Tuesday, January 24, 2012

A Woman-Centered Cesarean Birth

What a beautiful blend of obstetrics and midwifery to provide a woman-centered cesarean experience!


Thursday, January 19, 2012

QR Codes ~ what they are and why you may need one

Marketing is vital to birth professionals of all kinds, whether you are a doula, childbirth educator, lactation consultant, massage therapist - no matter what you do!  But marketing today is different than it was just five years ago.

When you hand out print materials (business cards, informational postcards or flyers - even posters), you want to entice the reader to visit your website or blog.  You want them to learn more about your philosophy, services and how to reach you.  The newest form of marketing to include on cards, postcards and flyers is called a QR Code.

A QR Code is a Quick Response Code or two dimensional code first introduced in Japan (Toyota). The code consists of black modules arranged in a square pattern on a white background.   Previously used to track auto parts, these Codes are now used in magazines, signs or city buses to drive visitors to URLs or Uniform Resource Locators, commonly called web addresses.


Now, if a person has a smart phone, they can download a QR Code Reader app and have access to the information encoded in the QR Code.


At this point, you may feel overwhelmed.  But if you can type in a web address and click your mouse, you are just a few moments away from creating your own QR Code!  And once you create it, you can put it on t-shirts, hats, bags and yes, even chocolates!


First, decide the URL that you are going to make into a QR Code.  Second, go to www.quikqr.com to make your Code.  Input the URL in the space provided.  Then you can either have it emailed to you OR you can right mouse click and open the image in any program that will transfer the image to a JPG or photo image (named after the group who created it: Joint Photographic Experts Group), such as the program Paint which is available on most PCs.  A JPG is nearly a universal photo image for use on computers, websites, etc.




Then, once you have saved your QR Code as a JPG, you are ready to insert it as a photo image on a variety of marketing items...want to give away chocolates with your Code on them?  Go to www.qrchocolates.com!  Need them on stickers or decals? Go to  http://www.dezignwithaz.com/modern-wall-stickers-objects/code-wall-decals-p-2371.html. How about a skin for your laptop, so the next time you are working at Starbucks, you can still be marketing?  Go to http://www.zazzle.com/laptop+skins+gifts.  And for business cards/postcards: www.vistaprint.com and for shirts and other imprinting www.4imprint.com.

I hope this has helped you with marketing your business.  Questions?  Email me at info@birthsource.com!



Wednesday, January 18, 2012

Comfort Measures ~ a vital role in childbirth education!

* You can find more articles like this at www.birthsource.com!


As you learn more and more about labor and the birth process, you will be fascinated by the number of comfort measures available to you. Each comfort measure is unique and designed to support you either physically or emotionally. You may not find complete information about all comfort measures in one place, however many of the most reliable measures are listed here.

Faith in the process, faith in the providers of care, and faith in your ability to make informed decisions about your care
Just as a marathon runner would not wait until the last moment to prepare for a major run, expectant parents should not wait either to be as prepared as possible. Emotional and physical preparation takes time and with time, comes faith in the knowledge and information you have received. You have the ability to make informed decisions based on the knowledge you have of alternatives. And carefully choosing care providers also enables you to trust in critical moments.

Active relaxation
There is definitely a difference between relaxation and sleeping. You can be tense and still fall asleep. Relaxation is a combination of rhythmic breathing and allowing tension to go out of your muscles. For some, relaxation techniques are not enough to get them to fully relax. Music therapy, massage and guided imagery may also be useful to get the expectant mother to relax.
Why is relaxation so important? More oxygen travels to both the laboring uterus and to the baby when a mother is relaxed. Also, the tension hormone, adrenaline, has the ability to slow or stop labor - depending on its level in the body. Reducing the tension in Mom can reduce the adrenaline, therefore enhancing labor!

Breathing techniques
Techniques vary based on the education and training from a childbirth instructor. Basically, breathing techniques keep you focused, maintain oxygen to both you and your baby, and give you something to concentrate on rather than the discomfort generated by the contractions. There is no one perfect set of techniques - rather it is the basic philosophy that works!
Education
Whether you take childbirth classes, do extensive reading, watch a variety of birth videos or obtain information from your care provider or, ideally, a combination of all, you should become educated as to the labor and birth process. Many mothers say that they are extremely frightened of the birth process, but that their fear and anxiety was greatly reduced with information!

Using a Trained Labor Support Person
Childbirth assistants or doulas can bring to your birth many emotional and physical advantages. These advantages include more comfort measures for your specific needs, a familiar face that stays beyond shift changes, comfort from a woman who has experienced childbirth ~ someone who can anticipate you and your coach's needs before you realize they are your needs. These women never take the place of the coach unless an expectant woman has no coach. Before choosing a doula, interview them and ask them about their experience and their philosophy of birth.

Birth ball in use Using Gravity to Enhance Labor
Try these helpful positions to keep labor moving right along!

  • upright positions
  • walking
  • hands and knees
  • using a Birthing Ball
  • squatting
  • supported lunge
  • swaying or dancing with partner
  • pelvic rocking
  • sitting in a rocking chair



Hot and Cold Therapy
Warm rice socks or ice pack can make lower abdominal or back labor more comfortable.


Music Therapy
Soft and quite relaxation CD's and tapes enhance relaxation at home and when you go to the hospital. Take along a CD player if one is not provided by the hospital.


Frequent urination
Emptying the bladder often reduces the discomfort of a full bladder and also reduces the blockage of the birth canal often made as the bladder increases in fluid.


Counter pressure
To help with the discomforts associated with true back labor, counter pressure is often the comfort measure of choice. Your childbirth educator or doula can help you with the specific positions for counter pressure and some interesting alternatives to just pressing with the palm of the hand!


Massage
Since the touch fibers in our bodies are larger than the pain fibers, messages travel faster from the area being touched to our brains. And since our brains can only process so much information, massage can help reduce the amount of pain our brain senses. How can this be? What happens when you stub your toe? You instinctively massage it and the pain magically becomes managable. This same principle can be used during labor. Massage is also a great way of reducing the tension in the body during labor.


Aromatherapy
Fresh cut grass reminds me of Saturday afternoons as a child; certain perfumes remind us of certain people. Pick a scent that will trigger pleasant thoughts and help you maintain relaxation during labor. Lavender and Chamomile are two scents that many expectant mothers prefer.


Water Therapies
Shower and the Labor Tub make use of heat therapy. And the Labor Tub uses hydrostatic pressure to reduce the feelings of discomfort brought about by increasingly intense contraction and the movement of the baby down into the pelvis. This increases relaxation and facilitates labor!


Focusing
A focal point: stuffed animal, photo, coach's face etc can help you keep focused on labor and relaxation, especially if you've practiced with it for months. Then it becomes a conditioned response to relax when looking at this object.


Guided Visual Imagery
Have someone read a very descriptive paragraph or story to you that could help you relax. Oddly enough, television is a form of guided imagery in that it takes us mentally from the place we are and transports us to different places. However, television does end and has commercials and this tends to break concentration.

References:
  1. Bobak, I., Jensen, M. Maternity & Gynecologic Care: The Nurse and the Family. (1989) St. Louis: Mosby Publishers.
  2. Nichols, F., Humenick, S. Childbirth Education: Practice, Research & Theory (2000) Saunders & Co.
  3. Livingston, C. The Birth Ball Source Book.  4th edition. 2011.  Perinatal Education Associates.
  4. Reeder, S., Martin, L., and Koniak-Griffin, D. Maternity Nursing: Family, Newborn, and Women's Health Care. (1997) Philadelphia: J.B. Lippincott Company.
  5. Sprague, A. Water Labour., Water Birth. 4th Edition. 2011. Amazon & Kindle Editions.
  6. Simkin and Ancheta. The Labor Progress Handbook: Early Interventions to Prevent and Treat Dystocia. 2nd Edition 2011. Wiley-Blackwell Publishers. Amazon/Kindle Editions.

Thursday, January 12, 2012

Learning Lamaze: Back to Basics!

You have been practicing the basics of Lamaze probably your whole life. Surprised? Let me explain…

Lamaze is built on the basic principle that you have the power to raise your pain tolerance through various comforting techniques. Lamaze, learning from the research of two specialists who published extensively in the 1960s, created techniques that challenged the body’s gating system. This gating system works on the principle that our pain fibers are smaller and the pain stimulation travels slower than touch. Our touch fibers are larger and thus the touch stimulation travels faster to the brain. If given a painful stimulus (stubbing one’s toe) and then rubbing the toe, the touch sensation travels to the brain faster and in greater quantity than the pain, thus closing the gate to the pain stimuli – as the brain can only take so much stimulation at one time. In turn, this enables the laboring mother to raise her pain tolerance (the variable degree of pain a person can endure) while acknowledging her pain threshold (the rising degree of pain from a particular source).

Lamaze also drew some of his knowledge from two Russian researchers who encouraged expectant mothers to practice certain techniques prenatally so that the techniques would seem almost automatic when they went into labor. These techniques included structured breathing patterns, focusing on an external source, and a relaxing touch technique call effleurage.

Breathing
All breathing begins with a Deep Cleansing Breath
Inhale-through the nose (if possible), keeping shoulders relaxed
Exhale-through the mouth, letting go of all the tension in your body

SLOW-PACED BREATHING
Rate is approximately half the number of breaths you normally take per minute; not less than 3 or 4 breaths per minute;aids relaxation and provides optimum oxygenation.
When doing the more advanced breathing techniques, return to slow-paced breathing when able.
Procedure:
Deep Cleansing Breath
Inhale (through nose if possible) to a count of 4 - In two, three, four
Exhale through mouth to a count of 4 - out two, three, four
Repeat the inhale/exhale throughout the contraction
When contraction ends, Deep Cleansing Breath

MODIFIED-PACED BREATHING
Rate is slightly faster than your normal breathing rate; not exceeding twice your resting rate; allows you to be more focused and alert.
Procedure:
Deep Cleansing Breath
Inhale through nose to a count of 2 - In two
Exhale through mouth to a count of 2 - Out two
Repeat the inhale/exhale throughout the contraction
When contraction ends, Deep Cleansing Breath

PANT-BLOW BREATHING
Same rate as modified-paced breathing
Blowing softly at regular intervals creates a rhythmic pattern
The pant is an in breath and an out breath (touching the tip of your tongue to the roof of your mouth will help keep your mouth moist)
Patterns may vary: pant - 2 -3 - 4 - blow, or pant - 2 - 3 - blow
Procedure:
Deep Cleansing Breath
Take upper chest, shallow breaths follow by relaxed exhales
At regular intervals, add a slightly emphasized exhalation (a sigh)
The importance is to keep facial muscles relaxed
When contraction ends, Deep Cleansing Breath

Focusing
A focal point is an object, such as a photo, stuffed animal or even a cross stitch piece that will help you to focus on something other than the contractions and the time that labor is taking. The focal point also helps to stimulate certain positive feelings…for example if you plan on giving the stuffed animal to the baby after the birth, there may be feelings of nurturing and love and motherhood attached to the stuffed animal. If the focal point is a photo of a place you have been, there may be feelings of calmness and serenity evoked when looking at the photo. If you choose to use your husband/partner’s eyes during labor as a focal point, this can be particularly empowering as you work together and a powerful team to being this new family! Knowing and drawing strength from your partner can energize a woman even in the closing hours of a long birth!

Effleurage
Effleurage is a rhythmic stroking motion on the larger portions of the body (long bones of the legs, back, abdomen) in circular or back-and-forth movements.
In the classical sense of Lamaze, the emphasis has been on carefully designed, learned and practiced breathing techniques, abdominal massage (effleurage), choosing a "focal point" to look at during uterine contractions, counting during contractions and understanding standard hospital procedures. Dr. Lamaze believed that distractions from pain reduces the perception of pain. Therefore, most women could labor and give birth awake, aware and under their own power if they mastered his techniques in order to avoid being overwhelmed by the intensity of labor. As mentioned previously, the Gate Control Theory or Gating Theory uses touch and effleurage as a key piece for raising pain tolerance.

While these tools and techniques cannot make labor painless, it can make labor less painful by showing you just how much power you have over the pain of the contractions!

Reference:
The Lamaze Guide: Giving Birth With Confidence, 2nd Edition Judy Lothian/Charlotte Dvries, 2010 

Friday, January 06, 2012

Update on Ingestion of Food and Fluids During Labor

Since C.L. Mendelson's report in 1946 (Mendelson C.L. The aspiration of stomach contents into the lungs during obstetric anesthesia. Am J Obstet Gynecol 1946; 52: 191-205.), most anesthesiologists assumed a very conservative stance used with obstetrical surgical patients with a "nil per os" (Latin for nothing by mouth or "NPO") for maximum safety. Is a slowing of the contraction pattern due to dehydration and no food/fuel? If so, does this also contribute to a slowed labor pattern and ultimately augmentation? More importantly, does having nothing in the stomach lower gastric acidity enough to protect the esophagus from corrosion should aspiration occur? Does being NPO eliminate Mendelson’s Syndrome?

Conversely, midwives and some physicians will allow fluids, soups, crackers, etc. during the early and active phases of labor. Can fluids or food during labor, along with IV fluids lower gastric acidity by giving the acid something to break down and facilitate the contraction pattern, possibly avoiding some interventions such as augmentation? And statistically, what is the likelihood of Mendelson's Syndrome or death from pneumonia due to aspiration?

According to Joy Hawkins, M.D. of the University of Colorado Health Sciences Center, scant key scientific data exists to show that laboring women who are kept NPO are less likely to die due to aspiration than women who had some sort of food or fluids. Without food, a laboring woman's body enters into ketosis. Starvation ketosis occurs when the pregnant body is starved, especially of carbohydrates. With starvation ketosis, tissues begin to breakdown and the byproducts of this ketabolism are called ketones, which actually aggravate nausea and possibly vomiting. So does keeping a woman NPO actually potentiate Mendelson's Syndrome? Additionally during pregnancy, women experience reflux due to delay emptying of stomach contents thought to be due to higher levels of progesterone, decreased motilin levels and the growing uterus applying pressure to the digestive system including the stomach valve. Do these hormonal influences along with NPO ketosis make things worse?

Dr. Robert Galser, M.D. of the University of Pennsylvania Medical Center says that we cannot afford to speculate as aspiration is a very real problem, especially for the mother who has general anesthesia with a cesarean section. Although Mendelson's research was mainly on rats and rabbits, it is suggested that IV's help to prevent ketosis while keeping stomach contents at a minimum. Currently, there is no evidence that moderate levels of ketosis are harmful to the fetus. Penny Simkin found that of several stressors in labor, being NPO was minimally stressful compared to not being active in labor.

In 2009, Maharaj (European Journal of Obstetrics, Gynecology and Reproductive Biology, September) stated that while the incidence of aspiration pneumonitis is rare, it is the fear of the birth-attendant to bear full responsibility if a patient inhales gastric contents when giving in to demands for liberal fluid and food regimes during labor that governs practice. While the bulk of evidence supports fluid intake in labor, there are insufficient published studies to draw conclusions about the relationship between fasting times and the risk of pulmonary aspiration during labor.

Singata, Tranmer and Gyte wrote in a 2010 Cochrane Database Systematic Review of restricting oral and fluid intake during labor (five studies and 3130 women), that the evidence “shows no benefits or harms” and that there “is no justification for the restriction of the fluids and food in labour for women at low risk for complications.

So is restricting food and fluids during labor a technocratic ritual or based on research? Since the basis for the restriction had the foundation of research in the 1940's when general anesthesia was the standard for cesarean sections, have we not progressed from there to the point where a significantly fewer number of women are exposed to general anesthesia for childbirth, with an even significantly fewer number of women aspirating acidic vomitus during anesthesia? Is this another case of "this is how we've always done it?"

Thursday, January 05, 2012

Pushing ~ What you need to know...


For most of labor, women feel like an observer instead of a participant. This feeling changes dramatically when the cervix reaches 10 centimeters dilated and 100% effaced. At this point the cervix is said to be “complete” and pushing can begin without fear of causing the cervix to swell or bruise (which can happen if pushing begins BEFORE the cervix is completely dilated or effaced).
The dynamics of pushing can be divided into 3 parts: position, breathing and effort.
Positions:
Techniques such as pushing while on a toilet, relaxes the perineal muscles while supporting the long bones of the upper legs. Psychologically, moms relax their bottoms when on the toilet and this become important during the Second Stage.
Many mothers will sit at a 30-40 degree angle or C-Position in the birthing bed. Any farther back or even a lying down position will work against gravity and often prolong the pushing part of labor.
Squatting either at the side of the bed or with the aid of a squatting bar encourages rapid descent, requires less physical effort and increases the diameter of the pelvis. Some moms may even do early squat pushing on egg-shaped birth balls. You work with gravity in a squat.
The hands-and-knees position is good for trying to turn a posterior baby, helps with fetal distress and takes the pressure off of the perineum. Many midwives say that this position is the best when there is suspected shoulder dystocia.
During a rapid birth, you may be instructed to side-lie, with your partner or assistant supporting the leg on top. This position slows descent somewhat, lowers the need for episiotomy and helps maintain good oxygen to the baby.
Breathing:
Continuous Breath Holding, also known as purple pushing refers to holding the breath so long and with such force that the small capillaries in the cheeks and face burst. Purple pushing produces Valsalva's Maneuver. Valsalva's Maneuver occurs with prolonged breath-holding ~ longer than 6 clock seconds. With prolonged breath-holding, there is an increase in the heart rate and the blood pressure. Immediately, a reflex of slower heart rate occurs. All of this disrupts the blood flow to the uterus and ultimately to the baby. This disruption in blood flow indicates a disruption in oxygen flow, which ultimately shows up on the fetal heart monitor as fetal distress. There is no clear evidence that closed glottis pushing (Valsalva's Maneuver) shortens second stage, decreases fatigue or minimizes pain. It has otherwise been suggested that bearing down for a prolonged period with a closed glottis alters the effectiveness of the contractions, leading to inefficient contractions and failure to progress.

Wednesday, January 04, 2012

Beyond Beyoncè: Five lies the media tells you about birth

As a birth journalist, I receive hundreds of pregnancy, birth and breastfeeding news alerts each day. About 85% of them are about celebrity pregnancies.  That leaves approximately 15% new stories, read by both parents and professionals,  that contain some modicum of truth.  Or do they?
What both parents and professionals see in the media (news, podcasts, internet, television shows and movies), to some degree, take away from the natural body instincts for birth and parenting.  Here are some examples:

  •      Childbirth is a dangerous event.   Studies from across the globe confirm that childbirth is inherently safe.  The WHO indicates that there may be only 10-15% of birth events in need of cesarean birth to maintain safety.
  •      Babies will drown during a waterbirth.  If you carefully examine the physiology of this event (water birth), you will see that since the baby is going from one water environment to another, and the umbilical cord is still attached there is no chance for drowning.  However, should the baby be brought up from the water and air is touch the face, this helps to initiate breathing and yes, if the baby is put fully back down in the water, that may cause a problem.
  •      The pain of childbirth is excruciating.  That actually depends on the situation.  Many times, pain is exacerbated by other situations: fear of the unknown, being alone, tension, reduced food and fluid intake, and sometimes just a simple low tolerance to pain.  In all of these cases, knowledge gained through childbirth education classes will help – not cure – the experience of pain in childbirth.

  •      Interventions during childbirth, including epidural anesthesia, are bad.  Again, knowledge is power.  With any medical procedure, from starting an IV to performing an episiotomy, there is risk.  However, the risks (all of them) must be weighed against the benefits (all of them) and vice versa.  This takes a birth team of skilled and knowledgeable people!  Another point to add here is that if the medical staff only know one way to handle a birthing situation, then all women in that birthing situation will be handled that one way.  It is how the staff are taught.  It is ingrained in then that THIS way is the BEST way….which may or may not be accurate.
  •      Because you are birthing in the US, you can be assured of accuracy, safety and a better birth outcome that most countries.  We Americans still have a LONG way to go in terms of the maternity care field.  While we don’t have the highest cesarean rate in the world, it is still over 33%.  Our maternal/infant mortality and morbidity statistics rank us lower and lower each year amongst other countries, sometimes as low as 51st place.



Regardless of whether you are a parent expecting a baby, or a birth professional, you need to know the facts, physiology and truth about pregnancy, birth and breastfeeding.  Read and read and learn, ask questions!  Go beyond Beyoncè to get the facts!