Monday, October 26, 2009

The Ten Pound Baby - Too Big!

I've heard it a hundred times and I should be used to it. But I'm not.
It happened again last week.

My friend was having her third baby. She's already pushed out two babies without problems - an 8 pound and a 9 pound baby.

She's into natural birth, even considered a home birth... but then got nervous thinking about it and went on with the obstetrician. He is a nice man. I like him a lot. If I had to pick a doctor, he'd be in the top dozen that I know. But he works in the hospital and thinks the way he was trained.

Two months ago my friend came home from a prenatal with the shocking, horrifying news, "Mary, they did an ultrasound and my baby already weighs over five pounds! He's gonna be HUGE by my due date!"

I talked her through it: She'd already pushed out a 9 pound baby. This one probably wouldn't be that much bigger, if even that big. She has a great body for having babies. If she was worried about her baby getting big, she could stay away from refined carbs and sugars.
She looked skeptical. I wondered if she really was scared of doing labor again and was hoping for a c-section. I hoped not, but I had to think that perhaps that was going through her head... I loaned her some books and told her that she'd already done it twice, and I was sure she could do it again.

About two weeks ago, they did another ultrasound. This time she was told that her baby already weighed a whopping TEN pounds! Her doctor didn't like the idea of her birthing a 10+ pound baby, and she really didn't like the idea. They mutually agreed that she'd have an elective cesarean section on the following Monday. She'd be 37 weeks. Everything would be fine.

So last Monday, her belly was sliced open and this "giant baby" was extracted. He weighed 6 pounds, 7 ounces. She sighed and laid there waiting for everyone to put her insides back together while he cried and squirmed in the warmer.

The doctor smiled - another successful c-section! No respiratory problems for the baby, no issues with the mother. The ultrasound estimate of size was a little off... but no harm was done, so that really didn't matter, right?

The nurses smiled, too. All was well as the new daddy stood near his baby and held his hand and the mommy was stitched neatly closed.

This is birth... the American way.

Morning Sickness Remedies

Is there anything worse than to be excited about being pregnant, but to feel so nauseous that you can't enjoy it for months?!

I share these suggestions with my homebirth clients frequently, and thought that others might benefit from the knowledge as well. So here goes....

The cause of morning sickness is not really known, although there are many theories, including hormonal changes in pregnancy (elevated levels of estrogen and human chorionic gonadotropin [hCG]), low blood sugar (perhaps caused by not eating, thereby creating a vicious cycle), gastric overloading, slowed peristalsis (intestinal action), a body overloaded with toxins, and any number of other possibilities.
Nausea occurs in half to three-quarters of pregnant women. Most women experience the worst nausea and vomiting at about 11 weeks gestation. It typically begins around 5-6 weeks. About half of pregnant women with nausea and vomiting find it completely gone by 14 weeks and 90 percent by 22 weeks. Women with a multiple gestation (twins, triplets, etc.) often have longer-lasting and more severe nausea and vomiting. The theory is that the extra hCG produced during a multiple pregnancy may be the cause.

Persistent and severe nausea and vomiting beyond the first trimester may indicate hyper emesis gravid arum or hydatidiform mole and should be taken seriously.

There are so many different things that can help morning sickness, but there certainly isn't a "one size fits all" remedy! One or all or any combination or none may be effective for a particular individual. For many women, just knowing that something might help is comforting!

The following suggestions are well-known and fairly common remedies that often help alleviate or eliminate nausea and vomiting during pregnancy.

Please do not take these suggestions as medical advice! Always consult your care provider before trying something new!

1. Eat small, frequent meals, including a protein food each time, as often as every 2 hours, or just “graze” continuously, not allowing more than an hour or so to pass without putting something in your mouth. The food is more apt to be retained than 3 large meals a day and prevents the blood sugar from dropping enough to cause nausea. If this seems to work for you, keep snacks by your bed (almonds, cheese sticks, yogurt, peanut butter and apples, etc) and eat several times during the night when you wake to go to the bathroom. This will keep your blood sugar from falling by morning, leaving you feeling nauseous upon awaking.

2. Eat dry crackers or toast or plain yogurt before getting up in the morning.

3. Sip on ginger or raspberry leaf tea. The best ginger tea is made by pouring one cup boiling water over 3-5 slices of fresh ginger root. Let steep 5 minutes and sip slowly.

4. Take Ginger capsules with your meals.

5. Avoid foods with strong or offensive odors.

6. Many women claim that homeopathics are effective in easing morning sickness. The remedies are specific to symptoms. Research Pulsitilla, Sepia, Nux Vomica, and Ipecacuanha. Additional remedies to consider include: Antimonium Tartrate, Argentum Nitricum, Petroleum, Sulfur, and Tabacum. Good references are: “Homepathic Medicine for Women” by Trevor Smith, MD, and “Homeopathic Medicines for Pregnancy and Childbirth” by Richard Moskowitz, MD.

7. Drink carbonated beverages - especially ginger ale. (I wouldn't recommend doing this on a
regular basis, but it does help some women with severe nausea!)

8. Rest.

9. Vitamin B6 (pyridoxine) either 25 mg four times a day or 50mg twice daily can be very effective.

10. Use medication. Some women find 50mg Vitamin B6 and 1 Unisom tablet at bedtime in addition to 25mg B6 twice daily to be very helpful. (Or, 25mg B6 and ½ Unisom tablet three times a day). Unisom can cause drowsiness, and of course, consult your healthcare provider before trying any medication!

Feel free to comment, adding your own suggestions or what did or did not work for you.
I welcome the collective wisdom of pregnant women and their care providers everywhere!

The Best Care for Healthy Pregnant Women

As technical advances become more complex, care has come to be increasingly controlled by, if not carried out by, specialist obstetricians. The benefits of this trend can be seriously challenged. It is inherently unwise, and perhaps unsafe, for women with normal pregnancies to be cared for by obstetric specialists, even if the required personnel were available. Specialists caring for women with both normal and abnormal pregnancies, because of time constraints, have to make an impossible choice: to neglect the normal pregnancies in order to concentrate their care on those with pathology, or to spend most of their time supervising biologically normal processes, in which case they would rapidly loose their specialist expertise.

Midwives and general practitioners, on the other hand, are primarily oriented to the care of women with normal pregnancies, and are likely to have more detailed knowledge of the particular circumstances of individual women. The care that they can give to the majority of women whose pregnancies are not affected by any major illness or serious complication will often be more responsive their needs than that given by specialist obstetricians.

-A Guide to Effective Care in Pregnancy and Childbirth,
Enkin, Keirse, and Chambers, Oxford University Press

Tuesday, October 13, 2009

People Tell You...

People tell you how tired you'll be,
but they don't tell you...
that you'll be able to survive without much sleep
because the simple act of looking at your baby
is stirring, gratifying, energizing.

- Carol Weston

Tuesday, August 4, 2009

New Study: Home Birth as Safe as Hospital Birth

Is anyone in the medical community paying attention?
This wasn't exactly a "small" study.
Will ACOG revise their radical stand opposing homebirth?
I'm just wonderin'. . .

Look at these rates:
Intrapartum death:
Home: 0.03% vs. Hospital: 0.04%

Intrapartum and neonatal death within 24 hours of birth:
Home: 0.05% vs. Hospital: 0.05%

Intrapartum and neonatal death within 7 days:
Home: 0.06% vs. Hospital: 0.07%

Neonatal admission to an intensive care unit:
Home: 0.17% vs. Hospital: 0.20%

It looks like people were just ever so slightly more likely to be "safer" at home. Hmm....
And as a side benefit, more happy and comfortable in their own beds and bathrooms and living rooms. Oh, and it cost less.

No matter where you have your baby, there is no guarantee that it will all turn out well or that you will like the outcome or that whatever happened couldn't have possibly been prevented in the opposite setting. BUT, to say that home is more risky than the hospital for healthy women...
Show me!!

NEW YORK (Reuters Health) Jul 28 -
In terms of perinatal morbidity and mortality, a planned home birth is as safe as a planned hospital birth, provided that a well-trained midwife is available, a good transportation and referral system is in place, and the mother has a low risk of developing any complications, new research shows.

"Low-risk women should be encouraged to plan their birth at the place of their preference, provided the maternity care system is well equipped to underpin women's choice," Dr. A. de Jonge, from TNO Quality of Life, Leiden, the Netherlands, and co-researchers emphasize in the August issue of BJOG: An International Journal of Obstetrics and Gynaecology.

Data regarding the safety of home births in low-risk women are lacking, due in part to the fact that studies with very large sample sizes are needed to assess relatively rare adverse outcomes. Moreover, randomized trials comparing home and hospital births have not been done because women usually want to choose their place of birth, the authors explain.

The present study, an analysis of 529,688 low-risk planned births, was conducted in the Netherlands, the only country in the west with a large enough data set. The group included 321,307 women who wanted to give birth at home, 163,261 who planned to give birth in the hospital, and 45,120 with an unknown intended place of birth.

All of the outcomes studied occurred with comparable frequency in the planned home and hospital birth groups. These included intrapartum death (0.03% vs. 0.04%), intrapartum and neonatal death within 24 hours of birth (0.05% vs. 0.05%), intrapartum and neonatal death within 7 days (0.06% vs. 0.07%), and neonatal admission to an intensive care unit (0.17% vs. 0.20%).

"As far as we know, this is the largest study into the safety of home births," the authors note. The findings, they conclude, indicate that with proper services in place, home births are just as safe as hospital births for low-risk women.

BJOG 2009;116:1177-1184.

Friday, July 10, 2009

"Pit Her til Distress..."

Pit til distress... A scenario that happens all too often in the hospital.
The thought in the back of everyone's mind seems to be, "Well, we can always turn the Pitocin down, and if that doesn't work, we can always do an emergency c-section."

Here, the labor and delivery nurse tells it from behind the scenes:
Pit to Distress: A Disturbing Reality

Thursday, June 18, 2009

Natural Birth Blogs

Looking for more interesting natural birth blogs to follow?

Check out this list of 100 best natural birth blogs....
Top 100 Natural Birthing Blogs

Thursday, June 4, 2009

The Classic Old-School Doc Re-Appears

I am at one of the local hospitals pretty frequently, supporting doula clients in labor - often enough that I now have some favorite nurses and some of the L&D staff people remember me. That's usually a good thing.

I've also done exactly one birth each with quite a few different doctors. Fortunately, some I never see again. Other times, I wish we could trade back for the doc that attended the last birth.

As a side note, I have only ONCE in the last 4 years of attending hospital births, ended up at a birth where the attending physician was actually the laboring woman's own doctor. I used to kind of hope/assume that my client's doctor who had signed off on their birth plan and all would be there. I've stopped planning on that. It's always somebody else. Usually, somebody from that practice, but I find that doctors came come from the North and South Pole and still be in the same practice together! So, we're always in for a surprise when the doctor walks in the door (unless I've worked with him/her before... in that case, I may have an idea about what's coming!).

Not long ago, "Belinda" was due and planning a natural birth in the hospital. She had 2 little ones already, so part of our doula visits prenatally focused on who would take care of the kids and arranging transportation and all kinds of practical details. Besides her husband was in Iraq for most of the pregnancy, and arrived back just a few days before she went into labor.

As for the birth plan, her doctor had said that she was fine with everything on it.
She said that she doesn't do an episiotomy "unless it's necessary."
She said that she avoids C-sections whenever possible.
That she encourages natural birth for any of her patients who want to try it.
That she would allow her patient to move and walk and do whatever she wanted to during labor.
That she would allow her to shower during labor (since a birthing tub wasn't available).
The only thing the doc wasn't very agreeable with was delayed cord clamping. But my client decided to give on that one if she had to.

Then labor happened.

The couple had just been moved from triage into their room. Labor was progressing quickly. The nurse checked Belinda's cervix and cheerily announced, "You're a good, stretchy 7 centimeters! I better tell the doctor to come right in!" With that, she chucked her glove in the trash and hurried out. Belinda was concentrating hard on the next contraction. It looked like all she could do to keep from screwing up her face and crying out in pain.

Meanwhile, the nursing student was having trouble getting the I.V. inserted. So the phlebotomy tech came in to help. Eventually, the I.V. was in and running after the fifth try. Belinda grimaced as she gripped my hand and said, "This is the last stick, right?"

And then Mr. Old School Doctor walked in. He looked like a classic, right out of a book about an eccentric old man... And it began.

"How are you, Ms. Smith?" he asked, touching her shoulder briefly.

"I'm, uh, ok." She sighed, exhausted. "What do you need to do right now?"

"Well, we need to assess how quickly you're progressing. So, I'm going to check your cervix, and we can break your water..."

"No, I - uh, don't want my water broken. Not right now, anyway."

"Oh." he stopped and shrugged. "Well, then that's fine for now." He turned back to adjusting his glove.

Belinda spoke up quickly before the next contraction. "Then can I get up and walk around after you check me?"

"No, oh NO! No, dear. You're going to stay right in that bed. Catastrophic things can happen if you get up and move around in labor."

Belinda looked a bit shocked, but another contraction hit, and she sank back against her pillow and closed her eyes. A couple of minutes later, as she opened her eyes, and looked back at the doctor, she brought it up again. "But I've been planning to walk and be up in labor all along. My doctor said it would be just fine. We talked about it a lot. She said as long as the baby was fine, I could get into whatever position feels good while I'm having contractions."

I chimed in to try to help her. "Maybe," I appealed to the doctor, "She could stand by the side of the bed and lean over it, but not walk around...?"

He looked at me as though I was suggesting that we bring a real, live tiger into the room to help things along. I backed off and he repeated, "No, no, no.... "
Then turning to Belinda again, "Honey, I don't let people do that. The best place for you and your baby is right in that bed."

He sounded patronizing, kind of grandfatherly, and yet... I wasn't sure what to do next. The nurse had a sympathetic look on her face, but she was nodding with the doctor. I knew she knew there was no good reason fItalicor this. I had just done a birth with her several weeks earlier and that doctor had let the woman move anywhere she wanted during labor.

Belinda's husband looked uncomfortable. Clearly, he didn't like the conflict. "Uh, honey, maybe..." he trailed off as Belinda rode another contraction out.

Then she snapped her head around and said very calmly but firmly, "I want to be upright. I've read that it can help with labor. Can't I do something that will aid gravity to make the baby come down and out easier?"

"Ah... " he rubbed the white stubble on his chin. "We have ways to get babies out if you're worried about that. Have you ever heard of the McRoberts position?"

Another contraction hit, but he kept talking. Belinda stared, glazed over at Dr. Old School as he rattled on about the McRoberts position while she breathed and nodded and winced. I pressed on her back and wondered to myself what would come next.
He repeated, "Do you know what the McRoberts position is?"

Belinda gripped her husband's hand a little tighter. "No," she gulped, catching her breath.
"The McRoberts position opens up your pelvis as wide as possible for your baby to come through. Its when we lay you on your back and pull your knees back to your ears. So, let's do that. Okay? When it's time to push, we'll lay you on your back and your pelvis will open wider so this baby won't get stuck."

Belinda nodded and was swallowed up by the next contraction. Afterward, she tried one more time, "But can I get up now? Can I stand by the bed or something? These contractions are KILLING me! They are hurting so bad in my back here in bed."

The old doctor straightened up and adjusted his glasses. "No, dear, did you already forget what I just explained? We need you IN BED till you have this baby, okay? Terrible, terrible things can happen to babies sometimes when you get up. You wouldn't even want to know what. But they are catastrophic. Sometimes babies die. I'm just trying to keep your baby safe. And didn't you understand, the best position for this baby to come out in is when you lay back? Do you understand?"

Belinda meekly nodded her head and then looked away as she felt another contraction coming.

And so went the labor... the whole thing. I tried asking the doctor lots of questions about the how's and why's of what he was decreeing, but nothing made a difference. Every time he didn't want something done a certain way, he'd say in his most grandfatherly voice: "Catastrophic things can happen if you do ____ . Do you understand, honey?"

Belinda pushed her baby out in the McRoberts position, which the doctor insisted upon.
And really, everything went fine. Nothing catastrophic or even close to it happened. She didn't have a tear or skid mark or anything.

It wasn't that terrible of a birth. But, Belinda was frustrated at her helplessness to have any say in simple matters of labor. Frankly, I was, too. I thought the whole "not getting out of bed" thing was ridiculous.

I was honestly a little surprised to find a doctor around still practicing so "old school"... He suctioned really vigorously on the perineum for over a minute before he let the shoulders deliver... and the amniotic fluid was completely clear. And then he spent a full two minutes holding a pink, kicking, screaming baby upside down, wiping it's face again and again and again before he handed him off to his mother. I don't know what he was thinking.
I guess it was just protocol.

That's the kind of hospital births I see a lot. They're usually kind of okay, but some of the stuff you put up with is just... dumb and frustrating at times, and for some mothers, infuriating!

People like Belinda will probably have a homebirth the next time. But the hospital might get to keep her as a patient if all their doctors would just be a little more open minded to a very few things that can make a big difference in a mother's experience.

As for the catastrophic things that were likely to happen, I'm still a little confused. Beyond the possibility of a cord prolapse (which can happen at any time, in about any position), what did he think was going to happen if the mother stood beside her bed?!

Oh well. I just hope that I never run into him again at a birth. And should I ever need to have a baby of my own born at that hospital, I hope Dr. Old School won't be the one walking into my room.

But, then, again, it really wouldn't be the end of the world. If I really, really needed hospital care for me or my baby, I would put up with most of it. And I'd try to be grateful. But it would be hard to be impressed. I'm just sayin'...

Saturday, March 14, 2009

The Trouble With Repeat Cesareans (Time Magazine)

Time Magazine is starting to get it... the mainstream media is publishing articles that are telling the truth about what has gone wrong in our modern maternity care system.

"Much ado has been made recently of women who choose to have cesareans, but little attention has been paid to the vast number of moms who are forced to have them. More than 9 out of 10 births following a C-section are now surgical deliveries, proving that 'once a cesarean, always a cesarean'--an axiom thought to be outmoded in the 1990s--is alive and kicking..."

Read the full article here at Time.

Waiting Till 40 Weeks of Pregnancy... So Much Better

The Wall Street Journal published an excellent article back in December, stating the benefits of carrying a pregnancy to term and the risks of inductions that are "just a few weeks early."

"Conventional wisdom has long held that inducing labor or having a Caesarean section a bit early posed little risk, since after 34 weeks gestation, all the baby has to do was grow.

But new research shows that those last weeks of pregnancy are more important than once thought for brain, lung and liver development. And there may be lasting consequences for babies born at 34 to 36 weeks, now called 'late preterm.' "

Check out the rest of the article here at the Wall Street Journal