Appropriate Use of Interventions: Induction or Augmentation with Pitocin

Pitocin — the synthetic form of oxytocin, the body’s natural hormone that stimulates contractions — is one of the most frequently used medical interventions to induce or augment (speed up) birth. Below are some facts and tips to help you learn more about Pitocin, including how to avoid it, when it’s necessary, and how to keep labor as normal as possible if you are induced with Pitocin.

From The Official Lamaze Guide: Giving Birth with Confidence.

What to Know:

  • Pitocin increases stress on your baby and your uterus and makes contractions more difficult to manage.
  • Pitocin use necessitates an IV and continuous EFM, restricts your mobility, and raises your risk of epidural and cesarean.
  • The WHO believes that Pitocin induction and augmentation are often used inappropriately.
  • The ACOG notes the risks of Pitocin use and recommends cautious decision making.

You’ll Need Induction if:

  • Your labor is slow and doesn’t respond to movement, position change, and hydration.
  • You don’t go into labor spontaneously by forty-two weeks gestation.
  • You have a uterine infection.
  • You have severe pregnancy-induced hypertension.

How to Avoid Unnecessary Use:

  • Be patient waiting for labor to begin and to progress.
  • Remember that your body knows how to give birth.
  • Surround yourself with helpers who trust birth.
  • Stay confident.
  • Use all the comfort measures you’ve learned.
  • Don’t agree to be induced because your caregiver says your baby is getting too big.
  • If your water breaks before contractions start, or if you go past your due date, discuss with your caregiver natural ways to stimulate contractions, such as drinking a bit of castor oil in juice, stimulating your nipples, and being active.
  • Ask, “What if I wait?” if your caregiver is insistent about inducing labor.

How to Keep Labor as Normal as Possible if You are Induced:

  • Make sure your helpers give you continuous emotional and physical support.
  • Actively seek comfort in response to the pain of contractions.
  • Remember that your body knows how to give birth.
  • Visualize your baby rotating and descending through your birth canal.
  • Keep moving and changing positions as much as possible.

Did you have Pitocin during your birth? How did it affect your experience? What advice can you give to other moms who may have Pitocin?

It’s in the Bag: How to Pack for a Hospital Birth

Ah, the hospital bag. Somewhere near the middle of the third trimester, many expectant moms start to think about (or obsess over) what to pack in their hospital bag for birth. Weeks later, that same mom will carry home a new baby and an over-packed hospital bag with many of the items unused. There’s no way to know exactly what you will want or need during your hospital stay, especially if this is your first experience. Which is why you often find first-time moms with over-stuffed bags — better to bring the kitchen sink than to wish you had it, right? Below you will find a list of suggestions offered up from moms who have given birth in the last couple of years. Pick and choose to your liking and if you have a suggestion, let us know in the comments!

 

For Mom

  • Outfit/gown/skirt & bra/oversized shirt to birth in if you prefer not to use the standard hospital gown
  • Socks or slippers
  • Lanolin for breastfeeding nipple TLC
  • Nursing bras (some women prefer to go without while learning)
  • Nursing pads (you will most likely not leak until your milk is in, which may not happen until you are at home; but if you have an extended hospital stay beyond 2 days, you may need them)
  • Nursing pillow (if you forget it, extra hospital pillows work fine too)
  • Toiletries: shampoo & soap, brush, make up, hair dryer, lotion, chapstick, tooth brush & toothpaste
  • Towel (hospital towels are notoriously small and scratchy; but you may not care!)
  • Personal pillow or pillow case (hospital pillows are thin; if you bring your own, be sure to use anything but a white pillowcase so as not to get it mixed up with the hospital’s)
  • Clothes/robe/night gown for recovery period (you’ll most likely want out of the awful hospital gown asap!)
  • Clothes to leave in (something loose fitting, like the maternity clothes you wore at around 6 months pregnant)
  • Underwear — if the thought of hospital-provided mesh undies makes you cringe, bring cheap cotton, stretchy, dark colored underwear that you won’t mind throwing away in a couple of weeks
  • LEAVE your pads at home; the hospital will provide these
  • Flip flops for showing (if showering in a public place bothers you)
  • Snacks (for labor and postpartum)
  • Small fan for white noise (this may be helpful if you are in an especially noisy part of the hospital)
  • Baby book
  • Folder for baby’s paperwork
  • Electronics: phone & charger, camera + batteries, iPad, laptop, iPod for labor music
  • Before you leave, ask for more supplies to take home: mesh underwear, peri bottles, witch hazel, baby wipes and diapers, and whatever else that is provided “free” to you that you think you may need more of

 

For Dad/Partner

  • Blanket (the hospital should have one, but it may be small, scratchy and thin)
  • Pillow (the hospital should have extras, but they may be small and thin)
  • Change of clothes (labor can get messy, even for partners!)
  • Change for vending machine snacks
  • Air mattress (many hospitals have a pull out couch, but some don’t)
  • Snacks
  • Toiletries (at least a toothbrush!)
  • Token thank-you gifts, like sweets or muffins, for nurses (not necessary, but always appreciated)

 

For Baby

  • Going-home outfit (hospitals offer outfits for baby during your stay — best to use them as they tend to get messy!)
  • Going-home blanket (hospitals provide blankets during your stay)
  • LEAVE diapers and wipes at home; the hospital provides these during your stay
  • Carseat

 

Photo by DieselDemon.

The Benefits of Delayed Cord Clamping

You may have heard or read about delaying the clamping of a baby’s umbilical cord after birth — but do you know why? The simple answer is, so baby can receive all of the blood and oxygen that is contained in the placenta. For a more detailed, scientific and visual explanation, check out the following YouTube video demonstration that shows the benefits of delayed cord clamping by reknowned author, doula and childbirth educator, Penny Simkin.

 

 

Six Tips for Gentle but Effective Hospital Negotiations

By Jessica English, CD(DONA), LCCE

Is the hospital you’ve chosen totally supportive of the six Lamaze Healthy Birth Practices?  Once you educate yourself on the elements of a healthy birth, there may be times you need to advocate for yourself and your baby. Hopefully you’re able to choose a birthplace that largely supports your goals for birth, but if that’s not possible, here are some suggestions that might make negotiating easier.

1. Talk it out beforehand, and get it in writing. If something is particularly important to you, talk it over with your midwife or doctor at an office visit. For example, if you know it’s standard for women to get a routine IV in labor, explain your concerns to your provider ahead of time. If you can agree that you will not have a routine IV for a healthy, normal birth, ask your provider to write that in your chart and either put it in writing on a prescription pad, or sign your birth plan. That way, if your doctor or midwife isn’t in the building when you arrive in labor, you’ll have that piece of paper to back you up. Individual midwives or doctors usually have the power to override routine policies for their own patients.

2. You’ll catch more flies with honey than vinegar. It’s great when moms and dads are passionate about healthy birth. Unfortunately, sometimes that passion can leave them feeling confrontational. You don’t need to start off with guns blazing. I suggest to my students that they are firm but very polite when working with the staff. Is continuous monitoring the policy at this hospital? You might say to the nurse, “Our midwife OK’d intermittent monitoring. We’d be so grateful if you could help us with that.” And if her answer is no, try again. “This is so important to us. I know it’s not the standard, but we really appreciate your understanding. We did OK it ahead of time.” Nurses, midwives and doctors are just people. A gentle approach is usually received much better than angry demands, and you’re more likely to get what you want. Be likeable.

3. Brainstorm. If you can get your nurse or provider working with you, they may start to take ownership of your ideas. Try asking for their help to brainstorm a problem. For example, a dad or other support person might say to the nurse between contractions, “We really want the baby to stay skin-to-skin after birth. Can you help us think about how that might work? Can some of the routine things be done while the baby is on her chest? What if we waited to weigh and measure him?” Or maybe continuous electronic monitoring is required because of a medical complication, and you’ve been asked to stay lying down in bed. Ask your nurse or provider to help you think through other options, such as laboring with continuous monitoring on the birth ball, on hands and knees or sitting upright. If they respond with reasons why something won’t work, you can always throw out a phrase like, “Let’s try together.” When people are part of the process they generally respond better than if you simply list your demands.

4. Bring a doula. An experienced doula has usually seen other families successfully negotiate in the hospital environment. She probably knows what’s possible and may have some techniques for helping you “get to yes.”  For example, hospitals in our area require 30-40 minutes of continuous monitoring when a woman first arrives, with intermittent monitoring as an option after that time. The mom is usually asked to lay on her side in the bed for this monitoring, which is hard for most women to do when they are in active labor. Sometimes the nurse will stay and hold the monitor device on her belly, so that she can still move with her contractions without losing the baby’s heart tones on the monitor. Once one of my doula clients had a nurse who was not willing or maybe not able to stay. The nurse kept insisting that the mom lay on her side, and the mom kept insisting that she couldn’t do that because it would make the contractions too intense. I asked if it might be possible for the dad to hold the device on her belly. The nurse happily agreed. She was able to leave and still get the monitoring she needed, the mom was able to continue standing and leaning with her contractions, and the dad was happy to help.

5. Don’t stop at the first “no.” If you’re asking for something outside routine hospital policy, the first answer you receive will probably be no. Expect that first no, and be pleasantly persistent, using all the techniques mentioned above. I know one woman whose nurse kept telling her there was no way she could have the special requests she’d made for her planned cesarean, such as having both her husband and her doula in the operating room and having her baby skin-to-skin on her chest while the doctor finished the surgery. The mother just kept nodding and smiling and saying, “I understand, but this is what I want. How can we make it happen?” Her negotiations were successful, and her doula and husband were both at her side when that beautiful baby was laid on her chest almost immediately after his cesarean birth. Had she accepted that first no, her birth experience would have been much different.

6. Remember, it’s your body, your birth and your baby. If it comes down to the line, remember that no one can force you to do anything or accept any intervention that you do not want. Shared decision making requires your consent. I remember my client who was pushing on hands and knees with a nurse, only to have a midwife come in at the last minute and tell her to turn over on her back. She asked why, and the midwife replied, “I don’t deliver babies this way.” Between strong pushes, the mom simply said, “No.” The midwife told her again to turn over, and again the woman said, “No.” The midwife successfully caught the baby while she stayed on her hands and knees. It was a beautiful birth! It can be intimidating to have professionals in scrubs and white coats telling you to do something, but if there is no clear safety reason for the request, it is always your right to say simply and clearly, “No.” After all, it is your body, your birth and your baby.

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.

10 Tips for Avoiding a First-Time Cesarean

By Jessica English, CD(DONA), LCCE

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

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

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

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

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

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

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

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

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

• “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.

 

Birth: To Plan or Not to Plan?

That IS the question that seems to pop up time and again for expectant moms. If you want to see evidence, check out the latest posts about birth plans (and the multitude of comments) from NPR on The Baby Project — here, here and here.

To some, the idea of a “birth plan” sounds silly and unnecessary. “What is my birth plan? Well, I plan to birth a baby!”  Still other moms hinge every other thought in their third trimester on their birth plan. And what about maternity care professionals — how do they feel about a birth plan? Well, it depends. At the hospital where I plan to give birth, nurses, OBs and midwives alike encourage moms to submit a birth plan and bring a few extra copies for everyone attending their birth to review. But I’ve also heard of care providers who scoff at the idea, even calling women who bring in an overly detailed birth plan an “automatic section” (as in, cesarean).

So where’s the middle ground? My personal philosophy, which I was happy to learn aligns with Lamaze educators, is that writing a simple, informed and succint birth plan helps a woman (and her birth parter): consider and research the many choices available surrounding labor and birth; open a discussion with her care provider that can sometimes reveal surprising differences in their “vision” for birth; and provides useful information to a woman’s birth team.

While there’s no “right or wrong” for creating a birth plan, there are some things to consider that will help you get the most out of the process and make it more likely that your care providers will read your plan.

A Birth Plan is Not a Script — or a “Plan”

You can plan your wedding day, you can plan a vacation, you can even make plans to build a house. The idea that you can “plan” a physiological event like birth is a bit of a misnomer. You can’t plan — or predict — exactly how labor and birth will unfold, but you can request preferences for you and your baby’s care during birth. With that in mind, it’s important to understand as you create your birth plan that birth is unpredictable and flexiblity is key. While certain birth plan requests, like allowing the baby’s cord to stop pulsing before being cut or delaying (or refusing) the Heb B newborn vaccine, should be observed regardless of the birth situation, other preferences may have to be amended depending on the health of both mom and baby.

Rixa Freeze, MA, PhD, a well-known birth advocacy blogger at Stand and Deliver who has written at length about birth plans, has this to say:

“…planning for birth is like preparing proactively for breastfeeding. There are the individual choices you make and have control over during pregnancy, such as provider or place of birth. There are the institutional protocols and provider preferences that will influence what happens to you during labor and birth. And then there are the unpredictable, uncontrollable events that may throw you a curveball during labor. Birth plans are primarily for the second category of events–navigating institutional routines and employee protocols that may or may not be what you want, and may or not be beneficial for you or your baby.

Involve Your Partner and Your Provider

Writing your birth plan is not a one-woman-show, but rather a group effort. Talk to you care provider about your birth plan preferences — are they in line with your care provider’s philosophy or what she will even allow? Are they in line with typical hospital protocols? If your birth plan is chock full of requests that go against standard hospital protocols or ask for tools (bath tub, wireless fetal monitoring, birth stool, nitrous oxide) that aren’t available, you might be disappointed on the big day. Involving your providers in your birth planning process will help you understand alternative options to achieve the care you desire or perhaps, seek a different care provider or place of birth.

Write an Outline, Not an Essay

Remember the “succinct” part I mentioned above about about birth plans? There’s good reason to keep birth plans short and sweet. For one, your care providers and birth team have will have limited time, especially on the day of your birth. If they are presented with a two and-a-half page, text-heavy document to read, it will most likely not happen. Create a birth plan that is easy-to-read and as short-as-possible (one side of a one 8.5 x 11 page is great!), with bulleted text and only the necessary details. For example, I didn’t include on my birth plan that I will eat and drink as necessary — I just plan to do it, even though I know it is against routine hospital policy. Per Rixa’s advice:

“…don’t worry about including any of the little things that you shouldn’t even be asking permission for. The don’t ask, just do kind of things. Eating and drinking if you’re hungry, moving and changing positions, music, lighting, unhooking yourself from the monitors to move/go to the bathroom/etc (especially if, like most women, you have no specific reason to be on constant monitoring). Just do these things and don’t take any flak from the nursing staff. Make sure your birth partner knows about these things and can buffer you from the nursing staff if you deviate from their policies or routines.”

For more on birth plans, stay tuned for Monday’s post where I will share and discuss my birth plan for my third (and due in about a month!) baby.

What is your personal philosophy on birth plans? If you used one for a previous birth, how did it help you?

 

 

How to Choose a Midwife

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?

Healthy Birth Around the World: Beijing, China

On Monday, January 18 at 3pm, Andrew and I gave birth to Roran, a beautiful 8 pound boy. All is well, there were no complications, and we have returned home to rest. Mom, dad, baby, brother and sister are delighting in the new dynamic of our family, and still soaking in the buzz of the experience we have just had. Below is our birth story.

After 42 full weeks of pregnancy, Andrew and I decided to employ acupuncture and Chinese herbs to encourage labor on Sunday, January 17. By 9 p.m. that night we were checking into the hospital and getting settled in our room with regular contractions about 7-10 minutes apart.

The children were thrilled with the hospital’s luxury birthing suite and big screen television, and we all stayed up until 2 in the morning watching Fiddler on the Roof. After a few hours of rest, by 7 a.m. Monday morning we were in the labor pool. The sensations were becoming more intense and quite frequent. Getting into the water was the most wonderful amelioration of “pain,” and after lighting candles in the room and putting on music, we stayed in the birthing pool until 11 a.m.

Despite the water feeling wonderful, I had not “progressed” and dilated, so we got out of the pool and headed back to the room to walk the halls and get a change of scenery. Contractions slowed down, and at 1 p.m. there had been no change in my cervix. The hospital’s staff started to exchange worried glances, whispering in the corner.

I should add at this point that although we explained to the hospital the type of natural birth we were looking for, the doctors and nurses were very worried about all sorts of fatal and other nasty possible complications that might arise from my having two previous c-sections. They were not pleased that we had refused all tests and scans, and we went in as infrequently as possible to let them take my blood pressure and chart my weight gain. It is only Andrew’s impeccable Chinese (both vocabulary and cultural understanding) that allowed us to decline each and every ultrasound, blood test and inspection, while still being allowed to show up and birth a baby.

It is no surprise at 1 p.m. I was offered drug intervention, and while refusing their suggestions, I have to say I started to become a little scared and worried. The sensations were fairly strong and yet it sounded like labor was not progressing in a quick manner, and I began to think of how easy it was to birth Niame and Ian. After preparation and surgery with the first two children, an hour and-a-half elapsed and I had a baby in my arms. I definitely began to question my desire for a natural, drug free birth this time around.

I stood up after the doctors left the room, and the sensations changed immediately. The intensity hit the roof, and all Hypnobirthing breathing techniques that I had learned were mostly thrown out the window. We asked for the birthing tub to be refilled, and I swirled my hips like a belly dancer for a good 40 minutes before the water was ready.

We got into the water, and immediately my body was pushing everything downward. It wasn’t like the movies; I was kneeling up in the water and my body and gravity did all the work. Within 10 minutes of being in the birthing pool I could feel the baby’s head, and we called the doctors. They couldn’t believe I had gone into the final stage of labor so quickly, and thought we were a little crazy when we said the head was crowning. Within an hour of entering the water, the baby was in my arms.

Andrew caught the baby, as I decided to stand up in the tub to birth him. Andrew cut the cord, weighed the baby, did all the diagnostic procedures, and when we left the hospital that morning, we realized that not one nurse or doctor ever put a finger on our child. We managed to show up and use the facilities and birth our boy naturally, without intervention, medicines, shots or tests, leaving a room full of Chinese hospital staff stunned watching the experience.

The children were present throughout the process, Ian filming the birth and Niame taking still photos. It was the most intense 24 hours that I have experienced in my life, and yet I woke up this morning and effortlessly dressed my baby and carried him out of the hospital and into a taxi to head home. Now that I reflect again on the “ease” of the cesarean I had with Ian and Niame, I remember that for three weeks following I hobbled around, barely able to bathe or cook for myself, with layers of abdominal sutures that rendered me mostly immobile.

After the birth, although a bit tired, I was fully functional and couldn’t believe that less than 24 hours before I was experiencing something more powerful than I had ever known.

Not knowing the sex of the baby ahead of time, we had three names typed out on paper to hand to the office when it was time to take care of paperwork. Andrew was left to make the final decision since he had always dreamed of naming a son Damien Michael, and it was only because of my loud protests that we spent 10 months looking for boy name alternatives.

Baby boy was born with blond red hair, and for the moment, grey blue eyes. To Andrew’s dismay the one thing he didn’t look like at all is a Damien.  Roran is sleeping and eating well, and has already blessed us with a basket of diapers to wash. He is bundled up in all the clothes that have been waiting folded in tiny little piles for his arrival, and the children just can’t get enough of him. He smells amazing, and makes sweet little sounds with his mouth.

We are truly blessed and happy.

Finding Mother-Friendly Care – Some Questions to Ask

This article has been excerpted from the publication Having a Baby? 10 Questions to Ask by the Coalition for Improving Maternity Services (CIMS).

 

Birthing care that is better and healthier for mothers and babies is called “mother-friendly.” Some birth places or settings are more mother-friendly than others.

A group of experts in birthing care came up with a list of 10 things to look for and ask about, all of which are supported by medical research and are also the best ways to be mother-friendly. Following are three of those questions.

  

Ask, “What happens during a normal labor and birth in your setting?”

If they give mother-friendly care, they will tell you how they handle every part of the birthing process. For example, how often do they give the mother a drug to speed up the birth? Or do they let labor and birth usually happen on its own timing? They will also tell you how often they do certain procedures. For example, they will have a record of the percentage of C-sections (Cesarean births) they do every year. If the number is too high, you’ll want to consider having your baby in another place or with another doctor or midwife.

Here are numbers we recommend you ask about.

  • They should not use oxytocin (a drug) to start labor for more than 1 in 10 women (10%).
  •  They should not do an episiotomy on more than 1 in 5 women (20%). They should be trying to bring that number down. (An episiotomy is a cut in the opening to the vagina to make it larger for birth. It is not necessary most of the time.)
  • They should not do C-sections on more than 1 in 10 women (10%) if it’s a community hospital. The rate should be 15% or less in hospitals that care for many high-risk mothers and babies. A C-section is a major operation in which a doctor cuts through the mother’s stomach into her womb and removes the baby through the opening. Mothers who have had a C-section can often have future babies normally. Look for a birth place in which 6 out of 10 women (60%) or more of the mothers who have had C-sections go on to have their other babies through the birth canal (VBAC).

 

Ask, “Can I walk and move around during labor? What position do you suggest for birth?”

In mother-friendly settings, you can walk around and move about as you choose during labor. You can choose the positions that are most comfortable and work best for you during labor and birth. (There may be a medical reason for you to be in a certain position.) Mother-friendly settings almost never put a woman flat on her back with her legs up in stirrups for the birth.

 

Ask, “How do you help mothers stay as comfortable as they can be? Besides drugs, how do you help mothers relieve the pain of labor?”

The people who care for you should know how to help you cope with labor. They should know about ways of dealing with your pain that don’t use drugs. They should suggest such things as changing your position, relaxing in a warm bath, having a massage and using music. These are called comfort measures.

Comfort measures help you handle your labor more easily and help you feel more in control. The people who care for you should not try to persuade you to use a drug for pain unless you need it to take care of a special medical problem. All drugs cross the placenta and reach the baby and can affect the baby.

Read the remaining 7 questions in the full publication by CIMS.

Have you given birth in a mother-friendly hospital or birth center? What was it like? What was the best part about your care?

Practices that Promote Healthy Birth: Avoid Common Interventions

Today, childbirth is viewed as and transpires as more of a medical procedure than a natural bodily function. Women who seek to have a natural birth often look for resources and information on how to achieve a more natural experience instead of one that is over-medicalized.

Truthfully, if you want to avoid all common hospital interventions, the best place to give birth (for low-risk women) is either at home or in a birth center. In my own experience, confronting hospital staff to avoid simple things like an IV line can bring added stress that just isn’t part of an enjoyable birth experience. That being said, birth should take place where you feel most comfortable, and if that is in a hospital, the best thing to do is educate yourself about the choices and risks and related to common medical interventions.

 

Common Medical Birth Interventions

  • IV for fluids
  • Epidural anesthesia
  • Continous electronic fetal monitoring
  • Pitocin
  • Artificially breaking the bag of water
  • Episiotomy

Most of these interventions are medically unnecessary, but are used in many hospitals today in the United States. An IV, for example, is used to administer fluids and medication, if necessary. However, when women are allowed to eat and drink during labor, an IV for fluids is not necessary. Recent studies show that there is no need to prevent a woman from eating and drinking while she is in labor

Continuous electronic fetal monitoring is also over-used in low-risk women. In recent years, The American Congress of Obstetricians and Gynecologists (ACOG) has shown that in the 40 years that electronic fetal monitoring has been the norm, there have been no improved outcomes in mothers or babies. Of course, like anything, there are some situations when it is necessary, but mostly in high-risk cases. 

Epidurals for those who choose to use them for labor can be the right fit, but they are not risk free. Epidurals can slow labor and pose other risks to mothers and babies. There are other, more natural and effective ways to help relieve the pain of labor

Pitocin can cause contractions, but it can also cause contractions that are too strong and result in fetal distress and bring on a cascade of interventions

Episiotomy has been shown in recent years to be medically unnecessary in the majority of cases. 

Skipping Common Interventions

There are several ways to avoid routine hospital interventions.

  • Hire a birth doula to help be your advocate and employ natural pain relieving strategies
  • Write a birth plan and provide copies to your provider and hospital staff on call during your stay
  • Talk to your provider about your expectations and practices and procedures you are concerned about
  • Take a tour of your hospital
  • Research your chosen hospital’s cesarean and intervention statistics prior to giving birth

These simple steps can help you avoid common medical interventions and increase your chance of having a safe and healthy birth experience.