Comfort in Labor Handout

Dec18

Childbirth Connection also has an excellent handout titled Comfort in Labor. It is by Penny Simkin and it has TONS of great line drawings and covers a lot of labor support material in 14 pages. For partners looking for ideas of how to support women in labor, this is almost like a really quick doula training!

What is a doula?

A doula is a labor support professional trained to support birthing women physically and emotionally. She is a non-medical care provider who offers continuous one-on-one care during labor and birth.

Cesarean Birth in a Culture of Fear Handout

Dec18

The cesarean rate in the US continues to rise and in 2006, 31% of all mothers had cesareans. The World Health Organization suggests a 10-15% cesarean rate is the upper limit to “necessary” cesareans and most experts agree that the US cesarean rate has gotten out of hand. Considering that a pregnant woman has a 1 in 3 chance of having major surgery just upon walking in the door of a hospital, it is important to become educated about cesareans and cesarean prevention.

In September, Mothering magazine published an excellent article called Cesarean Birth in a Culture of Fear. In addition to being a thought provoking analysis of technological birth in the US and the ever-rising cesarean rate, it was also extremely well illustrated (including a remarkable computer created image of a woman in a “traditional US hospital setting” that gives me chills–she has 16 different “attachments” hooked up to her as she tries to focus and give birth to her baby). There is also a series of illustrations that very clearly demonstrate the step-by-step process of a cesarean in a way that we rarely see. Now, this useful article has been turned into a booklet and made available as a handout on the Childbirth Connection site!

Can I Eat During Labor?

Dec14

A woman in labor is working harder and longer than she may ever have done before. Eating is important to maintain her energy, strength, stamina, and good health. Many women choose light, easily digested foods–whatever appeals to them most at the time. However, many hospitals and care providers have a policy in which laboring women can only have ice chips to “eat” during labor. Others permit water and sometimes clear liquids. This is an example of a situation in which common policy and routine is NOT in accordance with evidence based care.

A large recent study from the UK confirms what birth professionals have long felt to be true–that light eating during labor does NOT raise the risk of complications.

Policies denying women solid foods during labor are often explained with the reasoning that there is a risk of “aspiration pneumonia” if you eat during labor (and then end up having a cesarean under general anesthesia). The researcher, Dr. Liu, says that this problem “did not occur.” He also stated that the UK Department of Health’s records show only one case of aspiration in two million births (the risk of complications of cesarean is considerably higher than that and that doesn’t stop US doctors from having a 31% national rate of cesareans!).

Policies against eating during labor originated during the 1950’s and things have changed a good deal since then. As an ICAN representative stated, “This new study will allow doctors to rest assured that eating helps rather than hinders the birth experience.”

The excellent exhaustive research summary and review A Guide to Effective Care in Pregnancy & Childbirth (available for free download from Childbirth Connection), also supports light eating during labor, pointing out that not doing so leads to a risk of dehydration and/or ketosis. Withholding food or drink from women in labor is included in the Effective Care book’s table, “Forms of care unlikely to be beneficial.”

Evidence Based Care

Dec14

Simply put, evidence based care is care that is based on the best available evidence (research, studies, accurate, up-to-date published materials) and upon the individual woman’s unique situation. Any interventions are applied judiciously and with consideration of true medical indication and also the needs of the woman. Evidence based care is different than “routines” or “policies” which may or may not have a basis in evidence.

Citizens for Midwifery has an excellent fact sheet summarizing the evidence behind the Mother Friendly Childbirth Initiative’s 10 Steps.

In her excellent new book, Pushed, Jennifer Block shares the following about evidence based care:

“…The goal is to have a healthy baby. ‘This phrase is used over and over and over to shut down women’s requests,’ she [Erica Lyon] says. ‘The context needs to be that the goal is a healthy mom. Because mothers never make decisions without thinking about that healthy baby. And to suggest otherwise is insulting and degrading and disrespectful’…What’s best for women is best for babies. and what’s best for women and babies is minimally invasive births that are physically, emotionally, and socially supported. This is not the kind of experience that most women have. In the age of evidence based medicine, women need to know that standard American maternity care is not primarily driven by their health and well-being or by the health and well-being of their babies. Care is constrained and determined by liability and financial considerations, by a provider’s licensing regulations and malpractice insurer. The evidence often has nothing to do with it.” (emphasis mine)

In the next couple of posts I will address some specific examples of evidence based care.

Care Practices that Support Normal Birth

Dec5

The Lamaze Institute for Normal Birth has a powerful series of research based care practice papers describing the six care practices that support normal birth. The papers were updated recently and are available on their website in both HTML and printer-friendly PDF formats. These care practices are of vital importance to the normal birth process. The papers are extensively researched and include many citations and are an excellent resource to share with your doctor or with curious (or doubtful) family members or friends. These care practices form an underlying basis for much of the information I present during classes and are practices that should underlie good care in any birth setting (though, sadly, all too often what women receive from their care providers is NOT evidence based and does not follow these care practices. I will write more about this later). Lamaze’s Care Practices are:

Care Practice #1: Labor Begins on Its Own

“Labor is a set of complex, interacting components. Alteration of the natural process can expose a woman and her baby to unneeded risks.”

Care Practice #2: Freedom of Movement Throughout Labor

“Free movement during labor allows a woman to manage contractions and assist the baby’s rotation and movement through the pelvis.”

Care Practice #3: Continuous Labor Support

“Current research supports the benefits of continuous emotional and physical support during labor.”

Care Practice #4: No Routine Interventions

“Supporting the natural, normal, physiologic process of birth requires clear medical indications prior to any medical intervention.”

Care Practice #5: Spontaneous Pushing in Upright or Gravity-Neutral Positions

“Allowing a woman to find positions of comfort and encouraging her to push in response to what she feels is beneficial to the birth process.”

Care Practice #6: No Separation of Mother and Baby, with Unlimited Opportunities to Breastfeed

“When a baby is kept with the mother, there are physiological benefits to both, including the facilitation of breastfeeding.”

My own short description of the care practices using more direct language would be:

1. Avoid induction.

2. Stay out of bed. Move around a lot!

3. Hire a doula.

4. Demand individualized care–no interventions that are “just because” or “hospital policy.”

5. Squat, kneel, or get on all fours to push.

6. Breastfeed your baby early and often! Keep your baby with you and do not let hospital staff separate you from your baby because of routines or policies.

Rolla Area Groups for Mothers

Nov21

Forming supportive networks with other women is something that is important to most women. These contacts are especially important for new mothers. Early motherhood can be a very isolated time. A time in which massive changes are occurring in your family, your personal life, your identity, your relationship, and so forth. Rolla has several support groups available for local mothers:

La Leche League of Rolla, a mother-to-mother group for breastfeeding mothers or women who plan to breastfeed, is available with monthly meetings (informal get togethers with babies and toddlers welcome!) , an email discussion list, and free phone or email help for breastfeeding support.

Mindful Mothers is a group for mothers with children of all ages who wish to make informed parenting choices, including natural birth, attachment parenting, gentle discipline, holistic health care, nutritious whole foods, and environmentally conscious living. (This is a welcoming, supportive environment, you do not have to do everything “holistic” or “natural” in order to be welcomed into the group!)

Mothers of Preschoolers (MOPS)–the local chapter has twice monthly meetings at First Christian Church. The first Thursday of the month there is a speaker and the third Thursday there is a “creative activity.” Childcare is provided during the meetings.

If you know of a local mothers’ group that is available, but not listed here, please email me and let me know!