The Best Cesarean Possible by Penny Simkin

Ideas for the Best Cesarean Possible

By Penny Simkin

If you have learned that you must have a cesarean (a “planned cesarean”) for your

safety or the baby’s, you may feel disappointed that you cannot have the birth you

had hoped and planned for. Here are some ideas for tailoring the cesarean birth of

your baby to make it very special and personally satisfying for you, your partner,

and your baby.

Before the surgery:

*  Be sure you understand and agree with the reasons for the cesarean (i.e.,

malposition of the baby, a medical problem for you or the baby).

*  Learn about the procedure. Read about it in Pregnancy, Childbirth and the

Newborn or the Birth Partner and discuss it with your caregiver.

*  Learn about your anesthesia choices and how each is administered. General

information is available in the books mentioned above. If possible, however,

meet and discuss medications with an anesthesiologist along with any

concerns you have. A spinal or epidural block is the most common type of

anesthesia when a cesarean is planned in advance, but there are other

possibilities. (See “Anesthesia and medication issues below).

*  Learn the layout of the operating room, particularly where the baby will be

taken for initial care. Will she be in the same room or an adjacent room? Will

you be able to see her? Can your partner move back and forth between your

side and your baby’s?

*  Discuss the possibility of waiting until you go into labor and then going to the

hospital to have the cesarean. The advantage is that the timing for birth is

more likely to be optimal for the baby. The disadvantages are that you might

not know the doctor on call who will do the surgery, and that you cannot plan

ahead (which is the same as with most vaginal births).

*  If you do not decide to await the onset of labor, make your appointment for

the surgery. If there is a choice of times, you may want to consider having

the first appointment of the day for two reasons: there is less likely to be a

delay (from earlier surgeries taking longer than expected); and you will not

be as hungry if you do not have to wait all day. You will probably have to

avoid eating from the night before.

During the surgery and repair:

For your personal comfort, consider these ideas:

* Have your partner put some pleasant-scented (lavender and bergamot

are popular) lotion, massage oil, or cologne on your cheeks. He can also

put it on his wrist for you to sniff. This is soothing and may

counteract the “hospital smells.” Because some staff members may be

allergic to some scents, you’d better ask if this is okay.

* Ask if at least one arm can be left unrestrained.

* Bring your own CD or tape of music to be played during the surgery.

Music that is familiar and that you love improves the ambience. Many

operating rooms have CD players.

*  Plan to use relaxation techniques and slow breathing (like sighing)

during the surgery. Hold your partner’s hand.

* Ask that they lower the screen when the baby is lifted from your body so

that you can see the birth.

* During the repair procedure, there is one technique that some doctors do,

while others believe it is unnecessary and possibly problematic. This is to lift

the uterus out of the abdomen to inspect it and then replace it. This

procedure may cause considerable nausea while it is being done, and later gas

pains. You might wish to discuss this with your doctor beforehand. If he

customarily does it, ask for the advantages.

* Ask about picture taking during the surgery or afterwards. There sometimes

are policies restricting picture taking. A digital camera has the advantage of

allowing pictures of the baby to be shown to you within seconds. If your

baby is out of your sight, it may be possible for your partner (or a nurse) to

take a picture and show it to you.

* Once your baby is born, your partner might go to the baby and talk or sing to

him. A familiar voice often calms the baby at this time, and seeing the baby’s

response is a poignant moment for the partner. Some couples have sung a

special song (i.e., “You Are My Sunshine”) aloud to the baby frequently

before birth. The baby seems to be soothed when hearing that song.

* The partner may be able to bring the wrapped baby back to you for your

first contact. You can nuzzle, kiss and talk to your baby, but it is unlikely you

will be able to hold her or breastfeed until you leave the operating room,

because the operating table is narrow and you may feel quite weak.

Spinal or epidural anesthesia and other medication issues:

* The spinal block has many advantages for a planned cesarean, which make it

the usual choice. It is quick to administer and to take effect. It usually

involves only a single injection, and does not require a catheter in your back.

It causes numbness that lasts a few hours. You remain awake and aware. It

hardly affects your baby. The injection may also contain some long-acting

narcotic such as morphine that provides good postpartum pain relief without

grogginess for up to 24 hours after the surgery. An epidural is very similar

and has these advantages, but is more complex to administer and takes

longer to provide adequate pain relief. There are, however, some concerns

about spinal and epidural blocks that might be frightening:

- It is not uncommon to have a period during which you feel breathless

or as if you cannot breathe. It can be scary. It happens because the

anesthetic may numb the nerves that let you feel your breathing,

while the nerves to the muscles that make you breathe are not

blocked. In other words, you are breathing, but cannot feel it.

- What to do: Say that you cannot breathe. The anesthesiologist, who

is at your head, will check and reassure you. Your partner should

coach you with every breath, watching closely and saying, “Take a long

breath in -- yes you are doing it, and now breathe out. Good.” He

might hold your hand in front of your mouth so you can feel your

breath, and reassure you, “You are breathing, even though you can’t

feel it.” This feeling does not last for the entire surgery.

- On very rare occasions, the level of anesthesia rises high enough to

involve the muscles of breathing, so that you really are not breathing.

You cannot talk either. The anesthesiologist, who is watching the

monitors closely, discovers this and takes measures to assist your

breathing. You and your partner should also have a signal. If you can’t

breathe and can’t talk, blink your eyes many times. That means, “I

can’t breathe!” Your partner should be watching you, and if you blink

in that way, says, “I think she can’t breathe!” This may alert the

anesthesiologist a few seconds before he would pick up the problem.

- On other, even more rare occasions, the anesthesia is not adequate,

and you feel the surgery. This is very scary. The doctors will probably

want to make sure your reaction is not an anxiety reaction to the

surgery, and may seem not to believe you at first. If you are feeling

the surgery, tell them to stop. Your partner must help you with this.

Make them give you better anesthesia before proceeding. This might

mean repeating your block or giving you a general anesthetic.

* During the repair, you may feel nauseated and shaky for a period of time.

These are normal reactions to major surgery and vary from feelings of

queasiness to vomiting and from trembling to shaking and teeth chattering.

There are medications to ease these symptoms. They are often put into your

IV without you knowing, which may be okay with you. They may, however,

cause amnesia (e.g., Versed), or make you very sleepy. They can keep you

from being able to nurse your baby (or to remember that you did), and to

remember the first hours of your baby’s life. If you want to stay awake for

this time, discuss this with your anesthesiologist ahead of time. You might

ask the anesthesiologist not to give you anything for nausea or trembling

unless you ask. You may very well be able to tolerate the symptoms, but if

you find you cannot, then you can ask for the medication.

* Post-operative pain medications are available to help you during the days and

weeks after the birth. Some women try to avoid using them due to worries

about possible effects on the baby. However, since very small amounts reach

the baby, the effects to be minimal. The baby nurses and remains awake and

alert for periods of time. The downside of avoiding pain medications is

extreme pain, which greatly reduces your ability to move about and to care

for, nurse, and enjoy your baby. With adequate pain relief, you can have

more normal interactions with your baby.

The first few days:

* Most hospitals have a bed available for the partner so he or she can remain

in the hospital with you. This is lovely for many reasons. You are together

as a family. Your partner can share in baby care. If your partner is there,

your baby can probably room in with you the entire time. If he or she is not

there, you will need help from the nurse to change the baby’s diapers, move

him from one breast to the other, and carrying him, even for short

distances. In some hospitals, the baby spends more time in the nursery if

the partner is not there.

* Breastfeeding is definitely possible, but presents some challengs after a

cesarean. Nursing positions such as sidelying, and the “football” or clutch

hold avoid painful pressure on your incision. Using a pillow over the incision

also reduces pain while holding your baby on your lap. Ask for help from the

hospital’s lactation consultant in getting started with nursing.

* Rolling over in bed can be very painful, if you don’t know how to do it. The

least painful way uses “bridging.” To roll from back to side, first draw up

your legs, one at a time so that your feet are flat on the bed. Then

“bridge,” that is, lift your hips off the bed, by pressing your feet into the

bed. While your hips are raised, turn hips, legs, and shoulders over to one

side. This avoids strain on your incision.

* Help at home is essential to a rapid recovery. If possible, someone in

addition to your partner should help keep the household running smoothly.

If that person knows about newborn care and feeding, all the better. All

three (or more) of you need nurturing and help during the first days and

weeks to ease and speed your recovery and help you establish yourselves as

a happy family.

As you can see, there are many possible options for a cesarean birth. Some are

personal touches and personal self-care measures that will improve your

satisfaction and self-confidence. Others are measures that involve the support of

the hospital staff and your doctors. After thinking about your own preferences,

prepare a birth plan, review it with your caregiver, and bring it to the hospital for

the nurses to read.

I hope these suggestions will help you have the best cesarean ever!

Placenta Encapsulation

Mothers have been consuming their placentas since the beginning of time. All mammals, even herbivores, eat their placentas. Wise women are looking at this practice with new eyes, returning to a ritual that is older than human memory. Consuming the placenta returns valuable nutrients and life-force to the mother. Birth can sometimes leave a woman feeling drained physically and emotionally, which are risk factors for postpartum depression. Eating the placenta is one way to reduce those risks to promote a joyful postpartum.

There are many ways to eat a placenta, but some are afraid to try it. Placenta encapsulation is an answer to this problem. It is the process of preparing dehydrated, powdered placenta and putting it in capsules for swallowing in pill form.
 

The Placenta for Postpartum Healing

Today, approximately 80% of women experience some level of postpartum depression. Using the placenta for its medicinal properties during the postpartum period is a natural & healthier way you can help avoid these symptoms and the costly treatments that usually accompany them, such as medications and counseling.

Benefits of Placenta Capsules

The placenta has amazing abilities during the postpartum period; it can heal, sustain, and strengthen.

Traditionally Placenta Capsules are used to help:     - balance your hormones     - enhance milk supply     - increase your energy.

Placenta Capsules may also help:     - You to recover more quickly from birth
     - To bring the body back into balance
     - Prevent the "baby blues"
     - Shorten postpartum bleeding
     - Assist the uterus to return to size
     - Increase postpartum iron levels

The Process

Before being dried, the placenta is prepared using herbs that lend their healing properties to the placenta and benefit a postpartum mother. The placenta is then ground and encapsulated, and when properly stored, the capsules can be used long-term. 

Why Hire a Professional Placenta Encapsulation Specialist?

Ideally, the placenta is encapsulated within 48 hours after the birth.  While you bond with your new baby, she will come to you and take care of your placenta in your own home.  She is basically “on call” for you and will make every effort to come to your home within the 48-hour time frame to encapsulate your placenta.

Even if mama and baby are recovering in the hospital, she can encapsulate your placenta at home with your partner or other relatives present and get the capsules to you right away. 



Where Do I Go For Placenta Encapsulation?

Here in Sacramento we have a placenta encapsulation specialist, Tamara Morales. She is the owner of PlacentaMom. Click Here to view her site. 

Or contact her at: 
 916-934-3333
tamara@PlacentaMom.com


Not located in the Greater Sacramento Area?
Visit www.avoidthebabyblues.com for a directory of Independent Placenta Service Providers.

Natural Methods of Labor Induction

As an alternative to the traditional hospital route for induction, many modern mom's are looking to the past for tried and true old-fashioned methods of induction. Natural ways to induce labor may be chosen for many reasons, such as avoiding invasive medical ways to induce labor or for maternal or fetal risks that have medical induction on your care provider's mind.

It's important to note that none of these methods for inducing labor at home will work if your cervix is not ripe. These methods may help ripen your cervix-making it soften, efface and dilate.

It is also extremely important for me to remind the reader that before any at home method of induction is tried mom should be at least 40 weeks and needs to discuss it with her care provider before she attempts it.

The methods I discuss are: Sex, Food, Nipple Stimulation, Castor Oil, and Acupressure. 

Sex

Sex is not necessarily associated with starting labor but may help to ripen the cervix. Semen is the highest source of prostaglandins. Prostaglandins cause the cervix to "ripen", or soften and prepare to open. Sex can help the cervix to dilate and efface by depositing these prostaglandins on the cervix.

Furthermore nipple stimulation may also have a role in that it is known to release oxytocin, the hormone that causes contractions.  In addition, orgasms produce oxytocin.   So, between these factors, there is a pretty good case for the stimulation of labor.

As an alternative to intercourse, you might consider collecting semen in a condom, a diaphragm or an Instead cup to hold the semen against the cervix. An Instead cup is designed for use during menstruation, but theoretically could be used in this manner.

Studies about the effectiveness of sex starting labor are very few. And it should be noted that nothing should enter the vagina once the bag of water has ruptured.  However unappealing sex might sound at 40+ weeks pregnant, it can for many be a better option than a pitocin induction at the hospital.

Food

In every female circle their are women who swear to have the secret to starting labor. Which is often eating X Y or Z. Often times it's an extra spicy dish that they claim brought them face to face with their baby.

Unfortunately, the statistics are out on this one - there is simply not enough research to support that any foods are effective in inducing labor.

Many women have sworn the following are foods that will induce labor:

•     Pineapple
•     Spicy Foods
•     Chinese Food
•     Eggplant Parmesan
•     Licorice

The most well-known of these would have to be spicy foods, like hot peppers or any other spicy Mexican dish. What the research is now showing is that these foods may be something to avoid prior to labor.

This is due to the fact that certain spicy foods release capsasins, which may be counterproductive in labor. When the baby descends down the birth path, the pressure exerted releases endorphins into the woman's body. These endorphins are a natural pain-killer. In effect, the capsasins counteract the endorphins and rob the mother of her natural ability to have a pain-free birth.

The Eggplant Parmesan was also in vogue for a time. While this dish may have been contributing to labor, it is probably not due to the eggplant but rather to the seasonings in the dish. Both basil and oregano are herbs contraindicated in pregnancy due to their potential ability to start labor.

Pineapple is not supposed to induce labor, but rather is thought to be a cervical ripening agent that stimulates prostaglandins, although this has not been proven.

Licorice, real licorice candy, the black kind, is thought to also stimulate the production of prostaglandins. This is due to the chemical, glycyrrhizin. Eating lots of licorice might also result in mild diarrhea, which causes intestinal contractions that may lead to sympathetic uterine contractions. This type of licorice can also be found in tablet form. Again, no definitive research suggests that licorice can induce labor.

When looking for foods that induce labor, only consume them if they are something you normally select. There's just not enough evidence to say they work for certain, and in some cases they may cause more harm than help. 

Nipple Stimulation

Using nipple stimulation to induce labor has been practiced by women for centuries. It is one of the most effective at-home induction methods there is. This stimulation brings about the release of oxytocin, which is the natural form of pitocin. Oxytocin causes contractions, which can lead into true labor. It's important to note that this will only happen if your body is already close to labor. As with all natural labor induction techniques, don't attempt this until you are over 40 weeks.

This practice is often recommended by midwives when a woman is long past due or when labor is stalled.  This can be done manually or with an electric breast pump.

When this is performed, the uterus sometimes becomes hyperstimulated, meaning that it gets too little rest between contractions, so use caution and consult your practitioner first.

Here is a guide to help you understand the process:

1. Only massage one breast at a time.
   
   
2. Grasping the areola, rub in a circular motion until a contraction begins. It's important to mimic the suckling action of a baby.
   
   
3. Stop after the contraction begins.
   
   
4. Wait 15 minutes, then repeat.

Stop using nipple stimulation  if the contractions are 3 minutes apart or lasting 1 minute or longer.

Castor Oil

The theory behind using castor oil to induce labor is that it causes intestinal cramping and diarrhea, which stimulate the uterus, thus producing prostaglandins, which then cause contractions.

Are there risks in using castor

There has been much debate over whether castor oil will cause the baby to pass meconium, or its first bowel movement.   If the meconium is aspirated, or inhaled into the lungs, it can lead to aspiration pneumonia, which can be fatal or lead to serious developmental delays.Meconium is deemed a signal of fetal distress. However, research has been conducted that has found no increased occurrence of meconium staining with this type of induction.

The mother, however, can be at risk of dehydration due to the resulting diarrhea. This tires the mother and less able to endure through physical activity. It could also potentially endanger her milk supply. Also, if effective diarrhea can make labor a less pleasant experience. I recommend using extreme caution when taking castor oil, and of course consult your practitioner first.

How do I take it?

The usual dose is 2 tablespoons.  However, I strongly advise against taking it straight-you may not get it down. It's pretty nasty stuff. If you do pursue using castor oil for labor induction, take it in the morning after a good night's sleep. If taken at night, you most likely will not sleep due to the resulting diarrhea.

Here are some recipes to make it more palatable:

•     Put it in 3-4 oz. of root beer, shake vigorously, and then gulp it down.
•     Add a couple of scoops of ice cream to the castor oil and orange juice.
•     Scramble it with 3 eggs.
•     Drink the oil straight followed immediately by hot apple juice

As an alternative to using castor oil to induce labor, you may use evening primrose oil to naturally ripen the cervix. It is an excellent source of prostaglandins. It comes in a softgel that can be taken orally or inserted vaginally before bed. Oral use can start as early as 34 weeks and cervical application at full term.The recommended dose is two 500mg capsules per day. At full term you can add two capsules vaginally before bed, at which time the entire capsules will dissolve.

Acupressure

Using acupressure to induce labor is one of the most pleasant methods of natural labor induction. It is similar to using reflexology to induce labor or even going to the chiropractor for an adjustment.

To use acupressure as a method to induce labor, there are two pressure points that can be stimulated to produce contractions.

They are located:

•     In the webbing of your thumb and index finger.
•     Four finger-widths above the inside of your ankle bone.

To stimulate the first pressure point, pinch the webbing of your hand and rub in a circular motion for 30-60 seconds at a time, taking a 1-2 minute break in between contractions.

For the latter point, press firmly on the spot. It should feel sore if you've found the right spot. Press and rub in a circular motion until you have a contraction. When the contraction is done begin again.

Both pressure points can also be very helpful in progressing a long and slow labor.

All about Induction Part 3 - Pitocin

By far the most commonly used drug on the maternity floor, Pitocin is a drug used to start labor contractions or increase their intensity. I doubt many women in America have deliver a baby in the last decade who haven't at least heard the word. Pitocin, for better or worse has become a part of childbirth in American hospitals. 

What is Pitocin?

Pitocin is a synthetic oxytocin.  Oxytocin is a hormone that a woman's body naturally produces that cause contractions to begin.  When oxytocin isn't doing the job to get labor going, for whatever reason, then hospitals frequently use pitocin to get this process started.  This medical intervention is usually used in order to get labor started and to speed up the labor process.

When a woman's body makes oxytocin, it is secreted in bursts.  This creates a natural flow.  When pitocin is administered in a hospital, the woman has to be placed on an intravenous pump that gives her a steady flow of pitocin.  These contractions are quantitatively and qualitatively different than the ones she would experience on her own.

Benefits of Pitocin

• Pitocin does tend to make labor shorter. This is a huge bonus for many women exhausted by labor.
• Using synthetic oxytocin to stimulate labor if the membranes have been ruptured has cut down on infection rates.
• Contractions can be "controlled" by adjusting the dose of medication.
• Can be vital in helping stop excessive bleeding post birth, and can assist with placenta delivery. 

Drawbacks to Pitocin

Risks of Pitocin:
Contractions tend to be more painful and the mother is more likely to request pain medication or an epidural
Pitocin needs to be given by IV and the mother/baby will have to be constantly monitored, which makes it much hard to move around
Increases the chance of having a ruptured uterus
Increases the chance of the baby being in a bad position for delivery
Baby is more likely to have a depressed fetal heart rate pattern
More likely to need a cesarean
Increases risk of fetal distress, because there is less oxygen availableThe choice to utilize pitocin is a personal, and often controversial one. It is not a decision to be taken lightly, as it does carry significant risks, however it can also help women avoid infection and C-Sections. Be sure to talk openly with your care-provider before your birth about how and when he or she typically uses pitocin. If it is suggested as an option during labor, feel free to ask about alternatives so you can explore all of your options and make the best possible education decision.

*The information expressed here are my own views and are not intended to be substituted for medical advice. 

Cervidil

Cervidil

What is Cervidil?

Cervidil is the trademark name that Forest Laboratories, Inc. uses for prostaglandin E2 vaginal insert. It is a small rectangular pouch with a retrieval cord that looks similar to a tampon. It is inserted into the vagina.

Prostaglandin is one of the chemicals that play a part in ripening the cervix. A ripe cervix is soft and stretchy, ready to respond to uterine contractions. When given vaginally, cervidil may help to ripen the cervix.

Why choose Cervidil?

Cervidil is used to "ripen" the cervix when it is agreed that your baby is safer to be born than to remain in the uterus. Cervidil is the first step in a two part induction process when the cervix is not ready to respond to contractions.

Cervidil may increase the activity of non-productive contractions when no other labor stimulation agent has been used.

Cervidil allows the mother to use the medication for the prescribed amount of time an then remove it. In some cases a mother may be able to go home after administration to wait for labor to start. More often she will be admitted and the Cervidil will be administered overnight.

How effective is Cervidil?

Because prostaglandin E2 helps to make the connective tissue of the cervix more pliable while also stimulating contractions, it is more effective than synthetic oxytocin at inducing labor. The rates were similar for women giving birth within 12 hours, but more women had given birth within 24 hours with prostaglandin and the difference is even more pronounced at 48 hours. In addition, the rate of instrumental vaginal delivery is lower with women induced with prostaglandin E2.

This data sheet on Cervidil offers information from research trials about its efficacy.

Risks of using Cervidil

Risks for Mother


* Gastrointestinal effects such as nausea, vomiting and diarrhea.

* Small risk of uterine hyper stimulation.

* Requires continuous monitoring of baby's heart rate which decreases mobility.

* Another form of prostaglandin E2, Prepidil, cannot be removed if hyper stimulation occurs.

Risks for Baby

* Uterine hyper stimulation can cause abnormal fetal heart rate.

My Opinion

It's no secret that I am not a big fan of unnecessary induction. I really believe that most babies will come the exact time they are meant to and in most cases I lean towards trusting nature over science. With that said in times where induction is necessary Cervidil is a good option to get things going. I have often seen in used in conjunction with Pitocin (stay tuned for my Pitocin post). Typical administration is to inject the Cervidil and if contractions haven't started or increased to productive in 12 hours, add Pitocin. I always encourage Mom's to talk with there care providers and indpendlty research all of your options before labor and delivery begin.

Prostaglandin also occurs naturally in Seamen, and will be discussed further in my natural induction methods post.

References:
Goer, Henci. The Thinking Woman's Guide to a Better Birth. 1999. New York: The Berkley Publishing Group.
Enkin, Keirse, Nilson, Crowther, Duley, Hodnett and Hofmeyr. A guide to effective care in pregnancy and childbirth Third Edition. 2000. Oxford: Oxford University Press.

The Bishop Score - How you can decrease your chance of having a C-Section

This is my first post in a series about induction.

What is a Bishop's Score and How Does it Relate to Inducing Labor?

It amazes me how many inductions are scheduled with out any mention of the bishop score. This is system which places numeric value on factors such as effacement, dilation, cervical position, station, etc. to provide a guideline to determine how effect an induction would be in resulting in a vaginal delivery. Obtaining a bishop score is painless, and takes virtually no time, since your physician or midwife is likely doing vaginal exams anyway. It is my opinion that before any elective induction is schedule the bishop score should be discussed. Read below to find out how they are determined and check out the C-Section rates for the various scores.

A Bishop's Score refers to a group of measurements used to determine whether a woman may have a successful vaginal delivery and whether labor ought to be induced. Bishop's Score is based on station, dilation, effacement, position and consistency.

Station is a term used to describe the descent of the baby into the pelvis. An imaginary line is drawn between the two bones in the pelvis (known as ischial spines). This is the "zero" line, and when the baby reaches this line it is considered to be in "zero station." When the baby is above this imaginary line it is in a minus station. When the baby is below, it is in a "plus" station. Stations are measured from -5 at the pelvic inlet to +4 at the pelvic outlet.

Dilation is measured in centimeters, from 0 to 10. Your cervix is fully open and you should be able to push when it is dilated to 10 centimeters. Occasionally, a physician will measure dilation in "fingers." Dilation often begins days or weeks before labor actually begins. At first, the progress may be very slow. Some women may be dilated 2 to 3 centimeters long before labor. Once active labor begins, you will begin to dilate more quickly.

Effacement refers to the softening and thinning of the cervix. You won't feel this happening; it may only be measure with a vaginal exam. Effacement is measured in percent. When your cervix is normal, it is considered to be 0% effaced. When you're 50% effaced, your cervix is half its original thickness. When your cervix is 100% effaced it is completely thinned out and you are ready for vaginal delivery.

Position refers to the positioning of the cervix. If the cervix faces front (anterior) it is more favorable, while posterior is less favorable.

Consistency of the cervix is measured on a scale of firmness from firm to soft. The softer the cervix is, the better the chance of vaginal delivery.

The Bishops Score generally follows this scale:

Score Dilatation Effacement Station Position Consistency

0 closed 0 – 30% -3 posterior firm
1 1-2 cm 40 -50% -2 mid-position moderately firm
2 3-4 cm 60 -70% -1,0 anterior soft
3 5+ cm 80+% +1,+2

A point is added to the score for each of the following:
Preeclampsia
Each prior vaginal delivery

A point is subtracted from the score for:
Postdates pregnancy
Nulliparity
Premature or prolonged rupture of membranes
Interpretation

cesarean rates: first time mothers women with past vaginal deliveries

scores of 0 – 3: 45% 7.7%
scores of 4 - 6: 10% 3.9%
scores of 7 - 10: 1.4% .9%

Induction is generally attempted when a mother has a favorable Bishop's score. A mother may be given misoprostol, cytotec or prostaglandin gel to help ripen the cervix and improve the score. A score of five or less is said to be "unfavorable." If induction is indicated, the mother would be a candidate for a cervical ripening agent. These are usually introduced one or two nights before the planned induction. A score of eight or nine would indicate that the cervix was very ripe and induction would have a high probability of being successful.

Your physician can assist you in understanding and interpreting your own Bishop's Score.

4 Sisters, 4 Babies, 4 Days

Wow, what and amazing week! I just love thinking about how close those 4 kids will be, what a fantastic bond....and just think about the joint birthday party potential! :) Congrats to all the new mommies and daddies!!

CHICAGO — Four sisters from one family have each given birth within four days.

That's four sisters, four babies, four days.

The same obstetrician delivered the babies of three of the sisters — 27-year-old Lilian Sepulveda of Franklin Park, 29-year-old Saby Pazos of Bellwood and 24-year-old Leslie Pazos of Stone Park.

The three sisters gave birth at Westlake Hospital in Melrose Park on Friday and Saturday. A fourth sister — Heidi Lopez — had her baby on Monday in California.

Family members say the women didn't plan the timing. Obstetrician Dr. Jean Alexandre, who delivered the three babies in suburban Chicago, calls the births "very unusual but wonderful at the same time."

http://www.foxnews.com/story/0,2933,599182,00.html

Welcome Baby Lyra

Lyra Brielle

Born August 10th, 2010
at 9:47 PM

8lbs, 9oz

Congratulations to the joyful parents Olitan and Eric!

Welcome Baby Amya

Born August 4th
at 7:35 AM

Congrats to the new parents, Spenser and Taleah!

World Breastfeeding Week

World Breastfeeding Week is celebrated every year from 1 to 7 August in more than 120 countries to encourage breastfeeding and improve the health of babies around the world. It commemorates the Innocenti Declaration made by WHO (World Health Organization)and UNICEF policy-makers in August 1990 to protect, promote and support breastfeeding.

Breastfeeding is the best way to provide newborns with the nutrients they need. WHO recommends exclusive breastfeeding until a baby is six months old, and continued breastfeeding with the addition of nutritious complementary foods for up to two years or beyond.

Click Here for "Ten Steps to Successful Breastfeeding Videos"

Pledge your support! Click Here

Postpartum Depression - Part 3

Third and final installment in my Postpartum depression series. If you think you or someone you know might need help with postpartum depression, please contact your doctor or midwife.


From Dr. Karen Binder-Byrnes:

Having a baby is supposed to be one of the most exciting joy-filled times in life for a woman. After waiting with rapt anticipation for nine months, your baby has arrived safely into this world and you should be filled with relief, unbridled joy and happiness. It makes sense. However, 1 in 8 women suffer from mood disturbances after their delivery. Their mood swings can be caused by fluctuations in hormone levels, fatigue from the birth process or a wide variety of other life reasons, and usually go away on their own within a few weeks. This short-term state is usually described as “baby blues”. However, in 10% to 20% of all women, a longer lasting and more disturbing state of mood disorder develops which is labeled “postpartum depression”.

Recently, I worked with a patient who had happily anticipated the birth of her first child. She and her husband had waited years for this event and had gone through moderate infertility treatment. This baby was as wanted as any baby could be. The parents were emotionally stable and ready for a baby and finances were of no issue. They had familial support around them and wonderful medical attention. The baby girl arrived healthy and strong. My patient called me from the post-delivery room, ecstatic.

A week later, I encountered a very different new mother. Since arriving home form the hospital, my patient was tearful, had no energy, was feeling worthless and was not enjoying her baby at all. Worst of all, she felt terrible guilt about admitting to these feelings. I reassured her, that these mood states should pass and we agreed to keep in close touch. By a month after the baby’s birth, my patient was feeling worse and not better. At this point, I began to think of her troubling mood state as postpartum depression and we made plans to treat it aggressively. In this patient’s case, she had a familial history of clinical depressions (suggesting a possible biological predisposition) so we decided that a course of antidepressants as well as weekly phone sessions to talk about her feelings would be the best path.

Within a few weeks of this treatment, my patient’s mood began to improve and she was able to begin to enjoy her baby and new motherhood. As she felt better, she was able to join a new mother’s group and get social support from other new moms. After 6 months, she decided to go off the medication and has remained happily engaged with her baby ever since.

In this case, my patient had decided not to breast-feed her baby so taking the antidepressant did not pose a risk to her daughter. There are however, several antidepressants that can be used for breastfeeding moms. This should be discussed with the woman’s doctors. Not every woman who is suffering from postpartum depression will want to take medication. This, of course, is her right. However, she and her family members should be highly vigilant, that her mood state does not deteriorate in suicidal or homicidal feelings about herself and her baby and that she is capable of taking good care of the baby.. This is rare, but can be a possibility.

Besides professional help, the most important steps a woman can take is to:

* not be isolated
* to try to find a support network
* to ask for help from partner or friends and family when feeling overwhelmed
* not to be afraid to talk to her doctors.

There is absolutely, nothing to be ashamed of if a woman finds herself struggling with her mood state after giving birth. Most of us mothers today, especially in the Western World, live in a very different lifestyle than our ancestors. Typically, we are giving birth and raising our children away from our families, hometowns or villages. We are often alone for the most part with our new family (except for when family members visit or move in with us temporarily.) In the days of past, whole clans and the home-village helped with the childcare and a new mother was never isolated. Feeling depressed and moody after giving birth does not mean you are a bad mother or incapable of caring for a baby. What it means is that you are human and undergoing a huge transition in your life both psychologically and physically. Some of the best mothers I know today suffered from postpartum depression and got help and went on to love being moms who raised incredible kids!

Note: The American Journal of Medicine just released a new study which revealed that 10 percent of new fathers also suffer from postpartum depression before and after a birth and that by three months after the birth the rate rises to 26%.

Dr. Karen Binder-Brynes is a leading psychologist with a private practice in New York City for the past 15 years. See her website, DrKarennyc.com, for more information.
Dooce.com

Heather B. Armstrong is a blogger who has opened up her daily life for the past 9 years to a huge following on her website, dooce.com. She’s written about jobs, dating, marriage, having children, raising a family, and more. After the birth of her first child, she suffered from postpartum depression and eventually checked herself into a mental hospital. She shares it all on her blog and in what later became her book, “It Sucked and then I Cried,” a worthwhile read for anyone who thinks they may be suffering from this condition.

Postpartum Depression - Part 2

This is a beautiful, and stricking honest account of one mom's experience with postpartum depression. It's amazing how long she was able to hide her inner struggle.

From Bryce Dallas Howard:

I recently saw an interview I did on TV while promoting a film. In it, I was asked about my experience with post-partum depression and as I watched, I cringed. I said things like “It was a nightmare,” or “I felt like I was in a black hole.” But I couldn’t even begin to express my true feelings. On screen, I had seemed so together, so okay, as if I had everything under control. As I watched, it dawned on me. If I had been able to truthfully convey my ordeal with post-partum depression under the glare of those lights, I most likely would have said no words at all. I simply would have stared at the interviewer with an expression of deep, deep loss.

I found out I was pregnant seven days after my wedding. I was on honeymoon with my family. It’s a long story – but yes, I shared my honeymoon with my entire family. I have a heroic husband! After taking the pregnancy test, I held the paper strip while waiting for the telltale sign to appear and thought, “I have to be pregnant! I will not be okay if I am not pregnant.” It was an odd thought since I was 25, and my husband and I had no intention of starting a family until we were in our 30s, but as the slender strip turned blue, I leapt into the air with joy.

I loved being pregnant. Yes, I threw up every day for six months, and yes, the stretch marks were (and still are) obscene. But I treasured every moment I had with this new life growing inside me. My husband and I moved from our one-bedroom apartment into a “family” home we could barely afford. We watched the Dog Whisperer in order to acclimate our terrier for the baby-on-the-way. We peppered family and friends with endless questions about child rearing. I threw up, gained weight, and threw up some more, and tipping the scale at over 200 pounds; I entered the final month with nothing but confidence and blissful anticipation.

We had enthusiastically planned for a natural home birth. And, to be honest, I am glad we did. Natural labor was painful, but because I was home, my husband and parents were by my side every step of the way, and even when complications arose causing me to have to go to the hospital, my son was born with no medical interference.

Mostly I recall the moment someone handed my son to me, and I heard shouts of joy, and my father crying, “Bryce, you’re an incredible mother!” And then...

Nothing. I felt nothing.

Memories of the following events are hazy. I remember that I suddenly stopped feeling pain, despite having been stitched without anesthesia. I handed my son to my husband who cradled him and whispered in his ear, “Welcome to the world. Here, anything is possible.” Even as I write this, I’m moved to recall the gentleness of my 25-year old husband holding this new human being, his son, for the first time – and saying over and over, “anything is possible.” He still says these words every night before our son drifts off to sleep.

And yet, in those moments after giving birth, I felt nothing. Someone encouraged me to sit up, and slowly, one by one, friends and family visited. Some were crying, others bursting with joy. Glassy-eyed, I politely listened to their impressions of our new son. I had no impression of my own.

Forty minutes after giving birth, I opted to return home. Walking was challenging and painful, especially because I stubbornly tossed the Motrin IB the doctor urged me to take for fear it would hinder my ability to be present with my son.

For me, breast-feeding was even more painful than giving birth. And despite a lactation consultant offering help, I felt incompetent. I refused to give up, forcing myself to do everything possible so that my son would consume only my breast milk with no supplementation. I forged on, barely sleeping, always either breast feeding or pumping and never getting the hang of it. Occasionally I drifted off for a few minutes, but that decision to “feed at all costs” left me no room for recovery, no space to explore my feelings, no time to rest.

Five days after our son was born, my husband had to leave for a film shoot, so my mom and best girlfriend rotated sleeping in the bed beside “Theo” and myself, whom at that point I mysteriously referred to as “it,” even though we had named him. I should have taken that as a sign.

I distinctly remember the first night I was alone. It was less than a week after the birth, and I still refused to take even Aleve for fear of how it might affect my milk. Theo woke up next to me, and I knew I needed to begin breast-feeding. Because of the stitches, moving even an inch sent daggers of pain tearing through my body. I tried to sit, but finally gave up and lay still as my tiny son cried. I thought, “I’m going to die here, lying next to my newborn son. I am literally going to die tonight.”

It was not the last time I felt that way.

It is strange for me to recall what I was like at that time. I seemed to be suffering emotional amnesia. I couldn’t genuinely cry, or laugh, or be moved by anything. For the sake of those around me, including my son, I pretended, but when I began showering again in the second week, I let loose in the privacy of the bathroom, water flowing over me as I heaved uncontrollable sobs.

When I visited the midwife for a checkup, she gave me a questionnaire, rating things on a scale from 1-5 so that she could get a sense of my emotional state. I gave myself a perfect score. Despite my daily “shower breakdowns” months passed before I even began to acknowledge my true feelings.

Before Theo was born, I had been in good humor about my 80-pound weight gain, but I was now mortified by it. I felt I was failing at breast-feeding. My house was a mess. I believed I was a terrible dog owner. I was certain I was an awful actress; I dreaded a film I was scheduled to shoot only a few weeks after the birth because I could barely focus enough to read the script. And worst of all, I definitely felt I was a rotten mother--not a bad one, a rotten one. Because the truth was, every time I looked at my son, I wanted to disappear.

Although perceptive, intuitive, and sensitive individuals surrounded me, my numb performance of “delighted new mom” seemed to fool everyone. It wasn’t until my “shower breakdowns” began to manifest out in the open that people began to worry.

One afternoon my best friend found me sobbing on the floor of my bedroom with Theo sleeping in a bassinet beside me. It was late afternoon, and I hadn’t yet eaten because I was too overwhelmed to figure out how to walk downstairs to eat. “Bryce,” my friend said, looking confused, “if you need help preparing food, just ask me.”

“How can I take care of my son if I can’t take care of myself?” I sobbed.

My husband began shooting a television series, and late evenings when he returned home, I would meet him at the door, shaking with fury, “I’ve hit the wall and gone through it, and I feel I am expected to go further.”

He would ask what he could do to help, but knowing there was nothing he could do, I screamed expletives at him, behavior he had never experienced in the seven years we had been together.

Distraught and concerned, he told me he would figure everything out, tried to assure me I didn’t need to worry. He created a plan, and with the support of my husband, my friends and my family, I returned to my midwife. I finally understood I needed to answer her questions honestly, and when I did, she suggested a homeopathic treatment plan, reconnected me with my doctor who oversaw my care, and sent me to a therapist who diagnosed me with severe post-partum depression.

Although challenges lay ahead, little by little I got better. As it happened, the independent film I shot chronicled a woman falling deeper and deeper into her own insane delusions. The experience was serendipitous, just the material I needed to work on to help me to reconnect to my true feelings. Also, because I was working twelve to eighteen hours per day and shooting mostly at night, I had to rely on those around me to help care for Theo. In those weeks, a critical shift occurred.

A friend invited me to a “pow-wow” of mothers (in a tepee nonetheless); there we talked about the trials and tribulations of motherhood. The woman next to me coined the phrase “post partum denial,” and hearing her story helped me to understand my own. When I shared, somewhat disconnectedly and inarticulately some of my own disappointments, my feeling of not measuring up to what Theo deserved in a mother, one woman responded, “It takes a long time for them to grow up. You’ll have time to discover the kind of mother you are.” Another woman suggested I read Brooke Shields “Down Came the Rain.” Her book was a revelation.

Then one day I was sitting in my home with my best friend and my sister, and out of nowhere I got this sudden feeling of summer. When I told them they looked at me curiously and chuckled a little. I searched for a better way to describe my feelings, “I dunno, I just got this feeling… like everything is going to be okay.”

My depression was lifting. Later that day, I saw one of my closest friends; the person who had performed our wedding ceremony and had also videotaped Theo’s birth. He looked at me and without skipping a beat he said, “My friend is back.” I smiled. “It’s like you’ve been abducted by ‘The Borg’ for a year and a half, and now you’re back.”

The Borg is an alien species in Star Trek that takes over the mind and spirit of the individual it invades. Victims were depicted as emotionless robots, completely unaware of their own demise. When my friend said that, I howled with laughter--something I hadn’t done since before Theo’s birth. It was the kind of laughter that bubbles up at the recognition of something deeply true.

Post-partum depression is hard to describe—the way the body and mind and spirit fracture and crumble in the wake of what most believe should be a celebratory time. I cringed when I watched my interview on television because of my inability to share authentically what I was going through, what so many women go through. I fear more often than not, for this reason alone, we choose silence. And the danger of being silent means only that others will suffer in silence and may never be able to feel whole because of it.

Do I wish I had never endured post-partum depression? Absolutely. But to deny the experience is to deny who I am. I still mourn the loss of what could have been, but I also feel deep gratitude for those who stood by me, for the lesson that we must never be afraid to ask for help, and for the feeling of summer that still remains.

P.S. - As I write this, my little boy, now 3 and a half, is sleeping upstairs. Tonight as I put him to bed, he looked me straight in the eye and said, “Theo and Mama are two little peas in a pod!” I have no idea where he learned that phrase, but as I sat there giggling with him the miracle of the statement was not lost on me. It’s true. In the face of everything, Theo and I are two little peas in a pod.

Bryce Dallas Howard is an actress known most recently for her roles in Twilight: Eclipse, Spider-Man 3, and Terminator Salvation, and for her outstanding performance in As You Like It. She lives in Hollywood with her husband and son.

**Taken from www.goop.com**

Postpartum Depression - Part 1

This is the beggining of a 3-part blog sereis I am going to post about postpartum depression. It is a very serious issue that all moms-to-be and their families should educate themselves on. Thankfully there are wonderful treatments available to those suffering from postpartum depression, the help is there once you are able to ask for it.

**This information was copied from www.goop.com)**

From Dr. Laura Schiller:

For most women, having a baby is a joyous experience, but as many as 70 - 80% of women can feel sad, anxious, and overwhelmed after childbirth. For the vast majority of women, these are transient feelings that resolve in about one week. Postpartum blues or "baby blues" are considered a normal response to the fluctuations in hormone levels and adjusting to your new life after the birth of your baby. But if these feelings persist or get worse you may have Postpartum Depression.

Postpartum depression affects about 10% of new mothers and can occur within the 1st few weeks after delivery and even up to a year. Symptoms are similar to a major depression and include feelings of sadness, helplessness, fatigue, difficulty concentrating and having trouble sleeping, eating and making choices. Sometimes she is not able to care for herself or her baby and she has a difficult time functioning at home and at work. Most importantly women with Postpartum Depression need treatment with counseling and sometimes medication so that the depression does not become worse and last even longer. Anti-depressants are generally considered safe for breastfeeding and when necessary are very helpful in treating the depression.

Dr. Laura Schiller, MD is an Obstetrician and Gynecologist with a practice in New York City. She lives with her husband and twin daughters in NYC.

ACOG (finally) says VBACs are safe!!

The American College of Obstetricians and Gynecologists (ACOG) released a new article on July 21, 2010 stating that VBACs are a "safe and appropriate choice for most women". This is great news, especially living in a country where cesarean rates are skyrocketing, this gives women better access to safer, easier birth.

Link:


Article:
Attempting a vaginal birth after cesarean (VBAC) is a safe and appropriate choice for most women who have had a prior cesarean delivery, including for some women who have had two previous cesareans, according to guidelines released today by The American College of Obstetricians and Gynecologists.

The cesarean delivery rate in the US increased dramatically over the past four decades, from 5% in 1970 to over 31% in 2007. Before 1970, the standard practice was to perform a repeat cesarean after a prior cesarean birth. During the 1970s, as women achieved successful VBACs, it became viewed as a reasonable option for some women. Over time, the VBAC rate increased from just over 5% in 1985 to 28% by 1996, but then began a steady decline. By 2006, the VBAC rate fell to 8.5%, a decrease that reflects the restrictions that some hospitals and insurers placed on trial of labor after cesarean (TOLAC) as well as decisions by patients when presented with the risks and benefits.

"The current cesarean rate is undeniably high and absolutely concerns us as ob-gyns," said Richard N. Waldman, MD, president of The College. "These VBAC guidelines emphasize the need for thorough counseling of benefits and risks, shared patient-doctor decision making, and the importance of patient autonomy. Moving forward, we need to work collaboratively with our patients and our colleagues, hospitals, and insurers to swing the pendulum back to fewer cesareans and a more reasonable VBAC rate."

In keeping with past recommendations, most women with one previous cesarean delivery with a low-transverse incision are candidates for and should be counseled about VBAC and offered a TOLAC. In addition, "The College guidelines now clearly say that women with two previous low-transverse cesarean incisions, women carrying twins, and women with an unknown type of uterine scar are considered appropriate candidates for a TOLAC," said Jeffrey L. Ecker, MD, from Massachusetts General Hospital in Boston and immediate past vice chair of the Committee on Practice Bulletins-Obstetrics who co-wrote the document with William A. Grobman, MD, from Northwestern University in Chicago.

VBAC Counseling on Benefits and Risks

"In making plans for delivery, physicians and patients should consider a woman's chance of a successful VBAC as well as the risk of complications from a trial of labor, all viewed in the context of her future reproductive plans," said Dr. Ecker. Approximately 60-80% of appropriate candidates who attempt VBAC will be successful. A VBAC avoids major abdominal surgery, lowers a woman's risk of hemorrhage and infection, and shortens postpartum recovery. It may also help women avoid the possible future risks of having multiple cesareans such as hysterectomy, bowel and bladder injury, transfusion, infection, and abnormal placenta conditions (placenta previa and placenta accreta).

Both repeat cesarean and a TOLAC carry risks including maternal hemorrhage, infection, operative injury, blood clots, hysterectomy, and death. Most maternal injury that occurs during a TOLAC happens when a repeat cesarean becomes necessary after the TOLAC fails. A successful VBAC has fewer complications than an elective repeat cesarean while a failed TOLAC has more complications than an elective repeat cesarean.

Uterine Rupture

The risk of uterine rupture during a TOLAC is low—between 0.5% and 0.9%—but if it occurs, it is an emergency situation. A uterine rupture can cause serious injury to a mother and her baby. The College maintains that a TOLAC is most safely undertaken where staff can immediately provide an emergency cesarean, but recognizes that such resources may not be universally available.

"Given the onerous medical liability climate for ob-gyns, interpretation of The College's earlier guidelines led many hospitals to refuse allowing VBACs altogether," said Dr. Waldman. "Our primary goal is to promote the safest environment for labor and delivery, not to restrict women's access to VBAC."

Women and their physicians may still make a plan for a TOLAC in situations where there may not be "immediately available" staff to handle emergencies, but it requires a thorough discussion of the local health care system, the available resources, and the potential for incremental risk. "It is absolutely critical that a woman and her physician discuss VBAC early in the prenatal care period so that logistical plans can be made well in advance," said Dr. Grobman. And those hospitals that lack "immediately available" staff should develop a clear process for gathering them quickly and all hospitals should have a plan in place for managing emergency uterine ruptures, however rarely they may occur, Dr. Grobman added.

The College says that restrictive VBAC policies should not be used to force women to undergo a repeat cesarean delivery against their will if, for example, a woman in labor presents for care and declines a repeat cesarean delivery at a center that does not support TOLAC. On the other hand, if, during prenatal care, a physician is uncomfortable with a patient's desire to undergo VBAC, it is appropriate to refer her to another physician or center.

Practice Bulletin #115, "Vaginal Birth after Previous Cesarean Delivery," is published in the August 2010 issue of Obstetrics & Gynecology.

"All The Pregnant Ladies" music video

If you like Beyonce's "All The Single Ladies" wait until you see "All the Pregnant Ladies". Enjoy this cute and funny video!

Myth vs. Reality - Episiotomy

Myth: A nice clean cut is better than a jagged tear.

Reality: "Like any surgical procedure, episiotomy carries a number of risks: excessive blood loss, haematoma formation, and infection. . . . There is no evidence . . . that routine episiotomy reduces the risk of severe perineal trauma, improves perineal healing, prevents fetal trauma or reduces the risk of urinary stress incontinence." Sleep, Roberts, and Chalmers 1989

Summary of Significant Points, from Henci Goer's Book, Obstetric Myths vs. Research Realities

>Episiotomies do not prevent tears into or through the anal sphincter or vaginal tears. In fact, deep tears almost never occur in the absence of an episiotomy.

>If a woman does not have an episiotomy, she is likely to have a small tear, but with rare exceptions the tear will be, at worst, no worse than an episiotomy.

>Episiotomies do not prevent relaxation of the pelvic floor musculature. Therefore, they do not prevent urinary incontinence or improve sexual satisfaction.

>Episiotomies are not easier to repair than tears.

>Episiotomies do not heal better than tears.

>Episiotomies are not less painful than tears. They may cause prolonged problems with pain, especially pain during intercourse.

>Episiotomies do not prevent birth injuries or fetal brain damage.

>Episiotomies increase blood loss.

>As with any other surgical procedure, episiotomies may lead to infection, including fatal infections.

>Epidurals increase the need for episiotomy. They also increase the probability of instrumental delivery. Instrumental delivery increases both the odds of episiotomy and deep tears.

>The lithotomy position increases the need for episiotomy, probably because the perineum is tightly stretched.

>The birth attendant's philosophy, technique, skill, and experience are the major determinants of perineal outcome.

***Some techniques for reducing perineal trauma that have been evaluated and found effective are: prenatal perineal massage, slow delivery of the head, supporting the perineum, keeping the head flexed, delivering the shoulders one at a time, and doing instrumental deliveries without episiotomy. (Others, such as perineal massage during labor or hot compresses have yet to be studied.)

>Independent of specifically contracting the pelvic floor muscles (Kegels), a regular exercise program strengthens the pelvic floor.

Birth is NOT an Illness!

Birth is Not an Illness!
16 Recommendations from the World Health Organization


These 16 recommendations are based on the principle that each woman has a
fundamental right to receive proper prenatal care: that the woman has a central role in all aspects of this care, including participation in the planning, carrying out and evaluation of the care: and that social, emotional and psychological factors are decisive in the understanding and implementation of proper prenatal care.

- The whole community should be informed about the various procedures in
birth care, to enable each woman to choose the type of birth care she prefers.

- The training of professional midwives or birth attendants should be
promoted. Care during normal pregnancy and birth and following birth should
be the duty of this profession.

- Information about birth practices in hospitals (rates of cesarean sections, etc.)
should be given to the public served by the hospitals.

- There is no justification in any specific geographic region to have more than
10-15% cesarean section births (the current US c-section rate is estimated to be
about 23%).

- There is no evidence that a cesarean section is required after a previous
transverse low segment cesarean section birth. Vaginal deliveries after a
cesarean should normally be encouraged wherever emergency surgical capacity
is available.

- There is no evidence that routine electronic fetal monitoring during labor has
a positive effect on the outcome of pregnancy.

- There is no indication for pubic shaving or a pre-delivery enema.

- Pregnant women should not be put in a lithotomy (flat on the back) position
during labor or delivery. They should be encouraged to walk during labor and
each woman must freely decide which position to adopt during delivery.

- The systematic use of episiotomy (incision to enlarge the vaginal opening) is
not justified.

- Birth should not be induced (started artificially) for convenience and the
induction of labor should be reserved for specific medical indications. No
geographic region should have rates of induced labor over 10%.

- During delivery, the routine administration of analgesic or anesthetic drugs,
that are not specifically required to correct or prevent a complication in delivery,
should be avoided.

- Artificial early rupture of the membranes, as a routine process, is not
scientifically justified.

- The healthy newborn must remain with the mother whenever both their
conditions permit it. No process of observation of the healthy newborn justifies
a separation from the mother.

- The immediate beginning of breastfeeding should be promoted, even before
the mother leaves the delivery room.

- Obstetric care services that have critical attitudes towards technology and that
have adopted an attitude of respect for the emotional, psychological and social
aspects of birth should be identified. Such services should be encouraged and
the processes that have led them to their position must be studied so that they
can be used as models to foster similar attitudes in other centers and to influence
obstetrical views nationwide.

- Governments should consider developing regulations to permit the use of
new birth technology only after adequate evaluation.

Wait to cut umbilical cord - study says

Researchers recently published findings in the Journal of Cellular and Molecular Medicine that concluded that in normal birth, delayed cord clamping should be encouraged, as it amounts to “mankind’s first natural stem cell transplant.” MSNBC published an article about the research results.


http://www.msnbc.msn.com/id/37342877/ns/health-kids_and_parenting/

Know Your Birth Options Event

Know Your Birth Options Event

Tonight, July 15th
6:30pm - 8:00pm

At:
The Birth Center
5440 Laurel Hills Dr.
Sacramento, CA 95841
916-995-6358

Tonight we will be viewing Orgasmic Birth. A film about natural birth. This is a great opportunity to come and meet a variety of childbirth professionals, and learn about various options you have for pregnancy, birth and your postpartum time.

I look forward to seeing you tonight!!

What Is Support?

This was the first thing we read at my DONA training, and I really love it! Truly sums up who a doula is and what we do. 

What Is Support?

Support is unconditional.

It is listening...

not judging, not telling your own story.

Support is not offering advice...

it is offering a handkerchief, a touch, a hug...caring. 

We are here to help women discover what they are feeling...

not to make the feelings go away.

We are here to help a women identify her options...

not to tell her which option to choose.

We are here to discuss steps with a woman...

not to take the steps for her. 

We are here to help a woman discover her own strength...

not to rescue her and leave her still vulnerable. 

We are here to help a woman discover she can help herself...

not to take responsibility for her. 

We are here to help a woman learn to choose...

not to make it unnecessary for her to make difficult choices. 

-Anonymous