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).

Tuesday, July 10, 2012

Chemical free baby wipes!

I have long been flabbergasted by the number of hazardous, toxic and even questionable chemicals used on babies or in baby products. Even chemicals with an unknown level of effect on the developing body systems shouldn't be used; the mantra for baby products should be "harmful until proven safe". To make matters worse, not only are there a number of harmful chemicals in items baby's gnaw on, but there are numerous chemicals in products that are used daily on the most sensitive areas of a baby's body, such as diapers and wipes. Some of these chemicals include:
  • Phthalates - male reproductive system disorders
  • Fragrance (may also contain phthalates)- hormone disruptors, common allergen
  • PEG/Ceteareth/Polyethylene compunds - absorbs easily through skin, possible carcinogen
  • Parabens (all kinds) - estrogen mimicking preservative potentially contributing to reproductive, endocrine and developmental disorders 
... and this is just a part of the list

The first place I learned about the chemicals being used in products such as baby wipes was from the Environmental Working Group. They have easily accessible and useful databases, guides, and printouts about chemicals found in cosmetics, sunscreen, baby products and many other topics such as pesticides used on produce. Over two years ago I decided to purge all my cosmetics and begin fresh with chemical free products. I used information from EWG (from their cosmetics guide) to review the ingredients in each of the products I was looking to use. I was encouraged because I would be decreasing the toxic load my body had to handle, but frustrated that I needed to be so careful with products I buy because there is so little regulation into the ingredients that make up cosmetics and other body products.

Using the EWG cosmetic database, I performed a search for 'baby wipes' and the most commonly purchased wipes on the list (such as huggies) rate an 8 out of 10 on their scale of safety, which is 'high hazard'. Some of this hazard rating is attributed to having very little information about the ingredients these companies put in their products. Even a moderate level of safety from products that can damage a developing reproductive system and cause future issues with fertility or cancer is unacceptable; these companies need to demonstrate the safety of their ingredients and products, or at least make their ingredients known.

I recently stumbled across a blog from Wellness Mama where she gives a fantastic recipe for homemade baby wipes. The wipes contain ingredients such as witch hazel, aloe vera, oil, and castille soap (such as Dr. Bronner's), which can be purchased in bulk, and you can use paper towels or make reusable wipes from cloth. There are even suggestions for making cloth wipes for cleaning household items and surfaces... the possibilities are endless! This method not only saves money, but also helps protect your child's long and healthy life :)

This future mother aspires to use cloth diapers and natural, homemade wipes (not all the time, but I am going to try my best!) and I will use this recipe with some of my own preferences mixed in. I may try using coconut oil mostly because I love the smell, but it is also great for soothing, moisturizing and it has antimicrobial, fungal and bacterial properties. Check out Organic Facts for more about the health benefits of coconut oil (I also love to bake with it!).

Sunday, July 8, 2012

Delay Cord Clamping - Your Baby Deserves Their Blood!

The techno-medical management of birth is pervasive. I struggle to understand the origination of some obstetrical interventions, such as the immediate (or quick) clamping and cutting of the umbilical cord.

The umbilical cord develops between 3.5 and 8 gestational weeks and sustains the baby throughout the pregnancy and even in the minutes after birth by transferring nutrients and oxygen to the fetus from the placenta and carrying fetal waste away.

The transfer of nutrient rich and oxygenated blood continues after birth and is important for all babies to receive, but particularly important for babies that are slow to start breathing on their own.

I recently watched a youtube video of a Grand Rounds lecture from M.D. Nicholas Fogelson (AcademicOB/GYN) about delayed cord clamping and the importance of this as a standard of practice in medicine. He gives an excellent presentation and discusses several large well-executed research studies in which the evidence for delayed cord clamping is strong.

I was also intrigued by his slides and remarks about other mammals and what they do with the cord after birth, obviously they are very unconcerned with the cords and often leave them alone until after the placenta is birthed. In humans, some practice a "Lotus Birth" where the cord is not cut and the baby/placenta are left connected until the cord naturally falls off of the baby.

Some of the important points I took out of Dr. Fogelson's lecture include:
  • Delayed cord clamping results in about a 25-40% greater blood volume in the newborn that persists for about 2 weeks
    • If an adult had 40% less of their blood volume they would go into shock
  • Hematocrit levels are significantly higher in babies with delayed cord clamping (65% compared to 45%), however they stay below levels for polycythemia if the cord is left alone (ie. not stripped or "squeezed out"
  • Increased volume of red blood cells
    • There appears to be no greater incidence of jaundice noted in any of the studies (some believe this would occur because of the "higher"volume of red blood cells) and bilirubin levels often do not exceed the "pre-determined limit"
  • 50% of the placental transfusion occurs in the first minute (60 seconds) after birth, the remaining 50% occurs over the next 3-5 minutes

... what is SO complicated about leaving the mother and baby skin to skin for the first 5 or so minutes after birth, with the baby laying on the mother's abdomen before cutting the cord? We already know that laying on the mother's abdomen has many other benefits such as keeping the baby warm, increasing oxytocin release in the mother to help facilitate the birth of the placenta and decreasing maternal bleeding, and helps establish breastfeeding.


It needs to be standard practice that cord clamping and cutting is delayed for at least the first few minutes after birth.

As for cord blood collection, although the uses of cord blood appear to be growing, the benefits of babies receiving their own personal supply of embryonic and fetal stem cells, as well as stores of Iron and other nutrients, seems to be the most simple example of "do no harm" as there is no evidence to support that babies are BETTER without the cord and placental blood.

Also, as with all things we do with newborns and young children, our movements and intentions need to be gentle and respectful of their more sensitive needs; cord clamping and cutting can occur on the mother's warm and comforting body and the procedure and be done in a peaceful manner. This is the cutting of the mother and child's physical connection, something that could be very sacred and profound to some :)

Enjoy the moment and leave the cord alone!
~Wisdom and Birth 

Thursday, July 5, 2012

Pain in the Neonate

It was once a common thought among some (often more western) cultures that children didn't feel pain before the age of 3, or if they "felt" the pain, they didn't remember it so it didn't matter anyway.

This belief has persisted throughout many, many generations and our current medical model of care often manages to ignore the important fact that unborn and newborn babies DO feel pain. As for "remembering", we may not be able to recollect the things that happened to us in our infancy, but that doesn't mean they aren't a part of our unconscious thoughts, foundational behaviors, and cellular memory.

An article from Science Daily addresses recent research about painful procedures being performed on newborns in ICU's (this article is addressing research conducted in Paris, but our procedures are very similar), particularly how many procedures newborns undergo and that some of these are performed without any pain medication.

It is important to know, and the article addresses this, that these painful procedures are occurring at a time in development when pain is generally unexpected and newborn (as well as unborn) babies are more sensitive to pain than older children and adults. This just seems like common sense to me, but for those who do not naturally protect the young, we need lots of research to try and prove these "theories" and make a very crucial change in the medical system.

Kangaroo Care
As for the research, 430 neonates were observed and their average gestational age was 33 weeks, average ICU stay was 8.4 days. Painful and stressful procedures were measured as well as pain medication/relief.

The results are upsetting... the average number of procedures for each neonate during their ICU stay was 141, the average per neonate/per day was 16; of these, 70% of procedures were considered painful (such as nasal and tracheal aspiration, heel stick, adhesive removal) and 30% were considered stressful.

I'm not sure I see the need to separate the two (painful and stressful) for a neonate, I feel as though pain is stress inducing and stress can heighten receptivity to pain.

80% of these procedures were performed without pre-procedural analgesia ... however, the researchers noticed that when parents were present, or the procedure was being performed during day-time hours, more pain medication was used.  

How sad. I believe there are more effective and efficient ways to receive even better results for the health of the baby. For example, better record keeping and use of blood samples could decrease the overuse of heel sticks and we already know that kangaroo care and breastmilk are excellent supplements to almost any therapy. 

Some babies in the ICU are experiencing hundreds of painful and stress inducing procedures during their "treatment", I am certain these babies would be stronger and healthier if there were treated with respect and nurtured.

Now that we have the technology to treat conditions that result from prematurity, low-birth weight and other issues, we need to consider our ethical responsibilities to those we treat. We must keep in mind that the future of our humanity (and ourselves) is in the hands of the tiny babies we are treating and they will likely give back to us (and the world) as we have treated them... let's give them love!
 

As a professional, I would like to bring attention to this issue and to support a hasty change in the manner that procedures are conducted on neonates with very little to no pain medication.

This includes interventions that occur during labor, birth, and postpartum because many of these can increase stress and pain in the baby as well. Interventions such as pitocin, forceps delivery, fetal scalp monitor, removal from the mother after birth, suctioning, circumcision, etc.

A change can be made, but it is parents and birth professionals that need to advocate to make it happen!

Happy Advocating!
~Wisdom and Birth

References
JAMA and Archives Journals (2008, July 4). Newborns in ICUs often undergo painful procedures, most without pain medication.Retrieved from http://www.sciencedaily.com/releases/2008/07/080701165057.htm


Wednesday, July 4, 2012

Thoughts on Prenatal Psychology

For my first blog I would like to return to my interest in Prenatal and Perinatal Psychology (PPN) and how our current medical model of managed care can often negatively impact the optimal trajectory of human development. This topic is extensive and this blog was originally very lengthy, but I will keep this to a PPN introduction and more detailed thoughts about obstetrics and PPN will follow later.

Prenatal and perinatal research has demonstrated that a baby is conscious and aware during the prenatal period and that they  experience the mother's internal and emotional states. In the womb, babies are learning about themselves and the world around them through information obtained using their five senses as well as through the transfer of chemical messengers, such as hormones, in the shared maternal blood. Emerson (1998) discusses the long-term detrimental impact of many medical interventions on both the physical and psychological well-being of babies and reminds us that the mother's experience and perceptions of the pregnancy, labor, and birth not only influence her, but they also influence her baby (unborn and newborn).

I want to briefly address how this early learning is occurring through a simple understanding of behaviorism and reinforcement; a few examples may be the best way to do this. First, consider a mother who feels fear and intimidation whenever she thinks of, but especially sees, the baby's father and when he is around there is often loud disagreements. Not only is this fear felt by the baby (through maternal hormones crossing the placental barrier), but the baby also experiences the changes occurring in the mother's body (such as hearing the heart rate increase and change in tone of voice, yelling). We can see how the baby will quickly establish the association between the father's loud deep voice and fear/fight or flight. This learned behavior may become a foundational part of this baby and they may continue to have bodily reactions when they hear deep and loud male voices, they may shy away from loud confrontations, or conversely, they may learn to be loud and confrontational as well.

Let's also look at a positive example of this. The mother's heartbeat and the "whoosh" of blood being pumped throughout her body are the most dominating sounds for the unborn baby. Many experts believe that our time in the womb listening to this steady and reliable beat is why we enjoy the sound of drums, the tick of a metronome, the rush of water, and the clicking or humming of common environmental stimuli. The reinforcement provided in utero by the calming and steady heartbeat is why for babies are comforted outside the womb when they are held to someone's chest. This is also why many people sleep more soundly when there is white noise in the background such as a fan or air conditioner.

Prenatal and Perinatal Psychology is also demonstrating that babies are capable of picking up on conscious and unconscious thoughts, beliefs, and feelings of the mother in utero as well as other people around them after birth. This is a much greater discussion than will be addressed here, but the basis is that our heart and body send out a field of energy that is "felt" by others and provides information about our current state of being (anger, happiness, sadness...). You can find more about this at the Institute of HeartMath. I bring this up here to further support the need to respect the developing prenate and to use medical technologies in a conservative manner because we do not know the impact these interventions may have on the developing human psyche. An example of the prenate being affected by the thoughts and feelings of the mother can be seen in the case of a mother over age 35 who is told she is "high-risk" and her odds of having a baby affected by Down's Syndrome increases. This mother may receive a slew of extra exams, tests, and interventions and may begin to fear there is something wrong with her baby... the baby is awash in these emotions, feelings, and thoughts. Could these be influencing what the baby believes about themselves? What they believe their mother thinks of them? And since the mother is the entire world to this prenate, do they enter the world believing "it" thinks something is wrong with them too?

I write this first blog not only to begin my contributions to the world wide community, but also to bring more attention to the conscious abilities of the incredible human baby and to challenge everyone to give a little more respect where it is due. Some people argue that we cannot know what babies experience and that saying they are conscious and aware of their existence is unprovable... I feel that giving this respect to babies will not in any way harm their development, which cannot be said for many other false beliefs we have held in the past that have hurt so many.


You can also find resources and professionals from the Association for Prenatal and Perinatal Psychology and Health.

~Wisdom and Birth


References
Emerson, W. (1998). Birth trauma: the psychological effects of obstetrical interventions. Journal of Prenatal and Perinatal Psychology and Health, 13(1), 11-44.