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.
Tuesday, July 27, 2010
Monday, July 26, 2010
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**
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**
Saturday, July 24, 2010
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.
**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.
Friday, July 23, 2010
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.
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.
Wednesday, July 21, 2010
"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!
Sunday, July 18, 2010
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.
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.
Saturday, July 17, 2010
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.
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.
Friday, July 16, 2010
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/
http://www.msnbc.msn.com/id/37342877/ns/health-kids_and_parenting/
Thursday, July 15, 2010
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!!
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!!
Wednesday, July 14, 2010
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
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