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Friday, December 31, 2010

Photo illustration: delayed cord clamping vs. immediate cord clamping

 World Health Organization supports delayed cord clamping. Here's what research shows:
  • 25-50% of baby's blood volume is in the placenta and cord immediately after birth. 
  • In the minutes following birth, baby's circulatory system retrieves exactly the amount of richly oxygenated blood he or she needs. 
  • Premature cord clamping cuts off baby's oxygen supply from the placenta before the lungs begin to function, which is essential for brain function.
  • Babies whose cords are clamped and cut prematurely are more likely to have respiratory problems, need resuscitation, need a blood transfusion, and/or be anemic. 
  • Cord blood provides baby with his or her own essential stem cells when the cord is allowed to continue pulsating until it is physiologically finished. 
Nevertheless, many OBs (and even some midwives) continue to routinely clamp and cut the cord within 30 seconds after the birth. Why? Tradition and convenience.

Research also shows that pushing in upright positions on the mother's cues and instincts is more beneficial for both mother's and baby's health in the majority of instances. Here's an excellent 2 minute video clip on pushing positions. Although many OBs and midwives routinely practice active 3rd stage management (including immediate cord clamping and cutting, cord traction and fundal pressure to assist delivery of the placenta, and routine Pitocin shots), much has been written that suggests that these practices can cause many of the same problems they purport to prevent, such as hemorrhage.

Below are photos which two mothers have graciously given me permission to publish. They illustrate the difference in appearance of placentas after pushing on instinct in an upright position, physiologic 3rd stage management, and delayed cord clamping,  versus placenta after directed pushing in lithotomy position (on her back),  active 3rd stage management, and immediate cord clamping. These educational photos are graphic, therefore I'm giving fair warning to anyone who does NOT want to view photos of placentas.

*please continue to scroll down to see photos of placentas

*please continue to scroll down

*please continue to scroll down

* You can't say I didn't warn you if you haven't closed this page by now.

The first is a placenta after delayed cord clamping and cutting (30 or so minutes after the birth). The mother pushed on her body's cues in an upright position. She had a waterbirth and delivered the placenta into the birth pool on her body's cues about 30 minutes after the birth, then the placenta was transferred into this bowl right away. The amount of blood that was delivered with the placenta was so minimal that it did not even change the color of the water.

The next photo is of a placenta delivered after active third-stage management. The mother pushed in the lithotomy position (on her back) with directed pushing. The cord was clamped and cut within seconds after the birth. While the mother was still on her back, the midwife directed when and how to push the placenta out, while she gave cord traction. (This was not nearly all of the blood that was delivered with the placenta. It came out with a gush of blood, much of which went directly into a biohazard bag at the end of the bed.) I realize that much of this blood was mother's blood, not baby's blood (placental blood), but it still shows an interesting difference between examples of pushing on instinctive cues and directed pushing; between watchful waiting and active third-stage management. 

It is an interesting pictorial of the variations of third stage management, placentas, and cords.

I have a collection of links (including NIH, Cochrane Review, and PubMed research) on delayed cord clamping and the consequences of routine cord clamping here. I continually add to this bookmark site.

Here is Midwife Thinking's blog post on the role of the placenta and cord in the newborn transition.

Edited to add: Even in the case of C-section, moms can request delayed cord clamping (barring unexpected complications). It's being done safely in some major hospitals by OBs who are meeting consumer demands for delayed cord clamping and other options for a family-centered cesarean. You can read more about family-centered cesareans on ICAN's White Papers and here at Preparing For Birth's sample birth plan for family-centered cesarean. Preparing for Birth is owned by Desirre Andrews, who is ICAN's president as well as a childbirth educator and doula. Family-centered cesareans are another post for another day.

Wednesday, December 8, 2010

Wordless Wednesday: A Father's Labor Support

I took this photo of an amazing couple during labor. The father and mother's love for each other shined so beautifully. His caring presence and touch was a great comfort to her.

Tuesday, December 7, 2010

Remembering our angel babies at the holidays

I've been asked to write a blog on grief/loss/remembering lost babies over the holidays. It's such a tough topic to handle for so many reasons. There are so many different ways to grieve, different ways to honor memories of our lost babies, and even so many different ways of celebrating that time encompassing Thanksgiving,  Christmas, Chanukah, New Year's, Kwanzaa, Winter Solstice, and Festivus (did I leave anything out?).

I feel the need to give a disclaimer that whatever works for you, is the right answer for you. As I've said before, fear of criticism for saying the wrong thing has held me back from writing about grief and loss.

The holidays are often a grief trigger following a loss, even if things have seemed to be "fine" or at least "better" for a while. Why is that? Sometimes it has to do with expectations we had of that holiday: showing off an ultrasound, baby bump, or our new baby in our arms. Sometimes it means being around a mixture of relatives, some of whom don't know about the loss and it feels overwhelming to tell the whole story allllllll over again. Sometimes it feels like too much to answer questions about what happened. And all too often, it's awkward because there are no questions; everyone acts as though nothing happened. "Please pass the turkey." It's the elephant in the room nobody talks about.

Or maybe it's because nobody knows that the loss occurred because we hadn't announced the pregnancy, and we preferred to keep the loss and grieving process private. It can still be difficult to face a crowd when you are mourning and no one knows why you are not quite acting like "yourself."

Sometimes we *want* to talk about it but we don't know how to bring it up or who will be a sympathetic listener. Or we don't want to be the one to ruin the family get-together. Or we don't want to be accused of being self-centered or making the event "all about me." Or maybe that was just what I heard from certain family members. Or maybe we don't want to ruin our makeup when we tried so hard to put on a brave face and attend this thing after all.

Sometimes it's hard to be around family or friends who were pregnant at the same time as us or whose child(ren) is/are the same age as our baby would have been by then. It's hard to hold their baby, even though we want to hold them and love them.

Sometimes it's simply hard to be around festivity when deep down, we don't feel terribly festive.

Think about what brings you comfort: privacy and curling up on the couch with your honey, or being surrounded by friends and family at a gathering that is bustling and takes your mind off things for a while? Talk it over with your significant other and see if you can find a compromise that works for you both. Would you feel most comfortable attending a family gathering but setting a time limit on it? Would it help to have a code word that means "I can't do this, we have to leave now!"? Maybe this could play out: "Where's the mistletoe, honey?" "I'll get our coats."

If you just don't want to attend, and if you would rather send the gifts by mail or give them to a family member to take for you, or even if you want to send your significant other (and/or kids) as your ambassador and explain that you weren't feeling well and you regret that you couldn't be there, that would be 100% true.

Some families opt to do something different altogether to ease the pain of the absence of the loved one. This could be a temporary solution for one year, or a new tradition to keep each year. It's a bit of a different situation, but several years ago, my friend's mother died on Thanksgiving day after dinner after a long illness, and her father died of cancer a few months later. For the following Thanksgiving, she and her sister took a cruise over Thanksgiving instead of attending dinner at extended family's houses. I thought it was a great idea. Since that time, they have celebrated Thanksgiving with various other family members, but it really helped them make that transition for that first rough Thanksgiving without their mother. Getting away for a while could be a nice way to reconnect and recharge the batteries, physically and emotionally. Alternately, a new tradition closer to home could give a new way to honor baby's memory at the holidays, such as helping others (donating time, money, or needed items to a local family or charity in need) or even some fun activity such as going bowling or ice skating as a family.

Some moms find comfort in making or buying a memento, whether it's a piece of jewelry etched with baby's name, due date, or loss date; a Christmas ornament; a suncatcher; naming a star in his or her memory; donating to a charity in his or her name; a piece of art (custom or one you find) that represents your memory; a doll, stuffed animal, or blankie; a birdbath, fountain, or garden stepping stone (perhaps with a phrase or scripture that comforts you). Some parents write a poem (and even frame it) or journal to help in the grieving process. There are endless options for finding a way to honor your baby's memory in a way that represents you, your family, and your traditions.

If you receive money as a gift or want to buy a treat for yourself, My Forever Child is a great company owned by a jewelry artist who has lost a baby as well. Here are photos of my pendant I received as a gift from friends shortly after my loss. If you have actual handprints or footprints of your baby, you can scan and email them to her and she will custom-etch the images onto a pendant or keychain.


As for me, I wanted a Christmas stocking in memory of Evan, my baby who I lost in 2007. It is basically a place-holder, in my eyes. I didn't want to pretend he was never here. My mother-in-law made stockings for my husband and me when we got married, then gave a stocking of the same shape/pattern to each of our children for their first Christmas. I asked her in June 2007 if she would make a stocking in memory of Evan, but she said that she would not have time to do that. I asked my dear sister-in-law Candi if she would make a stocking for Evan, since she has my mother-in-law's pattern and this stocking would match all the others. Even though it was a sacrifice of time and effort, Candi took time every evening for several days straight to put together this stocking for me, allowing me to choose which fabrics I wanted and where. Her gift of love meant--and means--so much to me.

To mark the significance of the stocking, I added a Precious Feet pin, which is an accurate replica of a baby's feet at 10 weeks gestation. I lost Evan at nearly 15 weeks gestation, but he stopped growing at nearly 9 weeks gestation, so the pin is pretty close to the size of Evan's feet at the time we lost him.

Evan's stocking is the one with the snowman, in the middle.

All our stockings: the 5 children's, then mine and Rick's.

Having Evan's stocking as a physical way to honor his memory made the approaching Christmas season feel much more bearable. My children know whose stocking that is, and sometimes they tell visitors about it. It is a tangible witness to their baby brother's existence. They know that he was a real baby, that he is still their brother, and that he is in Heaven now.

I've put up Evan's stocking along with all the other stockings, each year. However, I also bought a Christmas ornament in Evan's memory in 2007, but this is the first year that I have felt strong enough to bring it out of its place in my memory box and hang it on the tree. I bought it October 2007 from a WV artisan at an arts and crafts festival, and the artisan inscribed it with his name and the year.

The underside of the blankie reads "Evan Michael DeGroff, 2007"

Maybe on a tree this size, no one else will even notice Evan's ornament, but I know it's there.

What are some of the ways that you or someone you know has handled the holidays after a loss?

Sunday, December 5, 2010

Commercial baby carriers: what's available other than crotch-danglers

Maybe you're looking for an ergonomic, safe baby carrier or sling, but you don't have a high-end baby boutique that would stock brands like Ergo, Boba, Beco, or Sakura Bloom. [Update: Toys 'R Us now stocks Ergos, both online and in some retail stores!] Maybe you are in a hurry and have to buy a baby gift for a shower this afternoon, and you don't have time to email Tre'Slings and custom-order a gorgeous, designer fabric ring sling (she ships anywhere in the US & Canada). Maybe you read my previous post "Babywearing FAQ" and you want a readily available baby carrier from Target or Toys 'R Us, but you want to avoid the pitfalls of crotch-dangler carriers. Here are a few great options.

One of my favorite carriers for newborns, among widely available commercial baby carriers, is the Moby Wrap. You can find them at most Target or Toys 'R Us/ Babies 'R Us stores for around $40.

I was so excited when I was at Marshall's the other day and I saw this new Infantino  Wrap & Tie, otherwise known as a Mei Tai style sling, for only $24.99!

"Buy this..."

The package was sealed so I didn't get to look at it closely or try it out, so I can't vouch for the quality, but this style carrier is so much more ergonomic for mom and baby both! As with many carriers, the packaging did show a photo of wearing a baby forward-facing using this Wrap & Tie, and I would advise against forward-facing babywearing for all the usual reasons, but this carrier looks like a great compromise for an affordable, safe, easily available baby carrier.

Unfortunately, right next to that Wrap & Tie, Marshall's had these crotch-dangler carriers, also $24.99 each:

"...not that."
I can't for the life of me figure out why these Infantino Front 2 Back Riders, Infantino Comfort Riders, Baby Bjorns and the like are even still on the market when there are such nicer alternatives for the same price. Maybe they're like pleated pants: they're not good for anyone, but so long as there are people willing to buy them, manufacturers will continue to produce them. They do not provide adequate support for baby's legs or spine in this position where baby's legs dangle straight down, whether baby is forward-facing or facing the wearer. Baby's weight and center of gravity are also pulled down and away from the wearer, instead of being wrapped around the wearer's body.

Although I haven't seen one in person yet, I've heard good reviews of Infantino's new Ergo knockoff, the Infantino Balance which sells for around $60 at Toys 'R Us. I'm encouraged that possibly market demand is forcing commercial baby product companies to offer better alternatives than the past. I'd love to see this trend continue, and who knows, maybe some day we will see BabyHawk, Ergo, BobaBeco, Sakura Bloom, or even Tre'Slings offered at Target and Toys 'R Us.

For more information about the difference between good, supportive baby carriers and crotch-danglers, see this helpful blog post by Becoming Mamas.

What about you? Have you seen any good, ergonomic, affordable baby carriers in chain stores? Which carriers? Which stores?

Wednesday, December 1, 2010

Myth-conceptions about Episiotomy,The Unkindest Cut.

This MyOBsaidWHAT.com entry particularly hit a nerve with me.

“I’m almost done, just putting in an extra stitch. It will make your husband really happy.” -OB during tear repair.

Where to even begin with how wrong this is. *sigh* You can read the comments at the bottom of the post to read the thoughts of childbirth educators, doulas, midwives, and other birth advocates. A great read on the facts and mythology regarding episiotomies is Chapter 14 from Henci Goer's Obstetric Myths Versus Research Realities, which can be read in its entirety here.

The assault on the woman's genital integrity and bodily autonomy by this OB's use of the "husband stitch" is so bad that it would require a whole other post. The mother whose original post that was did NOT consent to that procedure, and there's no way that an "extra" stitch would help her heal better in any way. If anything, her recovery would be prolonged, possibly by many months. That's a rant for another day.

At any rate, I hear this one a lot. It makes me really sad.

Often, my clients in my childbirth classes (or private in-home classes) will bring to class their mother, sister, or best friend who they want to be present at the birth. With this example, we will call the mom-to-be Ashlee and her mother (the grandmother-to-be) Jane (not their real names). As part of what I regularly cover in my classes, I explained to mom-to-be Ashlee that episiotomies are only medically necessary about 5% (or less) of the time and that most of the time, they amount to nothing more than genital mutilation. We discussed how a tear will often be far WORSE and deeper with an episiotomy, and how recovery from an episiotomy has been found in studies to be more painful and difficult to heal than after a natural tear. I also shared with them the most common (totally preventable) causes of tearing and how to prevent/avoid a tear. Grandma-to-be Jane nearly teared up after hearing this, sharing a bit of her birth story. She was glad that chose to have unmedicated births with her (now-grown) children and encouraged her daughters to have an unmedicated birth, if possible. She said that she treasured her memories of her own births--until she found out that what happened to her didn't have to be that way.

She said that everything went great up until the time that her OB cut a deep episiotomy on her, then as he stitched her up, he told her he was putting in "one more stitch for her husband." Jane said, "At the time, I thought that was normal, but now I think I should have popped him one!" I told her that I was sorry that she had that experience. She replied that she was glad she found out the truth so that hopefully her daughter wouldn't have to go through an unnecessary episiotomy and subsequent painful recovery.