Informed Choices for Childbirth
Labels: breastfeeding, choices, parenting, the media
"There seems to be a widespread culture of passivity when it comes to labour. Many expecting mothers do dedicate an enormous amount of time and effort to preparation, yet, in my experience, there are just as many who refuse to do adequate homework, preferring to sit back and see how things develop. It's not that these women are unsure about what sort of labour they'd like to have (almost always an uncomplicated vaginal delivery). They've simply decided that "waiting and seeing" is the only realistic approach. Why bother committing to a detailed birth plan when it will probably go wrong anyway? Perhaps other wait-and-seers are simply in denial, preferring not to think about an experience that is understandably terrifying. The end result is that they approach the business of labour with less preparation than they would bring to buying a new car."It's a great post, and I highly suggest clicking the link to read it!
Labels: birth, Cesarean birth, choices, parenting, pregnancy
"It’s not uncommon to resist making what feels like a drastic change at this point in pregnancy. But it is wise to explore your assumptions before you decide for good. For instance, you may think…BUT I already have a relationship with my current provider. It is more important that you feel supported in your decision-making than have a limited, ineffective relationship with your care provider. Also, remember that your prenatal visits will be more frequent now. You can expect to have enough visits to get to know a different care provider. BUT It’s too late in my pregnancy. It’s not too late if a new caregiver or birth setting does not have policies that prevent you from making a change at this time. Many care providers will accept new clients as late as 36 weeks or more, although it is best to make the switch sooner whenever possible. If you are not completely satisfied with your choice of care provider or setting, immediately explore your options. Interview other care providers before making this important decision. BUT I don’t feel comfortable “firing” my care provider. Most midwives and doctors understand that their clients’ needs and wishes change during the course of pregnancy, and they don’t take it personally when a woman wants to make a change. Even if your care provider doesn’t react well, know that it is your decision based on what you know is best for you. Why risk having negative memories of your birth experience or receiving care that doesn’t meet your needs just to avoid hurting someone’s feelings? BUT My provider knows what’s best for me. This is your birth and only you know best how you will feel supported. Unfortunately, many care providers practice in a way that serves their interests, not yours. Others practice “cookbook medicine”—applying the same care to all women regardless of their individual circumstances. If you don’t feel like you’re getting personal attention, or if you feel more like a “number” than an individual, it’s time to start looking elsewhere.
"As for how a baby is born, Swiss researchers are reporting in the journal Thorax this month that a Caesarean delivery is linked to a much higher risk for asthma compared with babies born vaginally.Interesting, isn't it? Espcially since,
In a study of nearly 3,000 children, the researchers found that 12 percent had been given a diagnosis of asthma by age 8. In that group, those born by C-section were nearly 80 percent more likely than the others to develop asthma. The explanation may be that a vaginal birth “primes” a baby’s immune system by exposing it to bacteria as it moves through the birth canal."
"Asthma has emerged as a major public health problem in the United States over the past 20 years. Currently, nearly 15 million Americans have asthma, including almost 5 million children. The number of asthma cases has more than doubled since 1980. Approximately 5,500 persons die from asthma each year, and rates have increased over the past 20 years. Rates of death, hospitalization, and emergency department visits are 2-3 times higher among African Americans than among white Americans. The costs of asthma have also increased to 12.7 billion dollars in 1998."
Labels: birth, Cesarean birth, choices, parenting
"The holidays are here. Given today's economy and the demand for toxic-free toys, parents are on the lookout for affordable, natural toys. Let Mothering help you choose the safest, highest quality gifts that won't break the bank.The other Mothering webinar I participated in was excellent, and I imagine this one will be very helpful too!
Mothering's own product reviewer, Candace Walsh, will help you find toys under $20 and answer the question "When is 'Made in China' OK?"
Also, green expert Mindy Pennybacker will discuss toxin-free toy options for your kids.
And mama crafter Amber Dusick will take the scariness out of scroll saw wooden toy making and discuss natural paint options."
Labels: birth, choices, Maine, pregnancy, resources, websites
"Childbirth is the leading reason for hospitalization in the USA and one of the top reasons for outpatient visits, yet much maternity care consists of high-tech procedures that lack scientific evidence of benefit for most women, a report says today.It's important to remember that these higher prices DO NOT equal better care. The United States is not the standard-bearer for safety for mothers and babies. Using 2008 statistics, the United States (6.3/1000) currently ranks BEHIND the following countries for infant mortality rates: South Korea (5.94/1000), Cuba, Isle of Man, Italy, Taiwan, San Marino, Greece, Monaco, Ireland, Canada, Jersey, New Zealand, United Kingdom, Gibraltar, Portugal, Netherlands, Luxembourg, Guernsey, Liechtenstein, Australia, Belgium, Austria, Denmark, Slovenia, Macau, Isreal, Spain, Switzerland, Andorra, Germany, Czech Republic, Malta, Norway, Anguilla, Finland, France, Iceland, Hong Kong, Japan, Sweden, and Singapore (2.3/1000).
U.S. hospital charges for maternal and newborn care jumped from $79 billion in 2005 to $86 billion in 2006, the authors write. More than $2.5 billion a year is spent on unnecessary C-sections, which now represent nearly a third of all deliveries. [The language in this sentence is unclear to me: it makes it sound like ALL of the Cesareans are unnecessary; clearly there are times when a Cesarean birth is appropriate use of technology. Maybe the "which now represent" refers to C-sections in general, not unnecessary ones in particular? Anyway...]
Reducing expensive techniques such as C-sections and increasing low-cost approaches such as childbirth assistants called doulas would improve mothers' and babies' health while cutting costs, the authors say.
. . .
"The University of Wisconsin's Douglas Laube, a former president of the American College of Obstetricians and Gynecologists, blames "very significant external forces" for the overuse of expensive technologies in maternity care.
"I don't like to admit it, but there are economic incentives" for doctors and hospitals to use the procedures, says Laube, who reviewed the new report before its release.
For example, some doctors might get bonuses for performing more labor inductions, which adds costs and increases the risk of C-sections, which, in turn, increase hospital profits because they require longer stays.
In addition, some doctors order unnecessary tests and procedures to protect against malpractice suits, Laube says."
"What are top implications for policy makers, childbearing women and maternity professionals?"
Policymakers can play an important role in improving quality, health outcomes and resource use by addressing barriers to evidence-based maternity care. Recommendations for addressing barriers in the new report (PDF) fall in four areas: measuring performance and leveraging results, fixing perverse financial incentives, educating the key groups, and filling priority research gaps.
Childbearing women need to understand that maternity care that is routinely available often is not in the best interest of themselves and their babies. Pregnant women have the right and responsibility to become informed and make wise choices — for example, their choice of caregiver, birth setting and specific procedures, drugs and tests. Becoming informed and taking responsibility can be a big task — and can have very big pay-offs.
Health professionals need to recognize that usual ways of practicing frequently do not reflect the best evidence about safe, effective maternity care. The field of pregnancy and childbirth care ushered in the era of evidence-based practice: many hundreds of currently underutilized systematic reviews point the way to improved maternity practice and outcomes. The Evidence-Based Maternity Care report (PDF) identifies dozens of reviews that are relevant to care of a large segment of the maternal-newborn population. Engaging with the unparalleled move for health care quality and patient safety can improve professional performance and satisfaction and reduce risk of liability.
Labels: birth, Cesarean birth, choices, pregnancy, resources, websites
"Only when I need to..." or
"Only when it's necessary..."
What percentage of births do you do ____________ for?
What specific situations do you use ____________________?
What other procedures/medications do you sometimes use instead & when/why?
I'm really hoping to avoid _________________, what can I do ahead of time or during the birth?
Normalcy of the Birth Process;Highlights of the Evidence is another two-page pdf that presents the evidence in very straight-forward, easy-to-read language.
Empowerment;
Autonomy;
Do No Harm;
Responsibility.
• care that considers mother & baby together; what’s good for mother is good for baby.But, I think one of the most significant things about mother-friendly care is that it is PERSONALIZED care.
• care that honors birth as the birth of a mother & family; as an opportunity to empower mothers as they begin their parenting journey.
• care that values mothers, encouraging and supporting them as partners…
**I** won't be one of the women who have a cesarean for failure-to-progress (the reason for 40% of primary cesareans).Turns out that many caregivers and hospitals have certain routines (routine IV, routine continuous electronic fetal monitoring, routine epidural), and they have varying degrees of willingness to deviate from that routine. According to the Listening to Mothers II report, "Each of the following interventions was experienced by most mothers: continuous electronic fetal monitoring, one or more vaginal exams, intravenous drip, epidural or spinal analgesia, and urinary catheter."
**MY baby** will stay with me for skin-to-skin bonding after the birth (according to the Listening to Mothers II report, 39% left their mother's arms during the first hour for "routine, non-urgent care").
**MY hospital/doctor/midwife** will treat me like an individual, offering care specific to my body, my baby and my birth.
Labels: birth, book review, choices, resources, websites
"We must relearn to trust the feminine, to trust women and their bodies as authoritative regarding the children they carry and the way they must birth them. When women and their families make their own decisions during pregnancy, when they realize their own wisdom regarding birth and its place in their lives, they have a foundation of confidence and sensitivity that will not desert them as parents."and a link to an excellent, excellent article, "VBAC & Choice: Many Questions and a Few Answers", by Nancy Wainer. I bet the whole article is amazing.
— Elizabeth Davis
Excerpted from "Autonomy at Work: Woman-Centered Birth and Midwifery," Midwifery Today, Issue 42
Abstract: This manager’s booklet is part of a series of materials designed to create breastfeeding friendly worksites. It focuses on a company’s potential return on investment in the areas of employee retention, health insurance, absenteeism, productivity, and employee loyalty. The booklet includes profiles of companies with existing supportive lactation programs and references.
Abstract: This employee’s booklet is part of a series of materials designed to create breastfeeding friendly worksites. It includes information on where to find breastfeeding help and support, how to begin breastfeeding at home, and how to adjust to breastfeeding at work. The booklet includes support websites, figures, and guidelines for addressing supervisors.
Abstract: This human resource’s booklet is part of a series of materials designed to create breastfeeding friendly worksites. It details an integrated approach to implementing a cost-effective lactation support program. The booklet gives steps to support breastfeeding employees, explains how to merge work requirements with employee needs, offers program options, and outlines the program’s return on investment for the company. It includes profiles of employers with existing supportive lactation programs.I ordered ten of each, completely for free (including S&H) just now, very easily.
Labels: breastfeeding, breech, choices, Maine, pregnancy, resources, websites
Other common components of the "mainstream" birth story include:87% of women are attended by a doctor for their prenatal/birth care (obstetricians - 79%; family practice doctors - 8%) 94% laboring/birthing women are monitored by the electronic fetal monitor, 93% of those continuously (76%) or most of the time (17%) 86% laboring women used pain medication during labor: 76% spinal/epidural and 22% narcotic (Nubain, Stadol, Demerol), and 92% of women push and give birth lying on their backs or propped up in a semi-sitting position.
This birth story works really well for some women, and not very well for others. It's the "normal" story - the one that most people tell, the one easiest to access over & over again. For example, TLC offers summaries upcoming "A Baby Story" episodes: in the first twenty, there is one mention of a midwife, one mention of a homebirth, three cesarean births, and many, many variations on "the" birth story I told above.41% caregivers tried to induce labor, with an 84% success rate --> 34% births are inductions 75% women stay in bed after they are admitted to the hospital, and 80% have an IV.
These possibilities do not exist for women who are unaware of them. If a woman has never heard of giving birth at a birth center, that possibility does not exist for her. If she thinks that the only safe way to give birth is with a doctor in a hospital, she probably won't explore other options. If she has never read or heard people talking about a birth experience that did not involve medication, that possibility may not seem very real. As Diane Korte, author of A Good Birth, A Safe Birth explains it, "If I don't know my options, I don't have any."9% of women are attended by midwives for their prenatal/birth care 3% use doulas for support during labor and birth 1% birth at home or in a birth center 3% are not attached to a fetal monitor, and had their baby's heartbeat monitored exclusively with a handheld device, and 6% use a deep tub for pain relief.
Before my second pregnancy, we moved further away from the hospital I had my daughter at, so I needed to go through the decision-making process again. This time, I chose a hospital because of its nursing staff - excellent nurses who supported the natural birth process and who had enough time to monitor me with a doppler instead of the EFM. This hospital was not the closest option, but it fit well with my developing philosophy. I also chose a practice of a midwife and an OB, and was seen by the midwife. That way, I knew who would be attending my birth unless the midwife had an emergency or I needed the care of an OB. Again, this decision was influenced by my first birth. My provider was part of a 4-doctor practice, and I hadn't laid eyes on the caregiver who attended my daughter's birth until I was in labor! It turned out fine, but I realized that I was lucky, and it became important to me to minimize the chances of that happening for my son's birth...47% provider is covered by her insurance 42% past experience with provider or group 26% recommendation from family or friends 26% nearby 18% mother's philosophy 17% attends at her preferred hospital
Labels: birth, book review, choices, Maine, websites
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I am an independent childbirth educator in the Central Maine area, where I live with my husband and two small children, our dog and two cats. I read a lot, work in my gardens, enjoy cooking, especially with the food that I grow, and love spending time with my family outside.
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My son, Owen, at one week.
Born 5/18/05
My daughter, Madelyn,
on her birthday.
Born 6/15/02
