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What Are the Options When Your Baby Is Breech?

March 11, 2013 By FitPregnancy 2 Comments

By Jeanne Faulkner, R.N., a labor nurse and writer for FitPregnancy. You can read more from Jeanne at fitpregnancy.com/labornurse.

In the U.S. today, about 4 percent of babies are breech at full term, which means they’re in position to exit the uterus feet- or butt-first rather than headfirst. Before 1959, virtually all such babies were safely delivered vaginally; today, most are born by Cesarean section. But as more mothers and babies are experiencing sometimes serious complications associated with surgical deliveries (in 1970, the C-section rate was 5.5 percent; today it’s 34 percent), some experts are re-evaluating their position regarding breech births.

Beginning in the 1960s, obstetricians gradually shifted the way they delivered breech babies because they preferred the predictability and the presumed greater safety of a C-section birth. But not every doctor jumped on the C-section wagon immediately; many continued favoring vaginal breech births. That is, until the Hannah Term Breech Trial (TBT) published in 2000 brought them to a screeching halt. The TBT followed 2,083 breech babies in 26 countries, randomly assigned to either vaginal or planned C-section delivery. Early data suggested fewer newborn deaths and injuries occurred in the C-section group. “The impact of this study was stunning,” says Heather Weldon, M.D., an OB-GYN at Southwest Medical Group OB/GYN Associates in Vancouver, Wash. “Within months, breech C-sections went from 50 percent to 80 percent and, by 2006, 90 percent. Then, we found out the study was flawed.”

In fact, critics began poking holes in the TBT immediately after its publication. For example, some poor outcomes attributed to vaginal delivery occurred in birth centers that used substandard techniques or unskilled birth attendants. Some babies had genetic defects or were premature. In short, most weren’t injured because they were delivered vaginally, but because of other factors. Further study indicated that most of the babies recovered fully from their birth injuries regardless of delivery method, and researchers also hadn’t factored in the increased health risks resulting from C-sections.

“The data actually support vaginal breech birth as safe in certain scenarios and not in others,” says Amy M. Romano, C.N.M., M.S.N., associate director of programs at Childbirth Connection, a nonprofit organization dedicated to promoting evidence-based maternity care. “The results should have supported informed decision-making, but instead, hospitals reacted by taking that choice away from women.” Another unfortunate result was that medical schools quit teaching vaginal breech delivery skills to entire generations of new doctors. “Any care provider can get surprised by a breech baby during labor, but many doctors don’t know what to do and that’s dangerous,” says Ina May Gaskin, C.P.M., founder of The Farm Midwifery Center in Tennessee and author of Ina May’s Guide to Childbirth (Random House) and Birth Matters (Seven Stories Press).

Making that baby flip

A baby can be breech off and on throughout pregnancy without causing concern. But after 32 weeks, it might be a good idea to try to reroute him if you want to avoid a C-section. If he’s still breech at 35 weeks, care providers tend to worry, and if 37 weeks comes and goes, it’s time to take action: The closer it gets to your due date, the less likely it is for your baby to flip because there’s just not enough wiggle room.

Three types of breech babies

1} Frank Breech The baby’s bottom faces the cervix and his legs are straight up. This is the most common type and can sometimes be delivered vaginally.

2} Footling Breech The baby’s feet are in the birth canal. This is the second most common type and is generally unsafe to deliver vaginally because of potential cord complications.

3} Complete Breech The baby’s bottom faces the cervix. His legs are bent at the knees, and his feet are near his bottom. The least common type, these babies can sometimes be delivered vaginally.

The following three methods can be tried at 32 weeks or later:

The tilt. Using cushions placed on the floor or an ironing board propped up against the seat of your couch, lie with your hips elevated about 1½ feet above your head. Do this for 10 to 15 minutes three times a day, preferably when your baby is active. There are no reliable statistics, but according to Gaskin, “It works a lot of the time.”

The Webster Technique. “This is a gentle chiropractic adjustment to the pelvis and sacrum that reduces uterine torsion [twisting] and balances the pelvic muscles so that the baby can move into a more optimal position for birth,” says Heather Yost, D.C., a chiropractor at Yost Family Chiropractic in Urbandale, Iowa. “It usually takes four to 10 adjustments, but some babies turn after just one attempt.” The Journal of Manipulative and Physiological Therapeutics reports the technique has a success rate of 82 percent.

Pulsatilla is a homeopathic remedy that stimulates the uterus to settle baby headfirst. It’s best to see a naturopathic physician (N.D.) or a homeopath, though some midwives feel comfortable recommending specific doses and instructions. It’s safe and “sometimes works,” Gaskin says.

The following two techniques should not be tried before 37 weeks because they may stimulate labor:

External cephalic version, performed by either a doctor or midwife, repositions the baby by pushing on the mom’s abdomen and the baby’s head. It’s like a deep abdominal massage. “Sometimes we relax the uterus with medication,” Weldon says. “Then we lift the baby’s body with one hand, get the opposite hand on the baby’s head and encourage a somersault.” An epidural may be given to minimize discomfort during the procedure. According to the American College of Obstetricians and Gynecologists, the average success rate is 58 percent.

Moxibustion, a technique performed by acupuncturists, uses heat from a burning herb, mugwort, to stimulate an acupuncture point on the outside of the smallest toe; this increases fetal activity. Studies show that moxibustion is 30 percent to 36 percent more likely than other methods to make a baby turn head-down, with some small studies indicating that its success rate may be higher than 80 percent.

If you’re close to your due date, your baby is still breech and you want to avoid a C-section, surgery may be your only option unless you can find a doctor or midwife who is qualified and willing to deliver him vaginally or you don’t meet the criteria for a safe vaginal birth. For details about one hospital’s pioneering program, see below.

If you want a vaginal delivery

Oregon Health & Science University (OHSU) in Portland is among a few hospitals nationwide to support vaginal breech delivery. “Without hospital-based options, some patients attempt high-risk deliveries at home,” says Leonardo Pereira, M.D., OHSU’s chief of maternal-fetal medicine. “OHSU has established safety criteria for patients, and we are training clinicians to deliver breeches vaginally in order to make the service available at more hospitals in the future.”

Among other criteria needed to qualify for an attempted vaginal breech delivery, the woman must have her pelvis measured via an MRI, and the baby must be full term and in frank or complete breech presentation. Very small or very large babies may not qualify. To find an appropriately trained doctor or midwife, call your closest academic health center and ask whether vaginal breech delivery is offered or whether they can refer you to providers who do offer it. You can also look for providers at midwife.org or birthpartners.org.

Filed Under Birth, Featured Story

Great Expectations: Rebecca @ 32 Weeks

March 8, 2013 By admin 1 Comment

Meet our newest Great Expectations blogger, Rebecca Headen. At 32 weeks into her third pregnancy, Rebecca has a lot to share in a short amount of time! We hope you enjoy following along with her journey and encourage you to drop a line in the comments.

At 32 weeks pregnant, I’m in a hotel in rural America about 400 miles from home on my last work trip before the baby comes, awaiting a snowstorm that may or may not delay my trip back, and planning our family’s latest hosting events — a birthday party for my about-to-be 4 year-old and a shower for our third baby to come (that’s right, third).  But none of that compares to what has been weighing on my mind for the past week: at just 8 weeks until the due date, I am considering changing my OB/Gyn.

You’re thinking there must be a reason. Of course there is, though like most things it’s not black-and-white.  I had my second baby with this set of doctors, although in the end an entirely different doc delivered her (he was on call at the time, and everything went fine and like the first: no interventions, no medications, I called the shots — what worked for me). But I have had a series of small issues with the care at this place, culminating in one large one two weeks ago and I think I may have had enough.  At this late stage of my pregnancy, there’s a voice in the back of my mind (the “mom” voice, the “Taurus scared of change” voice, the “you’re pregnant and you may not be entirely rational” voice) that says: “Why not just stick with what you know? It worked the last time.” As a person who relishes in the comfort of logic, I might tend to go with this head-driven approach. But so far in my life it is only when I’m pregnant that I find power in handing my instincts the mic. And so, there is a loud battle of the bands happening in my head right now while I board the plane, as I work with my colleagues here, as I have the after-bedtime goodnight conversation with my husband who is holding things down at home.

One of the best things about being pregnant the third time around is also one of the most challenging: everyone thinks you know what you’re doing. Which in some sense is true, as much as any of us knows what we’re doing.  But I think it’s also true that the more you know, the more aware you become that you can’t know it all — and you certainly don’t need to (thank goodness). I guess most people don’t think that experienced moms need to talk it out, too.  We still have questions, and not just the ones with answers we forgot about the first time around — new issues, or concerns, or items we never really resolved before.  I find myself missing what were once 10 minute conversations with my doctor but are now abbreviated as they confidently conclude: “Well, you’ve been there before. You know all this stuff. No problem.” At first, like anyone might, i felt boosted by these comments.  It meant I knew what I was doing.  That I didn’t really even need a doctor — everything I’ve ever read in my very natural birthing books (after all, if my health insurance paid for it, I would probably be at a birthing center instead of a doctor’s office anyway).  But as time went on, the statement, often said while the doctor was standing up with hand on the doorknob of the exam room, started to sound less like what they said and more like what I suspected they meant.  I started feeling like I was watching a dubbed movie, where they were mouthing the supportive words, but what I heard was “you don’t have any problems and I’m trying to make sure I see the required number of patients today so that my practice breaks even this month, so if there isn’t anything else, see you next time.”  Right or wrong, we all know that the stressors of health care often dictate the experience we have with medical professionals.

The thing that most surprises me about this situation is my own reaction.  I am not a shy person.  I am neither judgmental nor overbearing, but I definitely share my opinions (just ask my co-workers, or my husband). But somehow when it comes to dealing with a doctor, I have a hard time speaking my mind.  What I dread most isn’t seeing the doctor who was responsible for my recent bad experience (an extra test that resulted in a series of major side effects that I was not warned about), but actually bringing up the issue at all. I have a vision of the office, and me in it, ever so slowly explaining my problem with how the situation was handled, and why it made me trust them less and worry more. I anticipate the doctor reacting as any doctor would — with guarded concern, safeguarding their liability by empathizing while ever so slightly implying that I might be overreacting. And then, I see a few weeks down the road, when (lucky me) this very doctor just happens to be on call as I go into labor.  It is at this point that my instincts start screaming for an alternate road to the delivery room.  In recognizing all of this, I realize too how lucky I am — I have health insurance. I am well-educated.  I can Google my way around any situation (as I did in this one). I can change hospitals, doctors, breathing techniques. I have choices.

Getting my mind, body, family and life ready for baby number three is a different experience, one that I’m still learning to value on its own. Which is why I decided to at least make an appointment with a new doctor ASAP, even just to see how it would feel; and why I’ll continue planning that third shower; stay enrolled in the refresher birthing class (getting my mind ready for what my body knows is coming); and this time perhaps appreciate my instincts through pregnancy and beyond.  Who knows.  Some really good decisions may come of it.

Rebecca Headen lives in Washington, DC, where she is a social justice advocate and attorney, wife to an adoring superhusband/superdad, and proud mom raising two tenacious, questioning, independent and strong girls with a baby boy in the works.

Filed Under Featured Story, Great Expectations, Pregnancy

Interview with Wendy Isnardi, Author of “Nobody Told Me… My Battle with Postpartum Depression and OCD

March 6, 2013 By admin 7 Comments

If you’re just tuning in piece, be sure to check out the first piece in this two-part post, Kathy’s review of Wendy’s book, “Nobody Told Me… My Battle with Postpartum Depression and Obsessive Compulsive Disorder.”

By Kathy Morelli, LPC

Meet Wendy

Wendy Isnardi lives in Suffolk County, New York, along with her husband and two young daughters. Since the birth of her first daughter, she has been a staunch supporter and volunteer for the Postpartum Resource Center of New York. This is a non-profit agency dedicated to helping women and their families survive their ordeals with depression during pregnancy and depression following the birth of their children. She has dedicated countless time and energy to assure that the center continues to exist and provide the support that women need in order to beat serious mental diseases. She has put fighting women’s depression on the forefront of her life with great personal sacrifice.

 

Q: First off, I am honored that you agreed to let me interview you! Tell me briefly about your current volunteer work at the Postpartum Resource Center of NY.  

I am currently the resource coordinator and phone support.  In addition, I speak at “Family Night”  for the Circle of Caring Support Groups and I have facilitated support groups as well.

 

Q:  Tell me what motivated you to write your book?

Being  a volunteer at the Resource Center doing phone support I saw how important it was for me to get my story out.  So many women were afraid and embarrassed to discuss their PPD issue with anyone.  They were so afraid that they would be judged and branded a bad mother.

There is such a stigma with mental health issues that no one wants to talk about it. 

There was nothing wrong with me; I was a great mother that loved my daughter more than anything.  I became extremely ill after her birth and I got the help that I needed and got better.  There is no shame in that so I figured “why not write a story about my situation” and try to normalize it. I also wanted to show moms that you can go on and have other children and not be affected by the disorder again.  If I could help at least one mother then it was all worth it.

 

Q: Do you find writing to be a healing experience?

Absolutely! I wouldn’t change one thing about my experience because it changed me.

I feel that it made me a better, more understanding person.  As I wrote the book it took my back to that place and helped me come to terms with what happened. I will never forget that dark time, but I will also never forget the rewards that I got from that experience, especially the undying love I have for my daughters and husband. I did it all for them.

 

Q: I was especially riveted by your descriptions of harm befalling you and your baby.  You were so brave to expose these thoughts.  In fact I used these in a presentation, and it was quite powerful for the audience to hear these thoughts. 

How do you feel about these scenes in your book? (shark feeding scene, escalator scene, gun fears, etc). Why did you include such detail?

The escalator scene for me is what really changed everything.  That’s when I decided I wanted to go back into the hospital.  The thoughts were so graphic that I got physically ill.  I was scared to death.  I thought the safest place for me and everyone else was in the hospital.

The shark incident was probably the first time that I ever seriously contemplated suicide.  Walking into the aquarium I was already extremely anxious and severely depressed.  I hadn’t really been out in public too many times and the aquarium was packed.  Besides the fact that I really wasn’t comprehending the whole OCD concept, so I was really believing in all of the crazy thoughts that were going on in my head.

Once we came upon the huge shark tank I started to panic.  As I looked over into this tremendous tank I saw sharks in all different sizes swimming about, looking for food.  The image of my babies body falling into the tank flooded my head and it was all I could think about.  The more I tried to stop the thoughts the stronger and more graphic they became.

That was where the focus of my thoughts started to surround me and my own mortality.  That’s when I was afraid that I was going to take my own life.  And was when the reality that my husband had loaded guns in a safe right in our bedroom.  I never attempted suicide, nor did I have a plan, but the thoughts were there and they sickened me.

 

Q: Have you gotten negative feedback on this?

So far, I have only gotten positive feed back, but I know that there will be critics that don’t truly understand the disease that would think of my story negatively and wonder why I wasn’t arrested or committed.

 

Q: I was interested in your experiences with OCD before your birth.  Do you look back on your behaviors before the pregnancy and wonder why this was not previously addressed ?

All the time.  I worried about everything, all day every day, since I was a little girl.  I remember reacting to certain situations and wondered why other people didn’t feel the same way I did.

Everyone around me knew how much of a worrier I was and always accused me of being a hypochondriac.  I just thought I worried more than most.

Not until after I gave birth to Madison did the worrying take on a life of its own and literally knocked me off my feet.

 

Q: Does OCD still rear its unwelcome symptoms? 

Yes it does.  I think it’s always there.  Now I know how to handle it.

I’m not nearly as anxious as I was in the past.  The thoughts are about everyday nonsense and pass as soon as they come.  I do find my OCD peaks a bit when I ovulate and right before my period, but it’s no big deal. 

 

Q: Do you have any particular information you’d like to impart to persons suffering from OCD about their healing work to do before pregnancy and OCD postpartum? 

Most important is not to buy into the crazy thoughts.  A thought is just a thought.  A change in mood and becoming depressed and anxious is temporary and will get better when treated properly. You are not alone and you are a good mother.  Education is key and taking care of yourself is also extremely important.

 

Q: Do you feel your confusing relationship with your father contributed to your particular mental health difficulties?  Or have you considered it is more genetic? Or a combination?

I guess my relationship with my father made me very insecure and there was a need for me to feel accepted.  There is a tremendous connection genetically; my father and his siblings all suffered from  mental illness (untreated).  I definitely think it is a combination.

 

Q: What type of self-care do you engage in now to help yourself maintain good mental health?

I eat very healthy and drink lots of water.  I try very hard to keep active and exercise whenever I can, which isn’t often. I try to avoid stressful situations and when I feel anxious I realize it will pass. Stress and aggravation can bring on mood changes. In my opinion a good sense of humor goes a long way too.

 

Q: How are you continuing your advocacy work?

I am currently the Resource Coordinator for The Postpartum Resource Center of New York. I also provide phone support there as well, talking to moms and families in need.  I speak at seminars regarding PPD and mood disorders, and co-facilitate support groups.  I will do media work for the resource center.  I will basically do whatever it takes to make a difference.

 

Q: What are some of your future projects?

Being the best advocate for PPD! And  helping the Postpartum Resource Center of New York, Inc.’s VISION for 
a Perinatal Depression Parent Support Network in every New York State community. I have dedicated myself to the cause.  As I said before — whatever it takes.

 

Q: What do you do to relax on beautiful Long Island?

I spend time with my beautiful family.  We love going to Montauk and especially love The East End in the fall.  We have four dogs and take them for walks.  We just love being together.  I am blessed!!!

 

Kathy Morelli, LPC, has a professional marriage and family counseling practice with a focus on pregnancy, birth, postpartum and trauma in Wayne, NJ. Kathy also offers phone consultations and web-based courses. She has a long-term interest in mindbody therapies and is trained in shiatsu, acupressure and Reiki. She writes and speaks on birth comfort measures and perinatal mental health and has appeared at various universities and conferences across the country. She writes on perinatal mental health for Lamaze’s Science & Sensibility, is a board member of Prevention and Treatment of Traumatic Childbirth (PATTCh) and is one of Postpartum Support International’s (PSI) Virtual Volunteers. Visit her at birthtouch.com and kathymorelli.com.

Filed Under Featured Story, Postpartum, Postpartum Mood Disorder Tagged With postpartum disorders

Early Induction: What You Should Know

March 4, 2013 By Cara Terreri 3 Comments

In line with last week’s post about recommendations against elective induction before 39 weeks, let’s talk about what an early induction means. Below are some basic points with links to more in-depth information from evidence-based resources.

How early is an early induction?

An “early induction” is any induction that is performed before 39 weeks of pregnancy. Experts from several recognized organizations, including the American College of Obstetricians and Gynecologists (ACOG), Childbirth Connection and March of Dimes, state that a baby needs at least 39 completed weeks in order to fully develop their brain and other vital organs.

What are the risks of early induction?

Induction in and of itself carries risks to mom and baby. Because induction is an artificial process for starting labor, your body may not be ready to follow its cues. As a result, inductions can cause a cascade of additional medical processes (interventions) to keep labor going, which can ultimately lead to an increased risk for cesarean surgery. Unless there is clear medical indication (see below), letting labor begin on its own is the safest decision.

Induction before 39 weeks brings an additional risk of prematurity. Babies born even a little too early can experience complications like problems with breathing, feeding, maintaining body temperature and jaundice. In most cases, babies know best when it comes to being born.

What if I need to be induced?

There are solid medical reasons for induction before 39 weeks. Being done with being pregnant, isn’t one of them. ;)  There are also several reasons given for induction that are not true medical reasons. It’s important to know the difference. Click through and read up on the two links provided above on the new induction resource page on Childbirth Connection, a not-for-profit organization founded that works to improve the quality of maternity care.

If you’re pregnant and faced with the decision to induce — and even if you’re not — read up! Inform yourself. Learn all that you can, from sources in addition to your care provider and other than well-meaning family and friends. Start here:

Filed Under Birth, Featured Story, Healthy Birth Practice, Induction, Interventions Tagged With labor induction

“Choosing Wisely” & Reading the Fine Print with Maternity Care

March 1, 2013 By Cara Terreri 1 Comment

Did you know there are organizations out there that work to set checks and balances for our system of medical professionals? The ABIM Foundation, founded by the American Board of Internal Medicine, has made it their mission to enhance quality of care by encouraging regular assessment and improvement of our physicians, bringing diverse groups and leaders together, and promoting research. In line with their mission, ABIM Foundation developed the Choosing Wisely® initiative. Choosing Wisely aims to promote conversations between physicians and patients by helping patients choose care that is:

  • Supported by evidence
  • Not duplicative of other tests or procedures already received
  • Free from harm
  • Truly necessary

As a result, ABIM  developed a list, with input from national medical organizations, of  “Five Things Physicians and Patients Should Question.” The idea is that these lists (separated by medical specialty) will spark discussion about the need—or lack thereof—for many frequently ordered tests or treatments. This is great news for us as consumers — what more do we want than transparency with our care? We want to know if the test or treatment that’s been prescribed is truly necessary and helpful. We also want to know the risks, weighed properly against the benefits. With regard to maternity care, Choosing Wisely developed the following recommendations:

Don’t schedule elective, non-medically indicated inductions of labor or Cesarean deliveries before 39 weeks 0 days gestational age.
Delivery prior to 39 weeks 0 days has been shown to be associated with an increased risk of learning disabilities and a potential increase in morbidity and mortality. There are clear medical indications for delivery prior to 39 weeks 0 days based on maternal and/or fetal conditions. A mature fetal lung test, in the absence of appropriate clinical criteria, is not an indication for delivery.
Don’t schedule elective, non-medically indicated inductions of labor between 39 weeks 0 days and 41 weeks 0 days unless the cervix is deemed favorable.
Ideally, labor should start on its own initiative whenever possible. Higher Cesarean delivery rates result from inductions of labor when the cervix is unfavorable. Health care practitioners should discuss the risks and benefits with their patients before considering inductions of labor without medical indications.

Considering the high rates of elective inductions, often prior to 39 weeks, these recommendations are a breath of fresh air. Of course, this is not the first stand that has been taken against unnecessary inductions (the American College of Obstetricians, ACOG, has included this directive for some time). But with these particular recommendations, there is added stress on the importance of not inducing unless there is a favorable cervix, and the added emphasis that “labor should start on its own initiative.”

While these recommendations represent a healthy step forward in improving our maternity care, there are some concerns about how they could be misunderstood. In a review of these guidelines on the Lamaze blog, Science & Sensibility, Amy Romano of Childbirth Connection questions, “will the new message lead women and care providers to think that delivery is indicated once a woman’s cervix is ripe?” In other words, Romano cautions:

The best indicator of readiness is still the spontaneous onset of labor at term, the culmination of an intricate interplay of hormonal signals between the fetus and the woman. Anytime we intervene with the timing of birth we have to weigh the potential benefits and harms of overriding that process in the context of the fully informed preferences and values of women.

 So, while the Choosing Wisely recommendations are important and helpful in our quest for the best maternity care, it’s vital to keep in mind that, unless medically indicated, a date or length of pregnancy (ie, 39 weeks) should not be the reason for induction. It’s still best to allow labor to begin on its own. For a better understanding on the importance of labor starting spontaneously, check out the Lamaze Healthy Birth Practice video:

 

Have you experienced pressure to induce? What did you do? How did you discuss it with your care provider?

 

Filed Under Birth, Featured Story, Induction

Book Review: Nobody Told Me…My Battle with Postpartum Depression and OCD by Wendy Isnardi

February 27, 2013 By admin 4 Comments

When Wendy Isnardi published her book, I had to read it. I love reading books in this genre: books written by real women in the perinatal mental health advocacy community. I love the real life stories about women putting themselves out there kicking the perinatal mental illness stigma! (You can read my review of  Ivy Shih Leung’s book here and Walker Karraa’s interview with Ivy here.)

Wendy’s story is unique in this genre as she suffered from both postpartum depression and postpartum obsessive-compulsive disorder (OCD). Her story is especially relevant as she shows us the birth world and the maternal mental health world are truly related. The first woman-to-woman contact in her community who had the appropriate resources for her situation was her Lamaze instructor.  Her story illustrates how childbirth educators might very well be the first contact with the right referrals for perinatal mood disorders. It was fortunate her Lamaze instructor had the appropriate contacts for Wendy when she needed them.

Today, Wendy still successfully manages OCD.  OCD can be difficult to treat as it requires a great deal of strength, diligence and commitment to successfully manage. It’s tough and you gotta be tough to beat it.

Her storytelling is the in-your-face, no-holds-barred style of her native Brooklyn and her current residence, Long Island (where I was born and raised, so I can relate!).  She calls her absent, estranged biological father “the sperm donor” and her ever-present, ever-strong mother her “hero, ” and her step-father her “true father.”  She lived through several moves until she credits her mother and her real father with giving her the gift of a stable home life.

Wendy lived through stressful years of a dating and marriage to a person who abused substances and cleared out their back accounts.  She tells of her painful feelings of failure as she divorced and then filed for bankruptcy.

Wendy then met her true love, Joey, her husband. She tells us that all her life, she was labeled a “worrier.”  But, no one really identified her peculiarities, such as a need to line up lipsticks by the correct color, and her need to collect lots of types of things, like makeup brushes, as symptomatic of OCD.  In general, her life and the OCD symptoms she manifested were manageable before childbirth.

But Wendy’s OCD worsened when she became pregnant with her first daughter, Madison. It is well known that a woman with a history of mental illness (diagnosed or undiagnosed) is at risk for a perinatal mental illness.

Emotionally, she says she was a “bundle of nerves.” She tells us she obsessively searched the web for pregnancy information and obsessed about all the health messages. The messages were everywhere! Don’t eat tuna, don’t eat cold cuts, don’t wear high heels, don’t stand in front of a microwave, don’t eat maraschino cherries, the baby will get brain damage, etc. And, as Wendy says, everyone has an (unsolicited) opinion for a pregnant woman!

Wendy experienced a tough pregnancy physically, too.  She  suffered from excruciating constipation during pregnancy.

And Wendy’s birth experience was traumatic. She had a very frightening emergency cesarean section. Wendy actually saw her own “insides” all pulled out of her in a mirror during the surgery.   Her husband told her he was afraid he was going to lose her.

Then, we segue to her being at home with her baby daughter, Madison. And the worsening of the terrible unrelenting anxiety and depression so debilitating that she became unable to care for her baby. She was afraid to be alone. Her obsessive fears and scary thoughts took over her life. She had  paralyzing obsessive thoughts about bacteria in the baby bottles, about medication accidentally being dumped into the baby bottles. She quickly became afraid to be left alone with her baby. Her  emotional state impacted the whole family; her husband and mother had to take shifts, so she wouldn’t be alone.

What makes Wendy’s story so unique and riveting is her willingness to describe in excruciating detail her unrelenting “scary thoughts;” the debilitating thoughts that women with postpartum anxiety and OCD experience.

She now knows, and shares with us, that those scary thoughts were just thoughts, and were not precursors to harmful action. She says she knows she would never actually have harmed her baby, but the thoughts she was having terrified her. She couldn’t stop them and they were dark thoughts. She didn’t understand what they were all about. Her distress and fear were real.

During all of this, Wendy is feeling depressed and lost. But, by a happy coincidence, she meets her Lamaze instructor at a craft fair.  Her Lamaze instructor recognizes she needs help and gives her a referral to a professional licensed therapist. Wendy calls her immediately and starts to see her that week. She begins therapy, and gets set up with a psychiatrist who prescribes medication.

But Wendy still had a long and scary road.  Her healing process began, but it was a long fight, not for the faint of heart.

Wendy found professional help and then she also found peer support at the Postpartum Resource Center of New York, which is a non-profit agency dedicated to helping women and their families survive their ordeals with depression during pregnancy and depression following the birth of their children. She began to immediately get involved at the center, volunteering there, along with her husband and her mother.

Wendy shares with us that her scary thoughts and obsessions included bloody thoughts and fears about her husband’s gun (even thought Joey is a police officer who knows gun safety and appropriately locks it up). Other obsessive thoughts were frightening bloody thoughts about escalators and her all-consuming bloody terrors of the shark tanks when she visited the Seaquarium.

It is important to note here that her scary thoughts were just that — terrifying thoughts — not precursors to action, not full-blown delusions. She never lost touch with reality and right and wrong.  Wendy had frightening thoughts but she knew she would not hurt her baby.

Wendy’s story is riveting as she sought help and  never stopped fighting. She was able to fight through to a successful healing process. She moved on to help others, have another child and a fulfilled, successful life.

Come back next week to read my interview with author Wendy Isnardi.

Kathy Morelli, LPC, has a professional marriage and family counseling practice with a focus on pregnancy, birth, postpartum and trauma in Wayne, NJ. Kathy also offers phone consultations and web-based courses. She has a long-term interest in mindbody therapies and is trained in shiatsu, acupressure and Reiki. She writes and speaks on birth comfort measures and perinatal mental health and has appeared at various universities and conferences across the country. She writes on perinatal mental health for Lamaze’s Science & Sensibility, is a board member of Prevention and Treatment of Traumatic Childbirth (PATTCh) and is one of Postpartum Support International’s (PSI) Virtual Volunteers. Visit her at birthtouch.com and kathymorelli.com

 

Filed Under Featured Story, Postpartum, Postpartum Mood Disorder, Postpartum support

10 Ways to Help Overcome Your Birth Fears

February 25, 2013 By FitPregnancy 1 Comment
By Alice Lesch Kelly, a health and psychology writer for FitPregancy

Many women who whole-heartedly want to be mothers dread the prospect of having to actually deliver a baby. In fact, while just about every woman feels some anxiety about giving birth, 6 percent to 10 percent of pregnant women suffer intense fear. This can manifest itself in such symptoms as nightmares, heart palpitations, dizziness, shortness of breath, a racing pulse and difficulty concentrating. The good news is that there are ways to reduce your fear of childbirth. Here are 10 of them:

1. Track the source of your anxiety 
Certain experiences can trigger an intense fear of labor. These include a history of abuse or rape; a past miscarriage or stillbirth; a previous difficult delivery; and excessive exposure to traumatic labor stories. Also at risk are women with a history of anxiety, depression and low self-esteem, according to a 2008 study published in the international OBGYN journal BJOG. Understanding why you’re so afraid is a first step toward easing those feelings; keeping a journal can help.

2. Don’t wait until labor day
Start identifying and dealing with your fears at the beginning of your pregnancy, not the end. Chances are good that your worries are deep-seated, and it can take time to get to their root and address them. Anxiety tends to increase as a pregnancy progresses, becoming most intense as a woman’s due date approaches, so try to get a jump on the source and solutions early on.

3. Consider therapy 
A study conducted in Finland found that women with an intense fear of labor who underwent cognitive (talk) therapy had shorter labors and fewer unnecessary C-sections than those who didn’t. “If a woman feels that her fear is taking over other aspects of her life, such as her intimate relationships, I usually suggest that she see a therapist,” says Margaret Plumbo, C.N.M., a midwife at Health East Clinic in Woodbury, Minn.

4. Learn relaxation skills 
Practicing self-hypnosis, meditating and doing breathing exercises while you’re expecting can help calm you during pregnancy and labor. Listening to guided-relaxation tapes that describe your perfect “peaceful place” is another effective option.

5. Share your fears 
Don’t hesitate to tell your doctor or midwife that you’re afraid; just talking about it may help, and she may have ideas about how to reduce your anxiety. Sometimes just learning the facts—how often delivery complications actually occur, for example—can put your mind at ease. If your caregiver doesn’t seem to listen or lacks compassion, consider finding a new one.

6. Put your fears in writing 
Create a one-page birth plan that includes your desires about such options as pain medication, laboring positions and fetal monitoring as well as an honest explanation of your fears. Share it with your caregiver during a prenatal visit and have a copy ready to give to the nurses when you’re admitted to the hospital. Knowing that your caregivers are aware of your concerns will help reassure you.

7. Have a midwife or doula 
Midwives and doulas spend more time with women during prenatal visits and labor than OBs do, and their presence and insights can help you cope with your fears. “Your doula or midwife understands you and will stay with you during labor,” says Marshall, Va.-based former doula Bonnie B. Matheson, founder of Childbirth Solutions LLC.

8. Shut out negative stories 
Don’t watch scary TV shows about childbirth, read horror stories or listen to friends recount the gory details of their labors. Some experts believe that fear of delivery has become more widespread since the advent of sensationalized depictions of childbirth.

9. Learn about pain relief 
Most women fear the pain of childbirth to some degree, but knowing that safe and effective means of relief are available can help lessen your anxiety. Take a childbirth course, talk with your caregiver beforehand about medication and other pain-relief methods and include your intentions in your birth plan.

10. Explore your options 
Some women fear the typical hospital childbirth experience. Choosing alternatives, such as having your baby in a homelike birthing center that permits women to deliver in different positions and have more control over their experience and environment, can often allay such fears.

Filed Under Birth, Featured Story

Last Firsts – An Essay in Motherhood

February 22, 2013 By Meagan Church 2 Comments

The following is written by our former Great Expectations columnist and regular contributor, Meagan Church. 

Seven years ago, I was newly pregnant and, honestly, a bit freaked out. Matt and I had been married for seven years and we knew we wanted kids. I just wasn’t sure I wanted to be a mom. You see, I liked my life as it was. I liked my job, I liked my freedom, I liked being in control, plus I wasn’t much of a baby person. I knew having kids would change things and I wasn’t sure I wanted to make those changes.

Fast-forward seven years. Last week we celebrated Adelyn’s first birthday. Addie, our third (and last) baby, is technically not a baby anymore. And that makes me sad. For the past few weeks, I’ve found myself paying more attention to the last moments of Addie’s baby stage. I have been taking more joy in her giggles, rocking her for a few extra minutes and just taking the time to recognize that these moments won’t last forever, and much to my surprise, that saddens me a bit.

With our first two, I often found myself wishing away the early months and years. What got me through the first few months of our colicky first child was setting mini-goals. Okay, if we make it to six weeks, things will get better. Okay, now we just need to make it to three months. Okay, now six months…. The adjustment to motherhood was a tough one and my high-needs baby didn’t make it any easier for me.

When baby number two came along, I was still worn out from the first one. I once again spent most of that first year hoping to speed through it, so we could get back to “normal” life. Then we had our last baby. Suddenly I began to enjoy the baby stage and not wish it away quite so quickly.

Don’t get me wrong; there have been moments along the way that I’ve wanted to speed through. For instance, I very clearly remember that in those last moments of labor before she was born, the mantra that got me through it was, “Just push her out and you will never have to go through labor again. It will all be over. Just push. Just push.” There were also fussy breastfeeding sessions that made me long for toddlerhood when she would be weaned.

Yet overall, I have been enjoying her babyhood more than with the first two. I’m sure some of that has to do with the fact that I have a few years of experience under my belt. But I think a greater part is that I realize this stage of life we are in is about to change and we will never return to it. With every milestone Addie reaches (signing, crawling, talking, walking), I can’t help but think these are our last firsts. This is the last time one of our kids will reach this milestone for the first time…just when I felt like I was actually getting the hang of things.

I know they must grow up and that things will continue to change. But for just a few minutes longer, I want to hold on to my baby and rock her and sing to her and kiss her full cheeks. Seven years ago, I had no idea that I’d ever want those things so strongly. Seven years ago, I was afraid of how motherhood would change me. Yet, seven years later, I realize how blessed I am to get to experience it, and to grow and learn right alongside my kids. Who knew these last firsts would happen so quickly?

Filed Under Featured Story, Parenting

In the News: You Don’t Have to Worry About Worrying

February 20, 2013 By Cara Terreri Leave a Comment

In an article today on Slate.com, science and medical columnist Amanda Schaffer provides evidence that refutes the belief that worrying or anxiety leads to problems with infertility, premature birth, or developmental delays in children. For today’s generation of childbearing women, the worry over worrying is a vicious cycle. With women who are trying to get pregnant, they are told not to become too anxious about the process — that worrying about it can prolong conception. With women who are pregnant, they are told to monitor their levels of anxiety of stress, as it may lead to premature birth or cause later harm to their child’s development. As if we don’t have enough to think about during pregnancy, now we’re told we should worry about our worrying!

But Schaffer says it doesn’t have to be so:

…the reigning impression is wrong: The weight of evidence suggests that moderate levels of stress and anxiety do none of the things we fear. They seem not to affect whether women are able to conceive, whether they carry the fetus to term, or whether their kids reach normal developmental milestones. (If anything, some maternal stress during pregnancy seems to make kids mature a little faster.)

How did we create a culture that is obsessed over stress? More than likely, it’s the abundance of media and messaging we receive on a daily basis. Think about it — how many tabloids, websites, and social media messages have you seen in the last week that comment on a celebrity’s pregnancy? As Shaffer puts it, “A finding here, an anecdote there—women can easily get the wrong idea.”

So what does the evidence say? With regard to fertility, a meta-analysis in the British Medical Journal, which included more than 3,500 women, found: “Women’s emotional state before IVF bore no relationship to whether the treatment worked. In other words, women with more extreme levels of anxiety or depression were just as likely to get pregnant after a single cycle as women with milder levels.”

As for pregnancy, in a study that interviewed 78,000 Danish women, researchers found that “those who reported higher levels of life stress and more emotional symptoms like anxiety when they were 30 weeks pregnant did tend to give birth earlier. But the difference was pretty minimal: The women with the highest life-stress scores gave birth, on average, about two days before women with lower scores.”

And about child development? Take heart in knowing that your anxiety could actually help your child! Schaffer shares: “The most persuasive of these papers suggest that mild to moderate stress during pregnancy doesn’t hamper babies’ maturation—if anything, it may slightly hasten it.”

Of course, the article makes it clear that regardless of the findings, women who have worries or anxiety are encouraged to seek support, but as Schaffer says, “they should do so for their own sakes—not because distress will ruin their shot at motherhood or somehow damage their fetuses.”

To read the complete article, including more details about the included studies, visit Slate.com.

 

Filed Under Anxiety, Featured Story, Pre-pregnancy, Pregnancy

What Does Pushing Feel Like?

February 18, 2013 By Desirre Andrews 1 Comment

Women often ask me what pushing feels like. As an educator and doula it is probably one of the more challenging concepts to address.

Some of the imagery can be quite vulgar.  “Push like you are pooping.” Do women REALLY want the image of pooping out their babies?! Or the imagery puts pushing in a neat box. “The urge will overwhelm you and you cannot help it.” “You will just know.” Those do not adequately speak to what can occur. Some women get no urge to bear down until the baby is very low and engages the nerves. Others will have the urge when baby is high and dilation isn’t complete. Still other women do not get an intense urge at all regardless of pain management or natural birth.

For that matter, great rectal pressure may be felt, intense abdominal pressure felt, incredible pelvic pressure may be experienced,  or frankly not much at all can be felt.

I believe whatever a woman’s body does is right for her birth and her baby.

Below are many quotes that others openly offered to help women everywhere have a deeper understanding of what pushing is like.

Quotes from real women

“My babies #1-4 practically fell out. #5 I was in what looked like early labor for 4 days. Midwife assistant came over, checked me, I was at 7 cm but ‘not in active labor’. I got into it quickly! Long story short I pushed, painfully, for 3.5 hours, baby had 11″ cord with a true knot. She needed to be pinked up but is almost 3 and is doing well.”

“When I was coached to push (w/ no 3–first natural birth) I was in agony. When I was left alone and did not push (w/ no 4), life was good.”

“I feel like if I can just get to the pushing phase, it will be a breeze from there.” (and it was. The whole “surrender/dilate” phase is much more challenging to me than the whole “take control/pushing” phase.)”

“Pushing was fantastic with my 2nd baby and awful with my 3rd! It was really surprising because after my 2nd birth I thought “Okay so pushing is the really fun and satisfying part! That’s when it gets EASY.” Then my third birth totally shocked me. Pushing was the most painful and difficult part of the birth. I had stayed so calm and collected… until then. Every pregnancy and birth is so different!”

“I love the way it feels to have a baby move through me and into my waiting hands.”

“The mirror really gave me focus and helped me push very effectively when I inspired by seeing a peek of baby head.”

“I *loved* pushing. I didn’t do it for very long (two contractions), but it was so great to finally get there. I was told to purple push (not in those terms – the nurse told me to hold my breath), and intellectually I knew I shouldn’t, but I tried it and it really did feel like I was more productive that way. I felt like a warrior. It was awesome.”

“Before anyone hates me for only pushing through two contractions, you should know that I’d been in labor for three days – so it all comes out in the wash ”

“Pushing with my 2nd was horrible. 3+ hours of the worst pain I had experienced at that point in my life. Turns out her little fist was up by her cheek (um ouch) and her head did not mold much. My 3rd I did not push because she was precipitous and we were trying to get to the hospital. I felt like all the energy in the world was gathering and swirling at my fundus and then suddenly flowed through me carrying her with it. It was the best physical experience of my life.”

“I have heard some say that pushing feels good.. um, I personally have not experienced that and I have had clients remark the same … :p”

“Hmm…Definitely the best part of labor and delivery. For me though – never had any “urge” to push but still had baby out in 20 mins…I think I was feeling determined being a VBAC mom…still, would have been easier if I felt the need to and not just contractions. “

“Heard lots of clients say it feels good after hours of labor”

“Difficult. I had an urge to push “early” every time. Once I got to the “ring of fire” it was awesome though.  I knew I almost was there.”

“Ahhh, I’m not so fond of the pushing. Did it for 2 1/2 hours with my daughter (LOA) and though it was only about 20 minutes with my boys, they were both OP. That was, shall we say, unpleasant. I cannot relate to those who’ve told me it was such a relief!”

“My labor was surprisingly short, only 6 hours and she’s my first baby so far. I woke up in active labor and at 4 cm and I wanted to push THE WHOLE TIME! It was horrible having the nurse say I couldn’t push yet when I wanted to so badly, but once I did get to push, oh my goodness, it felt incredible. So much control and power, it felt so good to finally work to end. 3 big pushes and there she was. ”

“Sheer, immeasurable power. Unbelievable!”

“Babies actually come out of your butt. Don’t let anyone tell you otherwise.” One of my clients recently said that. ”

“Birth is shockingly rectal” – Gretchen Humphries. She was totally right.”

“Pushing with my first felt like I was satisfying an urge, an uncontrollable urge. It felt almost desperate I couldn’t stop it. (kinda like having that rectal urge when you REALLY have to poop). Pushing with my second was no big deal, I followed my urges again and pushed 3x and out she came in her 10# glory. It was extremely satisfying and powerful I felt like I had just finished exercising. Amazing!”

“The ring of fire OH MY it is indeed! Though as soon as the burn started the whole are went numb almost like too hot or too cold numb and the power of the urge to push my son out was almost beyond description.  Pushing was never easy for me as I have an unusual pelvic shape.  But my last son WOW no molding and quite a large head to birth him was incredible really.  No tearing, just some abrasion.  Recovery was a snap.”

“I had at the point of delivery what was the best orgasm of my life!”

“Pushing was totally primal.  I had an incredible urge and it took over.”

“The pressure of the baby entering deep into my pelvis and vagina was wild and almost overwhelming.”

“Feeling my baby when he was partially inside and partially outside of my body was a euphoric and surreal moment. The hour of pushing was well worth it.”

Bottom line – you and your baby are unique. You work together during all parts of labor including pushing through to delivery. Be confident. Use your intuition. Follow what your body desires to do.

Questions and Answers

  1. I have had a previous episiotomy, do I need another one automatically? No you don’t.  Depending on how your scar has set and the position you push in the scar can re-open or it adhesions in the scar will need to be broken up.  I would suggest perineal massage prenatally if there are any adhesions to break them up and soften the area prior and to choose a pushing position that doesn’t put all the tension on that exact area.
  2. Is is wrong to push when I am not fully dilated? Not necessarily.  Now I think grunty smaller pushes with those contractions can be effective to complete dilation if you are in transition.  Prior to that change the position you are laboring in to change where baby is placing pressure.  Knee chest can be very effective to abate very early pushing desire.
  3. What if I poop during pushing? Some women will pass some stool and some won’t.  An open bottom is vital to pushing, so it is a normal but not always occurence.  A fantastic nurse, MW or doc will not actually wipe it away but simply cover as to not cause constriction of the sphincter muscles which can disturb the pushing progress. If it is possible to discard the stool without disrupting you, it will be done very quietly, quickly and discreetly.
  4. I am very modest, do I have to have all my “glory” showing? Absolutely not.  You can maintain good modesty all the way up to delivery.  Even then you do not need to be fully exposed.  Truthfully a home birth or birth center birth with a midwife if likely going to help you have your modesty concerns respected and honored. Really no one needs to put hands in you during pushing, needs to stretch anything, or needs to see everything either.  A midwife is trained to see by taking a quick peek or simply to know when she needs to have hands ready to receive baby and to offer external positive pressure if mom wants.
  5. Is there a “right” position to push in? There IS a right position for you, your baby and your pelvis. The only way to know is to try a variety of positions, pushing spontaneously and listening to your body.  Generally the lithotomy or semi-reclined position disallows the tail bone to move up and out to create more space. Side-lying, squatting, leaning in a mild squat, hands and knees, hands and knees with a lunge, and even McRoberts can be excellent to open a pelvis to a large degree. Pay attention and go for what feels right.

 

This article has been reposted with permission from Preparing for Birth, http://prepforbirth.com/.

Filed Under Birth, Featured Story
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