Tuesday, March 9, 2010

Great Blog Interview

The blog may be a little slow over the next few weeks as I get organized for a big spring cleaning and get started out in the garden. But I just have to share a great interview post over at Progressive Pioneer: MamaViews: Donna of Banned From Baby Showers. Here's a teaser:
"My focus as a natural childbirth educator is to reach the mainstream and help them understand that this is not about being “crunchy” or alternative. It's simply about doing what we, as women, are made to do. Our bodies are amazing, and to numb the experience of childbirth is a shame. We avoid drugs throughout the pregnancy and load up in labor. It doesn't make sense. 'Mainstream.' 'Alternative.' 'Crunchy.' How about just 'Woman.'"
Good stuff, eh?

Have you come across any particularly interesting interviews or blog posts lately? Share in the comments!

Christina @ Birthing Your Baby
Independent Childbirth Classes for Central Maine
Mamas & Muffins: New Moms Group

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Monday, February 8, 2010

Date Night

At Your Cervix is one of my favorite birth blogs. It's written by a registered nurse who currently works on a L&D unit at a large teaching hospital. She's also in-training to become a midwife. Very interesting stuff, from a perspective that I won't have from personal experience.

She was recently invited to guest blog on another blog, and wrote "How to Take Charge of Your Labor and Delivery". Two things that she wrote in this post really stand out for me:
"Dads: what can you do to help Mom? Go to childbirth classes together. Consider it a date night before the baby arrives."
What a lovely idea! If a couple decides to do four classes with me, that's four date nights. Maybe they'll go out to eat afterwards, depending on time and finances. Or maybe they'll go for a nice long walk and talk. All of a sudden, what may have seemed a bit like a chore-commitment is a springboard for a really nice day together!

Also:

Why do people date? To get to know each other! And getting to know each other's ideas and preferences and fears around labor and birth is such an important part of the process.

Do dates cost money, at least some of the time? Yes. And so do birth classes. But for the cost of a night on the town, with a nice dinner and movie, a couple could attend birth classes that teach them life-long skills... classes that help them during an exciting and sometimes challenging time of life as individuals and as a couple... they get to explore, with each other, their ideas and dreams around meeting the life they created.

Dates sometimes take some planning, and some setting-aside-of-time during hectic daily life. So do birth classes. But is a date worth it? Yes. And so are birth classes!

Why?

Well, that's the other thing about At Your Cervix's guest post. She wrote, "Planning ahead and knowing what you might expect are important to your labor and delivery experience" followed by questions about the routine management of labor in most hospitals: fetal monitoring for how long? getting out of bed? IVs? Etc.

Of course it's important for moms & partners to know what the routine is at the birth place they chose. It's not good to think your date is to an elegant restaurant and then the car stops at McDonalds! But before women can choose where they want to give birth, they need to know their options! In order to know what we want, we need information.

Which takes me back to childbirth classes... independent childbirth classes to be specific.

If you're in the Central Maine area, and are having a baby - let's set up some date nights! They may be the most life-changing, important dates you ever go on.

Christina @ Birthing Your Baby
Independent Childbirth Classes for Central Maine
Mamas & Muffins: New Moms Group

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Wednesday, January 13, 2010

More on Coping Skills

Thanks for the comment on my last blog, Morgan. Reminds me that it might be helpful to post more specifics about the relaxation strategies I use! Here's the one I used the most during labor; it's also what I do if I'm in bed and worries or stressed about something, or if I'm having a hard time going back to sleep. Though I can't go through the whole "loose and limp" thing in situations like flying or driving, I do try to pay attention to and loosen up muscles that are tight due to tension, like raised shoulders or a clenched jaw.

This is the handout I give to all the moms/families I work with. Feel free to download it in word here, for personal use only, or link to it as you wish!

RELAXATION: BY YOURSELF
Lie on your side with a cushion under your head and another under the bent knee of your top let so that you are completely comfortable. Close your eyes, and allow all your body weight to drop comfortably onto the floor. Breathe deeply, relaxing each part of your body in turn with each exhalation. Keeping your awareness focused on your breath, find your center as you relax more and more deeply. Remain this way for 5-20 minutes. Before you come up, focus your awareness on your baby inside you, and spend a few minutes in peaceful relaxation together.

When you are finished, take your time to open your eyes, letting the light come in slowly instead of hurrying to look outwards. Keep the sense of inner peace and relaxation as you stretch out slowly and come up in your own time.

RELAXATION SCRIPT: WITH A PARTNER

Read quietly, slowly, and in a calm voice. Practice reading the script a few times to yourself. Eventually you won’t need it at all. Feel free to make it your own. Mom, let your reader know what works best for you! Practice at least 3 time/week.
Breathe with a steady, even rhythm. Not in the middle of your belly, but way down low. Listen to the quiet ease of your abdominal breathing. Use each outbreath to relax a little more deeply. Let the breath fill your entire body, surrounding and relaxing each muscle; wherever you feel tension, use the outbreath to send it away.

Concentrate on relaxing your belly extremely. Think of it just floating outward and away from you as you breathe in. Drop your head into the pillow. Don’t hold your head up with your neck muscles. Just let it drop into the pillow.

Smooth your eyelids, and concentrate on all those facial muscles being loose and slack. smooth your brow. Let your eyes rest. Let all the tension go from your face. Loosen your jaw and let it float open. Have a relaxed, open throat.

Drop your shoulders. Have no tension in them at all. Relax your back and let your belly relax completely, floating out and away from you. You can always relax your belly a little more. Each time you exhale, you let go a little more. Let your whole body sag and relax.

Locate any tension that is left in your shoulders and your arms and let go of it so it eases out through your hands. Let your hands be limp and let your fingers be loose and limp. Everything just sinks down into the pillows and mattress.

Let go of any strain or tension in your chest. Drop your whole body into that bed. Let go. Release everywhere. Relax your belly extremely. Concentrate on letting go and letting it float out and away from you. Keep your breathing very calm and quiet and steady and way down low in the bottom of your belly. Use each outbreath to relax a little more deeply. Let the breath fill your entire body, surrounding and relaxing each muscle; wherever you feel tension, use the outbreath to send it away.

Really let go. Don’t just hold yourself still. Keep loose and limp. Let your bottom relax completely.

Let your hips be slack and sink down into the bed. Let go of any tension in your thighs. Let it all go out through your legs and feet. Your legs are loose and easy now. Your feet are loose and limp.

That’s it. Go loose and limp. Breathe with a nice, quiet, steady rhythm. Listen to the sound of it, way down low in the bottom of your belly. You can always relax a little more and a bit more. Breathe and float.

Christina @ Birthing Your Baby
Independent Childbirth Classes for Central Maine
Mamas & Muffins: New Moms Group

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Saturday, January 9, 2010

Re-Using Coping Skills: Here is Your Life

Back when I attended Bradley Method classes to prepare for my daughter's birth, I learned about the effect deep, calm breathing can have on my physical and emotional state. I practiced these new coping skills in hopes of using them to help me relax during birth. I'm happy to report that they were incredibly useful during Madelyn's birth back in 2002 and for Owen's in 2005.

But their usefulness did not end there! Remember Guy Smiley on Sesame Street hosting the "Here is Your Life" segments - the one with the shoe? the one with the loaf of bread?

Well let's play "Here is Your Life" today so I can show you how the coping skills I learned continue to be a very helpful resource, 3 times even, in just the past week!

January 6th, 2010... I'm checking on my son after I put him to bed half an hour earlier, only to find that instead of being in bed, he is squatted down on the floor covering himself with his pillow. This is how he hides when he knows he's done something terribly naughty. I remove the pillow and ask him what the problem is... and he shows me that he bit the top off of a Christmas light, part of a strand that was decorating his room. Undoubtedly deep breathing on my part helped me to be calm, ask him if he had spit out the plastic and where was it etc... He was fine, I took down the lights, and I didn't yell (because really? who does that???) or laugh (because also: it was funny).

January 4th, 2010... First cross-country skiing of the year, on our local high school trails. Usually great conditions, but this time if was very, very icy. We'd gotten about 3/4 of the way around when we stopped to rest, and somehow my ski slipped and I totally rolled my ankle and crashed into the snow. It hurt, and I had heard an ominous crunching noise as I fell. My body wanted to panic - my heart started racing, and I got that light-headed, blurry vision feeling that precedes passing out. But deep breathing got me through. I calmed my body, realized the crunch was probably the ski against the icy snow, and that my ankle was not actually broken and that I was, in fact, going to live! Even to ski out and finish the day's errands, though my ankle did end up swelling from a slight sprain that's already better...

January 3rd, 2010... I'm returning from a visit to PA for the holidays, driving the normally nine-hour trip, just the kids and me. I get off to a good start, through NJ and up into NY. Close to Albany though, the wind is joined by snow (not "showers" as had been predicted by the weather.com) and the driving conditions deteriorate. It's terrible the last part of 87 and the beginning of 90 in NY, and really bad in the Berkshire Mts in Massachusetts. The other cars are also going slow, mostly, and I get behind someone going about 40mph, perfect for the conditions. Thankfully the children were very quiet & well-behaved, though they did wonder why I was going so slowly... just as they asked, a red car tried to pass me and we all watched as the car lost control, spun around, and ended up (I think) in the median. It was scary and added just that touch more of stress and panic to the already challenging driving conditions. You better believe that I was doing my deep breathing then. And listening to music (just like in labor) to help myself stay calm. The weather got better after the Berkshires, but by the time I got to NH and up into Maine, many hours later, I was exhausted, it was dark, and it was raining/sleeting/snowing again. As I drove, concentrating on keeping us safe and moving homeward, I kept reminding myself - that's another mile down: I don't have to do this mile again. Just like contractions - each one brings the baby closer, and each one down is one less to go. We ended up safe at home, where I fell into my husband's waiting arms and cried a few tears of relief & exhaustion, 11 hours from when we started in PA.

So those are my examples in the past week, how deep breathing helped me keep my brain and body calm. I've used it many other times in the past too...

Flying on Airplanes... I flew many times with my infant daughter, and later with my toddler daughter and infant son, by myself, on the way to PA. They were (thankfully!) short flights, but I am terrified of flying and I knew I had to do my best to remain calm so I could effectively parent, as well as to reduce the chance that I would freak out my kids. Because that would be so helpful - all of us crying in panic at the same time! The breathing helped incredibly, and those times I traveled with the children were some of the calmest trips I've had on airplanes, even though I had the additional stress of solo parenting while flying.

Watching my Kids do Scary Things... Like the time my kids were climbing some very scary stairs to a local lookout tower. Safe enough in theory, but absolutely terrifying for me to watch. Someone else helped them, of course, while I walked away and did my calming breathing.

Kids & Medical Problems... The time my son's finger got slammed in the door and looked terrible... the time I put him down for his nap fine and got him up to find his entire body covered in huge, puffy hives, including his neck. Deep breathing helped me stay calm and make effective decisions, while comforting him.

Anger Management... Two kids, a husband, life. Anger happens. Deep breathing helps me avoid losing it (at least some of the time!) and saying or doing things I would regret later.

In addition to using these techniques myself, I am teaching them to my children... when they are feeling angry or overwhelmed, or have been hurt, it's amazing to watch how well simple breathing in through the nose and out through the mouths, big belly breaths, helps them settle back down. It's a simple and extremely effective parenting technique.

Anyone care to join me in sharing a "Here is Your Life" with coping skills story? Which were your favorite for birth? Which do you use now? How?

Christina @ Birthing Your Baby
Independent Childbirth Classes for Central Maine
Mamas & Muffins: New Moms Group

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Sunday, September 20, 2009

Fall Classes & New Mamas Group

I'm currently scheduling group and private classes for this fall and early next year - moms with due dates from October thru January! Classes are held in Winthrop, which is about half an hour from Waterville and the Lewiston/Auburn area, and fifteen minutes from Augusta.

For more information, feel free to email me or visit Independent Childbirth Classes for Central Maine.

Read below for some of the benefits of attending Birthing Your Baby classes!*

CLASSES THROUGH MONMOUTH/WINTHROP ADULT EDUCATION
Preconception & Early Pregnancy Class
An introduction to pregnancy, with activities and discussion on nutrition, exercise, and self-care for a healthy, comfortable pregnancy as well as tips on choosing a care provider and putting together a supportive birth team. Enrollment is limited to women and their partners who are trying to conceive, or who are less than twenty weeks pregnant.

Thursday, September 24th, 6-9pm
Winthrop Middle School Library
Fee: $20/couple

To register, contact the Winthrop Adult Learning Center from 8-2:30 Monday thru Thursday at 377-2265 or Friday 8-10am.
Coping Strategies for Labor and Birth
Introduces a wide variety of coping strategies for labor and birth, including breathing, relaxation, massage, visualization, position change, and water therapy. Some practice time and a short video will help you start thinking about which strategies might work best for you. This class will also be helpful for the birth partner, providing lots of concrete ideas of how to be supportive during labor and birth. Enrollment is limited to women who are in their second or third trimester. Participants are encouraged to bring a support person.

Monday, November 9th, 6-9pm
Winthrop Middle School Library
Fee: $20/couple

To register, contact the Winthrop Adult Learning Center from 8-2:30 Monday thru Thursday at 377-2265 or Friday 8-10am.

MAMAS AND MUFFINS: NEW MOMS GROUP!
I invite all mamas and their "little muffins" ;-) to drop in anytime from 9 to 10am, have a muffin and some tea, and enjoy chatting with other new moms. From 10am to 11, there will be time for women to share their experiences, ask questions & get support. Free and open to all new mamas and their pre-crawling babies.

Groups will be held on the 1st and 3rd Mondays of each month, from 9-11am at the Winthrop United Methodist Church (58 Main Street in Winthrop), upstairs in the nursery. Use the side Wonder Awhile Nursery School entrance. Signs will be posted. Although the WUMC graciously hosts the group, the group itself is not connected with the church and is secular.

September 21st, 2009
October 5th & 19th, 2009
November 2nd & 16th, 2009
December 7th & 21st, 2009

*Wondering about the benefits of Birthing Your Baby classes?
Birthing Your Baby classes are centered in a deep belief in a woman’s ability to give birth… that birth can be an empowering, transforming experience in a woman’s life…that birth is an essentially safe process for baby and mother. The philosophy that drives these classes also inspires confidence and joy in the birth process and in your new lives as parents.

Birthing Your Baby classes are independent. I am not required to teach from a rigid curriculum that only “approves” of certain kinds of birth. This is your birth…your baby!! I will provide up-to-date, evidence-based information and then you can make your best decisions for a healthy and satisfying birth experience, whether it’s an all-natural home birth or a hospital birth with a planned epidural. We will also discuss and practice helpful communication skills so you can maintain an open dialogue with your careproviders.

I believe small classes work best, so there will never be more than five couples in a class. Small classes allow for more student interaction, for more discussion, and for the class content to be personalized to address each student’s particular needs. Private classes are also available.

I offer a variety of classes – group classes that last four to six weeks, as well as private classes. We discuss everything from how you’re all feeling that particular week and addressing any questions that have come up, to self-care during pregnancy, prenatal testing, nutrition, and exercise, to the emotional and physical aspects of labor, comfort measures, birth positions, and communicating with your caregivers, to the transitions of post-partum life, new baby care, breastfeeding and a lot more – the time seems to fly by… you’ll be talking, writing, laughing, drawing, moving around (a lot!), viewing videos, discovering sensations, and practicing, practicing, practicing!

Birthing Your Baby classes are consumer-oriented. In other words, I am not “prepping” you for the policies and routines for any particular birth place or caregiver. As Dr. Sears writes in The Birth Book, “some hospital-based educators, constrained by their own hospital’s birthing policies, prepare parents to more to be compliant patients than to be informed consumers” (53). Instead, Birthing Your Baby classes will teach you (and give you lots of time to practice) a variety of coping skills, relaxation techniques, and positions for labor and birth. Labor is impossible to predict, so the more tricks you can pull out of your bag, the better prepared you will be!

In addition to the individualized class attention, I provide (free) unlimited telephone and email consultation. Any time (pregnancy, birth, post-partum) you have questions or concerns, I welcome your call or email. I can research a topic… offer emotional support and affirmation… or simply listen.

I have a well-stocked pregnancy, childbirth, and parenting “lending library” that includes books, magazines, and videos that I encourage you to borrow from at any time. I have read all of these selections and can help you find ones which address the topics that interest you.

Birthing Your Baby classes encourage you to be open to the possibilities of birth. I will help you create a birth “plan”, but we will also talk about what the “next best thing” is if everything doesn’t go according to plan. Studies have shown that women who feel like they coped well and were active in making decisions about their care had the most satisfying birth experiences. Regardless of your plans for birth, whether this is your first birth or your third, Birthing Your Baby can provide the information and hands-on practice time to enhance your birth experience.
If you have questions about any of these classes or events, please email me or give me a call at 512-2627!

Christina @ Birthing Your Baby
Independent Childbirth Classes for Central Maine
Mamas & Muffins: New Moms Group

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Saturday, September 12, 2009

Why Ask Questions: Part II

I just watched a YouTube video on Nicole's blog Bellies & Babies. The post was about midwifery support videos on YouTube. But one of the videos in support of Australian midwives stood out to me as highlighting, again, the importance of asking questions. If you watch it, you may see why:



I'm going to assume that all these babies and mamas in this video were healthy after the birth. But what an enormous difference in their (mamas and babies) experiences. Sometimes medications or procedures are truly necessary... but sometimes they are a consequence of choices and decisions made earlier or they are agreed to when a mother/family has not been given all the information, has been coerced or bullied or rushed.

So, again: Ask questions. Own your power.

Christina @ Birthing Your Baby
Independent Childbirth Classes for Central Maine
Mamas & Muffins: New Moms Group

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Tuesday, September 8, 2009

Why Ask Questions?

I've read several blog posts lately that highlight the importance of asking questions in very dramatic (and uncomfortable: reader beware) ways.

Birth Trauma
Navalgazing Midwife wrote "Just because it's the standard of care* doesn't mean it's ethical" which lists and lists and lists some of the abusive things done and said to birthing women. She writes, "How can people NOT believe women would consider their experiences traumatic and abusive"??

Ask questions well ahead of time about the standard of care used by your doctor/midwife and birth place. Their answers and attitudes will help help you assess the likelihood that you may be on the receiving end of treatment like that listed by Navalgazing Midwife.

Lest you say, this could not happen to me, not here... let me offer you two examples in this local area:
"You have to have an IV or your baby could DIE!"

The details in this situation are that the woman (who took my birth classes) was asking about IVs because needles made her very nervous, and she was hoping to avoid one. She was also planning an unmedicated childbirth. This hostile (and untrue) response prompted her to change care providers. She ultimately had an unmedicated birth without an IV - a gorgeous, healthy baby girl - in a different birth place, with a different care provider.

"The anesthesiologist is leaving. If you want an epidural, you need to have it now."

Said to a friend of mine (who didn't take my classes) whose water had broken before contractions began. She went to the hospital, where she was admitted, and was waiting for contractions. Because she felt pressured, and didn't want to cause a scene, she had the epidural before she ever felt one contraction.
There is not any 100% guarantee against birth trauma. There are certain things you can do to avoid it though. Here are a few:

  • Ask questions.
  • Think carefully about where you are planning to birth and with whom.**
  • Educate yourself.
  • Have continuous support with you at the birth (partner, friend, relative, doula).

    I think there are certain uncontrollable/less-controllable factors that come into play as well. Mostly I believe we "make our own luck", but I do think there is a certain amount of luck involved too. I'll use my birth stories as an example.

    When I was pregnant with my first child, I did everything I could think of to educate myself, and to work towards having a relatively smooth, trauma-free, unmedicated birth. Which, thankfully, happened. But looking back on it, I realized that I had left one big variable open - care provider. I had established a wonderful relationship with my OB. She was in a practice with three other OBs. It didn't really dawn on me that I only had a 25% chance of birthing with her. I had not met two of the other OBs in the practice because, as a teacher, I could only schedule appointments after school, and these two OBs didn't have appointments after 3pm. The other OB I met I was not happy with - he measured this, checked that, said "any questions" without looking at me or sitting down, and strode briskly out of the room.

    It turned out that the doctor who attended my daughter's birth was neither of the OBs who I had met - though I am very happy and thankful to say that she was fantastic. Very supportive and friendly. She ended up helping me off the bed where my pushing wasn't very productive and onto a birth stool on the floor. She and the nurses sat cross-legged on the floor surrounding me, with the blue drapes all around me. I was like a birthing island in an ocean of blue. I gave birth as the sun rose, surrounded by these wonderful supportive women, one of whom remarked, "This is lovely! It's like a slumber party!!" I'll never forget that. At the time, it didn't feel much like a slumber party, but looking back I understand why she said that - it was the energy in the room. And that's where the luck came in - what do you want to bet that the birth energy would have been very, very different if the OB whom I had met and not liked attended the birth?

    I realized how lucky I was after the birth. For my son's birth three years later, I wanted to be sure I didn't leave care provider so much to chance. I chose to birth with two midwives, so I would know for sure that the person who attended my birth matched my preferences for standard of care and philosophy.

    Technology
    I believe that in this country at least, there will always be some new technology (machine that goes "ping" for you Monty Python fans) awaiting some women when they give birth in a hospital. Think forceps, earlier in the 20th century, or continuous electronic fetal monitoring. There is nothing inherently wrong with technology, certainly there are times when a Cesarean birth, or using a vacuum extractor or a dose of Pitocin, is what has become necessary for a healthy baby and mother. But! Technology used most of the time, for most births, low and high risk? Maybe not something all women want during their birth...

    Which is why it's so important to ask questions. Things like this lurk on our birth horizon.

    While you're at Nursing Birth's blog, take the time to check out her "Don't Let This Happen to You! The Injustice in Maternity Care" series. Scroll all the way down to start at the beginning. I think this series could highly motivate someone to ask questions, lots of questions!

    *What is "standard of care"? Standard of care is the typical, common (standard) care that is usually provided by a doctor/midwife/hospital. Various pressures (legal and financial and bureaucratic and staffing) as well as training, philosophy, routines at the birth place, peer pressure and current trends all impact the standard of care offered by a particular doctor/midwife. It is very much part of the time and place in which a woman births. For example, some hospitals have a Cesarean birth rate of 50% while some homebirth midwives have a Cesarean birth rate of less than 5% - with similar outcomes for mom and baby. Clearly the standard of care offered would be very different.

    **There are some that say "you bought the ticket, you go for the ride". Which is usually true. For example, if a woman gives birth at a hospital with a high Cesarean rate, she should not be surprised if she has a Cesarean. It would be like going to McDonalds and expecting a luxurious, five-course, chef-prepared dinner. Not going to happen.


    Christina @ Birthing Your Baby
    Independent Childbirth Classes for Central Maine
    Mamas & Muffins: New Moms Group

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    Sunday, September 6, 2009

    Ask Questions!



    Not sure what to ask?

    That could be a sign of a problem. Why? Most women have preferences when it comes to their birth experience - or they would if they knew some of their options ahead of time. The most important information needs to be obtained long before baby's birth day: when mom is choosing where to have her baby, and with whom.

    To find out more about your choices, do some reading, talk to an independent childbirth educator (one not affiliated with a hospital), talk to local women about their birth experiences, listening for a birth story that is like the one you want, watch some birth films (not necessarily birth tv).

    Then ask questions - respectfully, clearly, firmly. Specific questions that are not simply answered with a yes or a no. Ask follow-up why & how questions - how many ...? how come...? why not...? If questions seem to make your care provider angry or defensive, take these signs seriously. If your appointments don't last long enough for your care provider to answer your questions, or he/she doesn't take the time to answer thoroughly, take this seriously too.

    Asking questions is not rude, nor does it imply that you do not trust your care provider. A respectful care provider who takes you and your birth seriously will encourage you to ask questions and will be happy to answer them. Getting answers helps you evaluate your options, to be sure that the standard care provided by your doctor/midwife/birthplace is the type of care you prefer to receive. Asking questions and getting answers is one sign of a responsible parent, a responsibility that most of us take seriously from the first positive pregnancy test.

    Christina @ Birthing Your Baby
    Independent Childbirth Classes for Central Maine
    Mamas & Muffins: New Moms Group

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    Wednesday, August 19, 2009

    New Birth Stories

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    Tuesday, August 18, 2009

    Classes, Moms Group & More!

    And... I'm back! We've had a wonderful summer in many ways, with terrific company, fun times at the ocean and out on the boat, and a few precious lazy days. Must work in more lazy days for next year! And respectfully request more sun - that was sorely lacking this year, but we surely did take advantage of what we got, going to the ocean and lake beaches, whenever there was a sunny and hot (or even warm-ish!) day. Like today in fact, and yesterday! Now I'm getting ready to enjoy fall, and another school year with the children, who are attending 3-day a week nursery school and homeschooling. Fun times!

    MAMAS AND MUFFINS: NEW MOMS GROUP!
    I've changed times and format for the moms group... and it has a new name: Mamas and Muffins. It's still free, of course, and open to all new mamas and their pre-crawling babies. I invite all mamas and their "little muffins" ;-) to drop in anytime from 9 to 10am, have a muffin and some tea, and enjoy chatting with other new moms. From 10am to 11, there will be time for women to share their experiences, ask questions & get support.

    Groups will be held on the 1st and 3rd Mondays of each month, from 9-11am at the Winthrop United Methodist Church (58 Main Street in Winthrop), upstairs in the nursery. Use the side Wonder Awhile Nursery School entrance. Signs will be posted.

    September 21st, 2009
    October 5th & 19th, 2009
    November 2nd & 16th, 2009
    December 7th & 21st, 2009

    BIRTHING YOUR BABY CLASSES
    I am scheduling group and private classes for this fall. If you're expecting your baby in October, November, December, or January, give me a call at 512-2627 or email me!

    CLASSES THROUGH MONMOUTH/WINTHROP ADULT EDUCATION
    Preconception & Early Pregnancy Class

    An introduction to pregnancy, with activities and discussion on nutrition, exercise, and self-care for a healthy, comfortable pregnancy as well as tips on choosing a care provider and putting together a supportive birth team. Enrollment is limited to women and their partners who are trying to conceive, or who are less than twenty weeks pregnant.

    Thursday, September 24th, 6-9pm
    Winthrop Middle School Library
    Fee: $20/couple

    To register, contact the Winthrop Adult Learning Center from 8-2:30 Monday thru Thursday at 377-2265 or Friday 8-10am.

    Coping Strategies for Labor and Birth

    Introduces a wide variety of coping strategies for labor and birth, including breathing, relaxation, massage, visualization, position change, and water therapy. Some practice time and a short video will help you start thinking about which strategies might work best for you. This class will also be helpful for the birth partner, providing lots of concrete ideas of how to be supportive during labor and birth. Enrollment is limited to women who are in their second or third trimester. Participants are encouraged to bring a support person.

    Monday, November 9th, 6-9pm
    Winthrop Middle School Library
    Fee: $20/couple

    To register, contact the Winthrop Adult Learning Center from 8-2:30 Monday thru Thursday at 377-2265 or Friday 8-10am.

    UPCOMING!
    I am very excited to be working on a Pregnancy Wellness Fair - if you support women during the childbearing year (pregnancy, birth, postpartum) and are looking for ways to share your expertise, please contact me! I am especially interested in connecting more women with "outside the doctor's office" services with benefits that may not be well-known, like chiropractic care, massage therapy, accupuncture, doulas, and more. If you're pregnant, or trying to conceive, check back for more details!

    I am also planning a film screening or two for the fall & winter months!


    Christina @ Birthing Your Baby
    Independent Childbirth Classes for Central Maine
    Mamas & Muffins: New Moms Group

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    Friday, June 12, 2009

    Summer Vacation

    Summer has started for our family, after a whirlwind of spring recitals and performances. Homeschool and nursery school are over, and the children and I are traveling for most of June, so I expect I won't be blogging much for another month or so. I'll be back in a bit... I've got a bunch of ideas swirling around, so I know I won't be able to keep quiet for long!

    I also want to mention that the postpartum support group, New Moms Support Circle is taking a break for the summer. Look for fall meeting dates to be published sometime in August.

    I am continuing to teach and schedule classes for this summer and fall, so email me if you'd like to set up a time to meet or join a class. I will be able to check me email and voicemail while I'm away, and I'll get back in touch with you.

    Until then, here's a gorgeous poem I received in a Mothering email.

    Ripening

    As the baby, from seed to worldly entrance ripens
    So does the mother's consciousness mature through revelations
    of life's beginnings-
    During this, their growing season.

    Out of man and woman's union springs the fruit-
    A child swelling 'neath a woman's belly,
    And the Madonna-ripening fruit of womanhood.

    Joining forces, father and mother weed out their fears,
    To clear the ground and prepare the way for the day of harvesting.

    On that day, they reap as they sow, the fruits of their labor.


    -- Author Unknown

    There's so much to love in this poem, I had to share it with you!

    Hope your summer is off to a wonderful start!

    Christina @ Birthing Your Baby
    Independent Childbirth Classes for Central Maine
    New Mothers Support Circle

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    posted by Christina Kennedy at 4 Comments

    Saturday, April 25, 2009

    Birth: Assuming Control

    The word assume has several meanings - three that I want to highlight here:
    Assume can mean to take for granted or without proof; suppose. Clearly, this is the definition the well-known quip "assume makes an ass out of u and me" comes from.

    Assume can also mean to take upon oneself; undertake, as in assuming responsibility for a task.

    And, assume can mean to appropriate; seize; usurp - when a dictator assumes power, for example.
    What does this have to do with birth? I was enjoying Anna Quindlen's back-page opinion article a few weeks ago in Newsweek, Dollars and Sense, when that phrase popped out at me and has been stuck in my head ever since. She was discussing how few of us understand the complexities of our financial world,
    "the great unspoken issue behind the tanking of the market, the mess in subprime mortgages and the bailout bill is that Americans don't understand the basics of the economy. Faced with financial instruments increasingly arcane and complex and financial institutions increasingly faceless and vast, most outsourced knowledge and responsibility to those they assumed were ethical and responsible. The banker, the broker, the rating agencies: they would look out for us."
    As I read this article, I was struck by how this whole article could also apply to birth. And towards the end of the article, she wrote
    "Americans have given up understanding much of what passes for daily life . . . But there's also a precedent for assuming control, even of complex issues. Look at the way many Americans deal with health care today compared with a generation ago. Once doctors, like financial managers, were seen as keepers of a mysterious flame and patients as people who should simply do what they were told. Today many more patients think of themselves as partners and work hard to educate themselves about their health and their ailments before having surgery or taking medications."
    Is this true, do you think: have American women "assumed control" of birth?

    Unfortunately, I see and hear and read many, many more stories about women assuming (first definition) that they have control and many, many more stories about doctors and medwives assuming control (last definition). If I could make only one wish for my clients, it would be for them to assume control (second definition): not to assume that they can control birth, but that they would assume responsibility for making the choices that are right for themselves and their babies, with caring, responsive doctors and midwives to help them.

    I want to share a blog with you that I think is absolutely amazing, called Nursing Birth. It's written by a labor & delivery nurse, and she's started a series called "Don't Let This Happen to You" because, as she says, "Throughout my time as a labor and delivery nurse at a large urban hospital in the Northeast, I have mentally tallied up a list of patients and circumstances that make me go “WHAT!?! Are you SERIOUS!? Oh come ON!”

    Women need to read these stories and take them seriously. Just like any other aspect of life, don't just assume you're in control: assume control. What does that mean? Learn about birth and think about your options. Interview care providers and visit hospitals and birth centers. Find a good fit. If you find yourself in a situation that is not a good fit, make changes! Find support. Take classes (email me if you're in Maine!). Reflect, discuss, learn, practice what you've learned. Rehearse. Discuss some more. Assume control!

    Christina @ Birthing Your Baby
    Independent Childbirth Classes for Central Maine
    New Mothers Support Circle

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    Monday, April 6, 2009

    Scheduling Spring & Summer Birth Classes!

    I'm currently scheduling group and private classes for this spring and summer - moms with due dates from May to September! Classes are held in Winthrop, which is about half an hour from Waterville and the Lewiston/Auburn area, and fifteen minutes from Augusta.

    For more information, feel free to email me or visit Independent Childbirth Classes for Central Maine.

    Read on for some of the benefits of attending Birthing Your Baby classes!

    Birthing Your Baby classes are centered in a deep belief in a woman’s ability to give birth… that birth can be an empowering, transforming experience in a woman’s life…that birth is an essentially safe process for baby and mother. The philosophy that drives these classes also inspires confidence and joy in the birth process and in your new lives as parents.

    Birthing Your Baby classes are independent. I am not required to teach from a rigid curriculum that only “approves” of certain kinds of birth. This is your birth…your baby!! I will provide up-to-date, evidence-based information and then you can make your best decisions for a healthy and satisfying birth experience, whether it’s an all-natural home birth or a hospital birth with a planned epidural. We will also discuss and practice helpful communication skills so you can maintain an open dialogue with your careproviders.

    I believe small classes work best, so there will never be more than five couples in a class. Small classes allow for more student interaction, for more discussion, and for the class content to be personalized to address each student’s particular needs. Private classes are also available.

    I offer a variety of classes – group classes that last four to six weeks, as well as private classes. We discuss everything from how you’re all feeling that particular week and addressing any questions that have come up, to self-care during pregnancy, prenatal testing, nutrition, and exercise, to the emotional and physical aspects of labor, comfort measures, birth positions, and communicating with your caregivers, to the transitions of post-partum life, new baby care, breastfeeding and a lot more – the time seems to fly by… you’ll be talking, writing, laughing, drawing, moving around (a lot!), viewing videos, discovering sensations, and practicing, practicing, practicing!

    Birthing Your Baby classes are consumer-oriented. In other words, I am not “prepping” you for the policies and routines for any particular birth place or caregiver. As Dr. Sears writes in The Birth Book, “some hospital-based educators, constrained by their own hospital’s birthing policies, prepare parents to more to be compliant patients than to be informed consumers” (53). Instead, Birthing Your Baby classes will teach you (and give you lots of time to practice) a variety of coping skills, relaxation techniques, and positions for labor and birth. Labor is impossible to predict, so the more tricks you can pull out of your bag, the better prepared you will be!

    In addition to the individualized class attention, I provide (free) unlimited telephone and email consultation. Any time (pregnancy, birth, post-partum) you have questions or concerns, I welcome your call or email. I can research a topic… offer emotional support and affirmation… or simply listen.

    I have a well-stocked pregnancy, childbirth, and parenting “lending library” that includes books, magazines, and videos that I encourage you to borrow from at any time. I have read all of these selections and can help you find ones which address the topics that interest you.

    Birthing Your Baby classes encourage you to be open to the possibilities of birth. I will help you create a birth “plan”, but we will also talk about what the “next best thing” is if everything doesn’t go according to plan. Studies have shown that women who feel like they coped well and were active in making decisions about their care had the most satisfying birth experiences. Regardless of your plans for birth, whether this is your first birth or your third, Birthing Your Baby can provide the information and hands-on practice time to enhance your birth experience.

    Christina @ Birthing Your Baby
    Independent Childbirth Classes for Central Maine
    New Mothers Support Circle

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    Saturday, April 4, 2009

    Normal Childbirth?

    I've read lots of articles and blog posts and email conversations surrounding the many perceptions and definitions of "normal" childbirth and "natural" childbirth. One thing I've learned is that these definitions are extremely fluid and subjective. One person may define natural childbirth as any birth that is vaginal, others believe that a natural childbirth is one without any medical procedures or medications. What is defined as a procedure can even by tricky - while most of us would agree that artificially rupturing membranes is a procedure, what about a vaginal exam?

    Personally, I would define my first child's birth as natural, even though my membranes were ruptured (with my consent) when I got to 10cm and they were bulging, and I had some electronic fetal monitoring. Because I had nothing attached to me (IV, catheter, epidural) and no medication, that fits my personal definition of a natural birth.

    What's the big deal about this anyway? Well, as a former high school English teacher, I am a person who appreciates unambiguous language - I like it when people intentionally use the right word for something. In fact, this drives my husband crazy sometimes because he'll come home and use the word flu to describe just about anything going around his office. This word sets off a chain of (annoying, if you ask him) question: a stomach flu? the real flu? how long did it last? was there a fever? etc. Any cold with a fever or vomiting episode fits his definition of flu, but mine is much more narrow. What I want to know is what he might have been exposed to, and what symptoms I should be on the lookout for in the children, and his definition doesn't help me figure that out!

    Back to childbirth - does it matter if someone discussing a natural birth means that she didn't have a cesarean, and is basically using the word natural because she doesn't want to say the word vaginal in regular conversation?

    The word normal is even more slippery, because its definition is shaped so much by what is normal in any given culture or sub-culture. Normal could mean a very medicalized birth, with IV, epidural, catheter and prone pushing or it could be a homebirth with a midwife attending as a "guardian" who supports the mother and checks on the baby, but who does not do anything medical in nature beyond checking baby's heart tones and examining the placenta and the mother afterward for tears.

    I started thinking about these definitions because of a question I read in the Midwifery Today newsletter:
    "If the general public continues to be indoctrinated into medicalized birth, how can we expect women to stand up and fight against the marginalization of freestanding birth centers and midwifery in this country?"

    — Colleen Bak
    Indoctrination is a serious word. This question (or call to arms!) is all about definition, to me. If the definition of natural birth encompasses physiological birth and birth that is medicalized with procedures and medications that may or may not be evidence-based, it becomes very, very hard for people to understand and appreciate the benefits of physiological birth to mother and baby, as well as making that type of birth seem even more unusual than it is. A big part of why I offer independent childbirth classes (and write this blog) is because these are my ways of making a difference: they're my small way to fight against the indoctrination that pervades birth as portrayed on mainstream television and in movies, on TLC's Baby Story, and in some books and classes about birth.

    [And yes, I threw another birth category into that paragraph: physiological. What is physiological birth? Dictionary.com defines physiological as "characteristic of or appropriate to an organism's healthy or normal functioning". I like Dr. Kotaska's explanation, from Jennifer Block's book Pushed, “An unmedicated birth in an environment where a woman feels comfortable, where she’s adequately supported, where she has a degree of privacy that allows her brain and her uterus to do the dance that we understand very poorly called labor, is physiological birth.”]

    Before I eat lunch I want to wrap this up with a few more links. Lamaze International offers its defining qualities of normal birth with these six care practices. By normal, they mean normal physiologically, not culturally.

    And I want to point you to the free online sample of the excellent journal, Birth, where they've posted the articles from current issue (March 2009). The article that directly applies to this post is the editorial, "What is Normal Childbirth and Do We Need More Statements About It?", where you can read more about the words normal, natural, and physiological as they relate to birth. I'll leave you with a quote from the editorial,
    "Clearly, 'normal’ has a different meaning in different countries. The dominant cultural definition and experience of childbirth in North America and elsewhere are widely recognized to be medical and technological in both philosophy and practice (3,5), and as evidenced from the medical inclusion criteria for ‘normal birth’ listed in the British and Canadian statements (1,4). As long as birthing systems continue to evolve in this direction, definition of ‘normal’ will evolve to keep up. Provider and consumer groups will have to continue to make their voices heard in support of natural childbirth and, hopefully, a more normal ‘normal childbirth.’"
    And that's my addition to what I hope will swell to a growing chorus of women who support a more normal "normal childbirth".

    Christina @ Birthing Your Baby
    Independent Childbirth Classes for Central Maine
    New Mothers Support Circle

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    Friday, April 3, 2009

    Preparing for Birth: "What If?" Can Be Motivating

    The most recent Midwifery Today e-newsletter has a quote that ties in well to yesterday's post re: what do childbirth educators teach anyway? and re: how some of the most important work a woman does to birth her baby happens before the birth.
    "When we are aware of potential risk factors or when mothers express extreme anxiety we can take steps to remedy the situation and facilitate a smooth birth. Our actions will depend on the particular situation, but often just identifying the source of worry and getting it out into the open may be all that is needed to prevent related problems from arising in labor. Ultimately we want to empower moms to use the resources and address the problems before labor begins."

    — Heidi Nielson Sylvester
    Excerpted from "Psychological and Emotional Dystocia," Midwifery Today, Issue 81
    The above quote resonates so well with me because I've seen so many a-ha moments come from the activities we do in class around worrying. After we talk about the purpose of worrying, I encourage families to come up with a "worry list". I suggest they use the "what if" questions that linger in the back (and front!) of their minds as motivation to prepare during birth. One of my favorite activities we do together is the Birthing From Within "taming your birth tiger" visualization. I sometimes see a dramatic shift following this activity: moms and dads relax their shoulders and jaws and leave the class looking like a weight has literally been lifted away. I would love to be a fly on the dashboard of the car sometimes, to hear what conversations are sparked from this exercise.

    These discussions in class pave the way for couples to communicate concerns and preferences together, as well as with their care providers and other birth support people. Framing worry as a motivator instead of something to be suppressed and avoided totally changes a lot of people's perceptions and helps them feel more directed and in-control.

    For example, one of the my first clients turned out to be very, very afraid of and worried about needles, especially having an IV. I think she felt a little silly about this, but getting it out in the open seemed to be a relief. So we talked about ways needles and IVs in labor - why they are used and how they might be avoided. I strongly encouraged her to talk to her care provider about the routine care she provided during labor so she could be prepared ahead of time. Turns out this OB was very uncomfortable with anything less than a routine IV, and told the mom I was working with that she might die or her baby might die without one. Instead of frightening this mom, the OB's comment made her very angry, and motivated her to change care providers entirely, to a midwife who practiced at a different hospital. She went on to have a very satisfying (and safe) birth experience - without an IV!

    While we spend a lot of time on the birth process, and coping strategies, as well as discussing common procedures and medications, one thing that makes my classes different from the standard prenatal class is the focus on preparation that can be done now, while pregnant - whether it's nutrition, or exercise, or communicating, or reflection.

    Preparing for birth and parenting starts, in my opinion, during pregnancy - and it goes far beyond getting the baby's room ready and installing a car seat! To read more, click on the What If post I wrote a few months ago.

    I'm curious - what did you do (or are doing now) to prepare for your baby's birth? Was there anything you wished you had done?

    Christina @ Birthing Your Baby
    Independent Childbirth Classes for Central Maine
    New Mothers Support Circle

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    Thursday, April 2, 2009

    Reply Turned Post: What DO Childbirth Educators Teach??

    I've been thoroughly enjoying the posts over at Mom's Tinfoil Hat, and the whole idea of "reply turned post" seems to fit my response to this very interesting post from RedRN, "On Childbirth Education", which I highly recommend clicking over to read and respond to.

    This is my response:

    "Interesting post! It strikes me how "in the middle" nurses sometimes are, and impresses me all the more when I read about the patient advocating you and others like you do over & over.

    One of the things I tell clients (and write in my blog - see the sidebar on popular posts) over & over again is that the prep work done before the birth is extremely important. The mom needs to think about how she wants the birth to go (a set of educated preferences, not demands) and then do the work she can ahead of time to set herself up well: get support from partner and/or friend/family and/or doula; choose a careprovider who is a good match; choose a birth place that's a good match etc. & etc. And then keep reflecting and communicating.

    One thing I've noticed about teaching anything (I've taught high school, Sunday School, and birth classes) is that a teacher can say one thing, and there are as many interpretations of that thing as there are students. People tend to hear, in general I think, what makes sense to them, what fits in with their perceptions and experiences. So what you're seeing may or may not accurately reflect the information presented in a class.

    People do zone out - so few people contact me in enough time, with enough time, to do shorter classes over more weeks. Families usually choose two or four session classes of three or four hours each. Those are *full* classes, and it's hard to pay attention and process everything. Edited here to add that with breaks, and food, and a balance of activities, brainstorming, groupwork, movies and presentations I think families in my classes have a better shot at staying fully engaged!

    And I think you hit on something else important to keep in mind - there are some care providers who *say* one thing and then do another, or are misleadingly ambiguous, especially if asked vague questions with no follow-up. Add that to the fact that many women get care from a practice and may or may not see all the care providers to discuss each partners' routine management ahead of time... I really encourage and role-play with families ahead of time how to ask questions during their appointments, and how to follow-up to get the information they're looking for."

    A few more things I've thought of after I posted the reply:

    ** Some hospitals do allow doppler monitoring instead of electronic fetal monitoring. Other than a five minute test-strip when I first arrived, my son's heart rate was only tracked via doppler. I did discuss this ahead of time with my midwife, to be sure that doppler monitoring was possible.

    ** That some hospitals still don't allow moms to eat and/or drink during labor astounds me, given how many studies have shown that this is not evidence-based care. And like I tell clients: we're not advised to avoid eating or drinking before getting in the car, just in case there's an accident and we'll need anesthesia, are we? We're not given an IV just in case, either.

    ** I also continue to be amazed at how "railroaded" some families are during labor, like the scenario mentioned in the original blog post, with Dr. Ass. It's amazing to me that care providers act that way and it's amazing that women and their partners accept it. I understand that there will always be sub-par performers in any profession, and I understand that labor/birth is a very vulnerable time for women, and when providers pull out the "dead baby" card it would be very, very hard to be non-compliant.

    So, if you didn't - go read the original post and leave a reply!

    Or, to get more information about Birthing Your Baby classes, visit my Class Information page!

    Christina @ Birthing Your Baby
    Independent Childbirth Classes for Central Maine
    New Mothers Support Circle

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    Wednesday, March 11, 2009

    From Lamaze: "Making Tough Decisions Without All the Facts"

    I received this press release* from Lamaze International in my email inbox today and I am including it here because it highlights the importance of informed consent. Expectant families should not assume that the information needed to give true informed consent will necessarily be offered, should medications or medical procedures be recommended during labor and birth.

    Making Tough Decisions Without All the Facts: How Inadequate Informed Consent Puts Childbearing Families at Risk

    WASHINGTON (March 10, 2009)—Imagine you are a woman in labor and your doctor tells you that electronic fetal monitoring is necessary to record your baby’s heartbeat. Without any further information about the monitoring or its risks, you are given a consent form to sign. Believing the doctor is doing what is best for you and your baby, you sign. By neglecting to tell you that electronic fetal monitoring can result in labor complications and increases the need for cesarean surgery, your doctor has not held up his or her end of the informed consent process.

    This shocking scenario plays out nationwide thousands of times a day across a range of procedures. The purpose of informed consent is to ensure that before a health professional or researcher does something to a patient’s body, the patient must understand what is being done and give his or her voluntary consent. But in all aspects of medical care, informed consent can fall short of the mark. In the instance of childbirth, women and their partners may be asked to make decisions without being well-informed of the risks and potential outcomes that can affect moms and babies.

    “The fact that health care providers, whom society has been taught to trust, are neglecting to fully inform parents about risks associated with various procedures and interventions during childbirth is inexcusable,” says Judith Lothian, RN, PhD, LCCE, FACCE, co-author of The Official Lamaze Guide: Giving Birth With Confidence.

    A recent article published in The Journal of Perinatal Education reveals how sub-par information provided by health care providers undermines the purpose of informed consent. This results in parents having incomplete information when making decisions with potentially grave implications, such as whether or not to use medication or submit to obstetrical procedures during childbirth. The Milbank Report, Evidence-Based Maternity Care: What It Is and What It Can Achieve, found inadequate informed consent processes to be a major barrier to women benefiting from evidence-based maternity care.

    Lamaze International, an organization committed to ensuring childbearing families have access to information on the benefits of healthy birth practices, offers resources to help parents talk to their health care providers. Free tools include the Lamaze...Building Confidence Week by Week weekly e-mail series and the award-winning Lamaze: Pregnancy, Birth & Beyond magazine to help parents speak to their health care providers about a range of pregnancy and birth related issues.

    ###
    *Does anyone know if it's okay to a copy press release like this, into a blog? What's the copyright protocol?

    Christina @ Birthing Your Baby
    Independent Childbirth Classes for Central Maine
    New Mothers Support Circle

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    Friday, January 30, 2009

    Stay at Home!

    Even though we thoroughly discuss the benefits of staying at home in labor during birth classes, I would say at least half of the families I talk to after their babies are born make a comment about how either the mom or the dad wanted to leave for the hospital early and had to be talked down.

    This isn't surprising, really. There's trained help at the hospital or birth center. It seems to make sense to get there sooner than later: mom can "get comfortable" in her birth space, right? meet up with her doctor or midwife, yes? there will be nurses who can provide some labor support... the car ride will be easier to handle in early labor etc. & etc.

    Plus - and I think this is the biggest one - sometimes there is a little blood in early labor, and that, frankly, freaks some people out.

    Who mom chooses to attend the birth, where she plans to birth (hospital, birth center, or at home! then you really could stay at home!!), the support she has, and how well she's communicated her preferences ahead of time all play into the mix as well. But even in the best scenarios, it turns out there are some good reasons to stay home through early labor and into the beginning of active labor.

    Let's take a second look at those reasonable-sounding rationales for high-tailing it to the hospital, like they do in the movies:

    First: the doctors, nurses and midwives are trained, yes. But mostly what nurses and doctors are trained in is managing labor, and looking for problems. Care providers who trust the process, are women-centered, and make few "routine" decisions (as in, routine IV; routine continuous monitoring, etc) are more likely to let mom labor without any inteference. Otherwise, as I've heard it described, "you get on the train and you go for the ride". In other words, once mom gets to the hospital, she's on the hospital ride, more or less. Usually, a shorter ride is easier on mom and baby.

    Second: if "getting comfortable" means getting hooked up to an IV and continuous monitoring, then yes, by all means: go to the hospital and "get comfortable"! If your idea of comfort is wearing your own clothes and eating when you want and not answering questions about your pain level and lying in your own comfy bed or petting your cat or dog or taking a stroll in your garden and enjoying the sunshine: well, then, stay home for a little while longer.

    Third: Most doctors come in when mom is ready to start pushing or give birth, though they might be in/out to check mom too. Midwives may be present for more of labor, or they may not - depends on the midwife and/or her schedule.

    Fourth: Most nurses are there to check on mom - ask questions and assess progress, but do not rub backs, hold hands, or make lots of suggestions re: comfort techniques. I think most nurses would like to do more of this, but the realities of understaffing and charting makes this less a part of their job than they would like.

    Fifth: the car ride... yes, that one's valid! But weighed against all the others above, plus what's below... mom may decide it's worth the extra discomfort in the car, after all.

    According to the Lamaze 34 week e-newsletter, when mom gets to the hospital actually affects her likelihood for birthing vaginally vs. via surgery:
    "Can we safely lower the cesarean surgery rate simply by admitting women to the hospital later in labor? Research conducted on more than 40,000 births in California suggests strongly that the answer is yes. The research team compared the cesarean rates in low-risk, first-time mothers in 20 different hospitals. They calculated the number of women in each hospital who were admitted before they reached 3 cm dilation. After taking various other factors into account, they found that hospitals that admitted many women before 3 cm dilation tended to have very high cesarean surgery rates, while those who didn't admit many women before 3 cm tended to have low cesarean surgery rates. The babies born in the high-cesarean rate hospitals were no healthier than those born in the low-cesarean rate hospitals."
    Source: Main, E. K., Moore, D., Barrell, B., Schimmel, L. D., Altman, R. J., Abrahams, C., et al. (2006). Is there a useful cesarean birth measure? Assessment of the nulliparous term singleton vertex cesarean birth rate as a tool for obstetric quality improvement. American Journal of Obstetrics & Gynecology, 194, 1644-1652.

    Also, don't be afraid to be wrong. Maybe you think this is it, pack up, load up, get to the birth place and discover the contractions have stopped and progress is not being made, and/or you're 3 cm or less dilated. As long as you & the baby are doing fine, think about going home. You can always come back! And hey, me - the trained childbirth educator, second-time mom - I didn't get it right and did the whole rigamarole of calling husband home from work, MIL to stay with my daughter, pack up, load up, drive forty minutes to the hospital thing to find out: my contractions had stopped and I was not. dilated. at all. A little bit of squatting and walking to be sure I couldn't get the contractions to come back (after all they'd been five minutes apart for four hours) and then some crying, and I went home. Owen did come out eventually, short easy labor, yes, but two days later.

    Finally, do keep in mind that there are good reasons to leave for the hospital before the 4:1:1 suggestion I make to clients (contractions four minutes apart, lasting a minute, for one hour)... for example, a snowstorm; or living further from the place of birth; history of fast labor, or labor progressing quickly. Or, if mom feels like something isn't right, has a lot of bleeding, or a lot of pain between contractions, then it's time to head out right away.

    I like how Dr. Sears puts it in The Birth Book: "For most mothers the best odds for a safe and satisfying birth come with laboring at home as long as possible. Presenting yourself at the hospital too early may give you a case of performance anxiety. Soon after check-in the clock starts ticking and the pressure to progress begins. Early arrival opens the door for questionable interventions that may shake your confidence and slow your progress. Also, you're no longer queen in your castle, but a 'patient' in someone else's domain. The house rules are not yours" (214).

    So: don't let "bloody show" scare you to the hospital. It's a good sign - the capillaries (small blood vessels) in the cervix are breaking as the cervix thins and opens. Labor has started, or will start soon: but be patient and hang out at homoe a little longer, as queen of your castle.

    Christina @ Birthing Your Baby
    Independent Childbirth Classes for Central Maine

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    Wednesday, January 7, 2009

    Cesarean Births: Preventable?

    I'm home, and everyone's healthy: a state of affairs that hasn't happened much over the past two months! I am caught up on email and reading blogs and online newsletters (whew!). It was a lot of interesting reading, which, over the next week or so, I'll be providing links to so you can read too if you've missed it, say, because someone's been sick or you've been traveling!

    I have read a lot about cesarean birth in the past several weeks. Many readers have probably heard stories about emergency cesareans - when something happened with mother or baby which made a very fast procedure necessary. I'm thinking about cord prolapse (when the baby's umbilical cord slips past the baby's head is being compressed during contractions) or placental abruption (when the placenta detaches prematurely), for example. In an emergency situation, the time from indication to decision to incision and birth is very quick - a matter of ten or fifteen minutes.

    These emergency situations represent a very small number of the cesarean births. Much more commonly, cesarean births are urgent or they are the end result of a series of mother or careprovider choices, many of which are not openly acknowledged by care providers as increasing the risk of cesareans. Check out this very useful discussion defining types of cesarean births - moving beyond "unplanned = emergency vs planned = non-emergency" at Enjoy Birth.

    In fact, there is wide belief that many of the cesarean births happening in the United States right now are actually preventable. The World Health Oranization recommends a cesarean birth rate of 5-10%; at rates higher than 15%, the harm to mothers' and babies' health statistically outweighs perceived health benefits for the group as a whole. The United States is well past the "harm outweighing the benefits" range, with most hospitals performing a (very unusual) low of 15% cesarean birth to the average ~30% and some doing Cesareans for 50% of women's births.

    The Lamaze newsletter "Building Confidence" for Week 30 mothers has an excellent assessment of preventable cesareans,
    "Talk with almost any woman who has had a cesarean and she’ll say her surgery was necessary. Indeed, by the time many cesareans take place, the surgery has become necessary—either because the baby is signaling distress or labor is not progressing. But if you take a closer look, you’ll see that these problems often occurred as side effects of the way labor was managed. Some cesareans can be prevented with care that supports—rather than interferes with—the normal processes of labor and birth. By talking about “preventable cesareans,” instead of “unnecessary cesareans,” we can point to specific choices and care practices that might change the course of labor."
    Lamaze offers excellent information about The Six Care Practices that Support Normal Birth.

    Choosing a care provider and birth place can be a process, approached in a similar way to other big decisions, like buying a car. A person might go through a process like this to buy a car: deciding what qualities in a car are important - size, fuel efficiency, price, longevity, style; finding out which cars match their priorities; trying to find a reputable place that sells this kind of car; getting the car checked out and then buying it. This process, in my opinion, is much more likely to result in a car that matches a person's needs compared with a process which simply involves driving to the closest car dealership and asking the first salesperson to show you a car and buying it after a brief look-see.

    Reading and asking questions about birth, discussing options and the typical routine care offered by a care provider/birth place is of critical importance, in my opinion.

    If you're looking to minimize the likelihood of a Cesarean for your first birth experience, think about how to minimize the likelihood of having one of those preventable Cesarean.

    Read about the six care practices in the link above. Read independent blogs and books and magazines.

    Choose your care and birth place carefully. Understand that not all the care provided by hospitals and doctors/midwives is equal in preventing preventable Cesareans. For example, many hospitals automatically hook women up to electronic fetal monitoring (EFM) devices for all, or the majority, of their labor and birth experience. But in that same Week 30 newsletter, Lamaze excerpts this study,
    "Continuous electronic fetal monitoring is used in more than 90 percent of labors in the United States. However, decades of research show that this ubiquitous machine does not live up to its promise of safeguarding babies in labor. In fact, researchers who evaluated all of the published studies comparing continuous fetal monitoring with intermittent auscultation (a method where a provider listens to the baby’s heartbeat regularly throughout labor) found that, when the mothers are healthy and labor is uncomplicated, there were no differences in important outcomes for babies regardless of the method used. However, their research confirmed that intermittent auscultation has a major advantage—it results in far fewer cesarean surgeries.

    Source: Alfirevic, Z., Devane, D., & Gyte, G. M. (2006). Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour. Cochrane Database of Systematic Reviews, 3, CD006066."
    Take independent birth classes instead of the ones offered by the local hospital! Independent Childbirth offers insightful commentary on the cesarean epidemic in the United States, and the role of independent birth classes. If you're in Central Maine, consider calling me at 512-2627 to find out about the independent classes I teach. If you're in Southern Maine, consider calling Birth Roots at 772-4784. If you're outside of Maine, visit the Independent Childbirth Educators directory, or google search independent educators near you. You may not hear about us from the local hospital or doctor's office, but ask a midwife (especially a homebirth midwife); ask at your local health food store; ask at a La Leche League meeting: we're out there!

    ** Edited to add a link to this great birth story that serves as a real life "illustration" of the topics in this entry: Floppy's Birth.

    Christina @ Birthing Your Baby
    Independent Childbirth Classes for Central Maine

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    Wednesday, October 15, 2008

    Prenatal Vitamins

    Many pregnant women take prenatal vitamins, as recommended by most care providers. If you take prenatal vitamins, do you know what vitamins and minerals they contain, and at what levels?

    This is a "quiz" I do with families during our first class:

    How much of your daily requirements are supplied by your prenatal vitamin?

    Write down your estimate by each of the following ingredients:

    1. Vitamin A ______%

    2. Vitamin C ______%

    3. Folic Acid ______%

    4. Iron ______%

    5. Protein ______%

    6. Calcium ______%

    7. Omega-3 Fatty Acid ______%


    Some people believe that by taking a vitamin (or vitamins), they're covering their nutritional "bases" without eating a variety of foods, especially fruits and vegetables. Does taking a prenatal vitamin make up for a poor diet?

    I'll post a follow-up discussion and resources on prenatal vitamins tomorrow!

    Christina @ Birthing Your Baby
    Independent Childbirth Classes for Central Maine

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    Sunday, August 3, 2008

    Breastfeeding Basics - My Handout

    This is the first handout I provide to the families who take childbirth education classes with me. It is a summary of what I feel is the most important, basic information.

    TYPICAL FEEDING SESSION: NURSE AS LONG AS BABY WANTS ON SIDE #1. WHEN BABY COMES OFF OR FALLS ASLEEP, BURP, CHANGE (MANY BABIES POOP ABOUT NOW), AND OFFER SIDE #2 FOR AS LONG AS BABY WANTS. THIS COULD TAKE 15MIN OR – MUCH MORE LIKELY! 45 MIN OR MORE. START WITH SIDE #2 FOR NEXT FEEDING & REPEAT.

    Many newborns need to nurse every two or three hours, including the nursing session. So, a mom may breastfeed at 12pm for 45min, and then need to nurse again at 2pm or 2:30. The best way to make a good milk supply is to nurse a lot – whenever the baby displays any hunger cues or is fussy. It’s a lot easier to get a newborn to latch properly when (s)he starts to seem hungry instead of waiting for desperate “rooting” and crying. Offering the breast frequently, even if you’re not sure whether milk is what’s being requested, will not hurt. The “worst” that will happen is baby will fuss and turn away. Milk is made by supply/demand, so the more the baby empties the breast, the more milk is made.

    You may read or be told (by the peanut gallery, almost certainly not by a lactation consultant) that you should only nurse for five or ten minutes per side. There are many “reasons” a person/book might suggest this, mostly about decreasing the likelihood of nipple soreness or that ten minutes is all a baby needs, getting the baby on a schedule etc. In almost all cases, this is incorrect. Nipple soreness is primarily caused by a poor latch, not length of time at breast. Breasts are never empty – baby can always get a little more.

    In fact, it’s very important to let baby nurse as long as (s)he wants to: it increases milk supply and helps insure that baby is getting both foremilk (the milk that comes first has more sugar and protein; it is thinner and more “thirst-quenching”) and hindmilk (the fattier milk that helps make the baby full and gain weight). If a baby is moved from one side to the other on a schedule, (s)he may not have had time to get to the hindmilk on the first side, which can cause growth and digestive problems. Babies who get a good balance of fore/hindmilk typically have the typical “mustardy” color poops, with a seedy or curdy consistency (lovely, I know – but it smells much less than formula-fed baby poop).

    As babies get older, they typically become more efficient and are able to get more milk in a much shorter period of time, so these marathon nursing sessions decrease and/or disappear for the most part (common exceptions: during a growth spurt at three weeks, six weeks, three months and six months and sometimes as a baby gets better from being sick or stressed).

    All the nursing can be a little overwhelming for some new moms, or worrisome (why is baby nursing so much – is (s)he getting enough?) – do what you need to do to reassure yourself and know that all these feelings are normal. Do what you can to make the long nursing sessions comfortable (set up a comfy nursing station or two ahead of time; learn to nurse lying down; have good reading material/the phone/tv/music available) and remember that the long periods of time you may spend nursing in the beginning also give your body time to rest and heal, and are wonderful snuggle/bonding times with your new baby.

    Finally, here is a short list of issues that some moms experience at some point during nursing: sore nipples, engorgement, plugged ducts, mastitis (breast infection), oversupply (and much less commonly, undersupply), thrush (yeast infection) on nipple or baby’s mouth, inverted nipples. A good lactation consultant can almost always help mom overcome any/all of these issues and establish a successful breastfeeding relationship with her baby. There is also lots of information on reputable websites on these issues, as well as help available through La Leche League Leaders.

    Christina @ Birthing Your Baby
    Independent Childbirth Classes in Central Maine

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    Wednesday, July 2, 2008

    Not Just for Childbirth!

    As I've been teaching childbirth classes for a while now, it has occurred to me how many of the skills we practice and discuss in class are really "life-long" skills that can be used in many contexts outside of childbirth.

    For example, in Birthing Your Baby classes we discuss and practice a variety of pain-coping skills that are also good for anxiety: focusing on the breath; mantra; visualization etc. When I get hurt or am experiencing intense emotions like anxiety or anger, I do the "focus on my breath" thing to remain calm. When my kids get hurt, I remind them to take big deep breaths and to listen to their breath - it's AMAZING to me how well this works - it's second-best to mama-milk in calming children at my house (and first-best for the weaned kid).

    When I fly, which I do fairly often with my children, I have worked very hard to not show the (irrational, but still present) anxiety that I have about flying, especially take-off and landing. I don't want them to be anxious about flying, and so far, my mantras and breath-focusing, and noticing/releasing tension in my body, efforts have really worked - I don't dread flying as much and my kids have no idea that I'm working hard to overcome my anxiety.

    Another life-long skill is understanding the value of informed consent - medical or otherwise - and knowing the questions to ask to obtain it. We talk about the BRAIN acronym in class - benefits, risks, alternatives, intuition, and nothing as a quick way to remember the kinds of information you might want to have before making a decision about motherbaby's care during birth. But these same questions work both in the medical realm of child and adult care (antibiotics for baby? vaccinations? one test or another? one medication or another?) as well as decisions we need to make as parents (where baby sleeps... weaning... which school/homeschool...) and even just life decisions (jobs, moving, etc.). The whole idea of "not making a decision is making a decision" is also an important one, in my opinion.

    We do a lot of partner work in class - both parts of the couple make a list, or sort things in order of importance, etc. and then we discuss as a class. Frequently, the couples generally agree, but sometimes I suspect there are some interesting conversations in the car on the way home. Some couples communicate more, and more constructively, than others - all the choices to make around pregnancy/birth certainly give the opportunity for practice. But that's nothing compared to actually raising children together. Some people have the whole "my parents did ___________ this way, and I turned out ok, so I think we should do _____________ this way too" - and that could work out, but if the parents were raised differently (say, from spanking and non-spanking households), constructive communication is one of the best ways to avoid conflict. Birthing classes can give parents the opportunity and encouragement to open/continue constructive conversations about birth and parenting.

    Communication doesn't stop with the parenting partner though - many couples come in and share what's happening in their larger family - who agrees with what they plan to do re: birth/parenting, and who doesn't and we discuss ways to cope with differences. For example, some parents take a change in parenting the next generation as a criticism (breastfeeding, unmedicated birth, etc.), and respond to their now adult children from a place of guilt or frustration or even anger. Birth classes can be a good place to brainstorm how to deal with this, and other, common challenges.

    Birthing Your Baby classes also stress the importance of communicating with caregivers. Doctors, midwives, nurses, etc. cannot read people's minds, so communicating with them about birth preferences, early and often, is one of the best ways to increase your odds that your caregivers offer you individual care. The same things that work with caregivers around birth, also tend to work with other professionals encountered during parenting - pediatricians/family doctors, teachers, specialists etc. None of them know what you want unless you tell them! Of course what someone wants isn't always practical, or even possible, but there's no way to know unless you try.

    I believe that good birth classes can teach and encourage a set of skills that are great for birth, and also for life beyond birth.

    Christina @ Birthing Your Baby
    Independent Childbirth Classes in Central Maine

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    Hypnobirthing, anyone?

    One thing I teach in my classes is that whoever you are, you take your personality into labor with you - this isn't surprising, but I think it can lead to some interesting and worthwhile observations. That's why I have women brainstorm how they have coped with pain in the past (and partners write how they've been helpful) - because how they've coped in the past is a clue to what might work well during labor. Women who like to be distracted might have lots of people in the room; women who do not want to be touched while they're in pain are more likely to be the ones hissing "Don't TOUCH me!" through clenched teeth. Of course it doesn't always work out like that, but like I said - it's a clue.

    So, it wasn't surprising to me that, since I tend to be an "in my head", introspective-type person, I coped with my labors using a lot of "invisible" coping skills, that I did by myself: focusing on my breath; focal point; visualization. I used a bunch of others too, but my labors were fairly calm and quiet (for labor), because I was doing most of the coping work in my head.

    I teach all of the above in Birthing Your Baby classes, and really encourage participants to practice at home, with and without their labor support helping them (and we practice in class). Of course we discuss lots of other methods, because the more tools in the toolbox during labor, the better.

    Anyway, I'm wondering what overlap there is between these "in the head" methods of coping and hypnobirthing?? What specific techniques are used to create the self-hypnosis? I suspect that Birthing Your Baby classes do use a lot of hypnobirthing techniques, but I need to do some research to find out for sure.

    I've never been particularly attracted to hypnobirthing, for a few basic reasons: I like to call a spade a spade - no "rushes" or "surges" - they're contractions, to me. I also have wondered if some teachers focus too much on the promise of "no pain", to the point that women who do experience pain might feel like they're not trying hard enough, or are doing something wrong... Finally, I've talked to a few women whose hypnobirthing instructors didn't want to "scare" them by discussing possible (very common) procedures... this feels a little paternalistic to me - I want to give moms/dads information so they can make their best decisions, not encourage them to stick their fingers in their ears and sing lalalala "I don't need to know this because it won't happen to me" lalalala.

    But that's just me... I've read enough birth stories to realize that hypnobirthing works marvelously for some moms, and that's awesome.

    What started me thinking more about this is an article I read recently "Overcome the Fear and Pain of Childbirth Using Hypnosis" by Angela Monti Fox, LCSW. I really, really liked what she said in the beginning of the article:
    "The first goal in the process is to overcome the fear of childbirth that has been embedded in each woman's consciousness, a natural consequence of cultural conditioning. Probably from before a woman has even thought about having a child or becoming pregnant she has been taught to believe that childbirth will be the most painful experience of her life. This is what we call being negatively hypnotized. This is not to say that giving birth is easy, it certainly is not—it probably will be the hardest work a woman will ever have to do with one of the most sensitive parts of her body—that is why it is called “labor.” However, it can also be one of the most fulfilling, wonderful and ecstatic events in a woman’s life, one that can impact many aspects of her life for years to come. How a woman gives birth can have a powerful effect on many aspects of her sense of self, her feelings of self confidence and personal power, her feelings toward her body and new born; and her feelings toward her sexuality as well as the resumption of her sexual life with her partner."

    I read that and I thought - wow! I need to check out this hypnobirthing more closely - maybe what/how I teach has more in common with it than I thought...

    But then this sentence: "Learning to birth with hypnosis—especially for first time moms—means learning to birth without fear and pain" makes me go - huh? what does "learning to birth without pain" mean? If I learn the right things and try hard enough, I shouldn't feel pain during labor? I feel very uncomfortable with that statement. Some women don't feel pain in labor - hypnobirth insturction or otherwise - and that's awesome... but I'm not sure learning something (anything, in particular) directly equals birth without pain with any true consistency. Lots of techniques can help, sure, but so does having appropriate care and good support and a baby in a good position, and... and... and - these are not necessarily things that we "learn" - they're things we try to make happen, or not, and that work out, or don't. There's only a certain level of control that can be exerted - and birth is notoriously something that is it's own thing, that I think works best if we don't try to control it - much better to just be with it, to be in the moment, to let things flow & see what happens (as long as motherbaby is doing well, of course).

    I also really liked the paragraph that explains hypnosis as a "natural cognitive function" or state of "focused concentration" and how hypnobirthing "teaches [laboring women] to relax and divert her attention away from each contraction".

    But that paragraph ends with "She may wish to experience a surge as a sensation of pressure, or a pulling up or stretching, but not pain. In addition, when using hypnosis, time can be condensed. Moms that birth with hypnosis, are trained to experience each new surge as lasting no longer that 15 or 20 seconds" and those statements just don't make sense to me.

    The article continues with a bunch more great information about hypnosis (this author clearly believes in informed consent, as well - yay!).

    So, I am now definitely motivated to learn more about hypnobirthing - what it is, what it isn't, how instructors teach it, etc. I just bought that book Birthing in the Spirit, so that might give me some insight.

    Anyone have any experience with hypnobirth? I'd love to hear it... as well as any recommendations for good books, articles, or websites about hypnobirthing.

    Anyone... anyone...???? ;-)

    Christina @ Birthing Your Baby
    Independent Childbirth Classes in Central Maine

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