focus on the task at hand instead of worrying about what’s to come.

 

Postpartum

Speak up. It’s wonderful to have friends and family ooo and ahh at your new little joy. But a house full of visitors can be overwhelming during a time when you’re trying to understand a brand new world. Feel free to ask for some time and space alone with your baby. Post visiting hours on your front door or update your Facebook status to let friends know when you’re accepting visitors.

Know the signs of postpartum depression/disorders. Postpartum mood disorders (anxiety, depression, OCD, psychosis) affect hundreds of thousands of women every year. With knowledge of the warning signs and access to resources, women who suffer from postpartum mood disorders can and do recover.

What is a Safe and Healthy Birth?

Adapted from The Official Lamaze Guide: Giving Birth with Confidence.

We are just one generation away from the days when a girl grew up on a farm watching the sheep and pigs give birth. Anyone who saw that year after year knew that giving birth was a natural process, a process that could be trusted. —Ina May Gaskin

The mission of Lamaze International is to promote, support and protect natural, safe and healthy birth through education and advocacy through the dedicated efforts of childbirth educators, providers and parents. A normal birth is one that unfolds naturally, free of unnecessary interventions. A woman’s body is beautifully designed to grow, birth and nurture a baby. To work properly, this elegant design requires patience and trust.

An evolving body of research repeatedly shows the danger of interfering without a valid reason in the natural processes of pregnancy, birth, and breastfeeding. Any intervention, no matter how simple it seems, may disrupt the normal process and create problems that, in turn, must be managed with more interventions. All interventions have side effects that can be risky for both mothers and babies. In light of such evidence, the World Health Organization (WHO), a leader in the international public health effort to promote normal birth, says that maternity care should aim to achieve a healthy mother and child with the least intervention safely possible.

In the United States, reality falls far short of this goal. Most births in the U.S. today are interrupted by procedures designed to start, maintain, and finish labor according to an arbitrary schedule. Few women experience their pregnant bodies unfolding and opening in their own time, in their own way. Ironically, normal birth isn’t the norm for American women.

Practices That Support Normal Birth

Research reveals not only the dangers of interfering in the natural process of birth, but also maternity care practices that help keep birth normal. The WHO identifies four care practices, and Lamaze adds two more (marked with asterisks: *). These practices ensure the best care for birthing women around the world.

  1. Let Labor begin on its own.
  2. Walk, move around, and change position throughout labor.*
  3. Bring a loved one, friend, or doula for continuous support.
  4. Avoid interventions that are not medically indicated.*
  5. Avoid giving birth on your back, and follow your body’s urges to push.
  6. Keep mother and baby together – its best for mother, baby, and breastfeeding.

Additional important information:

Maternal Mental Health: Pre-Existing Risk Factors for PTSD and Childbirth

In light of the horrific and tragic events that took place at Sandy Hook Elementary School last Friday, Giving Birth with Confidence will be dedicating our posts this week to providing resources relating to mental health and wellness. Approximately 1.3 million women annually suffer from mental health disorders that occur during pregnancy and in the postpartum period. Perinatal and postpartum anxiety and mood disorders far outweigh the annual occurrence of several other major diseases combined. The key to finding help and treating mental health disorders is awareness; the more people who know how to spot warning signs and what to do to find help, the greater our possibility for better health.

 

 

This article is part of the Traumatic Birth Prevention & Resource Guide by PATTCh. Access the complete guide to learn more about traumatic birth and find resources for women and families.

By Heidi Koss, MA, LMHC

Health care providers aren’t exactly sure why some people get post-traumatic stress disorder (PTSD) when exposed to a traumatic event while others do not. Post-traumatic stress disorder can develop when you go through, see or learn about an event that causes intense fear, helplessness or horror. Any trauma, including birth trauma, lies in the eye of the beholder. What one may perceive as traumatic might not be traumatic to others.

As with most mental health problems, PTSD is probably caused by a complex mix of:

  • Your inherited mental health risks, such as an increased risk of anxiety and depression
  • Your life experiences, including the amount and severity of trauma you’ve gone through since early childhood. PTSD can result from a cumulative effect of multiple traumas over a lifetime.
  • The inherited aspects of your personality — often called your temperament
  • The way your brain regulates the chemicals and hormones your body releases in response to stress

General Risk factors for Post-Traumatic Stress Disorder
People of all ages can have post-traumatic stress disorder. However, some factors increase risk of developing PTSD after a traumatic event, including:

  • Being female — women may be at increased risk of PTSD because they are more likely to experience the kinds of trauma that can trigger the condition.
  • Experiencing intense or long-lasting trauma
  • Having experienced other trauma earlier in life
  • Having other mental health problems, such as anxiety or depression
  • Lacking a good support system of family and friends
  • Having first-degree relatives with mental health problems, including PTSD and depression
  • History of abuse (such as childhood abuse, sexual abuse, rape)
  • Combat exposure
  • Physical attack
  • Being threatened with a weapon
  • Car accident, plane or train crash
  • Life threatening experience (such as natural disaster, critical injury, medical crisis, attack, mugging)

These symptoms should alert you to possible PTSD:

  • Flashbacks of the event — vivid and sudden memories
  • Nightmares
  • Insomnia
  • Fears of recurrence
  • Emotional numbing
  • Panic attacks
  • Inability to recall important aspects of the event — psychogenic amnesia
  • Exaggerated startle response, hyper-arousal, always on guard
  • Hyper-vigilance, constantly looking around for trouble or stressors
  • Avoidance of reminders of the traumatic event
  • Intense psychological stress at exposure to events that resemble the traumatic event

How is PTSD different than other Pregnancy and Postpartum Mood Disorders?
Sometimes perinatal mood disorders overlap and it’s hard to tell where one ends and the other begins. PTSD is caused by an event in which you feel threatened, violated, and feel as if you could die. By the way our brain has processed the memory of the event, is causes heightened anxiety, hypervigilance, flashbacks, nightmares, etc. Therefore PTSD is an anxiety or stress reaction and it is different from other postpartum mood disorders such as depression and anxiety. However, other postpartum mood disorders can occur at the same time PTSD.

Resources
Recommended Books:

  • Postpartum Mood and Anxiety Disorders, A Clinician’s Guide, by Cheryl Tatano Beck and Jeanne Watson Driscoll
  • Beyond the Birth, A Family’s Guide to Postpartum Mood Disorders, by Juliana Nason, Patricia Spach and Anna Gruen. Published by Postpartum Support International of WA
  • When Survivors Give Birth: Understanding and Healing the Effects of Early Sexual Abuse on Childbearing Women, by Penny Simkin and Phyllis Klaus

Useful Organizations & Websites:

Heidi Koss, MA, LMHCA is a psychotherapist in private practice in Redmond, WA specializing in pregnancy and postpartum mood disorders (PPMD), birth trauma, and parent adjustment issues. She has been the Executive Director of Postpartum Support International of Washington (PSI of WA), WA State Coordinator for Postpartum Support International as well as co-founder of the Northwest Association for Postpartum Support (NAPS). She offers consultant services and PPMD trainings. Heidi has also been a postpartum doula and certified lactation educator. Heidi is the proud mother of two beautiful daughters.

 

 

 

PATTCh is a not-for-profit, multidisciplinary organization dedicated to the prevention and treatment of traumatic childbirth. Our mission is to develop cross-disciplinary relationships, research, and programs that:

  • prevent PTSD following childbirth through education, interdisciplinary collaboration, and multidisciplinary research;
  • educate perinatal care providers and paraprofessionals in the prevention and treatment of birth and reproduction related trauma;
  • encourage the development of culturally appropriate therapeutic approaches to post-traumatic stress symptoms following childbirth;
  • promote healthy birth practices for all women and families;
  • promote evidence-based research regarding PTSD secondary to childbirth;
  • increase global awareness of the prevalence, risk factors, and effects of PTSD secondary to childbirth; and
  • support collaboration and understanding among all stake-holders, including: researchers, policy makers, medical and mental health care providers, educators, community members, volunteers, women, and families.

 

Maternal Mental Health: Daily Support Service for Mothers Who Suffer from Postpartum Disorders

In light of the horrific and tragic events that took place at Sandy Hook Elementary School last Friday, Giving Birth with Confidence will be dedicating our posts this week to providing resources relating to mental health and wellness. Approximately 1.3 million women annually suffer from mental health disorders that occur during pregnancy and in the postpartum period. Perinatal and postpartum anxiety and mood disorders far outweigh the annual occurrence of several other major diseases combined. The key to finding help and treating mental health disorders is awareness; the more people who know how to spot warning signs and what to do to find help, the greater our possibility for better health.

Postpartum Progress (www.postpartumprogress.com), the most widely-read blog in the United States on postpartum depression, hosts a service to help pregnant and new mothers get through the difficulty of perinatal mood and anxiety disorders.

Daily Hope is the nation’s first support service featuring once-daily e-mails to mothers with postpartum depression, postpartum anxiety, postpartum OCD and antenatal depression or anxiety. This free service provides encouragement from survivors, the country’s top perinatal mental health specialists and authors of the leading books on perinatal mood and anxiety disorders and parenting.

Many of the nearly one million women who suffer each year do not have access to perinatal mental health specialists or PPD support groups where they live. “I hear from thousands of mothers across the country and around the world who say that having someone to lean on who deeply understands can contribute a great deal to their recovery process,” said Katherine Stone, founder of Postpartum Progress and survivor of postpartum OCD. “I felt Daily Hope would be a great way to use technology to offer mothers encouragement from the nation’s most trusted experts on their illnesses, regardless of where they live or what type of health insurance they have. The more support we can provide to women with postpartum depression, the better, because the quicker the recovery, the less likely the illness will have a long-term impact on mom and baby.”

Contributors to Daily Hope include, among many:

  • Karen Kleiman, MSW, author of “This Isn’t What I Expected: Overcoming Postpartum Depression”
  • Ann Dunnewold, PhD, author of “Life Will Never Be the Same: The Real Mom’s Postpartum Survival Guide” and “Even June Cleaver Would Forget the Juice Box”
  • Marlene Freeman, MD, MGH Center for Women’s Mental Health and Harvard University
  • Pamela Weigartz, author of “The Pregnancy & Postpartum Anxiety Workbook”
  • Susan Stone, LCSW, former president of Postpartum Support International
  • Janice Croze, co-founder of 5MinutesforMom.com and survivor of PPD
  • “Aunt Becky,” author of the blog Mommy Wants Vodka, founder of Band Back Together and survivor of antenatal depression
  • Adrienne Griffen, founder of Postpartum Support Virginia

To sign up (for free) and subscribe to Daily Hope, click here.

Postpartum Progress, founded in 2004, provides the most comprehensive, in-depth and accessible information available on perinatal mental illness for pregnant women and new mothers. Having already helped more than 350,000 women and healthcare providers, Postpartum Progress offers an unflinching look at getting through postpartum depression, postpartum anxiety, postpartum OCD, postpartum psychosis, and antenatal depression & anxiety. Postpartum Progress has been named one of the top 10 depression blogs on the web by Psych Central, the winner of Fit Pregnancy’s Best of the Web Awards in the Advice category, and was a runner-up in Parenting’s Must-Read Moms and Scholastic Parent & Child’s Best Parenting Blogs Awards. It has been featured on Babble, ParentDish, Café Mom, Health.com and many other parenting websites. Postpartum Progress was founded by Katherine Stone, who was named a WebMD Health Hero in 2008 and won the Bloganthropy Award in 2010 for her advocacy work for pregnant and new mothers with maternal mental illness.

Postpartum Progress the blog and Daily Hope are both offered by Postpartum Progress Inc., a non-profit organization dedicated to vastly improving the amount of services and support available to women with perinatal mood and anxiety disorders.

Maternal Mental Health: Anxiety Disorders in Pregnancy

In light of the horrific and tragic events that took place at Sandy Hook Elementary School last Friday, Giving Birth with Confidence will be dedicating our posts this week to providing resources relating to mental health and wellness. Approximately 1.3 million women annually suffer from mental health disorders that occur during pregnancy and in the postpartum period. Perinatal and postpartum anxiety and mood disorders far outweigh the annual occurrence of several other major diseases combined. The key to finding help and treating mental health disorders is awareness; the more people who know how to spot warning signs and what to do to find help, the greater our possibility for better health.

 

This World is Not Flat: Anxiety Disorders in Pregnancy

Imagine you are sitting in your care provider’s office, and next to the scary “universal pain chart” with the not-so-happy faces getting progressively more distressed and discolored, is this chart:

1 in 8 pregnant women will develop an illness that poses these risks:

  • preterm birth (the leading cause of infant mortality and disability in US)1,2,3
  • low birth weight4
  • low APGAR scores5
  • a more difficult labor and delivery with increase of PTSD symptoms related to birth6,7,8,9
  • increased chance of Postpartum Depression/Anxiety Disorders after birth10,11
  • newborn may have increased agitation12,13
  • jittery infants up to 6 months after delivery14
  • breastfeeding difficulties15
  • child may develop learning and attention disorders later in childhood16,17,18

Genetic Disorder? Pre-ecamplsia? STD?

Nope. Perinatal Anxiety Disorder.

Current estimates are that anywhere from 5% to nearly 25% of pregnant women (1 in 8 ) will have a mood or anxiety disorder.19,20,21 And for pregnant women with anxiety disorders, high levels of cortisol cross the placenta and have long-term effects noted long after birth.22

With my first pregnancy, I began developing symptoms of depression and anxiety shortly after my second trimester. I knew something was wrong, and had both physical and emotional symptoms that were getting progressively worse. At the time (10 years ago), my providers didn’t know to ask about depression and anxiety during pregnancy—and I did a darned good job covering it up. My illness went untreated, and I ended up suffering Post-Traumatic Stress Disorder (PTSD) in labor and developing severe postpartum depression and anxiety after the birth. I was three months postpartum before my illness got severe enough, and life threatening, to the point where any of us knew I needed immediate medical treatment.

Anxiety in pregnancy and birth is universal and normal. It is a normal reaction to a physically and emotionally stressful, life-altering event. Secondly, an anxiety disorder in pregnancy is a medical illness, not a character flaw or personality trait. Its etiology is currently traced to an interplay of hormonal, genetic, environmental and immunological systems of the body23,24 – not the half shot of espresso in your latte, your character, or your inability to relax in your [irritating] prenatal yoga class. Newer research is looking at the role of increased oxytocin around the time of birth in influencing the onset of Perinatal Anxiety Disorders (PAD).25 Bottom line: It is not your fault.

 

Symptoms of Anxiety Disorders
Anxiety in pregnancy is normal. But when anxiety in pregnancy is significant enough to cause physical, emotional, and cognitive distress — a perinatal anxiety disorder may be occurring and you need help.26

Pec Indman, EdD, MFT and co-author of the award winning book, Beyond the Blues: Understanding and Treating Prenatal and Postpartum Mood/Anxiety Disorders offered this in a recent interview for this post:

While it’s normal to have some worries during pregnancy (for example, “Will my baby be healthy? or, “ Will I be a good mom”?)–women with anxiety find the worry gets in the way of enjoying the pregnancy and other aspects of life. Women with anxiety may also have appetite changes (often difficulty eating), and find that the worry makes it difficult to fall asleep. Some women experience panic episodes during pregnancy. These are times of extreme anxiety where there may be hot or cold feelings, difficulty breathing or a smothering sensation, numbness or tingling in the fingers or around the mouth, a racing heart, and a feeling of loss of control.

There are several types of anxiety disorders that occur in pregnancy and postpartum, including Generalized Anxiety Disorder, Obsessive Compulsive Disorder, Panic Disorder, and PTSD. You can learn more about each type at www.postpartum.net under “Get the Facts.” But generally, symptoms27 of an anxiety disorder include:

  • Excessive, ongoing worry that impacts your day to day activities
  • Thoughts of worry regarding the future, or catastrophic events occurring
  • Insomnia
  • Poor appetite
  • Physical restlessness, inability to sit still
  • Dizziness, hot flashes, nausea
  • Panic attacks

 

Risk Factors
Research shows that there are some risk factors that may predispose some of us to anxiety disorders in pregnancy, and can be discussed with your care provider, partner, family or trained professional. Risk factors28,29 include:

  • Family history of anxiety disorders
  • Personal history of depression or anxiety
  • Thyroid imbalance

 

What do you do if you have symptoms or risk factors for an anxiety disorder in pregnancy?

1. Get help. Talk to a care provider. If you can’t talk yourself, find someone you trust to do so with you. The risks are too great. Pec Indman, EdD, MFT, shares:
If a woman is struggling during pregnancy it is essential to get help. Talk to a trained (many providers have not been trained in this area) and understanding professional. There are lots of kinds of effective treatments including counseling (in particular Cognitive-Behavioral Therapy and Interpersonal Therapy), social support, exercise, Omega-3 fatty acids, acupuncture, and medication.

Regarding women currently on medication, Pec continues:
Women who are on medication for depression, bipolar disorder, or anxiety, should consult with a prenatal (or perinatal) mental health expert before stopping medication. We know that over 50% of women who stop their medication before, or when they are find out they are pregnant, become ill again. Many medications can be taken during pregnancy and will help prevent a relapse.30

2. Ask your care providers (OB/GYN, Midwife, Nurse Practitioner, Family Practitioner) if they are trained in depression and anxiety in pregnancy. One tip I give women is to phrase it this way: “If I develop depression or anxiety during pregnancy or after, how will you be able to help me?” or “How do you help women who develop anxiety or depression in pregnancy?” If it is too difficult to do that, ask a trusted friend, partner, or family member to go with you to your next appointment and help you approach your care provider. Write a list of questions and concerns before you go. Calling ahead to let the front office know you need extra time in your appointment is also a good idea.

What if? If your only option is a care provider who is not trained in this area, go to Postpartum Support International (PSI) for excellent resources to take with you to your appointment, or to find local support systems, or call the warm-line for volunteer support on getting help in your area (1-800-944-4773). If making that call or going online is anxiety producing, ask a trusted friend, partner, or family member to go online for you or with you, to PSI and get the information you need.

3. GET A TRAINED DOULA!!! Birth and postpartum doulas can help you get through birth and postpartum adjustment. I strongly suggest you hire a doula who has training in this area (birth doulas are not required to know this information and postpartum doulas often receive little and/or outdated training on anxiety and depression disorders in pregnancy). Some good questions when interviewing doulas are:

  • What training do you have in anxiety and depression disorders in pregnancy?
  • If I get depressed or anxious, how will you know and how will you help?
  • What local resources do you give to clients?
  • How do you feel about anti-depressant medication during pregnancy and breastfeeding? Any doula who is completely “anti-medication” for any medical illness needs to turn in their birth ball and get with the program (it’s a blog, I can say things like that!). They do not have the skills to help you. Go to PSI and ask therapists in your area for referrals to doulas with experience.

 

Nothing Flat About this World of Anxiety Disorders
Pec Indman notes, “Healthcare professionals used to think pregnant women didn’t experience depression or anxiety. We also used to think the world was flat! Thinking has changed about a lot of things.”

Just as thinking and care regarding birth has changed, health care providers are starting to get it regarding mood and anxiety disorders in pregnancy. But much like our births, women have to raise our voices to raise awareness, and in turn get the care we so desperately deserve and need, for our brains and our reproductive systems.

With my second pregnancy, I knew before I peed on the stick — based on my first pregnancy — I had significant risks for depression and anxiety, that it was a physical illness, and that the risks to me and my baby were real and needed to be avoided. I was extremely fortunate to have the financial access to good, trained providers — they are forever in my heart. And I went through a mine field of providers who didn’t know current research and made me feel like a bad mother until I found the ones who “got it.” I firmly believe that when given the right information regarding our bodies, and particularly our pregnant bodies, we do a damn good job to learn more, discuss with those who could help us with treatment, and make the best informed choices for our lives. Once we remind ourselves and our care providers that our brain and uterus inhabit the same body and need the same kind of care, we will be part of the move to see that the world is not flat.
.

A special thanks to Pec Indman, EdD, MFT for her contribution to this article, humor, and support.

Pec Indman EdD, MFT, is a mom with over 20 years experience as a perinatal mental health psychotherapist and educator. She is the chair of education and training for Postpartum Support International, and co-author of the award-winning book, Beyond the Blues. An updated edition will be available the end of Oct. 2010. Beyond the Blues, Understanding and Treating Prenatal and Postpartum Depression & Anxiety.

 

References

 

  1. Perkin, M.R., Bland J.M. et al. 1993. The effect of anxiety and depression during pregnancy on obstetrical complications. BrJournal of Obstet Gynaecol 100:629-34.
  2. Wadwa, P.D., Sandman, C.A. et al. 1993. The association between prenatal stress and infant birth weight and gestational age at birth: a prospective investigation. Am J Obstet Gynecol 169:858-64.
  3. Orr, S. T., J. P. Reiter, D. G. Blazer, and S. A. James. 2007. Maternal prenatal pregnancy-related anxiety and spontaneous preterm birth in Baltimore, Maryland. Psychosomatic Medicine 69 (6):566-70.
  4. Ibid.
  5. Ibid.
  6. Beck, C. T., 2004a. Birth trauma: In the eye of the beholder. Nursing Research 53, 28-35.
  7. Beck, C. T., 2004b. Post-traumatic stress disorder due to childbirth: The aftermath. Nursing Research 53, 216-224.
  8. Keogh, E., S. Ayers, and H. Francis. 2002. Does anxiety sensitivity predict post-traumatic stress symptoms following childbirth? A preliminary report. Cognitive Behavioral Therapy 31 (4): 145-55.
  9. Kelly, R. H., J. Russo, and W. Katon. 2001. Somatic complaints among pregnant women cared for in obstetrics: Normal pregnancy or depressive and anxiety symptoms amplification revisited? General Hospital Psychiatry 23 (3):107-113.
  10. Lee A.M., Lam S.K. et al. 2007. Prevalence, course and risk factors for antenatal anxiety and depression. Obstet Gynecol 110:1102-1112.
  11. Rambelli, C., Montagnani, M.S. et al. 2010. Panic disorder as a risk factor for post-partum depression: results from the perinatal depression-research and screening unit study. Journal of Affect Disord,122(1-2):139-143.
  12. Coplan, R. J., K. O”Neil, and K. A. Arbeau. 2005. Maternal anxiety during and after pregnancy and infant temperament at three months of age. Journal of Prenatal and Perinatal Psychology and Health 19 (3):199-215.
  13. Tagle, N., Neal, C., Glover, V. 2007. Antenatal maternal stress and long term effects on child neurodevelopment: How and why? Journal of Child Psychology and Psychiatry, 48, 245-261.
  14. Ibid.
  15. Britton, J.R. 2007. Postpartum anxiety and breastfeeding. Journal of Reproductive Medicine, 52:689-695.
  16. Weinberg, M. Tronic, E.Z. 1998. The impact of maternal illness on infant development. J Clinc. Psychiatry 59(suppl 2):53-61
  17. O’Connor, T. G., J. Heron, and V. Glover. 2002. Antenatal anxiety predicts child behavioral/emotional problems independently of postnatal depression. Journal of the American Academy of Child and Adolescent Psychiatry 41 (12): 1470-77.
  18. Ibid.
  19. Onunaku, N. 2005. Improving maternal and infant mental health: Focus on maternal depression. National Center for Infant and Early Childhood Health Policy at UCLA.
  20. Knitzer, J., Theberge, S., Johnson, K. 2008. Reducing maternal depression and its impact on young children: Toward a responsive early childhood policy framework. National Center for Children in Poverty, Project Five Issue Brief 2.
  21. Gaynes B., Gavin, N., Melter-Brody, S., Lhor, K., Swinson, T., Gartlehner, G., et al. 2005. Perinatal depression prevalence, screening accuracy, and screening outcomes: Summary, evidence report and technology assessment, No 119. AHRQ Publication No. 05-E006-1.
  22. Ibid.
  23. Altemus, M. 2001. Obsessive-compulsive disorder during pregnancy and postpartum. In: Yonkers, K., Little., B. (eds) Management of psychiatric disorder in pregnancy. Oxford University Press, NY, pp 149-163.
  24. Stein, D.J., Hollander, E., Simeon, D., et al. 1993. Pregnancy and obsessive-compulsive disorder. Am J Psychiatry 150:1131-1132.
  25. Bartz, J.A., Hollander, E. 2008. Oxytocin and experimental therapeutics in autism spectrum disorders. Progressive Brain Research, 170:451-462.
  26. American Psychiatric Association. 2000. Diagnostic and statistical manual of mental disorders (4th ed, text revision). Author, Washington, DC.
  27. Ibid.
  28. Lee A.M., Lam S.K. et al. 2007. Prevalence, course and risk factors for antenatal anxiety and depression. Obstet Gynecol 110:1102-1112.
  29. Ibid.
  30. Cohen, L.S., Altshuler, L.L. 2006. Relapse of major depression during pregnancy in women who maintain or discontinue antidepressant treatment. JAMA, 295:499-507

New Resource: What Every Pregnant Woman Needs to Know About Cesarean Section

Childbirth Connection has published a new mother and family-friendly resource that speaks in detail about cesarean section. The free resource guide talks about the current statistics, the possible benefits and harms, how to make informed decisions, how to help prevent a cesarean, and provides realistic information on what it’s like to have a c-section, including the particulars during birth and postpartum recovery.

If you are pregnant, I encourage you to read through this informative, easy-to-read, and helpful guide. Many pregnant women do not want to think about the possibility of having a c-section, but it’s important for everyone to know about and understand the procedure.

 

Weighing the Pros and Cons of Planned VBAC and Repeat Cesarean Section

 

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 the index page.

 

By Allison Shorten

 

The decision to plan a vaginal birth after cesarean (VBAC) or a repeat cesarean section (RCS) is a very individual one. There are different risks and benefits for mothers and babies. It is important to weigh
these risks and benefits while taking into account each woman’s unique values, needs, expectations,
past experiences, and desired level of involvement in this decision-making process.

The following summary table compares the various risks and benefits of planned VBAC and planned repeat cesarean section.  This is a list of complications that are often talked about when women are thinking about planned VBAC or planned RCS. In a group of 100,000 women who plan a VBAC, there will be some who experience problems. If those same 100,000 women all planned repeat cesarean surgery, there would also be some who experience problems. There is no certain way to predict what the birth will be like no matter which option is chosen. That is why it is important to think about all of the things that are important to you in making any healthcare decision.

For many of the complications listed, the number of women who experience them during VBAC or RCS is still relatively small in number. It is always important to discuss any questions or concerns about options for birth with a trusted pregnancy care provider who can provide more detailed information and meet your individual decision making needs.

 

 

Information in these tables has been collated from the Final Statement of the National Institutes of Health (NIH) Consensus Conference on VBAC held in Washington on March 12, 2010. The other main source of information is the evidence-based report that informed the NIH conference panel (Guise et al 2010). The following list of resources may also be helpful to you if you need further information.

Additional Reading

Are You Due on Christmas? Don’t Be Pressured into an Induction!

In the rush of the holiday season, most people worry about on-time delivery of important gifts and packages for friends and loved ones.  But if you’re a pregnant woman due around the holidays, there’s an added worry about when your baby will arrive.

Around the holidays, many pregnant women experience pressure from family or their healthcare providers to “schedule” their baby’s birthday around festivities and travel plans.  Be aware, however, that scheduling a baby’s delivery without a compelling medical reason can put your baby at risk.

“Few doctors want to be pacing the halls on Thanksgiving or Christmas, waiting for a mother to deliver,” said Marilyn Curl, CNM, MSN, LCCE, FACCE and president of Lamaze International.  “So it’s not uncommon to see a surge of women with normal pregnancies being told that there might be an issue and that they should consider scheduling the delivery, coincidentally, right before a holiday.”

It’s not just your healthcare professional who may try to rush your baby’s arrival.  Families often can feel stressed about the uncertainty of the baby’s arrival and feel it may compromise the celebration of holidays.  Some women also fear that their preferred healthcare provider won’t be available and will agree to a scheduled early delivery to guarantee that their provider will be available for the birth.

“I really understand that pressure.  You build a relationship with your care provider over the course of a pregnancy.  Plus, you build up expectations about your holiday celebration.  So it seems like ‘no big deal’ just to get the birth over with,” said Sue Galyen, RN, MSN, HCHI, LCCE, FACCE, a Lamaze childbirth educator from Brownsburg, IN.  “But it’s so hard to think that a scheduled delivery, whether through induction or cesarean, was worth it when either the mother or baby experiences a complication as a result.”

One complication of scheduling your baby’s birthday is that often, baby is delivered just a little too early.  A growing body of research shows that giving a baby those last few weeks or days inside the uterus can be crucial to the baby’s health.  Babies born even a “little” early face risks including breastfeeding difficulties, learning and behavioral problems, breathing problems, increased chance of time in the neonatal intensive care unit (NICU) and risk of death.

You can play a key part in driving down avoidable prematurity.  “Red flags” that might signal being pressured into an unnecessarily early delivery include:
• The care provider suggests that the baby is too big and will be easier to deliver “a little early”
• The suggestion is made that the care provider won’t be available for a holiday delivery or will be “booked up”
• The timing of the delivery is centered on travel and celebration schedules
• Holiday stress is driving feelings of wanting to get the pregnancy “over with”

Here are some things you can do if you feel you are being pressured into an early delivery:

  • Ask your provider if you need to make a decision right now.  If not, ask why not?  Few decisions need to be made on the spot unless the mother or baby are clearly doing poorly.
  • Research your options.  Use credible sources of information, like LamazeChildbirth ConnectionMothering Magazine’s online forum or your doula to see what the research says and talk to other moms about their experiences.
  • Make a pro/con list.  Label your pros and cons with “medical” vs. “personal” and weigh the “medical” pros and cons more heavily.  If you are talking about a major medical intervention like cesarean or induction and you don’t have a good list of cons, it’s a good sign that you need to do more research.
  • Trust your gut.  Your instincts are geared to protect you and your baby from risk.  Listen to what your gut is saying in the context of the research.
  • Find support.  It’s hard to disagree with your health care provider, so be sure that you go into your appointments with someone who can help you have an informed, evidence-based conversation about your best options.

Inducing labor without a compelling medical reason is one of many routine interventions that has not proven a medical benefit to mothers and babies and can impose harm.  Other common routine interventions include continuous fetal monitoring, coached pushing, being positioned on your back during labor, requiring repeat cesarean surgeries for women with a prior cesarean and separating mothers and babies after birth.

You can learn more about the Lamaze Six Healthy Birth Practices by enrolling in a Lamaze childbirth education class and visiting www.lamaze.org/healthybirthpractices.

Great Expectations: Pamela @ 38 weeks

Words to describe this stage in pregnancy:  Uncomfortable. Waddle. Sleepless. Cranky. Blessed.

Being 38 weeks pregnant with two little children to care for as well as the holidays to deal with has been overwhelming, but at the same time it’s a blessing to make it this far into a pregnancy when I know a lot of women who were unable to make it this far for a variety of reasons. Despite the sleepless nights (which I truly believe are preparing me for newborn hours) and a very sore body, I am trying my hardest to enjoy these final days of pregnancy.  At this point in our lives and our family, we are not planning on having any more children so the thought of these being my final days of ever being pregnant, of feeling a life inside me and knowing the miracle it has been to get him here, are important for me to cherish.

I am less fearful of the process of childbirth after meditating on my last birth and watching some beautiful natural births online through the Peaceful Birth Project.  Today I met a woman who was served by my same midwife for both of her births.  In her second birth, her labor started and stopped multiple times, enough that my midwife had come and set up her supplies each time.  When her daughter was finally born she was born with her cord wrapped around her neck, arm, and torso.  My midwife’s response to the birth was that the baby was just doing what she had to do to come out safely.   This phrase is so profound because my midwife truly believes in the power of a woman’s body as well as trusts in the process of birth and babies.  While she monitors and makes sure everyone is safe and healthy, she does so without undermining the power of a woman’s body.  Knowing my midwife has my back makes a world of difference for me and feeling prepared to go into labor.  I only wish that all pregnant women can feel this supported.

Most recent family picture, all 4.9 of us.

Selfishly, today I got excited thinking that within weeks I’ll hopefully be able to fit into something non-maternity, even if it may not be pretty.  I also got excited about not having to track everything I eat, even though I plan on maintaining my similar diet post-pregnancy because of how good it has made me feel.  What are another two to four weeks of pregnant bliss after 38 weeks?  It is funny, too, seeing the look on people’s faces when they ask when I’m due and I say, “any time now,” and they don’t know how to respond to me.  Some people back away, some people want to offer me a chair.  Often times lately I’ve been getting the empathizing look from other women who know just how uncomfortable it is to be 38 weeks pregnant.

Birth supplies are stacked in boxes in my living room, essential oils for birth and postpartum are ordered, and my birth pool is literally in front of me waiting to be assembled.  After this, almost everything on my to-do list is done and we will be on cruise control waiting for this little peanut to make his grand entrance.  With any luck, my 40 week update will be an announcement of his arrival.  To everyone also in their final weeks of pregnancy, how are you keeping distracted from the biggest test of patience of your life?

Using BRAINS When Communicating with Your Care Provider

By Deena H. Blumenfeld, RYT, RPYT, LCCE

Lamaze is about life skills, not just labor skills.  In class you learn breathing, relaxation and massage, all of which can be used outside of your childbirth experience.  In class, we build your confidence in your own abilities.  Some of that confidence comes from learning how to talk to your care provider and express what it is that you want and need.  Some of that confidence comes from knowing that you are empowered to make decisions about your body and about your baby.

Effective communication with your care provider is one of the keys to having a good birth experience.  Being sure that what your care provider is suggesting is the best, most appropriate course of action is important.  Having full informed consent before any test, procedure or medication is given is not only important, but it’s the law.

One of the most effective decision making tools I’ve found is the acronym BRAINED or BRAINS.  When we use this tool, it better allows for collaborative decision making. This is how you can ensure that things are being done for you and not to you.

 

BRAINED
Benefits – How could the recommended course of action help me or my baby?
Risks – How could the recommended course of action harm me or my baby?
Alternatives – Are there any other courses of action I could consider?
Intuition – What are my gut feelings about this?
Nothing – What happens if I do nothing?
Evaluate – Can you give me some time to consider my choices? Then…
Decide – Now that I have the information I need, I’m ready to make a decision.

 

BRAINS

Benefits- How will this procedure benefit me and my baby?
Risks – What are the risks to me and my baby?
Alternatives – What are some other things we might try instead?
Instinct/Intuition – What is your gut telling you?
Now/Never/Nothing – What if we don’t do the procedure right now? What if we never do it? What if we do nothing?
Safety/Satisfaction – Will this procedure increase the safety and satisfaction of the birth for me and my baby?

 

By asking the BRAINS questions, you can feel confident in your choices during birth, and know that you are part of the decision making process, working collaboratively with your care provider to have the best possible outcome for both you and your baby.

 

Deena is a Certified Khalsa Way™ Prenatal Yoga Teacher and Lamaze® Certified Childbirth Educator. She has been practicing yoga for more than 15 years. She became a certified Yoga instructor through 3rd Street Yoga in December 2008. She completed her 60 hour Prenatal Yoga training in February 2009 in Los Angeles at Golden Bridge Yoga with Gurmukh.

Her Lamaze certification was completed in October 2010, through Magee Women’s Hospital and Lamaze International. She is an advocate of empowered birth for women. Through the teaching of Prenatal Yoga and Childbirth Education classes, she helps women become more confident in their choices regarding pregnancy, birth and parenthood. 

Deena is also a mom of two – a son, born via c-section in April 2005, and a daughter in March 2009, a VBAC. She is an active member of the local ICAN chapter and a member of the Coalition for Improving Maternity Services.