Stem Cells in Breastmilk!

I just read some cool news about a recent discovery that there appear to be stem cells in breastmilk!

A quote from the article:

“The point is that many mothers see milks as identical – formula milk and breast milk look the same so they must be the same. But we know now that they are quite different and a lot of the effects of breast milk versus formula don’t become apparent for decades. Formula companies have focussed on matching breast milk’s nutritional qualities but formula can never provide the developmental guidance.”

Truly, breastmilk is unmatchable. It seems almost magical 🙂

New, Free Breastfeeding Guide from LLLI!

Feb8

La Leche League International has completely redone their catalog–the layout and appearance have received a stunning makeover and the result is a beautiful new “pocket guide” called “Breastfeeding Guide: tips & products.” So, instead of being a catalog, it is actually a helpful little booklet first and a catalog second (the products come in the second half of the booklet, after the tips. 26 pages of questions answered and then 25 pages of catalog–pocket sized though, so maybe 3 x 5?). For being so small, it covers a remarkable amount of territory and gives lots of good information–from “How often will my baby nurse?” to “When will baby sleep all night?” to “Is it possible to breastfeed twins?” It is a great little *book* not just a catalog. I love it and think it was a stroke of genius to reach out this way! The format is inspired (and inspiring!)

Childbirth educators, doulas, and lactation consultants wishing to acquire many of these Guides in bulk to distribute to their clients can do so for only the cost of shipping! ($5.41 for 50 little books!) Go to the LLLI online store to order some. They really are a lovely and useful resource!

Will I need an episiotomy?

Feb5

The short answer is no, you do not “need” an episiotomy. Women rarely (if EVER) actually “need” an episiotomy. An episiotomy is a surgical incision made in the perineum to enlarge the vaginal opening as the baby’s head is being born. This procedure is rarely necessary and you should ask your care provider how often they perform episiotomies. A good answer is, “almost never” or “I’ve done 3 or 4 in my career.” Answers that are NOT good and that should encourage you to question further are, “only if you need it” or, “many first time moms need one” or, “a clean cut is easier to repair than a nasty, jagged tear!” or, “don’t worry about it. I’ll make the decision when the time comes.” These are not good answers, because there has no study has ever shown any benefit to routine use of episiotomy! There is no scientific evidence supporting the practice.

A commonly used analogy to explain why a cut is NOT better than a tear is to imagine a piece of fabric–when you try to tear it, it resists. But, when you make a small cut in the top of the fabric and then then try to tear it, it easily rips all the way down. The same is true of your skin! (and your muscles–an episiotomy cuts through your muscle as well as your skin. Many naturally occurring tears are very small and occur only on the surface of your skin).

Here is some more explanation from an issue of Midwifery Today e-news issue number 8:23:

“Ironically, one of the biggest contributors to perineal tearing is episiotomy, which has long been heralded as the great preventer of tearing. One recent study, which only assessed the effects of episiotomy on third and fourth degree tearing, found a definite correlation between episiotomy and tearing. The risk of severe tearing was found to be nearly four times higher with episiotomy than without. Another study involving thousands of women found that the number one risk factor for perineal tearing was episiotomy.”

Though it often is presented as a choice–i.e. “would you rather tear or be cut?” I offer that there is a third option….Neither! A perineal wound is NOT an inevitable part of giving birth (even with your first baby). Though it is not abnormal to tear, it is also perfectly possible to not tear or need stitches. One way to work with your body to avoid tearing is to give birth on your hands and knees, kneeling, or squatting. Another way is to stop pushing when you feel a burning sensation or “ring of fire” and let the baby’s head naturally ease out. Your uterus will push the baby out without sustained, breath holding, high exertion pushing from you–you can rest and let your uterus do the work! When you are doing forceful or directed pushing you are more likely to tear than if you follow your own body’s pushing urges and signals. Some people also advocate perineal massage prior to birth to help the tissues stretch. While it does not hurt to become more familiar with this part of your body and how your muscles feel when they are relaxed or tense, perineal massage has not been shown to have very much effect on your chance of tearing during birth.

Care in Normal Birth

Feb4

I recently discovered there is a free pdf book available from the World Health Organization called Care in Normal Birth: A Practical Guide. The booklet is very research oriented, so while it is great for finding evidence based information, it is not “light” reading for every day use! It is directed towards birth professionals.

Good Foods to Eat in Labor

Feb4

Eating is important during early labor to keep up your strength and provide you with energy for your work. Many women find that they naturally no longer wish to eat once in active (serious) labor. Eat small portions of easily digested foods that you know that you like and that sound good to you at the time. Choose foods that are light and stomach-friendly. Complex carbohydrates are better choices than fatty or fried foods.

Some ideas are:

soups
crackers
graham crackers
fruits
bananas
Jello
pasta
honey sticks (plastic tube with about a TB of honey in it–good quick energy boost, especially in a birth setting with restrictions on food or drink intake. See my previous post for a discussion of the validity of withholding food and drink from laboring women).
toast
broth
yogurt
herbal tea
white grape juice
apple juice
miso soup
popsicles
fruit juice or honey-sweetened tea frozen into ice cubes
cereal
noodles
rice
cooked cereals
scrambled or boiled egg
applesauce

It is also very important to stay hydrated during your labor! Try to take a sip of something every 15-30 minutes and at least once an hour. Have one of your labor support helpers follow you around with a drink with a straw in it and hold it to your lips every so often. If you feel like sucking, you will, if you don’t, you won’t. There is no need to have a big conversation about it every time. Some women like to drink apple juice during labor, other feel it is too acidic. Orange juice is not usually recommended as it might make you feel sick or vomit. Some women choose to drink a sports drink (like Gatorade). Water is always a good choice! Other women choose hard candy to suck on during labor. Be careful choosing a flavor, because you may taste it again later and it may bother you. Avoid carbonated drinks.

What about dad?

Make sure you have snacks packed for you as well! Avoid anything that will linger unpleasantly on your breath (garlicky pasta is out!) Dads may like to have some easy to grab, quickly nutritious snacks like trail mix, granola bars, peanut butter, nuts, fruit, or an already prepared sandwich.

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Evidence Based Care Fact Sheet (& Mother Friendly Care)

Jan22

In Sept. 2007, Citizens for Midwifery published a useful new fact sheet summarizing the evidence basis for the 10 Steps for Mother-Friendly Care. The fact sheet is two sided and packed with information. The Coalition for Improving Maternity Services (CIMS) has a mission “to promote a wellness model of maternity care that will improve birth outcomes and substantially reduce costs.” To this end, they created the evidence based
Mother-Friendly Childbirth Initiative (MFCI). This Initiative “provides guidelines for identifying and designating “mother-friendly” birth sites including hospitals, birth centers and home-birth services.” There are ten steps for mother-friendly care and ample evidence supporting each step.

CIMS also has a very useful consumer handout–“Having a Baby: 10 Questions to Ask“–that helps expectant couples ask questions of their health care providers to determine if the care they are receiving is the evidence based, mother friendly care all pregnant women deserve.

The 10 Steps are:

“A mother-friendly hospital, birth center, or home birth service:

Offers all birthing mothers:
- Unrestricted access to the birth companions of her choice, including fathers, partners, children, family members, and friends;
- Unrestricted access to continuous emotional and physical support from a skilled woman-for example, a doula or labor-support professional:
- Access to professional midwifery care.
Provides accurate descriptive and statistical information to the public about its practices and procedures for birth care, including measures of interventions and outcomes.
Provides culturally competent care — that is, care that is sensitive and responsive to the specific beliefs, values, and customs of the mother’s ethnicity and religion.
Provides the birthing woman with the freedom to walk, move about, and assume the positions of her choice during labor and birth (unless restriction is specifically required to correct a complication), and discourages the use of the lithotomy (flat on back with legs elevated) position.
Has clearly defined policies and procedures for:
- collaborating and consulting throughout the perinatal period with other maternity services, including communicating with the original caregiver when transfer from one birth site to another is necessary;
- linking the mother and baby to appropriate community resources, including prenatal and post-discharge follow-up and breastfeeding support.
Does not routinely employ practices and procedures that are unsupported by scientific evidence, including but not limited to the following:
- shaving;
- enemas;
- IVs (intravenous drip);
- withholding nourishment;
- early rupture of membranes;
- electronic fetal monitoring;
Other interventions are limited as follows:
- Has an induction rate of 10% or less;
- Has an episiotomy rate of 20% or less, with a goal of 5% or less;
- Has a total cesarean rate of 10% or less in community hospitals, and 15% or less in tertiary care (high-risk) hospitals;
- Has a VBAC (vaginal birth after cesarean) rate of 60% or more with a goal of 75% or more.
Educates staff in non-drug methods of pain relief and does not promote the use of analgesic or anesthetic drugs not specifically required to correct a complication.
Encourages all mothers and families, including those with sick or premature newborns or infants with congenital problems, to touch, hold, breastfeed, and care for their babies to the extent compatible with their conditions.
Discourages non-religious circumcision of the newborn.
Strives to achieve the WHO-UNICEF “Ten Steps of the Baby-Friendly Hospital Initiative” to promote successful breastfeeding…”

Why “Woman-Centered” Childbirth?

Jan15

I refer to my approach to childbirth education as “woman-centered.” Why? I believe woman-centered birth supports normal birth. The two are inextricably linked. According to the Association of Labor Assistants and Childbirth Educators, “woman-centered childbirth recognizes the primary role of the mother, and allows labor to progress according to the mother’s natural rhythms.” As an ALACE trained educator, I stress the importance of respecting the mother’s instincts and choices about how to give birth, including positions for labor and birth, comfort measures, and choice of caregivers and support. My goal is to help women reclaim trust in their bodies inherent abilities to give birth in a safe and unhindered manner.

This does not mean there is not a role for the father in birth or that I do not value the role of fathers. A father most definitely goes through a “birth” of his own–into fatherhood–and the psychological growth he experiences is significant. He also experiences fears and changes as he prepares to meet his baby and is of significant importance during labor and birth in his irreplaceable role of loving and supporting the mother of his baby. My beliefs about birth are underscored by the feeling that the mother is of central importance in the process of birth and that respecting birth as a woman-centered and woman-directed passage is the healthiest, safest, and best way for babies (and therefore, families!) to be born.

Pushing the issue of pushing in labor…

Jan14

Coping with the second stage (pushing) of labor can involve several different approaches. There are many benefits to pushing according to your own body’s urging and natural rhythms. Your uterus will actually push the baby out for you without any straining from you if you are in a gravity utilizing position–upright–and following your body’s spontaneous pushing urges! Some care providers and nurses instead encourage “purple pushing”–this is often the kind of pushing you see on television portrayals of birth, prolonged breath holding and bearing down, red straining face, and directed efforts (often with loud counting to 10).

The benefits of spontaneous bearing down instead of controlled, prolonged, directed pushing, and straining include:

less strain on your perineum and consequently less chance of tearing
less incontinence later
better oxygenation for your baby (less breath holding–>more breathing–>more oxygen for baby)
less wasted effort since you are working in harmony with your uterus

If you have an epidural, delaying pushing until you feel an urge or the baby’s head is visible on your perineum is preferred as well and reduces your chance of tearing and of trying to push out a malpositioned baby.

How can your labor support person “push the issue of pushing” during labor? (i.e. support you in spontaneous pushing instead of the controlled, directed pushing common on labor & delivery units). Your labor support person–husband, partner, friend, mother, sister, doula, or other person offering you their nonmedical companionship during labor–can remind provider and nurses of your birth plan (which should specify spontaneous pushing). If directed pushing is being used anyway–i.e. loud counting–your labor support can try the counting as well once or twice and then ask you in an audible voice: “does it help you when I count like that while you push?” You can then say, “no”–this is not directly offensive to nurses, but clearly states what is helping and what isn’t and getting pushing back into your “court” which is absolutely where it belongs!

Thanks to the fabulous publication International Doula for getting me thinking about this topic (and for the catchy title)!

What about fetal monitoring?

Jan9

Another area in which common practice or hospital policy often diverges from evidence based pratice. Women in hospitals commonly experience electronic fetal monitoring as a matter of course, particularly an “admission strip” on the baby and then at least 15 minutes of monitoring throughout labor. ACOG itself has recommended that routine continuous fetal monitoring be dropped from the standard of care for low-risk pregnant women and instead recommends intermittent fetal heart tone listening (which can be done with a hand held doppler instead of a fetal monitoring belt). Still, at least 85% of women giving birth in the US have electronic fetal monitoring even thought their practitioners own trade union (ACOG) does not specifically recommend it. Additionally, “electronic fetal monitoring without access to fetal scalp sampling” is on A Guide to Effective Care in Pregnancy and Childbirth table of forms of care likely to be ineffective or harmful. This exhaustive research summary of evidence based care practices for pregnant women also nots that there is insufficient data to support or to disprove the use of short periods of electronic fetal monitoring upon admission to the hospital.

Continuous electronic fetal monitoring with scalp sampling vs. intermittent ascultation (listening) during labor is included on the table of tradeoffs between benefits and harm. the book suggests that women and caregivers weigh the effects of those practices according to circumstances, priorities, and preferences (this is the same table under which epidural analgesia is classified).