I knew it was going to be aired one of these days, but a local lactation consultant woke me up to tell me that the segment on birth doulas the Today show promised to deliver was being aired this morning.  (Sort of like a birth, the doula community have stood by waiting in “on call” mode!)  I quickly texted other area doulas and such then sat down to watch it.

Here it is!

http://today.msnbc.msn.com/id/26184891/vp/18424824#27820601

On the whole, it was pretty balanced, but I did have a few cringe-worthy moments.

They did make mention that a doula is a non-medical professional and shouldn’t be interfering in the advice from doctors/midwives/nurses, which is something I also strongly agree with.  The most I’ll do is offer up alternatives we can ask the care providers about: “Could we try nipple simulation or acupressure for a while before that Pitocin?” “What about trying pushing in another position?”  I’ll never step in and disagree with a doctor or nurse.  I don’t have medical training, and those medical professionals might know something I don’t!  And even if I did disagree, doing so out loud to the mother would only make the laboring mom feel alone and uncomfortable.  If we offer an alternative, I figure out a way to help the mom and partner roll with it and tackle the next challenge her birth is throwing their way.  I wish after they’d mentioned this problem they would have interviewed a doula and had her tell where that line is and how we operate under a code of ethics and standards of practice that make sure we don’t overstep that boundary.

The only time I felt the segment was a little off is when the doc said “[Doulas] come from very well trained people who have been labor and delivery nurses and midwives to people who have taken a couple of courses.”  First of all, since doulas shouldn’t be giving medical advice, there’s no reason for a doula to be an RN or midwife.  In fact, having medical training could even get in the way of a doula’s role of providing solely emotional support while the rest of the birth team supports her medically.  And certified doulas have to do several things to get their certification, not just take one or two courses.  DONA, my certifying organization, requires birth doulas to read a slew of books, observe a childbirth class, take a labor support course, take a breastfeeding course, take a self-assessment test, write several essays, build a local resource list, sign code of ethics and standards of practice forms, attend several births, and be evaluated by both mothers and care providers.  It was a process that took me about nine months to complete.  And I still am learning something new at every birth I attend!

It was apparent that the doctor they chose to interview was not a doula fan - her hospital had banned them, a very rare step taken in only a handful of hospitals in the country.  I’m sorry that one or two bad doulas had tainted her view.  I wish they’d also interviewed a doctor who supports birth doulas - they are definitely out there (yes, even here in the Tri-Cities)!  In fact, the University of Washington Medical Center actually has volunteer doulas on staff as an option for any of their laboring mothers.

The Today Show’s corresponding article, which goes into a little more depth, can be found here.

The pros and cons of birth plans

If you read any books about pregnancy and childbirth, you’ll quickly encounter an idea called the birth plan.  Birth plans have great intentions - they are supposed to be a written statement of your desires for birth, and usually are written by women wanting an unmedicated and less interventive birth experience. There are both pros — and cons — for creating a birth plan, many of which may be surprising.  Here’s a rundown of their pros, the cons, and some alternatives that may be even more effective.

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PRO:  Just by creating a birth plan, parents can learn what their options for birth might be. Many moms might not know what their choices are, or that they have choices in birth at all. Just by going through the process of writing a birth plan, parents learn the “whys” of various procedures, what their risks and benefits are, and what their options for alternatives might be.  For example, while writing their birth plan, Sally and Joe might learn that it may be possible to have skin-to-skin contact for an hour or so after birth.  They might wonder what the benefits are of skin-to-skin contact, and learn through research that it promotes bonding between parents and baby, regulates baby’s temperature, and is associated with higher success rates with breastfeeding.  They might also learn that most of the nurse care that happens after the birth - weighing, vitamin K shots, hep b shot, eye prophylaxis, etc. can either be postponed for an hour or done when the baby is right on the mother’s chest.

CON:  There are so many aspects of birth that can’t be planned. If you get too rigid of an idea of what your birth will look and feel like stuck in your head, you may be setting yourself up for some negative feelings when the birth does not follow your plan to a “t”.  There are always surprises in birth.  Consider Sally and Joe in the above example — in their birth, what happens if there was meconium present, and the policy at their hospital states that in the presence of meconium, babies must go to the warmer after the birth for suctioning and evaluation and they end up missing that skin-on-skin time they were so excited about?  If parents create too small of an idea of what birth is “good” and “bad”, they may inadvertently create feelings of anger, sadness, or disappointment.  And where will these bad feelings be directed?  Perhaps to the care provider, the partner, the baby, God, or to the mother herself.  These negative feelings can interfere with bonding, breastfeeding, postpartum emotions, and family cohesiveness - the same traits the birth plan was meant to strengthen.

ALTERNATIVE:  Build knowledge of options, without closing completely down to unwished-for events. There is a time and a place for everything in birth, and that time and place is different for everyone.  And you can’t control everything.  If an unwished-for event is happening, you can ask if you can change the circumstances, and if you can’t, try to bring it into the experience in the most loving way possible.  Additionally, you might be surprised that your preferences for birth may change dramatically depending on what is going on in the moment.  No matter what happens in a birth experience, valuable insight about yourself is gained.  Keeping your mind — and heart — open to whatever birth is there to teach you can help create a positive memory, no matter what the “birth fairy” has in store for you.  And isn’t opening what birth is really all about?

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PRO:  Birth plans can be a great communication tool between care provider and family, most effectively in the weeks before the birth. If you do write a birth plan, sharing it with a care provider (doctor or midwife) as soon before your birth as possible can be very helpful.  It can help you understand your provider’s preferences for care and how well they align with your preferences for birth.  Doing so early on can open a dialog where you can reach compromises with your care that work for both of you, or you may find “red flags” in your provider’s policy which might have you looking for another provider (which, if you wait too late in your pregnancy, most providers won’t take a transfer of care of a term pregnant woman).

CON:  Birth plans often all look the same to providers, and most don’t take them seriously. Your birth plan might have taken you days or weeks to create and is precious to you, but to your provider, most birth plans look very similar to one another.  Often, birth plans are long, dry lists of interventions to be avoided.  They may only skim the plan at best.  And providers often feel that, when it really comes down to it, they are going to do whatever they need to do medically, regardless of what it might say on a piece of paper.  For some women in labor, it can be startling when this happens.  The conversation in her head might go like this:  “Doesn’t she know that I wrote I didn’t want Pitocin in my birth plan?  She’s offering it to me anyway.  She must think I really need it.  Or maybe she doesn’t even care what my feelings are.”  You can see how this inner dialogue might easily shift to helplessness, embarrassment, frustration, or anger.

ALTERNATIVE:  Don’t rely on a piece of paper as a crutch — talk face-to-face. I recommend, whether you write a birth plan or not, to talk to your provider about his/her usual policies for such things as episiotomy, induction, indications for cesarean, etc. as soon as you can in your relationship.  And I recommend you ask direct questions that require real answers.  If you say, “I’d like to avoid episiotomy, is that possible?” consider how the answer might be different than asking, “How often do you find episiotomy necessary in your practice, and for what reasons?”  No piece of paper can be a replacement for the give-and-take that a real conversation holds.  If you are afaid you’ll forget what you want to talk about, jotting down some questions before the appointment to pull out if you forget can be helpful.  If you are intimidated by the idea of talking with your provider in such an open way, consider why you might feel this way.  Is it because you fear their response won’t be what you wished for?  If so, maybe you know in your heart already that you may not have yet found the right provider for you.  But the conversation is inevitable if your wishes for your birth are different than your provider’s, and it’s much easier to have the conversation before you’re in the middle of labor.  As another doula I know says, “would you rather have this conversation with your panties on or with your panties off?”

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PRO: Birth plans may give a woman a voice when she may not have the mindstate in labor to have one. Women in labor without drugs, especially toward the end of labor, are working very hard, expending the same amount of calories that an athlete uses to run a marathon (no joke!)  During this physical ordeal, it takes a great amount of concentration and they may have trouble finding energy enough to tell the doctors or nurses their preferences. Additionally, unmedicated women in labor enter a sort of trance state, brought on by hormones present, that create a frame of mind which helps a mother cope through the hard work of birth.  When a woman is in the middle of “Laborland”, it may be distracting for her to have to come out of it and into her cognitive mind to speak of her preferences for birth.  If the providers have read the birth plan, they will know your preferences ahead of time, and the mother will not have to be bothered.

CON: Many providers have a strong bias against birth plans. There is a belief among many providers that birth plans lead to cesarean section, although the research doesn’t bare this out.   Consider what just the presence of a birth plan might be doing to the mindset of the people who are to care for you.  Often a laundry list of things that providers are being told they can’t do can make them feel like their hands are tied to assist you in your birth.  The people you are relying for compassionate care may be aggrivated by you just for the existence of your birth plan.

ALTERNATIVE:  There are ways to communicate, even in the middle of birth’s intensity. Most things in a typical birth plan can be said in the moment instead of written out.  This way you only have to address the issues that come up in your birth.  This may preserve the feelings of your birth team and in turn make for a better birth experience.  If you are having difficulty speaking in the intensity of birth, you can wait until you are between contractions to address the issue, or you can have your partner speak to the provider (doctor, nurse or midwife) on your behalf.  You don’t have to give all the reasons in the middle of birth - if you are offered something you’d like to avoid, just a simple “no thanks” may do.  However, if something comes up in your care, you or your partner can take the time to explore it more fully by asking questions before you make a decision.  You can ask about benefits to procedures, what risks they hold, what other interventions come as a “package deal” with the procedure, any alternatives you might be able to try first, and so on.  Acknowledging the provider’s good intention for offering the change in your care first can help to keep the dialog friendly - for instance, “I understand you’d like to break my water to get labor to progress.”  THEN ask about the risks, benefits, alternatives and so on.  Most people find that if they have the ability to be involved at this level in their care, they feel better about the entire birth experience.

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CON:  Just because you wrote something down doesn’t make it happen or not happen. Often women get so caught up in the resulting imagery of writing a birth plan that they think they are creating a reality.  But many have noticed (myself included), that whatever isn’t “invited” to the birth often finds a way to crash the party.  If your biggest fear is of cesarean, will writing “I wish to avoid a cesarean section” really help you avoid one?  As Pam England, creator of Birthing From Within, says, “Birth is what’s happening while you are busy making birth plans.”

ALTERNATIVE:  Prepare for all possibilities. Instead of just writing you’d like to avoid something, learn about alternatives so you can suggest them as things come up.   Or, you have strong fears around a particular event happening, you may be able to deal with these fears beforehand so if this event becomes the next best thing in your care, you are more prepared.  You might explore your emotions through birth art, for example, or see a counselor to work through past events and their emotions that may find their way to your birth.  You could experiment with techniques such as relaxation, meditation, guided visualization or hypnotherapy to distract you through an event which might cause you distress.  Or, for some people, learning all you can about a feared procedure can be helpful.

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There’s no clear answer whether birth plans are good things or bad things, and each family must make the decision for what is right for them.  But understanding both sides of the birth plan debate can be helpful when making the decision whether or not to expend time writing one, or use that same energy to learn ways to communicate that may avoid the pitfalls that are commonly associated with a written plan for birth.

New Cochrane study: Midwife model of care recommended

Cochrane reviews do meta-analyses of all available research on a given topic then present their findings, and many have described them as the “gold standard” for medical research.  It’s a great place to get evidence-based information for any medical area, including Pregnancy and Childbirth.

A new Cochrane Review says that the Midwives’ Model of Care (intervening less often, only when medically indicated, instead of as a preventative measure) is the preferred, recommended model for low-risk women and has better outcomes.  Here’s the abstract:

Midwife-led versus other models of care for childbearing women

Midwife-led care confers benefits for pregnant women and their babies and is recommended.

In many parts of the world, midwives are the primary providers of care for childbearing women. Elsewhere it may be medical doctors or family physicians who have the main responsibility for care, or the responsibility may be shared. The underpinning philosophy of midwife-led care is normality and being cared for by a known and trusted midwife during labour. There is an emphasis on the natural ability of women to experience birth with minimum intervention. Some models of midwife-led care provide a service through a team of midwives sharing a caseload, often called ‘team’ midwifery. Another model is ‘caseload midwifery’, where the aim is to offer greater continuity of caregiver throughout the episode of care. Caseload midwifery aims to ensure that the woman receives all her care from one midwife or her/his practice partner. By contrast, medical-led models of care are where an obstetrician or family physician is primarily responsible for care. In shared-care models, responsibility is shared between different healthcare professionals.

The review of midwife-led care covered midwives providing care antenatally, during labour and postnatally. This was compared with models of medical-led care and shared care, and identified 11 trials, involving 12,276 women. Midwife-led care was associated with several benefits for mothers and babies, and had no identified adverse effects. The main benefits were a reduced risk of losing a baby before 24 weeks. Also during labour, there was a reduced use of regional analgesia, with fewer episiotomies or instrumental births. Midwife-led care also increased the woman’s chance of being cared for in labour by a midwife she had got to know. It also increased the chance of a spontaneous vaginal birth and initiation of breastfeeding. In addition, midwife-led care led to more women feeling they were in control during labour. There was no difference in risk of a mother losing her baby after 24 weeks. The review concluded that all women should be offered midwife-led models of care.

Although in recent months with the closing of the birth center and several midwives leaving town our options are more limited, there are still a few practicing midwives here in the Tri-Cities, for both home and hospital birth.  Also remember that some midwives practice more like docs, and vice versa.  There are  obstetricians who practice more closely to the Midwives’ Model of Care than to a typical doctor.  Asking pointed questions in an office visit can help you understand the usual ways of practice of any provider.

If you are looking for a midwife/midwifery practice and your local hospital does not offer one, speak up!  It will be impossible for the hospital to get one in time for your birth, but if enough people express interest you might just pay it forward to pregnant women who come after you.

Pretty new brochures and website stuff

I’ve got a few new pages on my website and wanted to share them with you.  Note specifically the “downloads” section where I’ve put up my pretty new brochures for you all to fawn over!  Please feel free to pass them on - in person or electronically.

- My new doula brochure

- My new Birthing From Within childbirth class brochure

I’ve also got a registration form on my site, and a calendar  (on the right-hand side) that lists upcoming classes (and hopefully soon, events).

- My new Birthing From Within class registration form

And also I’ve listed books in my lending library for those of you who are already clients.

“Mommy Brain” proven a myth

We mothers can’t use our maternal status as an excuse for forgetfulness anymore: it turns out that “mommy brain” is a myth.  Actually, motherhood IMPROVES our brain function.

“The researchers studied rats and primates and compared the brains and skills of females with and without offspring. As well as physical brain differences, they found that females with offspring were braver, could find food up to five times more quickly, and had better spatial ability than females without offspring.  Mother rats were much better at multi-tasking than non-mothers, they were better at finding their way through mazes and they were less anxious and fearful.”

Way to go, all you brave, resourceful, smart mommies!

I joined the Army today…

…and you can too.  Join the Army of Women and help fight breast cancer.

http://www.armyofwomen.org

New Birthing From Within class starting November 3rd

I’ll be starting a new Birthing From Within class starting in a few weeks.  There is still space left in the class - please contact me if you are in your second or third trimester and interested in joining in!  Here’s the class information:

Dates: Mondays, November 3rd, 10th, 17th and 24th
Hours: 6pm-9pm
Location: Wild Rose Midwifery (Fran Wilson, CNM) offices - corner of Fruitland and Kennewick Avenue in downtown Kennewick
Cost: $200 per family (feel free to bring your partner and/or one other person attending your birth)

I love a wide variety of people in my classes.  No matter if you are planning a homebirth or hospital birth, or if drugs and intervention are or are not a planned part of your birth, my goal is that you will accepted for your choices and benefit from the class.  We’ll cover lots of comfort measures, draw pictures, learn about pain of birth and much, much more.

I do teach within the Birthing From Within framework/philosophy, and throw a bunch of other things in I’ve learned from Lamaze training (but no pattered breathing) and also my doula training.  You can learn more about Birthing From Within by reading the book by Pam England (that’s the Amazon.com listing and it’s also fairly available commercially) and checking out the website at www.birthingfromwithin.com (make sure to read their philosophy here).

Generally, Birthing From Within classes might differ than a generic birth class in a couple of profound ways; they aren’t outcome-focused and want to teach a woman how to get through birth an any way she needs to get through it; they have some ancient techniques borrowed from Eastern philosophies such as Taoism, Zen and Bhuddism (but aren’t overtly religious), and they try and connect parents with their primal, creative brain rather than their cognitive, frontal-lobe brain as it’s that primal brain that’s activated in labor and the cognitive brain is harder to connect with.  However I also throw in a lot of practical information as well.

I’d love to have you join our class!

Doulas and more about childbirth in ‘USA Today’

Great article here. I especially loved this quote by Valarie King, Family Doctor from Oregon Health Sciences University (OHSU):

“If a doula could be put in an IV drip, everyone would get it.”

La Leche League rejoins the Tri-Cities!

After a long hiatus, La Leche League is back in the Tri-Cities!  I’m pleased as punch that there will be a support group again for breastfeeding mothers in the area.  PJ Jacobsen, a La Leche League leader, board-certified lactation consultant and owner of the breastfeeding megastore Birth and Baby will be leading.  Meetings will be held the first Wednesday of every month at 6pm at Jessica Burden’s home, as part of her postpartum support group, which meets the first and third Wednesdays of each month at 6pm and the second and fourth Fridays at 10am.  If you are interested, contact PJ Jacobsen or Jessica Burden to find out more.

Fertility Tourism?

You may have heard about plastic surgery tourism in the news, where people travel out-of-country for a breast augmentation, a tummy tuck, or a nose job, either for a lower price or for recovery away from public scrutiny in a pleasant atmosphere.

But what about fertility tourism?

In some countries, such as in the UK, it is advised that women who undergo IVF (In Vitro Fertilization) have only one embryo transferred into their uterus.  There, fertility treatment is covered by the NHS (the UK’s public medical system free to all citizens), but the wait is long.   In the US, we have a privatized medical system.  IVF is very expensive, and not covered by insurance.

There is a 10-25% chance of implantation success with each embryo transferred.  So, in the US, most women opt for multiple embryos transferred in the hopes that they’ll not have to pay for treatment again and again (average cost for IVF is about $10,000-$15,000 per treatment).

Some women in the UK are opting to go ahead and pay for the treatment abroad (not to mention a vacation) in exchange for a faster treatment time and upping their chances of success. The NHS is not particularly happy about this, because of the risks and cost of higher order multiple pregnancies.

Here in the US, women are also opting for fertility tourism to find lower cost options than the staggering price tags they are hit with here in the states.

Some governments are pushing for more international regulation of fertility treatments to counteract potential downsides to this phenomenon.

I don’t have any particular insight about all this, but thought it was an interesting cultural phenomenon.  The world is certainly flat.