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Push for Better!

January 25, 2013 By Cara Terreri Leave a Comment

Be an active partner with your care provider, and get the best care.

Oh the joys of pregnancy… you’ve battled nausea, your back hurts, you’re not sleeping, and you’re running to the bathroom every 20 minutes. Still, you’re absolutely 100 percent devoted to having the absolute best of everything for your baby. You’ve researched the safest car seats, highest-quality strollers, best cribs and smartest baby monitors. You and your baby are all set, right?

There’s one thing that’s important not to leave off your “smart shopper” checklist; your baby’s birth day!

Like any other kind of health care, maternity care isn’t perfect. You can help your baby and you get the best care by being an active partner in your care. Your health care provider – doctor or midwife – has important knowledge and skills, but they don’t always know everything about you or what is best for you and your baby. They need you to speak up about your concerns and needs early so you can get the care you’re looking for throughout pregnancy, labor and birth.

Why does your voice matter? A lot of the regular care that pregnant women receive includes unnecessary interventions that don’t always help and can sometimes even cause harm. Routine care isn’t designed for you and your baby’s unique needs.

So when you’re told that you can’t eat or drink in labor, that you should stay confined to bed to stay attached to the monitor, or that your labor should beartificially started because you’re a few days “overdue” it’s fair to question and discuss these practices with your health care provider.

Remember that getting the care that matches your and your baby’s needs may mean saying, “I’d like to consider another option.” Asking questions and providing information builds trust, and it’s the best way to make sure everyone is working toward the same goal – the safest, healthiest birth possible.

 

The Lamaze “Push for Your Baby” campaign encourages women to advocate for better care for their babies and themselves. With the right information and education, women have the opportunity to be active partners in their care during pregnancy and birth. This campaign is designed to help women be ‘savvy shoppers’ and prepared to seek out the best care for their babies and themselves. Watch the video to find out what moms and dads have learned about pushing for the best care

Filed Under Birth, Choosing a care provider, Featured Story, Pregnancy, Push for Your Baby Tagged With Push for Your Baby

Questions to Ask When Choosing Your Care Provider

November 7, 2012 By admin Leave a Comment

Finding the right person to care for you and your baby during pregnancy, labor and birth is one of the most important decisions you will make, and it can help you feel confident to push for the safest, healthiest birth. As you review doctors and midwives in your area, the following questions can help you find someone who will provide the care you are looking for. Asking questions and providing information builds trust, and it’s the best way to make sure everyone is working toward the same goal – the safest, healthiest birth possible for you and your baby.

  1. What is my role in helping to achieve a safe and healthy birth?
    This is an important question that will help you determine whether your care provider will be respectful of your choices and invite your input. By being an active and attentive participant in pregnancy, labor and birth, you can help achieve the best outcomes for you and your baby. Your health care provider – doctor or midwife – has important knowledge and skills, but they don’t always know everything about you or what is best for you and your baby. Find out how openly you can share your needs and work in partnership with your care provider to get the care that’s best for you.
  2. What standard routine practices should I expect in labor?
    This information will help you identify any practices that your care provider may see as needed or routine. While many interventions may seem like they would make childbirth easier, did you know that some of the care that pregnant women routinely receive can have unintended consequences and potentially make birth more difficult and less safe? Many practices in maternity care aren’t always necessary, including:

    • C-sections;
    • Electronic Fetal Monitoring;
    • Epidurals;
    • Episiotomy (surgically cutting the area between the vagina and the anus, called the “perineum,” in order to make the vaginal opening larger)
    • Induced labor;
    • Restricting women from eating and drinking freely;
    • Restricting movement;
    • Directed pushing; and,
    • Separating mom and baby.

    Get the most out of your conversation and be specific. Find out more here in Childbirth Challenges.

  3. How will you work with me as your patient to identify mine and my baby’s unique needs?
    You and your baby’s unique needs should be front and center throughout pregnancy, labor and birth. Like any other kind of health care, maternity care isn’t perfect. A lot of the regular care that pregnant women get includes interventions that don’t always help and can sometimes even cause harm. Ask your care provider about what’s negotiable and what’s not. Weigh the answers you get; they will give you good insight into whether you’ve found a good match. It’s important to work with your health care provider early on, because routine care isn’t always designed for you and your baby’s individuality. Remember that getting the care that matches your and your baby’s needs may mean saying, “I’d like to consider another option.”
  4. How do you feel about me bringing someone like a doula for one-on-one support?
    Many women count on having a nurse by their side to provide important support. But labor nurses may be caring for several women at the same time, and may not have the time to provide contraction by contraction support. Dads are often expected to fill this role, but many times they are new to the process too and need cues on how to best be supportive in labor. A continuous support partner, such as a doula, can help you navigate your labor, support good decision-making and help make sure you’re able to communicate your wishes to your health care provider. Keep in mind, some health care providers may not agree to the use of a continuous support partner, such as a doula. Be prepared to ask them “why?”
  5. What is your rate for C-sections? What are the main reasons you perform them? Is there anything you know about me and my baby that might suggest I would need a C-section?
    A health care provider’s C-section rate can tell you a lot. Cesarean surgery can save lives, but just like any other surgery, it carries risks for you and your baby. More and more babies are being delivered by cesarean, even when there’s not a good medical reason to do so. One of the best ways to reduce your chances of a C-section is to give birth in a location , and with a provider, that maintains low cesarean rates . There is no federal requirement for health care providers to report this information, so you need to ask your care provider directly for these details. If your health care provider has a high rate because they say they care for many “high risk” women, be sure to probe about what they consider to be “high risk.”
  6. Do you limit the length of labor? Or will you support continuing labor as long as my baby and I are doing OK?
    Certain care providers and birthplaces may be under pressure to speed up the birthing process, or put a time limit on your labor and birth. Labor is an intense process, at times overwhelming and draining. But, the good news is that your body is perfectly designed to birth your baby. It’s important for you to find out if your care provider will give your body and your baby time to move the process along, and let nature take its course . Childbirth education classes can help you identify various options to keep labor progressing.
  7. How often do you perform inductions? What are the main reasons you perform them? Is there anything you know about me and my baby that might suggest I would need an induction?
    Due dates aren’t an exact science. Even if you and your care provider feel sure about your date, every baby matures at a different rate. Inducing labor can mean your baby is born before he or she is ready. Labor should only be induced if it is more risky for your baby to remain inside than to be born. Studies have consistently shown your risk of having a C-section nearly doubles with induction with your first labor. It also increases your baby’s chance of being born premature. Your best chance of avoiding an induction is by finding a health care provider who uses them sparingly. Lamaze childbirth education classes can also give you many strategies to help labor start on its own.
  8. How will you monitor the baby’s heartbeat during labor?
    We all want to know our babies are doing OK. Using the same thinking, most care providers will monitor your baby’s every heartbeat during labor using electronic fetal monitoring, or EFM. However, EFM can mean you are confined to a bed and not able to use gravity and movement to advance the birthing process. Studies show that a baby’s heart rate can be monitored just as safely with a nurse, doctor or midwife regularly checking in to listen at key points in your labor with a Doppler hand-held monitor or something similar. Talk with your health care provider about whether they use intermittent listening so you can move freely, relax between contractions, and avoid the anxiety that comes with being tied to a machine. Ask whether the nurses on staff will use it too.
  9. Will I be able to move around during labor, or will I be confined to bed? In what position will I be giving birth?
    Contrary to Hollywood’s portrayal of labor, lying on your back in a hospital bed is not the only way to give birth! In fact, walking, moving around and changing positions throughout labor makes the birth of your baby easier. Movement is a natural and active way of responding to the pain of childbirth. When it comes time to push, staying off your back and pushing with your natural urges can be key to making it as easy as possible on you and your baby. Find out if your health care provider will encourage you to stay mobile.
  10. Will my baby be kept in the nursery or in my room?
    In many hospitals, it’s standard procedure to separate mom and baby for periods of time. However, research has shown that it’s best for mom and her healthy baby to stay together after birth. Skin-to-skin contact helps your healthy baby stay warm, cry less, and be more likely to breastfeed. In fact, interrupting, delaying or limiting the time that mom and baby spend together may have a harmful effect on their relationship and on successful breastfeeding. Talk to your care provider and ask if they support “rooming-in ,” which will maximize your time with your little one, as well as opportunities for breastfeeding.

This an more resources can be found on the Lamaze Push for Your Baby website.

Filed Under Choosing a care provider, Featured Story, Pregnancy

Spot the Best Care

August 20, 2012 By Cara Terreri Leave a Comment

Knowing how to spot good maternity care is the key to getting it.

There are countless places on the Internet with information about being pregnant – this is probably not the first website you’ve visited! With so much information about pregnancy and birth available, how do you separate fact from fiction?

Lamaze International has simplified the scientific facts into six healthy birth practices to make it easy for you to choose the safest care, understand your options, and steer clear of care practices or unnecessary interventions that may not be the best for you and your baby.

  • Let Labor Begin on Its Own: The research around induction of labor has become so convincing that many hospitals are clamping down on inductions that don’t have a strong, compelling medical reason. But not everyone has caught up with the research yet. Be wary of induction that’s suggested because your baby is “measuring big,” you’re a few days past your due date, or your mom wants to schedule her travel. For the best chance at a healthy baby and healthy mom, it’s best to let your baby and your body tell you when it’s time.
  • Walk, Move Around and Change Positions Throughout Labor: In childbirth, gravity is your friend. It helps to move your baby down and makes it easier for your baby to fit and rotate. Movement is also a natural and active way to manage labor pain.
  • Bring a Loved One, Friend or Doula for Continuous Support: Doctors, midwives and nurses work hard to meet the needs of their patients. But few women find a care provider who will stay by their side throughout labor. A continuous support person, such as your partner or a doula, can help you feel safer and more comfortable, and help your labor progress.

  • Avoid Unnecessary Interventions: Many interventions may seem like they would make childbirth easier, but they can have unintended consequences and can make birth more difficult and less safe. Knowing the difference between something that’s medically necessary and something that’s done purely out of “routine” can help you feel equipped to partner with your care provider in making important decisions.
  • Avoid Giving Birth on Your Back, and Follow Your Body’s Urges to Push: The last birth you saw was probably a Hollywood portrayal of labor, with a woman giving birth on her back in a hospital bed. But, did you know that you don’t have to be on your back when you give birth and wait for your care provider to tell you when to push? During pushing, ease your baby down and out when and how your body tells you to and choose the positions for birth that are the most comfortable for you. By responding to what you are feeling, you will make birth easier and safer for you and your baby.
  • Keep Mother and Baby Together – It’s Best for Mother, Baby and Breastfeeding: During pregnancy, you and your little one were inseparable. Continuing that important connection after birth is best for you and your healthy baby. Skin-to-skin contact helps your healthy baby stay warm, cry less, and be more likely to breastfeed. In fact, interrupting, delaying, or limiting the time that you spend together may have a harmful effect on your relationship and on successful breastfeeding.
Filed Under Birth, Choosing a care provider, Featured Story, Healthy Birth Practice, Pregnancy, Push for Your Baby Tagged With Healthy Birth Practices, Push for Your Baby

Questions to Ask When Choosing Your Care Provider

May 30, 2012 By admin 2 Comments

The following resource is part of the Lamaze “Push for Your Baby” campaign, which aims to provide expectant women with the tools and resources they need to get the best care for their babies and themselves.

You may be wondering how to choose the best health care provider for the job. Finding the right person to care for you and your baby during pregnancy, labor and birth is one of the most important decisions you will make, and it can help you feel confident to push for the safest, healthiest birth. As you review doctors and midwives in your area, the following questions can help you find someone who will provide the care you are looking for. Asking questions and providing information builds trust, and it’s the best way to make sure everyone is working toward the same goal – the safest, healthiest birth possible for you and your baby.

  1. What is my role in helping to achieve a safe and healthy birth?
    This is an important question that will help you determine whether your care provider will be respectful of your choices and invite your input. By being an active and attentive participant in pregnancy, labor and birth, you can help achieve the best outcomes for you and your baby. Your health care provider – doctor or midwife – has important knowledge and skills, but they don’t always know everything about you or what is best for you and your baby. Find out how openly you can share your needs and work in partnership with your care provider to get the care that’s best for you.
  2. What standard routine practices should I expect in labor?
    This information will help you identify any practices that your care provider may see as needed or routine. While many interventions may seem like they would make childbirth easier, did you know that some of the care that pregnant women routinely receive can have unintended consequences and potentially make birth more difficult and less safe? Many practices in maternity care aren’t always necessary, including:

    • C-sections;
    • Electronic Fetal Monitoring;
    • Epidurals;
    • Episiotomy (surgically cutting the area between the vagina and the anus, called the “perineum,” in order to make the vaginal opening larger)
    • Induced labor;
    • Restricting women from eating and drinking freely;
    • Restricting movement;
    • Directed pushing; and,
    • Separating mom and baby.

    Get the most out of your conversation and be specific. Find out more here inChildbirth Challenges.

  3. How will you work with me as your patient to identify mine and my baby’s unique needs?
    You and your baby’s unique needs should be front and center throughout pregnancy, labor and birth. Like any other kind of health care, maternity care isn’t perfect. A lot of the regular care that pregnant women get includes interventions that don’t always help and can sometimes even cause harm. Ask your care provider about what’s negotiable and what’s not. Weigh the answers you get; they will give you good insight into whether you’ve found a good match. It’s important to work with your health care provider early on, because routine care isn’t always designed for you and your baby’s individuality. Remember that getting the care that matches your and your baby’s needs may mean saying, “I’d like to consider another option.”
  4. How do you feel about me bringing someone like a doula for one-on-one support?
    Many women count on having a nurse by their side to provide important support. But labor nurses may be caring for several women at the same time, and may not have the time to provide contraction by contraction support. Dads are often expected to fill this role, but many times they are new to the process too and need cues on how to best be supportive in labor. A continuous support partner, such as a doula, can help you navigate your labor, support good decision-making and help make sure you’re able to communicate your wishes to your health care provider. Keep in mind, some health care providers may not agree to the use of a continuous support partner, such as a doula. Be prepared to ask them “why?”
  5. What is your rate for C-sections? What are the main reasons you perform them? Is there anything you know about me and my baby that might suggest I would need a C-section?
    A health care provider’s C-section rate can tell you a lot. Cesarean surgery can save lives, but just like any other surgery, it carries risks for you and your baby. More and more babies are being delivered by cesarean, even when there’s not a good medical reason to do so. One of the best ways to reduce your chances of a C-section is to give birth in a location , and with a provider, that maintains low cesarean rates . There is no federal requirement for health care providers to report this information, so you need to ask your care provider directly for these details. If your health care provider has a high rate because they say they care for many “high risk” women, be sure to probe about what they consider to be “high risk.”
  6. Do you limit the length of labor? Or will you support continuing labor as long as my baby and I are doing OK?
    Certain care providers and birthplaces may be under pressure to speed up the birthing process, or put a time limit on your labor and birth. Labor is an intense process, at times overwhelming and draining. But, the good news is that your body is perfectly designed to birth your baby. It’s important for you to find out if your care provider will give your body and your baby time to move the process along, and let nature take its course . Childbirth education classes can help you identify various options to keep labor progressing.
  7. How often do you perform inductions? What are the main reasons you perform them? Is there anything you know about me and my baby that might suggest I would need an induction?
    Due dates aren’t an exact science. Even if you and your care provider feel sure about your date, every baby matures at a different rate. Inducing labor can mean your baby is born before he or she is ready. Labor should only be induced if it is more risky for your baby to remain inside than to be born. Studies have consistently shown your risk of having a C-section nearly doubles with induction with your first labor. It also increases your baby’s chance of being born premature. Your best chance of avoiding an induction is by finding a health care provider who uses them sparingly. Lamaze childbirth education classes can also give you many strategies to help labor start on its own.
  8. How will you monitor the baby’s heartbeat during labor?
    We all want to know our babies are doing OK. Using the same thinking, most care providers will monitor your baby’s every heartbeat during labor using electronic fetal monitoring, or EFM. However, EFM can mean you are confined to a bed and not able to use gravity and movement to advance the birthing process. Studies show that a baby’s heart rate can be monitored just as safely with a nurse, doctor or midwife regularly checking in to listen at key points in your labor with a Doppler hand-held monitor or something similar. Talk with your health care provider about whether they use intermittent listening so you can move freely, relax between contractions, and avoid the anxiety that comes with being tied to a machine. Ask whether the nurses on staff will use it too.
  9. Will I be able to move around during labor, or will I be confined to bed? In what position will I be giving birth?
    Contrary to Hollywood’s portrayal of labor, lying on your back in a hospital bed is not the only way to give birth! In fact, walking, moving around and changing positions throughout labor makes the birth of your baby easier. Movement is a natural and active way of responding to the pain of childbirth. When it comes time to push, staying off your back and pushing with your natural urges can be key to making it as easy as possible on you and your baby. Find out if your health care provider will encourage you to stay mobile.
  10. Will my baby be kept in the nursery or in my room?
    In many hospitals, it’s standard procedure to separate mom and baby for periods of time. However, research has shown that it’s best for mom and her healthy baby to stay together after birth. Skin-to-skin contact helps your healthy baby stay warm, cry less, and be more likely to breastfeed. In fact, interrupting, delaying or limiting the time that mom and baby spend together may have a harmful effect on their relationship and on successful breastfeeding. Talk to your care provider and ask if they support “rooming-in ,” which will maximize your time with your little one, as well as opportunities for breastfeeding.

Filed Under Choosing a care provider, Featured Story, Pregnancy, Push for Your Baby Tagged With care provider, Push for Your Baby

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 11 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
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