Tag Archive | birth education

Healthy Birth Guides

I recently received a shipment of The 2008/2009 Guide to a Healthy Birth published and distributed free of charge by Choices in Childbirth in NYC. I ordered a stack of these nice little booklets for only the cost of shipping ($11 for 50 booklets). I really like the content and plan to distribute these in my birth classes and encourage other educators to do the same. The emphasis of the booklet is on being an informed consumer and it also touches on the politics of birth and the business of birth, which I really liked. The end of the booklet has an article by Dr. Harvey Karp about the 5 S’s. I particularly enjoyed the chapter called “The Purpose and Power of Pain in Labor.”

All in all, this is a fantastic and nearly free resource and I’m pleased to have them available! Check them out yourself! (You can also download the booklet for free as a pdf.)

I first learned of these booklets from the wonderful Passion for Birth blog.

Top Five Birth Plan…

Apr29

Birth plans are a topic often discussed in birth classes. There are SO many things that could be put onto a birth plan that sometimes it is difficult to sort out the most important. I encourage couples in my classes to complete two different “values clarification” exercises to help them include those things on their plan that are MOST important to them, rather than trying to cover everything on a one page birth plan. They often ask what I think is important to include. So, recently I started thinking that if I needed to create a birth plan for a birth in hospital that was as normal and natural as possible and could only include five elements, what would be most important to me, my baby, and a normal birth?

These are my top five after first going into the hospital as late in labor as possible (this isn’t included on my birth plan and doesn’t need to be on anyone’s birth plan–“I plan to labor at home as long as possible”–because it isn’t relevant by the time you get there and people are reading your plan. It belongs on your own personal plan, but not in your “official” plan):

No pitocin.
Minimal fetal monitoring and preferably with a Doppler only.
Freedom of movement throughout labor (stay out of bed, use it as an active tool rather than as a place to lie down. Stay upright during any necessary monitoring.)
Push with the urge in whatever position works best for me (NO coached, directed, or “cheerleader” style pushing).
Baby immediately to me. NO separation.

“Balanced” Information?

Mar15

Occasionally I read that someone is planning to take a hospital sponsored birth class because they feel they will get more “balanced” information. This usually seems to be said with regard to medications “versus” natural birth. There is an excellent discussion about this issue in the book Mother’s Intention: How Belief Shapes Birth.

“Let us look at [the word] ‘balanced’ first…’to make two parts exactly equal.’ What if the two parts are not equal? What if a parent will be making decisions that will affect her and her baby with both short and long term consequences? Is it fair to distort reality so that the information she has to choose from seems ‘equal,’ even though it really isn’t? Why would a parent want information that appears balanced, but isn’t factual?”

From my perspective, independent classes are better able to provide you with truly helpful, accurate, and factual information (even though they might not feel “balanced” towards all interventions/options), because the educator is working for you and not for an institution.

Overused & Underused Procedures

Feb22

My previous post about a good experience and a healthy baby as well as reading a relevant section in the wonderful new Our Bodies, Ourselves: Pregnancy & Birth book I’m reviewing made me want to post about this topic. There are a multitude of common procedures that are overused in hospitals and that when used routinely actually harm mothers and babies. I also thought about the multitude of evidence based, helpful procedures that are underused in many birth environments despite research indicating that they contribute to better outcomes for both mother and baby. (The use of the terms “overused” and “underused” and the examples below are taken from the OBOS book.)

Overused Procedures–these techniques are often used routinely (instead of appropriately based on true level of need in which case they can be truly helpful and sometimes even save lives) despite clear evidence that overuse is harmful:

Induction of labor
Episiotomy
Epidurals
Cesarean sections

Underused Procedures that have been shown to improve birth outcomes as well as to improve women’s satisfaction with their birth experiences include:

Continuous one-on-one support from a skilled caregiver during labor (a doula is a professional labor support provider who offers this one-to-one support).
Changing positions during labor (especially positions using gravity).
Laboring out of bed.
Walking during labor.
Comfort measures such as water, massage, and birth balls.

To increase your likelihood of satisfaction with your birth experience and of having a normal birth as well as a healthy mother and baby, choose a birth setting and care provider that supports and USES these underused procedures and only rarely, and appropriately, uses the overused procedures listed above.

Birth Experience or Healthy Baby?

Feb20

As you may have read in many blogs in the birth world, ACOG issued a press release this month opposing the choice of homebirth for women. One of the quotes towards the end of the release, “Choosing to deliver a baby at home, however, is to place the process of giving birth over the goal of having a healthy baby,” is a sentiment that I see expressed fairly frequently and I’d like to explore it a little. I do not think these two things are mutually exclusive by any means. I say, why not BOTH? A “good experience”/process of giving birth AND healthy baby–these two things can, should, and do go together. Many of the elements that make up a good experience are also things that are best for the baby–as I said, the two concepts are not mutually exclusive, instead they reinforce and contribute to each other! Most of the time, taking good care of a mother in birth (i.e. contributing to her “good birth experience”) is the very best thing you can do to take care of her baby. Babies do not need to be “rescued” from their mother’s bodies–healthy mothers help lead to healthy babies! Women and babies BOTH deserve a good birth experience.

I also question whether ANY mother actually considers this a choice, or makes this choice. Erica Lyon, quoted in the book Pushed, speaks eloquently on this topic:

“…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)

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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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 is Holistic Childbirth Education?

Nov28

A definition I like is one from midwife and author, Penfield Chester:

“The holistic model holds that birth is a normal, woman-centered process in which mind and body are one and that, in the vast majority of cases, nature is sufficient to create a healthy pregnancy and birth.”

My certifying organization, ALACE, uses the word holistic to mean a childbirth educator who incorporates psychological aspects and mind-body integration into their classes.