Friday, August 22, 2008

Questioning Safety: Hospital, Birth Center, and Homebirth

Where is it safe to birth your baby? Is the hospital the safest option? The only safe option? Are planned homebirths safe? Is it safer to have an OB/GYN (obstetrician, who is a doctor) as a care provider, or are CNMs (certified nurse midwife) and CPMs (certified professional midwife) safe options too?

First, I want to share a quote by Harriette Hartigan (midwife/photographer) that is commonly heard in the birthing community, "Birth is as safe as life gets". I wonder what the context of this quote originally was... to me, it suggests several important ideas:
  • Birth is a part of life. This is easy to forget when, in our culture, birth is so removed from life - usually taking place in the hospital, with only the birthing mother, her partner and maybe a female friend or relative. Very, very few of the pregnant mamas who take my classes have ever seen a real birth - human or animal. Contrast that experience with the one pictured below, where you can see birth really is a part of life:



  • While birth is safe, there are no guarantees. And that, I think, is the hardest thing. We've all heard horror stories, and I feel no need to put additional details in people's heads. Thankfully, in our country, most births conclude with a healthy mother and healthy baby (not that there isn't room for improvement!). But there are times, so sadly, when despite careful attention to mother and baby, something goes wrong. Sometimes with a warning, sometimes not. Even sometimes when the mother has had excellent prenatal care, an uncomplicated pregnancy, and highly qualified, experienced birth attendants. As sad as that is - it's life. People die. The struggle is to avoid medicalizing the experience of so many motherbabies in the name of preventing one or two deaths. Because doing that - continuous fetal monitoring, or not laboring at all and giving birth via a cesarean at 39 weeks - actually carries many, many more risks for mothers and babies, as well as the health of their future children. The struggle is to avoid lawsuits where something bad happens despite excellent care. This tendency has had the unfortunate effect of justifying doctors who practice defensive medicine: monitoring continuously for the paper trail, and the many cesareans that happen "just in case", because doctors know they will be sued over the cesarean they didn't do, not the one they did.

  • Choices we make can make birth safer. I wear my seat belt, and buckle my kids into booster seats. We wear life jackets. We get consistent check-ups by experienced, well-trained care providers. We eat lots of fruits and vegetables and whole grains etc. & etc. & etc. My husband and I make choices for ourselves, and for our children, that - to the best of our knowledge - enhance and protect our healthy bodies. Women can make choices for their birth experience that enhance and protect their bodies and their babies.

    One last point - while I wear a seat belt, I do still drive a car. I know that accidents happen, but that doesn't change my decision to drive on a daily basis. While I try to minimize the chance that something catastrophic happens while we're in the car, I understand that driving safely, while I'm not too tired, in a safe vehicle that gets routine maintenance, doesn't completely protect me. There are things that happen where no blame can be assigned - they just happen.
  • I believe birth is very similar to driving a car. Safe most of the time, even when people don't make the best choices; safest, but not perfectly safe, when they do. So, back to the original questions: where, and with whom, is it safe to give birth?

    Book after book that I've read reassures that quality care in a well-prepared home or quality birth center is as safe if not safer than a hospital birth attended by a doctor. Here are some excerpts that I found particularly helpful:

    From the Sears' Birth Book on birth center births, "In 1989 the New England Journal of Medicine reported a study of nearly twelve thousand women admitted for labor and delivery to eight-four free-standing birth centers in the United States. The study concluded that birth centers offer a safe and acceptable alternative to hospital births for low-risk women. The cesarean-section rate for the women in the study was 4.4 percent, far below the national average. There were no maternal deaths, and the neonatal death rate was well below average" (Sears 42). To find a birth center near you (as well as lots of other great information), check out American Association of Birth Centers . For questions to ask and things to think about, visit Childbirth Connections "Tips and Tools for Choosing a Place of Birth" page.

    While discussing homebirth, the Sears' write: "In 1900 fewer than 5 percent of births took place in hospitals. This increased to 75 percent by 1936, and by 1970 approximately 99 percent of mothers delivered in hospitals. But is this progress? Illustrating the differing perceptions of home birthing are these two mothers discussing their birth choices: 'You are brave to have a home birth,' said a concerned mother. 'You are brave to have a hospital birth,' replied the other" (43). They go on to discuss the safety of home births this way, "both sides of statistics to support their view. The people in white coats boast that the chances of a mother dying in childbirth was much higher in 1935 than in 1980, and that this is the result of technology available only in the hospital. Home-birth supporters argue that there is no reason to believe that there is a cause-and-effect relationship between birth in the hospital and lower mortality rates. Today's women have better access to prenatal care and more is known about safe birthing. Antibiotics are available to treat infections, and most aspects of health are better now than they used to be. Hospitals actually have higher mortality rates than home births, in part because mothers with the highest risk of life-threatening medical problems deliver in hospitals. Statistics that show poor outcomes in home births are equally misleading since these studies lump all out-of-hospital births together, whether they're planned, properly attended home births or involve foolhardy couples with no prenatal care doing it on their own [or happen by accident, at home or en route, mom has the baby earlier than anticipated]" (46).

    The more recently published book, Having a Baby Naturally, comes to similar conclusions. O'Mara asks "Which birth environment is safest? Surprisingly, home births, birthing in birthing centers, and hospital births are equally safe. Recent studies show definitively that there is no improvement in outcome, for mother or baby, in hospital births as compared to those that happen at home or in a birthing center . . . in fact, there is an indication that outcome is actually slightly better in low-risk births out of the hospital" (34). She goes on to explain that "home births, and births in birthing centers, have enjoyed a recent renaissance in the United States. However, there is still a lingering societal question about the safety of such births, and most women continue to go to the maternity ward of the hospital where their caregiver practices. Choosing to do something different may take real courage, as friends and relatives may be particularly concerned about the safety of your choice" (35).

    There is a great website that offers answers to many of the "What if" questions friends and family might ask. It does have some loud music that accompanies it, but if it bothers you, just mute it.

    The Home Birth Reference Site has some terrific information too, on the safety of homebirth, as well as home birth stories, reasons why people homebirth, how to plan a homebirth, more answers to "what if?" questions and other useful information. The North Carolina Homebirth website provides additional information on why homebirth, how to plan and prepare, and more birth stories.

    A few additional links include:
  • Citizens for Midwifery document comparing WHO recommendations, CIMS suggestions, and the reality of birth in the US as of 2004.

  • An article by Pam England (Birthing From Within), "No Place Like Home".

  • Childbirth Connections offers excellent information about the different care provider options, as well as information on questions to ask yourself in making a choice, and questions to ask during the interview process.
  • Finally, I want to mention that 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).

    There is something many (but not all) of these other countries have in common: universal access to prenatal care, and more support and use of midwives and out-of-hospital births.

    Marsden Wagner's book Born in the USA offers some interesting critiques and comparisons of care in the US vs. care in other developed countries. He writes, "Whenever I discuss home birth with obstetricians in the United Sates, I need only ask, 'What about the Netherlands?' to see their faces fall. The Netherlands has a long tradition of planned home birth. As recently as thirty years ago, half of all births in the Netherlands were planned home births. The percentage fell to one-third in the 1980s, but the rate has been climbing for the last ten years and is now more than one-third - 36 percent. The Dutch do not have significantly more women and babies dying around the time of birth than other Western European countries, and they have lower mortality rates than the United States does" (144).

    Later he also discuss birth in Denmark: "Denmark also guarantees a choice of place of birth to all Danish families. Like every other highly industrialized country except the United States, Denmark also has a national health care system. In Denmark, midwives attend all low-risk births either in the hospital or in the family's home . . . The home birth rate varies within Denmark (it is around 10 percent of all births in some districts), and Denmark's mortality rates for birthing women and newborn babies are among the lowest in the world" (193).

    Wagner also explains that "In some areas of Western Europe and Scandinavia, a low-risk pregnant woman can choose a small group of midwives who share a practice. The woman will usually get to know all of the midwives during prenatal visits over the course of her pregnancy, and when she goes into labor, one of them will come to the home or hospital and assist for the entire time, even if the labor is thirty-six hours long. This allows the woman to receive one-on-one continuous care with a known midwife - so this scientifically proven ideal scenario is not pie in the sky, but quite feasible. All those countries in Western Europe and Scandinavia where midwives handle prenatal and birth care for low-risk women exclusively have lower mortality rates for birthing women and their babies than the United States does" (198).

    He goes on to use a few more examples - "a resurgence of birth houses in Japan began [after the Americans left post-World War II], and more and more midwives are leaving hospital practice to work as community midwives in birth houses. This Japanese experience confirms what we have seen in the United States, that in the end, attempts to eradicate midwifery are not successful. In every society, there will always be midwives working to maintain women's freedom to control their own reproductive lives, and there will always be women who will avail themselves of midwifery services" (199).

    And, "In New Zealand, the maternity system is similar to Scandinavia's, but a woman having a low-risk pregnancy can choose either a midwife or a family physician to provide her prenatal and birth care" (Wagner 199).

    Each of these countries have significantly better outcomes for babies: New Zealand (4.99/1000), Netherlands (4.81/1000), Denmark (4.40/1000), Japan (ranked third, at 2.80/1000), and Sweden (ranked second, at 2.75/1000).

    Another famous champion of birth, Barbara Katz-Rothman, explains that "Birth is not only about making babies. Birth is about making mothers - strong, competent, capable mothers who trust themselves and know their inner strength." Safety concerns should not limit women's options for where they give birth, and with whom. Women should be able to choose the options that feel safest to them - hospital or birth center or homebirth, obstetrician, family physician, or midwife. All care providers should encourage women to trust themselves, to participate in decision-making, and treat each birthing motherbaby as individuals. Your baby has only one birth experience; you will probably only have one or a few birth experiences - and each one is an amazing opportunity for growth and joy.

    There's a quote in Our Bodies, Ourselves For the New Century that I share with my clients: “When women go to caregivers for checkups, they should walk out from every visit feeling ten feet tall. Every site of care and style of care, no matter who gives it, ought not only give surveillance but should educate and empower, should enhance every woman’s feeling of ability to do what she’s doing well” (451). That sums it up beautifully for me, and I hope this blog entry helps you explore the options for care that surround you so that you enjoy education and empowerment on your journey to motherhood.

    Christina @ Birthing Your Baby
    Independent Childbirth Classes for Central Maine

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    Monday, August 18, 2008

    New Links & Resources

    Before I get to the safety issues surrounding different birth choices, I want to highlight several of the interesting resources and links I've come across lately.

    Some goodies from the Midwifery Today online newsletter "E-News 10:17", include a quote
    "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."

    — Elizabeth Davis
    Excerpted from "Autonomy at Work: Woman-Centered Birth and Midwifery," Midwifery Today, Issue 42
    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.

    The Mothering email newsletter also offered a great article, "Easing Tension and Fear in Natural Childbirth by Understanding Sphinct*r Law*: A Conversation with Ina May Gaskin" as well as information about how to attend a free "webinar" (I've done two through Lamaze so far, and they've been great) on cosleeping, presented by James McKenna and Dr. Paul Fleiss. To learn more and how to sign up, visit http://www.mothering.com/interactive/webinars/cosleeping.html. I'll "be there".

    In the Lamaze online newsletter for "Week 11" (no, I'm not pregnant - just checking out their resources!), there was an ask-the-expert question about pregnancy classes. The question was: "I’m in my first trimester with my first baby. I plan to take childbirth classes closer to my due date. But I feel like there is so much to learn about pregnancy—not just the birth. My doctor answers some of my questions during my prenatal appointments, but there isn’t enough time for all of them. Is there a class I can take about pregnancy?" I wonder if there is enough interest to do a pregnancy class here in Central Maine? I would love to do a class for moms/partners who are TTC or are newly pregnant - to answer questions about pregnancy, prenatal testing, exercise and nutrition, and also to talk about choices for care providers and hospitals. At the point when most of my clients' take classes, they have to be supremely unhappy with or uneasy about their care provider to change (though some still do!). I'd love to offer women/partners the information they need to think through their choices before their third trimester! Any thoughts on pregnancy classes? Oh - and if you're reading this and wondering, I would happily do a private pregnancy class - just send me an email!

    Also, my local LLL leader sent out an email with information about new resources from the US Department of Health and Human Services, Health Resources and Services Administration regarding breastfeeding and employee/employer policies. They're free, too.

    "The Business Case for Breastfeeding. Steps for Creating a Breastfeeding Friendly Worksite: For Business Managers"
    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.

    "The Business Case for Breastfeeding. Steps to Creating a Breastfeeding Friendly Worksite: Employees' Guide to Breastfeeding and Working"
    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.

    The Business Case for Breastfeeding. Steps for Creating a Breastfeeding Friendly Worksite: Easy Steps to Supporting Breastfeeding Employees
    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.

    And lastly, The True Face of Birth blog has had some great posts in the past few days, including one about doulas ("Doulas Make a Difference"), which sites a RCT (randomized controlled trial) study about doulas; one about "The Dance of Breech" with great drawings and links; and a reminder that "The Birth Survey is Here!" - yay! There doesn't seem to be any information for Maine mothers yet, but hopefully there will be soon.

    Enjoy the links!

    Christina @ Birthing Your Baby
    Independent Childbirth Classes for Central Maine

    *Sorry about the asterisk - that word was attracting some unwanted attention from search bots.

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    Thursday, August 14, 2008

    Choosing a Care Provider & Birth Place

    In many parts of the United States, women can choose between a hospital birth, a birth center birth, or a homebirth; they can choose an OB doctor (obstetrician), a FP doctor (family practice), a CNM (certified nurse midwife) or CPM (certified professional midwife). Different states have a variety of legal options, and even in the states where homebirth isn't explicitly legal (or is explicitly illegal) there are "underground" networks of midwives. To find out more about the status of midwifery in your state, visit the Midwives Alliance of North America (MANA) chart.

    In Maine, there is currently one birth center, The Birth House, located in Bridgton, and run by Birthwise Midwifery. To find a birth center outside of Maine, try searching the American Association of Birth Centers Find a Birthcenter page - though there may be a birth center in your area that is not accredited.

    There are also quite a few CPMs who attend homebirths in Maine. For more information on finding a midwife to attend your homebirth, you can visit the Birthing Your Baby Local Resources page or the Midwives of Maine site. To find a CNM for a hospital birth, visit the Find a Midwife section of the American College of Nurse-Midwives website.

    If you're interested in learning more about your options, there are lots of websites and books to help you explore.

    BOOKS

    The Birth Book(1994), by William Sears, M.D., and Martha Sears, R.N.
    The Sears' dedicate a whole chapter, "Choices in Childbirth" to discuss the many options that are available to birthing women. There is in-depth information about choosing a birth team (who your care providers will be), questions to ask during the interview process, choosing labor-support, choosing a birth place, and choosing childbirth education classes.

    I especially like their "Sample Prenatal Interview List":

    "While quizzing your prospective doctor [or any care provider], be sure you know where he or she stands on these important topics:
  • labor management
  • pain management
  • natural childbirth
  • walking during labor
  • improvising various labor and birth positions
  • electronic fetal monitoring: continuous, intermittent, telemetry, none
  • labor-support persons: professional assistant, baby's father
  • episiotomy: how often performed, alternatives
  • forceps and vacuum extractors
  • birth plans
  • criteria for cesarean birth
  • vaginal birth after cesarean
  • use of water during labor [or birth]
  • epidural anesthesia
  • childbirth classes
  • pregnancy health: exercise, nutrition, weight gain, etc.
  • hospital affiliations
  • routine prenatal screening tests
  • call schedule (group or solo practice; birth philosophy of covering [providers])
  • vacation schedule (in case it's during your due date)
  • fees, insurance plans (usually handled by office staff)
  • What would birth look like in this country if most women asked some questions about their care providers philosophy before or during the first visit. What would happen, I wonder, if women no longer accepted vague reassurances when they asked about cesarean birth rates? What would happen if women flocked to care providers who allowed eating and drinking, who encouraged women to give birth in a position that was comfortable for her, even if it was not on the bed, even if it was in a tub!

    The reality, though, is that, right now, most women do not ask questions about the routine care practices of their care providers. It's not that there are wrong answers (well, vague or misleading or dishonest answers are wrong) - the philosophies of the birthing woman/family and the care provider either match, or they don't. But if a woman doesn't find out until the birth that the hospital's routine care involves an IV, and the care provider will harass her if she doesn't submit to one, or that the care provider does not believe that a natural tear is better than an episiotomy and so routinely preps and performs them, even when a woman states that she does not want one - that's too late to make a change, obviously.

    Unfortunately, I'm not exaggerating. I had a client who was really afraid of needles, and was very concerned about a routine IV. She didn't want one unless absolutely necessary. I encouraged her to ask her care provider what her options were regarding an IV, given her personal fear of needles. My client had the conversation with her care provider, who said - "If you don't have an IV, your baby might DIE!!" and who went on to explain how important she believed a routine IV is to the care of mothers and babies. My client was horrified by the scare tactics used by the care provider, and since she found out in plenty of time (second trimester) that her philosophies didn't match her care provider's, she changed practices (yay for her!).

    Another key point in the Sears' list is knowing the call schedule of your provider. So many of my clients are surprised to hear that the providers in the office alternate - if there are four providers on a call schedule, a birthing woman has a 25% chance of being cared for by her primary care provider during her birth. There are ways to make this more palatable, by meeting all the care providers in the practice, and knowing that they have similar philosophies about routine care, for example. But here's another personal example - my sister in PA went to a well-known OB/CNM practice, who asked women to meet all the possible care providers who might attend the birth - there were something like ten. So much for continuity of care! Yes, she had a ten-minute appointment with each provider, but did she really get to know any of them? No. For her second baby, she went to a birth center - for that reason and many others.

    Another section in the Sears' chapter on choices that I really appreciated personally was their discussion of in-hospital vs. out-of-hospital classes. Here's part of it:
    "Ideally, schools should prepare students for the real world in a variety of circumstances. In-hospital classes prepare you for the birth policies of that hospital. On the other hand, out-of-hospital classes have the advantage of describing a variety of birth choices so that you can prepare for the birth you want - but one that the hospital may not be willing to deliver. Ideally, birth place, birth attendant, and childbirth educator should all share the same birth philosophy, but where this is not the case, a good childbirth class should help you understand your doctor better and enable you to work with him or her and the hospital staff to achieve a birth that is safe and satisfying. Look for an instructor who emphasizes flexibility and good communication between parents and professionals" (51-52).
    Sometimes people wonder why I don't teach for a hospital, or why anyone would need or want to take a class that wasn't provided by the hospital. I like the freedom to teach what I believe is most important; I like to teach about making informed choices, and encourage my clients to think of themselves as consumers, not as "patients". I think there is value to being outside of "the system", free from any influence other than my clients' best interest. My philosophy isn't that all women should give birth one way, or another - instead, I encourage mothers/partners to think about what they want in the birth experience, and to communicate with their care providers. Birth is a once in a lifetime experience - even if a woman has several babies - each birth is that baby's only birth. I do encourage flexibility; though we talk about birth plans, we also talk about living in the moment and doing "the next best thing" if the first best thing doesn't work out, which we all know sometimes happens. Birth is a part of life! Plus, I have small classes (one to four couples), I can work my schedule to accommodate people who call me a month before they're due, or who work at night, etc., and I offer unlimited telephone and email support. It's a good deal for everyone!

    Anyway, back to resources... Next up is Mothering Magazine's Having A Baby, Naturally (2003), by Peggy O'Mara. She also offers an entire chapter on "Making Birth Choices - Choosing Your Place of Birth and Your Birth Attendant". O'Mara lists "reasons to choose" and "reasons not to choose" to birth at home, a freestanding birth center, or at a teaching/large hospital; she also mentions a few other choices like smaller hospitals, alternative birth centers within hospitals, and water birth. There is an explanation of the typical care provided by midwives, obstetricians, and family physicians.

    O'Mara offers several considerations at the beginning of the chapter to help families assess which birth setting might work best for them, including information on safety and cost. She goes on to write:
    "A more important 'cost' to assess, however, has to do with the effects that birth trauma and general hospital-style treatment have on the bonding between a mother and her child. High levels of stress incurred in hospital settings can seriously affect a parent's ability to function well in the difficult weeks after birth. Many women agonize about their negative birthing experiences, including unnecessary interventions and unkind or patronizing treatment, for months or even years after birth. Since birth sets the stage for your early parenting experiences, it makes sense to avoid anything that increases stress for you or reduces your ability to bond with your child. Making a decision on where your baby's birth will take place is second in importance only in making the decision to become parents in the first place! Take time to explore all the options you have" (35).
    The "Which One is Best for Me?" list of considerations is also helpful:
    "There is no formula that can help a mother-to-be decide what type of care provider will be best for her. That is because every provider is different, even within such different categories as 'obstetrician' and 'midwife.' Some obstetricians are very open to the idea of a birth with minimal or no interventions [like my daughter's birth, born after minimal procedures while I squatted on a birth stool, the OB hovering to play catch on the floor - it was great!]. Some midwives may practice in hospitals and be much more likely to rely on technology than others [my sister, who had her membranes sweeped, water broken, Pitocin, Nubain etc. & etc. had a "medwife" - a medically-minded midwife].

    For this reason, it is necessary to interview several candidates before making a final decision. It also helps to know that no decision is absolutely final. While it may not be ideal to change birth attendants midstream, it is better than working with someone you find you are unhappy with. To decide who to interview, consider these points:

  • Check to see if this person is able or willing to attend a birth in the location you have chosen. Most doctors will not attend home births, so this will narrow your field automatically.
  • If you want an attendant who will be with you throughout most of your labor, you should consider using a midwife. Obstetricians will generally only be with you during the final stages of labor, checking on you intermittently beforehand. You will be attended to by labor nurses for the most part.
  • Know that midwives spend significantly longer on regular checkups than most doctors do, from twenty to forty minutes per visit. Again, there are always exceptions to this.
  • Cesarean section rates, on average, are much lower for midwives than for medical doctors. In addition, rates of successful VBACs (vaginal births after a cesarean) are better for midwives. Certified nurse-midwives, for example, have a rate of 11.6 percent for C-sections and 68.9percent for successful VBACs. The national average is, respectively, 23.3 percent and 24.9 percent [much higher national average C-section rate now, hovering around a third of all births].
  • Choosing a male ob/gyn, rather than a female increases your chance of ending up with a cesarean section by 40 percent.
  • Using a family practice physician can be advantageous if this is a person who is already very familiar with you and your family. Perhaps this will be the same person who is going to care for your newborn" (42-43).
  • Finally, O'Mara suggests questions to ask during the interview process, and some pointers on how to communicate effectively with your care provider.

    Another great book resource is Henci Goer's The Thinking Woman's Guide to a Better Birth (1999). She includes three separate chapters on choices for care during pregnancy and birth, "Professional Labor Support: Mothering the Mother", "Obstetricians, Midwives, and Family Practitioners: Someone to Watch Over You" and "The Place of Birth: Location, Location, Location". There is some very solid information in these chapters, including interview questions, lots of lists of pros/cons, some advice on what to do when provider choice is limited, either by insurance or by medical conditions or mother's location, a thorough comparison of birth sites that is really terrific, and more.

    There are some great "reality checks" throughout these chapters, including the following in the labor support chapter: "If you are a first-time mom planning a hospital birth, you're probably assuming that your nurse will shepherd you and your partner through labor. Ever-present, she will comfort and ten you. I suppose it happens occasionally, but not often. Studies show that the average labor and delivery nurse spends fifteen minutes of her eight-hour shift [italics mine] offering physical comfort measures, providing emotional support, or advocating for her patients. Another study showed that time with laboring women didn't increase even with a group of nurses who acknowledged the importance of labor support and when that was the study's intent. Meanwhile, with staff cutbacks the order of the day, even the best-intentioned nurse has not time to labor-sit" (177).

    Hopefully you have not heard responses like the ones listed below from your caregiver. If you have, Henci Goer suggests, “these behaviors will tell you that you have the wrong person, someone who wants to coerce rather than convince you” (196). Here are the “red flags” listed in The Thinking Woman’s Guide to a Better Birth:
    • Scare tactics. “We can do that – if you don’t care what happens to the baby.” “Which would you rather have: a nice experience or a healthy baby?” You can have both. In fact, the things that make a nice experience also make for a healthy baby.
    • Anger. “And where did you go to medical school?” “I can’t take care of you if you don’t trust me.” Of course you should trust your caregiver, but the trust must be earned.
    • Ridiculing your concerns, desires, opinions, or competency to participate in decisions about your care. “I see you’ve been reading those women’s magazines.” “You want natural childbirth? I think that makes about as much sense as natural dentistry.”
    • Patronizing you. “Don’t worry about a thing; just leave everything to me.”
    • Vagueness. It’s a bad sign when you can’t pin a caregiver down enough to get at least ballpark estimates of personal statistics such as cesarean rates . . . It’s also bad when the caregiver says you can do anything you want during labor and won’t specify what situations might preclude that" (196-197).
    Finally, there are some great suggestions regarding choices for provider and location in The Big Book of Birth (2007) by Erica Lyon, who was the education coordinator and administrative supervisor at the Elizabeth Seton Chilbearing Center in NYC. A few of suggestions in this chapter include:
  • "Check if your practitioner's belief system matches yours. There is a range of how practitioners 'manage' or 'care for' women, from authoritarian to nurturing, of how available and accessible they are. Most of us know whether we want someone more authoritarian who can tell us what will happen [debatable, I think, if anyone can tell us for sure what's going to happen, other than a baby is going to come out, some way or another!] and what to do when we're birthing our baby, or someone who is more nurturing and gives us more personal responsibility. Asking questions to gauge if this is a good match so that you are relaxed and feel you can trust your practitioner in labor is very important . . . If you think your practitioner is eroding your confidence, causing unnecessary concer, or looking for problems where they don't exist, then changing may be a good course of action" (269).
  • "Think outside the bassinet. By this I mean look at models of care around the world that get good (better than the U.S.) outcomes and try to model your care after that [planning to discuss this in my next post]" (270).
  • Stop reading What to Expect When You're Expecting, or any book that has headlines like "Warning" or "Danger". The anxiety such a book produces is not helpful . . . to normal pregnancy and produces a lot of unnecessary guilt and concern [time enough for that after the baby is born & you're parenting - hahah!]. No one can tell you what to expect, only the various paths and options and how all of these can be relative at times" (270).
  • "Take a moment and be honest about your concerns and fears. Understanding our emotions and psychology does not necessarily give us more control over a situation but it does help us cope and identify what we truly need" (271). This is so important! I ask all my moms to ask themselves "What is most important thing your care provider could do during the birth to help you?" and they think for a minute and come up with an answer. Then I ask - "Have you talked to him/her about this?" and as of yet, every single mother has said, why no, I haven't. So there it is: care providers cannot read minds. And sometimes, we ourselves aren't sure what is most important if we haven't taken some time to think about it; only after the fact can we identify something that could have been done differently to improve our experience. So, I encourage women to do a lot of reflecting themselves, and then have some honest conversations with their partners and their care providers about the kind of care and support they want for the birth!
  • And the last one I'll mention from this terrific section, "Give some thought about what might make this more manageable for you. In which areas do you need reassurance? . . . Labor and birth are challenging no matter how we do it, but what can you put in place for yourself that will give you confidence and help you go through it . . . When we take care of the mother, we take care of the baby. (The baby is still part of us at this point!) As I write this, I can hear the 'reactive' voice to this statement: 'How selfish! Labor is not about the woman, it's about a healthy baby!' Yes, at the end of the day absolutely true; however we women know that and we will make decision that help us cope and meet that objective. (To imply otherwise is a wee bit patronizing.) . . . with information and support, we move through labor knowing that we are doing what we have to, what we believe in, what we are capable of given all the variables - and that it is okay" (272).
  • Two other very interesting books about care during pregnancy and birth in the United States are Pushed: The Painful Truth about Childbirth and Modern Maternity Care by Jennifer Block and Born in the United States: How a Broken Maternity System Must be Fixed to Put Women and Children First, by Marsden Wagner. I'm sure there are other books that I'm not mentioning - if you're thinking of one that has helpful information on choosing a care provider or the birth place, please leave it in the comments!

    WEBSITES

    The excellent organization Childbirth Connection offers an entire section on Choosing a Caregiver, highlighting the importance of making an informed choice about, what the different care provider options are, and other insightful information. I appreciate that they also include reasons that are "insufficient" for choosing a caregiver:
    "It is not wise to select a caregiver solely because:
  • that person practices near your home or workplace — convenience is nice, but you may need to travel further to find the right person
  • you know someone who worked with that person — even if recommended by a friend or relative, you will want to be sure that a maternity caregiver's style will meet your needs and values and reflects the best available research
  • that person is a woman, or a man — if you have a preference for caregiver gender, you will want to be sure that that person's maternity philosophy and style of practice match well with your needs and values and with the best available research
  • that person has been your provider for well-woman or primary care — you will want to learn about that person's maternity philosophy and style of practice before making your decision."
  • The next pages offer information on midwives and obstetricians and family physicians, as well as "Best Evidence (a discussion of studies done about differences between midwifery and obtetric care)," "Tips & Tools" (interview questions, etc.), and "Resources" (links to helpful resources).

    Childbirth Connection offers a similar set of resources about Choosing a Place of Birth: a review of the options, best evidence, tips & tools, and resources.

    Childbirth Connection offers many more terrific resources, including an important free .pdf called The Rights of Childbearing Women, as well as a free .pdf download of the Listening to Mothers surveys (interesting to get a picture of what birth has been like in the United States for the past few years), and the amazing resource A Guide to Effective Care in Pregnancy and Childbirth - buy it on Amazon for a lot of money or read the sections that interest you here for free! A Guide to Effective Care "is an overview of results of the best available research about effects of specific maternity practices. The full text of the current edition (Oxford University Press, 2000) is available on this website [linked chapter by chapter] courtesy of the authors: Murray Enkin, Marc J.N.C. Keirse, James Neilson, Caroline Crowther, Lelia Duley, Ellen Hodnett and Justus Hofmeyr." I could keep highlighting useful information for their site like the pregnancy pictures and stages of pregnancy etc. & etc. but really, go check it out - amazing resources!

    Coalition for Improving Maternity Services (CIMS) has some useful downloads on its site, including information the Mother-Friendly Childbirth Initiative with links to "Evidence Basis for Mother-Friendly Care" and "Having a Baby? Ten Questions to Ask" and other helpful documents.

    UNICEF and WHO joined together to create the Baby Friendly Hospital Initiative, with an explanation of what a "Baby Friendly" label means, and a list of "Baby Friendly" hospitals and birth centers. In Maine, as of July 2008, we have Central Maine Medical Center in Lewiston, Maine General Medical Center in Augusta and Waterville, Miles Memorial Hospital in Damariscotta, and York Hospital, in York.

    Citizens for Midwifery offers a chart Ideals vs. Reality in U.S. Births, which compares the WHO recommendations, CIMS recommendations, and U.S. reality as of 2004.

    So that's my highlight of information that could help a mother (and her partner) choose the kind of care provider and birth setting that will work the best for them, as well as information on interviewing/choosing a specific provider and setting. The most important things to remember, in my opinion, are that you do have choices, and that the choices you make can have a very significant impact on your birth experience. If you're not happy with the care you're receiving or the setting you initially chose - please consider reviewing your options. One of the statements that is repeated over and over in all the books and sites I include in this entry is the importance of making choices about provider and setting that are right for you and your family as you get ready to meet the new little person growing inside of you.

    Happy exploring, and best wishes for making the best choice possible!

    Christina @ Birthing Your Baby
    Independent Childbirth Classes for Central Maine

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    Friday, August 8, 2008

    Pregnancy and Birth: What Are My Choices?

    I love birth stories. I've read lots of them, in various books* and online**. I've also heard a lot of stories from friends, relatives and strangers, as well as watched some on television, ranging from pure entertainment on sitcoms to "info-tainment" shows like Baby Story, to excellent documentaries***. Because of my passion for birth, I've searched for stories that are outside of the mainstream experience - natural birth stories, home birth stories, etc. When I was pregnant, I wanted to understand my full range of options, not just what "everyone else" does.

    Right now in the United States, there is a narrative that describes the birthing experience for a significant majority of women. It goes like this:

    "I thought I might be in labor... I was really excited! I called my doctor... contractions got stronger... went to the hospital... They settled me in bed with an IV and the fetal monitor... my contractions were really painful, so I asked for an epidural... the pain mostly disappeared, yay!... the nurse checked me and told me it was time to push, so I pushed lying on my back (or kind of propped up) and pushed some more! and then my baby was born!"

    According to the Listening to Mothers Survey II (2006):
  • 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.
  • Other common components of the "mainstream" birth story include:
  • 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.
  • 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.

    But: this story isn't the only story! Birthing women do have other options. Other stories exist, showing women different possibilities:
  • 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.
  • 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."

    A helpful resource: Building Confidence, the free Lamaze newsletter, offers some useful perspectives in their Week 9 email about how to "Take Charge of Your Care".



    Where does a woman begin her exploration of options? Let's start with two of the biggest choices a pregnant woman has to make about her and her baby's care for pregnancy and birth: caregiver and birth place.

    Women can give birth in a hospital, at the birth center (in Maine, we have The Birth House), or at home.

    Women can choose to give birth attended by an obstetrician (OB), a family practice doctor, or a certified nurse midwife (CNM); in Maine, these providers commonly practice in the hospital setting. Some women choose to use a certified professional midwife (CPM) for a provider, and have their babies at home or at a birth center. Occasionally women may need the additional expertise of a perinatologist, who specializes in care of women and babies with higher risks of problems. And even more rarely, women decide to give birth at home, unattended.

    [For a list of birth places and providers in central Maine, visit Birthing Your Baby's local resources page.]

    Provider and birth place are interconnected. Most providers practice only in specific settings; OBs and CNMs generally have "rights" at one - sometimes two - hospitals. CPMs attend births at home or at a birth center. The decision needs to be made quickly. If a woman finds out she's pregnant at four, five, or six weeks, she has only a few weeks to make her first prenatal appointment; most providers want to see her at the end of her first trimester (10 weeks or so).

    For example, for my first baby, I had narrowed down the practice I wanted to go to because of the quality of the hospital and its location (less than five minutes away). When I called to schedule my appointment, the receptionist asked if I wanted a midwife or a doctor. The midwife option had never occurred to me... so I just said, doctor. And there. My decision was made. Of course, if I hadn't received care that "worked" for me, I would have changed providers. But that would have taken time and energy, and is something few women actually do.

    My first experience mirrors the decision-making process that most women go through to choose a provider. According to Listening to Mothers II (2006), women choose a provider for the following reasons:
  • 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
  • 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...

    During the next few weeks, I will be posting with suggested resources to help women find the setting and provider who will best fit their needs. I'll be discussing the safety of various settings and providers, as well as an in-depth explanation of each kind of setting and provider.



    BIRTH STORY RESOURCES

    One thing to keep in mind: birth stories, and information about birth itself, are a little like food - some is junk and some is nourishing. As much as reading, viewing, and discussing birth and birth stories can be positive, too much can be overwhelming. Stories that are scary or unsupportive - you know, the ones so many strangers (and sometimes friends) horrify women with at the end of their pregnancies - are best ignored, if it's not possible to get away from the "well-meaning" narrator. The Birthing From Within website offers a great article, called Information vs. Awareness, about using information to nurture yourself.

    *Books with Birth Stories
  • Ina May's Guide to Childbirth;
  • Journey into Motherhood: Inspirational Stories of Natural Birth
  • Adventures in Natural Childbirth
  • Baby Catcher: Chronicles of a Modern Midwife
  • A Midwife's Story
  • Giving Birth: A Journey into the World of Mothers and Midwives
  • Delivery: A Nurse-Midwife's Story

    **Online Stories
  • My kids' birth stories, plus a client's birth story
  • Birthstories
  • Making Leta
  • MoonDragon Birth Stories - scroll almost all the way down
  • My Big Ugly VBAC
  • North Carolina Homebirth Birth Stories
  • Circle of Life Midwifery Slide Show
  • Birth Story Diaries

    ***A Few Video Stories
  • Birth Day
  • The Business of Being Born
  • Gentle Birth Choices

    Christina @ Birthing Your Baby
    Independent Childbirth Classes for Central Maine

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    Monday, August 4, 2008

    Books about Breastfeeding

    There are so many books about breastfeeding - here are a few that I've read, most of which are in my birth class library:

    Breastfeeding: Pure and Simple (2000)
    Gwen Gotsch

    Book Description: Offers information and inspiration that mothers need to begin breastfeeding and to continue for many months. It gives concise answers to common questions and provides practical solutions for problems mothers encounter such as avoiding sore nipples, dealing with newborn jaundice, breastfeeding after a cesarean, deciding when and how to wean, starting solids and finding time for mothers.

    My Note: An easy-to-read, brief but complete book published by La Leche League International. There are lots of helpful pictures too (in black and white, and a little dated, but still worthwhile).




    Breastfeeding Your Baby (1995)
    Sheila Kitzinger

    From Publishers Weekly: With a simple, short explanatory text and some 200 photographs (approximately 100 in color) of nursing mothers, the author of The Complete Book of Pregnancy and Childbirth sets out to dispel fears about breastfeeding and conveys practical advice about positioning the baby, interpreting the baby's sucking rhythms, maternal nutrition and breast care. The most valuable parts of the book, however, are not on honing "technical skills" but those that treat aspects of the intimate communication between mother and baby--during breastfeeding and beyond.

    My Note: This is an excellent book – providing reassurance and practical information about breastfeeding. I wish I’d had it when I started nursing Madelyn! Another good book for dads to look at.

    Don’t Miss: The photographs are wonderful – if nothing else, flip through this book together. The whole book is terrific.




    So That’s What They’re For: Breastfeeding Basics (2005)
    Janet Tamaro

    From Ingram, about an earlier edition: Filling the gap left in a market glutted with dated or dry books on breastfeeding, So That's What They're For! lends support and encouragement to those wondering whether they should try breastfeeding, for pregnant women who are sure they will breastfeed and for new moms who are having trouble and are considering stopping. With hilarious anecdotes and wonderful illustrations, this comprehensive guide offers a supportive, pragmatic view from the real world.

    My Note: This book does not sacrifice realistic, helpful information about breastfeeding by also including humor. A great read – maybe a book on breastfeeding dads might enjoy skimming as well.

    Don’t Miss: 29 reasons to breastfeed; Chapter 4, “Getting Ready for the Big Arrival” explains what to do to get the best start breastfeeding and what to expect those first few days at the hospital; Chapter 5, “Directions: Inserting Breast A into Mouth B” gets down to the basics of breastfeeding; you can find information about breastfeeding challenges in both Chapters 6 (“The First Few Days: Tackling Common Obstacles”) and 9 (“Problems: From Small Ones to Big Ones”).




    The Womanly Art of Breastfeeding (2004)
    La Leche League International

    From Amazon.com, about an earlier edition: The Womanly Art of Breastfeeding is a comprehensive resource guide providing just about everything you need to know about how--and why--to breastfeed your baby. Latch on to this book for step-by-step guides to early months, common concerns, problems, and weaning. Additional sections on general nutrition, sleep issues, going back to work, discipline, and fathering are useful for all breastfeeding mothers.

    My Note: This book is about so much more than breastfeeding, The information on breastfeeding is excellent, even though it doesn’t include a lot of illustrations/photos.

    Don’t Miss: Chapters 4 (“Your Baby Arrives”) and 5 (“At Home with Your Baby”) for basic information. The section on your baby’s nursing style (pgs. 71-73) is also helpful. Many other topics about breastfeeding and baby care are also thoughtfully covered.




    The Nursing Mother's Companion (2005)
    Kathleen Huggins, R.N., M.S.

    Product Description from Amazon.com: Breastfeeding may be natural, but it is not always instinctive. The 20th Anniversary Edition of this classic guide to breastfeeding, beloved by a generation of women, has been completely revised and updated to provide even more practical, reassuring advice and support for today's expectant and nursing mothers. Easy-reference survival guides help identify and resolve problems at each stage. An appendix on drug safety is a unique feature among breastfeeding books.

    My Notes: I have an earlier edition (4th), and what stands out about this books is the practical way in which it has been organized, and the complete, reassuring information it provides. I especially like the appendix "The Safety of Drugs During Breastfeeding" and how the book is organized by time - preparing during pregnancy, the first week, the first two months etc.




    Nursing Mother, Working Mother (2005)
    Gale Pryor

    Product Description from Amazon.com: The World Health Organization, the American Academy of Pediatrics, and other authorities on maternal-infant health all recommend breastfeeding exclusively for the first six months of a baby s life and continued breastfeeding through one to two years of age (or for as long as mother and baby desire). For working mothers of infants (more than half of all new mothers) meeting this goal can be challenging. The newly updated Nursing Mother, Working Mother offers you practical and reassuring advice on everything from choosing the right pump in every situation, to securing lactation space and respect at the workplace, to instructing childcare providers on feeding pumped breast milk, to continuing breastfeeding even when your job requires business travel. It also includes information on changes in workplace laws. As a breastfeeding mother, you need guidance and support to combine breastfeeding with your working life, and the reassuring and informative revised edition of Nursing Mother, Working Mother assists you at every step.

    My Notes: Sounds like this new edition is great! The edition I have is good too, with information organized by time-frame - "life on leave: the fourth trimester", which discusses the time mom has before returning to work; lots of preparation information for returning to work; and then the final chapter on returning to work. This is a very encouraging, supportive book with specific suggestions and advice for moms who will be working outside the home after baby is born.




    Adventures in Tandem Nursing (2003)
    Hilary Flower

    Book Description from Amazon.com: Book Description
    There is no doubt about it—when breastfeeding and pregnancy overlap, the questions abound! In this, the first full-length book ever on the topic of tandem nursing, Hilary Flower gives comprehensive and in-depth answers to a wide range of questions related to breastfeeding during pregnancy and tandem nursing.
    Drawn from a great reservoir of mother wisdom, this book pools the stories of over 200 mothers from around the world. Extensive reviews of medical research and discussions with experts in the fields of nutrition, obstetrics, and anthropology have provided the author with a thorough understanding of what we know and what we can surmise on this important topic. Each mother’s experience will be a one-of-a-kind adventure, full of surprises and choices. Adventures in Tandem Nursing provides an essential source of support, humor, and information for the journey.

    My notes: This book was the reassurance for me while I nursed my first child during my second preganancy, and tandem nursed for almost a year. While I had the support of my midwife, and the child(ren)'s pediatrician, none of my friends had tandem nursed before... so this book filled a gap for me. There is lots of practical information, as well as stories and pictures from other tandem nursing moms. I especially loved the pictures, which I shared with my daughter, which helped her understand that she was going to be sharing her beloved "goody milk" with her new baby brother. I highly, highly recommend this resource for moms who nursing during pregnancy and/or beyond.




    Mothering Your Nursing Toddler (2000)
    Norma Jane Bumgarner

    Book Description from Amazon.com: The classic handbook for mothers who breastfeed their children past infancy in an updated expanded edition. Norma Jane Bumgarner puts the experience of nursing an older baby or child in perspective, within the context of the entire mother-child relationship. She cites biological, cultural, and historical evidence in support of extended breastfeeding and shares stories gleaned from thousands of families for whom breastfeeding and natural weaning have been the norm.

    My notes: I don't own this book, but borrowed it several times from various sources. I remember finding it very reassuring and useful.




    There is also excellent breastfeeding information in several of the Sears' books: The Baby Book (2003) and The Breastfeeding Book (2000).

    I highly recommend reading through one or two books about breastfeeding during the end of pregnancy. Even if you're not sure you want to try breastfeeding, you have some information if you need it. Most of these books are available in excellent condition for less than $5 on amazon.com through their used book sellers - some sell for less than $1, so are less than $5 including s&h. Most are also available through the Maine library system, though you may need to request what you're looking for if it isn't at your particular library. Either way, the book(s) that can help you during the breastfeeding process are available for minimal investment.

    If I've left off your favorite breastfeeding book, go ahead and add it in the comments - I'm always looking for new ideas for my library!

    Happy reading!

    Christina @ Birthing Your Baby
    Independent Childbirth Classes in 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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    Saturday, August 2, 2008

    Breastfeeding Resources for Central Maine Mamas

    LA LECHE LEAGUE MEETINGS IN CENTRAL MAINE

    The Augusta/Gardiner Group meets on the third Tuesday of each month. Contact Katherine via email or at 582-8250 for more information. I think Katherine is also organizing or has organized an evening meeting time as well.

    The Bangor Group meets on the first Wednesday of each month at 10am. Contact Melanie via email or at 942-2362 for more information.

    The Lewiston/Auburn Group meets on the second Wednesday of each month. Contact Nancy via email or at 782-6645 for more information.

    The Brunswick Group meets on the third Monday of each month at 9:30am. Contact Linda via email or at 221-

    Complete list of LLLI meetings in ME, including Bridgton, Camden/Rockland, Skowhegan, Norway and others.

    HOSPITAL BREASTFEEDING SUPPORT GROUPS
    Many hospitals offer breastfeeding support groups, which can be a terrific breastfeeding (and parenting!) resource. Most are led by trained lactation consultants. You can also contact the lactation consultants listed for information on breastfeeding classes to take before your baby's birth. Some hospitals also sell breastfeeding supplies. I know MaineGeneral in Augusta does, and Mid Coast Hospital in Brunswick does as well.

    MaineGeneral Augusta Campus, offers a general breastfeeding support group, led by Janet Sirois (626-1426). This group meets four times a month at MaineGeneral Medical Center, Augusta Campus, 6 E. Chesnut Street, Augusta. Meetings alternate between Tuesdays, 6 to 8 p.m., or Wednesdays, 12:30 to 2:30 p.m. Call Janet for a schedule.

    MaineGeneral Waterville Campus, offers a general breastfeeding support group, led by Cheryl Bean-Moody (872-1625). This group meets twice a month, 12:30 to 2 p.m. or 6 to 7 p.m., in Dean 2, MaineGeneral Medical Center, Thayer Campus, 149 North Street, Waterville. Call Cheryl for a schedule.

    Inland Hospital offers a breastfeeding support group ,led by Connie Finley (861-3100). This group meets most Fridays at 1pm at the hosptial's birth center. Call Connie for a schedule.

    I think Central Maine Medical Center (CMMC) in Lewiston has a support group, but I can't find it on their website. For additional information, contact Gloria Oullette or Vicki Roy, their lactation consultants, at 795-2528.

    St. Mary's Hospital, in Lewiston, does not offer a support group, but you can contact their lactation consultant, Gail Martell, at 783-6987 to get breastfeeding class information.

    Mid Coast Hospital, in Brunswick, offers a range of breastfeeding services. These include a Nursing Mother's Tea held the 1st Wednesday of each month from 7-8:30 p.m. and the 3rd Wednesday of each month from 10-11:30 a.m. in Mid Coast Hospital’s Café Conference Room, 123 Medical Center Drive, Brunswick, breastfeeding classes, and a boutique that sells supplies. Jerri Walker is Mid Coast's lactation consultant, she can be reached on Mondays, Wednesdays, and Fridays at 373-6530.

    THE WIC PROGRAM
    WIC (Women Infants and Children Nutrition Program) also offers breastfeeding resources, including breastpumps for women who meet certain criteria.

    From their site: Who can apply for the Maine WIC Nutrition Program? Women who are pregnant, breastfeeding or had a baby in the past six months. Infants and children up to the age of five including foster children. Fathers may apply for their children. You must live in Maine or be a migrant working in Maine.

    Locations include:

    Midcoast Maine Community Action Program
    34 Wing Farm Parkway, Bath, ME 04530
    Tel: 442-7963 or 1-800-221-2221

    HealthReach Network
    263 Water St., 4 th Floor, Augusta, ME 04330 (621-6202)
    63 Eustis Parkway., Waterville, ME 04901 (872-1593)
    165 North Ave., Skowhegan, ME 04976 (474-7463)

    Western Maine Community Action Program
    1 Auburn Center, Auburn, ME 04210
    Tel: 795-4016 or 1-877-512-8856

    If you know of any other breastfeeding resources for Central Maine mamas, please leave a comment!

    Christina @ Birthing Your Baby
    Independent Childbirth Classes in Central Maine

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    Online Breastfeeding Resources

    There are tons of online resources to support breastfeeding mothers. Here is a list to get you started. It is not, of course, complete - what list could be!?? Feel free to comment with your suggestions...

    HOW-TO
    Breastfeeding Answers from La Leche League International
    Breastfeeding.com's Answer Center - pretty mainstream
    How to Bring Baby to Breast - from US Dept of Health & Human Services
    Correct Latch - from US Dept of Health & Human Services
    Breastfeeding Holds - from US Dept of Health & Human Services
    Breastfeeding Help from Dr. Jack Newman
    KellyMom: Breastfeeding - an amazing resource
    Breastfeeding on the Ask Dr. Sears website - you can skip thru the newsletters
    Breastfeeding Articles from Mothering
    Breastfeeding Lying Down


    REFERENCE
    American Academy of Pediatrics: Breastfeeding and the Use of Human Milk
    Breastfeeding - from US Dept of Health & Human Services
    Breastfeeding Know-How, from US Dept of Health & Human Services
    American College of OB/GYN Breastfeeding Your Baby pamphlet
    Dr. Hale's Breastfeeding and Medications Forum - Dr. Hale is the expert on breastfeeding and medication
    Selected List of Medications approved by the AAP for breastfeeding mothers - on the Kellymom website
    Herbals and Breastfeeding - from the US Pharmacist
    Anatomy of a Nursing Breast
    Choices that Affect Breastfeeding - analysis of choices made during childbirth/post-partum that potentially affect breastfeeding
    Is This Safe While Breastfeeding - from KellyMom.com
    Nursing During Pregnancy and Tandem Nursing - from KellyMom.com
    Bra-Sizer Application - especially useful for online shopping...

    VIDEOS & CLIPS
    Breastfeeding.com Informational Clips - a wide variety of topics
    Dr. Jack Newman's video clips
    Great Latch-on video from Ameda

    SUPPORT
    Find a La Leche League Leader or Group near you
    La Leche League Mother-to-Mother Forums
    Breastfeeding.com Forums
    Motherwear Blog
    Breastfeeding Help Line - from US Dept of Health & Human Services
    KellyMom Forums
    Breastfeeding Forums at MotheringDotCommune - scroll down to find them

    BENEFITS
    Benefits of breastfeeding from La Leche League International
    101 Reasons to Breastfeed Your Child
    Benefits of Breastfeeding - from US Dept of Health & Human Services
    Breastfeeding is Priceless
    10 Reasons Why Breastfeeding Rocks - from girl-mom

    SHOPPING
    Motherwear - don't forget to check out their sale pages - I got a nursing bathing suit there for ~$15!!
    Bravado Bras - I liked their sports bras
    Glamourmom.com
    NestMom.com - where I got my washable nursing pads
    Nursing Nightgown Pattern from Elizabeth Lee Designs

    I almost forgot! EDITED TO ADD MY FAVORITE NURSING BRA (for daytime)- from Walmart, of all places (I almost never go, but someone told me they have the best nursing bra... I have in turn recommended it to many, who have thanked me because they love it too!): the Bestform Sports Nursing Bra, for all of $11!! It's cotton, comfortable, has no underwire, wide straps, easy to hook/unhook etc...

    Christina @ Birthing Your Baby
    Independent Childbirth Classes in Central Maine

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    Friday, August 1, 2008

    World Breastfeeding Week

    Summer is short here in Maine, and I've been busy in the garden and in the kitchen, freezing some of what I've picked (blueberries, raspberries, green beans, peas, cucumbers, lettuce and the first tomatoes!) for the winter and trying to find ways to prepare the rest. Just like in Blueberries for Sal, minus the bear and add another kid. I have so many ideas for posts! But there are only 24 hours in a day!! Next week I'm going to kick off a "Choices in Childbirth" series, discussing the many options women have for care during the childbearing year. But first, an entry to add my celebratory voice to World Breastfeeding Week...

    What is World Breastfeeding Week? The World Breastfeeding Week website explains that:
    "Breastfeeding results from a reproductive health continuum for the mother to the child with no beginning or end, from generation to generation. When a practice is disrupted, it must be restored. However, restoration of the breastfeeding culture demands more resources and mobilization.

    In conjunction with the Olympics next August, WBW 2008 calls for greater support for mothers in achieving the gold standard of infant feeding: breastfeeding exclusively for six months, and providing appropriate complementary foods with continued breastfeeding for up to two years or beyond.

    As every country sends its best athletes to compete at these global games, it is important to remind ourselves that, in a similar fashion, a healthy young athlete can only emerge from a healthy start on life. There is no question that optimal infant and young child feeding is essential for optimal growth and development.

    Supporting Mother = Supporting Her to Provide the Golden Start For Every Child!"

    Also, I loved viewing the beautiful results of the World Breastfeeding photo contest.

    I have breastfed two children, for a total of just over six years. One has been weaned for a while; the other is weaning. During those six years of offering the incredible nutritional benefits of breastmilk, I have experienced so many moments of joy:
    the contented milky smile;
    eyes rolling in ecstasy;
    the brief pull-off to grin that goofy "thank you grin"
    sweet baby paws kneading me;
    rocking my sleeping but still nursing baby (milk coma), drinking in the sight and smell of baby, baby, baby;
    the joy of reconnecting with a big baby or young child after a busy day;
    nursing in bed with the baby curled up against my belly;
    instantly solving fear, frustration, exhaustion, a temper tantrum, overstimulation etc. with mama-milk;
    listening to the contented murmurings and squeaks;
    the amusing bob of a frantically rooting infant;
    that intense loving gaze of a nursing child;
    long long gulping swallowing, gulping gulping;
    the surprise of my nursing child who is kicked by her sibling growing in my belly;
    baby's wiggle of anticipation as I get ready to nurse;
    the funny names my kids came up with: "the other side" "mama gah" "goody milk"
    there was even a song, the "goody milk" song - "goody, goody, goody, goody milk, milk MILK"...

    There were struggles, too: flat nipples; oversupply with lots (and lots and lots) of leaking; engorgement; baby with a tongue-tie but a good latch; long-lasting nipple soreness from my first baby, the one without a tongue tie (??); thrush (the baby, thankfully not me); one (just one, so thankful) bout of mastitis. The struggles, though, were all short-term, compared to the long-term gift of extended breastfeeding - my gift to my children, who gave me so many gifts back during our breastfeeding relationships...

    Baby snuggles:
    PhotobucketPhotobucket

    The last day + Weaning Party gift:
    PhotobucketPhotobucket

    Now he's a big boy, who still loves his "mama gah":
    PhotobucketPhotobucket

    Looking through my archives to find these pictures, I wish now I had a lot more... there are a few of my daughter as an infant that are not digital, but this is about all I have. I wish I'd taken a some every few months or so, especially as young babies. I don't have any tandem nursing pics at all (not surprising, since I only nursed them at the same time a few times, but still, now I really wish I had a few).

    I've breastfed my children in a lot of places - at home, of course; in restaurants; at the movies; outside in all four seasons while hiking, camping etc.; at the beach; in the airplane squished between other travelers; in all manner of stores and shops; in the stopped car and in the moving car, with both of us still buckled in; at church; in waiting rooms; at playgroups; at the library; etc & etc. I can happily report, too, that no one has ever asked me to stop or move, or even given me a nasty look.

    So that's an introduction, and a little of my personal history. The next post will be online resources and local resources for Central Maine Mamas.

    Happy Breastfeeding!

    Christina @ Birthing Your Baby
    Independent Childbirth Classes in Central Maine

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