You are here: Home / Birth

The Wonder of Mothers: Spontaneous Pushing During Birth

May 9, 2012 By Cara Terreri 3 Comments

May 13 is Mother’s Day and to celebrate, Giving Birth with Confidence will post throughout the month of May on “The Wonder of Mothers,” a series dedicated to sharing some of the many ways mothers’ bodies are beautifully designed to grow, birth, and nourish her baby. We’re also giving away a Lamaze stroller and infant car seat, so be sure to enter to win!

 

The Wonder of Mothers: Spontaneous Pushing During Birth

As a writer for Lamaze for nearly eight years now, I’ve read time and again about the point in birth when a woman’s body “just takes over” and she feels the uncontrollable urge to push out her baby. But it wasn’t until last year, during my third birth, that I truly experienced the phenomenon known as “spontaneous pushing.” After birthing two children, this was my first birth without any medicinal pain relief. When it came time for me to push (a mere 10 minutes after being admitted to my room), there was no denying the intense urge. My brain was no longer in control — my body “just took over.” At the time, I remember feeling overwhelmed by the intensity and seeming lack of control. And when you think about it, it can feel scary to lose control. What I realized after the fact, however, is that I did have control, my body was controlling and leading the way to birthing my baby. The wonder — and power — of a mother’s body is awesome.

The following is excerpted from the Lamaze Healthy Birth Practice #5 and talks about the benefits of spontaneous pushing.

Types of Pushing 
When you push in response to the natural urge to push, it is called “spontaneous pushing,” meaning you are doing what your body tells you to do. This natural urge comes and goes several times during each contraction. Each of these bearing-down efforts or urges usually lasts from five to seven seconds. However, when you are directed by your caregiver and those around you to hold your breath and push to a count of 10 seconds, repeating this two to three times during a contraction, you are using directed pushing.

Responding to the urge to push with short periods of holding your breath in a calm, unrushed environment has many advantages. Your baby will get more oxygen through the placenta, you will be less likely to become physically exhausted, and there is less chance of damage to the perineum and the muscles of the pelvic floor in the vagina (Albers, Sedler, Bedrick, Teaf, & Peralta, 2006; Roberts & Hanson, 2007). If you are having a very difficult time pushing the baby out, directed pushing might help. However, pushing spontaneously will usually be easiest and safest for both you and your baby.

What Research Tells Us 
According to the Cochrane Pregnancy and Childbirth Group, a respected international organization that defines best practices based on research, the use of any upright or side-lying position compared with lying on your back with your legs in stirrups is associated with the following results:

  • shorter second (pushing) stage of labor;
  • a small decrease in the use of vacuum or forceps;
  • fewer episiotomies;
  • less chance of experiencing severe pain;
  • fewer abnormal fetal heart tracings;
  • a small increase in second-degree tears (in the upright group only); and
  • an increase in estimated blood loss, although there was no evidence of serious or long-term problems from the extra blood loss (Gupta, Hofmeyr, & Smyth, 2004).

Were you able to spontaneously push during your labor? Share in the comments about your experience!

Filed Under Birth, Featured Story, Healthy Birth Practice, Hospital Birth Tagged With pushing, spontaneous pushing

The Wonder of Mothers: Skin-to-Skin Care

May 2, 2012 By Cara Terreri 1 Comment

May 13 is Mother’s Day and to celebrate, Giving Birth with Confidence will post throughout the month of May on “The Wonder of Mothers,” a series dedicated to sharing some of the many ways mothers’ bodies are beautifully designed to grow, birth, and nourish her baby. We’ll also be giving away a Lamaze stroller and infant car seat, so be sure to check back regularly!

 

The Wonder of Mothers: Skin-to-Skin Care

You may have heard of the phrase “skin-to-skin” or ”kangaroo” care, but if you’re new to the idea, here’s a simple definition:

Skin-to-skin or “kangaroo” care is when a newborn baby is placed unclothed on mother’s chest directly after birth and as often as possible during the newborn stage. This kind of care has been proven to have many health benefits for healthy full-term babies, as well as quicker recovery from illness and difficulties for premature and sick babies.

So what is it about a mother’s body that makes skin-to-skin care so important? Because of the unique symbiosis between a mother and her baby, a mother’s body is designed to provide the perfect environment for her newborn baby. When a baby is placed on her mother’s chest, the temperature of mom’s body not only keeps baby warm, but helps regulate a baby’s temperature to what he/she needs at that very moment. Some babies are born with the inability to regulate their own temperature. Studies have shown that skin-to-skin care is best for keeping a baby’s ideal temperature. It is often reported that artificial heat from an incubator cannot replicate the effects of mom’s touch. It also has been shown that the temperature for twins who are each placed on one of mom’s breasts are regulated independently, adjusting according to their individual needs!

Beyond temperature, skin-to-skin care has been shown to also provide newborn benefits in the way of regulating blood sugar levels, stabilizing heart rate, reducing crying, increasing mother-baby bonding, and establishing and maintaining breastfeeding. Mothers’ bodies are amazing!

Requesting Skin-to-Skin Care at a Hospital

If you are planning a hospital birth, know that many hospitals routinely perform infant procedures shortly after birth. If your baby is healthy, it is safe and encouraged to delay newborn procedures like weight and measurements, bathing, and any routine shots or ointments. Instead, use the first couple of hours after birth to spend skin-to-skin time with your baby. Talk to your care provider, your birth partner, and your doula about your preferences to hold your baby skin-to-skin after birth. And, ask your partner or doula to remind the nurses on staff during your labor of your birth preferences. You may need to speak up to get what you want, but remember, it’s your baby and your right!

Did you practice skin-to-skin care with your newborn? How do you think it helped you or your baby?

Filed Under Birth, Featured Story, Newborn, Parenting, Preterm Birth, Skin-to-Skin Tagged With kangaroo care, premature, skin-to-skin

Cesarean Awareness Month: Cesarean Resources

April 30, 2012 By Cara Terreri 2 Comments

Today is the last day of Cesarean Awareness Month. Throughout the month, Giving Birth with Confidence posted a variety of information and resources on cesarean birth. As the month comes to a close, we would like to leave you with a list of helpful resources for cesarean information. (The description for the resources below has been taken from each respective website.)

ICAN (International Cesarean Awareness Network) - www.ican-online.org

The International Cesarean Awareness Network, Inc. (ICAN) is a nonprofit organization that was founded by Esther Booth Zorn and many other motivated women in 1982.  ICAN has now grown to over 130 chapters throughout the United States and worldwide.

The Unnecesarean - www.theunnecesarean.com

Blog and site author Jill Arnold is a consumer advocate who founded The Unnecesarean in August 2008 as a collection of big baby birth stories, as well as women’s accounts of their cesareans and VBACs (vaginal births after cesarean).  After refusing a planned cesarean for suspected macrosomia based on a 38 week ultrasound estimate of fetal weight, she gave birth vaginally to a healthy baby and later found that the midwives model of care better met her needs as a pregnant woman.

Childbirth Connection - www.childbirthconnection.org

Childbirth Connection is a national not-for-profit organization founded in 1918 as Maternity Center Association. Their mission is to improve the quality and value of maternity care through consumer engagement and health system transformation. Childbirth Connection promotes safe, effective and satisfying evidence-based maternity care and is a voice for the needs and interests of childbearing families.

VBAC Facts - http://vbacfacts.com

After her daughter’s birth in 2004, site author Jennifer Kamel spent the next couple years wading through the research on vaginal birth after cesarean and became frustrated. Over the years, she slowly and meticulously collected information. And after her son’s victorious birth in 2007, a home VBAC, she created VBACFACTS.com in order to make the studies she had compiled, and the analyses she performed, easily accessible to others.

Cesarean Rates - www.cesareanrates.com

CesareanRates.com is a snapshot of online cesarean rate reporting in the United States as of January 2012. The site compiles the most current hospital-level data accessible to the public online, whether reported directly by a state’s department of health or gathered from state hospital association web sites via pull-down menus.

Special Scars – Special Women - www.specialscars.org

A “special scar” is one resulting from a Classical, Inverted T, J, Low Vertical, Upright T or any other cesarean incision other than the most often used Low Transverse. The Special Scars website was born from the need to get more accurate information to women with these scars. It is a collection of information — articles, studies, & our own stories — regarding the possibility of VBAC after an these special incisions.

A Woman’s Guide to VBAC: Navigating the NIH Consensus Recommendations - http://givingbirthwithconfidence.org/

A group of maternity care experts and VBAC advocates came together to create A Woman’s Guide to VBAC: Navigating the NIH Consensus Recommendations, a free online resource guide that addresses the most common and pressing questions women may have about their birth choices in what could be called the “post-NIH-Consensus-Recommendations Era.” The guide gives you the tools you need to empower yourself to advocate for you, your baby, and your birth choices!

 

Do you have a cesarean resource to add? Let us know below in the comments. 

Filed Under Birth, Cesarean, Featured Story Tagged With Cesarean Awareness Month, cesarean support

Communicating with Your Care Provider: Are You on the Same Page?

April 25, 2012 By admin Leave a Comment

By Anna Deligio, MSW, Labor Doula, LCCE, Reiki Master

 

First, do no harm.

This instructional value statement is often attributed to different versions of the Hippocratic oath medical doctors take as they embark on their healing careers.  It seems simple enough and certainly it would be easy enough to assume that its interpretation is universal.

We all know what happens to you and me when we assume, though, and to do so within conversations with your medical practitioner can often lead to more than just a need for clarification. Ensuring that a shared understanding exists of the language being used is critical to ensuring that you receive the care that is best for you.

Take the idea of “doing no harm.” Let’s say you’re in active labor and have been going strong for some time without any medicated pain management. You are working through your contractions well but are tired, overwhelmed, and lacking good support. You are starting to feel like you may not be able to continue without medication. The next time your nurse comes in, you say that you’d like to talk about getting an epidural. The nurse alerts anesthesia and soon you are talking with that person about the potential of getting an epidural.

Drawing on what you learned during your pregnancy from your own research and your childbirth preparation class, you know that epidurals can come with increased risks. You ask the anesthesiologist if the epidural will harm your baby. The anesthesiologist gives you a quick and confidant “absolutely not.”

Does that mean that you move forward with the procedure? Not necessarily. First it is important to make sure both of you are operating from the same understanding of “harm.” You might be thinking that “harm” includes the potential for a sleepy baby after the birth and one who may struggle to establish good breast-feeding. The anesthesiologist may be thinking that “harm” means the epidural would kill or permanently damage your baby.  Without clarifying follow-up questions such as “What impact will it have on the baby?” and “How long can I expect that impact to last after the birth?” you are risking approving a procedure that is not in line with your values of birth.

An online search for “tips on communicating with doctors” reveals a theme of writing down questions before the appointment, remembering that you are the consumer, bringing someone with you to appointments, and writing down the answers you get. Added to this needs to be, “ask clarifying questions until you are confident that you and your provider are using the same definitions for words.”

In many childbirth preparation classes, the acronym BRAIN is used to teach participants what questions to ask when faced with a decision. The letters cover the Benefits, Risks, Alternatives, your Intuition, and the potential of doing Nothing and are a way to remember which questions to ask in order to ensure that the procedure undertaken is the one you want.  This model is a wonderful first step, but can still lead to miscommunication if clarification of terms is not established through follow-up questions.

This can be a laborious process and not one you necessarily want to step into during your labor. More the reason to have these conversations during your prenatal visits, write a succinct and clear birth plan, and make sure that you have a support person with you during labor who understands your intent during the birth and can support you in communicating that intent to your medical staff.

Language is wonderful in its ability to convey specific ideas and still leave room for interpretation. While it may be fun to explore the intended meaning behind words when reading a piece of creative writing, it is critical to explore the intended meaning when discussing your care with your medical provider.

Insurance and funding permitting, the ability to pick a provider from the start that shares your values will go a long way in making sure language meaning is shared. That said, you will likely interact with many medical providers during your labor and, like us, each brings his/her own lens, values, histories, and definitions to the conversation.

Practicing asking clarifying questions during your appointments will give you the confidence needed to draw on that tool during your labor with each provider with whom you interact. Each question will get you closer to creating a shared understanding with your providers and build your confidence in your ability to participate actively in the labor you intend to have.

 

Anna Deligio is a Lamaze Certified Childbirth Educator and Labor Doula through her business Nourishing Roots, work that is greatly informed by her previous experiences as an MSW working with families in crisis and babies in foster care, a Special Education teacher of high school students with learning and emotional challenges, a marketing writer, and a waitress at a French restaurant. She loves working with pregnant people and their support people during the transformative time that is pregnancy and birth. When not enjoying the company of pregnant people, she enjoys relaxing with her partner Cathy at their home in Salem, OR.

 

Filed Under Birth, Birth plans, Choosing a care provider, Featured Story, Pregnancy Tagged With birth plan, care provider

Cesarean Awareness Month: Postpartum Recovery Tips for Cesarean Birth

April 23, 2012 By admin 4 Comments

April is Cesarean Awareness Month. What should you be aware of? Be aware that a cesarean, while it can be a life-saving procedure for mom and baby, is often prescribed when vaginal birth is a safe and sound option. Be aware that you have options, that you have a right to ask questions, and a right to know your risks. Educating yourself about birth is your best and first defense against an unnecessary cesarean. 

Throughout the month, Giving Birth with Confidence will be posting cesarean resources for moms. We encourage you to add comments with your experience as well as any questions — we will tag cesarean questions and answer them in a subsequent post. For more information and stories this month, check out the International Cesarean Awareness Network Blog.


Postpartum Recovery Tips for Cesarean Birth

By Sharon Muza, CD(DONA), BDT(DONA), LCCE, FACCE

 

Giving birth, whether vaginally or by cesarean, is a major physical event. A mother’s body goes through immense physical changes in the minutes, hours and first days after birth.  Recovering from major abdominal surgery while making the transition to not being pregnant and caring for a newborn can be extra challenging.  Here are some tips for the very first days after you have had a cesarean, and some of this information is just good info for the first days after birth, no matter how your baby arrived.

1. Discuss with the anesthesiologist about the possibility of having them administer Duramorph for immediate post-op pain.  This medication is placed through the spinal needle or epidural catheter during the surgery, and usually provides effective regional pain relief for 18-24 hours.  After that, you can switch over to oral medications as prescribed by your doctor or midwife.

2. Stay on top of your oral pain medication.  This is not the time to be a hero!  Make sure you are taking the right dosage of meds at the right time, even if the pain has not returned fully yet.  It is really hard to play “catch-up,” so taking your medication in a timely manner allows you to feel your best, be more open to moving and functioning, and gently participating in baby care. You may even want to set your smart phone to “alarm” a few minutes before each dose is due, to help you track and remember what is needed and when. Give yourself some time before you try and reduce the amount of oral pain meds you need. The more you move and do some gentle, easy walking, the faster your recovery may be. Adequate pain medication will help in this process.

3. Think about your recovery set up at home?  Where is your bedroom?  Is your bed very low to the ground?  Where are your baby changing stations?  If you have a lot of stairs, consider relocating your sleeping area to one that is more accessible, close to a bathroom and the kitchen/place to eat.  It will only be a temporary move, but may make things easier for taking naps and resting.  If your bed is very low, consider placing it temporarily on cement or wooden blocks to make it higher.  It will be easier on your abdominal muscles to get up and down from a higher bed.  You can set up a portable changing area for the baby close by or in the same room as where you will be spending most of your time.

4. Use a pillow to “brace” your abdomen when getting up from a chair, couch or bed.  Sometimes, when you are laughing, sneezing or coughing, that can be helpful too.  If your couch or favorite chair is too low, think about adding some extra pillows for the additional height that you need in the early days.

5. Consider using a TENS (Transcutaneous Electrical Nerve Stimulation) unit to help with post-surgery discomfort.  Several studies show that women who used a TENS unit around the incision area needed less narcotic pain medication during their cesarean  recovery. (TENS units can be purchased online or may be acquired from your care provider.)

6. You may want to consider using a gentle belly binder or even a rebozo to “hold things together” for the first days or even weeks post cesarean.  Some women find that the gentle support offered by these products helps them to feel less sore and more supported.  Just be sure that whatever you use does not irritate the incision. (Some care providers offer belly binders automatically during your hospital stay. If not, you can ask for one.)

7. Work at becoming an expert in the side-lying breastfeeding position, which I consider the hardest to master for the mother-baby dyad, but the most useful once you do.  This way, you can rest as much as possible, and even doze for a few minutes during those extended feedings.  The key to doing this successfully is lots and lots of pillows!  A couple for your head, one between your legs, one behind your back at a minimum.  In general, your milk may come in a little slower after surgery than after a vaginal birth, so frequent nursing sessions, and lots of skin-to-skin time with your baby will help this to happen sooner.

8. Be sure to use stool softeners, stay very hydrated and eat food with lots of fiber. Oatmeal is a galactogogue (food that helps increase milk production) and is high in fiber at the same time.  Narcotic pain medication can cause constipation, and post surgery, the thought of having to strain to have a bowel movement can be emotionally challenging.  Most women find the fear is worse then the reality, but it is good to do what you can to keep things “moving,” so to speak.  Also, your bladder and urethra may be a bit irritated from the foley catheter that was placed to drain urine during surgery and the first hours of recovery. You may want to take cranberry pills or drink cranberry juice to help with bladder health and prevent a urinary tract infection.  Also, you will have received IV antibiotics before or during the surgery to prevent infection, and some women are more prone to getting yeast infections after receiving antibiotics.  A  yeast infection on your nipples (Thrush) is no fun either, and can be shared between you and the baby. You may want to use some probiotics (found over the counter in a pharmacy) or eat yogurt with live cultures, to help restore the balance of good bacteria normally found in your digestive tract.

9. Create a “nursing bag” full of all the things you need during a nursing session.  Cell phone, snacks, filled water bottle you can operate with one hand, something to read, burp cloth, breast care products, etc. can all be put in a bag or basket, and moved around with you, so that you have everything you need when you sit down to nurse.

10. Ask your friends and family to do some of the more physical household tasks and contribute meals during your recovery.  Use a website like Takethemameal.com or Care.com for scheduling assistance and for letting people know how and when they can help.

11. Recognize that you will have lifting restrictions that limit the weight you can carry to just the baby for at least a couple of weeks or even more!  It is recommended that you not lift the carseat with the baby in it until you have done some healing.  You also may not be driving for several weeks, (and certainly not while on narcotic pain meds) and your partner may have returned to work already, leaving you feeling a bit isolated.  It would be nice to have someone stop be every day to help, visit, or take you out for a short trip if you are up for it.  You may want a baby carrier (sling, Moby Wrap etc.) to help you hold/carry your newborn while your physical recovery moves forward and your mobility returns.

12. Working with a massage therapist who specializes in postpartum recovery can also help with postpartum pain and minimize the development of internal adhesions and promote healing.  Get a recommendation for someone skilled in this type of scar work and see if they make house calls!  Some massage therapists will come to the house in the first days of your postpartum period.

13. Connect with your local International Cesarean Awareness Network chapter, (www.ican-online.org to find one near you) and consider joining their online group or attending a meeting when you are ready.  This peer-to-peer support is invaluable as you process your birth and recover from a cesarean.

 

Go easy on yourself after you have had a cesarean birth.  It is hard to recover from surgery and ease into parenting a newborn at the same time.  Ask for help, make little changes around the house to support your recovery, and take it easy to give your body a chance to heal.  Laying low and resting will give you plenty of time to connect and snuggle with your new little one while you get your strength back.

 

Sharon Muza, CD(DONA), BDT(DONA), LCCE, FACCE, is a birth doula, doula trainer and Lamaze Certified Childbirth Educator in Seattle, WA.  Sharon is also the co-leader of the Seattle chapter of the International Cesarean Awareness Network, (ICAN.)  Sharon can be reached through her website, www.newmoonbirth.com, if you would like more information. 

Filed Under Birth, Cesarean, Featured Story, Postpartum Tagged With cesarean, Cesarean Awareness Month, postpartum care

Cesarean Awareness Month: Making Your Cesarean Mother-Baby Friendly

April 18, 2012 By admin 3 Comments

April is Cesarean Awareness Month. What should you be aware of? Be aware that a cesarean, while it can be a life-saving procedure for mom and baby, is often prescribed when vaginal birth is a safe and sound option. Be aware that you have options, that you have a right to ask questions, and a right to know your risks. Educating yourself about birth is your best and first defense against an unnecessary cesarean. 

Throughout the month, Giving Birth with Confidence will be posting cesarean resources for moms. We encourage you to add comments with your experience as well as any questions — we will tag cesarean questions and answer them in a subsequent post. For more information and stories this month, check out the International Cesarean Awareness Network Blog.

Making Your Cesarean Mother-Baby Friendly

By Sharon Muza, CD(DONA), BDT(DONA), LCCE, FACCE

You may find yourself headed for a cesarean birth, even when that was not what you planned.  A cesarean might have been in the cards all along for a variety of reasons, or  this change in plans might occur before labor begins, or during labor, when you, your partner and health care providers feel that a cesarean is now the best option.

As a long time birth doula and Lamaze certified CBE, I always encourage my clients and students to plan for a potential cesarean, even though many mothers feel like that outcome is unlikely.  Current cesarean rates in theUnited States tell us that more than 1 in 3 women will give birth by cesarean this year.  Having a simple plan with some wishes that continue to honor the birth of your baby, can go a long way toward making the experience a positive one.

Here are my top tips to make your cesarean birth as mother-baby friendly as possible. Discuss these items in advance with your health care provider to see what is possible in your situation and in your place of birth.

1. If you know you are going to have a cesarean, without an opportunity to labor, discuss with your provider if there is any risk in letting the baby pick his/her birth date and you heading to the hospital when your water breaks or gentle contractions start.  There are many benefits to your body, your baby and future labors if you allow your baby to initiate labor.  There are certain situations that may preclude this from being an option available to you, like placenta previa, where the placenta covers the cervical opening.

2. When the decision is made to have a cesarean, and if time allows, take a moment to talk to your baby.  Let him or her know what will be happening, that you have confidence in your team and your baby and that you will soon be holding him or her in your arms.

3. Walk into the operating room if possible.  It is very empowering to move to the OR under your own steam, if you and the baby are stable.  If you have been laboring without an epidural or the cesarean is planned, anesthesia is usually done in the OR, so you should be able to walk there on your own.

4. Ask for two support people in the operating room with you.  Your partner can be one, of course, and then your doula, family or friend may also be included.  Having two people in the OR means that your partner can go over to greet your baby at the warmer, and you can still have support with you right by your head. If your baby needs immediate transfer to a special care nursery, your partner can go with the baby, without worrying about leaving you alone.

5. Bring in music of your choice that can be played during the birth.  A CD or even an mp3 or smartphone placed on the pillow near your head playing softly can help you remain relaxed and positive.

6. Ask that everyone in the room take a moment to introduce themselves before the surgery begins.  There are several more people than you might expect in the OR during a cesarean birth, and everyone may look the same, all gowned and masked.  It can feel a little more personal to hear the staff introduce themselves and state their job…”I am Mary and I am the baby nurse…” can help you to feel like it is not such an impersonal procedure.

7. If you were waiting to discover the sex of the baby at birth, you can still do that.  The staff and surgeons do not need to announce “boy or girl” but leave that to be discovered by you and your partner.

8. Ask if it is possible to delay cord clamping for even a very short amount of time, if baby is stable.  Even 30 seconds of continued pulsing can provide benefit to your baby.

9. Sometimes, women may feel a bit nauseous during the surgery.  It may be a result of the procedure, or nerves, or unfamiliar sights, sounds and smells.  Consider bringing a little cotton ball or gauze pad with some peppermint oil dabbed on it, in a Ziploc bag.  Peppermint oil can reduced the nauseous feeling and help you to not vomit.  There is medication that can be given to you during the operation, but it may also make you sleepy, so if you can avoid it, that is great.

10. Talk to your baby after s/he has been born.  Ask your partner to tell you what is going on, and what your baby looks like; “Oh, honey, he has the same long fingers as you do…” Talk or sing to your baby, so that your little one can hear your voice as it makes the transition to the outside world.  When your baby is brought over to you, you and your partner can sing happy birthday or a special song that you may have been singing to your baby during pregnancy.

11. Ask that all possible newborn procedures be delayed until after you have returned to your room with your baby and had a chance to breastfeed.  Unless it is critical to have the weight of the baby immediately, this measurement and other procedures, (Vitamin K, eye antibiotic medication, dressing, etc.) may be able to wait until you and your baby have had a good snuggle and a breastfeeding session back in your room.

12. Ask if it is possible to get skin to skin with your baby in the OR, while your incision is being closed.  Prepare for this in advance by having removed or unsnapped your gown, and having just a warm blanket on top of you, ready for the baby.  While the baby may not be able to breastfeed in the OR, while you are on the table, you can certainly have the closeness and skin-to-skin snuggles.  You will always need some support during this time, so make sure that partner knows to keep their hands on the baby for safety.  If you are unable or prefer not to have skin-to-skin in the OR, consider letting your partner have some skin-to-skin time with the baby while sitting next to you.  Wearing a shirt that opens in the front, or even a t-shirt that has been cut a little down the neck will make it easier to slip your naked little one inside their OR gown or scrubs.

13. Ask that your uterus not be exteriorized during the procedure.  Exteriorizing your uterus is when the surgeon moves the uterus out of your body and onto the sterile field for examination and repair.  Studies show that postpartum pain after the surgery is greater when this has occurred and offers no benefits over doing the repair “in situ” (in position).

14. Ask that your uterus be double-layer sutured.  While current research is not clear that this provides any advantage over single-layer suturing, should you wish to attempt a vaginal birth after a cesarean with a subsequent pregnancy, some physicians are more comfortable and supportive of this VBAC attempt if there has been double layer suturing during the repair.

15. When you return to your room and get a chance to spend those first minutes really holding your baby and initiating breastfeeding, try and keep visitors and guests away for just a little bit, so you and your baby can get a chance to get acquainted on the outside.  This time is precious and the fewer distractions the better, to help you and your baby connect and bond.

A cesarean birth, whether expected or unplanned, offers unique challenges and circumstances for you and your baby.  It is helpful to recognize that a cesarean birth is still a birth, and you can prepare in advance by including plans for a birth on your terms, even when it occurs in the operating room.

 

Sharon Muza, CD(DONA), BDT(DONA), LCCE, FACCE is a birth doula, doula trainer and Lamaze certified childbirth educator in Seattle, WA.  Sharon is also the co-leader of the Seattle chapter of the International Cesarean Awareness Network, (ICAN.)  Sharon can be reached through her website, www.newmoonbirth.com, if you would like more information or need some support in planning your birth.

Filed Under Birth, Birth plans, Cesarean, Complications and high risk pregnancies, Featured Story, Pregnancy, Preparing for VBAC Tagged With cesarean, Cesarean Awareness Month

Cesarean Awareness Month: “Big Babies” and Cesarean

April 16, 2012 By Cara Terreri 3 Comments

April is Cesarean Awareness Month. What should you be aware of? Be aware that a cesarean, while it can be a life-saving procedure for mom and baby, is often prescribed when vaginal birth is a safe and sound option. Be aware that you have options, that you have a right to ask questions, and a right to know your risks. Educating yourself about birth is your best and first defense against an unnecessary cesarean. 

Throughout the month, Giving Birth with Confidence will be posting cesarean resources for moms. We encourage you to add comments with your experience as well as any questions — we will tag cesarean questions and answer them in a subsequent post. For more information and stories this month, check out theInternational Cesarean Awareness Network Blog.

The following is a previously posted blog from obstetrical expert Henci Goer in which she answers one mom’s question about “big babies.” For more answers from Henci, visit her forum on the Lamaze website. 

Q

More and more we hear about “big baby” as a justification for induction or c-section. I was one of those mothers myself before becoming more educated in my options. However, my second baby was 11lbs. at birth. What do you feel are the things to consider when you may be genetically prone to growing a “big baby”? Do you feel the position of the baby is more important than the baby’s size when it comes to birthing a “big baby”?

A

Unfavorable position is clearly the bigger problem because it affects babies of all sizes, but while, logically, size has to be an issue as well, there are no neat cut-off points. Here is what the research tells us about big babies that can inform strategies for maximizing safe, healthy birth:

  • High BMI women tend to have bigger babies. Take home message: losing weight sensibly before pregnancy might be beneficial.
  • Eating a healthy diet and exercising regularly optimizes sugar metabolism. Take home message: this, too, could optimize fetal weight.
  • When obstetricians wrongly believe (based on sonographic weight estimates) that the baby will be big, women are much more likely to have a cesarean than when the baby actually is big, but the doctor didn’t suspect it and vice versa. Take home message: I’m not sure that refusing a weight estimate will help because, as this makes clear, it is a matter of what the obstetrician believes. I think it would be more useful for women to explore early on how her care provider feels about women’s ability to birth bigger babies and how he or she handles that situation. Specifically . . .
  • Inducing labor for “suspected macrosomia (baby predicted to weigh 8 lb 13 oz or more)” increases cesarean surgery rates without reducing incidence of shoulder dystocia (the head is born but the shoulders hang up behind the pubic bone) or delivery injury rates. Take home message: await spontaneous labor onset.
  • Planning cesarean surgery exposes women to the serious potential harms of major surgery. The best way of determining whether the baby is too big to come out is to go through labor and see. Take home message: don’t plan surgery.
  • Labor with a big baby is likely to take longer, at least partly because the cervix may have to open further to pass a bigger head. (The “10 cm diameter” definition of full dilation is actually not really 10 cm. For the last few cm of dilation, clinicians measure, not the diameter, but how much rim is left. This means that the true diameter might be a cm or two bigger.) Take home message: find a care provider willing to be patient with a longer labor and who has no preset time limits for making progress.
  • Epidurals, confining women to bed, pushing while reclining or semi-reclining can all impede progress. Take home message: choose a place of birth that allows freedom of movement and plan alternative means of coping with labor pain so as to bypass or delay an epidural. Also, hire a doula. Doulas can help with strategies to promote good progress and increase comfort as well as with emotional support should labor progress slowly.
  • The best “first response” to shoulder dystocia is assuming a hands-and-knees position: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9610468. Take home message: either plan to give birth in this position or have a plan with the care provider to turn to this position should the shoulders hang up. (With today’s modern “light” epidurals, it should be possible to turn to all fours with assistance even with an epidural in place.)
Filed Under Birth, Cesarean, Featured Story Tagged With big baby, cesarean, Cesarean Awareness Month

Cesarean Awareness Month: A Woman’s Guide to VBAC

April 9, 2012 By Cara Terreri Leave a Comment

April is Cesarean Awareness Month. What should you be aware of? Be aware that a cesarean, while it can be a life-saving procedure for mom and baby, is often prescribed when vaginal birth is a safe and sound option. Be aware that you have options, that you have a right to ask questions, and a right to know your risks. Educating yourself about birth is your best and first defense against an unnecessary cesarean. 

Throughout the month, Giving Birth with Confidence will be posting cesarean resources for moms. We encourage you to add comments with your experience as well as any questions — we will tag cesarean questions and answer them in a subsequent post. For more information and stories this month, check out theInternational Cesarean Awareness Network Blog.

Nearly two years ago, Lamaze published A Woman’s Guide to VBAC: Navigating the NIH Consensus Recommendations, a guide for women seeking to understand the information, risks, and statistics behind vaginal birth after cesarean. The guide has been an invaluable springboard for women to research their decision on VBAC. We invite you to read the following introduction, click through to each section of the guide, and post your own thoughts, comments, and questions on VBAC. 

A Woman’s Guide to VBAC: Navigating the NIH Consensus Recommendations

In June 2010, a National Institutes of Health (NIH) panel published a Consensus Development Conference Statement on vaginal birth after cesarean (VBAC).

In addition to examining the current evidence related to VBAC and offering recommendations for future research on this topic, the NIH panel concluded that VBAC was a “reasonable option” for most women with a previous cesarean section.

In the context of a current birth climate that can be somewhat hostile toward VBAC, this was an exciting moment for many birth advocates, maternity care providers, and mothers!

But even with all that is included in the NIH Statement on VBAC, it might be difficult for many of us to wade through the information in it and figure out what it means for us and our particular birth options and unique circumstances.

This is where A Woman’s Guide to VBAC comes into play.

A group of maternity care experts and VBAC advocates came together to create A Woman’s Guide to VBAC: Navigating the NIH Consensus Recommendations, a free online resource guide that addresses the most common and pressing questions women may have about their birth choices in what could be called the “post-NIH-Consensus-Recommendations Era.” We hope the guide gives you the tools you need to empower yourself to advocate for you, your baby, and your birth choices!

Sections in A Woman’s Guide to VBAC:

 

The Inspiration for this Project

The concept for this guide was borne out of many things: the timeliness of the NIH panel’s statement on VBAC, the importance of the statement itself, and our personal interest in advocating for women seeking vaginal birth after cesarean.

But we would be remiss if we didn’t acknowledge another source of inspiration for this project: namely, the heartfelt and heartening consumer participation in the NIH Consensus Development Conference on Vaginal Birth After Cesarean.

As women who were lucky enough to attend the NIH Consensus Conference on VBAC in person (Kristen) or view the entire proceedings in real time by webcast (Amy), we can say with some certainty that consumers — that is, the mothers, doulas, midwives, nurses, doctors, and other birth advocates who traveled from near and far and volunteered their time to attend — played a big role in this conference!

We listened, we read, we talked with one another, we got the word out to women who couldn’t participate in the meeting, and we asked some of the most incisive questions of the entire conference proceedings.

Quite simply, we made a difference.

This guide is dedicated to those consumers—and to all of us who are maternity care consumers, whether we are currently pregnant, have been pregnant, or simply work and advocate on behalf of pregnant women.

What exactly is a National Institutes of Health Consensus Development Statement?

This statement is the product of an NIH Consensus Development Conference. These two-and-a-half day conferences—which are free and open to the public—are organized by the NIH to address issues in medicine that are both controversial and pertinent to health care providers and the general public.

During the NIH Consensus Development Conference on VBAC, an independent panel listened to presentations given by invited expert speakers.  The panel also heard input from members of the general public during Q&A sessions. Finally, drawing upon the conference proceedings and upon a systematic review of the evidence on VBAC, the panel drafted their statement on VBAC.

Like all Consensus Development Statements, the statement on VBAC is not legally binding. It does not create practice guidelines, nor does it establish any health policies. Nonetheless, it is still an exceedingly important document. In fact, because of the high-quality evidence that the NIH panel uses to create consensus development statements, the NIH claims that it is “reasonable to expect that the panel will be able to give clinical guidance” to care providers.


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

Cesarean Awareness Month: 10 Tips for Avoiding a First-Time Cesarean

April 4, 2012 By admin 5 Comments

April is Cesarean Awareness Month. What should you be aware of? Be aware that a cesarean, while it can be a life-saving procedure for mom and baby, is often prescribed when vaginal birth is a safe and sound option. Be aware that you have options, that you have a right to ask questions, and a right to know your risks. Educating yourself about birth is your best and first defense against an unnecessary cesarean. 

Throughout the month, Giving Birth with Confidence will be posting cesarean resources for moms. We encourage you to add comments with your experience as well as any questions — we will tag cesarean questions and answer them in a subsequent post. For more information and stories this month, check out the International Cesarean Awareness Network Blog.

10 Tips for Avoiding a First-Time Cesarean

By Jessica English, CD(DONA), LCCE

More and more women in the United States (and around the world) are having cesarean births. A recent study from the Yale University of Medicine showed two main reasons for the rise: more c-sections in first-time moms and lower rates of VBAC (vaginal birth after cesarean).

For your first baby, what can you do to reduce your chances of an unnecessary cesarean birth? We’ve identified 10 areas where you can be proactive and stack the deck in your favor.

1) Hire your provider wisely. This point is number one for a reason – it’s critical. In most practices, you could have any one of several doctors or midwives. You get whoever is on call when you go into labor. It’s helpful to know your practice’s cesarean rates. The labels “obstetrician,” “family doctor” and “midwife” don’t necessarily tell you what you need to know about your provider’s philosophy. Some doctors practice more like midwives, and some midwives practice more like a stereotypical doctor. Will they have a toolbox of natural techniques or only medical tool to help you if your labor is complex? If you’re not sure which doctor or midwife to choose, ask a doula. Doulas see all kinds of births with many different practices, and they will be happy to make a recommendation of a provider with a low cesarean rate and good bedside manner.  If you find out that your provider is not supportive, it is never too late to switch, even if you are just a few weeks or even days before your due date.

2) Hire a doula. Simply put, doulas make birth better, and there’s research to prove it. A meta-analysis of studies shows that women who use a doula are 26 percent less likely to have a cesarean birth, among other dramatic benefits. Having continuous support from a friend of family member can be helpful too, but the best results come when women hire an outside doula, according to a recent Cochrane Review. What exactly is the doula magic? The research hasn’t pinpointed the magic, but I think the unique combination of physical, emotional and informational support, plus gentle advocacy makes a huge difference. Doulas help women feel safe and comfortable so the hormones of labor can work at optimal levels, positioning ideas and tricks can help babies work their way out, and evidence-based information and help communicating with the medical staff can help women have their best chance inside a system that doesn’t really promote natural birth.

3) Take an independent natural childbirth class. It’s not so much that you need to know a lot about giving birth, but many women (and men) need to undo what society has taught us about birth. Independent classes are usually longer and more in-depth, with more interaction and less lecture. A good instructor can help increase your confidence in your body and help you trust in the normal birth process. An independent Lamaze-certified instructor will base her class on the six Lamaze Healthy Birth Practices, a wonderful resource that lays the groundwork for the best possible birth. Another benefit of an independent class is that your teacher works for you. She can teach you how to advocate for yourself within the system, without having to worry about what doctors, administrators or anyone else might think.

4) Avoid induction unless there’s a serious medical problem. As a first-time mom, some studies show that simply walking in the door for an induction of labor doubles your risk of a cesarean. Doubles it. That’s huge! Avoiding induction is never more important than with a first baby. But if you must be induced for a medical reason, call on your natural childbirth instructor and your doula (remember them?) to help you with tips to keep it as normal and natural an experience as possible, even with the unexpected circumstances. If mom and baby are not in immediate danger, low-and-slow inductions can result in a better chance of a vaginal birth, but you’ll need great support on the journey.

5) If having your baby in the hospital, stay home at least until strong, active labor. Your independent childbirth instructor will teach you how to recognize active labor. If you follow the common hospital recommendation to “come in when contractions are five minutes apart, at least a minute long, for at least an hour,” most women having their first baby will be very early in labor. The intensity of contractions is a much better guide than the timing. The more hours you are at the hospital before your baby is born, the higher your risk of intervention (including a cesarean). In her book “Pushed: The Painful Truth About Childbirth and Modern Maternity Care,” Jennifer Block tells the story of a hospital in Florida that lost power after a major hurricane. A generator kept the essentials running, but there was not enough power for air conditioning. They wanted to save resources and keep laboring women cool, so for a full week they turned away any woman who was not in full-blown, active labor. Their emergency cesarean rates during that week dropped dramatically.

6) Avoid an epidural, at least in early labor. Research is a bit mixed, and not all studies have been high quality. But still, the best evidence available does seem to show that epidurals, especially when women get them early in labor, do increase the cesarean rate in first-time mothers. Childbirth Connection is a great resource for information on the benefits and risks of epidurals. There are rare times, of course, when getting an epidural can actually help a woman have a vaginal birth, if she simply doesn’t have the strength to go on. Every labor is different. But an epidural also makes it harder for a baby in a bad position to move into a better one, it limits your ability to move, and it requires a lot of other interventions (IV, continuous monitoring, bladder catheter, etc.). Your doula and your independent childbirth class may give you enough natural tools so that you won’t even need the drugs. Most women don’t.

7) Read only the best childbirth books. Get these books, and read them cover-to-cover. Seriously, throw away “What to Expect When You’re Expecting,” and dive into these wonderful books instead.

And while you’re at it, buy the DVDs “The Business of Being Born” and “Orgasmic Birth” – they’re even on Netflix. That’s right, I’m recommending “Orgasmic Birth.” Stretch yourself a little!

8) Get your partner on board. It’s hard to do this alone, you need support! Even with the best doula, your partner is still an integral part of your birth journey. Penny Simkin’s book “The Birth Partner: A Complete Guide to Childbirth for Dads, Doulas and All Other Labor Companions” is a great place to start. Be sure your partner attends that independent childbirth class with you – sometimes partners benefit even more than moms from that information and support.

9) Consider an out-of-hospital birth. It’s possible, with the right support, to have a great first birth in the hospital – even a vaginal birth without pain medication. As a doula I see them fairly often, and you should definitely choose the hospital if that’s where you feel safest and most comfortable. But the best research is pretty clear that your odds of a vaginal birth are better outside of the hospital: at home or in a birth center. In 2005 the British Medical Journal published a large study that looked at home births in the United States attended by Certified Professional Midwives. The women who gave birth at home had similar outcomes to low-risk women who had hospital births in terms of safety for moms and babies. But just 3.7 percent of the women who had their babies at home transferred to the hospital for a cesarean, while 19 percent of the low-risk women who had their babies in the hospital ended up with c-sections. The current cesarean rate in the United States is 32.9 percent, according to the Centers for Disease Control. Many studies have shown similar results, which makes out-of-hospital birth at least worth considering.

10) Believe in your body! The cesarean rate for women who birth at The Farm in Tennessee is less than 2 percent. Many industrialized countries around the world have cesarean rates of 15 percent or less. Women have been doing this for millions of years! Your body works. Birth works, in all its complex and wonderful variations. Surround yourself with knowledgeable support, of course, in case you encounter any rare and unexpected complications. But truly… trust your body. Trust birth.

 

Jessica English, CD(DONA), LCCE, is the owner of Birth Kalamazoo, which offers birth and postpartum doula services, natural childbirth and breastfeeding classes, and in-home lactation consults. A DONA-certified birth doula and Lamaze-certified childbirth educator, she teaches an 8-week series of classes called “The Best of Natural Birth.” She is the editor of DONA International’s eDoula newsletter. A longtime writer and business woman, she also works as a consultant for organizations and birth professionals.

Filed Under Birth, Featured Story Tagged With Cesarean Awareness Month

Finding Your Most Accurate Due Date

March 28, 2012 By Cara Terreri Leave a Comment

Calculating your due date can be tricky. Unfortunately, it’s not as simple as knowing the date of your last menstrual period (LMP), a tool used by most online due date calculators and care providers. Even the high-tech ultrasound, which can be helpful in detecting some things, is not the best at figuring out your due date.

Knowing your most accurate due date is important as you near the time of birth. Many care providers impose limits for how long a woman can go past 40 weeks before scheduling an induction (despite guidelines from the American Congress of Obstetricians and Gynecologists stating that a full-term pregnancy is 42 weeks). If your due date is calculated for July 1, but your actual due date is July 10, you may receive unwarranted pressure to induce when in reality, your baby has not even reached 40 weeks gestation. Inductions carry a host of risks and interventions and should be scheduled only if medically necessary for the health of you and your baby.

So how do you calculate your most accurate due date? Childbirth Connection has created a simple worksheet to answer questions and use in conjunction with your care provider to determine your due date. The form is below, and it can also be downloaded on the Childbirth Connection website.

 

 

 

Filed Under Birth, Due Date, Featured Story, Induction
« Older Posts