Well Rounded Birth Prep

Well Rounded Birth Prep

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Tuesday, November 23, 2010

Informed consent: Moms, do YOU want to be vaccinated after giving birth?

I wanted to give a heads up to moms who will be giving birth anytime soon in a hospital and possibly in freestanding birth centers. Several different moms have told me recently that after they gave birth in a hospital (two different hospitals), staff offered vaccinations to the mother. I'm not talking about the Hepatitis B vaccine typically offered to newborns. I'm talking about vaccines for mom.

One mom, in her post-birth blur, said that she was pretty sure that one of the vaccines may have been pertussis and she wasn't sure what the second one was (possibly flu?). She consented because the healthcare worker (I'm not sure whether it was a nurse, doctor, or other) rolled up her gown sleeve for her and told her that she *had* to have these vaccines. She did receive both vaccines, but she didn't feel that it was informed consent.

The other hospital did not present it falsely as a mandate, and the mother at that hospital declined the vaccines without any further struggle.

I'm not telling you to accept or decline any vaccine. I'm just here to give moms a heads up that they may need to make such a decision shortly after giving birth in an institution, so it's best to research your options and make your choices on available information instead of in a rushed manner, without having time to read product inserts or ingredient lists, and when they know that you're distracted with a newborn on your chest. Whether to accept or decline vaccines for mom is not something that most women think to include in their birth plans.

Links to CDC list of vaccine ingredients, PDF (US licensed vaccines)

Links to package inserts for US licensed vaccines

CDC page listing possible side effects of US vaccines

CDC list of vaccine contraindications (US vaccines)

VAERS (Vaccine Adverse Event Reporting System), co-sponsored by CDC, FDA, and US Dept. of Health and Human Services

National Institutes of Health/ Cochrane Review to "assess all studies evaluating the effects of vaccines against influenza in healthy adults." Conclusion: "Influenza vaccines have a modest effect in reducing influenza symptoms and working days lost. There is no evidence that they affect complications, such as pneumonia, or transmission.WARNING: This review includes 15 out of 36 trials funded by industry (four had no funding declaration). An earlier systematic review of 274 influenza vaccine studies published up to 2007 found industry funded studies were published in more prestigious journals and cited more than other studies independently from methodological quality and size. Studies funded from public sources were significantly less likely to report conclusions favorable to the vaccines. The review showed that reliable evidence on influenza vaccines is thin but there is evidence of widespread manipulation of conclusions and spurious notoriety of the studies. The content and conclusions of this review should be interpreted in light of this finding."

It's always a good idea to research ingredients and relative safety/risk of each vaccine vs. the relative safety/risk of each illness as well as the effectiveness (or lack thereof) of each vaccine. It seems that many people spend more time reading the ingredient list on the back of their cereal boxes than they do reading what is injected into their (or their children's) bodies.

Tuesday, November 16, 2010

One man's trash is another man's treasure?

A few days ago, I was making small talk with another mom who asked me what I do for a living. I told her that I homeschool my 4 kids and I teach childbirth classes. That's an interesting conversation opener. You'd be surprised how many people automatically start telling me about their births--even men, sharing how their wife had to have 2 Cesareans and why.

Like so many others, she told me how she has had cesareans with all three of her kids. She didn't say why she "needed" her first cesarean, but she did say that she scheduled her cesareans with the next two children. After all, her dad had read on the internet about "those VBACs." (I'm not making this up.) Besides, she elaborated, it made it so much easier to schedule her in-laws' visit around the scheduled C-section, and her husband could plan ahead when he needed to take off work.

I smiled and nodded. She didn't ask me any questions, and I didn't give her any commentary. I didn't even tell her how my own children were born. Someone changed the subject, and that was fine.

Then I received a text message from a friend who is a doula. She had been keeping me updated for days about her VBAC client's progress. She had texted me a few times for advice or encouragement, and I was honored to be a text-witness to something amazing. The text I received while sitting with this mother: "VBAC!!!!!!" Yes, she had finally achieved her VBAC after a 60 hour, unmedicated hospital VBAC. She worked so hard for that birth, not just those 60 hours but for the previous 40-ish weeks, preparing for and working toward this birth, overcoming incredible obstacles from her previous traumatic birth.

It was an interesting juxtaposition to observe, sitting at the table with a mother who knows nothing about what her body is capable of or designed to accomplish with birth, who was content with her three cesareans and said she would schedule cesareans if they have any future children, then receiving that text: "VBAC!!!!!!" Knowing what incredible event had just transpired, and how much that mother had wanted it--what victory.

It's interesting to observe who is content with what and why.

Monday, November 15, 2010

"How do you overcome the fear that your body doesn't work?"

On my Well Rounded Birth Prep Facebook page, Samantha posed this question: "How do you overcome the fear that your body doesn't work?" It's such a huge and important question, one that so many women face, especially after a difficult or traumatic birth.

I don't know Samantha's (or anyone else's) particular situation or medical history, so I'll try to write out a few things that many moms find helpful.

First of all, I'm sorry that you had an experience that left you with doubt and fear. It can be helpful to request a copy of your medical records from your previous birth(s) to see the details of what happened. Maybe a midwife or doula could help you decode what you read and help you identify any preventable interventions or other potentially avoidable factors that occurred before. This can give you a better idea of what you can do next time to help have a different result.

For example, some moms know that they had a bad reaction to narcotics or other medicines in the past. For them, having a game plan to avoid those meds in a future birth can help them feel less fearful and more confident for a future birth. For others, a bad perineal tear may cause intense fear of future birth. If lithotomy pushing (on back, hold breath, count to ten) is to blame, that's another fairly easily avoided situation. If there was a bad outcome following an induction, it can be helpful to avoid an induction the next time around (more on that later) unless it's medically indicated and if the potential benefits outweigh the risks of induction. If the last birth was a cesarean birth, identifying which factors led to that can help you decide what action plan will help give you the best odds of a vaginal birth the next time around.

Reading every GOOD birth book and article possible can be a great first step in processing all this. I keep meaning to write a blog with my book recommendations. Many of them are on the Amazon.com widget to the lower right on each of my blog posts. If you scroll through the pages, there are birth books for many different topics and situations. I can't overemphasize the importance of reading fact-based, evidence-based birth books instead of funny, tongue-in-cheek books, or worse: those which downplay the risks involved with birth interventions and normalize a medical birth. A few suggestions:

to read:

The Thinking Woman's Guide to a Better Birth by Henci Goer

Ina May's Guide to Childbirth by Ina May Gaskin

Pregnancy, Childbirth, and the Newborn by Simkin, Whalley, Durham, Bolding, and Keppler

to watch:

The Business of Being Born, produced by Ricki Lake and directed by Abby Epstein

for VBAC hopefuls:

The VBAC Companion: The Expectant Mother's Guide to Vaginal Birth After Cesarean by Diana Korte

Silent Knife: Cesarean Prevention and Vaginal Birth After Cesarean VBAC by Nancy Wainer Cohen and Lois J. Estner

ICAN (International Cesarean Awareness Network) is a great resource for cesarean research, articles, information, support, and healing. Their White Pages are a wonderful resource for statistics and current cesarean recommendations. ICAN's community and message board have been a source of healing and cesarean/VBAC info for thousands of women.

This is just the beginning for a reading list, but if I keep going, this will morph into that other blog I still need to write.

If you PM me your particular interests for reading or specific situation, I can try to point you toward books, articles, research, and/or websites to help you start your quest for information and empowerment.

Have you read about the fear-tension-pain cycle during labor and birth? Ina May's Guide to Childbirth describes it in detail. A good, independent childbirth class (NOT affiliated with a hospital or other institution) can go a long way toward helping you understand how your body works and how birth works. For anyone in western or southern WV, I can recommend one. ;-) The more you know and understand about the design of birth, the more you can recognize what's normal, and the less there is to fear. This, combined with your reading, can help you have a good grasp on how rare true, non-preventable birth complications are, and how they can be safely handled. This won't guarantee that you won't be one of the rare few, but perspective does help bring confidence and reassurance.

Finding a supportive care provider (midwife or OB) AND place of birth that are compatible with and supportive of your birth philosophy are CRUCIAL to working toward the birth you envision. To quote Desirre Andrews, ICAN President and owner of Preparing For Birth, "It comes down to the fact that you can't get Chinese food at McDonald's." Most hospitals, birth centers, OBs, and even midwives have a pretty firmly set order of operations. They are unlikely to bend their normal procedures to your requests. It's far easier to find a care provider who supports you than to struggle against your OB, nurses, and hospital during the time that you should be able to put all your focus on labor instead of arguing with staff. Here's my blog on "How to Avoid the Ol' Bait-and-Switch with your OB."

It might be worth your time to interview midwives and even consider whether you might be a candidate for a homebirth or freestanding birth center birth. It can be helpful to discuss your concerns openly with your care provider so that she or he can be aware of your grief and/or trauma triggers and be sensitive about them.

On that note, it's crucial to be selective who you invite to attend the birth. A sense of safety (both emotional and physical), security, and privacy is so important in allowing labor to unfold unhindered. It's essential that anyone present is someone who you would feel comfortable with in your most vulnerable moments, and that he or she supports you and your birth plan 100%. "Giving Birth With Confidence" had a great article on this topic. A doula can be a wonderful asset to your birth experience as well.

Journaling or otherwise processing what happened with your previous birth(s) is another step you may find helpful. I have compiled a few links on birth related PTSD and PPD, and I'm continually adding to the lists.

I also encourage my birth class students to recognize what can and what cannot be controlled with a birth. You can (generally) choose your care provider, birth setting, environment (candles, quiet, mood). While birth itself cannot be scripted, many moms find it reassuring to write birth plans for Plan A, Plan B, and Plan C eventualities of birth, with their preferences for example, with Plan A for a non-medicated birth with no interventions, Plan B for preferences if induction becomes medically necessary, and Plan C for a family-centered cesarean should the need arise. This allows you to make thoughtful decisions for your preferences, in advance while you are level-headed and have time to research various options. Some expectant families even write out their preferences in the event of a stillbirth or if the baby dies (photography: Now I Lay Me Down To Sleep, assist in bathing and dressing baby, save a lock of baby's hair, and more). While it's unpleasant to think about anything but Plan A of birth, it can give a sense of relief and free up mom not to have to worry so much about "What if?" when many possibilities have been covered with the birth plan.

Whether you are still in the planning/preparing stage for your next pregnancy or whether you are already pregnant, optimizing your health is another proactive step you can take. The common sense things like taking your prenatal vitamins, exercising to your ability, and best possible nutrition really do make a difference.

I'd like to sum it up by saying, you are the expert on your own body and on your baby. Read, prepare, surround yourself with great support people, then listen to your gut. Nobody knows what *your* normal feels like and what's right for *you*-- but you.

I hope this list is helpful. Feel free to add a comment with your own experiences.

What has worked for you to help you overcome fear that your body doesn't work or any other birth fears?