***trigger warning*** This blog is about miscarriage.
I realized that I have never written about That Day, the day I found out that my baby was dead, at 14 weeks 3 days along. I've written about the day after, researching my options and trying to decide whether to be induced or whether to wait it out to allow my body to go into labor naturally or whether to choose a D&C. I've written about the path to healing. But not about what happened That Day.
Four years ago today, I thought everything was fine. I was pregnant with my fourth baby, and my oldest child was four and a half years old. I had a regular prenatal appointment at my house with my midwife That Day. My last prenatal appointment had been at 8 weeks 3 days along. I had asked my midwife if we could stretch the next prenatal appointment a bit farther than the usual 4 weeks between visits because I had a busy schedule around that time, and she accommodated me.
The first part of my checkup went normally: blood pressure, pulse, weight, urinalysis, my midwife asking me how morning sickness was going and whether I had started to feel better yet. (My morning sickness had been normal, with queasiness starting around 6 weeks along and lessening around 13 weeks. My pregnancy hormone levels were high and healthy.)
Everything was fine until my midwife got out her Doppler to listen to baby's heartbeat. She couldn't find it right away, but I wasn't alarmed. She tried to reposition it to see if she could hear it from a different angle, but still couldn't locate it. I still wasn't worried. I figured that it could be possibly still be difficult to find the heartbeat on Doppler this early. My midwife wanted to get me an appointment for an ultrasound right away. Like, 3 hours later. I was a bit taken aback at the seeming urgency for this, but went along with it, knowing that I would feel much reassured after seeing that baby was fine when I had an ultrasound.
At first, my husband Rick said that he wasn't sure if he would be able to take the afternoon off. Neither he nor I understood the seriousness of the situation. My midwife said that if he couldn't come, she would go with me, because I should not go to that appointment alone. Uh oh. That doesn't sound good. Rick managed to hurry home and we got the kids into the car and rushed them off to my friend's house so we could go to the ultrasound alone.
I remember that it was chilly and drizzling that day--same as today. I remember being on the interstate nearing the hospital, thinking it was so surreal, still thinking that everything was fine. I remember thinking that we would look back on this afterward and think, "Wow, that sure was a close call. Pretty scary. I'm glad everything was OK." I just didn't get it.
We didn't have to wait in the lobby for long. They took me and Rick back to the private ultrasound room. The ultrasound tech started the scan--and my heart sank right away. She moved the transducer around, but my baby didn't move. There was no heartbeat. And I've seen enough ultrasounds to have a general idea what babies look like at different gestational ages on ultrasounds; this definitely wasn't right. My baby not only didn't move, but was way too small. The ultrasound tech said she was sorry, but there was no heartbeat, and the "fetus" measured 8 weeks 5 days. She left to get the doctor to confirm. I was shocked. My world was crushed in an instant.
The doctor was very matter-of-fact and sort of cold. I don't remember his exact words; they cut too deep for me to record them at the time. He was quite casual about it, saying that 25-50% of all pregnancies end in miscarriage, often before the mother even knows she's pregnant. That may be true, but it didn't change the fact that my baby just died. MY BABY DIED. Whatever else he said involved the words "product of conception," the first of many times I would hear that phrase from medical professionals over the next few days, unfortunately.
I cried. Rick held my hand. Then we did the Walk of Shame as they ushered us quietly out the rear exit. I was embarrassed because I realized that it was more for the sake of the other pregnant mothers in the waiting room, to spare them from having to see me shaking with sobs, rather than to spare me from having to see other pregnant women.
We made our way back to our van. I had no idea what to do next. We called my friend who was watching our kids to let her know what had happened, and she said to take as much time as we needed. Rick and I took a drive for a few hours, talking it over and calling our family and a few close friends to tell them the news. Ironically, the sky cleared and the sun came out. The rest of the day was beautiful.
This happened on a Thursday, so I knew that I was pressured for time to decide what to do. If I decided to wait it out for my body to miscarry naturally, I would be in no hurry, but who knows how long until my body got the memo. I had not had any cramping, bleeding, or any other miscarriage symptoms yet. But I wanted this over with. My baby was gone already, so it didn't matter to try to have the "best birth possible to keep baby safe." I could not begin to seek closure while my baby's body was still in my womb, and waiting could potentially take weeks. I was also frightened of what a natural miscarriage could be like. I wish I had known more people who had been diagnosed with a "missed miscarriage" like mine, who did choose to wait it out, because I might have chosen differently had I not been so afraid. I felt rushed because if I didn't make my decision that night, I'd be forced to wait out the weekend and would not be able to have a D&C or induction until Monday. I didn't want to be cornered into a decision because I was pressed for time.
I would never be the same person after That Day.
Well Rounded Birth Prep
WellRoundedBirthPrep.com
Wednesday, April 27, 2011
Sunday, April 17, 2011
Good labor snacks--and why moms need them
There's an old wives' tale that you shouldn't have anything to eat other than ice chips during labor (with the possible exception of clear liquids such as popsicles). The good news: research has shown for years that there are clear risks to withholding food and drink from laboring moms, and that they need calories and hydration to complete the hard work of labor and birth, with literally no benefits at all to withholding food or drink. This means you should be able to eat and drink anything you want! The bad news: most OBs believe the old wives' tale and aren't even aware of research contradicting it.
Chapter 4 of The Thinking Woman's Guide to a Better Birth, by Henci Goer, is called "IVs: 'Water, Water, Everywhere, Nor Any Drop to Drink." She details the history behind current obstetrical traditions and superstitions regarding eating and drinking during labor, as well as the risks of withholding food and drink from a laboring woman, and risk/benefit comparisons. There are several pages of explanation of why routine IVs have serious risks of their own with no potential benefits; routine IVs do not replace eating and drinking in labor.
Synopsis of Ms. Goer's Bottom Line on Forbidding Food and Drink in Labor:
Pros: None
Cons: Hunger, thirst, discomfort, dehydration sometimes resulting in fever, exhaustion leading to fewer or less effective contractions (which is viewed "Failure to Progress" and is seen as a necessity to augment labor by means of Pitocin or other drugs and interventions), imbalance of electrolytes, drop-off in blood sugar levels producing ketones which can cross into fetal circulation causing fetal blood to become more acidic (acidosis) which is a symptom of fetal distress. Increased perception of pain when hungry and/or thirsty. Seizures can result if mom's electrolytes are out of whack and blood sugar is bottomed out.
What kinds of foods make good snacks during labor? Here's Ms. Goer's suggestion: "Fat delays digestion. Solids must be broken down into tiny bits to pass into the intestines. High concentrations of sugar and acid and either low or high concentrations of salt also slow digestion. Heavily sweetened drinks can also cause nausea and acid in the stomach, which, as we have seen, should be avoided. Icy liquids empty more slowly as well. Given these criteria, choose food and drink that you know you tolerate well, the kind you would consume if you were recovering from the stomach flu."
Eating and drinking small quantities more often is easier on the digestion than larger quantities less frequently.
That being said, it's your labor, and if you're craving something that's on the forbidden list (for example, greasy or rich foods) and don't care if it comes back up, have at it. While not all moms vomit during labor, vomiting can help with dilation.
Many mommas can manage to eat lightly in early labor but don't want to eat as labor progresses. Some moms aren't hungry in labor or are nauseated and food doesn't appeal to them. For a short labor, that's fine; listen to your body. For a long labor, momma will need sustenance from somewhere (if not from food and drink, then from IVs. See chapter 4 of The Thinking Woman's Guide to a Better Birth for full list of pros and cons to that option). Sometimes it's easier to drink little sips in between contractions even in active labor, transition, and pushing, than it is to eat.
I've compiled a list of popular labor snacks and drinks. Feel free to take what works for you and leave the rest behind, keeping in mind your particular dietary needs and preferences.
Labor drinks:
water (will meet your hydration needs but not needs for calories, blood sugar, electrolytes, and more). Bring plenty of bottled water for your birth partner and doula, as well as for yourself for dumping in electrolyte powdered drink mixes.
100% fruit juice (non-acidic). If packing for hospital or birth center, 100% fruit juice boxes are convenient.
electrolyte drinks. You can make your own safe electrolyte drinks if you don't want to ingest the artificial ingredients in Gatorade. Some moms have enjoyed Emergen-C powdered instant drinks for a labor pick-me-up, but as the previous linked article explains, there's a question whether Vitamin C overload (or possibly the imbalance of calcium and other minerals/vitamins in the presence of large volumes of Vit C) can contribute to hemorrhage. A sort-of-natural alternative to Gatorade is Crystal Lite's Pure Fitness powdered electrolyte drink, which contains no artificial colors, flavors, or preservatives, and is sweetened by Stevia. While traditional artificial sweeteners such as aspartame, saccharin, acesulfame K, etc., are clearly not safe for pregnancy, Stevia may be a safe alternative. I'm not turning this blog into a discussion about Stevia; you can Google it if you're concerned. I've also heard good reviews about Vitalyte electrolyte drink, but I do not have personal experience with it.
coconut water, which contains many nutrients and also contains electrolytes and outperforms electrolyte sports drinks and plain water in research on rehydration.
decaffeinated tea, unsweetened or sweetened with honey
Red Raspberry Leaf tea, which also confers labor benefits (as well as 3rd trimester benefits). You can also blend RRL tea into Pregnancy Punch with apple juice, honey, and frozen red raspberries for a delicious and nutritious labor snack, or freeze it as popsicles.
skim milk
fruit smoothies made with non-acidic fruits (and any other ingredients from this list that sound good, such as honey, yogurt, skim milk, etc.) Here's Birth Faith's Birthing Brew for labor nutrition and possible prevention of hemorrhage (this statement has not been tested by the FDA for effectiveness of use, etc.).
protein shakes/drinks
Light carbs:
honey. Honey sticks, honey packets, honey bears, whatever is most convenient. Honey sticks are easiest for mom to suck on without changing her position.
soft, non-acidic fruits
100% applesauce. If packing for hospital or birth center, individual packs are handy. Here's an innovative form of applesauce packaging: you slurp it through a built-in straw. Handy so that mom doesn't have to change positions.
rice cakes (with jam, honey, applesauce, etc.)
plain bagels (with jam, honey, applesauce, etc.)
toast (with jam, honey, applesauce, etc.)
oatmeal
Cream of Wheat
graham crackers. saltine crackers, any other crackers
cooked pasta, plain or with a bit of salt or cheese
cooked rice. If packing for hospital or birth center, the ready-packs of rice that only need microwaved 90 seconds are a convenient option.
granola bars or trail mix
cereal with skim milk
pancakes or waffles. You can make your own healthy ones ahead of time and freeze them to reheat, or buy pre-made ones. They have healthy alternative ones in the organic frozen section now.
puddings, custards (nonfat or low fat)
Jell-o. Make your own or buy pre-made packs.
sorbet. Individual cups are always a good idea. Do you really want to be looking for an ice cream scoop during labor?
popsicles
lollipops, especially sour ones. They tend to be less nauseating than sweet ones.
Light proteins:
fat-free yogurt or Go-gurt (These taste great frozen, and they have new natural Go-gurts with no HFCS and no artificial colors, flavors or preservatives.)
cheese cubes or string cheese
peanut butter crackers
eggs
chicken noodle soup or broth
protein bars
Don't forget to have more substantial food to sustain your birth partner (husband or significant other), doula, and possibly your midwives (if homebirth). Crackers likely won't tide them over. Also, Mom will likely be ravenous after delivering and will want a hearty meal to reward her for her hard work.
If your hospital has a policy of "nothing but ice chips or clear liquids," it's best to discuss this well in advance with your care provider to see whether this is strictly enforced or whether most moms do in fact eat and drink freely while in labor at that facility. Find out early enough so that if this is going to be a problem, you have time to shop for another care provider or another birth location. If you cannot or choose not to change birth location, you can pack a small lunchbox/cooler of foods and drinks for your birth partner who will certainly be very hungry and thirsty. If any staff asks about the food stash, you can truthfully tell them that your birth partner gets hungry and needs to eat to maintain blood sugar and supportive mood. Do you catch my drift? Good, because I would never tell you to lie to staff or care provider.
Now, go eat, drink, and be merry!
What did you eat and drink during labor? What did you wish you could have but didn't/couldn't? What was satisfying?
Chapter 4 of The Thinking Woman's Guide to a Better Birth, by Henci Goer, is called "IVs: 'Water, Water, Everywhere, Nor Any Drop to Drink." She details the history behind current obstetrical traditions and superstitions regarding eating and drinking during labor, as well as the risks of withholding food and drink from a laboring woman, and risk/benefit comparisons. There are several pages of explanation of why routine IVs have serious risks of their own with no potential benefits; routine IVs do not replace eating and drinking in labor.
Synopsis of Ms. Goer's Bottom Line on Forbidding Food and Drink in Labor:
Pros: None
Cons: Hunger, thirst, discomfort, dehydration sometimes resulting in fever, exhaustion leading to fewer or less effective contractions (which is viewed "Failure to Progress" and is seen as a necessity to augment labor by means of Pitocin or other drugs and interventions), imbalance of electrolytes, drop-off in blood sugar levels producing ketones which can cross into fetal circulation causing fetal blood to become more acidic (acidosis) which is a symptom of fetal distress. Increased perception of pain when hungry and/or thirsty. Seizures can result if mom's electrolytes are out of whack and blood sugar is bottomed out.
What kinds of foods make good snacks during labor? Here's Ms. Goer's suggestion: "Fat delays digestion. Solids must be broken down into tiny bits to pass into the intestines. High concentrations of sugar and acid and either low or high concentrations of salt also slow digestion. Heavily sweetened drinks can also cause nausea and acid in the stomach, which, as we have seen, should be avoided. Icy liquids empty more slowly as well. Given these criteria, choose food and drink that you know you tolerate well, the kind you would consume if you were recovering from the stomach flu."
Eating and drinking small quantities more often is easier on the digestion than larger quantities less frequently.
That being said, it's your labor, and if you're craving something that's on the forbidden list (for example, greasy or rich foods) and don't care if it comes back up, have at it. While not all moms vomit during labor, vomiting can help with dilation.
Many mommas can manage to eat lightly in early labor but don't want to eat as labor progresses. Some moms aren't hungry in labor or are nauseated and food doesn't appeal to them. For a short labor, that's fine; listen to your body. For a long labor, momma will need sustenance from somewhere (if not from food and drink, then from IVs. See chapter 4 of The Thinking Woman's Guide to a Better Birth for full list of pros and cons to that option). Sometimes it's easier to drink little sips in between contractions even in active labor, transition, and pushing, than it is to eat.
I've compiled a list of popular labor snacks and drinks. Feel free to take what works for you and leave the rest behind, keeping in mind your particular dietary needs and preferences.
Labor drinks:
water (will meet your hydration needs but not needs for calories, blood sugar, electrolytes, and more). Bring plenty of bottled water for your birth partner and doula, as well as for yourself for dumping in electrolyte powdered drink mixes.
100% fruit juice (non-acidic). If packing for hospital or birth center, 100% fruit juice boxes are convenient.
electrolyte drinks. You can make your own safe electrolyte drinks if you don't want to ingest the artificial ingredients in Gatorade. Some moms have enjoyed Emergen-C powdered instant drinks for a labor pick-me-up, but as the previous linked article explains, there's a question whether Vitamin C overload (or possibly the imbalance of calcium and other minerals/vitamins in the presence of large volumes of Vit C) can contribute to hemorrhage. A sort-of-natural alternative to Gatorade is Crystal Lite's Pure Fitness powdered electrolyte drink, which contains no artificial colors, flavors, or preservatives, and is sweetened by Stevia. While traditional artificial sweeteners such as aspartame, saccharin, acesulfame K, etc., are clearly not safe for pregnancy, Stevia may be a safe alternative. I'm not turning this blog into a discussion about Stevia; you can Google it if you're concerned. I've also heard good reviews about Vitalyte electrolyte drink, but I do not have personal experience with it.
coconut water, which contains many nutrients and also contains electrolytes and outperforms electrolyte sports drinks and plain water in research on rehydration.
decaffeinated tea, unsweetened or sweetened with honey
Red Raspberry Leaf tea, which also confers labor benefits (as well as 3rd trimester benefits). You can also blend RRL tea into Pregnancy Punch with apple juice, honey, and frozen red raspberries for a delicious and nutritious labor snack, or freeze it as popsicles.
skim milk
fruit smoothies made with non-acidic fruits (and any other ingredients from this list that sound good, such as honey, yogurt, skim milk, etc.) Here's Birth Faith's Birthing Brew for labor nutrition and possible prevention of hemorrhage (this statement has not been tested by the FDA for effectiveness of use, etc.).
protein shakes/drinks
Light carbs:
honey. Honey sticks, honey packets, honey bears, whatever is most convenient. Honey sticks are easiest for mom to suck on without changing her position.
soft, non-acidic fruits
100% applesauce. If packing for hospital or birth center, individual packs are handy. Here's an innovative form of applesauce packaging: you slurp it through a built-in straw. Handy so that mom doesn't have to change positions.
rice cakes (with jam, honey, applesauce, etc.)
plain bagels (with jam, honey, applesauce, etc.)
toast (with jam, honey, applesauce, etc.)
oatmeal
Cream of Wheat
graham crackers. saltine crackers, any other crackers
cooked pasta, plain or with a bit of salt or cheese
cooked rice. If packing for hospital or birth center, the ready-packs of rice that only need microwaved 90 seconds are a convenient option.
granola bars or trail mix
cereal with skim milk
pancakes or waffles. You can make your own healthy ones ahead of time and freeze them to reheat, or buy pre-made ones. They have healthy alternative ones in the organic frozen section now.
puddings, custards (nonfat or low fat)
Jell-o. Make your own or buy pre-made packs.
sorbet. Individual cups are always a good idea. Do you really want to be looking for an ice cream scoop during labor?
popsicles
lollipops, especially sour ones. They tend to be less nauseating than sweet ones.
Light proteins:
fat-free yogurt or Go-gurt (These taste great frozen, and they have new natural Go-gurts with no HFCS and no artificial colors, flavors or preservatives.)
cheese cubes or string cheese
peanut butter crackers
eggs
chicken noodle soup or broth
protein bars
Don't forget to have more substantial food to sustain your birth partner (husband or significant other), doula, and possibly your midwives (if homebirth). Crackers likely won't tide them over. Also, Mom will likely be ravenous after delivering and will want a hearty meal to reward her for her hard work.
If your hospital has a policy of "nothing but ice chips or clear liquids," it's best to discuss this well in advance with your care provider to see whether this is strictly enforced or whether most moms do in fact eat and drink freely while in labor at that facility. Find out early enough so that if this is going to be a problem, you have time to shop for another care provider or another birth location. If you cannot or choose not to change birth location, you can pack a small lunchbox/cooler of foods and drinks for your birth partner who will certainly be very hungry and thirsty. If any staff asks about the food stash, you can truthfully tell them that your birth partner gets hungry and needs to eat to maintain blood sugar and supportive mood. Do you catch my drift? Good, because I would never tell you to lie to staff or care provider.
Now, go eat, drink, and be merry!
What did you eat and drink during labor? What did you wish you could have but didn't/couldn't? What was satisfying?
Saturday, April 9, 2011
Celebrating my 1 year anniversary as a childbirth educator
Today marks one year from the beginning of my journey as a childbirth educator. April 8-9, 2010, I attended an ICEA workshop taught by Connie Livingston in Dayton, OH. I wasn't even quite sure what my goals were as a future childbirth educator. I had spent countless hours reading books, articles, and research about pregnancy and birth, and it seemed like sort of a waste to have no outlet for that information other than preaching to the choir in message boards for birth junkies, doulas, childbirth educators, and midwives-to-be. I had helped a few friends find the information they needed to make informed decisions about their births, but my scope was limited since I was "just another mom who might have read one too many birth books." I didn't even know what certification might entail. I felt that I needed to take this workshop to become a more effective help, no matter how many or few couples I would teach.
A year ago today, I could never have foreseen how far I would come in a year. I acknowledge that I have so much still to learn, and I'm continually striving to learn more, but I can see progress in a year's time. I've completed the majority of the requirements for completing certification as a childbirth educator with ICEA. Now if only someone would come watch my kids for me so I could get the rest of my reading finished, then I can take the written exam and make it official! (ICEA gives applicants two years from the date of application to complete certification, so I'm ahead of my goal dates.)
* I was required to attend a minimum of two births to satisfy ICEA requirements for my certification. So far, I've attended four births since June 2010.
* In June 2010, I completed (and recorded, and sent to Connie on DVD) a four-week, 12 hour childbirth class series, which she and my clients/students evaluated in depth on ICEA's evaluations. To count for certification requirements, I had to teach a real pregnant momma and her birth partner (not just teach to a camera in an empty room); I was blessed to have 4 pregnant mommas with birth partners for my first teaching series! In the past year I have taught a total of 20 expectant mommas and their families.
I look back fondly at the past year, at the classes I have taught, friends I have made, myths I have busted, and foundations I have built. I'm thankful for these opportunities, and I won't take them for granted or let them go to waste. I look forward to my future.
A year ago today, I could never have foreseen how far I would come in a year. I acknowledge that I have so much still to learn, and I'm continually striving to learn more, but I can see progress in a year's time. I've completed the majority of the requirements for completing certification as a childbirth educator with ICEA. Now if only someone would come watch my kids for me so I could get the rest of my reading finished, then I can take the written exam and make it official! (ICEA gives applicants two years from the date of application to complete certification, so I'm ahead of my goal dates.)
* I was required to attend a minimum of two births to satisfy ICEA requirements for my certification. So far, I've attended four births since June 2010.
* In June 2010, I completed (and recorded, and sent to Connie on DVD) a four-week, 12 hour childbirth class series, which she and my clients/students evaluated in depth on ICEA's evaluations. To count for certification requirements, I had to teach a real pregnant momma and her birth partner (not just teach to a camera in an empty room); I was blessed to have 4 pregnant mommas with birth partners for my first teaching series! In the past year I have taught a total of 20 expectant mommas and their families.
I look back fondly at the past year, at the classes I have taught, friends I have made, myths I have busted, and foundations I have built. I'm thankful for these opportunities, and I won't take them for granted or let them go to waste. I look forward to my future.
Thursday, February 17, 2011
How to have a "natural" cesarean
I get asked this one a lot and figured it would be faster to put together a blog with links than to re-type the same email several times a month.
Maybe you have a rare medical condition that requires a scheduled C-section. Maybe you are going to be induced and are aware that induction doubles your risk of needing a C-section and would like to plan to have the best possible C-section if it comes to that. Maybe you're attempting a VBAC and would like to have a backup plan in place. Maybe you're a healthy, low-risk mom who is planning an unmedicated birth (whether at home, birth center, or hospital) and would like to prepare for the slim chance that a cesarean may become necessary. Maybe you are having an elective cesarean.
In any case, all moms have the right to be treated with dignity and respect. Many moms are unaware that they have options to make a cesarean the best possible experience (considering the circumstances) and that often, there are options moms can request to help with bonding with baby, allow immediate skin-to-skin contact with baby, facilitate breastfeeding, reduce your risk of postpartum depression, and more.
"Family centered cesarean" or "natural cesarean" can mean a wide variety of things. You can view some of these options on this sample cesarean birth plan by Preparing For Birth. Personally, I think it's a good idea for all expectant mothers to have Plan A, Plan B, and Plan C lined up just in case, because a birth plan is not designed to be a script for how the birth should go, but rather, it's a well thought out list of preferences the family would have in the event of different circumstances.
Please remember that no birth plan is legally binding. It's crucial to find a care provider who truly supports you as you work toward the birth you want, whatever kind of birth that is. Many care providers will give lip service to supporting moms, but will deny them at the end. Finding the right hospital and OB to perform a family-friendly cesarean will be worth the effort. Hiring a doula or having your midwife present for this role can help boost your odds of achieving a gentler cesarean. A doula can help calm your nerves in the hours before a planned cesarean while you wait and fill out paperwork, and she can answer any questions you have along the way as to what is going on, why something is happening, whether that's normal, and what options (and legal rights) you have. She can also tag in to the OR if your partner leaves you after the delivery to follow the baby to the nursery, so that you don't have to be alone while they stitch you back up. She can assist you with relaxation and breathing techniques to keep you calm, as well. Here's doula (The Feminist Breeder) Gina Crosley-Corcoran's blog about her experience supporting a client during her cesarean.
The natural caesarean: a woman-centred technique--National Institutes of Health (NIH)
Family-Centered Cesarean--ICAN (International Cesarean Awareness Network) White Papers
Ideas for the best cesarean possible--by Penny Simkin. Free PDF printable.
The new "natural" cesarean--UK Times
"Natural" cesarean mimics vaginal birth experience--Reuters UK
"Every bit as magical": A British doctor is challenging convention to pioneer the 'natural' cesarean. Joanna Moorhead watched one baby's slow and gentle arrival.--Guardian UK
Delivered safely by caesarean with his mother's hands ("assisted cesarean")--The Age (Australia)
The Case for Kangaroo Daddy Care--Baby Gooroo--One family's story of how Dad provided Kangaroo Care for baby while mother was recovering post-cesarean, and why babies can benefit from this.
Above is the 8 minute trailer for the documentary, "Breast is Best," showing how to get breastfeeding off to a good start. The opening scene shows a "natural" cesarean with baby being brought skin-to-skin on mom's chest so he can nurse while she is still being stitched up on the OR table. Immediate skin-to-skin contact on mom's chest immediately after birth helps stabilize baby's breathing, heart rate, blood sugars, and body temperature, all while promoting bonding and reassuring both mom and baby in each other's presence.
12 minute video describing "The Natural Caesarean: a woman-centred technique":
The "natural" cesarean described by the above links, with baby's slow, gentle emergence from the womb, somewhat reduces baby's risk of respiratory distress after cesarean birth, which is common for cesarean babies since they do not receive the benefit of having their lungs squeezed and emptied of mucus, which occurs naturally in a a vaginal birth.
Having a cesarean birth is compatible with having the placenta encapsulated (placentophagy). If you're unfamiliar with this, you'll have to hang tight until I can post a blog with all the research and reasons why it's a great option for postpartum, regardless of the method of birth. To make a long story short, the placenta can be steamed, dried, ground, and encapsulated into geltabs so that it's no different than taking a multivitamin. Research indicates that placentophagy, which has been traditional around the world for thousands of years, may potentially offer the following benefits: reduced risk of postpartum depression, reduced risk of anemia (by restoring her iron reserves), helps bring postpartum hormones back into balance, improved mothers' energy and sense of well-being postpartum, and a boost in establishing milk supply. While all of these are wonderful benefits for any mom postpartum, they are especially beneficial post-cesarean. Here's a great FAQ on placenta encapsulation, including tips on how to get your placenta released from the hospital.
For many moms who are planning a cesarean (whether for medical or elective reasons), waiting on labor to begin before going in for the cesarean is an option. If this is a possibility, based on your medical situation, this is helpful for mom and baby both. By allowing labor to begin, you can rest assured that baby was "ready," precluding the all-too-common iatrogenic (doctor-caused) prematurity which is on the rise. Mom and baby both receive the chemical/hormonal benefits of the beginnings of labor, and if mom has a good series of contractions before a cesarean, baby's risk of respiratory distress and other respiratory problems is somewhat lessened because the squeezing effects of efficient contractions help push mucus out of baby's lungs (which occurs naturally in vaginal births).
A gentler cesarean birth is possible--even here in America. However, it is going to take informed consumers to drive this change. If enough moms request this, it can become the standard for cesarean care. With the current state of affairs in American maternity care, I'm not optimistic that I could see that scale of change in my lifetime, but that's irrelevant. You don't have to wait until evidence-based care of any sort--including "natural" cesarean--is the norm. You can find a way to make it possible for *you*, regardless of what everyone else is doing.
It would be irresponsible to post all this information about "natural" cesarean without making sure that you have links to weigh all the risks of cesareans. Cesarean birth is a major abdominal surgery with serious risks and consequences, both short-term and long-term, for mom and for baby. The point of this blog is not to encourage an even higher cesarean rate (32.3% of US births are cesarean as of 2008, while the World Health Organization has stated that 10-15% should be the maximum), but rather to make alternative options more widely available for situations when cesareans are needed or desired, based on fully informed consent.
The Risks of Cesarean Section Fact Sheet--Free printable PDF--CIMS (Coalition for Improvement of Maternity Services). Current (Feb. 2010 publication). Includes checklist for expectant mothers to read during pregnancy and discuss with their care providers.
Cesarean Fact Sheet--ICAN (International Cesarean Awareness Network)
Cesarean Section: Myth vs. Reality--Childbirth Connection
Patient Choice Cesarean Position Sheet--ICAN (International Cesarean Awareness Network)
Where to turn for more information about cesareans--California Watch
A Woman's Guide to VBAC. How to weigh the National Institutes of Health recommendations for considerations of VBAC vs. repeat elective cesarean, based on each woman's individual circumstances.-- Giving Birth With Confidence/Lamaze International.
(Disclaimer: I'm not a doctor. I'm not trying to tell you to have a cesarean or not to have a cesarean. I'm encouraging all expectant families to READ, READ, READ and learn their options so that they may make fully informed decisions with their care providers as to what is the safest route for their individual situation.)
Maybe you have a rare medical condition that requires a scheduled C-section. Maybe you are going to be induced and are aware that induction doubles your risk of needing a C-section and would like to plan to have the best possible C-section if it comes to that. Maybe you're attempting a VBAC and would like to have a backup plan in place. Maybe you're a healthy, low-risk mom who is planning an unmedicated birth (whether at home, birth center, or hospital) and would like to prepare for the slim chance that a cesarean may become necessary. Maybe you are having an elective cesarean.
In any case, all moms have the right to be treated with dignity and respect. Many moms are unaware that they have options to make a cesarean the best possible experience (considering the circumstances) and that often, there are options moms can request to help with bonding with baby, allow immediate skin-to-skin contact with baby, facilitate breastfeeding, reduce your risk of postpartum depression, and more.
"Family centered cesarean" or "natural cesarean" can mean a wide variety of things. You can view some of these options on this sample cesarean birth plan by Preparing For Birth. Personally, I think it's a good idea for all expectant mothers to have Plan A, Plan B, and Plan C lined up just in case, because a birth plan is not designed to be a script for how the birth should go, but rather, it's a well thought out list of preferences the family would have in the event of different circumstances.
Please remember that no birth plan is legally binding. It's crucial to find a care provider who truly supports you as you work toward the birth you want, whatever kind of birth that is. Many care providers will give lip service to supporting moms, but will deny them at the end. Finding the right hospital and OB to perform a family-friendly cesarean will be worth the effort. Hiring a doula or having your midwife present for this role can help boost your odds of achieving a gentler cesarean. A doula can help calm your nerves in the hours before a planned cesarean while you wait and fill out paperwork, and she can answer any questions you have along the way as to what is going on, why something is happening, whether that's normal, and what options (and legal rights) you have. She can also tag in to the OR if your partner leaves you after the delivery to follow the baby to the nursery, so that you don't have to be alone while they stitch you back up. She can assist you with relaxation and breathing techniques to keep you calm, as well. Here's doula (The Feminist Breeder) Gina Crosley-Corcoran's blog about her experience supporting a client during her cesarean.
The natural caesarean: a woman-centred technique--National Institutes of Health (NIH)
Family-Centered Cesarean--ICAN (International Cesarean Awareness Network) White Papers
Ideas for the best cesarean possible--by Penny Simkin. Free PDF printable.
The new "natural" cesarean--UK Times
"Natural" cesarean mimics vaginal birth experience--Reuters UK
"Every bit as magical": A British doctor is challenging convention to pioneer the 'natural' cesarean. Joanna Moorhead watched one baby's slow and gentle arrival.--Guardian UK
Delivered safely by caesarean with his mother's hands ("assisted cesarean")--The Age (Australia)
The Case for Kangaroo Daddy Care--Baby Gooroo--One family's story of how Dad provided Kangaroo Care for baby while mother was recovering post-cesarean, and why babies can benefit from this.
Above is the 8 minute trailer for the documentary, "Breast is Best," showing how to get breastfeeding off to a good start. The opening scene shows a "natural" cesarean with baby being brought skin-to-skin on mom's chest so he can nurse while she is still being stitched up on the OR table. Immediate skin-to-skin contact on mom's chest immediately after birth helps stabilize baby's breathing, heart rate, blood sugars, and body temperature, all while promoting bonding and reassuring both mom and baby in each other's presence.
12 minute video describing "The Natural Caesarean: a woman-centred technique":
The "natural" cesarean described by the above links, with baby's slow, gentle emergence from the womb, somewhat reduces baby's risk of respiratory distress after cesarean birth, which is common for cesarean babies since they do not receive the benefit of having their lungs squeezed and emptied of mucus, which occurs naturally in a a vaginal birth.
Having a cesarean birth is compatible with having the placenta encapsulated (placentophagy). If you're unfamiliar with this, you'll have to hang tight until I can post a blog with all the research and reasons why it's a great option for postpartum, regardless of the method of birth. To make a long story short, the placenta can be steamed, dried, ground, and encapsulated into geltabs so that it's no different than taking a multivitamin. Research indicates that placentophagy, which has been traditional around the world for thousands of years, may potentially offer the following benefits: reduced risk of postpartum depression, reduced risk of anemia (by restoring her iron reserves), helps bring postpartum hormones back into balance, improved mothers' energy and sense of well-being postpartum, and a boost in establishing milk supply. While all of these are wonderful benefits for any mom postpartum, they are especially beneficial post-cesarean. Here's a great FAQ on placenta encapsulation, including tips on how to get your placenta released from the hospital.
For many moms who are planning a cesarean (whether for medical or elective reasons), waiting on labor to begin before going in for the cesarean is an option. If this is a possibility, based on your medical situation, this is helpful for mom and baby both. By allowing labor to begin, you can rest assured that baby was "ready," precluding the all-too-common iatrogenic (doctor-caused) prematurity which is on the rise. Mom and baby both receive the chemical/hormonal benefits of the beginnings of labor, and if mom has a good series of contractions before a cesarean, baby's risk of respiratory distress and other respiratory problems is somewhat lessened because the squeezing effects of efficient contractions help push mucus out of baby's lungs (which occurs naturally in vaginal births).
A gentler cesarean birth is possible--even here in America. However, it is going to take informed consumers to drive this change. If enough moms request this, it can become the standard for cesarean care. With the current state of affairs in American maternity care, I'm not optimistic that I could see that scale of change in my lifetime, but that's irrelevant. You don't have to wait until evidence-based care of any sort--including "natural" cesarean--is the norm. You can find a way to make it possible for *you*, regardless of what everyone else is doing.
It would be irresponsible to post all this information about "natural" cesarean without making sure that you have links to weigh all the risks of cesareans. Cesarean birth is a major abdominal surgery with serious risks and consequences, both short-term and long-term, for mom and for baby. The point of this blog is not to encourage an even higher cesarean rate (32.3% of US births are cesarean as of 2008, while the World Health Organization has stated that 10-15% should be the maximum), but rather to make alternative options more widely available for situations when cesareans are needed or desired, based on fully informed consent.
The Risks of Cesarean Section Fact Sheet--Free printable PDF--CIMS (Coalition for Improvement of Maternity Services). Current (Feb. 2010 publication). Includes checklist for expectant mothers to read during pregnancy and discuss with their care providers.
Cesarean Fact Sheet--ICAN (International Cesarean Awareness Network)
Cesarean Section: Myth vs. Reality--Childbirth Connection
Patient Choice Cesarean Position Sheet--ICAN (International Cesarean Awareness Network)
Where to turn for more information about cesareans--California Watch
A Woman's Guide to VBAC. How to weigh the National Institutes of Health recommendations for considerations of VBAC vs. repeat elective cesarean, based on each woman's individual circumstances.-- Giving Birth With Confidence/Lamaze International.
(Disclaimer: I'm not a doctor. I'm not trying to tell you to have a cesarean or not to have a cesarean. I'm encouraging all expectant families to READ, READ, READ and learn their options so that they may make fully informed decisions with their care providers as to what is the safest route for their individual situation.)
Wednesday, February 16, 2011
"Is the hCG diet safe for breastfeeding?"
I got an email from a blog reader asking, "Is the hCG diet safe for breastfeeding? the OBGYN's nurse said she doesn't know if its safe to take the HCG drops while nursing. We all agree no one while nursing (probably not even not nursing) should cut back to 500 calories a day... but they say the diet will still work if you just eat healthy and take the HCG drops, it'll just work slower, not so dramatically.
DO you know? Is it safe to take the HCG drops while nursing? Does it cross over through the breast milk? Does it affect the breast milk supply or anything?"
I had never heard of this fad diet and had to Google it.
I think the first question to ask is, "Is the hCG diet safe for anyone at all?" We'll get to that.
HCG supplements/injections are not listed in Dr. Hale's Medications and Mother's Milk guide which I own because it's a supplement and not a medication.
The official hCG diet website says regarding the hCG diet and breastfeeding: "So, is it ok for a woman to breast feed while on the HCG diet? The definitive answer will need to come from her doctor. However, it looks like it wouldn’t be a good idea, simply because the caloric needs during breastfeeding are just too great and not a conducive to following the HCG diet."
Consuming a mere 500 calories per day, as outlined by the hCG diet, is not safe for any adult (man or woman), let alone a breastfeeding mother. Breastfeeding burns about 200-500 calories per day, and the best research says that breastfeeding mothers need to be consuming a bare minimum of 1500-1800 calories per day (often more). If a mother is not eating enough calories, her milk supply will suffer. Here are a few articles outlining how to lose weight safely while breastfeeding, so that you can maintain your health and your milk supply:
http://www.kellymom.com/nutrition/mom/mom-weightloss.html
and an article on herbal supplements and other diet aids while breastfeeding:
http://www.kellymom.com/nutrition/mom/mom-herbalweightloss.html
I am highly cautious with anything involving artificial hormones. While they can have their place in certain medical situations, it's not to be taken lightly. I tried to find info on the side effects of hCG injections and found this about the hCG diet on Discovery Health online. HCG is only approved by the FDA as a fertility drug (you heard that correctly--should newly postpartum moms be taking a FERTILITY DRUG as a weight loss supplement???), and it is not FDA approved as a dietary supplement.
According to Discovery Health, "There have been few reports of health problems developing as a result of the hCG diet, although there are some risks, among them an increased risk of blood clots, headaches, restlessness and depression. Also, you may feel, well, like you're pregnant -- swelling, breast tenderness and water retention, anyone? HCG can also cause a potentially life-threatening condition called ovarian hyperstimulation syndrome (OHSS)."
One aspect of the question was whether hCG supplements could cause a drop in milk supply, even if the mother ate a sufficient number of calories. While this might be a question better answered by an endocrinologist, I would be concerned that along with the other pregnancy symptoms that are a side effect of hCG supplementation, a drop in milk supply could be a potential side effect. I looked far and wide to find the chemical mechanism by which many mothers experience a drop in milk supply when they become pregnant while still nursing. Rising levels of progesterone are responsible for the drop in milk supply, but I could not find an answer as to whether hCG supplements could stimulate a rise in progesterone (subsequently causing a drop in milk supply even if mom's caloric intake were sufficient).
The hCG diet official page states a breastfeeding myth, "If she fails to eat properly, this will negatively affect the quality of the milk she produces. The baby may not receive nutritious milk if a woman does not eat enough or enough of the right things." Contrast that with research from La Leche League on the quality of mom's diet and its effect (or lack thereof) on the quality of her breastmilk: "In recent years, research has confirmed that even if some nutrients are missing in a woman’s daily diet, she will still produce milk that will help her child grow. There is very little difference in the milk of healthy mothers and mothers who are severely malnourished. For example, if a mother’s diet is lacking in calories, her body makes up the deficit, drawing on the reserves laid down during pregnancy or before." Mother's milk supply may drop and her health may suffer for her lack of adequate nutrition, but the quality of her breastmilk will not be affected.
I'm not really in the loop in terms of what's popular, and since this diet fad seems to be having its 15 minutes of fame, I wanted to make sure that moms had the info to weigh the risks.
DO you know? Is it safe to take the HCG drops while nursing? Does it cross over through the breast milk? Does it affect the breast milk supply or anything?"
I had never heard of this fad diet and had to Google it.
I think the first question to ask is, "Is the hCG diet safe for anyone at all?" We'll get to that.
HCG supplements/injections are not listed in Dr. Hale's Medications and Mother's Milk guide which I own because it's a supplement and not a medication.
The official hCG diet website says regarding the hCG diet and breastfeeding: "So, is it ok for a woman to breast feed while on the HCG diet? The definitive answer will need to come from her doctor. However, it looks like it wouldn’t be a good idea, simply because the caloric needs during breastfeeding are just too great and not a conducive to following the HCG diet."
Consuming a mere 500 calories per day, as outlined by the hCG diet, is not safe for any adult (man or woman), let alone a breastfeeding mother. Breastfeeding burns about 200-500 calories per day, and the best research says that breastfeeding mothers need to be consuming a bare minimum of 1500-1800 calories per day (often more). If a mother is not eating enough calories, her milk supply will suffer. Here are a few articles outlining how to lose weight safely while breastfeeding, so that you can maintain your health and your milk supply:
http://www.kellymom.com/nutrition/mom/mom-weightloss.html
and an article on herbal supplements and other diet aids while breastfeeding:
http://www.kellymom.com/nutrition/mom/mom-herbalweightloss.html
I am highly cautious with anything involving artificial hormones. While they can have their place in certain medical situations, it's not to be taken lightly. I tried to find info on the side effects of hCG injections and found this about the hCG diet on Discovery Health online. HCG is only approved by the FDA as a fertility drug (you heard that correctly--should newly postpartum moms be taking a FERTILITY DRUG as a weight loss supplement???), and it is not FDA approved as a dietary supplement.
According to Discovery Health, "There have been few reports of health problems developing as a result of the hCG diet, although there are some risks, among them an increased risk of blood clots, headaches, restlessness and depression. Also, you may feel, well, like you're pregnant -- swelling, breast tenderness and water retention, anyone? HCG can also cause a potentially life-threatening condition called ovarian hyperstimulation syndrome (OHSS)."
One aspect of the question was whether hCG supplements could cause a drop in milk supply, even if the mother ate a sufficient number of calories. While this might be a question better answered by an endocrinologist, I would be concerned that along with the other pregnancy symptoms that are a side effect of hCG supplementation, a drop in milk supply could be a potential side effect. I looked far and wide to find the chemical mechanism by which many mothers experience a drop in milk supply when they become pregnant while still nursing. Rising levels of progesterone are responsible for the drop in milk supply, but I could not find an answer as to whether hCG supplements could stimulate a rise in progesterone (subsequently causing a drop in milk supply even if mom's caloric intake were sufficient).
The hCG diet official page states a breastfeeding myth, "If she fails to eat properly, this will negatively affect the quality of the milk she produces. The baby may not receive nutritious milk if a woman does not eat enough or enough of the right things." Contrast that with research from La Leche League on the quality of mom's diet and its effect (or lack thereof) on the quality of her breastmilk: "In recent years, research has confirmed that even if some nutrients are missing in a woman’s daily diet, she will still produce milk that will help her child grow. There is very little difference in the milk of healthy mothers and mothers who are severely malnourished. For example, if a mother’s diet is lacking in calories, her body makes up the deficit, drawing on the reserves laid down during pregnancy or before." Mother's milk supply may drop and her health may suffer for her lack of adequate nutrition, but the quality of her breastmilk will not be affected.
I'm not really in the loop in terms of what's popular, and since this diet fad seems to be having its 15 minutes of fame, I wanted to make sure that moms had the info to weigh the risks.
Sunday, February 6, 2011
So thankful to make a difference.
I had such a wonderful private childbirth class tonight, for two couples, first time parents. This was my second private class for them, and while I really *need* 12-15 hours of face-to-face contact to cover what first-time parents need to know, I had to condense it to 6 hours (2 private classes, each 3 hours long). I couldn't shortchange them; I had to stay to cover what they needed/wanted covered, 1 1/2 hours "late" tonight. I didn't charge extra and didn't want to. I *wanted* to help. It is my pleasure, my joy, my heart's desire.
I so relate to one of my midwives' recent blog (Jennifer Stewart of Joy in Birth Midwifery) titled, "Can I help you? Please?". I can't stand to see mothers have traumatic births when there were preventable interventions that led to the trauma. (I'm not implying that all interventive births are traumatic, because they are not. I'm not implying that all traumatic births are preventable, because they are not. Many are both, and therein lies my struggle.) I don't teach childbirth classes because I hope to get rich in the process. (Trust me, childbirth educators, doulas, and midwives do not get paid much. They're in it because they believe in it.) I teach birth classes because I am compelled to, driven to. It would be unethical if I did not share this information, not for my sake or glory, but so that families have the evidence-based info they need to make empowered, educated decisions regarding their pregnancies, birth, breastfeeding, parenting, and childbearing year.
When I hear that a friend or acquaintance who turned down my help has an outcome she did not want, a traumatic birth that did not have to be, separation due to complications and/or NICU, I am so distraught for them. Sometimes I cry for days, mourning for their loss. I pray for their recovery, for health for mom and baby, and for God to make a way to reunite and bond the family.
I realize that not everyone wants my help. I try to mind my own business and only give information if they ask. It's so hard to sit aside and say nothing if I see that a family is making fear-based decisions or are accepting the default routine interventions that their care provider does to everyone in their assembly-line birth practice. I can accept any decisions that someone makes for their birth--if I feel confident that they have researched their options thoroughly and are making their decisions with purpose, rather than by default or backed into a corner. Just ask my variety of clients I have served: planned homebirth with midwives clients; birth center with midwives clients; hospital unmedicated birth clients; planned induction clients; and elective scheduled cesarean clients. Regardless of their choices, I want them to know what their options are and how to have the safest birth possible, considering their circumstances.
Tonight was so refreshing. It's easy to become weary when looking at American maternity care as a whole. It's easy to get discouraged when so many expectant parents turn down my help, saying, "Thanks, but I trust my doctor. I'm sure s/he wouldn't do anything unsafe," without researching their birth options. These two couples, each expecting their first child, were eager learners and renewed my soul. They were thankful for my help. Once in a while, God puts people like this in our lives to help recharge and inspire us so we can continue with our work. I'm reminded why I do what I do, and that while I can't help everyone, I am making a difference for *someone*. I'm so thankful for that.
I so relate to one of my midwives' recent blog (Jennifer Stewart of Joy in Birth Midwifery) titled, "Can I help you? Please?". I can't stand to see mothers have traumatic births when there were preventable interventions that led to the trauma. (I'm not implying that all interventive births are traumatic, because they are not. I'm not implying that all traumatic births are preventable, because they are not. Many are both, and therein lies my struggle.) I don't teach childbirth classes because I hope to get rich in the process. (Trust me, childbirth educators, doulas, and midwives do not get paid much. They're in it because they believe in it.) I teach birth classes because I am compelled to, driven to. It would be unethical if I did not share this information, not for my sake or glory, but so that families have the evidence-based info they need to make empowered, educated decisions regarding their pregnancies, birth, breastfeeding, parenting, and childbearing year.
When I hear that a friend or acquaintance who turned down my help has an outcome she did not want, a traumatic birth that did not have to be, separation due to complications and/or NICU, I am so distraught for them. Sometimes I cry for days, mourning for their loss. I pray for their recovery, for health for mom and baby, and for God to make a way to reunite and bond the family.
I realize that not everyone wants my help. I try to mind my own business and only give information if they ask. It's so hard to sit aside and say nothing if I see that a family is making fear-based decisions or are accepting the default routine interventions that their care provider does to everyone in their assembly-line birth practice. I can accept any decisions that someone makes for their birth--if I feel confident that they have researched their options thoroughly and are making their decisions with purpose, rather than by default or backed into a corner. Just ask my variety of clients I have served: planned homebirth with midwives clients; birth center with midwives clients; hospital unmedicated birth clients; planned induction clients; and elective scheduled cesarean clients. Regardless of their choices, I want them to know what their options are and how to have the safest birth possible, considering their circumstances.
Tonight was so refreshing. It's easy to become weary when looking at American maternity care as a whole. It's easy to get discouraged when so many expectant parents turn down my help, saying, "Thanks, but I trust my doctor. I'm sure s/he wouldn't do anything unsafe," without researching their birth options. These two couples, each expecting their first child, were eager learners and renewed my soul. They were thankful for my help. Once in a while, God puts people like this in our lives to help recharge and inspire us so we can continue with our work. I'm reminded why I do what I do, and that while I can't help everyone, I am making a difference for *someone*. I'm so thankful for that.
Wednesday, February 2, 2011
Wordless Wednesday: beautiful nursing toddler (guest post)
Thanks to Christine for sharing these beautiful, intimate professional portraits taken with her husband and their first child when their son was 17 months old in January 2004. Photographer: Kathleen Swisher. (You might remember Christine from her birth story posted here, home waterbirth of her 4th child with cord wrapped around his neck 4 times.)
And for good measure, in case you are wondering why on earth someone would nurse a toddler beyond a year of age:
Breastfeeding past infancy: fact sheet (from kellymom.com)
And for good measure, in case you are wondering why on earth someone would nurse a toddler beyond a year of age:
Breastfeeding past infancy: fact sheet (from kellymom.com)
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