Friday, November 16, 2012

World Prematurity Day, 2012

November 17, 2012 


World Prematurity Day!

Prematurity, or preterm birth, refers to live births that occur before 37 weeks gestational age. The following are categories defined by how many weeks gestation were completed before the birth:
  • extremely preterm (under 28 weeks gestation)
  • very preterm (28 to 32 weeks gestation)
  • moderate to late preterm (32 to under 37 weeks gestation) 
A pregnancy is considered full-term at 39 weeks and as such I think these definitions need some adjusting, but March of Dimes, WHO, ACOG and many others agree that an induction or caesarean birth should not be planned before 39 completed weeks unless there is a TRUE medical indication. However, if your pregnancy is healthy, it is best if your baby is born at 40 weeks or later! (watch for a future post on this!)

Preterm birth can lead to a variety of complications and the earlier the baby is born, the more severe the health challenges they will face. More infants die from preterm related problems than any other single cause. Preterm babies often spend days or weeks in the Neonatal Intensive Care Unit (NICU) and preterm babies have a higher risk of:
  • Intellectual diabilities
  • Cerebral palsy
  • Breathing and respiratory problems.
  • Visual problems including retinopathy of prematurity
  • Hearing Loss
  • Feeding and digestive problems.

Preterm birth is a serious global problem with an estimated 15 millions babies born too soon around the world... and this number is rising. This translates to one in every 10 babies worldwide being born too soon.

 According to the World Health Organization:
  • An estimated 1 million babies die annually from preterm birth complications.
  • Preterm birth is the leading cause of newborn deaths (babies in the first four weeks of life) and the second leading cause of death after pneumonia in children under five years.
  • Three-quarters of them could be saved with current, cost-effective interventions, even without intensive care facilities.
  • Across 184 countries, the rate of preterm birth ranges from 5% to 18% of babies born.
In the United States, 1 in 8 babies are born too soon. This number is higher than many other developed nations and the March of Dimes gives the U.S. a "C" grade on the prematurity report card. You can see the report card here and find the grade for your state! Sadly, only 4 states in the nation have an "A" grade.


Unfortunately we still do not know all the reasons for preterm birth, but a few risk factors include: multiple pregnancies (such as twins, triplets), infections and chronic conditions (such as diabetes, high blood pressure), and there is also a genetic influence.

With advances in technology we are now able to save many babies using cost-effective care such as: antenatal steroid injections (given to pregnant women at risk of preterm labour to strengthen the babies’ lungs), kangaroo mother care (the baby is carried by the mother with skin-to-skin contact and frequent breastfeeding), antiseptic cream for the umbilical cord, and antibiotics to treat newborn infections – even without the availability of neonatal intensive care.

Ensuring skilled health care workers and crucial supplies are also important factors in decreasing deaths due to prematurity and some countries, over the past decade,  have halved deaths due to preterm birth. These include Ecuador, Oman, Sri Lanka and Turkey. Also, to reduce preterm birth rates, women – especially adolescents – need better access to family planning and increased empowerment, as well as improved care before, between and during pregnancies.

If you are pregnant, it is important to receive early prenatal care from a health professional such as a doctor or midwife. Eating a healthy diet, taking prenatal vitamins and ensuring proper care of any chronic diseases is important to decreasing the chances of preterm birth. Here is more information on prenatal care.

The March of Dimes is a powerful advocate for prematurity awareness, support and prevention, and they have funded the development of technologies, such as surfactant to help premature babies breathe,as well as being an ally for every family with a premature baby. If you can, please consider giving to their incredible organization and improving the lives of women, infants, and families around the world. (donate here). You can also give in other ways, such as volunteering at one of their fundraising events!

However, if you can't give any financial support, you can make an impact in SO many other ways! Most importantly, spread the word! Share what you learn with friends, family, co-workers, and encourage them to get involved. Chances are you know someone effected by preterm birth, with 1 in 10 babies born premature worldwide, and 1 in 8 born premature in the U.S.

Tuesday, September 25, 2012

Best (and worst) Countries for Motherhood

Save the Children has released their most recent report on the State of the World's Mothers and one of the features is a rank of the countries based on a number of maternal and child health indicators.

This report not only shows the top countries for motherhood, but discusses very thoroughly the devastating health conditions that far too many mothers, infants, and children experience around the world, and thus the worst countries for motherhood.

The countries are ranked based on scores in certain indicators including female education, political representation, MCH policies (such as maternity leave), life expectancy, maternal and infant mortality rates, etc.

To exemplify the extremes, In Niger (#165) the life expectancy for women is 56 compared to 83 in Norway (#1), which offers one of the best maternity leave policies in the world.  Every mother in Niger is likely to suffer the loss of a child.

These rankings give you an idea of the overall picture of maternal health and motherhood in the respective countries, but it does not provide information on the distribution of health and experiences of motherhood within a country; where some may have poor health.

And on to the rankings...

The first 30 countries ranked: 

1. Norway
2. Iceland
3. Sweden
4. New Zealand
5. Denmark
6. Finland
7. Australia
8. Belgium
9. Ireland
10. The Netherlands
11.United Kingdom
12. Germany
14. France
15. Portugal
16. Spain
17. Estonia
18. Switzerland
20. Greece
21. Italy
22. Hungary
24. Belarus
25. United States
26. Czech Republic
28. Poland
29. Croatia
30. Japan 

... and the 10 worst countries for Motherhood (last 10 in the list)

156. DR Congo
156. South Sudan
156. Sudan
159. Chad
160. Eritrea
161. Mali
162. Guinea-Bissau
163. Yemen
164. Afghanistan
165. Niger

Many of the poor outcomes and deaths in the "worst" ranked countries can be avoided! Measures to decrease postpartum hemorrhage (such as having trained birth attendants), decrease infant death from diarrhea (support exclusive breastfeeding), and many other seemingly simple practices would improve motherhood around the world.

So whether you are looking for the best country to be a mom or where you can give support to make motherhood better for others, being informed will help you spread awareness too!

Thursday, August 30, 2012

Natural Nipple Creams

This post is in response to an excellent inquiry made by a friend. She wanted to know what I thought about lanolin, coconut oil, or shea butter as a natural nipple cream. I wasn't sure how to answer, so this blog is my researched response!

First I would like to recommend good 'ole Breastmilk for nipple care. You can rub a little breastmilk on the nipples and allow them to air dry. For many women this is all they need for normal nipple care.

Also, remember that you DO NOT need to use any soap on your nipples! This will only increase dryness and decrease your own natural and protective oils.

As for some other commonly used natural products...

Lanolin, which means "wool oil", is a yellowish and waxy secretion from the sebaceous glands of woolly animals; most commonly from sheep. Lanolin is collected from the sheep's wool when it is pressed between rollers and squeezed out.

While scouring the internet I found some mothers wondering and discussing about thrush and lanolin use. It seems as though lanolin may increase the incidence of thrush, OR, if you have thrush (or the baby) don't use it because it may sustain the infection. Lanolin doesn't have anti-bacterial/fungal properties (like coconut oil) so this may be why infection occurs; mothers may not always have clean hands when applying nipple cream and bacteria could be introduced. This is one of the most commonly used nipple creams and is handed out by many hospitals and lactation consultants, but personally I think the plant based alternatives may be better and I found this report from Medline Plus for lanolin poisoning (which is not likely, but obviously possible). 

As for coconut oil, this stuff is AMAZING!!! A plant based oil with antifungal, antibacterial, antimicrobial, anti-inflammatory, SPF(5), and moisturizing properties and it can be safely used on or consumed by almost anyone (allergic reactions are rare, if they do occur they are often mild). Some critics remind that this is still a saturated fat and consumption needs to be limited, however others herald the incredible plethora of health benefits... here are a few articles that give more information on some little known uses for coconut oil, as well as an excellent summary of the history, uses, and research findings for this increasingly popular nut. Can also be used on babies as a diaper cream! This is my personal choice for best cream because if you find that you need a cream (breastmilk isn't quite enough), then you may need the bacteria and fungal fighting properties that coconut oil provides.

  Finally, shea butter. From the nut of the Shea Tree, found in Africa, shea butter is a highly nourishing moisturizer which can be used for a great variety of skin and hair related issues; as well as for cooking and baking. There are a number of vitamins, minerals, and other excellent compounds found in shea butter, it has an SPF of 6 and it appears to have anti-inflammatory and anti-microbial properties as well. Seeing as how it comes from a nut, some people with nut allergies may experience a minor reaction. Seems like an excellent moisturizer and prevention/treatment for stretch marks!

SO, to answer the original inquiry about which may be best to use as a nipple cream. Personally, I would not use lanolin because there are two alternatives that are plant based rather than animal based (however if someone has a nut allergy or a history of nut allergy then perhaps lanolin can be an alternative).

Breastmilk is my first choice of "nipple creams", but based on what I've learned in creating this post I think I will have both coconut oil and shea butter to use for any skin care need that arises! If you need something that helps manage bacteria or fungal issues such as yeast, then use coconut oil, for extra moisture you can use shea butter - The best of both worlds! I am definitely going to use shea butter to help prevent and treat my future stretch marks! :)

Please share your experience with any of the above OR other creams in the comments below :)

Also, I always recommend buying products that are pure, organic, and sustainably produced. Shea butter comes from Africa, so please buy from a company that supports this continent and the incredible people that live there!

IMPORTANT NOTE: If you are having breastfeeding issues or PAIN while nursing then please contact a lactation consultant in your area or your local La Leche League and they can help! Breastfeeding should not be painful!

This IS NOT medical advice. Talk to your doctor, midwife, herbalist, nutritionist, or other health provider if you have questions or concerns.

Happy Nursing!
~Wisdom and Birth

Monday, August 27, 2012

Childbirth and Your Pelvic Health ~ Guest Post!

The following is written by Elizabeth Carrollton about pelvic health during pregnancy and the postpartum period. She addresses some common issues, excellent ways to prevent pelvic floor related problems, and brings awareness to some major issues with surgical treatment using transvaginal mesh. Thank you Elizabeth for all you do to improve maternal health and safety!! 

Childbirth is the biggest risk factor for pelvic floor problems like pelvic organ prolapse (POP) and stress urinary incontinence (SUI). Half of all women who have had at least one child will develop POP to some degree, and SUI occurs in about a quarter of childbearing women. However, paying attention to your pelvic health during pregnancy and after childbirth can help reduce your risk of developing these disorders.

Why Pelvic Health Matters
Healthy, strong pelvic muscles serve a lot of important functions in the body, such as enhancing sexual sensation, making childbirth easier, holding pelvic organs securely in place, supporting the spine, contributing to balance and movement, and aiding in urinary and bowel function. On the other hand, weak pelvic floor muscles can be the source of quite a few problems, like lower back pain, difficult labor and delivery, sexual dysfunction and pelvic support problems.
Among the most common pelvic support problems encountered by women are stress urinary incontinence and pelvic organ prolapse. SUI occurs when pelvic floor muscles have become too weak to hold back urine flow, allowing leakage when a woman coughs, laughs or exercises. It can also be an early sign of POP, which happens when the pelvic floor becomes so stretched or weakened that it cannot support pelvic organs properly, such as the bladder, rectum and uterus, allowing them to drop down within the pelvic cavity to place pressure on the vagina.
The pelvic floor weakness that is at the root of both of these pelvic support problems is most often caused by the strain of childbirth, but obesity, heavy lifting, straining due to constipation and chronic coughing can also contribute. Estrogen loss during menopause causes muscles and tissues to become less elastic, which can cause further weakening of the pelvic floor.

Maintaining Pelvic Floor Strength and Flexibility
Pelvic health problems often can be avoided by keeping the muscles of the pelvic floor strong and flexible. Pelvic floor exercise is essential in meeting that goal, done regularly throughout life, but especially during pregnancy, after delivery and during the years that lead up to menopause. Seeing a fitness professional can help you devise a good exercise routine for pelvic health.
Maintaining a healthy body weight is also important, since being overweight places excess pressure on pelvic muscles. Good nutrition matters, too, since a well-balanced diet provides the nutrients your muscles need to maintain health and proper function. If you've already developed POP or SUI, these measures can also help reduce symptoms in many cases.

Words of Caution on POP, SUI and Transvaginal Mesh
Some women will develop pelvic organ prolapse or stress urinary incontinence despite their best efforts toward prevention, and in severe cases, surgery may be necessary to provide relief. It is important for any woman who is considering surgery to know that procedures that use transvaginal mesh implants or bladder slings in SUI or POP repair have been associated with serious complications in thousands of women.
Among the most common problems reported are mesh erosion, mesh protrusion through vaginal tissues, mesh shrinkage, organ perforation and infection. Filing a vaginal mesh lawsuit is a route several women have taken, due to these severe complications.  Most cases of POP and SUI can be resolved without mesh, so be sure to ask your doctor about traditional POP or SUI procedures that do not use mesh implants.

Elizabeth Carrollton writes about defective medical devices and dangerous drugs for

Tuesday, August 14, 2012

Empowered Birth Awareness Week

Empowered Birth Awareness Week is quickly approaching and I am continuing my efforts to draw attention to Evidence-Based Maternity Care and safe birth choices for all women.

Birth is an event we all share. I have heard before, that the status of a country, government, or people can be judged off how they treat their most vulnerable, in this case the United States and the American people fare poorly in regards to how our mothers and infants are treated during Birth.

Our modern maternity care system has seen some positive changes, but there is still so much room for growth. Most importantly we need hospitals and Birth professionals to be accountable for the care they provide and women deserve Evidence-Based Care.The long-term effects of obstetrical interventions are finally being realized and we need to change the face of medically managed birth!


Here are a few ideas that you can do to support Evidence-Based Maternity Care:

  • Check out Improving Birth to find a "Rally for Change" in your area, or to start one of your own!
  • Create your own expression or interpretation of Empowered Birth and share online - artwork, video, photo (YouTube, Facebook, Pintrest)
Here is some of my Birth artwork :)

  • Change your Facebook picture to something birth related (you can use one of the images from this post!) or maybe an image of you/ your family during or after birth

  • Ask a woman you know (mother, sister, friend) to share her birth story with you

  • Watch a movie you haven't seen to learn more about Birth such as: Orgasmic Birth, The Business of Being Born and More Business of Being Born

  • If you are pregnant, learn about a different option for your birth, something you hadn't known about before, such as having a doula, birthing at a birth center, having a VBAC...
*You could use both of these to ask for Evidence-Based Care in your local hospital!*

Share more ideas in the 'comments' section below or tell about what you will do/did for Empowered Birth Awareness Week!!!

~Wisdom and Birth

Sunday, August 12, 2012

Unassisted Childbirth, sometimes the only 'Choice'?

Unassisted Childbirth (UC) refers to birth in which the mother delivers without professional assistance (such as from a midwife or OB) and has also been referred to as 'freebirth'; this does not mean the mother and her partner have not prepared for labor and birth, just that they do not have a licensed professional present when the baby is born.

Some women labor and deliver completely alone while others may be emotionally and physically supported by their partner, a friend/family member or a doula. There are a multitude of reasons why women choose to birth unassisted and some women choose to do so because this is the best choice for them, but for too many women, they have to have a UC in order to have their baby at home.

In the U.S., 99% of births occur in the hospital, however the numbers of women choosing home birth are growing. Most home-births in the U.S are attended by midwives, however, many states still have laws that prohibit midwives from attending home-births and the women that choose to stay at home must birth unassisted. Furthermore, many mothers that plan to have an unassisted childbirth are choosing to do so because one or more of their previous births entailed a negative or traumatic hospital birth experience, such as a c-section and they are looking to avoid this experience again.

Take the rather common example of a woman who has had one (or more) c-section deliveries and the doctors in her area tell her they will not 'permit' a VBAC (vaginal birth after a cesarean), so if she delivers in the hospital, the baby will be delivered by major abdominal surgery. This woman may choose to have a home birth, but if she lives in one of 10 states that still has regulations against midwifery practice outside of hospitals, then she will have to consider delivering at home, unassisted by a licensed professional.

Women will choose to deliver unassisted for many different reasons and all women deserve the right to choose, but there must be access to safe birth choices for all women and midwife attended birth is a safe option! When so many women are confronted with a choice between major abdominal surgery (just to have a baby!) or birth alone without the oversight of a caring and knowledgeable professional, such as a midwife, I wonder... what kind of choice is that?

In addition, childbirth as a rite of passage entails that some women will feel safe and empowered to birth alone, we should not take this away from them. For many of these women their birth will open them to a new depth of respect for themselves and love for their family. In the event that complications do arise and these mothers decide they need medical assistance, they should be treated with the dignity and respect as any other patient.

A post from Self-Directed Childbirth, describes a beautiful example of an unassisted childbirth in a hospital, which gives me confidence that the medical model of birth is slowly shifting and women will continue to have greater access to a multitude of choices in childbirth and respect when they decide what is best for them and their baby. However, this is not what is normally experienced and more women than before are considering birthing alone in order to avoid the interference frequently caused by medical birth professionals, sometimes even from midwives! 

There are a number of safe birth options for women to choose from and we should not discourage or punish mothers who have a desire to birth their babies at home, even without assistance. In particular, however, we need to ensure that all mothers who choose home birth have the legal choice to be attended by a midwife. Trying to prevent home birth by outlawing midwifery practice outside of hospitals will only force some women into delivering unassisted at home. This could lead to injuries or deaths that are completely preventable in our developed health care system. Instead we should look to the other successful and empowered models, such as that in the UK, where laws require midwives to attend women wherever they choose to labor, no matter the location.

I envision a system where women that choose to deliver in a hospital can still have access to the privacy and respect that is found most often in home-births and women that choose to deliver at home can do so in any state with the support of a trained professional midwife. Women are not looking to endanger themselves or their children, rather they are looking to have the most fulfilling birth experience as both a woman and mother.

Friday, August 10, 2012

Documentary about VBAC - "Trial of Labor"

The location where you give birth is so important. What the people around you believe about birth will affect your experience. Obstetricians are surgeons and they are trained in a model that believes birth must be managed because it is wrought with danger. The midwifery model believes in the strength and robust nature of women's bodies and the midwife is present to encourage and support this natural, physiologic process.

Too many women are birthing in a model where their bodies are seen as defective. Too many women are having C-sections and then being denied the opportunity to have a VBAC for subsequent births.

In this new documentary Trial of Labor (click for their website), mothers share their stories about a previous C-Section and their desire to do it differently the second (or third) time. This women were not prepared for birth the first time around and they are determined to do it differently this time!

As a doula, I have provided labor support to two mothers who had successful VBAC's (Vaginal Birth After a Cesarean); one of these was a home birth with a midwife and the other was a hospital birth with an OB. 

This film needs donations to support the final development... please consider donating (even $1) to help makes this excellent idea a reality!!! (click here for the website)

They also talk about the importance of having a doula :)

Friday, August 3, 2012

When a Mother Chooses NOT to Breastfeed...

There are so many choices that mothers make which will be debated over, questioned, and even attacked by strangers, coworkers, friends, and even family. How a woman chooses to give birth and feed her child is of particular interest and debate, especially in recent years.

Not only is it World Breastfeeding Week and I wanted to highlight a topic, but I just received the 'Birth Plan' for my next doula client and she explicitly states that she does NOT want to breastfeed and does not want any lactation counselors to come talk to her while in the hospital. I knew about this decision from our prenatal appointment, but as a passionate advocate for Breastfeeding, I was motivated to educate her and maybe change her mind with information and positive encouragement/support. I didn't fully accept her decision until I saw it in print... so I had to hang my doula hat for a moment and try to understand.  

We ALL know that 'Breast is Best', but do we know that formula IS NOT the second best alternative to mothers breast milk? When it comes to infant feeding, the hierarchy is as follows...

1. Feeding Baby at the Mother's Breast
2. Mother's own Expressed Milk (pump and bottle feed milk)
3. Another Mother's Expressed Milk (milk bank, donated milk)
4. Formula (not all formulas are equal, some are worse than others!)

Human milk can come from milk banks such as Human Milk Banking Association of North America where milk has a price and sometimes it is a little costly, but donors are screened and receive blood tests and the milk is pasteurized to kill bacteria (this does decrease some good properties of the milk, but only slightly). These banks need many more donations of human milk to meet growing need, but rigorous tests to be a donor, milk collection standards, and the cost deter many women. This milk is being used more and more for premature infants and the high standards/safety of the milk is an appropriate prevention strategy and is likely beneficial to these fragile babies.

Women have also shared milk and nursed other women's babies throughout human history. There are informal and formal networks for  milk sharing among women, one such example is Human Milk for Human Babies.There are some concerns about the spread of disease among informal breast milk sharing.

When marketed, formula appears to be 'almost' as good as mother's breast milk... but this isn't even remotely true! Formula can be contaminated with dangerous chemicals and powdered formula IS NOT sterile. Formula just isn't the 'almost' that so many parents are led to believe it is.

Some thoughts about the safety of formula-
  • Formula can be RECALLED due to contamination!! (In the photo to the left, the formula was recalled due to contamination from pieces of bugs and larvae)
  •  Formula can become contaminated during any step of the collection and manufacturing process as well as while being used in your home
  •  Contamination can occur from many sources and in severe cases can lead to death. Such examples include: Enterobacter sakazakii and other microorganisms in powdered formula, additives such as melamine and mercury, as well as from the water being used to mix the formula, improperly cleaned bottles and nipples, plastic can contain Bisphenol A, etc...
  • Most parents do not PREPARE powdered formula correctly to kill microorganisms such as E. sakazakii and many do not use formula as instructed (such as throwing unfinished formula away after feeding).
Powdered formula needs to be heated to at least 158 degrees F (to kill bacteria and microorganisms that can be IN the FORMULA) - then it can be cooled and fed to baby immediately, or refrigerated for no more than 24 hours, HOWEVER, this is rarely done by parents in the U.S. and even formula companies and WIC do not have updated recommendations for how to properly prepare formula.

Here is a link to the Health Department in the UK that describes how to properly prepare powdered formula.

Also, in comparison to feeding the baby at the breast, when bottles are used babies tend to be overfed and parents tend to hold the baby less during feedings (ie. prop up bottles). 
So back to mothers choosing not to breastfeed. As with many decisions made for a new baby, choosing not to breastfeed would be a very difficult decision to make; even though there is still a lack of respect and support for breastfeeding in the U.S., choosing NOT to breastfeed is fiercely protested by many, many others. I look forward to a day when Breastfeeding is the norm again and very, very few women feel uncomfortable or 'wrong' about breastfeeding and breastmilk. Until then, there needs to be more support for mothers who choose to breastfeed, access to donated and affordable human milk, accurate information about infant formula and proper preparation, and an environment supportive of women's rights to choose!

and remember...

Normal Feeding! 

~Wisdom and Birth

Monday, July 23, 2012

Doula-ing a HypnoBirth

Over the weekend I attended the labor of my first HypnoBirth mother. Labor progressed at home for quite some time before arriving at the hospital at 100% effacement and 3cm dilation. This mother was amazing, so calm and in control - I really experienced how to be present for a woman and to affirm her strength in labor.

First, I think I may love HypnoBirth! When I met this particular family they were taking the childbirth education classes and shared how much they were enjoying the philosophy of centered and empowered birth. I was excited to experience something new! At our prenatal visit they let me borrow the book and I devoured the first half in two days.
HypnoBirth is based on the understanding that birth is not inherently painful and it is fear that leads to tension within the body and the experience of pain. Mothers spend a little time each day envisioning a peaceful, gentle, and fulfilling birth while preparing for the physical demands of labor using breathing exercises and relaxing to encourage a state of 'self-hypnosis'. There is also a focus on the baby's experience of pregnancy, birth and postpartum as well as encouragement of bonding during all these stages; which is refreshing to see childbirth education giving information about the psychology of the baby and the impact their experiences have on their psychological development. Preparation for birth involves an understanding of childbirth, just like other classes, but the difference being the use of positive language and affirmations about the strong nature of women's bodies and their right to experience a peaceful and gentle birth. For example, the following list shows some examples of the language used in medicine and the HypnoBirth comparison...
Contraction - Uterine Surge or Wave
Coach - Birth Companion
Due Date - Birth Month, Guess Date
Pain or Contractions -  Pressure/Sensation/Tightening
Water Breaking/Rupture - Membranes Releasing
Pushing - Breathing Down
Mucous Plug - Uterine Seal
Effacing/Dilating - Thinning/Opening
Clients/Patients - Parents
False Labor - Practice Labor

My favorite chapter of the book describes the reasoning behind their philosophy and is one of my personal interests, it is called The Power of the Mind. The opening quote is excellent,

"The mind is capable of anything-
because everything is in it, all the past,
as well as the future." -Joseph Conrad

There are four basic tenets, the Laws of the Mind, they are:
1. The Law of Psycho-Physical response - states that for every suggestion, thought or emotion a person entertains, there is a corresponding physiological and chemical response within the body
2. The Law of Harmonious Attraction - entails that our thoughts/words/beliefs/actions have energy and what we send out comes back to us, therefore you strengthen the vibration this thought/word/belief/action causes and attract the same back to you (ex: healthy people rarely speak of becoming ill, yet people who aren't healthy frequently talk about their ill health)
3. The Law of Repetition - states that when you are frequently exposed to particular concepts, through conditioning these concepts become embedded in your thoughts/words/beliefs/actions
4. The Law of Motivation - states that when the mind is highly motivated, the body responds properly (ex: playing a sport on a sprained ankle; lifting a car off a child)

These are the basis for using positive birth language, affirmations, visualizations and having the people and environment around you reflect the same. I have been growing in my use and understanding of these laws for quite some time and I am happy to see them applied to labor and birth!

The mother I doula-ed for was incredible! She maintained a state of calm throughout the entire labor, with the exception of own short moment of fear when she requested her options concerning pain medications and doubted her ability to handle "anymore"; she likely did this because she was very close to being 'complete' (aka transition). With encouragement, support, and information about choices, she was able to calm and center herself again and maintained this state throughout her pushing. This mother may have already been on a path to a more simple and blissful birth, but I believe HypnoBirth gave her the tools she needed to build confidence in her ability to birth confidently and peacefully. 

~Congratulations to a new family :) Cheers!

Friday, July 20, 2012

Thoughts and Praise for Labor Companions!

"The first intervention in birth, that a healthy woman takes, is when she walks out the front door of her home, in labour. From that first intervention, all others will follow".
~Dr. Michael Rosenthal - Obstetrician  

“You are a birth servant. Do good without show or fuss. If you must take the lead, lead so that the mother is helped, yet still free and in charge. When the baby is born, they will rightly say: ‘We did it ourselves!’ ~from the Tao Te Ching

"If I don't know my options, I don't have any." ~Diana Korte
"All over the world there exists in every society a small group of women who feel themselves strongly attracted to giving care to other women during pregnancy and childbirth. Failure to make use of this group of highly motivated people is regrettable and a sin against the principle of subsidiary."
~ Dr. Kloosterman, Chief of OB/GYN, Univ. of Amsterdam, Holland
"Pregnancy and birth knit womankind together.  Help weave a gorgeous thread to add to the fabric.  Be supportive.  Be kind.  Be wise.  Be open."  ~Desirre Andrews
"Attending births is like growing roses.  You have to marvel at the ones that just open up and bloom at the first kiss of the sun but you wouldn't dream of pulling open the petals of the tightly closed buds and forcing them to blossom to your time line"  ~Gloria Lemay
"The more births I attend, the more I realize how much we disturb the birthing woman."
~Gloria Lemay - Birth Attendant

"We must give women the opportunity to challenge their fears, work with them, and birth through them. Not only will this change each woman, it will change the political and medical climate in which they make these choices."
~Connee L. Pike-Urlacher

"For birth companions to simply be, to do nothing when nothing is all there is to be done, to offer support without judgement, guidance without attachment, love without conditions - that is perhaps the greatest challenge and the greatest gift."
~Vicki Chan, Midwife 

  "…labor is not about dilation. Your body knows how to give birth whether or not you ever have a pelvic exam during labor. Birthing women need encouragement to trust their bodies, and to be the stars of their own labors…”  ~The Doula Guide to Birth

  "If a doula were a drug, it would be unethical not to use it."
~ John H. Kennell, MD   
 ***Cheers to all the doulas, midwives, fathers, and many others who support birthing mothers!***
 ~Wisdom and Birth

Tuesday, July 17, 2012

Remember... Vaginas are 'Private Parts'

Since when did the birthing vagina lose it's privacy?!?

In the United States, the majority of births occur in the hospital where women are EXPECTED to deliver their baby's in the lithotomy position; which is extremely counterproductive to pushing and I think we would all agree it's uncomfortable and unflattering.

How humiliating the traditional hospital birth must be for some women who have kept their sexuality within the confines of their relationships and bedroom, but now their most intimate body part is exposed during a more or less "unflattering" event. Some women even experience a level of embarrassment or anxiety when it comes to topics relating to, or issues with, their vaginas.

From early childhood we are trained that our genitals are "private parts" intended only for ourselves and those we love and trust. We spend years functioning with this knowledge and it becomes a part of what we believe to our very core. Then we are expected to set dignity aside in order to make OUR BIRTH more convenient for the practitioner catching the baby... this needs to change!

In the past, I had only thought of this as an issue for myself and I decided that I wanted to have my births at home; not only to avoid the diseases and interventions that hospitals have a plethora of, but also because I saw this as the only location where I could preserve my pride and dignity.

Around this time I read Brigitte Jordan's book Birth in Four Cultures and I was particularly moved by the respect shown to laboring mothers by the Mayan Midwife who never looks under the sheet hanging over the woman's legs because this would undermine her privacy, rather, she uses her hands to 'see' what she needs to.

I recently met a potential birth client who was experiencing anxiety from the knowledge that during her birth she would be so inhumanely exposed and embarrassed by the attention focused at her vagina. She requested that vaginal exams be kept to an absolute minimum and even asked if a curtain could be hung, like in Cesarean births, so she couldn't see what was going on... essentially she is trying to disconnect from the lower half of her body so she doesn't feel the embarrassment of exposure.

This is FEAR that can easily be avoided! We MUST maintain a women's dignity and encourage her empowerment and pride. Allowing her the comfort and respect for privacy will decrease her fear, enabling the birth process to function in a more optimal manner.

While reading HypnoBirthing - The Mongan Method, I was struck by one of the "Articles of Birth Affirmations" which says:
  • Women's bodies and, in particular, their vaginas, are as sacrosanct during pregnancy and birth as they are at any other time. Routine and unnecessary prodding and manipulation should be avoided in the absence of medical urgency. 
... beautiful and extremely well said!

The Purpose and Value of Labor Support: My Doula Certification Essay

We know, without any doubt, that women have been providing emotional, physical and experiential support to other women in labor throughout much of human history. We now have a plethora of research to demonstrate the beneficial effects of continuous, knowledgeable labor support, such as that of a Birth Doula. However, in our hearts, we don’t need the research to acknowledge the ease we feel when others are present to support us in a time of powerful internal and external struggle and growth. During such monumental transitions and experiences it is important to have supportive, nurturing, and knowledgeable witnesses and this is the service of Doula care.
A doula, Greek for a woman who serves, is a caregiver who is present to provide continuous emotional, physical and informed care especially to the mother, but also to her partner and/or family. According to DONA International’s Code of Ethics, “the doula’s primary responsibility is to her clients… the doula should promote the general health of women and their babies, and whenever possible, that of their family and friends as well.” The doula provides individualized care to a mother, her baby and her family; while also working alongside, and not contradictory to, the healthcare staff providing care. A doula places their wishes, beliefs and experiences aside and concentrates on the desires of the laboring mother and strives to act as a personal advocate for the mother while providing emotional and physical care. A doula does not perform medical tasks such as vaginal exams, blood pressure checks, or provide medical advice. A doula specializes in natural pain management techniques and comfort measures such as breathing and visualizing techniques, labor positions, and provides reassurance through a foundational knowledge of, and training in, childbirth.
Labor support provides far reaching benefits to more than just the mother and her family, but also to the other medical attendants, our healthcare system, and society as a whole. Research by Kennel and Klaus, cited in the Birth Doula’s Position Paper by DONA International, shows the incredible impact of continuous labor support by a doula on the maternal-infant bond and on decreasing the incidence of labor and delivery related complications. When delivery complications are decreased there is less money spent on medical interventions, less strain placed on nurses and doctors, and better outcomes for mothers and their babies. The importance of a strong maternal-infant bond is tantamount in increasing the length of breastfeeding, decreasing the incidence of postpartum depression and enhancing the experience of childhood and parenting for both parties.  Providing continuous, knowledgeable labor support, such as from a doula, can positively impact our collective maternal and child health, but also improve the experience and health of the individuals we serve.
                On a more personal level, I believe the modern doula is a necessity, created to save the act of childbirth from an impersonal, medical model of conveyor-belt-birth. When the last thread of natural, sacred and spiritual birth was fraying to an end, the modern birth doula emerged to protect the humanity of mothers and their babies. The modern Doula has begun to restore the spiritual aspect of birth and to support the individual and personal experience women face during labor. The collective experience of childbirth is shifting once again and we will learn to respect the emotional and spiritual nature of childbirth, as we once did, when women labored in the arms of safety, love, and experience of other women, doulas.

Sunday, July 15, 2012

Becoming a birth doula, CD(DONA)

When I first knew I wanted to break into the birth world I had no idea of where to start. I researched every profession and pathway I could find and chose to become a birth doula first. I decided to go with DONA International because of their strong evidence-based position on the positive effects of continuous labor support, the well-known names that founded the organization, and the fact that it is an international organization and I may decide to live and practice outside the U.S. someday. 
I began with the required readings and finished these before purchasing my packet. In March 2010 I took the DONA International doula training, which entailed two full days of hands on birth learning with about 15 other very passionate women in the basement of a doula trainer's home. I felt exhilarated and empowered by my birth doula training and I was ready and determined to conquer the birth world. Within two months I found a Bradley Childbirth Education class that I was able to sit-in on for free and thus completed the CBE component of my training. 
At the time a family friend was a DONA certified birth doula and invited me to tag along on her next birth. I met the family for a brief visit before the birth and then when the time came to attend her labor I received a phone call from the main doula, in the middle of my work day, and feigned illness so I could leave early... I rushed to the hospital. The labor was completely medically managed and I was somewhat disappointed in how little my new skills and knowledge was needed, but in the end, I was pleasantly surprised with how happy this mother was with her birth experience and I began to fully understand the role of a doula... to advocate for and support a mother in choosing the best birth for her.
As for my 3 births towards certification. I attended two hospital births with very few interventions, vaginal delivery, and mostly satisfied mothers. One mother had an episiotomy and was discouraged by this because she labored without ANY other intervention and felt this was done against her wishes and with little effort on the midwife's part to help her change positions to get the baby out... I learned from this too! Next time I will have the knowledge, experience, and confidence to speak up and protect the wises of laboring mothers. Finding these births was a little challenging and I definitely had to look around for women that wanted a student doula (I charged $200 a birth for travel expenses and potential lost wages from missing work). 
Finally, my final certification birth was, and still is, my favorite. It was a home birth VBAC; their first born had been delivered by emergency c-section, which the parents later felt was absolutely unnecessary and wouldn't happen again. They wised up for the birth of their second and attended childbirth education classes, rented a birthing pool and hired a midwife to attend their VBAC at home; then they asked me to be their doula. This was an incredible experience and one I will hold dear for the rest of my life, I love home birth and will always be an advocate for mother's who want to labor and deliver in the comfort and safety of their home. 
I tried to find a breastfeeding class to take because I wanted the interaction and visual learning experience, but after many months of searching and not being able to afford some of the more expensive classes, I decided to complete the online Breastfeeding Basics course. I ended up taking this course multiple times, which really didn't bother me, but I couldn't figure out how to register correctly and I was never sure my completion of the course was noted and sent to DONA. In the end I took this training 3 times, and was finally able to get a certificate of completion after the third try... this would have been frustrating if I wasn't so interested in also being a breastfeeding professional.
In the end, my whole certification process took almost two full years, but this was because of my lack of follow through to complete the final requirements. The bulk of the "work" I completed within 8 months, but I took a long break before finishing my resource list and writing my labor support essay. 
Once I completed my packet and it was submitted, it was 2 months before I heard from my reviewer. She was very friendly and had my references called and all my materials evaluated within two weeks... then I was officially a certified birth doula! About 3 months later I called DONA International and asked if my certificate, badge, and ID would be mailed soon and they got around to it immediately after that. Unfortunately my name was mis-spelled on all my materials and I was a little frustrated, but DONA has redeemed themselves by sending me corrected replacements in less than one week!
I am now a certified birth doula and I proudly carry CD(DONA) next to my name. I attend births in any setting and I understand that my role is to support women in having the birth that is right for them!
As a doula, I provide one or two prenatal visits (depending on the amount of time before their EDD), phone and email contact throughout the pregnancy, I am "on call" around their EDD and I provide continuous labor support once the family decides my presence is desired. I stay with the family for about 2 hours postpartum to help with breastfeeding, newborn procedures, and provide any other informational/emotional support needed. I also provide a postpartum visit about 2-5 days after the birth to check in on the health and well-being of the mother and baby, help with breastfeeding issues, and discuss the birth with the mother and her partner. I charge one fee to cover all these services.

Book Review: Birthing a Better Way

A supportive, no-nonsense approach to informed childbirth in any setting; a hospital, birth center or at home. Cook and Christensen have compiled 12 “secrets” for natural childbirth encouraging women to understand the powerful and spiritual process of birth and to be truly informed when it comes to birthing in any setting. I am thrilled this book is hitting the birth market and I have high hopes that the bold captivating title, with the promise of learning 12 natural childbirth secrets, will contribute to the movement back towards natural, holistic birth.
Each chapter addresses one of the “12 secrets for natural childbirth” and provides a wonderful compilation of research based information, advice from well-known experts in the field, and a wide variety of positive and encouraging birth stories. Among the first pages, readers will find professional advice from Christine Northrup, M.D. and Margaret Christensen, M.D.; addressing a common fear- based model of birth and encouraging women to arm themselves with natural childbirth information and a supportive environment when bringing their baby into the world. Kalena Cook describes her personal motivation to avoid a cesarean and thus, through dedication and research, having a natural childbirth. Her birth inspired her to write a book filled with positive and informative stories, evidence-based support for natural childbirth and professional advice for mothers-to-be concerning how to make the best, informed decisions for their birth experience.
The first of the “12 secrets for a natural childbirth” entails reading positive birth stories and provides information concerning why women choose natural, un-medicated birth when medication is widely available. Included is also Kalena Cook’s personal birth story and some of the shocking information she discovered during her journey toward motherhood. Cook makes her points in a factual and blunt way such as stating “These drugs can affect the baby’s ability to breathe after birth. I was shocked to find that the FDA does not require drugs used in labor be proven safe for the unborn baby”, (Cook, 12). Following Cook’s  birth story readers will find Margaret Christensen’s story about how a doctor, despite the challenges and pressure from hospital colleagues and medical training, is able to transform her birth experience from that of her first child, full of interventions, to practicing age old birth traditions such as hypnotherapy and visualization during her subsequent births.
Among the other “12 secrets for natural childbirth” are: Turn Scared into Sacred, Don’t Take Labor Lying Down, Learn Hospital Strategies, Transform Life’s Challenges, Go Confidently With Expert Encouragement and many more. The secrets range from informative (Know There’s a Reason for the Squeezin’,) to providing access to out of hospital options (Find Out How Birth Centers Bridge the Choice), as well as acknowledging the spiritual enlightenment an informed, natural childbirth entails (Make a Mind-Body-Spirit Commitment). There are birth stories of successful, planned natural births in the hospital, birth center and at home as well as stories of unexpected complications, delivering twins naturally, VBACs, delivering a baby with Down Syndrome and more. The final chapter, Prepare for Baby’s Arrival, covers breastfeeding, postpartum depression and the controversial issue of circumcision; again, Cook provides straightforward information concerning the lack of data supporting such an unnecessary and traumatic procedure. There are additional resources in the appendix addressing nutrition, exercise, epidural ingredients and side effects, resources and simple birth plans; making this book a truly comprehensive birth book for mothers-to-be.
Throughout the book readers will be encouraged, guided and motivated by influential birth professionals such as Ina May Gaskin, Penny Simkin, Sheila Kitzinger, Susan Atkins and Aviva Romm and many more. Access to statistics, comparative views of technocratic vs. holistic birth models, questions to ask yourself and professionals concerning the environment you are considering for your birth, outlines of commonly offered childbirth education classes, how to calculate due dates, and much, much, more is provided throughout the pages of this book. I am certain women of all cultures, ages, backgrounds and socio-economic status will find this book useful and rewarding when discovering the birth they want to experience. My hope is that the bold, powerful title along with the promise of learning “secrets”, which entices us all from time-to-time, will give women the confidence to pull this book from the shelf first and heed its wonderful direction.
A fantastic resource for mothers to be, whether their first child or their fourth, Birthing a Better way is exactly that; a resource informing women how to birth a more natural, informed and better way. Cook provides bold, clear statements concerning the dangers of interventions, the importance of bonding and being supported through the physical and spiritual process of birth and transition to motherhood. I am thrilled to be a birth professional today when we are beginning to let our voices be heard and we can stand proudly by natural birth and say “This is a better way to birth!”
McCallian, R.J. (2010). Birthing a better way: 12 secrets of natural childbirth. [Review of the book Birthing a Better Way: 12 Secrets for Natural Childbirth, by K. Cook & M. Christensen]. Journal of Prenatal and Perinatal Psychology and Health, 25(2).