Support at Labor & Birth

Being a nurse as well as a doula, allows me to do alot of observing while my client is in labor. I recently did a birth at a large city hospital. My client's birth plan was to have minimal interventions plus do alot of moving to assist the baby through the cardinal movements ~ thus making labor shorter and easier on everyone. She had discussed this at length with her care provider and he had signed off on each one of her requests.

To make a long story short, upon arriving at the hospital my client was immediately "put to bed" with continuous fetal heart monitoring inspite of what the physician had ok'd and with no medical intervention. When asked by my client why this was necessary, the nurse said that she felt that it is always safer to watch the mother and the baby as a couplet and the only way to do this is with the EFM in place. Then the nurse left the room.

Had my client been high risk or had the baby shown signs of trouble, I would have been in 100% agreement with the nurse. However, when I went out to go to the bathroom and walked by the nurses desk, my client's nurse was sitting at the computer charting and talking with the other nurses.

As a nurse, I am the first one to admit that today's litigious society causes many of our maternity policies and procedures to become less mother centered. However, how will this ever stop? AWHONN, the Association of Women's Health, Obstetric and Neonatal Nursing stated in their 2000 Position Paper on Nursing Support of Laboring Women: "AWHONN veiws labor care and labor support as powerful nursing functions and believes it is incumbent on health care facilities to provide an environment that encourages the unique patient-nurse relationship during childbirth".

If the largest nursing organization believes this, and we know this to be true from the research, then WHY do most women NOT receive this type of supported care?

If the hospitals cannot "provide an environment that encourages" this type of patient support, and nurses know why they cannot provide this type of support, then why do they often make doulas (trained women who DO provide this support), feel uncomfortable?

The bottom line is that women in labor need emotional and physical support. Nearly 30 years of research demonstrates this to be true. It does not matter who provides it. It simply has to occur.
Perhaps if we stop being so territorial about WHO provides this support and focus more on providing care that is mother-friendly and mother-centered, then we will transform maternity care in the United States into something other countries will want to imitate.

And just perhaps, our maternal/fetal statistics will improve and we will no longer be 27th or 28th in the world.

Tough observations with relatively simple answers....

Part 2

This is the Part 2 to my slight rant of earlier.

1. Solutions to a woman's fears: let's address the fear of pain and the fear of the unknown from an educational point of view. We also need to address the fact that the pain in childbirth is not like other types of pain, it is intermittant (with rest periods that allow the mother to work with her support team) and the pain also tells the mother where she is in labor (contrasting the duration and frequency of the contractions) AND that the pain in labor is also a signal that she needs to move to help the baby complete the cardinal movements. We, as health care professionals, need to write books - there are precious few new books written by childbirth educators, nurses, or doulas.

2. Freedom from pain: see #1 above PLUS we need to talk about our society's love affair with pain relief and pain medications. On any given night, count how many commercials have to do with this topic.

3. The Lure & The Guarantee: we are confronted with a society of women who really don't understand that the pain medications for labor DO affect the labor and DO affect the baby. The placenta is not selective and they are cause their babies harm. However, those who produce or administer these medications DON'T want the mothers to hear about that (re: the Cytotec controversy). Additionally, with the nursing shortage, it is easier for the overworked/underpaid L&D nurse to watch her 4 patients who are quiet with their epidurals on the monitors rather than scamper back and forth between rooms.

4. Consistency: the marketing campaign for natural childbirth and the impact of medications and interventions on the newborn must be consistent, frequent, branded, recognizable and in many different places at the same time.

5. Access to the media: obviously, there needs to be a core group of people devoted to organizing a media campaign that runs consistently and for a long duration.

6. Professionalism in marketing materials: 'nuff said.

7. Selectivity in research: a core group of research obtained from NIH or Cochrane Review would give the marketing team the "ammunition" it would need to mount a sizable and convincing campaign.

8. Multi-marketing: see #4, #5 and #6. And keep it circulating.

9. Follow-up: we also need to watch the statisticians such as the CDC and the Listening To Mothers Survey so we can determine if the marketing campaign is reaching the pretermined goals. And we need to have these mothers who have sampled natural childbirth speak out as testimonials ~ very much like the "Business of Being Born" and "Orgasmic Birth" movies.

10. Infighting: all too often women in the decision-making seats of major childbirth organizations lose site of the real passion, the real reason why they volunteered for the position. They need to rediscover the energy that got them into the position and put it into the work of helping women have a ligitimate choice of options. Become the 'sagefemmes' that you can be, and ignore the lure of power. Use the power...don't let it abuse you.

Part 1: Stop Whining and Start Acting

Ok, I admit this blog entry will be a little harsh.

For the past 28 years I have watched my colleagues make the same mistakes. We believe, due to research outcomes, in mother-centered care, family centered maternity care and the type of care that minimizes risks to both mother and baby ~ normal birth.

Why, then, is NORMAL birth not the standard way?

Why are we almost apologetic when we talk about natural or normal birth?

The answer is quite simple ~ marketing. Those with differing opinions than us are much better, albeit savvy, than we are at marketing. This is what they do and we don't do well:

1. Solutions to a woman's fears ~ "Don't worry, I can take care of everything" says her care giver. This enables the woman to forfeit her feelings and control.

2. Freedom from pain ~ an easy fix with medications such as an epidural. Our society is not one that readily accepts hard work OR looking at the cause of pain...we just want it easy and the pain quickly eliminated.

3. The lure and the guarantee ~ you can have everything you want: painfree childbirth and your baby without working for it. Now, who wouldn't want that?

4. Consistency ~ they all say the same lines...frequently. A "blah" marketing campaign with consistency is preferred over a fabulous & glitzy marketing campaign that is nothing more than a flash in the pan.

5. Access to the media ~ press releases, experts interviewed on a regular and frequent basis (see #4).

6. Professionalism in marketing materials and LOTS of those materials.

7. Selectivity in the research that is in the limelight ~ focusing on the research that benefits only their opinion.

8. Multi-marketing techniques are a basic fundamental of success. Combinations that are constantly flowing by the client - websites AND brochures AND commercials AND emails AND newsletters AND press releases.

9. Follow-up: 68% of general sales are lost due to customers being ignored after the sale. This applies to birthing professionals because we do not refer back and forth enough to show our client base that there is a network of like-minded individuals.

10. Infighting: there is little of this in the predominately patriarchal microsociety. Since OUR community is made up of mostly women, there is alot of infighting.

So we have our work cut out for us. In my next blog entry, I will be looking at solutions to these 10 problems.

Great Things for May!

May is going to be a great month ~ it ushers in a whole summer of excitement for expectant parents and birth professionals!

First, here in Dayton Ohio on May 3, is the 4th Annual Bright Beginnings Pregnancy Fair. Sponsored by Dayton Area Labor Support Inc (the local doula group), the Fair generates funds that will be used to provide doula care for underserved expectant mothers.

Second is the Waterbirth Credentialing Workshop for Legacy Emmanual Hospital in Portland Oregon....followed by the Workshop coming to Dayton on June 20! The day after, June 21, Barbara Harper will be hosting the new film "Orgasmic Birth" in Dayton and on June 22, she will be hosting it in Indianapolis! Both parents and professionals alike will be interested in this film that celebrates the JOY surrounding birth rather than the fear that many birth-related television shows portray.

Third, during the summer, Birthsource.com will be a place to order the "Birth Pool In A Box"! One of the only inflatable Birth Pools made without phthalates, it is better for the environment, better for mom and baby. Keep watching for more details!

The Summer of '08 will certainly be one to remember...and this is just the beginning!

Cleveland Rocks!

How do you describe a workshop where midwives and physicians and nurses come together to learn and talk about waterbirth and water labor? How do you put into words the incredible energy that is felt not only at the workshop but also afterwards? How can you wait until your next childbirth class to tell the clients all the things you learned??????

Well, I am not sure what the answers are to any of the above questions. There was an incredible energy on Thursday in Cleveland at the Waterbirth Credentialing Workshop! Research and interesting information was presented. A "Birth Pool in a Box" was available for we the practitioners to get into and "try out". It is one thing to assist a mother during labor in a pool, it is quite another experience to try it and see how it might feel! Of course there was no water in the pool, however it gave us all new ideas on how to assist women who choose water labor and water birth!

I feel honored and very blessed to be assisting with these workshop during this year!

Waterbirth Workshop Tomorrow

I will be traveling to Cleveland today to assist in the first traveling Waterbirth Credentialing Workshop of 2008. We will be at Lakewood Hospital. It will truly be exciting to bring such great research to communities across the country ~

We are even planning some Workshops in Canada. That will definitely be fun to be back up there, eh? (LOL) I love my Canadian birth sisters. Several years ago, they made me an honorary Canadian - of which I am very proud!!!

But I don't intend to work the entire time I am in Cleveland. Since I am driving, I plan to visit the Hard Rock Cafe in Cleveland and also perhaps travel a little to the west to Marblehead Lighthouse and Sandusky. I hear the Lake Perch is really tasty.

Speaking Up...Speaking Out...again!

The third in a series of exposes about childbirth in America - the trailer is now on You Tube - Pregnant In America.

Film maker Steve Buonaugurio, who recently become a father, presents the evidence-based information about the sad state of maternity care in the United States.

You cannot argue with facts, although some still try. Birth statistics prove that in countries where midwives practice both in and outside of hospitals AND where homebirth is more common than in the US, those countries have better pregnancy outcomes than we do.

You cannot argue with facts - many maternity policies and procedures pave the way for fetal distress (those include restricting food/fluids to laboring women, restricting activity during labor, lying down positions for a majority of the labor and during second stage pushing).

You cannot argue with facts - those of us who experienced the natural childbirth movement in the 60's and 70's are working again to bring childbirth back to NORMAL. Pregnancy is NOT a state of illness....it is a state of health. Women and their immediate support systems should be educated to make the important decisions when giving birth in the hospital or wherever they are birthing.

You cannot argue with facts - the way we give birth in America often sabotages the breastfeeding success of many women. Epidurals do impede newborn reflexes such as sucking and latching on.

You cannot argue with facts - According to Autism Today, the web's largest site dedicated to autism, when you factor in a large national induction rate, Cesarean rate of 31% and epidural rates as high as 95%, a staggering number of medically managed births are subjected to a high level of pharmaceutical interventions that have never been approved for use in fetuses - for example Cytotec. And "Since autistic disorders produce an inability to make or maintain affectionate bonds or have normal social relationships, one cannot help but wonder if perhaps there is an causal relationship between these disorders and exogenous sources of an artificial form of oxytocin. Perhaps flooding the immature body of the fetus (especially boy babies) with this gender-specific synthetic hormone from animals somehow interferes with the eventual function of these psychological systems. It is an intriguing question."

Films such as "Pregnant in America" "Orgasmic Birth" and "The Business of Being Born" are not just radical granola crunchers looking for attention. We in the medical profession are sounding an alarm for the sake of

generations to come.

New Birth Film

What if there was no fear of childbirth? What if there was only joy, anticipation and positive expectation?

The second of three birth films for 2008 will be unveiled soon...it is called "Orgasmic Birth". Featuring Christiane Northrup MD, Marsden Wagner MD, Ina May Gaskin MA CPM, Maureen Corry MPH, Robbie Davis-Floyd PhD, and Sarah Buckley MD, this film is the "baby" of Debra Pascali-Bonaro. Debra (Director/Producer) is an internationally renowned childbirth expert, 26-year speaker in childbirth education, and a Lamaze-certified veteran in maternity care with a passion for birth. She is also the mother of three sons and two stepchildren; her three sons were delivered naturally.

I have known Debra for many years, having worked with her on several Boards of Directors of various birthing organizations. Debra brings her zeal and dedication to the screen, showcasing the normalcy of birth and the evidence based information to back up this normalcy!

Debra will premiere her documentary film Orgasmic Birth on May 12th at the World Respected Childbirth Week conference in Prague, Czech Republic, followed by a May 16th feature segment on ABC-TV’s “20/20.”

I am happy to be helping Debra with some of the PR surrounding her film. To learn more, go to www.orgasmicbirth.com. To schedule a screening in your community and receive the comprehensive screening host packet, email screening@orgasmicbirth.com.

Educate, educate, educate, advocate

In August of 1980, when I taught my very first Lamaze Childbirth Class, little did I know that I was joining a growing sorority of birth advocates. I was soon enveloped into a new world ~ a world where others cared about the emotional and spirituality of birth as well as the physical outcomes. Someone had finally put the pieces together. I felt it.

In 2004 I read the book "Impact of Birthing Practices on Breastfeeding: Protecting the Mother and Baby Continuum" by Mary Kroeger and Linda Smith. This book has rock solid research to substantiate the fact that our US birthing practices are not mother friendly nor are they baby friendly. It shines the light on how many of our birthing practices are more tradition than backed by research. It also focuses on how these same traditional birthing practices often negatively impact breastfeeding ~ we sabotage our own clients/patients!

So as I look forward to my 30th year of teaching in 2010, I continue to teach and educate expectant parents on the wide range of birthing options available to them....not just those available in their community but available to all. Why? Doesn't this set some of them up for disappointment? Change will not happen because a nurse, childbirth educator, doula, doctor or midwife advocates for change. Change will happen when the consumer, the clients/patients desire and ask for the change in policy and procedures.

Just as happened back in the 1970's when the Childbirth Movement was in its hay day, we can once again educate women, empower them with data, and support them in helping to make the changes in our maternity care system. A good example of ignored data is the statement by Dr. John Kennell who has said that "If a doula were a drug, it would be unethical not to use it." His nearly 30 years of research with Dr. Marshall Klaus and others show that the providing the mother with a doula made a remarkable difference on obstetric outcomes. Doulas can empower women by answering the questions not answered by childbirth education classes, show the mother and her partner relaxation and non-pharmacologic pain relief techniques that can reduce the perception of pain by as much as 65% and so much more.

It is important to educate and stand firmly on the foundation of research. Through research, education and empowerment, women will find their joy in the childbirth experience.

Skin to Skin ~ why aren't we doing this?

I recently read this information written by Dr. Jack Newman:

< To recap, skin to skin contact immediately after birth, which lasts for at least an hour has the following positive effects on the baby:

• Are more likely to latch on


• Are more likely to latch on well


• Have more stable and normal skin temperatures


• Have more stable and normal heart rates and blood pressures


• Have higher blood sugars


• Are less likely to cry


• Are more likely to breastfeed exclusively longer
  
  There is no reason that the vast majority of babies cannot be skin to skin with the mother immediately after birth for at least an hour. Hospital routines, such as weighing the baby, should not take precedence.

The baby should be dried off and put on the mother. Nobody should be pushing the baby to do anything; nobody should be trying to help the baby latch on during this time. The mother, of course, may make some attempts to help the baby, and this should not be discouraged. The mother and baby should just be left in peace to enjoy each other's company. (The mother and baby should not be left alone, however, especially if the mother has received medication, and it is important that not only the mother's partner, but also a nurse, midwife, doula or physician stay with them—occasionally, some babies do need medical help and someone qualified should be there "just in case"). The eyedrops and the injection of vitamin K can wait a couple of hours. By the way, immediate skin to skin contact can also be done after cæsarean section, even while the mother is getting stitched up, unless there are medical reasons which prevent it.>>

If we KNOW that babies do better skin-to-skin, and the studies show that babies do better skin-to-skin, then why are so many hospitals not using skin-to-skin?

Why aren't we doing this?

Why is Natural Childbirth Taboo?

Natural Childbirth ~ according to Wikipedia, natural childbirth is a birthing philosophy that attempts to minimize medical intervention, particularly the use of medications and surgical interventions such as episiotomies, forceps, vacuum and cesareans.

A recent study (2007) revealed the rates of medical intervention in childbirth in the U.S.:
• Electronic fetal monitoring- 93%
• Epidural use- 63%
• Had their membranes ruptured- 55%
• Received oxytocin to progress labor- 53%
• Received episiotomies- 52%
and Cesarean Sections in the US are at an all time high of 31.1%

Even with the use of interventions over 50% of the time, the US infant mortality/morbidity and maternal mortality/morbidity is sluggish to say the least. Evidence mounts that despite the use of interventions, we are not a healthier birthing society.

While the US is generally ignoring evidence-based practices...wait! The evidence does not support the use of medications and interventions? That is correct! Infant and maternal outcomes are better where women are allowed to labor naturally. Well, is this new information? Could it be we just have not heard about it?

In 1985, the WHO Joint Interregional Conference on Appropriate Technology for Birth came up with general recommendations based on evidence including:

1. The psychological well being of the new mother must be ensured not only through free access to a relation of her choice during birth but also through easy visiting during the postnatal period.
2. The healthy newborn must remain with the mother, whenever both their conditions permit it. No process of observation of the healthy newborn justifies a separation from the mother.
3. Countries with some of the lowest mortality rates in the world have cesarean rates under 10%. Clearly there is no justification in any geographic region to have more than 10-15% cesarean rate.
4. There is no evidence that routine electronic fetal monitoring has a positive effect on the outcome of the pregnancy.
5. Pregnant women should not be in the lithotomy position during labour and delivery. They should be encouraged to walk about in labor and each woman must freely decide which position to adopt during delivery.
6. Birth should not be induced for convenience and the induction of labor should be reserved for medical indications.

...........and the list goes on.

What we have observed is that maternity care practices vary greatly based on many factors including how caregivers were trained, what the "we have always done it this way" practices are, how much caregivers embrace new research and how much pressure high level hospital directors dictate evidence-based care.

The concept to remember is that evidence-based care is generally mother-friendly care. The exact why of why we don't embrace it is complicated. But it shouldn't be.

If caregivers are truly in their profession to help women, to help babies be born and have the best interested of babies and mothers and families in their hearts, then evidence-based care should be the norm.

Therefore, natural childbirth should be the norm.

Perhaps it is time for all caregivers to reassess their definition of care to include "evidence-based".

Sacred Space

While watching Animal Planet the other day, I couldn't help but notice the birth practices of animals. Most hide and make a special place in which to birth. They take great care in creating the safe and serene space where their newborns will come into this world - safe from preditors and safe from the elements.

We humans rarely take the time to make our sacred space in which to birth. If we did, I imagine that birth would take only a fraction of the time that it does. Why? Ina May Gaskin said that the cervix is basically a sphincter. Sphincters are muscles that contract and relax involuntarily and voluntarily in response to certain stimuli. Just as you would not be able to have a bowel movement in front of 4-5 of your relatives or friends, why are women expected to give birth in front of any audience. The sphincter or cervix just will not relax on demand without some effort.

Creating the sacred space for birth is a basic primal instinct. It reaches the very core of our motherhood and the need to protect our little loved one. If we do not create a space for love and acceptance of our babies, does this impact them? Does it impact us as parents? Will it have a lasting impact on us?

Only time may tell us........

Just the Facts, Ma'am

Perhaps you are not old enough to remember the "Dragnet" series that ran on radio and television or the movie of the same name with Tom Hanks. But what may be familiar to you is the tag line "just the facts ma'am".

When faced with the facts of childbirth today in the US, this litany of remarkable and regretable stats might make you ill:

1) the US dropped 1 level to #28 in the world for maternal morbidity and mortality.
2) the US cesarean section rate is 31.1%. And based on a study which looked at US birth certificate data, there is a significant number done under the designation of "no indicated risk". Nearly 5% of cesareans in the US are under this category.
3) infant mortality and morbidity in the US is not improving.
4) induction rates are at an all time high, often resulting in premature births.
5) risks of cesareans for both mother and baby are not being explained sufficiently to mother so they can make informed choices.
6) the only countries with higher cesarean section rates are Italy (37%) and South Korea (35%) among industrialied countries.

Has the US become the "McBirth" Society? Are we in such a hurry to live that we fail to value life?

Are we women so "tired of being pregnant" that we would rather visit our premature baby struggling in the NICU than wait a few more days until their lungs mature?

Have we become so complacent with surgery due to all of the television shows talking about plastic surgery that we see cesarean as another elective surgery?

These are tough questions. But then again, these are tough times for babies.

When will we begin to care about them?

Return from the CIMS Conference

According to Wikipedia: A blizzard is a severe winter storm condition characterized by low temperatures, strong winds, and heavy blowing snow. Blizzards are formed when a high pressure system, also known as a ridge, interacts with a low pressure system; this results in the advection of air from the high pressure zone into the low pressure area.

Traveling home from the CIMS Conference in Orlando took 2 days and I didn't drive. Flights were canceled to all of the locations closest to home AND to home. So I enjoyed Atlanta for 2 days then flew into Cincinnati as the flights were booked to Dayton until March 11 - today. Need to know anything about Hartsfield/Jackson Airport - I am your gal~!

Note to self: extend self-moratorium on travel from November 1 - March 1 to November 1 - April 1. That should catch all of the blizzards....

CIMS Conference in Orlando #4

Amidst the tornado warnings for central Florida and the estimated 3-8 inches of snow at home (Ohio), the CIMS Conference is going strong. After listening to Eugene Declercq this morning, Charles Mahan last night, Debra Bingham - well all I can say is wow. I feel like I have been fed by a firehose with information and it will probably take the entire flight home PLUS some to process all of the valuable information that I have gotten here.

While I have not done any Disney shopping, I have added books to my library!

Guilt-Gift Shopping is on my agenda next........

CIMS Conference in Orlando #3

Today is Day One of the CIMS Forum or Conference and I must say that if you are not attending, you are missing a great conference. Today were all day workshops - I attended "Every Change Needs a Champion" with Debra Bingham MS RN LCCE from California. She was amazing in walking us through the steps to making change happen - very methodical and thoughtful process. I also had lunch with my friend Nicette and am looking forward to hearing Dr. Charles Mahan this evening.

Then it is out to dinner with some of my Floridian birthing friends.

CIMS Conference in Orlando #2

Well, after an icy start this morning I am finally in sunny Orlando. I was wondering where the sun was hiding and......I found it. It has been hanging out in FL!

Tomorrow morning begins the CIMS conference and I am exciting to be around birthing experts. I am really looking forward to hearing Nicette Jukelevics, a friend of mine and webmaster to www.vbac.com, Dr. Charles Mahan (Dean at USF/Tampa), Eugene Declercq (you may have seen him in "The Business of Being Born" and all of the other fabulous speakers.

Conferences are not only a great way to network, but they reenergize and inspire! It will be an exciting next few days!

CIMS Conference in Orlando

I am working on my presentation for the CIMS conference next week. I am speaking on honoring the physio-structural systems of women: with a focus on positioning and the pelvis. It is going to be a great opportunity to see FL friends and go to a conference that I have not been to before.

In doing some additional research for the CIMS session, my rep from Injoy Videos told me about their new DVD, Positions for Labor. It is a really good video with an accompanying handout. The DVD is only 19 minutes which makes it great for teaching and it is only $150. Injoy is really committed to developing videos that portray the evidence based information. I really like their stuff.

Soon, we will be carrying the book "Blessing Ways" ~ I am excited because it will pair nicely with our blessing way kits.

Waterbirth Credentialing Coming to Midwest

For those of you who live in Ohio, Indiana, Kentucky, Illinois, Michigan, Pennsylvania, WV, Tennessee OR who don't mind a small trip, the Waterbirth Credentialing Workshop taught by Barbara Harper RN will be in Dayton Ohio on June 20, 2008 from 9 am to 5:30 pm.

Barbara is the founder and director of Waterbirth International and the Global Maternal/Child Health Association, a non profit organization. The mission is to preserve, protect and enhance the well-being of women and children during pregnancy, birth and early childhood. A Midwesterner herself, Barbara has been referred to as the "Billy Graham of waterbirth" due to her expertise, enthusiasm and wealth of knowledge. She has lectured in 35 countries including medical schools, nursing schools and midwifery programs.

What does this mean? It means that we can better meet the needs of our expectant clients who wish to labor and/or birth using hydrotherapy! Whether you are a physician, midwife, nurse, childbirth educator, doula or other maternity/child health specialist, this workshop is ideal.

Watch www.birthsource.com and my quarterly newsletter for more information about Early Bird Registrations and how to register.

Lacking Evidence

On February 6, 2008, the American College of Obstetricians and Gynecologists issued a press release advising expectant mothers against home birth and births with CPMs (certified professional midwives). Ignoring the fact that 22 US states allow births with CPM and the facts that the US infant mortality and morbidity is still ranked in the low 20's (meaning that 20+ countries have birth outcomes better than the US), they propose to keep the management of birth the same.

This press release was without footnotes or evidence based references. It would be interesting to see where the basis for their statements came from. This press release is also somewhat opposite of the latest issue by their sister organization, AWHONN's (Association of Women's Health, Obstetrics and Neonatal Nursing) journal: Journal of Obstetric and Gynocology, Neonatal Nursing. In the January/February 2008 issue, several writers demonstrate the evidence based research FOR normal birth and the choice more and more women are making for a more normal AND natural birthing experience.

The tide has been ready to turn. Now it is time...in shadow of the videos "The Business of Being Born" and "Pregnant in America" the change in the conversation about birth has begun!