Monday, May 23, 2016

Summer Reading Suggestion: Cut It Out, the C-section Epidemic in America

It is summer time and you may be looking for a good book to read.  Like many birth professionals, you may want to stick with a specific genre - birth.  So here is a good....not GREAT book to consider for your summer reading time.  It is a page turner.  Yes, it's THAT good.

I did write about this book in 2013 when it was first released but feel that even now, there are valid points to be made. Cut It Out examines the exponential increase in the United States of the
most technological form of birth that exists: the cesarean section. While c-section births pose a higher risk of maternal death and medical complications, can have negative future reproductive consequences for the mother, increase the recovery time for mothers after birth, and cost almost twice as much as vaginal deliveries, the 2011 cesarean section rate of 33 percent is one of the highest recorded rates in U.S. history, and an increase of 50 percent over the past decade. Further, once a woman gives birth by c-section, her chances of having a vaginal delivery for future births drops dramatically. This decrease in vaginal births after cesarean sections (VBAC) is even more alarming: one third of hospitals and one half of physicians do not even allow a woman a trial of labor after a c-section, and 90 percent of women will go on to have the c-section surgery again for subsequent pregnancies. Of comparative developed countries, only Brazil and Italy have higher c-section rates; c-sections occur in only 19% of births in France, 17% of births in Japan, and 16% of births in Finland.

Author Theresa Morris systematically examines the reasons for the epidemic rise in cesareans as four pronged: women know very little about labor and birth and do not have complete access to unbiased, evidence-based information.  The co-optation of childbirth classes in the 1980s is the reason for this.  Yes, it may have been a "good idea" at the time to have childbirth classes move from the community to the hospital, but what many authors of the time feared would happen, has happened:  hospital based childbirth classes, generally, are a commercial for what can be expected at that facility.  Few mention broad options for childbirth, non-pharmacologic pain relief methods or informed decision making.  Secondly, care providers are constrained by their tunnel-vision training and/or their employer's risk management rules and do not or can not practice evidence-based care.  Thirdly, organizations take an inordinate amount of time to change policies, procedures and practice guidelines.  This encompasses ACOG and hospitals.  And finally, we live in such a litigious society that this hinders any type of movement forward in evidence-based quality of maternity care.

Morris points out that if our intervention rate (including cesarean sections) is rising, the maternal/infant mortality/morbidity rate should be dropping.  It isn't.  In other words, the more that is done to women, more mothers and babies are dying in America.  But Morris doesn't leave you stranded.  She thoughtfully points out a road map for change.

I suggest we all get on the road to change.

"Cut it Out: The C-Section Epidemic in America" is available through Amazon.  Hardcover is $30 but for those of us who don't like to wait, it is $9.99 on Kindle.  Happy reading!

Monday, May 16, 2016

HG Awareness Day ~ May 15....and every day!

Hyperemesis Gravidarum Awareness Day was Sunday May 15.  
However, it should be EVERY day!

In 1979, a young twenty-three year old was expecting her first child.  During her first trimester, she experienced the typical morning sickness.  At the cusp between second and third trimester, this young woman developed severe nausea and vomiting.  The severity was overwhelming to the point that she had to bring a “barf bag” with her wherever she went.  When she (a med-surg nurse) brought it to her obstetrician’s attention, he turned a blind eye, said hyperemesis gravidarum didn’t really exist, it was all in her head and handed her “water pills” to relieve the pitting edema in her calves, ankles and feet.  Fortunately, this young woman gave birth vaginally and had a healthy baby girl.  However, on the day of discharge from the hospital, her obstetrician told her that she would not be able to breastfeed because the water pills had dried up all of her milk.

According to Medscape, hyperemesis gravidarum (HG) is the most severe form of nausea and vomiting in pregnancy, characterized by persistent nausea and vomiting associated with ketosis, dehydration and weight loss (>5% of prepregnancy weight). This condition may cause volume depletion, electrolytes and acid-base imbalances, nutritional deficiencies, and even death. Severe hyperemesis requiring hospital admission occurs in 0.3-2% of pregnancies.

The HER Foundation (Hyperemesis Education & Research Foundation: is a non-profit organization that has been dedicated to HG support, education, research and advocacy since 2003.  The HER Foundation says there is no clear etiology for HG and it could even be due to multiple causes. When first recognized several centuries ago, HG was thought to be caused by toxins, ulcerations or an infection.  In the 20th century it was decided that HG was a psychological condition.  Today, lab tests can be done to confirm hyperemesis gravidarum.  These tests include urinalysis for ketones and specific gravity, serum levels of electrolytes and ketones, TSH and free T, and hematocrit levels to name a few. 

The only FDA approved drug for treating nausea and vomiting in pregnancy is pyridoxine or Vitamin B6.  Herbals such as ginger may also be helpful, but not in all cases.  In severe cases, antiemetics, corticosteroids or antihistamines may also be used.  Nutritional supplementations either by IV or directly into the GI system may help with nutritional deficiencies.

There are several handouts available from the HER Foundation and the University of Southern California:

Remember that young nurse from 1979?  She went on to become a childbirth educator so that other mothers could be aware of HG.  She also successfully breastfed her first baby, thanks to the local La Leche League.  That young woman was me. 

Tuesday, May 10, 2016

Childbirth Today Vlog for May 10!

In today's Vlog, we chatted about last week's Maternal Mental Health Day and noted that former Postpartum Support International President Birdie Gunyon Meyer will be a guest on the May 24th show.  She had trouble accessing the Vlog last week.

We also talked about International Day of the Midwife May 5 and how a Time Magazine article written by the program officer of the Bill and Melinda Gates Maternal, Newborn and Child Health Foundation stated that midwives are essential to Global health.  They are.  The research shows it. Unfortunately, we are just slow in embracing this!

Below is a portion of the interview with Jennifer Shryock, owner of Family Paws Inc. and her discussion about integrating babies into families that already contain pets.  Learn about Jennifer's upcoming speaking events and her international conference coming in July!

It is only a partial interview as the Blab platform is a beta version and prone to glitches.  It is also on my YouTube Channel ( - as are the other two interviews and shows plus much more!  Enjoy!


Wednesday, April 27, 2016

What is a Doula? Watch this!

Have you ever wanted to know about Doulas?

Have you ever needed a video to show potential clients?

This amazing video done by doula Amy Chavez is, well, perfect.

Take 20 minutes and enjoy!


Monday, April 25, 2016

Update: New Findings on Delayed Cord Clamping

Several new studies demonstrate the benefits of delayed cord clamping in infants, particularly preterm infants.

A study in the Journal of Maternal-fetal and neonatal medicine: the official journal of the European Association of Perinatal Medicine the Federation of Asia and Oceania Perinatal Societies and the International Society of Perinatal Obstetricians, states that after implementation of a delayed cord clamping (DCC) policy, preterm singleton infants had improved temperatures, increased hematocrits and decrease in the prevalence of intraventricular hemorrhage without significant adverse outcomes.

Jelin, A.C. et al. (2016) Clamp late and maintain perfusion (CLAMP) policy: delayed cord clamping in preterm infants. Journal of Maternal-Fetal and Neonatal Medicine.  29(11): 1705-9.


An interesting study from Advances in Neonatal Care: the official journal of the National Association of Neonatal Nurses tells us that DCC was the mainstay practice until the 1950s when a few studies suggested that it might interfere with active management of the third stage of labor. 

Bayer, K. (2016) Delayed Umbilical Cord Clamping in the 21st Century: Indications for practice. Advances in Neonatal Care. 16(1): 68-73.


A study published in  Transfusion states that DCC greatly diminishes volume and thus impedes the mount of blood collectable for cord blood banking.

Alan, D.S. (2016) Delayed clamping of the umbilical cord after delivery and implications for public cord blood banking. Transfusion  56(3): 662-5.


ACOG has not updated their Practice Bulletin/Opinion since 2014, however, they do state that a delay in umbilical cord clamping for up to 60 seconds may increase total body iron stores and blood volume in all infants .  In preterm infants, benefits include improved transitional circulation, better establishment of RBC volume and decreased need for blood transfusion.


There is a nice website called Delayed Cord Clamping with some updates through 2015 of evidence based articles:


And here is a nice overview of a study that followed children years later after DCC:

Monday, April 11, 2016

Childbirth Today is going LIVE on April 26!

The Childbirth Today has been very popular world wide for the past 7 years.  So on April 26 at 2:00 pm EST, Childbirth Today is going LIVE!

Thanks to the new and innovative chat app, BLAB, you will be able to find out about topics such as the "week in review" (hot topics in the maternity care community), meet new people and chat with our guests!  In a way, BLAB is a lot like Periscope but for groups!

Of course, I'll still have the same weekly update to the written blog, in cases the live chat is not your cup of tea.

So tune in on April 26 at 2 pm for Childbirth Today - we will give you the top 3 things you need to know for the week and so much more!