Friday, January 30, 2009

Stay at Home!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Christina @ Birthing Your Baby
Independent Childbirth Classes for Central Maine

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Wednesday, January 28, 2009

Same Old, Same Old??

Adbusters published a provocative essay on childbirth last fall, "Industrial Childbirth," and while the piece was written about a birth that took place in Dublin, Ireland, there are many similarities between the management of this birth and how birth is routinely managed throughout the United States. The author, Shonagh Strachan, begins her essay, explaining that
"My experience of childbirth was not an unusually traumatic one. In medical parlance I had an NVD: a Normal Vaginal Delivery. The midwives were pleasant. I was given an epidural. I was admitted to hospital at 2pm and delivered a healthy baby boy ( 8lb 7oz ) eleven hours later. This is the essential information, is it not? This is the only kind of information that we ever really hear about other women’s experiences with childbirth.

But there is more to it than that. It took me a while to sort out my feelings after the birth – the elation you feel at the presence of a new life combined with your physical exhaustion leave room for little else. And I never really experienced the hopeless grief of the flippantly named “baby blues” in the weeks or months that followed. What I felt – when I was finally able to identify the reasons for my confusion – was anger.

Is anger only blame and self-pity? Or can it be illuminating? For me it can – anger has traveled beyond blame, beyond the individuals involved and my personal experience, and shocked me into changing my whole outlook on life."
She goes on to describe her birth experience: artificial rupture of membrane; contractions that did not progress dilation quickly enough, which led to Pitocin; an epidural. This birth story is what is typically offered in United States hospitals as well. The 2006 Listening to Mothers Survey II reports that, "Despite the primarily healthy population and the fact that birth is not intrinsically pathologic, technology-intensive childbirth care was the norm. 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."

Okay, so this is where I admit: already, I'm shocked. But remember, the author of the essay is explaining how, so far, she is not angry. Yet.
"The point at which I started to feel a twinge of anger was when, after the delivery, I wasn’t allowed to feed my baby. It was only then that my instinct was strong enough to say, “No. This is really wrong.” There is a period of about an hour after the birth where the newborn is alert and breastfeeding can be established. However, after a brief hold, he was taken away as I was given a Syntometrine injection and his placenta was delivered (by tugging on the cord). He remained away as I was stitched and examined and had to wait for a doctor to examine me.

By the time I was given the all clear (in tears at this point asking, “Can I feed him now?”), I had to be moved from the delivery ward and down to the post-natal ward. It was now 2 am, so friends and family in the waiting room were told to go home without ever having seen the baby or me. The baby’s dad had been present at the birth but was also sent home. Yet again I asked, “Please, can I try to feed my baby?” but he had to be taken away again – this time for a Vitamin K injection and for the nurse to bathe him and put his first vest and Baby Gro on."
But the whole separation of mother/baby: that's old-school, right? Now the baby's first examination (weighing, measuring, etc. & etc.) can be done by the mother, and he never leaves mother's side, right? Well, that may or may not be the reality. Listening to Mothers II reports that "Despite the importance of early contact for attachment and breastfeeding, most babies were not in their mothers' arms during the first hour after birth, with a troubling proportion with staff for routine, nonurgent care (39%)." Add that to babies who needed urgent care, and that's a significant number of babies who are away from their mothers during that first hour. Of course, as the Adbusters' essay shows, even one baby separated from mama for nonurgent reasons is significant, at the very least to that baby and mama.

[And as a public service announcement, here is a link to a blog entry that discusses and shows one newborn's bathing experience, "How NOT to Bathe the Baby". I couldn't get through the video myself: it's horrifying. But I do believe it's incredibly important, if at all possible, to have someone who cares about baby accompany him or her at all times as an advocate.]

Shonagh Strachan explains another source of anger:
"In theory, a woman has the right to refuse any of the interventions offered to her. In practice, the normality of intervention and the culture of risk minimization (read: liability minimization) mean that women do not feel empowered to say “no.” I certainly never thought about saying “no” or asking what the alternatives were. I blame myself for this – that I was not more informed and proactive. But I am also angry at the bullying system in place. It is hurried and overwhelming so there is never time or space to question the “professional” medical opinion as to what is really right for you and your baby. So we become numbers, subject to routine interventions."
And ends her essay with these paragraphs:
"It is my belief that at some deep level, we all feel that we have been robbed. We pass through our childbirth initiation to become disempowered, disconnected, long-suffering, patriarchal mothers. We tell our horror stories as just that, or we say nothing at all. But it doesn’t have to be this way. If I ever have another child, it will not be in the same way. And it doesn’t stop there. I will never again blindly place my trust in authoritarian professionals and institutions. I will recognize all capitalist patriarchy for what it is and I will do my best to speak out against it.

Every day, in every way, my son is a wonderful gift. I would go through ten more hospital births just to keep him. I am sorry for his shabby entrance into this world but I am thankful to this little person for helping me to see something: the bald, blatant, oppressive, damaging, misogynistic forces at play in the most vital aspects of women’s lives. Revisiting his birth has made me angry, but that has made so much else clear: how blinded we can be by the guise of protection, how crippled we can be made by fear.

I wish that we talked about it. That we could stop reveling in horror stories and better place our fingers on the reason for our traumatic births – not the curse of Eve medicated to by our benevolent system – but the systematic violence that delivers our babies for fear that we might give birth to them ourselves. For in the process we might begin to understand our own strength and find words for our anger. We might begin to disobey."
Very, very powerful.

Here's another thing that shocks me: it seems like we're fighting for the same things, over and over again. In her excellent memoir, Lady's Hands, Lion's Heart: A Midwife's Saga, Carol Leonard tells how she tries to institute changes in a local New Hampshire hospital - back in the late seventies. She creates a list of changes that she thinks would result in more family-centered maternity care, and offers them to the Chief of Obstetrics, "First on this list, obviously, is discarding the wrist restraints. No more being tied down like a deranged animal. Also, deep-six the standard prep of high enema and shaving" (116). These routines have thankfully ceased to be standard, as they were for my birth, in 1974.

However, most of the rest of Leonard's list looks appallingly familiar: "No more routine, continuous electronic fetal monitoring for normal, uncomplicated births. No arbitrary, elective Pitocin inductions without some clear medical indication . . . no more routine drugs, episiotomies, or mandated supine - flat on one's back - positions. No more withholding fluids and nourishment, 'just in case anesthesia is needed,' and no more routine, artificial, early rupture of membranes, which has never been proven advantageous by any evidence-based data. And babies are allowed to remain with their mothers at all times" (117).

How are we going to change this system? I think it goes back to basics: being informed, asking questions, networking, and insisting on a different experience, whether in a hospital, birth center, or at home. Excellent hospital births are possible - I know, because I had two: go check out Madelyn & Owen's birth stories here, if you'd like. Or go read this terrific article in the Los Angeles Times, "Midwives Deliver".

I have more ideas in old posts, "Mother-Friendly Childbirth", and "Questioning Safety" and "Choosing a Care Provider and Birth Place" and "Pregnancy and Birth: What Are My Choices?".

Christina @ Birthing Your Baby
Independent Childbirth Classes for Central Maine

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Sunday, January 25, 2009

What Shocks Us

It's interesting to me how different people can be, and how this difference is reflected in our perspectives or attitudes. For example, I avoid watching the very common CSI-type shows because it seems to me that almost every show has has a plot line and/or images of violence against women or children.

When I see or hear blood, screaming etc. on the television, I cannot help but think of myself or my sisters/mother/friends or our children in this specific situation. Watching too much of this type of television would undoubtedly make me paranoid!

But! I can watch any graphic woman-centered childbirth video without upset, even while snacking or eating my lunch. Full-on crowning shot? No problem. Triumphant birth howls? Sure. Deliriously happy mama embracing her blood-streaked, vernix-covered baby for the first time on her bare skin? Terrific! Yes, I may get a little teary, but those images are beautiful to me. However, from what I hear casually, as well as from friends and family, most people in this culture would be much more uncomfortable and/or shocked by this type of video versus the graphically violent images on CSI-type shows. Interesting, isn't it?

I got the chance to watch 20/20's "Extreme Motherhood" show when it aired, January 2nd. My first thought was that it seemed bizarre to combine orgasmic birth, women who nurse their children beyond infancy and babyhood, and women who birth at home with midwives (which for some reason 20/20 labeled as "unassisted") with the much more rare women who mother the uber-realistic (creepily realistic, to me) baby dolls called Reborns, and who are "serial" surrogate mothers.

Anyway, clearly all of these topics were supposed to be "extreme" or shocking!! in some way.

Let's look at the whole "orgasmic" childbirth thing. Here is the 20/20 clip: Orgasmic Birth, it's about seven minutes long. There are two things in this clip that, in my opinion, might seem shocking.

The first is simply connecting the idea of an orgasm (sex) to the idea of childbirth (a baby). You just don't hear those two words together very often, I don't think, especially on network television.

The second one is the idea that childbirth could be "orgasmic". But really: it's the same body parts... the same hormones... and childbirth is a direct result of having sex. Is it really such an extreme position to take that childbirth could be pleasurable instead of painful? Because that's what the clip is really suggesting, I think. "To actually experience an orgasmic, or pleasurable birth, Northrup [Dr. Christiane Northrup] says it's important for women to lose their fear and their inhibitions." A mother interviewed for the show explained, "I hope women watching and men watching don't feel that what we're saying is, every woman should have an orgasmic birth," she said. "Our message is that women can journey through labor and birth in all different ways. And there are a lot more options out there, to make this a positive and pleasurable experience." It seems to me to be more of a media-type attention-grabbing trick to stretch the label of pleasurable to orgasmic (though I do not doubt at all that orgasmic birth happens!).

Why the idea of childbirth as pleasurable is shocking is because the vast majority of American women labor under conditions that would make it almost impossible to experience pleasurable sensations during labor and birth. Many are tied to a bed via an IV, continuous fetal monitoring, an epidural, and a catheter. The epidural numbs them to the sensations of birth: can you imagine if it was the norm for virgin young women to be given an epidural during their first sexual experience because it might hurt? Add any number of other factors, including a lack of exposure to labor/birth as normal, fears from watching the many emergency-birth shows on tv, lack of support, threat of cesarean, time limits etc. & etc. Contrast these scenarios with the births discussed on 20/20 - they're day and night, and, in my opinion, go a long way to explaining why many women feel pain and fear and the few who labor unmedicated, with support, upright and moving, with water - with true woman-centered care, may experience pleasure during their births.

What's shocking to me is that so many women labor and birth the hard way.

Or how about this for shocking?

"Best Practices in Maternity Care Not Widely Used in the United States"
WASHINGTON (January 7, 2009)— Despite best evidence, health care providers continue to perform routine procedures during labor and birth that often are unnecessary and can have harmful results for mothers and babies. The Centers for Disease Control’s (CDC) most recent release of birth statistics reveals that the rate of cesarean surgery, for example, is on the rise to 31.1% of all births—50% greater than data from 1996. This information comes on the heels of The Milbank Report’s Evidence-Based Maternity Care, which confirms that beneficial, evidence-based maternity care practices are underused in the U.S. health care system.

Research indicates that routinely used procedures, such as continuous electronic fetal monitoring, labor induction for low-risk women and cesarean surgery, have not improved health outcomes for women and, in fact, can cause harm. In contrast, care practices that support a healthy labor and birth are unavailable to or underused with the majority of women in the United States.

Beneficial care practices outlined by Evidence-Based Maternity Care, a report produced by a collaboration of Childbirth Connection, the Reforming States Group and the Milbank Memorial Fund, could have a positive impact on the quality of maternity care if widely implemented throughout the United States. Suggested practices include to:

Let labor begin on its own.
Walk, move around, and change positions throughout labor.
Bring a loved one, friend, or doula to support you
Avoid interventions that are not medically necessary
Choose the most comfortable position to give birth and follow your body’s urges to push
Keep your baby with you – it's best for you, your baby and breastfeeding.

Lamaze International has developed six care practice papers that are supported by research studies and represent “gold-standard” maternity care. When adopted, these care practices have a profound effect—instilling confidence in the mother, and facilitating a natural process that results in an active, healthy baby. Each one of the Lamaze care practices is cited in the Evidence-Based Maternity Care report as being underused in the U.S. maternity care system.

Debra Bingham, MS, RN, DrPH(c), Chair of the Lamaze International Institute for Normal Birth says, “As with any drug, we need to be sure that women and their babies receive the right dose of medical interventions. In the United States we are giving too high a dose of cesarean sections and other medical interventions which are causing harm to women and their babies. Yet there are many countries where life saving medical interventions are under dosed which can also cause harm. Every woman and her baby needs and deserves the right dose of medical interventions during childbirth.”

The research is clear, when medically necessary, interventions, such as cesarean surgery, can be lifesaving procedures for both mother and baby, and worth the risks involved. However, in recent years, the rate of cesarean surgeries cause more risks than benefits for mothers and babies. Cesarean surgery is a major abdominal surgery, and carries both short-term risks, such as blood loss, clotting, infection and severe pain, and poses future risks, such as infertility and complications during future pregnancies such as percreta and accreta, which can lead to excessive bleeding, bladder injury, a hysterectomy, and maternal death. Cesarean surgery also increases harm to babies including women giving birth prior to full brain development, breathing problems, surgical injury and difficulties with breastfeeding.
Read more about Lamaze's Six Care Practices that Support Normal Birth here.

To read other reviews of 20/20's "Extreme Motherhood" show, visit Kathy's blog article at Woman to Woman Childbirth Education or the Navelgazing Midwife's commentary.

Or read this short review, "Orgasmic Birth: The Natural Reality Behind the Hype", which offers a gem of a quote from Debra Pascalli-Bonaro, the filmmaker of Orgasmic Birth: the idea that orgasmic birth "sounds strange in our culture because we're used to seeing birth dealt with on an illness model, rather than a wellness model. Birth is part of a woman's sexual life."

More to be shocked about coming soon.

Christina @ Birthing Your Baby
Independent Childbirth Classes for Central Maine

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Wednesday, January 21, 2009

Lecithin, Plugged Ducts & Mastitis

I had not heard of lecithin until today, in the Midwifery Today e-newsletter, where they featured this information about it:
Lecithin is present in many of the foods we eat, but it is most concentrated in foods that are high in cholesterol and fats. Organ meats, red meats and eggs are the most concentrated sources of dietary lecithin. With the current trend of reducing cardiovascular disease and improving overall health quality, many breastfeeding women lean toward low-calorie, low-cholesterol diets. People are limiting their consumption of organ meats and eggs, thus limiting their intake of lecithin (USDA 1979 and 1992). This reduction most likely results in an inadequate dietary intake of lecithin.

The diet of the average American today also has less lecithin than that of the previous generation because purified and refined foods comprise the bulk of their diet. With the current demand for highly processed foods, refined sugars and hydrogenated fats, consumption of lecithin is further decreased, possibly even to the point where consumption of foods containing lecithin is at suboptimal levels for health.

The average pregnant and breastfeeding woman eating the Standard American Diet (SAD), which is high in saturated fats, is not able to naturally produce enough lecithin to assist with the emulsification of fats in her blood stream and carry out milk duct cleanup.

Scientists tell us that the body, without dietary sources, is not able to synthesize an adequate supply of lecithin. Lecithin is produced in the liver, and small amounts are present in foods such as brewer's yeast, grains, legumes, fish and wheat germ. People who eat the SAD, elderly people, breastfeeding women, infants, children and those who would like to improve memory, strengthen nerve growth and decrease buildup of fatty deposits in liver, heart and brain would benefit from supplemental lecithin.

The best form of supplemental lecithin is the granular form. Avoiding liquid lecithin, usually found in gel capsules, is advisable. It is primarily designed for commercial use as an emulsifier in food, cosmetics, paints and so on. It is a bad-tasting, sticky material and consists of about 37% oil and only 60% phosphatides. This combination would add to the high dietary fat content that lecithin has to clean up in the body. Capsules are a high-calorie, low-potency supplement, but if a pregnant or breastfeeding woman cannot find granulated lecithin locally or has difficulty adapting to sprinkling granules on her food, taking lecithin in capsule form is far better than not taking it at all.

— Cheryl Renfree Scott
Excerpted from "Lecithin: It Isn't Just for Plugged Milk Ducts and Mastitis Anymore," Midwifery Today, Issue 76
I thought it was particularly interesting in relation to plugged ducts and mastitis. Kellymom also has a page about plugged ducts and lecithin, Lecithin treatment for recurrent plugged ducts.

Plugged ducts can be very uncomfortable and can lead to mastitis. Kellymom has some excellent general information on plugged ducts and mastitis: Plugged Ducts and Mastitis.

These are the recommendations I share with my clients on how to avoid plugged ducts & mastitis:

** Do not wear bras that are too tight.

** Do not wear underwire bras.

** Take care of yourself: get some rest, and eat nutritious food.

** Breastfeed frequently, making sure to empty both breasts over the course of several feeding sessions.

** Pay attention to how you sleep – avoid compressing breast tissue overnight.

** Make sure to feed baby from both breasts during the night, too. Sometimes it’s easier to favor one breast if baby is sleeping with you.

When I had mastitis (thankfully, only once) from a plugged duct, what helped me the most was hot showers and really hot compresses over the blockage and feeding my son from that side first, when he was hungriest. The trick that I didn’t hear about until later: point the baby’s chin toward the blockage (try different positions as necessary), as that tends to direct the most efficient pressure at the plugged duct.

Christina @ Birthing Your Baby
Independent Childbirth Classes for Central Maine

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Thursday, January 15, 2009

More on Vitamins: Vitamin D & DHA in Formula

In my last post on vitamins, I included the hugely informative link to Navelgazing Midwife's post on Vitamin D & It's Role in Women and Children.

I want to add a link to a New York Times article I read that summarizes a study done at Boston University that concluded that Vitamin D deficiency may increase the risk of an emergency cesarean.
"The researchers studied 253 births at a Boston hospital from 2005 to 2007. After controlling for other variables, the scientists found that women with low blood levels of vitamin D were almost four times as likely to have an emergency C-section as those with normal levels. Vitamin D deficiency has been associated with muscle weakness and high blood pressure, which might help explain the finding."
I would be interested to know if these cesareans were truly emergency, and even more importantly, what specific, medical reason for the cesarean birth was given.

I also wanted to offer this link to the Motherwear blog post on Vitamin D. There is great information on breastmilk and Vitamin D in the two links provided in this post. And, there is interesting discussion in the comments.

Finally, when I wrote the post on Omega-3's during pregnancy, I wasn't thinking about formula, and the attempts on the part of formula-makers to manipulate mothers into buying DHA-"enhanced" formula.

I believe that adding DHA/ARA is a marketing ploy made to manipulate mothers into buying a more expensive product that contains additives of questionable value. As someone who believes in the inherent superiority of breastmilk for infants, I also would hate to think that any mother ever gives up on nursing thinking that DHA/ARA formula is "close enough" to human milk - that the DHA/ARA confers some magic benefits. I am not anti-formula - there are times when it is necessary; however, I am firmly against the manipulative scare tactics employed by many companies marketing to mothers.

According to an article in Mothering's May/June 2008 magazine, "test results have shown the additives have negligible positive effects on infant development. The FDA's initial analysis of the additives reached no determination of their safety, while noting that some studies reported unexpected deaths among infants who have been fed DHA/ARA formula" and that there have been an array of symptoms (vomiting and diarrhea) reported by parents and doctors that "disappeared when the infants were switched to a non DHA/ARA formula".

To read more about DHA/ARA in formula, read the .pdf "Replacing Mother: Imitating Breastmilk in the Laboratory".

Christina @ Birthing Your Baby
Independent Childbirth Classes for Central Maine

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Tuesday, January 13, 2009

Vaccine Links

I have several interesting links to share regarding vaccines.

This first one is a link to a study, "Pediatric Vaccines Influence Primate Behavior", regarding the use of thimerosol and vaccines. The study's conclusion:
"This animal model, which examines for the first time, behavioral, functional, and neuromorphometric consequences of the childhood vaccine regimen, mimics certain neurological abnormalities of autism. The findings raise important safety issues while providing a potential model for examining aspects of causation and disease pathogenesis in acquired disorders of behavior and development."
Keep in mind that thimerosol has been phased out of many vaccines (excepting the flu vaccine, to my knowledge). But I still found this interesting, especially from a standpoint that this information remains widely unacknowledged by the medical community.

After I had already written this post and set it to publish, I received a link to this article, "Sharp Rise in Autism is Real", which debunks the myth that real autism rates have not changed, but have only seemed to have increased due to earlier and better reporting.
"Many experts contend that other factors account for the increase, such as greater awareness among parents and pediatricians, and therefore a greater likelihood of a diagnosis.

But that accounts for only a fraction of the more than 600 percent jump, said Irva Hertz-Picciotto, whose work was published this month in the journal Epidemiology. . .

Hertz-Picciotto and her colleague, Lora Delwiche, found that less than 10 percent of the estimated increase could be attributed to the inclusion -- after 1993 -- of milder forms of autism, and about 4 percent of the increase was attributed to a trend toward earlier diagnosis. . .

Many scientists think people have a genetic predisposition to autism that is triggered by some environmental factor. Hertz-Picciotto believes it's probably multiple genetic susceptibilities and more than one environmental trigger. . .

Stanley Swartz, an autism researcher and professor of special education at Cal State San Bernardino, said it will be hard to get a consensus on causes for the increase.

'The problem is we're operating almost completely on theories," he said. "What we have to consider is that this is not a single syndrome with a single cause. ... There's more going on than just one thing because you do see such a wide variety of cases of autism.'"
Again, I'm curious what, if anything, will come of this study and how well the findings will be publicized by mainstream media.

I read What Your Doctor May Not Tell You About Children's Vaccinations to help my family decide about vaccinations. There are other good books out there, I'm sure. The Sears' recently added The Vaccine Book: Making the Right Decision for Your Child to their well-respected library, but I haven't read it yet. Dr. Bob Sears has also written an interesting article published in the Jan/Feb 2008 Mothering magazine, "Is Aluminum the New Thimerasol?".

Do you have any recommendations for books or websites on this issue? Michelle - didn't you have a book sent to you for free? Can you include info on it in the comments?

Finally, there is a link on the Dr. Sears site that lists Vaccine-Friendly Doctors, those doctors "who are friendly toward parents who want help with the vaccine decision or who want to delay or decline vaccines. The doctors listed here will have read, or be familiar with, my book and contacted me to have their practice listed here as a place such patients can come and feel welcome."

Unfortunately, there are no Maine doctors mentioned. Anyone have good experiences with doctors re: delaying or declining vaccinations or selectively vaccinating? Leave a comment if you can recommend someone!

Christina @ Birthing Your Baby
Independent Childbirth Classes for Central Maine

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Sunday, January 11, 2009

Cesarean Births: Too Early?

A USA Today article, "Elective C-sections performed too early 36% of the time", reporting on a recent study published in the New England Journal of Medicine, begins with this startling information:
"More than a third of elective C-sections are performed too early, increasing newborns' risk of respiratory distress and other problems, researchers report today."
Full-term is now defined as 37-41 weeks (used to be full-term was considered 38-42 weeks), and although the American College of Obstetricians and Gynecologists (ACOG) recommend that elective cesareans are performed no earlier than 39 weeks gestation, the study results found that 36% of the time, ceseareans are performed before 39 weeks.

Highlights from the article include this statement about the difference between baby-initiated labor and induced labor/cesarean birth:
"At 37 weeks, babies are considered fullterm, but there's a difference between those delivered vaginally and by elective C-section, says coauthor John Thorp, professor of obstetrics and gynecology at the University of North Carolina, Chapel Hill. "We would not worry about a 37 1/2-week baby born vaginally with the onset of labor," Thorp says. In that case, 'there is some signal from a baby to his mother that says, "I'm ready …"'".
People mature - physically and emotionally - at very different rates. Think of the range for puberty... some girls start menstruating at age nine, and others at fourteen. Both situations are within the normal range, and indicate that particular body's readiness for puberty. I was one of the fourteen year olds; my body was no where near puberty or womanhood at age nine. Of course, we can't induce menstruation on young girls - who would want to?

But ask a woman when she's nine months pregnant if, uninformed of any risks, she might want to birth her baby a few weeks early. She just might be inclined to jump at the chance to meet her baby and end the last, frequently uncomfortable, stage of pregnancy.

What are the risks? Well, the USA Today article explains that
"Overall, about 10% of the babies at birth had at least one of these problems: respiratory distress, low blood sugar, infection or need for a respirator or intensive care. Those born at 37 weeks were twice as likely and those born at 38 weeks 50% more likely to have a problem than those at 39."
Are most women informed about these risks when their cesarean birth is scheduled? I doubt it.

Also, note that this article discusses "elective" cesarean births. Just to clarify, so this post does not add to the myth that many women are choosing elective cesarean births, the vast, vast majority of "elective" cesarean births are not a mother's first choice. In the Listening to Mothers II study, only one mother in 1500 indicated that a cesarean was her personal birth choice while many others (25%) indicated that they felt pressure from their care providers to "choose" a cesarean. Read Childbirth Connections interesting article, "Why the National U.S. C-Section Rate is Rising" for more information.

What's the best way to minimize the risk of performing a cesarean birth too early? If possible, don't schedule it! Wait until labor begins, and then go to the hospital for the cesarean birth. In many "elective" cesarean births, this method should be without additional risks: for a twin birth, or a breech birth, or birth after a previous cesarean (though for all of these situations, a trained care provider can frequently have just as safe or safer outcomes with a vaginal birth). There are, of course, other situations when this "contractions before cesarean" method would not be safe, for example, if the placenta covers part or all of the cervix (placenta previa).

Does waiting until labor sound inconveniant? There could certainly be inconveniances with this strategy, of waiting for labor to begin and then going in for surgery: the inconveniance of waiting; the inconveniance of not knowing when labor will start; the possible discomfort/inconveniance of going into labor; inconveniance for the doctor's schedule. But balance those inconveniances with the increased risk of a NICU stay... short- or long-term medical problems... the emotional roller coaster... the larger possibility of immediate and prolonged separation.

Add future safety to the list too: ICAN reports that women who went into labor on their own before a Cesarean birth were less likely have a uterine rupture during a subsequent VBAC. The study, published in Obstetrics and Gynecology found that
"Women with a history of either spontaneous labor or vaginal birth had one rupture for every 460 deliveries, compared with one rupture in 95 among women without this history who also required induction for their trial of labor."
For more information about the risks of Cesarean births versus the risks of vaginal births, as well as several links on this topic, visit one of my earlier posts: "In the News: Where is Birth Going & Who is Taking it There?" Additional, very complete and scholarly information is available on ICAN's webpage "Fighting the VBAC-Lash: Critiquing Current Research".

Christina @ Birthing Your Baby
Independent Childbirth Classes for Central Maine

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Wednesday, January 7, 2009

Cesarean Births: Preventable?

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

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

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

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

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

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

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

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

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

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

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

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

Christina @ Birthing Your Baby
Independent Childbirth Classes for Central Maine

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