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PostHeaderIcon What to Reject When You Are Expecting

PostDateIcon May 13th, 2012 | PostAuthorIcon Author: admin

Despite a health-care system that outspends those in the rest of the world, infants and mothers fare worse in the U.S. than in many other industrialized nations. The infant mortality rate in Canada is 25 percent lower than it is in the U.S.; the Japanese rate, more than 60 percent lower. According to the World Health Organization, America ranks behind 41 other countries in preventing mothers from dying during childbirth.

With technological advances in medicine, you would expect those numbers to steadily improve. But the rate of maternal deaths has risen over the last decade, and the number of premature and low-birth-weight babies is higher now than it was in the 1980s and 1990s.

Why are we doing so badly? Partly because mothers tend to be less healthy than in the past, “which contributes to a higher-risk pregnancy,” says Diane Ashton, M.D., deputy medical director of the March of Dimes.

But another key reason appears to be a health-care system that has developed into a highly profitable labor-and-delivery machine, operating according to its own timetable rather than the less predictable schedule of mothers and babies. Childbirth is the leading reason for hospital admission, and the system is set up to make the most of the opportunity. Keeping things chugging along are technological interventions that can be lifesaving in some situations but also interfere with healthy, natural processes and increase risk when used inappropriately.

Topping the list are unnecessary cesarean sections. The rate has risen steadily since the mid-1990s to the point that nearly one of every three American babies now comes into the world through this surgical delivery. That’s double or even triple what the World Health Organization considers optimal.

Some people say that the increase in C-sections and other interventions stems mostly from women, who may be requesting more of the procedures. That could be a contributing cause but it’s not the major one, says Carol Sakala, Ph.D., director of programs at Childbirth Connection, a nonprofit organization that promotes evidence-based maternity care.

“We see rates going up across all birthing groups, including all ages, races, and classes,” Sakala says. “What we are seeing is a change in practice standards, a lowering of the bar for what’s an acceptable indication for medical interventions.”

10 overused procedures

Of course, the idea is not to reject all interventions. The course of childbirth is not something that anyone can completely control. In some situations, inducing labor or doing a C-section is the safest option. And complications are the exception, not the norm. But when they’re not medically necessary, the interventions listed below are associated with poorer outcomes for moms and babies.

1. A C-section with a low-risk first birth

While C-sections are generally quite safe, “the safest method for both mom and baby is an uncomplicated vaginal birth,” says Catherine Spong, M.D., chief of the pregnancy and perinatology branch at the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

The U.S. health-care system has developed into a profitable labor-and- delivery machine that operates on its own timetable—not the schedule of mothers and babies.

The best way to reduce the number of C-sections overall is to decrease the number of them among low-risk women delivering their first child. That’s because having an initial C-section “sets the stage for a woman’s entire reproductive life,” says Elliott Main, M.D., chairman of the department of obstetrics and gynecology at the California Pacific Medical Center and director of the California Maternal Quality Care Collaborative. “In this country, if your first birth is a C-section, there’s a 95 percent chance all subsequent births will be as well,” he says.

A C-section is major surgery. So it’s no surprise that as rates for the procedure go down, so do the numbers for several complications, especially infection or pain at the site of the incision. Rare but potentially life-threatening complications include severe bleeding, blood clots, and bowel obstruction. A C-section can also complicate future pregnancies, increasing the risk of problems with the placenta, ectopic pregnancies (those that occur outside the uterus), or a rupture of the uterine scar. And the risks increase with each additional cesarean birth.

Babies born by C-section can be accidentally injured or cut during the procedure and are more likely to have breathing problems. They are also less likely to breast-feed, perhaps because of the challenges of starting in a post-surgical setting.

In some situations, such as when the mother is bleeding heavily or the baby’s oxygen supply is compromised, surgical delivery is absolutely necessary. But women can maximize their chances of avoiding an unnecessary cesarean by finding a caregiver and birthing environment that supports vaginal birth.

When choosing a practitioner and hospital or birthing center, ask about C-section rates, particularly rates for low-risk women having their first child. The target rate for that population should be around 15 percent, according to the American Congress of Obstetrics and Gynecology (ACOG). Although it can be difficult to find a hospital with a C-section rate that low, you might be able find one that meets the more modest goal of about 24 percent, which was set by the government’s Healthy People 2020 initiative.

About a third of the babies born in the U.S. are now delivered by C-section.

2. An automatic second C-section

Just because your first baby was delivered by C-section doesn’t mean your second has to be, too. In fact, most women who have had a C-section with a “low-transverse incision” on the uterus are good candidates for a vaginal birth after cesarean (VBAC), according to ACOG. (Note that a “bikini scar” on the skin does not indicate the type of uterine scar.) About three quarters of such women who attempt a VBAC are able to deliver vaginally.

Yet the percentage of VBACs has declined sharply since the mid-1990s, particularly after ACOG said in 1999 that they should be considered only if hospitals had staff “immediately available” to do emergency C-sections if necessary. And some obstetricians don’t do VBACs because they lack hospital support or training or because their malpractice insurance won’t provide coverage. So women seeking a VBAC delivery might have trouble finding a supportive practitioner and hospital.

“It’s tragic, really,” Main says. “In many parts of the country, the option has all but disappeared.”

In response, ACOG recently relaxed its guidelines. For example, it makes clear that while it’s preferable for staff to be at the ready, hospitals can make do with a clear plan for dealing with uterine ruptures and assembling an emergency team quickly. Experts we spoke with say it’s too early to tell if the move will lead to a change in clinical practice.

Although some women turn to home births as an alternative, our experts say that isn’t a good idea in this situation. “The risk of uterine rupture is low,” Main says, “but if it happens, it can be catastrophic.”

Instead, if you had a C-section, find out whether your obstetrician and hospital are willing to try a VBAC. Let them know that you understand that you your baby will be monitored continuously during labor, and ask what the hospital would do if an emergency C-section became necessary.

Vaginal births after a C-section have declined sharply since the late 1990s.

3. An elective early delivery

A full-term pregnancy goes to at least 39 weeks, but over the last two decades many doctors have come to think they can deliver babies sooner than Mother Nature intended. Between 1990 and 2007, births at 37 and 38 weeks increased 45 percent, according to the March of Dimes. At the same time, full-term births dropped by 26 percent.

Because nearly all late preterm babies survive and eventually thrive, many doctors see no harm in moving up a delivery date to fit a schedule. “Although we knew 39 weeks or later was the optimal time for delivery, until recently there wasn’t a good evidence showing that a lot of maturation took place after 37 weeks,” says Ashton of the March of Dimes, who terms research from the last five years “eye opening.”

Late preterm babies “may look like full term babies,” she says, “but they are different in important ways.”

It turns out that carrying an infant to term has health benefits for both moms and babies. Research shows that babies born at 39 weeks or later have lower rates of breathing problems and are less likely to need neonatal intensive care. Full-term babies may also be less likely to be affected by cerebral palsy or jaundice, have fewer feeding problems, and have a higher rate of survival in their first year. Some research even suggests that full-term infants benefit from cognitive and learning advantages that continue through adolescence.

Perhaps because late preterm infants have more problems, mothers are more likely to suffer from postpartum depression. In addition, the procedures required to intentionally deliver a baby early—either an induced labor or a C-section—also carry a higher risk of complications than a full-term vaginal delivery. “There is just much more chance of things going wrong if you interrupt the normal course of pregnancy,” Spong says.

Of course, some babies arrive sooner than expected and complications during pregnancy, such as skyrocketing blood pressure in the mother, can make early delivery the safest option. But hastening the conclusion of an otherwise healthy pregnancy—even by a couple of days—is never a good idea.

The rate of early deliveries varies widely among hospitals, as demonstrated in the table below of all six hospitals in Utah that report that data to Leapfrog Group. It shows the percentage of early deliveries in each hospital that were done without medical reason. See the rates of planned early deliveries for the hosptials in your state on Leapfrog’s website.

The rate of scheduled early deliveries varies widely in six Utah hospitals.

4. Inducing labor without a medical reason

The percentage of births resulting from artificially induced labor more than doubled from 1990 to 2008. “In many ways the system has become centered on convenience rather than evidence-based care,” says Sakala of the Childbirth Connection. She points out that it’s no coincidence that more babies are born on Tuesdays than any other day of the week. “The births are scheduled so that parents and providers can all be home by the weekend.”

It’s no coincidence that more babies are born on Tuesdays. The births are scheduled so the parents and providers can all be home by the weekend.

But whether artificially induced or spontaneous, labor is labor, right? “Absolutely not,” says Deborah Bingham Dr.PH., R.N., vice president of the Association of Women’s Health, Obstetric and Neonatal Nurses. She points out that women who go into labor naturally can usually spend the early portion at home, moving around as they feel most comfortable. An induced labor takes place in a hospital, where a woman will be hooked up to at least one intravenous line and an electronic fetal monitor. In addition, most hospitals don’t allow eating or drinking once induction begins.

“An induced labor may also occur prior to a woman’s body or baby being ready,” Bingham says. “This means labor may take longer and that the woman is two to three times more likely to give birth surgically.” In addition, induced labor frequently leads to further interventions—including epidurals for pain relief, deliveries with the use of forceps or vacuums, and C-sections—that carry risks of their own. For example, a 2011 study found that women who had labor induced without a recognized indication were 67 percent more likely to have a C-section, and their babies were 64 percent more likely to wind up in a neonatal intensive care unit, compared with women allowed to go into labor on their own.

Induction is justified when there’s a medical reason, such as when a woman’s membranes rupture, or her “water breaks,” and labor doesn’t start immediately, or when she’s a week or more past her due date.

5. Ultrasounds after 24 weeks

Unless there is a specific condition your provider is tracking, you don’t need an ultrasound after 24 weeks. Although some practitioners use ultrasounds after this point to estimate fetal size or due date, it’s not a good idea because the margin of error increases significantly as the pregnancy progresses. And the procedure doesn’t provide any additional information leading to better outcomes for either mother or baby, according to a 2009 review of eight trials involving 27,024 women. In fact, the practice was linked to a slightly higher C-section rate.

6. Continuous electronic fetal monitoring

Continuous monitoring, during which you’re hooked up to monitor to record your baby’s heartbeat throughout labor, restricts your movement and increases the chance of a cesarean and delivery with forceps. In addition, it doesn’t reduce the risk of cerebral palsy or death for the baby, research suggests. The alternative is to monitor the baby at regular intervals using an electronic fetal monitor, a handheld ultrasound device, or a special stethoscope. Continuous electronic monitoring is recommended if you’re given oxytocin to strengthen labor, you’ve had an epidural, or you’re attempting a VBAC.

7. Early epidurals

An epidural places anesthesia directly into the spinal canal, so that you remain awake but don’t feel pain below the administration point. But the longer an epidural is in place, the more medication accumulates and the less likely you will be able to feel to push. Epidurals can also slow labor. By delaying administration and using effective labor support strategies, you might be able to get past a tough spot and progress to the point you no longer feel it’s needed. If you do have an epidural, ask the anesthesiologist about a lighter block. “Ideally, a woman should still be able to move her legs and lift her buttocks,” Main says.

8. Routinely rupturing the amniotic membranes

Doctors sometimes rupture the amniotic membranes or “break the waters,” supposedly to strengthen contractions and shorten labor. But the practice doesn’t have that affect and may increase the risk of C-sections, according to a 2009 review of 15 trials involving 5,583 women. In addition, artificially rupturing amniotic membranes can cause rare but serious complications, including problems with the umbilical cord or the baby’s heart rate.

9. Routine episiotomies

Practitioners sometimes make a surgical cut just before delivery to enlarge the opening of the vagina. That can be necessary in the case of a delivery that requires help from forceps or a vacuum, or if the baby is descending too quickly for the tissues to stretch. But in other cases, routine episiotomies don’t help and are associated with several significant problems, including more damage to the perineal area and a longer healing period, according to a 2009 review involving more than 5,000 women.

Allowing healthy infants and moms to stay together right after delivery promotes bonding and breast-feeding.

10. Sending your newborn to the nursery

If your baby has a problem that needs special monitoring, then sending him or her to a nursery or even an intensive care unit is essential. But in other cases, allowing healthy infants and mothers to stay together promotes bonding and breast-feeding. Moms get just as much sleep, research shows, and they learn to respond to the feeding cues of their babies. Allowing mothers and babies to stay together is one of the criteria hospitals must meet to be certified as “baby friendly” by the Baby-Friendly Hospital Initiative, a program sponsored by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF).

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PostHeaderIcon Mother-Friendly Childbirth Initiative

PostDateIcon December 24th, 2011 | PostAuthorIcon Author: admin

Mission

The Coalition for Improving Maternity Services (CIMS) is a coalition of individuals and national organizations with concern for the care and wellbeing of mothers, babies, and families. Our mission is to promote a wellness model of maternity care that will improve birth outcomes and substantially reduce costs. This evidence-based mother-, baby-, and family-friendly model focuses on prevention and wellness as the alternatives to high-cost screening, diagnosis, and treatment programs.

Preamble

Whereas:

  • In spite of spending far more money per capita on maternity and newborn care than any other country, the United States falls behind most industrialized countries in perinatal* morbidity* and mortality, and maternal mortality is four times greater for African-American women than for Euro-American women;
  • Midwives attend the vast majority of births in those industrialized countries with the best perinatal outcomes, yet in the United States, midwives are the principal attendants at only a small percentage of births;
  • Current maternity and newborn practices that contribute to high costs and inferior outcomes include the inappropriate application of technology and routine procedures that are not based on scientific evidence;
  • Increased dependence on technology has diminished confidence in women’s innate ability to give birth without intervention;
  • The integrity of the mother-child relationship, which begins in pregnancy, is compromised by the obstetrical treatment of mother and baby as if they were separate units with conflicting needs;
  • Although breastfeeding has been scientifically shown to provide optimum health, nutritional, and developmental benefits to newborns and their mothers, only a fraction of U.S. mothers are fully breastfeeding their babies by the age of six weeks;
  • The current maternity care system in the United States does not provide equal access to health care resources for women from disadvantaged population groups, women without insurance, and women whose insurance dictates caregivers or place of birth;

Therefore,
We, the undersigned members of CIMS, hereby resolve to define and promote mother-friendly maternity services in accordance with the following principles:

Principles

We believe the philosophical cornerstones of mother-friendly care to be as follows:
Normalcy of the Birthing Process

  • Birth is a normal, natural, and healthy process.
  • Women and babies have the inherent wisdom necessary for birth.
  • Babies are aware, sensitive human beings at the time of birth, and should be acknowledged and treated as such.
  • Breastfeeding provides the optimum nourishment for newborns and infants.
  • Birth can safely take place in hospitals, birth centers, and homes.
  • The midwifery model of care, which supports and protects the normal birth process, is the most appropriate for the majority of women during pregnancy and birth.

Empowerment

  • A woman’s confidence and ability to give birth and to care for her baby are enhanced or diminished by every person who gives her care, and by the environment in which she gives birth.
  • A mother and baby are distinct yet interdependent during pregnancy, birth, and infancy. Their interconnected–ness is vital and must be respected.
  • Pregnancy, birth, and the postpartum period are milestone events in the continuum of life. These experiences profoundly affect women, babies, fathers, and families, and have important and long-lasting effects on society.

Autonomy

  • Every woman should have the opportunity to:
  • Have a healthy and joyous birth experience for herself and her family, regardless of her age or circumstances;
  • Give birth as she wishes in an environment in which she feels nurtured and secure, and her emotional well-being, privacy, and personal preferences are respected;
  • Have access to the full range of options for pregnancy, birth, and nurturing her baby, and to accurate information on all available birthing sites, caregivers, and practices;
  • Receive accurate and up-to-date information about the benefits and risks of all procedures, drugs, and tests suggested for use during pregnancy, birth, and the postpartum period, with the rights to informed consent and informed refusal;
  • Receive support for making informed choices about what is best for her and her baby based on her individual values and beliefs.

Do No Harm

  • Interventions should not be applied routinely during pregnancy, birth, or the postpartum period. Many standard medical tests, procedures, technologies, and drugs carry risks to both mother and baby, and should be avoided in the absence of specific scientific indications for their use.
  • If complications arise during pregnancy, birth, or the postpartum period, medical treatments should be evidence-based.

Responsibility

  • Each caregiver is responsible for the quality of care she or he provides.
  • Maternity care practice should be based not on the needs of the caregiver or provider, but solely on the needs of the mother and child.
  • Each hospital and birth center is responsible for the periodic review and evaluation, according to current scientific evidence, of the effectiveness, risks, and rates of use of its medical procedures for mothers and babies.
  • Society, through both its government and the public health establishment, is responsible for ensuring access to maternity services for all women, and for monitoring the quality of those services.
  • Individuals are ultimately responsible for making informed choices about the health care they and their babies receive.

These principles give rise to the following steps, which support, protect, and promote mother-friendly maternity services:

Ten Steps of the Mother-Friendly Childbirth Initiative
For Mother-Friendly Hospitals, Birth Centers,* and Home Birth Services

To receive CIMS designation as “mother-friendly,” a hospital, birth center, or home birth service must carry out the above philosophical principles by fulfilling the Ten Steps of Mother-Friendly Care.

A mother-friendly hospital, birth center, or home birth service:

  1. Offers all birthing mothers:
    • Unrestricted access to the birth companions of her choice, including fathers, partners, children, family members, and friends;
    • Unrestricted access to continuous emotional and physical support from a skilled woman—for example, a doula,* or labor-support professional;
    • Access to professional midwifery care.
  2. Provides accurate descriptive and statistical information to the public about its practices and procedures for birth care, including measures of interventions and outcomes.
  3. Provides culturally competent care—that is, care that is sensitive and responsive to the specific beliefs, values, and customs of the mother’s ethnicity and religion.
  4. Provides the birthing woman with the freedom to walk, move about, and assume the positions of her choice during labor and birth (unless restriction is specifically required to correct a complication), and discourages the use of the lithotomy (flat on back with legs elevated) position.
  5. Has clearly defined policies and procedures for:
    • collaborating and consulting throughout the perinatal period with other maternity services, including communicating with the original caregiver when transfer from one birth site to another is necessary;
    • linking the mother and baby to appropriate community resources, including prenatal and post-discharge follow-up and breastfeeding support.
  6. Does not routinely employ practices and procedures that are unsupported by scientific evidence, including but not limited to the following:
    • shaving;
    • enemas;
    • IVs (intravenous drip);
    • withholding nourishment or water;
    • early rupture of membranes*;
    • electronic fetal monitoring;

    other interventions are limited as follows:

    • Has an induction* rate of 10% or less;†
    • Has an episiotomy* rate of 20% or less, with a goal of 5% or less;
    • Has a total cesarean rate of 10% or less in community hospitals, and 15% or less in tertiary care (high-risk) hospitals;
    • Has a VBAC (vaginal birth after cesarean) rate of 60% or more with a goal of 75% or more.
  7. Educates staff in non-drug methods of pain relief, and does not promote the use of analgesic or anesthetic drugs not specifically required to correct a complication.
  8. Encourages all mothers and families, including those with sick or premature newborns or infants with congenital problems, to touch, hold, breastfeed, and care for their babies to the extent compatible with their conditions.
  9. Discourages non-religious circumcision of the newborn.
  10. Strives to achieve the WHO-UNICEF “Ten Steps of the Baby-Friendly Hospital Initiative” to promote successful breastfeeding:
    1. Have a written breastfeeding policy that is routinely communicated to all health care staff;
    2. Train all health care staff in skills necessary to implement this policy;
    3. Inform all pregnant women about the benefits and management of breastfeeding;
    4. Help mothers initiate breastfeeding within a half-hour of birth;
    5. Show mothers how to breastfeed and how to maintain lactation even if they should be separated from their infants;
    6. Give newborn infants no food or drink other than breast milk unless medically indicated;
    7. Practice rooming in: allow mothers and infants to remain together 24 hours a day;
    8. Encourage breastfeeding on demand;
    9. Give no artificial teat or pacifiers (also called dummies or soothers) to breastfeeding infants;
    10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from hospitals or clinics

† This criterion is presently under review.

* Glossary

Augmentation: Speeding up labor.
Birth Center: Free-standing maternity center.
Doula: A woman who gives continuous physical, emotional, and informational support during labor and birth—may also provide postpartum care in the home.
Episiotomy: Surgically cutting to widen the vaginal opening for birth.
Induction: Artificially starting labor.
Morbidity: Disease or injury.
Oxytocin: Synthetic form of oxytocin (a naturally occurring hormone) given intravenously to start or speed up labor.
Perinatal: Around the time of birth.
Rupture of Membranes: Breaking the “bag of waters.”

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PostHeaderIcon New Book “Birthing in Alaska: A Modern Woman’s Guide”

PostDateIcon July 12th, 2011 | PostAuthorIcon Author: admin

One of our Birth Network members, childbirth educator Maranda Williamson of Balli Birthing has just released a new book! “Birthing in Alaska: A Modern Woman’s Guide” is filled with birth stories from Alaskan women. This uplifting book is great to read as you prepare for your birth and makes a wonderful present for expecting moms!

About the book:

“Do you know what a maternity ward, a mountain top, and a four-wheeler all have in common? The answer can be found in one of the many stories of  Birthing in Alaska: A Modern Woman’s Guide. Women from all over Alaska share their unique yet powerfully related birthing experiences involving failures, successes, accidental home births, and unexpected cesareans.”

You can order a copy online from Balli Birthing for $12.99 + $5.00 flat rate shipping.

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PostHeaderIcon A Man’s Guide to Homebirth

PostDateIcon June 5th, 2011 | PostAuthorIcon Author: admin

A Man’s Guide to Homebirth

by Tony Whitman

When my wife decided to have a homebirth – she did her best to furnish me with the best reading and preparatory material that was available. However, since I was neither a medical professional nor a woman, the material just did not really apply to me. I could not memorize the medical terminology or get all touchy-feely for the homebirthing guides to really sink in. After our birth, I decided to write my own guide – to touch on the things that I wish someone had told me, in ways that I could understand.

The approach of this guide centers on a checklist of things that I feel a man needs when being the other primary person in his wife’s homebirth. There may be doulas, midwives, family, friends, and a host of other related people at the homebirth – but even with these people present, I still feel that men are the most important person there in their wife’s eyes; and will need this information. The steps of the homebirth will be walked through and discussed in terms of the item on the checklist needed for it.

These are the items that men need to assist in a homebirth (not in order of use by the way): a black-light, princess wand (a Barbie wand or any other type of wand toy will do,) fun-house mirror, catchers mitt/fishing net/soccer gloves, pocket watch, thesaurus, woman who has witnessed a live birth, six pack of beer (or favorite alcohol), shovel, bucket, 1 dozen eggs, shredded mozzarella cheese, shower shoes, swimming shorts, push-up/pull-up bars or a wheelbarrow, old table covers (plastic holiday ones are best,) 1 big steak (or other red meat,) and 1 big cliche. Most of these items are for preparing for the birth, while a few are for the actual birthing.

The first real stage that lets a man know that labor is coming is what I call the “Hypno-Fog.” For example: my first child’s birth, (at a ‘birthing center’ – which for me seemed to be a glorified hotel room with an attendant who spoke English, but that’s not important,) I fell asleep when we got there while she was in labor. She gave me shit for years. With the second pregnancy I slept almost 18 hours a day for the week before she was due in preparation.

So when I came down the stairs and was informed that she was in labor at 9am-ish, I felt ready this time since I just slept for 10 friggin hours. Alas, after hanging around downstairs for about 10 minutes, my eyes rolled into the back of my head and I went and took a nap. On a side note, this is where the doula’s biggest strength lies – they are highly trained to withstand the Hypno-Fog. It was after that nap during the Hypno-Fog stage that I discovered that women who are about to go into labor cast this area-of-effect spell that can drop a man to the floor in a matter of minutes.

So, you can either do what I did and sleep till she has that five minute window of alertness when she tells you it’s time before she goes into labor la-la land…Or you can buy a pocket watch at month three of the pregnancy and try to hypnotize yourself once a week. Building up an immunity and resistance to trances will greatly increase your chances of withstanding the Hypno-Fog.

Now your wife is in labor-la-la land. You can tell her that President Reagan has crawled out of his grave, went to Burger King, and brought us some burgers – and she will say that sounds great! This is where the thesaurus comes in. Almost every guide out there says men need to say supportive things in-between contractions for thousands of reasons. But hey, I’m no PhD in English Composition – there are only so many different ways a person can say “Great Job Honey,” or “Doing Good!” So, during the last three months of the pregnancy I highly recommend writing down as many different ways of saying “good job” as you possibly can. Then take this list and write it on your wrist while she is maintaining her Hypno-Fog.

It’s been a while since the Hypno-Fog has dissipated. She’s knee-deep in contractions. Go have a beer. Seriously. One beer, or a few sips of wine, or even a shot of scotch. Even though you and Ronald Reagan are sharing that burger in the kitchen – your wife’s instincts are going strong in Superman mode. If you are tense, stressed, or panicky, she will sense it and she will become tense, stressed, or panicky. This is where I highly, highly, highly recommend the one beer an hour rule. My advice here is for taking the edge off. If you just hammer the beers and get drunk, then you are worthless and a moron; and you and your wife should not have procreated. Having said that, there is nothing wrong with stepping out for a second and having a few sips of beer. (Make sure you have gum as well, beer breath is nasty to women in general, but especially women in labor.)

Now you’re relaxed, your wife is relaxed, and her body is completely dedicated to pushing out Worf, Son of Mog. This is where the fun house mirror comes in. I learned that a woman’s body in labor is like a slinky made out of chicken bones. It bends and warps in ways unimaginable to us mere men. If you stand in front of that fun-house mirror once a week and practice viewing how the body warps, twists, and morphs like a long lost member of the X-Men – you will actually be able to assist your wife in active labor.

Basically, my wife asked me to push and pull in places that seemed entirely unrelated to me. For example, if you push on both sides of her hip bones, her pelvis fans out at the opposite end like a Chinese paper-fan. If you push on her tailbone, her uterus does a reverse-gainer with a triple-twist-Greg-Louganis style. During labor I really had to fight the urge to push on other places to see what else would happen. Maybe if I put my left index finger on the base of her skull, and my right elbow on the 5th lateral vertebrae – I could get her to reflexively punch a hole in the shower wall. This is the type of mentality you need to have, by practicing with that fun-house mirror, when she asks you to push somewhere specific to help.

After some serious labor, the baby is close to ‘presenting’ (or popping out.) Your wife will start to plead with you to do something about the pain. You can do what I did – sit there like a buffoon with a confused look on your face. Or… you can bust out the Princess Wand with confidence and start waving it over her while chanting “Anall Na-thrach Uth-Vas Bethud….” There is nothing worse that sitting there helpless while she asks you to perform magic tricks. At least with the Barbie princess wand you can make it look like you are making the utmost effort to make that pain go away even though she repeatedly stated before the birth that she wanted a “natural birth.”

The pain is magically gone from the wand waving, and now the baby is presenting. If you took this manual seriously – then you are ready for what comes next. You took that black-light and bathed yourself in its hippy-trippy glow in a dark room a few times for this moment. The baby will be a splendid combination of purple and blue when it comes out. Don’t panic, you’re wife did not have an affair with Papa Smurf. That color is natural. You may have watched some you-tube videos of live birth, but it just doesn’t come close to seeing it in real life.

The baby’s Klingon-like head is starting to come out fully. This is where the woman who has witnessed a live birth comes in handy. It took every ounce of willpower I had to keep from blurting out “dear god I thought pterodactyl’s were extinct, where is the rest of his face?!?!” But luckily I had the quick wit to look at my wife’s friend and mouth the words “Is this normal?” And she also had the common sense to just nod instead of calling me a total idiot. The bottom line, the last thing your wife will want to hear while she is pushing a baby out is you exclaiming shockingly that the baby is a mutant and the other woman stating that you are in fact, an idiot. She might start to feel that there might indeed be something wrong with the baby, and panic herself.

While waiting for the baby’s shoulders to come out – I stumbled upon one of the most fascinating psychological phobias in the history of mankind. Even though your wife tells you she has the utmost confidence in you as a husband, lover, father, friend… she still harbors the very deep-seated fear that when the baby comes out you will be attempting to use a Jedi mind trick to make the infant levitate in place for fifteen minutes.

Yes, you heard me right, all woman have the real and serious fear that men will drop the baby when it comes out. She may be able to feel your forearms pressed on her thighs, she may see the top of your head as you are peering intently into her nether regions like you are deciphering Linear A writing, but she still thinks you are just hiding that apple and chainsaw and will start to juggle that baby when you have a firm grip on it. I wish that someone took a picture of my face so all could see the look of puzzlement when she asked me three times if I was ready to catch him.

This is where the catcher’s mitt, fishing net, or soccer gloves come in. Choose one of those three items (if I ever catch a baby again, I’m going with the soccer gloves with the rubber gripping.) Set that item next to the place where your wife plans on having her baby at least two months prior to the due date. Seeing it day after day will help to dispel her phobia and make the last stage of labor more pleasant for the both of you. She will instinctively know that when the baby comes out, you will indeed be very ready; and that is no need to worry about your silly Jedi mind tricks.

You’ve caught the baby, it is in your hands, and your wife is crying. After the glow wears off, you will notice that you are covered in more fluids than your favorite porn star. You will need to be able to walk around without slipping and falling like a bad cartoon. The shower shoes and swim trunks help serve this purpose. But furthermore, you wont be grossed out or panicky that you are now a walking petri dish for a new secret government biological weapon. I made the hilarious attempt to count how many different fluids were on me and baby. I stopped counting at seven.

One month prior to the due date, take an afternoon off. Grab that bucket, the eggs, the mozzarella cheese, and the shovel. Put a shovel-full of dirt in the bucket, put in the dozen egg yolks, and the cheese. Mix it all together. Pour it all over yourself, let it dry….and let it stay on you for roughly three or so hours. I think you get the gist. The mud is the mix of blood and feces, the egg yolks for that nice texture and consistency, and the cheese represents the mucous and vernix. Doing this exercise will make sure you will not be distracted when you are covered in this wonderful biological recipe.

For even though the baby is out of your wife’s body, the process is still far from over. I was under the naive assumption that hey, baby’s born, time to make some calls and get some rest…..oh no my friend. Not even close. While the wife is in labor, the plastic table cloths should be put any where on the floor where she plans on walking. Most men are not told that when the placenta comes out, it is also accompanied by golf-ball sized clots of blood, or just blood in general – along with leftovers of your famous Colonel Manly’s bucket recipe.

The placenta is out, and its friends are scattered on the floor like a Jackson Pollack painting. If you’re lucky, your wife didn’t have a too difficult delivery. But more often than not, she can barely stand up. Did you buy those push-up bars? If you are a well prepared man, you exercised for the whole nine months and are strong enough to wave your blond Fabio locks in the wind, pick her up like the Queen she is, and carry her to the designated place of rest while singing The Music of the Night from the Phantom of the Opera soundtrack.

Or…you are a lazy schlub like me who gets winded after retrieving the remote from the other couch. In this case, if necessary, bust out that wheelbarrow and cart her to the place of rest while resisting the urge to make livestock sounds. It is around this time that she is returning from her journey to labor-la-la land and will start to remember the things you said.

The birth is done, you have showered – but what is that smell? Ah yes, you wont notice it. During your preparatory afternoon of walking around covered in dried and sticky Colonel Manly sauce, you took that steak, cut it in half; and let half of it sit around in the sun for two hours while you put the other half in the oven and let it burn. Then you put the two differently prepared halves of the steak into a bowl, and let it sit on the counter for two days. This will imitate the lingering smell from the fluids released during the birth. But have no fear, it will go away. Just tell people visiting the baby that you sacrificed two baby lambs to the great fire of Zeus in your den in honor of the new arrival.

When all is said and done, there is one thing you will need throughout all of this. Your wife will never tell you what it is, but I will. It is a cliche. During her nesting stage your wife will have lists for other lists. She will have bags of items placed strategically around the house in case of nuclear attack. You don’t need to know what is on these lists, or what is in the bags. These are more for easing her recovery after birth than for you to administer and memorize.

In this case, that cliche is presence. She needs your strong presence. To be the clear-headed and commanding person there. This doesn’t mean be a control freak, a micro-manager, or a bossy dick. You don’t need to go to other end of the pendulum either and be the towering mute moron standing in the corner barely caring whats happening. It means just have that aura of confidence that lets her know that you know that everything will go perfectly. If she knows that, despite the overwhelming absurdity that men feel being an active participant in a birth, you are totally there and engaged – it will be better than any drug or shortcut a person could have up their sleeve. And by killing two birds with one stone, by being there with her to ease the whole process and making her memories of the birth more positive – she will repay you in the future. Women know men like rewards too.

Copyright 2010 – Tony Whitman, published here with permission.

Happy Father’s Day!

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PostHeaderIcon Prevent complications with great nutrition.

PostDateIcon February 1st, 2010 | PostAuthorIcon Author: admin

woman_eatingNutrition is the foundation for a healthy pregnancy. Without it, your pregnancy can be fraught with complications. Pre-Eclampsia, high blood pressure, excessive weight gain, weight loss, gestational diabetes…..etc.  All of these things can be affected by something as simple as choosing the right foods to eat every day.

If a woman is trying to conceive, she should also be thinking about how she plans to prepare her body for that new life.  She should start by keeping a daily food diary. What are you really eating?  Do you get 5-7 servings of vegetables and fruits a day?  Are you eating a lot of white carbohydrates?  Do you eat more than 1 serving of sweets per day?  Do you indulge in coffee or caffeinated sodas?

Our O.B.s usually spend about 5 minutes discussing nutrition with us. They might tell you that sushi and hot dogs are dangerous to eat.  They might tell you that you need to avoid tuna as well and to drink lots of water to stay hydrated.  But is 5 minutes and a few warnings really enough?

Did you know that when you are pregnant your blood volume increases by 50%, but the red blood cell count remains the same?  This is why many women need to take steps to avoid pregnancy induced anemia.  As a pregnancy continues, the placenta will take the iron it needs right from mom. Maintaining a diet rich in iron will help to ensure she remains healthy during this time when her body is using her own personal nutritional stores to grow a healthy baby.  It is recommended that pregnant women try to get as much of their iron through food instead of relying on supplements. To find out which foods are high in iron, please click this link

What about salt?  Women in pregnancy actually have increase cravings and need for salt in their diets.  If you avoid processed foods and salt to taste, you should get just the right amount.

A famous and well respected OB, Dr. Tom Brewer created a high protein and nutrient dense diet called the “Brewer’s Diet”.  He had a remarkable record of preventing pre-eclampsia, swelling and high blood pressure in his patients.  One of his tricks was to His research showed that women in pregnancy have cravings for salty food because they need more salt in their diets.  A complete breakdown of this diet can be found here at the Blue Ribbon Diet. Also please check out more information here.

Weight gain is a hot topic among both health practitioners and women. Years ago it was thought that maintaining a low weight gain of just 10 – 20 pounds would prevent complications like toxemia and overly large babies. However, it only made some pregnancies more dangerous and caused more low-birth weight babies and infants with neurological defects. This is not ancient history either. This was as recent as 1985 in the decade most of you were born.  Currently, maternity care providers are watching nutrition as opposed to watching the scales. Midwives are leading this movement with their interest in the physiology of normal and natural pregnancy.  A good diet will help you nourish yourself and your baby, as well as achieve a nice, steady weight gain quite painlessly.  In fact, you might enjoy your new healthy lifestyle and continue after baby is here!

I have only touched briefly on some of the benefits of why nutrition is so crucial to a healthy pregnancy and healthy baby. Good nutrition really can help to prevent many pregnancy complications. I invite you to ask a care provider for more about this subject along with doing some research for yourself.

-Tammy

http://www.acog.org/publications/patient_education/bp001.cfm

http://www.midwiferyservices.org/pregnancy_nutrition.htm

http://www.midwiferytoday.com/articles/nutrition.asp

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PostHeaderIcon Protect your newborn from sickness:

PostDateIcon October 25th, 2009 | PostAuthorIcon Author: admin

breastfeeding_mother_baby Newborn immune systems are undeveloped and need antibodies from their mother’s milk to stay healthy. Studies have shown that artificially fed babies are up to 15 times more likely to be hospitalized in their first year. Breastfed babies receive a whole arsenal of immune components while formula fed babies receive none.  So how to do make sure that you will be able to breastfeed?  We commonly hear from mothers share that “I didn’t have enough milk” or “My baby liked  the bottle better”, etc.   Lacation experts say the one reason women have troubles breastfeeding is lack of support and education. Follow these steps to make sure you reach your breastfeeding goals:

  1. Get good information: Go to a breastfeeding class and bring your partner, family members and other care givers. It’s important they learn the basics so they can help you and won’t unintentionally sabotage your efforts. Read a breastfeeding book like “Breastfeeding Made Simple” or “The Womanly Art of Breastfeeding”. Check out www.breastfeeding.com for great articles and advice.
  2. Connect with nursing moms: Spend time and befriend women who successfully breastfed. Don’t take advice from people who didn’t. (I know it sounds obvious, but I made that mistake!)  Look for a mother to mother support group or La Leche League meeting.  Make these connections before you have your baby.
  3. Choose your birth location carefully: Deliver at a “Baby Friendly” hospital, birthing center or at home. Ask the hospital if they have lactation consultants to help you. Some staff nurses don’t have much lactation training and/or have never breastfed themselves. We were told by a mom recently that when she asked for help  at an Anchorage hospital they gave her a bottle instead. Not good.  And don’t keep any formula samples you get in the mail or from the hospital.  It’s too tempting to have it in the house.
  4. Plan a drug free, normal birth: IVs, epidurals, c-sections and narcotic drugs in labor all make breastfeeding harder. The more drugs, fluids and painful incisions you have, the harder it will be for the baby to latch on and the longer it will take for you to produce milk. Choose midwife or obstetrician that supports natural birth. Learn about and practice mental and spiritual techniques like non-focused awareness, prayer, hypnobirthing, and visualization.  Take a childbirth education class that focuses on natural birth. Find out if you will have access to a birthing tub, shower, birthing ball, food during labor, etc.  Hire a doula.  If you do need pain medications, ask for the lowest dosage.
  5. If you have concerns, get professional lactation support immediately: WIC offers free breastfeeding support for their clients. Some pediatric offices have lactation consultants on staff . You can call the hospital where you delivered and get phone help. Most home birth and birthing center midwives will visit you in your home. ANMC has a program where they will come to your house and help you as well. LLL leaders and members are another great resource. Don’t wait to get help if things aren’t going well. Pick up the phone instead of a bottle.
  6. Pediatrician or nurse practitioner: Find a provider that not only supports breastfeeding but that can give you specific help and advice. Some medical schools offer ZERO lactation education. Other pediatricians have done extensive training and have breastfed their own children. Ask about their training, experience and philosophy.  Consider using a nurse practicioner or naturopathic physician.
  7. Plan for pumping at work: Delay returning to work as long as possible.  Try to arrange for job sharing, part-time, work from home or creative scheduling.  Nurse your baby at night to make up for lost nursing and cuddle time. Make sure to find a place to pump before you take maternity leave. We know women who have left their jobs to go to others that were more breastfeeding friendly.
    Going back to work and maintaining milk supply is a major challenge for women.  Remember that even a little breastmilk is valuable and better than none at all.  With enough support, you can do it!
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PostHeaderIcon Skin-to-skin, right after birth.

PostDateIcon July 29th, 2009 | PostAuthorIcon Author: admin

skintoskin2

Did you know that skin-to-skin contact during the first 60 minutes after birth is crucial for breastfeeding and bonding ?  The best way to insure a good start is by immediately placing the baby on mother’s bare chest after birth.  This is when baby is most alert and the latch reflex is strongest.  Many hospitals use this crucial bonding time to do routine exams.  Imagine after waiting 9 months to hold your baby, he or she is not in your arms but down the hall, alone on his back, arms flailing, disoriented and crying while a nurse does non-urgent procedures and paperwork.   One review of over 30 studies showed that skin-to-skin contact between mother and baby at birth reduces crying, improves mother-baby interaction, keeps the baby warmer, and helps women breastfeed successfully.  Health facilities that routinely separate newborns and mothers are simply out of date.  Make sure you get the best start with your baby.   Write a birth plan and talk to your provider about this crucial time for you and your baby.  Ask them about their policies and protocols and don’t be afraid to change providers if you don’t get the answers  you are looking for.  Pick a Mother-Friendly pediatrician ahead of time and get written orders from him or her as well.  Plan for this sacred time for you and your new one.  You won’t regret it!

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