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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

10 Ways You Can Get Good Maternity Care

February 15, 2012 By Cara Terreri Leave a Comment

Source: Childbirth Connection

Know your maternity care rights
Your rights may not be protected if you do not understand and exercise them. Download The Rights of Childbearing Women.

Choose your caregiver and birth setting wisely
These choices set into motion other choices that you may find you have less control over. There are good and bad caregivers and good and bad hospitals and birth centers through out this country. Check the quality of the options in your area, and aim to find caregivers you trust and a safe, family-friendly birth setting. Learn more about choosing a caregiver and birth setting.

Take responsibility for your health during pregnancy
This means eating well and exercising, learning as much as you can about pregnancy and birth, and working with your caregiver to get the care you need when you need it.

Ask about the evidence
Tests and procedures are very common in pregnancy and birth, but often there’s no research to support their use. Sometimes, the research even suggests the interventions are harmful. Ask what the research says, and learn how to understand research findings.

Expect personalized information
If your care provider recommends a test, procedure, medication, or surgery, take time to learn what it involves and the likely benefits and harms for you and your baby. Learn more about making the informed decisions that are right for you.

Think about what is important to you, and communicate this to your care team
Your preferences and values matter. In maternity care there is rarely one “right” choice. Usually there are several choices, each with their own potential benefits and harms. You are the one who should decide which benefits and harms matter most to you.

Keep a copy of your care records, and make sure the information in them is complete and accurate
Your health record is an important way for your caregivers to communicate with each other, so if the information is wrong or missing, you could be in danger of unsafe or inappropriate care. You have a right to access or keep a copy of your complete health record, and many women find it empowering to do so.

Arrange the best labor support possible
Good support goes a long way to help you cope with the physical and emotional challenges of labor. Continuous labor support from a knowledgeable companion like a doula also has surprising health benefits. Such support has been shown to decrease the chance of a c-section, the need for pain medication, and feelings of dissatisfaction about the birth. Find out more about these and other benefits of labor support.

Learn as much as you can about labor, birth, and postpartum before you get there
Labor is challenging. So are the first days and weeks of motherhood. Trying to learn new information to make choices about your care in labor or after giving birth can be difficult. Be prepared by taking a high-quality childbirth education class if possible. Trustworthy books, videos and web sites can also help you understand your care options. Learn how to find a childbirth education class and see a list of recommended resources.

Give your caregivers and hospital or birth center feedback about your care
Birth professionals and birth facilities should always work to do better. You can help them improve care for future women and families by telling them what you liked and didn’t like about your care experience.

To learn more, go to jointhetransformation.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.

Filed Under Birth, Choosing a care provider, Featured Story, Pregnancy Tagged With care provider, Childbirth Connection, maternity care

What You Need to Know About Premature Birth

November 16, 2011 By Cara Terreri 5 Comments

Tomorrow, November 17, is World Prematurity Day — an event created as part of the March of Dimes Prematurity Campaign to raise awareness of and remember babies who died from premature birth. Worldwide, 13 million babies are born prematurely. Prematurity is the leading cause of death among newborns, and causes complications at birth and lifelong illnesses. In the last 25 years, the prematurity rate in the United States has risen by 36% — one of the highest rates for preterm birth in the world.

Sometimes, in cases of true complications, preterm labor and birth is unavoidable. In many cases, however, preterm birth can be prevented. If you are pregnant, there are things you can do to lower your risk of preterm birth.

Lowering Your Risk of Preterm Birth

Prenatal Care – Seek ongoing prenatal care from a reputable care provider. Whether your preference is for midwife or obstetrician, be sure to research your care provider’s history and practices. Ask about their rate of induction. If they don’t know it or report a rate ranging from 20-30+%, consider finding another care provider.

Induction – Inducing birth or scheduling a cesarean surgery prior to 39 weeks of pregnancy can lead to premature babies. Even if friends and family tell you different, every week counts! Babies undergo vital development up to the very moment of their birth. And, because your due date is just an estimate, it can be off by up to two weeks in either direction. So, a baby that is induced at 38 weeks may only be at 36 weeks gestation. If your care provider is pushing for early induction, ask questions! Learn what counts as true medical indication for early induction or cesarean surgery. If being “so done with being pregnant” is getting to you, hold tight and think of the babies born at 28 weeks, with mommies who would have given anything to make it to 40 weeks.

Education – The Internet is overwhelming. When it comes to making informed decisions in pregnancy and birth, the Internet is a good place to start, but not a good place to stop. Sign up to take a childbirth education class from a childbirth educator certified by a reputable childbirth education organization (there are many, but we really think Lamaze is tops!). Childbirth education provides the foundation for educated, evidence-based decision making for you and your partner throughout pregnancy and birth.

Filed Under Birth, Childbirth education, Choosing a care provider, Featured Story, Induction, Pregnancy, Preterm Birth, Working with a midwife Tagged With Preterm Birth, Preterm Labor

Martyr vs. Marvel: The Debate over Natural Birth

October 3, 2011 By Cara Terreri 7 Comments

Start a public discussion on “natural” birth (vaginal birth without pain medication) and you’ll receive an avalanche of opinions and reactions that generally fall into two camps: “Give me an epidural — I’m no martyr!” or “My natural birth was amazing — I can’t imagine it any other way!”  Don’t believe me? Scan the comment section in this article on Baby Center that discusses one mom’s aversion to natural birth. As emotions heighten and passions inflame, a respectful discussion turns into finger-pointing, mockery, defensiveness and ultimately, a misunderstanding and lack of respect for each others’ point of view.

After two uncomplicated births with an epidural, I longed for a birth without pain medication. For me, the desire for a “natural” birth came from how I felt after my first two births and wanting a different, healthier experience for myself and my baby. Lying on my back, numb from the waist down, pushing to the tune of nurses counting to 10 — I felt like a passive participant in my own birth, like I was racing a marathon from the sidelines. (Note: this is how I felt, not a projection of judgement on women who choose to birth with an epidural.) My choice to go without pain meds for my third birth wasn’t about being a martyr or a “hero” — it was an informed, conscious decision that I felt was best for me and my baby. In fact, prior to the birth, I told few people of my plans simply because it didn’t matter if they knew. And after the birth of my third baby without pain meds, yes, I felt proud and triumphant. But no, there were no badges, no parades, no flag-waving of any kind. I birthed my baby the way I wanted and life continued on.

So why does the controversy persist? Why does one group insist that women who birth “au naturel” are martyrs looking for a merit badge, and why do the others pass judgement on women who say, “Give me the drugs!”

When it all boils down, it’s not about my choice vs. your choice or right vs. wrong; it’s about informed choice. True informed choice goes beyond “My doctor says epidurals are safe.” It also goes beyond “My mom thinks I should birth naturally — that’s how she did it.”  To be truly informed requires looking at and understanding the evidence surrounding choices in childbirth. It means finding a reputable source and a second opinion — your care provider and a quality childbirth education class, for example. Only then can women make the best decisions for themselves and their baby.

How did you make informed choices surrounding your birth? Were you judged for your decisions? 

 

 

Filed Under Birth, Birth stories, Childbirth education, Choosing a care provider, Featured Story, Pregnancy

10 Tips for Avoiding a First-Time Cesarean

July 27, 2011 By admin 3 Comments

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.

• “The Official Lamaze Guide: Giving Birth with Confidence,” by Judith Lothian and Charlotte Devries (the book that inspired this blog!)

• “Ina May’s Guide to Childbirth,” by Ina May Gaskin

• “The Thinking Woman’s Guide to a Better Birth,” by Henci Goer (Written in 1999, this book is due for a revision, but it’s still excellent information and routine procedures and hospital technology have not changed much since that time. Henci also runs a helpful Q&A forum on the Lamaze International web site, so you can ask the expert yourself.)

• “Your Best Birth: Know All Your Options, Discover the Natural Choices, and Take Back the Birth Experience,” by Ricki Lake and Abby Epstein (they also offer a great web site and community)

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 All Recent Articles, Birth, Birth plans, Choosing a care provider, Healthy Birth Practice, Homebirth, Induction, Pregnancy, Working with a doula Tagged With cesarean, childbirth class, doula, home birth, hospital birth, labor induction, Lamaze Certified Childbirth Educator, natural birth

How to Choose a Midwife

July 20, 2011 By FitPregnancy 2 Comments

By Jeanne Faulkner, RN, a labor nurse in Portland, Oregon

More women are choosing midwives, but lingering myths and confusion mean that many moms-to-be still have questions. We’ve got answers.

Midwives are being “rediscovered” by growing numbers of pregnant women today. According to the National Center for Health Statistics, in 2006 (the most recent figures available), they attended a record-busting 317,168 births—7.4 percent of all U.S. births; 96.7 percent of them took place in hospitals, 2 percent in birth centers and 1.3 percent in homes. To help you decide whether to go the midwife route, here are answers to some of the most common questions.

What advantages do midwives offer?

The Midwives Model of Care views pregnancy and birth as normal events; as a result, midwives suggest and perform fewer interventions than are typical with most obstetric care. “Midwives focus more on nutrition and education,” says Judi Tinkelenberg, C.N.M., R.N., clinical director of Sage Femme Midwifery Service and Birth Center in San Francisco. “We do fewer routine, often unnecessary tests—for example, we don’t automatically do ultrasounds if they’re not needed. We make decisions with patients based on informed consent.” Midwives also spend more time with patients than most OBs do, which means they often offer more personalized care.

What exactly does “midwife” mean?

All midwives provide prenatal and postpartum care, attend labors and deliver babies. Some provide additional services, such as routine gynecologic exams and contraception care. But do your homework; anyone can call herself a midwife. Here are the distinctions:

>>Certified midwives (C.M.) meet American College of Nurse-Midwives (www.midwife.org) requirements, but they do not need to be nurses.

>>Certified nurse-midwives (C.N.M.) are nurse- practitioners who are certified by the American College of Nurse-Midwives.

>>Certified professional midwives (C.P.M.) meet North American Registry of Midwives (www.narm.org) certification standards.

>>Direct entry midwives (D.E.M.) are educated through self-study, apprenticeship, midwifery school or college- or university-based programs that don’t include nursing. They include certified midwives and certified professional midwives.

>>Lay midwives are sometimes called traditional, unlicensed or “granny” midwives. These women are educated through self-study and apprenticeships, and while they may be highly experienced and skilled, they aren’t certified or licensed.

>>Licensed midwives (L.M.) can practice in a particular jurisdiction, usually a state or province.

For more information on the different types of midwives, go to www.mana.org.

What’s the best kind of midwife?

That depends on whether you want a hospital or out-of-hospital birth, a low-intervention or medicated one. The most important thing is to make sure anyone you’re considering is qualified and experienced. “Direct entry midwives and certified nurse-midwives have different educational pathways, but they’re all well-trained and competent,” says Geradine Simkins, D.E.M., C.N.M., M.S.N., president of the Midwives Alliance of North America. Most C.N.M.s deliver in hospitals, while C.P.M.s have specific training and expertise in out-of-hospital births.

The Institute of Medicine and the National Commission to Prevent Infant Mortality praise the contributions of certified nurse-midwives in reducing the incidence of low-birth-weight infants and call for their increased utilization, and the new federal Health Care Reform Act strengthens the legitimacy of certified direct entry midwives.

Is it safe to go with a midwife?

Yes, as long as you have no pregnancy complications or risk factors for birth complications. For 60 to 80 percent of low-risk pregnancies, it may be even safer to go with a C.M. or a C.N.M. than with an obstetrician. That’s because midwives use less fetal monitoring and over-diagnose fetal distress less often, which means fewer interventions, such as C-sections and forceps- or vacuum-assisted deliveries. Studies show that C.N.M.-attended births are associated with 31 percent fewer low-birth-weight babies and 33 percent less neonatal mortality.

If you have certain health risks, including obesity, diabetes or hypertension or are carrying multiples, you might still qualify for midwife care, but only if it’s coordinated with an OB. If you want to give birth at home, make sure your midwife has protocols for a quick transfer to a hospital in case of an emergency.

How do costs and care compare with those of obstetricians?

Midwifery care can cost less overall, but C.N.M.s are sometimes paid similar rates as OBs. Insurance companies currently pay for most C.N.M. services, and under the new federal health care legislation, certified D.E.M.s will also be covered.

As for whether the midwife you see for prenatal visits will deliver your baby, it’s the same as if you were seeing an OB. “Many private practice midwives make a special effort to be at their own patients’ births, even when they share call with partners,” says Karen Parker Linn, a C.N.M. in Portland, Ore. In shared practices, several midwives work together. Patients see different ones during pregnancy and deliver with whomever is on call, though midwives sometimes come in for patients with whom they’ve formed a special bond, Linn adds.

Do doctors respect midwives?

Most hospital-based midwives are well-respected by OBs. Out-of-hospital midwives? Not as much. Most out-of-hospital births are safe, but when trouble arises and patients are transferred to hospitals, doctors sometimes feel like the clean-up crew for high-risk deliveries.

“Midwives are fantastic options for low-risk women,” says Kathleen Harney, M.D., chief of obstetrics for Cambridge Health Alliance and the C.N.M-managed Cambridge Birth Center in Massachusetts. “Their philosophy and training are more focused on birth as a healthy, natural process. Doctors are trained to think something adverse may happen,” she explains. “The truth is somewhere in between. Working in concert with midwives reminds OBs not to be overly interventionalist.” .

5 questions to ask a midwife

1. What is your training, experience and certification, and do you have references?

2. Where do you deliver—at home, in a birth center and/or in the hospital?

3. What percentage of your prenatal patients do you actually deliver yourself?

4. For an out-of-hospital birth, what’s your emergency backup plan?

5. Do you take medical insurance?

Filed Under All Recent Articles, Birth, Choosing a care provider, Pregnancy, Working with a midwife Tagged With Certified Nurse Midwife, hospital birth, midwife, midwife care, Midwives Model of Care, natural birth

Testing 1, 2, 3: Which of the Prenatal Tests Are Necessary?

June 29, 2011 By admin 15 Comments

Not every prenatal test that your health-care provider suggests is necessary. We review the five you definitely need and give you the real deal on those you don’t.

By Judith A. Lothian, RN, PhD, LCCE, FACCE, and Charlotte DeVries

Adapted from The Offical Lamaze Guide: Giving Birth with Confidence

These days, it can seem like your doctor has another round of prenatal testing every time you go in for an exam. OB/GYNs and midwives used to check only a few vital statistics throughout a woman’s pregnancy, but during the past 20 years, the extent of prenatal testing has increased dramatically. Yet not everyone in the medical community agrees that all of these extra tests are of
value. Instead of being vigilant about picking up on problems, many health-care providers (doctors far more than midwives) over-test because they fear liability and simply expect trouble.

Many of these newer tests were created to diagnose problems in high-risk pregnancies. But with the increased medicalization of pregnancy, they have become routine for healthy women with no known risks. This does not mean that every test is right for everyone, however, or that they are risk-free themselves. There may be a problem that prenatal testing doesn’t show, or a
problem may not exist even if the test suggests it does. Results that are unclear or even misleading can plague your peace of mind and decrease your confidence. The barrage of tests can also make you feel like your health-care provider knows everything there is to know about your pregnancy, which is not the case.

This list details the prenatal testing that is considered essential by everyone, as well as other tests that you’re likely to encounter during the next few months. You have the right to ask about and understand why each test is being recommended, the particulars of how a test will be done, all the risks associated with a test and if there are less risky approaches to diagnosing a problem or concern. Your health-care provider should let you know that you have a right to refuse a test, and he should welcome your questions and respect your decisions.

The Essentials

BLOOD PRESSURE CHECKS are necessary because rising blood pressure, especially in the last trimester, can indicate pregnancy-induced hypertension (also called preeclampsia or pretoxemia), which, if not treated, can be dangerous for you and your baby.

WEIGHT CHECKS make sure that you’re gaining enough weight for your baby’s health; they are not to keep you from gaining too much. And by tracking the growth of the uterus, your health-care provider can make sure that your baby is growing well. If your uterus gets larger more quickly than expected, it may indicate something quite different: multiples.

BLOOD TESTS identify a number of factors, including your blood type and cell count, iron level, immunity to chicken pox and other diseases, and Rh factor, as well as certain sexually transmitted diseases or infections. They are considered standard and acknowledged as important by all because they help established your overall wellness.

URINE TESTS monitor the status of sugars and proteins in your body. High sugar levels may suggest diabetes, and high proteins in your body can indicate a treatable bladder infection. Protein in the urine, especially in the last trimester, can indicate pregnancy-induced hypertension (see above).

Although simple urine tests have been done routinely for years, there is little data to show that they are important for healthy women, especially if they don’t have high blood pressure.

FETAL HEART TONES can be monitored by your health-care provider with a fetoscope (a type of stethoscope) or handheld Doppler device. This test may reassure you that all is well, but your own knowledge of your baby’s movements throughout the day and night is equally important. There is no need for sonograms or electronic fetal monitoring to test these indicators.

The Others

CERVICAL CHECKS are invasive and provide little useful information on their own early in pregnancy, and there is no evidence that they should be a routine part of prenatal care. A pap smear can diagnose sexually transmitted diseases and other infections, but so can a blood test. The only time a cervical check may really help is if you are two weeks past your due date and your health-care provider is trying to determine if induction is appropriate.

ULTRASOUND EXAMINATIONS (sonograms) create a picture of a baby inside the womb using the sound waves that are produced by moving a transducer (like a computer mouse) across the mother’s abdomen. They are often used to determine a due date or to attempt to diagnose problems, but they are not always reliable. Misread sonogram results may lead to unnecessary or incorrect interventions.

For example, the nuchal translucency test uses ultrasound to measure the clear (hence, translucent) space in the tissue at the back of the baby’s neck. Doctors use this measurement to assess the baby’s risk for Down’s syndrome and other chromosomal abnormalities. But the diagnosis isn’t definite: The ultrasound isn’t directly testing for chromosomal problems or telling you for sure if your baby has normal chromosomes. Instead, it just gives you a better idea of the statistical likelihood that your baby will have a problem. Plus, a normal result isn’t a guarantee that everything is okay (just that a problem is unlikely), and an abnormal result doesn’t mean that your baby has a problem (just that he has an increased risk of one). It may only cause you unnecessary worry or, unfortunately, false joy.

Both the World Health Organization and the National Institutes of Health agree that routine ultrasound testing during pregnancy has not been sufficiently evaluated to go unquestioned. There is strong disagreement on the effect of ultrasound waves on a fetus. In fact, the Food and Drug Administration has declared that “prenatal ultrasounds can’t be considered completely innocuous,” and the American College of Obstetricians and Gynecologists says that casual use of ultrasound during pregnancy should be avoided.

CHRONIC VILLUS SAMPLING (CVS) attempts to detect some birth defects by looking for chromosomal abnormalities. It is not routinely offered, but can be done at around 10 to 12 weeks to check for certain disorders, such as Down’s syndrome, in everyone who is tested. CVS also includes assessment for such conditions as cystic fibrosis or sickle cell anemia if your baby is thought to be at risk, but it can’t detect neural tube defects, such as spina bifida. There is a small chance of getting a false-positive (a result that incorrectly indicates that there might be something wrong), so CVS often leads to amniocentesis (see below) for confirmation. When the test is done too early in pregnancy, it has been associated with limb defects, such as missing fingers or toes, and miscarriage.

MATERNAL SERUM SCREENING TESTS, including the Alpha-fetoprotein and multiple marker tests such as triple screen, are done at 15 to 20 weeks to look for the presence of proteins or hormones in your blood that may signal a genetic or developmental problem in the baby. These screens have a high rate of false positives that are often discovered when further testing yields different results or when babies are born without problems. The results can cause unnecessary anxiety as well as more tests than needed.

You have a right to refuse these screens. Before you decide, think about what you would do with the results. If you don’t want to take the next step, amniocentesis (see below), it makes sense to consider not having these screens at all. If you have a family history of genetic diseases, including neural tube defects, you might consider them, but you can decline.

AMNIOCENTESIS is a procedure in which a small amount of fluid and cells is taken from the amniotic sac surrounding the fetus and tested to discover if the baby has Down’s syndrome or other birth defects. Many women, especially those over 35, are pressured to have this test. What may not be emphasized is that it is invasive and puts a woman’s body and baby at risk for infection, possibly causing bleeding, the leaking of more amniotic fluid, premature labor, fetal distress and even miscarriage.

Again, it is crucial to think about what you will do with the results before you agree to an amniocentesis. If the information will not change the course of your pregnancy in any way, then the test may not be worth having. However, you may find it helpful to know in advance that your baby might have a problem. Decide what’s best for you.

GLUCOSE SCREENING is a test for gestational diabetes, which is diagnosed in about 5 percent to 7 percent of women. Taken at 24 to 28 weeks, you drink a special sugar mixture, and an hour later, a blood sample is drawn and measured for its glucose level. If it’s too high, you may have gestational diabetes. It’s important to know, however, that your baby needs plenty of glucose, which helps him grow and develop. The only possible downside to this condition is that the baby may get large amounts of it and be big at the time of birth.

You Decide

Midwives in the Netherlands use the term “spoiling the pregnancy” for the unnecessary worry that the false-positive results of prenatal testing can have on a mother-to-be, says Barbara Katz Rothman, author of Recreating Motherhood (Rutgers University Press). They understand that this misinformation may rob you of joy, peace and a relaxed relationship with the baby you’re carrying inside of you.

So keep that in mind as you’re choosing from the menu of tests presented to you. Routine prenatal testing can medicalize your pregnancy and rob you of your confidence. It may make you feel that your health, happiness and baby’s perfection is ensured, or it may scare you into believing that your baby won’t be born healthy. Either way, prenatal testing cannot guarantee any specific outcome, so it may not be worth the extra emotions it brings.

If you refuse to have some prenatal testing done, remember that you are not the first or the last woman to make this choice. Not everyone needs or wants to know that there may be problems with their baby, and many women don’t want the false alarms and worry. What your doctor sees as an absolutely necessary test may not be what a midwife sees. And it may not be what you see either.

Filed Under All Recent Articles, Choosing a care provider, Pregnancy, Testing choices Tagged With prenatal tests, The Official Lamaze Guide

How to Communicate with Your OB

February 21, 2011 By admin 3 Comments

By Ami Burns, CD(DONA), LCCE, FACCE

Childbirth classes are the ideal place to learn about your options for labor and birth. But even if your class is awesome – and I hope it will be – all the education in the world won’t matter if you don’t communicate your wishes with your OB.

In some cases, learning is the easy part, but communicating? Not so much.

Ideally, you have a positive relationship with your doctor from the start. Maybe she’s been your GYN since before you were pregnant, or perhaps you were able to interview her before selecting her for maternity care.  Even if you have a new provider, or are limited by your health insurance company, mutual respect and trust is important.

Building a positive, trusting relationship with your OB sets the stage for open communication. I believe it’s key to having a positive birth experience – even if things don’t go exactly as you may hope.

Here are some communication tips:

1. Don’t hesitate to ask questions

If your OB asks “Any questions?” at your next appointment, your answer should be “yes!” Some OBs take a lot of time with patients, others may not. Be sure to ask questions – even if you have to speak up to say you have some!

Chances are you may learn via childbirth classes about options in birth you didn’t know about. Depending on what your ideal labor looks like, you may want to ask the following questions:

-          What is your experience with normal, natural (free of pain medication) birth?

-          What is your induction rate?

-          What is your epidural rate?

-          What is your c-section rate (primary or VBAC)?

-          What is your protocol if my water breaks before labor starts? How soon do I have to come to the hospital?

2. Remind yourself to ask questions

Set a reminder on you smart phone to go off during your next OB appointment. As questions come up during the month or week before you meet, type them into the calendar – they’ll pop up during your next appointment. This is perfect for “pregnant brains!” If you’re not tech-savvy, keep a small notebook in your bag and jot down questions or information you want to talk about.

3. Don’t wait until labor

Express your wishes for labor and birth with your OB before you’re in labor. Take childbirth classes. Tour your hospital’s labor and delivery unit. Read good books about birth. Talk to other moms about their experiences. Start figuring out what you want your labor to be like – and talk it over with your doctor. Labor is not the time to suddenly find out whether or not you and your OB are on the same page.

4. Keep communicating throughout the process

While labor isn’t the time to start communicating, it also isn’t the time to stop. If your primary OB isn’t on call, share your wishes with the OB who attends your labor and delivery. Even if you write down your wishes for birth, verbal communication is still really important.

5. Remember, you’ll only have this experience once

Even if you go on to have more babies, you only get one shot at this labor and birth. I teach many second-time moms who say “I wish I spoke up about my wishes the first time around.”

Filed Under All Recent Articles, Birth, Birth plans, Childbirth education, Choosing a care provider, Pregnancy

Early Induction: Why all the Hype?

February 9, 2011 By Cara Terreri 5 Comments

The term “early induction” has been tossed around the Internet a lot lately– it has even shown up on mainstream media outlets like Wall Street Journal and BusinessWeek. What are they saying and what does it mean for pregnant women? Below are some basic points with links to more in-depth information from credible 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 All Recent Articles, Birth, Choosing a care provider, Complications and high risk pregnancies, Healthy Birth Practice, Induction, Pregnancy Tagged With early induction, labor induction

Preparing for Birth Before Going Into Labor

February 2, 2011 By FitPregnancy 4 Comments

By Gayle Sato

The words “easy labor” may seem like an oxymoron, but there are steps you can take, both throughout pregnancy and during labor, to make your experience less stressful and more comfortable, less clinical and more joyful. And although the following tips won’t guarantee you’ll have a sweat-free, pang-free birth, they can help make your labor and delivery more manageable.

1. Start preparing now. When you’re in the grip of labor, it’s too late to crack open that self-hypnosis book or locate a birthing ball. Preparation counts. Case in point: Squatting increases the size of the pelvic opening by about 28 percent. But if you wait until you’re in labor to try it for the first time, your squatting stamina won’t add up to … well, squat.

2. Seek higher education. Take a childbirth class, and enroll as early as possible: Not only do classes fill up fast, but some run 12 weeks, which means you need to start them in your second trimester. Learn about the different stages of labor so you know what to expect. Ask tough questions—and “stupid” ones, too. Find out your doctor’s philosophy on epidurals vs. nondrug ways of managing pain, as well as on Cesarean sections. “The better prepared you are, the more choices you have during labor,” says nurse practitioner Lynette Miya, M.N., R.N.P., co-owner of Bright Beginnings & Beyond, a childbirth and family resource
center in Redondo Beach, Calif. “You don’t want to arrive at the hospital without any idea of what’s going to happen.” Once labor starts, no surprise is a good surprise.

3. Take a prenatal yoga class. “The most important thing women learn through yoga is how to focus,” says Carmela Cattuti, L.P.N., founder of Yoga for Pregnancy & Fitness in Boston. “Yoga also strengthens the entire body, increases flexibility and gives you stamina. But maybe more importantly, it helps your mind relax.” This, in turn, leaves your body free to go about the business of birthing.

4. Hire a certified doula. Doulas are nonmedical professionals trained to provide emotional and physical support as well as information to women during pregnancy and labor. Studies have found that with a trained doula’s continuous support, epidural use decreased by 60 percent; C-sections, 50 percent; oxytocin use for induction, 40 percent; forceps use, 40 percent; and average length of labor, 25 percent. To locate a certified doula in your area, visit dona.org.

5. Give yourself options. During my first labor, breathing exercises gave me a massive sinus attack. Worse, I was out of tricks—no alternative pain-coping techniques, no weapon handy to beat my husband for getting me pregnant. Don’t let this happen to you. Learn several techniques to manage pain, such as self-hypnosis, position changes, heat packs and different breathing methods; bring music to play for relaxation. “If you don’t know what your options are, you don’t have any,” says Tracy Hartley, a certified doula and owner of BEST Doula Service in Southern California.

6. See no evil, hear no evil. Some childbirth educators believe graphic images, catastrophic tales and words of discouragement (“You’ll never be able to get that monster out without a C-section!”) can affect your subconscious and
create a mental block during labor. At best, negative thoughts make labor stressful; at worst, they’ll actually intensify pain. Change the channel, cover your eyes, tune out or walk away when the subject matter makes you uncomfortable. Bonus: Being able to do this will help you ignore all the unwanted advice you’ll get after the baby is born.

7. Set the mood. For most women, a dark, quiet environment is ideal during labor, so ask your nurse or partner to dim the lights and minimize noise. Little touches make a difference: a favorite pillow, pair of socks or soothing scent. “Aromatherapy, especially the scent of lavender, is very calming in labor,” says nurse practitioner Miya.

8. Don’t take labor lying down. Upright positions, such as standing, walking, kneeling, slow dancing, sitting and squatting, allow gravity to help move the baby down and out. “Sometimes, getting the baby into the pelvis is like fitting a key into a lock,” Hartley says. “You need to do a little jiggling. Rocking back and forth on your hands and knees may get the baby into position.”

9. Get wet. Early in labor, a warm bath is a blessing. Later, the sustained warmth and weightlessness that water provides can feel more like a miracle. If you have access to a warm tub during labor, run—OK, roll, if you have to—and take the plunge. (Be sure to get your doctor or midwife’s green light before doing so; there’s a risk of infection if your water has broken.) If a soak isn’t possible, take a shower.

10. Stand your ground. Labor transforms you, but it won’t make you suddenly love lime Jell-O, New Age music or the sight of your in-laws as you breathe through a contraction. People may press all kinds of suggestions on you during labor; listen but don’t feel you have to go along with them. It’s your body, your baby and your labor, so stick to your guns. Consider it practice for when your baby is a teenager.

Filed Under All Recent Articles, Birth, Birth plans, Childbirth education, Choosing a care provider, Coping with pain, Exercise, Labor, Pregnancy, Working with a doula
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