Three Rivers Birth Services

I am excited to announce that I have entered into a professional mentor/apprentice relationship with new doula, Melissa Reid, of In Bloom Birth Support.  What we’ve worked out is that when she is hired, I will mentor her via email, phone and in-person support through the prenatal and postpartum times for her client.  Depending on my availability in the moment, I will also attend the birth (if this is a part of the family’s wishes).  She will be the lead doula and I’ll be hanging back to help or problem-solve as needed.  This way, her clients will benefit from TWO doulas at a birth putting their heads togther.  So if my calendar shows that I am not available for your birthing time, know that this is another way to (probably) have me attend your birth.  Here is Melissa’s bio:

Name: Melissa Reid
Services Offered: birth doula services
Business Name: In Bloom Birth Support
Website: www.inbloombirth.com
Phone Number: (509) 539-0058
Email: inbloombirth *at* gmail *dot* com
Paragraph Bio: Melissa is currently pursuing certification with DONA International and is excited to train at the Seattle Midwifery School in September. She is currently accepting clients with due dates beginning in October.  She is offering her services at a discount while she is in the certification process.
Personal Philosophy: Melissa believes that pregnancy is a time to dream, hope, and prepare.  And it is her experience that things don’t always go as hoped for in the delivery room.  Having a doula at your birth can help to facilitate the desired outcome and provide a continuity and support that families may not have otherwise.
Favorite Quote:  “We have a secret in our culture, and it’s not that birth is painful.  It’s that women are strong.” – Laura Stavoe Harm
Favorite Books:
The Birth Partner by Penny Simkin
Ina May’s Guide to Childbirth by Ina May Gaskin
The Thinking Woman’s Guide to a Better Birth by Henci Goer

Alternatively, there are loads of great newer and experienced doulas here in the Tri-Cities – you can rest assured that you can find someone to fit every personality, philosophy and budget.  Contact me for more information!  And if you are interested in hiring me in helping mentor YOUR career path in as a doula, get ahold of me – and let’s talk!

A recent study is showing that as much as 7 out of 10 pregnant women in the US are low on levels of Vitamin D.

Vitamin D is important to bone health and development in both mother and fetus.  Vitamin D deficiency can lead to rickets, a weakening of bones, and early in life has been linked to increased risk of respiratory infections and childhood wheezing. Lower levels in adults have been linked to cardiovascular disease and specific types of cancer.

Natural Vitamin D development comes most easily from the sun, though it is also added to several foods and in vitamin supplements.

The easiest way to increase your Vitamin D intake is to spend more time in the sun, exposing some skin to the sun’s rays.  Depending on climate and skin color, we only need to be in the sun about 30 minutes, twice a week.  In the United States, with our indoors culture, this little amount is not being met by most pregnant women.  It is controversial how much sunscreen blocks Vitamin D production.

And while you are in the sun, it is a great opportunity to be active – perhaps go for a walk or bike ride on one of our many city paths or a hike up Badger Mountain, or even try a little prenatal outdoor yoga.

My first introduction to nitrous oxide and oxygen — or “gas and air” — as an option for pain management in labor was reading about an American woman giving birth in the UK a few years ago.  She was surprised and happy that with this birth, she felt more in control of her labor experience, was able to move around, yet still had some pharmacological help with the pain of birth.  She still had pain, but she was able to get through it without an epidural – something she had felt impossible with the birth of her first child.

Gas and air is used often in many countries.  In the United States, gas and air has not become a standard of care for pain management for birth.  In fact, only two hospitals in the country use it for birth- one being the University of Washington Medical Center in Seattle.  Yet recently, the American College of Nurse-Midwives is pushing for its more widespread use.

Consider the benefits of nitrous oxide pain management:

- It starts working very quickly, and can be started and stopped easily on a mother’s own will (by putting the gas mask to her face or taking it off).  She is in control of her own experience.

- It doesn’t slow labor as epidurals do.  It doesn’t increase risk of foreceps/vacuum extraction.

- It doesn’t require more monitoring and other interventions as epidurals do (blood pressure cuff, pulse, IV fluids, bladder catheter, more intensive monitoring, etc.)

- You can still move around to other positions for labor and pushing, and can still feel the urge to push.

You should know that it does make a mom a little light-headed, and like any drug, some of it does go to the baby, passing through it’s liver for processing, which can take a few days.  Read more about the nitrous oxide for birth here, then write your hospital/care provider and ask them to look into approving this method of pain management for birth.  Historically, it has been consumers who have changed the maternity care system in this country!

Sounds like our mothers and grandmothers were mistaken when they told us to take it easy during pregnancy: a new study shows that both mother and baby are not harmed when mom keeps exercising through to the end of pregnancy.  What’s more – there may be some benefit:

“Sedentary mothers of higher pre-gestational weight gave birth to heavier newborns. This relationship, however, was not observed in the group of women who exercised during pregnancy”, the researcher concludes. According to experts, babies with excessive weight (more than 4 kg) are more at risk of developing diabetes and certain types of cancer as adults, in addition to complications that may occur at birth.

Disclaimer: this may not be true for all mothers who may have different heath needs dependent on their unique condition.  Please check with your midwife or doctor before changing starting any exercise program.

Researchers have found for the first time that drinking more than 5 servings of sugar-sweetened cola a week prior to pregnancy appears to significantly elevate the risk of developing diabetes during pregnancy.

Link to study

What this tells me is good news for those of you not yet pregnant: you may have the opportunity, right now, to significantly lower your chances of gestational diabetes by watching what you eat, especially being careful to watch your intake of added sugars. Why care if you get gestational diabetes while you are pregnant? Women with gestational diabetes have a higher risk of bigger babies, induction of labor, cesarean birth and premature birth. More than that, if you’ve had gestational diabetes, you double your chances of developing regular diabetes later.  There is a statistical correlation that shows that your baby may also grow to develop diabetes or obesity later in life.

Of course, sugar intake isn’t the only thing to blame for GD, but it is one small way to try and lower our chances of disease in pregnancy.  And lowering our sugar intake is good for all kids of health reasons – for pregnancy and beyond!

Check out this great article from About.com, written by a dad who was not as excited as her wife was about their hiring a doula…and did a 180 degree turn from that opinion after the birth.

http://pregnancy.about.com/od/doula1/a/dads-and-doulas.htm

Although I won’t let a couple hire me unless BOTH of them agree and want me there, often even if the guy was a bit skeptical, he’s got even bigger “thank you’s” than the mother does after the birth of their child!

It happens to a lot of my clients; we’re nearing to the point where their provider wants to induce labor and the mom is desperate to get labor started more naturally.  When talking to the provider on putting it off doesn’t work (this is STILL an induction and has risks), this may be another way.  As with anything, please check with your provider before you attempt a method of induction.

Here are suggested guidelines on using a breast pump to induce labor.  Studies show it is as effective as Pitocin for starting labor in 3 days.

• Turn on the pump, and see if the flange that rests against your nipple fits, or if it pinches.  If it pinches, get a larger flange.
• Pump until you feel a contraction, then turn off the pump.  After 5 minutes, turn it on again until you feel a contraction, to mimic labor.  After a few minutes if your body is tolerating one side, you can try to bump it up to “level two” by pumping both sides simultaneously (if you have that kind of pump).
• Repeat for an hour.
• Do this three times a day for 3 days.
• If contractions are longer than 90 seconds each, stop pumping all together.

For safety, it must be advised that the mother bring her pump to a midwife or physician’s office the first time she tries this, while the provider listens to the baby’s heartbeat.  This is because there is low risk that the baby won’t tolerate these contractions well, as any form of induction usually produces stronger, longer and more sudden contractions than labor that starts on its own, and this is still a form of induction.  The breast pump is generally milder and safer than Pitocin, but it is always best to check the heartbeat and the baby’s response to induction before going home.  For the same reason, if a contraction occurs spontaneously between the 5 minute intervals with the breast pump, wait a full five minutes from that spontaneous contraction before using the pump again.

Partial list of references:

• J Reprod Med. 1986 Feb; 31(2):116-8. Chayen, et. al. Induction of labor with an electric breast pump.
• Cochrane Collaboration, 2007: Breast stimulation appears beneficial in relation to the number of women not in labor after 72 hours. http://www.cochrane.org/reviews/en/ab003392.html

Most of us doulas help women understand that moving around during labor, as opposed to curling up in a bed, helps labor progress quicker (on the average, 1 hour shorter, according to research) and with better results for baby’s positioning during birth.  However, current hospital rooms have the bed as a focal point as a comfortable place, and while a woman is in pain, it can be awfully enticing just to climb in between the sheets and curl into the fetal position (pun intended!).

But what if hospital rooms for birth looked completely different?  A pilot study at a Canadian hospital ran with this idea and came up with a pilot study called PLACE (Pregnant and Laboring in an Ambient Clinical Environment).  The way the study worked was like this:

Half of the mothers in labor labored in an ambient room, where a portable, double-sized matress with several comfortable pillows was put in the corner of the room in place of the hospital bed.  Fluorescent lighting was dimmed, and DVDs of ocean beaches, waterfalls and other soothing vistas were projected onto a wall.  A wide variety of music was also made available.  The result:

The other half of study participants gave birth in a typical labor room.

“The removal of the standard hospital bed sent a message that this was not the only place a woman could labour,” says Ellen Hodnett, RN, PhD, Researcher at the Bloomberg Faculty of Nursing, University of Toronto Hodnett. “The intent was to allow the women the ability to move about freely during their labour, to permit close contact with their support people, and to promote feelings of calm and confidence,” says Hodnett.

Reaction to the ambient room was overwhelmingly positive.  Perhaps more importantly were the other findings of the study.  Women who birthed in the ambient room:

• more than 65% of the women in the ambient room, compared to 13% in the standard room, reported they spent less than half their hospital labor in the bed
• women in the ambient room benefited from a 28% drop in infusions of artificial oxytocin (Pitocin), a powerful (and painful) drug used to advance slow labors
• women in the ambient room reported they received greater one-on-one attention and support from their nurses

I also wonder: did the women in the ambient room have less requests for pain medication?  Less cesarean births?  Were their labors shorter?  Did they have happier birth experiences?  Less postpartum depression?  Better breastfeeding success?

At any rate, the room’s design sure beats the alternative:

“This study raises questions about the assumptions underlying the design of the typical hospital labor room,” says Hodnett. “The birth environment seems to affect the behavior of everyone in it – the laboring women as well as those who provide care for her.

Hodnett hopes to further this study with a larger, randomized controlled trial.

View Dr. Hodnett’s study here: http://www3.interscience.wiley.com/cgi-bin/fulltext/122413904/HTMLSTART

Read her bio here: http://bloomberg.nursing.utoronto.ca/staff/Faculty_Bios/Ellen_Hodnett.htm

I’ve been conflicted about showing my statistics regarding my doula services and childbirth education.  On one hand, as a Birthing From Within mentor, I feel strongly that birth education and doula services shouldn’t be outcome-focused.  I don’t want people reading these statistics and get angry with themselves if they become in the minority and decide to go for an epidural or require a cesarean.  We can’t control birth, and in most cases there is no one to blame.  Yet, many people looking for a doula or a childbirth educator are doing so in the hopes of avoiding pain medication or cesarean birth.  And as a patient in the American medical system I wish that providers shared more statistics with their patients so that patients can choose the right provider for them.  It is a sticky wicket.

I’ve decided to put them down here, for now.  I don’t know how long I’ll keep them here.  I may continue to update them, or I may delete them tomorrow.  But first, please read a few disclaimers:

1) I absolutely realize that a healthy baby and healthy mother are goals number one for any birth.  I don’t publish health outcome statistics, because as a doula or a childbirth educator, I don’t practice medicine.  Doulas measure their success on the emotional happiness of the families who have their babies, which makes a ton of difference with regard to breastfeeding success, postpartum depression avoidance, and general family stability.  Of course there is no easy way to measure happiness.

2) I don’t think all interventions are evil, and certainly don’t teach that in my classes.  In fact, we do a lot of softening around the ideas of interventions if they become necessary, while at the same time empowering mothers and partners to ask questions that come up so they with their provider can make the right answer FOR THEM.  It is no surprise that I think that as a whole, the American medical system uses interventions too often and this causes more health problems than it prevents, statistically speaking.  I also believe interventions save lives every day.  And while I GENERALLY agree that birth can happen more often than not without routine interventions, I INDIVIDUALLY will stand strong for what a woman’s particular case is, medically AND emotionally.  Most, but not all, families who hire me are looking to avoid pain meds and/or cesarean birth, so that is what I’ll measure here.

With that said, here are the statistics so far for epidurals and cesareans from doula clients and folks who have taken my class:

***PEOPLE WHO HAVE ATTENDED MY CLASS WHO HAVE SO FAR GIVEN BIRTH***

EPIDURALS

Epidural – 16%* (Compare to average area hospital rates of 90%)
No Epidural – 58%** (note the unknowns lowers the stat – if unknowns are taken out, the number jumps to 79%)
Unknown – 16%
Other – 10%**

* Epidurals in most cases were because of inductions that were unplanned so their choice for pain medication changed.  However in the “no epidural” camp are plenty of women who had inductions without epidurals (it can be done!).
** A couple of these include women who chose a narcotic to “take the edge off”.
** Cesarean births without labor.

CESAREANS

Yes – 16%* (Compare to area hospital/national rates of 33%)
Unknown – 11%
No Cesarean – 73%** (note the unknowns lowers the stat – if unknowns are taken out, the number jumps to 82%)

* cesareans include planned breech cesarean birth, induction that ended in cesarean, and a previa.

***BIRTHS I’VE ATTENDED AS A DOULA***

Out of 13 births – two homebirth,  11 hospital

EPIDURALS

Planned – 15%
Unplanned – 23%*
None – 54%** (Compare to area hospitals at 10%)
Other – 8% ***

* Unplanned epidurals were mainly because of induction, however as soon as they found out they would be induced they became open to epidural.  An occasional induction was used as a last-ditch attempt to avoid a cesarean.

** Two were homebirths with a licensed midwife in attendance, most were hospital births with no pain meds at all, and occasionally there is a hospital birth with a shot of narcotic to “take the edge off”.

*** This was a planned cesarean birth I attended.

CESAREAN BIRTHS

Planned – 8%
Unplanned – 15%*
Total Cesareans – 23%**

* Unplanned cesareans were half for medical anatomical issues and half for failed induction.

** Since I’ve been teaching Birthing From Within this number has gone down considerably – so far not one of my doula births have been by cesarean.

Women who give birth in prison in most states are regularly shackled, preventing them from moving about during labor, and as anyone knows who’s ever attended one, women almost always move and change position during birth.  Although the American College of Obstetricians and Gynecologists (ACOG) has released a position saying that this is inhumane, only five states have outlawed the practice.  New York state will soon sign a bill into law and become the sixth state to outlaw shackling during childbirth. Incarcerated women in Washington State may are not shackled during birth as corrections policies forbid it, although there is no law on the books banning the practice. Quote from the NYT article:

“It is unbelievable that in this day and age a child is born to a woman in shackles,” Mr. Erato [a husband of a woman who was shackled during birth who had committed a nonviolent crime] said. “It sounds like something from slavery 200 years ago.”

In most cases, people who have studied the issue said, women are shackled because prison rules are unthinkingly exported to a hospital setting.

“This is the perfect example of rule-following at the expense of common sense,” said William F. Schulz, the executive director of Amnesty International U.S.A. “It’s almost as stupid as shackling someone in a coma.”

Clearly this is a controversial subject, as women who have been imprisoned are sometimes a violence risk, even if most are not.  Yet, could there be other ways of handling the situation, with guards standing by?  Is shackling inhumane treatment?  Thought-provoking articles from Salon.com and the New York Times here and here.