MOMS for the 21st Century Act ~ Have you heard????????

On July 21st, 2010, Congresswoman Lucille Roybal-Allard (CA-D) introduced the Maximizing Optimal Maternity Services (MOMS) for the 21st Century Act on July 21st in the House of Representatives. This legislation proposed by Congresswoman Roybal-Allard of California is designed to improve maternal and infant outcomes in the US.


If passed in its current form, House Bill 5807 could change the face of maternity care in the United States!  It will not only address the health and well-being of mothers and babies, but in the process save thousands of dollars now being spent for unnecessary interventions in all aspects of maternity care.  Thus the intent of this House Bill is to make the passion and dream of many a midwife, nurse, childbirth educator and doula come true: make evidence based maternity care a reality.


Particularly thrilling is the promotion of a Consumer Education Campaign (Section 103, page 17 line 22.) which "highlights the importance of protecting, promoting, and supporting the innate capacities of childbearing women and their newborns for childbirth, breastfeeding and attachment PLUS promoting the understanding of the importance of using obstetric interventions only when supported by strong, high quality evidence".  Later  in the same section, the Bill speaks of utilizing "non-invasive maternity practices....that are significantly underused in the United States, including...continuous labor support."  Clearly the writers of this Bill have done their homework and have spoken to the right people, as the verbage is heavy towards consumer education.


Title III (page 28, line 17) and other portions of the Bill addresses the need for more geographical and ethnic diversity.  The Bill incentivizes entering obstetrical care by providing financial support for physicians (OB and family physicians), and midwives (CPM and CNMs) as well as grants to professional organizations to increase diversity in maternity care professionals.  Additionally, the Bill addresses the disparities of maternity care of women/care of newborns along racial and ethnic lines.  In spite of tremendous strides in innovative technology, our statistics in the world as far as maternal morbidity/mortality and infant morbidity/mortality is bleak.  Many hospitals in this country are either updating NICUs or building newer/bigger NICUs for the influx of near-term infants, many of whom are the result of inductions too early.


As it reads now, the bill will create a Center for Excellence on Optimal Maternity Outcomes to oversee many of the above projects.  As long as the sponsors of this bill (currently 24 and referred to the House Energy and Commerce subcommittee and the House Ways and Means subcommittee), stay true to the verbage of this version of the bill, great things will happen for women and children in the United States.

Where to take it from here?  Not sure?

Here are some easy steps!  And this is what I am doing!

1) Find out who your US Congressperson is ~ not sure?  click here  If you are close to several districts, make sure you energize others in those districts to make appointments NOW with the Rep.  They will very soon be on a six week summer break!  Most likely, the bill will be reintroduced after the first of the new year.  


2) Take some information with you as evidence of why you are supporting this bill!  First read the bill yourself and highlight the points you want to make with your Rep.  You may not have much time to meet with them.  Not sure what to take?  I have put together a packet of information for my own visits.  I will gladly send one to you for the cost of copying and postage.  Contact me for additional information on this packet at info@birthsource.com. 


3) After you have met with your Congressperson, let me others know what you did and what the reaction was!  Email me and I'll be posting the responses on the my Facebook page!

Sorting Out All of The Recent Flood of Research!

There is NO doubt about it ~ there has been a flood recently of information, data, research and press releases regarding maternity care.  One of the two most fascinating pieces of information is the newest ACOG (American College of Obstetricians and Gynecologists) Practice Bulletin on VBAC (#115).  I recently blogged about this very Practice Bulletin.

Now, in a great PDF by Childbirth Connection, you can print off the "Comparison of American College of Obstetricians and Gynecologists VBAC Practice Bulletin 115 (2010) with VBAC Practice Bulletin 54 (2004) and Induction of Labor for VBAC Committee Opinion 342 (2006).

You will be able to see side-by-side comparisons of the three articles/Practice Bulletins including "What resources are recommended for offering labor after cesarean", "Who is a candidate?", "What Kind of Care is Appropriate for labor after Cesarean" PLUS whether the recommendations are Level A ~ based on good and consistent scientific evidence, Level B ~ based on limited or inconsistent scientific evidence or Level C ~ recommendations are based primarily on consensus and expert opinion.

Great handout for professionals and expectant parents!

2 + 2 Is Still = 4, So Don't Discourage Childbirth Classes

I can remember sometime between junior high and high school, new math was introduced.  It would revolutionize math as we knew it ~ we would be math geniuses, plus run faster and jump higher (insert some sarcasm here).  But alas, 2 + 2 still equalled 4.

For years, (ok perhaps decades), childbirth educators have been discussing, exploring, documenting, investigating, mulling-over, speaking about, shouting about, and jumping up/down about the link between early induction of labor, the rise in the cesarean rate and near term infant births.

Dr. Deborah Ehrenthal of Christiana Care Health System published a study in the July issue of the journal Obstetrics & Gynecology found that among more than 7,800 women giving birth for the first time, those whose labor was induced were twice as likely to have a C-section delivery as those who experienced spontaneous labor.

In today's Time Magazine article  Are C-Sections Overused? Rethinking Induced Labor, author Tiffany O'Callaghan states that "the (high) rate (of induction) is significant because ACOG guidelines, which have been in place since 1982, recommend against elective inductions in the early term, or anytime before 39 weeks."  She hits a home run when she also states that "Despite studies showing VBAC to be safe for most women — ACOG data suggests that 60% to 80% of women who attempt VBAC will succeed — many hospitals have urged women to undergo a repeat cesarean over the past decade, largely to avoid medical risks and malpractice suits."

In discussing the relationship between early induction and the need for cesareans, O'Callaghan reported that researchers found that under the new policy the overall induction rate dropped 33% and the rate of elective inductions fell by roughly the same amount. What's more, the total number of C-sections among first-time mothers who underwent elective induction dropped 60%. The results of the Magee-Womens study were published in April 2009 in the journal Obstetrics & Gynecology.

Near the close of the article, Dr. Ehrenthal advised that patients should be informed and included in the decisionmaking process.  That is something, too, that childbirth educators have been including in their classes for decades.  

However, with the amount of clout that physicians/obstetricians do have with their patients, they must certainly understand that discouraging attendance at childbirth education classes interferes with the amount of birthing information, knowledge of alternatives and exposure to informed consent.  Since we all live in a mobile society, many of us do not have the luxury of learning about birth from the wise women in our families, nor do we have the opportunity to attend the births of our aunts or siblings.  Hence, we read books (some questionable at best), view birth related television shows (now those are factual, aren't they ~ oops, sarcasm again), or surf the internet. I think it would be fair to say that perhaps none of the above 3 information gathering techniques (books, tv or the internet) would lead to definitively lead a pregnant women to the Healthy Care Practices from the World Health Organization or those crafted by Lamaze International.


As Mary Kroeger stated in the book Impact of Birthing Practices on Breastfeeding, "Solid scientific evidence shows that returning to birthing practices that preserve normalcy can accomplish many things: faster, easier births; healthier, more active and alert mothers and newborns; and mother-baby pairs physiologically and optimally ready to breastfeed."


The information in the ACOG revision and the Time Magazine article (plus thousands of other media publications) regarding inductions/cesareans/VBACs is not new.  2 + 2 still = 4.  If physicians would be willing to work together with childbirth educators to achieve Dr. Ehrenthal's suggestion (and that of Healthy People 2010) that patients should be informed and included in the decisionmaking process, then we just would not only lower the U.S. cesarean rate, but also impact the health of newborns with fewer admissions to the NICU, higher breastfeeding rates, AND maternal morbidity/mortality rates that are better than some third world countries.

ACOG's Reversal: VBACs are ok now?

Just about everyone has now weighed in on the July 21st statement from the American College of Obstetricians/Gynecologists regarding their reversal of opinions of VBAC (vaginal birth after cesarean).


From Arkansas, THV reported these statements.  Their statements are in blue.  Mine are in green.

The number c-sections performed in the U.S. each year has been on the rise, now accounting for one third of all births. Doctors say preventing unnecessary repeat c-sections is one way to bring down those rates. 

Yes, this is true.  The US cesarean rate is flirting with 33%.  Wasn't just in March of this year when the National Institute of Health convened and contradicted just about every negative reference to VBAC with facts?  And what about those restrictive policies that often contribute to cesarean surgery?  Such as restriction of light foods and fluids during labor (cars need gas to run...so do humans), staying in bed rather than moving around or getting into gravity positive positions to facilitate and enhance labor/birth?  Induction of labor with an unfavorable Bishop score and no signs of labor AND no signs that the baby/mother are in distress?

According to the journal, 60 to 80 percent of women who've had up to two previous c-sections, are appropriate candidates for natural delivery.

Despite our best efforts and most current technology, the maternal morbidity/mortality rate in the US continues to climb.  Why did it take so very long for ACOG to address the research?

But patient fears, coupled with insurance company restrictions on doctors, have kept the vaginal birth or v-bac rate low.

Yes, patient fears.  Anecdotally, in my own practice, it has been a combination of physician scare tactics and media irresponsibility that have contributed to my clients' fears of VBAC.  I would be curious to hear what others think here.

Some doctors have had legitimate concerns about v-bac; because there can be complications like uterus rupturing; adding that multiple c-sections can put women at risk for hysterectomies, colon and bladder injuries and infection.

In the same statement by ACOG (2004) they state that "misoprostol (Cytotec) has been associated with an unacceptably high rate of uterine rupture in women with a previous cesarean delivery."  Research shows the risk of uterine rupture with Cytotec without every having given birth!  Yet, physicians and an alarmingly increasing number of midwives are using Cytotec because, apparently, it is more economical.  Uterine rupture with VBAC is 1/2 of 1%.

And Lamaze International was right in issuing caution in their statement:

"The revised guidelines acknowledge that requiring “immediately available” resources for an emergency cesarean have resulted in hospitals, insurers and the obstetric community issuing formal or informal bans of VBAC, effectively denying women access to care and choice in birth.  While this was not the intention, the “immediately available” language remains in the new guidelines, which may continue to unfairly limit women’s access to VBAC. "

So when it all shakes out, what does all of this mean?

It means several things, clearly.  

We advise expectant parents to READ, LEARN, and READ some more to get a clear and distinct picture of the research and evidence.  Investigate as many sources as possible during your nine months of preparation for your baby: your physician or midwife, your childbirth education classes, friends, books, and the internet.  

Secondly, we URGE childbirth educators to teach evidence-based information in an easy-to-understand format to support all (regardless of age or education) women to make informed decisions about all aspects of the pregnancy/birthing process.

No one will take better care of you than you!  And no one will take better care of your baby than you.  Begin now!

In Preparation for World Breastfeeding Week ~ 10 More Days...

With only 10 days to go until World Breastfeeding Week, I thought I'd share some quotes about breastfeeding with you.  Using attribution, you can add them to websites, blogs, Facebook, Twitter, handouts, flyers and more!  I hope you enjoy them as much as I enjoyed collecting them!


If a multinational company developed a product that was a nutritionally balanced and delicious food, a wonder drug that both prevented and treated disease, cost almost nothing to produce and could be delivered in quantities controlled by the consumers' needs, the very announcement of their find would send their shares rocketing to the top of the stock market.  The scientists who developed the product would win prizes and the wealth and influence of everyone involved would increase dramatically.  Women have been producing such a miraculous substance, breastmilk, since the beginning of human existence.  ~Gabrielle Palmer




Nursing does not diminish the beauty of a woman's breasts; it enhances their charm by making them look lived in and happy.  ~Robert A. Heinlein


Mother's milk, time-tested for millions of years, is the best nutrient for babies because it is nature's perfect food.  ~Robert S. Mendelsohn


People need to understand that when they're deciding between breastmilk and formula, they're not deciding between Coke and Pepsi.... They're choosing between a live, pure substance and a dead substance made with the cheapest oils available.  ~Chele Marmet


When we trust the makers of baby formula more than we do our own ability to nourish our babies, we lose a chance to claim an aspect of our power as women.  Thinking that baby formula is as good as breast milk is believing that thirty years of technology is superior to three million years of nature's evolution.  Countless women have regained trust in their bodies through nursing their children, even if they weren't sure at first that they could do it.  It is an act of female power, and I think of it as feminism in its purest form.  

~ Dr. Christiane Northrup

A baby nursing at a mother's breast... is an undeniable affirmation of our rootedness in nature.  

~David Suzuki

Ten Ideas for World Breastfeeding Week 2010

You know World Breastfeeding Week is just a few days away....now, how are you going to promote it in your community?

Here are 10 quick ideas to help you get started!

1) Visit the World Breastfeeding Week website (www.worldbreastfeedingweek.org) and download free promotional materials!


2) Take the PLEDGE to promote World Breastfeeding Week ~ go to www.tensteps.org/pledge-form.shtml and put your promotion on the map!


3) Do you have a Facebook page or do you Twitter?  During the week of August 1-7, put something about breastfeeding out there each day.


4) Wonder how others have put the international sign for breastfeeding support on their Facebook profile page?  Here's how: http://twibbon.com/cause/World-Breastfeeding-Week/facebook


5) Honor the local lactation consultants: invite them for ice cream, take one to lunch or hold a tea in their honor!


6) Write a press release about World Breastfeeding Week and send/fax it to your local newspaper.


7) Tell others about the podcasts about breastfeeding from La Leche League.


8) Visit latchon.org for more ideas.


9) Visit the La Leche League page for World Breastfeeding Week for even more info.


10) Get the 8th (newest) edition of "The Womanly Art of Breastfeeding", just released!

What We Can Learn About Birth From History ~ Part 4 (final)

In this excerpt from "The Timeless Way", film makers at Injoy give us something to think about: Consequences of Modern Birth Practices.  This serves as an intro to my next blog post. 

If you are viewing this on Facebook, to see the video go to http://www.childbirthtoday.blogspot.com/.

What We Can Learn About Birth From History ~ Part 3

In this excerpt from "The Timeless Way", film makers at Injoy give us a unique picture of birth in the past ~ the 1800s!  If you are viewing this on Facebook, to see the video go to www.childbirthtoday.blogspot.com.

My Passion for Chocolate ~ Justified!

Ok, so this entry in my blog is not necessarily about birth ~ one of my passions.  It is about one of my OTHER passions ~ chocolate.


I am forever justifying to anyone who will listen about the health benefits of chocolate.  Finally, I have compiled a list that is evidence-based!

Chocolate is loaded with antioxidants, calcium, potassium and vitamins B-2 and E.

The darker you go the better. The darker it is means it has more cocoa – an ingredient shown to trigger the release of neurotransmitters that help alleviate depression.

Chocolate can also help relieve stress. In a recent study, those who ate about an ounce and a half of dark chocolate every day for two weeks, reduced their stress hormones. (For some, this may be reason enough!)

Theobromine, an ingredient in chocolate, is more effective at stopping persistent coughs than codeine.

Chocolate is also good for your heart, it contains oleic acid – a monounsaturated fat that helps boost good cholesterol levels.

Flavanols in chocolate MAY help prevent arteries from hardening. 


So there...you have it.  The very next time you need chocolate, here is why!

What We Can Learn About Birth From History ~ Part 2

  In this excerpt from "The Timeless Way", film makers at Injoy give us a unique picture of birth in the past and in other cultures...through art.  The important take-away from this is that upright, gravity positive positioning does enhance the birth process AND that support during labor will also enhance the experience. If you are viewing this on Facebook, to see the video go to www.childbirthtoday.blogspot.com.

What We Can Learn About Birth From History ~ Part 1

Art does imitate life.  Sometimes, art is the only way we can view the past.  In this excerpt from "The Timeless Way", film makers at Injoy give us a unique picture of birth in the past and in other cultures...through art.  If you are viewing this on Facebook, to see the video go to www.childbirthtoday.blogspot.com.

A Breech In The System: Trailer to a New Film!

If you are viewing this on Facebook, to see the video go to www.childbirthtoday.blogspot.com.

A Follow-up Post

If you are viewing this on Facebook, to see the video go to www.childbirthtoday.blogspot.com.

Reinventing Childbirth Education: Another Call To Action

I sat absolutely riveted to the latest issue of BIRTH (Vol 37, No 2 June 2010), particularly the Editorial by Diony Young (Childbirth Education, the Internet, and Reality Television: Challenges Ahead), and an article by Theresa Morris PhD and Katherine McInerney MA titled "Media Representations of Pregnancy and Childbirth: An Analysis of Reality Television Program in the United States".

Morris/McInerney analyzed 41 episodes of Birth Day,  and 44 episodes of A Baby Story for a total of 123 births.  Not to any maternal child health professional's surprise, interventions and technological control such as IVs were portrayed as natural and normal, and birth with medications such as epidurals was portrayed as easy and fun.  Seven of the births were out of hospital (two homebirths and five in birth centers), but were marginalized under titles such as "alternative" or "unexpected" ~ since only 5.7% of the births were such, the chances of a random viewer seeing them was slim.

It was no surprise that pregnancy and childbirth was represented as dramatic and perilous ~ after all, that is what brings in viewers and consumers and sells the products touted during the commercials.  Morris/McInerney suggest that the practices shown in these childbirth reality shows are not consistent with evidence-based care.  Women are viewed as in danger and in need of technology to rescue them.

Diony Young, editor of BIRTH, stated that according to the Listening to Mothers II survey, 25% of women reported attending childbirth education ~ a drop from 70%  in 2002.  Most women use the internet as a source of information on pregnancy and childbirth - nearly 97% and 68% of women watch the reality birth shows regularly.

These findings walk hand in hand with those brought forth by Vicki Elson in her documentary film "Laboring Under An Illusion" (click here for review of that film).  Elson concludes that media makes women scared of the normal physiological birth process.

Young goes on to say "Childbirth educators and other health professionals will have to find new ways to fill in the gaps and help women evaluate what they see, understand the evidence, and sort out the facts from the fiction."  Lastly, she makes an incredibly intuitive statement:  "They will have to re-invent childbirth education".

I sat long and hard staring at the BIRTH articles trying to figure out how to reinvent childbirth education and came up with a few steps to do this.  I wanted to share with you what I came up with:

1. Childbirth Educators must look and act professional in all that we say and do.  From your blog, to Facebook to your website, it must be professional and evidence-based.  It must have references and footnotes to show research.  That way, visitors know it is not just your opinion.

2. We must ALL take a lesson in marketing our classes - become more savvy and smart.

3. We must ALL take a good hard look at our teaching techniques ~ you cannot teach like its 1999!

4. We must ALL become more well read as far as research and journals. 

5. We must ALL become a part of something larger than ourselves.  An easy fix to this is to attend the Lamaze/ICEA Mega Conference in Milwaukee in September.

6. We must ALL bring that spirit of something bigger back to our own community, re-energize those who were not able to go and then reach out in innovative ways to the pregnant community.

7. We must ALL refuse the pull to be adversarial - enabling arguements and ill feelings only cause us to spin our energy wheels while defensive medicine and interventive birth becomes more accustomized into our culture.

8.  We must ALL form a new paradigm for childbirth education ~ discuss what this looks like and rapidly implement it to begin a revolutionary change.

9. We should ALL read the book "Lead, Follow or Get Out of the Way."

Because if we don't, there may not be a future of birth ~ we need to be making a difference again!

Thank you so much to Diony Young for such a dynamic issue of BIRTH: Issues in Perinatal Care!

Important Notice from RxList.com

[If you are reading this on Facebook, please go to www.childbirthtoday.blogspot.com]


Many of you have visited RxList.com to check on medications, indications and dosages.

From their website, "RxList.com is Owned and Operated by WebMD and part of the WebMD network.  RxList is an online medical resource dedicated to offering detailed and current pharmaceutical information on brand and generic drugs. Founded by pharmacists in 1995, RxList is the premier Internet Drug Index resource. Our knowledgeable staff at RxList continuously reviews and updates the site with articles written by pharmacists and physicians and data provided by credible and reliable sources like the FDA and First Data Bank, Inc. to ensure the most accurate and beneficial information is provided."



So this is a website we can trust and quote, right?

Upon scanning for indications for Pitocin use, I found this, boxed and highlighted:


IMPORTANT NOTICE



Elective induction of labor is defined as the initiation of labor in a pregnant individual who has no medical indications for induction. Since the available data are inadequate to evaluate the benefits- to-risks considerations, Pitocin is not indicated for elective induction of labor.

Your thoughts?

My Top Fav Quotes, As Applied to Birth

I was updating my Facebook Info page the other day when I took a good look at my quotes.  So I decided to take my favorite quotations and apply them to birth!  Yes, this is a quirkie blog post!  If you are reading this on Facebook, please go to http://www.childbirthtoday.blogspot.com/ to read more posts.


Always stand on principle, even if you stand alone ~ John Quincy Adams
This has pretty much been my credo as I became a birth researcher many years ago and discovered, much to my distress, that nursing practice and maternity care does not always follow the evidence to provide optimal outcomes for mothers and babies.


"Well Behaved Women Rarely make History!"
Those of us who do stand on principle, don't expect to be famous or remembered.  We work everyday so birth can be safe for those who are birthing today and tomorrow.


"It is very Vermonty this time of year"
This is from the movie classic "White Christmas" but it refers to the cold winters of Vermont.  Unfortunately, it also reminds me of the bedside manner of many care providers today.


"Oh, Hell No" (Will Smith)
What is mentally going through my head when a client is facing an unnecessary intervention!  It does NOT come out of my mouth, however!  LOL!


"You need to be more F-L-E-X-I-B-L-E" ~ Elastagirl in The IncrediblesWhat I try to instill in my clients when talking about birth plans - yes, birth PLANS. 


"It's Guuuuuud" (Jim Carrey from Bruce Almighty)
What birth is most of the time!


"Now that is dirty" Mike Rowe from Dirty Jobs
Now some people think that breastfeeding is "dirty" or "sexual".  No people, it is food.  FOOD!  And don't even think about saying a mother should feed her baby in a bathroom - never say that to me!

"No Fear" ~ a sticker I bought.With education, there would be no fear of pregnancy, birth, breastfeeding or parenting.  We study for a driving test, why don't we study for the most important jobs of our lives?
 "If you polish a turd it is still a turd" ~ Peanut, comedian Jeff Dunham's "friend"
Um, what I think of some research and studies who spin results to suit the sponsor's agenda.

New Doula Movie!

It is exciting indeed to see a movie specifically about doulas!  Due to be released in June, this movie is 65 minutes in length and is set for world-wide distribution.  While I have my copy on order and admittedly have not seen it all, the trailer is certainly promising!

Evidence-Based: Important and Necessary...now!

The undercurrent of maternity care practice, whether one is a physician, midwife, nurse, childbirth educator, doula or lactation consultant, is the question of evidence based practice.
As defined by Childbirth Connection, evidence based maternity care uses the best available research on the safety and effectiveness of specific practices to help guide maternity care decisions and to facilitate optimal outcomes in mothers and newborns.
For independent practitioners, implementation of new practices based on evidence may not be as cumbersome as in large facilities or institutions. Researching and rewriting current policies, procedures and practice guidelines takes dedication to the health and well-being of mothers and babies, funding, time and consensus amongst those in the approval process. These long processes are a challenge to translating the evidence into practice and prolong the adverse reactions to increased intervention and keep the US maternal and infant mortality/morbidity rates in the substandard category.


Foremost in the minds of care providers must be the fact that for most childbearing women in the US (and for that matter world-wide), pregnancy and birth are conditions of health and most women are at low risk for complications. A broad knowledge base is needed to provide care and support for physiologic birth – an instinctual and hormonally driven process. The body has the potential of producing high levels of pain-relieving opiate beta-endorphins and endogenous oxytocin, which both facilitate labor and birth, inhibits postpartum hemorrhage and promotes fierce bonding and newborn wellness.


However, lacking from 99% of nursing school curriculum and residency programs are the skills necessary to promote physiologic birth. Underused practices include skilled labor support, facilitation of labor through the use of gravity positive positioning, enhancement of Second Stage through gravity positive positioning, labor comforts including aromatherapy, relaxation and hydrotherapy, delayed cord clamping and uninterrupted skin-to-skin contact.


Although not just iatrogenic, blame can also be placed in the area of inadequate informed consent practices AND a lack of preparation by expectant women and their partners. An embarrassing average of 25% of women attend any type of childbirth education classes in the US, enabling them to remain uninformed, unprepared and uneducated. With the biased view of birth presented by the media, clients come to childbirth education class with nearly ridiculous views of their body, pain in labor and birth itself.
It is evident that women do not know their options because they often do not have credible sources of information at their fingertips. What they read in books, hear in childbirth class, or are told by their care providers often clash and send the expectant mother into confusion ~ who can she believe, who should she believe?

Putting the mother or family between a rock and a hard place is our fault. There should be consistency in the evidence-based material given to women. And we should begin being consistent NOW!

Staying Objective When Talking About Informed Consent

As childbirth educators, doulas, lactation consultants and nurses/physicians, we all use informed consent when presenting information to our clients/patients.  To thoroughly understand the need for objectivity in presentation, one must first understand the meaning of informed consent.

What is informed consent? Informed consent, or freedom-to-choose, have become frequently used terms, not only in the current maternity/health care environment, but also in every day life. The idea of informed consent fosters learning about the birthing event that may change a woman's perception about her role as a mother and quite possibly her total self-concept. To interfere with this growing and learning process, to stifle the process of informed consent is possibly to set up a situation of sadness, anger, disillusion or feelings of failure.Informed consent is a legal doctrine in America that is defined in all 50 states as consent to treatment (for example, consent to a cesarean section/ abdominal surgery to assist in the delivery of the baby) obtained after adequate disclosure. As defined by Ethics in Medicine from the University of Washington School of Medicine, informed consent "is the process by which a fully informed patient can participate in choices about her health care. It originates from the legal and ethical right the patient has to direct what happens to her body and from the ethical duty of the physician to involve the patient in her health care."

This definition is simple in theory but complex in operation. The problem is, "What is adequate disclosure?" Adequate disclosure varies from state to state. Informed consent is defined in most states as a consent obtained after telling the patient the following:



1. What is the proposed treatment or procedure? Make sure you fully understand what is suggested and how it is done.


2. What are the benefits?


3. What are the risks?


4. What are my alternatives?

5. What would happen if I did nothing?

That being said, informed consent should go one step farther and incorporate voice inflection, facial expressions and body language when covering the above 5 steps as to not to overtly or covertly influence behaviors.  This involves knowing ones triggers and being in control when discussing trigger-producing subjects.  For example, if a care provider has deep feelings about epidural anesthesia, their voice or body language may "say" one thing while the words that they say may "say" quite another.

To be absolutely fair and present informed consent in an unbiased way, our body language should be appropriate.  Acknowledge that body language can be a powerfully persuasive tool and assess yourself for body language cues.  With an estimated 55%+ of what you say as nonverbal, what are you saying to clients/patients?  Our voice intonation tells a whopping 38% and only 7% is verbally what we really mean.  So in a normal conversation, 93% of what someone else is getting from us is NOT coming from the actual words we are using!

Yes, it is very difficult to be objective when discussing a concept that is a trigger or perhaps giving unbiased information.  But if we truly espouse the concept of freedom of choice based on knowledge of alternatives and informed consent, then it is our duty to make every possible effort to present information in an unbiased and objective manner.  It is up to our clients/patients to make decisions ~ not us.

You Tube Comes to the Rescue...Again!

As a childbirth educator who works in a variety of locations, I like to have a wide range of videos to show my "students".  Some are birthing in a hospital, some in a birth center and some at home ~ so the classes are mixed, you might say.  To give a fair and balanced view of birth, I also like my videos to be balanced. 

So when I come to the topic of Comfort Measures for labor and birth, specifically hydrotherapy and waterbirth, I like to have on hand a video that shows a waterlabor and waterbirth in the hospital.  Amazingly enough, I found this on You Tube...and of course, it is from our friends at Injoy Videos!

Enjoy and Happy Mother's Day!

New Free Resource!!!

Have you been to http://www.mothersadvocate.org/?  If not, you need to right now!  It is the best free resource to come along for childbirth educators in a long, long time!

A collaborative effort between Injoy Video Productions in Boulder, Colorado and Lamaze International, the interactive website provides free PDF handouts about the Six Lamaze Care Practices for Safe and Healthy Birth ~ PLUS, free video segments that you can download from their new video, seen here at the right.

Already very reasonably priced at only $9.95, Healthy Birth - Your Way is a wonderful video illustration of the six care practices.

Congrats to Injoy and Lamaze ~ what a great gift!  Thanks!

Are You A Veteran Too????

I had to laugh at myself this morning as I was setting up for Day 2 of the ICEA Professional Childbirth Educator Workshop.

We are starting the day with teaching comfort measures and I took out my mini-speakers and I-Pod.

I remembered the first childbirth class I ever taught in Lompoc, California in August of 1980. I had a cassette tape of relaxation music.

Some years later, I was teaching childbirth classes at a community college south of Melbourne, Florida and I had a boom box.

Now a set of speakers and COUNTLESS tunes on my I-Pod. Including my favorite to teach relaxation and breathing ~ "Mexican Memories" by Michael Jones from his Seascapes CD.

We've come a long way baby! A very long way. ROFLOL!

Why We MUST Teach Breathing if We Teach Relaxation

As I prepare to teach my next ICEA Professional Childbirth Educator Workshop, I am reminded why it is imperative that we teach breathing techniques if we want those in our childbirth classes to know how to really relax.

First, we should teach nasal breathing on the inward breath and outward breath as the nose provides a much more direct route for air to fully inflate the lungs than does the mouth.

Second, when the nasal breath is slow, meticulous and full, the lungs fully inflate and stimulate the nerves which signal "Ok, no stress, relax!" Within seconds of doing this, the amount of stress hormones in the body (catecolamines) is reduced, the blood pressure drops slightly as does the pulse.

Third, without the fight/flight stress hormones, the person is free to relax completely, do some positive relaxation techniques, or just coast.

Let's face it...Lamaze made breathing famous and many of those attending childbirth classes have heard about breathing techniques for labor and birth. But more than being famous, slow breathing techniques help all of us live more stress free lives..

...and isn't that what we would all like to have? Less stress?

Top 10 Myths about Birth & Breastfeeding

In no particular order, here they are:

1. You have to give birth unmedicated to have a healthy baby.

FALSE. While all medications do cross the placenta (the placenta is not a barrier and is not selective), judicious use of medication as a coping tool can lead to a wonderful birthing experience. Mothers do not have to have high thresholds of pain to give birth. Rather, education and some great coping tools can really help!

2. You have to have big breasts like Dolly Parton to breastfeed your baby.

FALSE. It is not about the size of the breasts but that you have ample and unobstructed milk ducts, a supportive environment, good nutrition and hydration, and the internal desire to breastfeed that is important!

3. It is my due date. This baby should come out NOW!

FALSE. Each woman gestates their babies at differing lengths of time. That is to say, one woman may be "at term" at 38 weeks and another be "at term" at 42 weeks. Both are normal for both women. So, if you gestate your babies to 42 weeks and that is term for you, an elective induction at 38 or 39 weeks might result in a 3-4 week premature baby. Remember that Due Dates are merely estimates!

4. I am scared to try a water labor or water birth. I am afraid the baby will drown.

FALSE. No need to worry here. The baby will not take a breath until air pressure changes are registered by the trigeminal nerves on the face. The baby will be oxygenated by the blood in the umbilical cord from the placenta. The baby cannot stay submerged for a long time, though. Once the baby has been born, a hormonal shift takes place and the placenta will begin to detach from the wall of the uterus, interfering with the blood flow.

5. I don't need to take childbirth education classes. My doctor and the nurses will be with me all of the time to coach and help me.

FALSE. Only in RARE situations will this occur. Physicians and even midwives have office hours with patients to see, plus other actively laboring patients. Nurses, given the nursing shortage and tight hospital budgets, often have 2-4 actively laboring patients to care for. Attending childbirth education classes should address the fear factor of labor and educate you so labor isn't as scary, give you comfort measures to reduce your tension and pain, and give you information so you can make informed decisions!

6. If I have a cesarean, I won't be in as much pain as if I had labor.

FALSE. Remember that a "cesarean" is really major abdominal surgery. You will have an incision not only on your outer skin but also on your uterus. Recovery with a cesarean is much, much slower than with a vaginal birth. Please research this thoroughly if you are considering an elective cesarean birth.

7. Home birth is dangerous and only fringey people do it. There are no emergency precautions!

FALSE. There is much literature showing the safety of home birth when an well-educated, low risk expectant couple and a qualified birth attendant (such as a Certified Professional Midwife) are working together. In fact, there is literature showing that homebirth, in certain situations, is safer than hospital birth. Again, this is a topic that deserves more research if you are considering it.

8. The hospital nurses know the latest in breastfeeding techniques.

Generally false. For continuing education, some nurses elect to take advance breastfeeding courses or become Certified Lactation Consultants. Many nurses do not, or opt for more technological courses for continuing education such as reading fetal heart monitoring. If you have questions about breastfeeding, it is generally best to consult a Lactation Consultant for the most up-to-date and accurate information about breastfeeding.

9. My grandmother doesn't think my breastmilk is enough to fill up the baby's belly. She wants me to use formula supplements.

FALSE. If the baby is gaining weight, producing wet and soiled diapers, and is content, the baby is getting enough to eat. Breastmilk might look thin and weak, but it packs a punch in the nutrition department! Formula has additives that the baby cannot digest and can contribute to childhood obesity.

10. My doctor (and my hospital) won't do a VBAC: they say it is unsafe.

FALSE. According to the recent (March 2010) National Institute of Health Consensus on VBAC, VBAC is a plausible option for most women with a previous cesarean with low transverse uterine incision. http://consensus.nih.gov/2010/images/vbac/vbac_statement.pdf

The Evidence Says: Delayed Umbilical Cord Clamping is Safe

Last year, I wrote a series of blogs titled “The Evidence Says”. This series of evidence-based maternity care blogs were very popular and I have had many requests to do another series this year. So for the first in the 2010 series, the topic is….delayed cord clamping.

Back in the time when we were living in caves and wearing fig leaves, we didn’t have the technology, sanitary conditions or even perhaps the knowledge to clamp and cut the umbilical cord on a newborn. For that reason, and perhaps others, Mother Nature covered the umbilical cord with a protective and insulating mucous tissue called Wharton’s Jelly. Wharton's jelly, when exposed to temperature and moisture differences, collapses structures within the umbilical cord and thus will provide a physiological clamping of the cord, approximately 5 minutes after birth. One wonders if early clamping of the cord in today’s maternity care setting results in lesser blood volume that was intended for the baby?

Lotus birth is the practice of leaving the umbilical cord unclamped and attached to the placenta after birth of both the baby and the placenta. In a Lotus Birth, the placenta is typically wrapped and carried with the baby until the cord naturally dries and detaches a few days after birth. Often, the placenta is treated with salts and herbs to preserve the meat and prevent spoiling and odor. Cultural disposal of the placenta varies from planting under a tree (the tree then becomes the child’s tree), to making a very nourishing placental soup, to dehydration and encapsulation for the mother to take by mouth. Studies are being done as to the impact of ingestion of the placenta on the postpartum period.

A review of current medical literature (2005-2010) finds overwhelming recommendations that late cord clamping can be advantageous for newborns by improving iron status and does not increase the risk of postpartum hemorrhage (Cochrane Database Syst Review. 2008 Apr 16;(2):CD004074.). A 2007 article in the Journal of the American Medical Association found that delay clamping in full term babies is beneficial to the newborn and the increase in polycythemia was benign. (Journal of the American Medical Association 2007 Mar 21;297(11):1241-52. Hutton EK, Hassan ES “Late vs early clamping of the umbilical cord in full-term neonates: systematic review and meta-analysis of controlled trials”.)

When looking at the effect of placentofetal transfusion on cerebral oxygenation in preterm infants, delayed clamping of the umbilical cord actually improved cerebral oxygenation in these infants in the first 24 hours. (Pediatrics. 2007 Mar;119(3):455-9).

Finally, an article in the British Medical Journal addressed concerns that delayed cord clamping could not only increase polycythemia but also cause hyperbilirubinaemia (abnormally high levels of red blood cells and bile pigments in the bloodstream, often leading to jaundice). However, trials show this is not the case. (British Medical Journal 2007, August 17 18;335(7615):312-3. Weeks, A. “Umbilical Cord Clamping After Birth”).

Obviously, if the newborn was compromised during labor or birth and needs specific and emergent care, the possibility of delayed cord clamping may also be compromised.

Waterbirth of Breech Baby

Having just taught two nearly back-to-back Childbirth Educator Training Workshops, I am back to updating my websites and also my Blog. Found this Breech Waterbirth and thought you'd enjoy it!

When A Cesarean IS Necessary ~ making a plan.

Our guest blogger is Desirre Andrews, President of ICAN ~ the International Cesarean Awareness Network. The International Cesarean Awareness Network, Inc. ICAN is a nonprofit organization that was founded by Esther Booth Zorn in 1982. Their mission is to improve maternal-child health by preventing unnecessary cesareans through education, providing support for cesarean recovery, and promoting Vaginal Birth After Cesarean (VBAC).


In the event a cesarean is needed to bring your baby into the world, there are still many options available for you and your baby that can help bring the spirit of a vaginal birth into the OR. The tip sheet below is a guide in planning the big day, as a conversational piece with your provider, and a working “Birth Plan” to make into your own. You may find that in addition to speaking with your OB, you may need to contact the nurse manager and the anesthesiology department to set-up the important details for the day your baby’s birthday.

Cesarean Planning Tip Sheet

It is very important to me that though this is a surgical delivery that it is as family centered and intimate as possible. My requests are to help bridge the gap between a vaginal birth and a routine cesarean for me and my baby. I also understand that though my requests may not be standard protocol, that they are reasonable and doable.

• I prefer to walk into OR and greet and be greeted by every staff person by name.
• I would like my husband/partner present/doula present.
• Epidural/Spinal – please no amnesia meds as I want to remember everything.
• I would like at least one arm free and my gown open on top.
• Lowered sterile drape to see my baby being “born”.
• Please describe events as they are occurring with only essential conversation.
• I would like my husband/partner/support person to take photographs and/or video.
• My baby put skin to skin and assessments done on my chest (unless baby needs resuscitation)
• To increase bonding and limit overstimulation to my baby
• Limit contact with others outside of me and husband/partner/support person
• Delay immunizations and eye ointment
• Baby to stay with me and my husband/partner/support person in OR and in recovery
• Immediate breastfeeding
• No bathing of my baby until I can participate. Only basic swaddling .
• No bottles, pacifiers or formula.
• In the event of medically necessary separation of me and my baby
• Initial wipe down towel given to me for smell/fluid transfer
• No bathing or complete dressing of my baby until I can participate later.
• No contact with others except for my husband/partner/support person and nursery nurse.
• If baby must be fed. Hand express from me and spoon or syringe feed colostrum to baby
• I would like my secondary support person (doula) to remain with me so I am never alone.

Some other considerations:

Think about asking for a vaginal swabbing with a sterile towel to then colonize baby with expected bacteria in the mouth and eyes. Anecdotal, however, may be helpful to baby since did not pass through your vagina.

Ask physician what type of suture material and technique will be used. Synthetic material with non-interlocking weave appear to be the best for next pregnancy and VBAC safety. Single layer suturing also has less infection rate and easier recovery associated with it.

In looking ahead to recovery, your hospital stay will likely be between 2-4 days. Practicing deep breathing techniques and getting out of bed to move around your room are helpful in initial healing. Oral medications are often given for pain relief. It is important to stay ahead of surgical pain in order to breastfeed comfortably. It is fairly common for there to be tissue swelling from the intravenous fluids. If breastfeeding becomes difficult, seek out the lactation consultant. Tissue engorgement is not the same as milk engorgement.

Recovery Helpful Hints:

• Stay hydrated.
• Get a small amount of exercise every day.
• Have extra support at home to take care of everyday details so you can be with your baby.
• Make meals ahead and freeze and/or have others bring in meals.
• Take it easy for at least the first two weeks. Recovery can take many weeks. Overdoing it is very easy to do.
• Have a pillow available to add pressure support to wound area in order to simplify getting up and down, coughing, being in the car, and rolling over.
• Be patient with your baby and breastfeeding. Your mature milk may not come in right away (up to day 5 to 7 since no labor occurred). Allowing baby to feed frequently with most often provide enough food and help bring your milk in faster. Please have lactation help available and it is a good idea to have a home visit the day you come home from the hospital.
• As with vaginal birth your postpartum bleeding should ebb off. If it picks up and becomes bright red. Slow down and rest.

Be aware of signs of post surgical infection. Contact your provider immediately and be seen if you experience any of these or a combination of them.

• Exhaustion with overall achiness
• Fever
• Unpleasant odor from wound site
• Pus or more than clear discharge from wound site
• Heat, redness or swelling in area of the wound site.

Beware of signs for postpartum mood disorders – anxiety and/or depression. Be seen immediately.

Lastly be gentle on yourself. Having a baby to care for is a big work by itself. Having a baby to care for and major abdominal surgery is an even bigger work.

For more information visit and resources visit: ICAN at www.ican-online.org for recovery support, education, and more!