Monday, February 28, 2011

Birth Dream

After reading Rixa's post Supporting Your Own Perineum yesterday, I had a dream last night that I was birthing at home. At least it felt like home, but it did not look like the house we live currently live in or any house I've lived in before. Ina May Gaskin was my midwife. She sat cross-legged in the corner of the room and quietly watched while I crouched on the floor and provided my own counter-pressure as I birthed a baby boy into my own hands. It was a beautiful dream.

The Birthing Quilt

Rixa also recently shared the link to the story of this beautiful birthing quilt. Read the story, it is very special. I love the image on it--I think that is the position I was in in my dream.

Thursday, February 24, 2011

Making baby food is easy. Toddler food, not so much.

I have made baby food for both of my kids. I mostly did purees frozen in ice cube trays. The Wholesome Baby Food website has been my go-to resource for this. I have found it is pretty easy to make purees, but really struggled when my babies got old enough to not want purees but not quite old enough to always eat everything the rest of the family was eating (say we were having pork chops and a baby spinach salad for dinner--not exactly 11-month-old friendly). I often end up resorting to the expensive pre-made "todder food"--those sauce-less ravioli things are pretty neat, after all.

But I would love to have some resources for more homemade options for my son's current age. Especially because I'm pretty sure my son has problems digesting dairy. I'm not sure if it is a problem with the milk sugar (lactose) or the milk protein (casein) yet--still trying to figure that out (that matters because some dairy foods, such as cheese, do not contain lactose). Many commercial toddler meals contain dairy, so I have to check the labels, and it limits the selection for him.

I was intrigued back in December when I read Enjoy Birth's review of the book So Easy Toddler Food and thought it might be something our family could use sometime. This was before I discovered my son's dairy issues and before he decided he didn't want to be spoon-fed anymore. I forgot about the book at the time, but now I realize that I also think some of the info in the book would also be helpful for my 3-year-old, since food battles are pretty common with her. And I could use the recipes for both of my kids. I was excited to learn today that Enjoy Birth is having a giveaway of a free copy of the book. Click here to find out how you can enter the giveaway.

Monday, February 21, 2011

Blurry Lines

Focus ubt
Focus by Tomasz Sienicki

A few months ago, I read the collection of midwife stories, Sisters on a Journey: Portraits of American Midwives by Penfield Chester. I mentioned it in a previous post. I wanted to go into a little more detail about the lessons I learned from this book, most specifically about the various roles that are all part of midwifery.

Midwife as Childbirth Educator

Ideally, the role of a midwife is not just to provide medical care that is less technological than the medical model, while still being the "birth expert." The role of a midwife is to foster independence in the woman. This is evidenced by the practice of showing the woman how to dip her own urine strips and read the results herself. The midwifery practice I went to for my first couple of appointments when pregnant with my son, before we moved here, used this method. Midwifery is supposed to be about teaching the woman how to take responsibility for her own health. A good midwife will help prepare her clients for childbirth. In some respects, a midwife is a childbirth educator.

As I have read blogs by midwives discussing unassisted birth, I find it interesting that some midwives feel that having a midwife teach a UCer how to perform assessments on herself makes it not "unassisted" anymore. But where is the line between "childbirth education" and "midwifery"? If a UC mom takes a childbirth class, that wouldn't be considered "having a midwife." What if a childbirth educator taught women how to do their own prenatal and birth health care?

Midwife as Doula

Midwifery care is holistic--midwives treat the entire patient, body and mind. They believe that a woman's emotions can have a direct impact on her body's processes, and works to help her feel emotionally supported during pregnancy and birth. A good midwife is skilled in natural pain relief techniques and helps her clients use them during labor. A doula's role is said to be "mothering the mother," but isn't this also what midwives do? A midwife is also a doula.

When I wrote my post on Doulas and Hombirth, I realized that line between midwife and doula becomes blurry when you consider the possibility of a doula attending a UC. How is a doula-attended planned UC different from a planned homebirth with an unlicensed midwife? On paper, they are virtually the same thing.

Midwife as Healthcare Provider

The other role of a midwife is to observe the mother and baby for signs of problems and treat them if treatment is in her scope of practice or refer to another healthcare provider. This part of a midwife's role is similar to a physician, though her perspective on how to go about providing this healthcare is usually different than that of an obstetrician (though I would think a family practice physician might have a more midwife-like approach). And because midwives practice low intervention care and treat low-risk patients, the healthcare provider part of her role is a small part, though a very important one.

The professions of "childbirth educator" and "doula" are both relatively new because their roles were performed by midwives and their partners or apprentices before birth moved to the hospital and began being attended by physicians. The majority of physicians view the practice of medicine as dealing only with the body, not the mind, and those who are specialists like OB/GYNs are only concerned with the specific parts of the body they specialize in. Women have invented our own systems for filling the holes left in our healthcare by modern medicine, and have created the childbirth educator and the doula--and thus, the "team" of physician, childbirth educator, and doula together does all the jobs of midwifery.

Me, a Midwife?

I have recently been seriously considering the possibility of becoming a midwife someday. I have been considering the pros and cons of various paths to midwifery--ideally, I'd like to train as a midwife in another country, but I'm not sure that would work for my family. It won't happen until our own family is complete, and I feel that I won't know it is time for that until it happens. I want to be a midwife, but as I've said before, I'm quite intimidated by it. I realize, though, that what I am doing now allows women to have all aspects of their maternity care needs address (just not all by one person), so I am already helping women have care that is as close to midwifery care as they can get without actually having a midwife--to some extent, I might consider that being "part of midwifery."

Wednesday, February 16, 2011

Continuous Labor Support Reduces Risk of Cesarean Section and Other Adverse Outcomes in Women and Newborns

The following press release comes from Childbirth Connection, it is available in PDF here.

FOR IMMEDIATE RELEASE - 11 am ET, February 16, 2011

Continuous Labor Support Reduces Risk of Cesarean Section and Other Adverse Outcomes in Women and Newborns
Type of Caregiver Can Make a Big Difference in Labor Experience

New York City — Women who labor with a dedicated support companion are less likely than women without such support to experience a series of risky birth procedures, according to a review published in the current issue of The Cochrane Library. The comprehensive study of experiences of 15,061 women who participated in 21 randomized controlled trials confirms previously known benefits for maternal health, identifies an additional benefit for newborns, and finds no downsides. The study was carried out through the prestigious Cochrane Collaboration, an independent international organization that prepares and keeps up to date rigorous systematic reviews of evidence from the best available studies.

Overall, women who received supportive care from a companion throughout labor were less likely than women without such support to have a cesarean section, to use narcotics or any other pain medication, to use regional pain medication such as epidural analgesia, to give birth with vacuum extraction or forceps, and to rate their childbirth experience poorly. Having continuous support shortened labor and increased the likelihood of having a “spontaneous” birth with neither cesarean nor vacuum extraction nor forceps. These results confirm previous research. With the inclusion of six new randomized controlled trials, the present systematic review, identified another benefit of continuous labor support: reduced likelihood of a baby with a poor “Apgar score” rating of well being five minutes after birth. The authors conclude that all women should have continuous support while giving birth.
Ellen D. Hodnett, RN, PhD, Professor and Heather M. Reisman Chair of Perinatal Nursing Research, University of Toronto, and co-authors of “Continuous Support for Women During Childbirth” limited the study to randomized controlled trials. This type of research helps ensure that study groups are similar and that results are a true reflection of the effects of the care being studied — here, continuous labor support.

“Cesarean section, vacuum extraction and forceps, and pain medications are interventions that increase the likelihood of adverse short- and longer-term effects in women and babies. Continuous labor support is an important way for women to avoid overuse and harms of these practices, and to have a positive experience at this special time,” said Carol Sakala, PhD, MSPH, Director of Programs at Childbirth Connection. Dr. Sakala is a co-author of the report.

Supportive care during labor and birth does not involve clinical care, and may include:
• helping women with physical comfort
• providing emotional support
• offering information
• helping women communicate their wishes to caregivers
• engaging women’s husbands or partners, as desired by the couple.

Impact Depends on Type of Caregiver
The study provides new knowledge about effects of continuous labor support under different conditions. A major finding is that the impact of this care appears to differ, according to the type of person providing the care. Effects were strongest when the caregiver was neither a member of the hospital staff nor a person in the woman’s social network, and was present solely to provide one-to-one supportive care, such as a doula. Compared with women who had no continuous support, women with companions who were neither on the hospital staff nor in the woman’s social network were:
  • 28% less likely to have a cesarean section
  • 31% less likely to use synthetic oxytocin to speed labor
  • 9% less likely to use any pain medication
  • 34% less like to rate their childbirth experience negatively.
When compared with no continuous support, continuous support by members of the hospital staff did not appear to reduce the likelihood of having a cesarean section or improve ratings of the childbirth experience and may have increased the likelihood of using synthetic oxytocin. These results may reflect the fact that hospital staff can experience divided loyalties, additional duties, and constraints of institutional policies when providing continuous support. Continuous support from a person in the mother’s social network (for example, her partner, husband, other relative, or friend) appeared to increase the mother’s satisfaction with her childbirth experience, but did not seem to impact her likelihood of undergoing a series of labor and birth interventions.

Historically, laboring women routinely received support from female companions. However, more recently in hospitals worldwide, continuous labor support has become the exception rather than the norm. “There is concern about widespread dehumanization of women’s birth experiences,” said Dr. Hodnett. “Concern about institutional routines, high rates of intervention in healthy women and newborns, limits on women’s autonomy and control, unfamiliar personnel, and lack of privacy is leading to calls for making continuous labor support widely available to childbearing women.”

Leading options for continuous labor support in the United States include trained labor support companions known as doulas and — for satisfaction with the childbirth experience — the help of a friend or family member who is invited to be present when a woman gives birth. Childbirth Connection’s second national Listening to Mothers survey found that just 3% of women who gave birth in U.S. hospitals in 2005 experienced the most beneficial type of labor support, in the form of doula care. Although insurance coverage of doula services is limited, trained doulas are available in many communities throughout the United States. Typically, a woman (and her partner, if she has one) selects a doula during pregnancy, and they discuss the woman’s goals, preferences, and concerns. Some hospitals sponsor doula programs to increase access to continuous labor support. In addition to continuous presence during labor, birth doulas may provide some support in the days after birth.

“Hiring a doula was one of the best decisions my husband and I made during pregnancy,” said new mom Jenny McElroy. “Though we prepared by reading books, taking childbirth classes, and practicing comfort techniques, we were inexperienced with childbirth. Our doula knew exactly how to help my husband support me, help me cope with the pain, and help us stay calm and have the birth experience we wanted.”

Effective Strategy for Improving Maternity Care Quality and Value
Medicaid programs and taxpayers cover about 42% of the nation’s births, and private insurers and employers cover about half. The review authors encourage policy makers to provide coverage and hospitals to provide programs for continuous labor support. “The benefits of continuous labor support for mothers and babies are numerous, well established, and compelling, and warrant economic analyses of the relative costs and benefits,” said Maureen Corry, MPH, Executive Director of Childbirth Connection. “Medicaid programs and others seeking ways to improve maternity care quality and value and women’s experiences of care should consider continuous labor support as a key component of a high-quality, high-value maternity care system.”

Resources for Childbearing Women, Health Professionals and Policy Makers
Childbirth Connection’s website includes an in-depth evidence-based section to help childbearing women understand the benefits of continuous labor support, decide whether to have a continuous labor support companion, and arrange for such care (see The professional area of the website includes a summary of results of the updated review and provides access to the full review, at

Thursday, February 10, 2011

Doulas and Homebirth

In a previous post, I discussed how doulas can benefit women with various different birth plans and support scenarios, but a commenter notified me that I left one out...

How can a doula benefit me if I'm having a homebirth?

Part of the answer to this question relates closely to another post I started a long time ago but haven't finished yet about the similarities and differences in the roles of doulas and midwives. I will try to get that finished soon so that it can complement this post. I believe that the role of a midwife is meant to encompass the role of the doula, but it doesn't always happen that way.

I think that the degree of necessity for a doula in a homebirth is going to vary depending on several factors. The following are some situations where it would be to your advantage to have a doula at your homebirth:

busy midwife: If your midwife is at another birth when your labor begins, she may send a partner to be with you. You should be given an opportunity to meet any partner your midwife works with before your birth, but you may not have the same relationship with her you you have with your own midwife, but you will have that relationship with your doula.

absent partner: If you are a single mom or there is a chance your partner may not be present for the birth, a doula can act as your primary birth partner. This may also apply if you have a husband who is uncomfortable with playing an active role in the birth, disturbed by blood, etc.

sometimes even homebirthers need to be protected from trauma: Unfortunately, not all midwives are as gentle and respectful as what most homebirthing moms are looking for. I recently came across some birth stories of women (the blogger at Mandala Mom and Dy at Complete Beginnings) who hexperienced trauma because of the way they were treated by their homebirth midwives. I will give the founder of the midwifery method implicated in these posts the benefit of the doubt, and say that I don't think she intended for her ideas to be used this way, but I think it is important to understand that things like this can happen, and would like to propose that a good doula can help you find your voice when a provider (even a midwife) is trying to do something to you that you do not want. The women in the stories above both said that they had no indication of their midwives having anything in their philosophy that they disagreed with. All birthing women need to watch out for themselves, and a doula can be your watchdog.

What if I want an unassisted birth?

I am by no means an expert on UC. I imagine that for some women, hiring a doula may not align with their reasons for choosing an unassisted birth. Others may see a benefit to having an extra person around who knows about unmedicated birth is experienced in birth support in case you need an another pair of hands for something.

Monday, February 7, 2011

Giveaways for moms and birth workers

Sheridan at Enjoybirth is doing two giveaways on her blog. One is for birth workers and one is for moms. (Since I am both, I'm entering both giveaways).

For Moms: Tag*a*Long Giveaway

The Tag*a*Long is a handle you can attach to a stroller for a child to hold on to while you push the stroller. I think this is a great idea. We don't own a double stroller because when my son was smaller, I'd wear him in my wrap and my daughter would ride in the stroller. Now that they are bigger, I like to put my son in the stroller and have my daughter walk, but she needs something to hold on to so she doesn't wander and the Tag*a*Long would be perfect because if she holds onto the stroller itself she is in my way.

For Birth Workers: $25 Injoy Gift Certificate Giveaway

Injoy supplies birth and parenting educational materials, including videos and web-enhanced booklets. Many of the materials would be a great supplement to any childbirth education program or could be used as an informative resource for doulas or for healthcare providers.

If you are interested in either giveaway, check them out today!

Wednesday, February 2, 2011

Three years ago today...

...I gave birth for the first time. That's right, my baby girl is three years old today. We are doing the celebration with a little party with a few friends on Saturday. I have spent a lot of time thinking and writing about her birth over the past three years--trying to understand exactly what happened and why it happened, how I felt and what caused me to feel that way. I even wrote a very extensive paper about it for my doula training course. In the end, I realize that it really was a good birth. Would I do some things differently if I were doing it all again with the knowledge I have now? Yes. But what happened is what happened and it was really not bad. I really was not adequately prepared for labor and I think that even without the pitocin, I would have needed to re-evaluate my plans for unmedicated birth when I got into active labor. I really believe that.

Pam England, author of Birthing From Within, has a blog called Birth Peeps. Her current theme for her blog is Fifty Ways to Change Birth in Our Culture. Change #2 was Tell Children A Magical Story of Their Birth, and I really love the idea.

So, here is my daughter's magical birth story:


I wanted to have the best chance at a great birth for you, so I switched to a group of midwives late in my pregnancy. I was supposed to try to see all the midwives at least once before you were born, but through some random chances, I ended up seeing, one midwife, Mindy, a lot more than any of the others. I think our Heavenly Father knew that you would be born when it was Mindy's turn to be at the hospital, and it was a blessing that she knew us as well as she did.

The night you were born was very dark and there was snow on the ground outside. Your dad and your Grandma were there in the room. The room had a big window with a view of the Mt. Timpanogos temple, which was all lit up. The curtains were open, and the light from the House of God guided you into the world.

When it was time for you to be born, my womb opened and you came down my birth canal and into midwife Mindy's hands. She put you on my belly. I was so happy you were here. I looked at the window, and I saw the reflection of me holding you, while the temple glowed in the distance. I pray that the Lord's Holy House will always be your guiding light.

I love you, Princess, Happy Birthday!

Photo 12/23/2010 by JC Photography

Tuesday, February 1, 2011

Video of an OBGYN speaking on timing of cord clamping

I wanted to share the link to the video Dr. Nicholas Fogelson posted on his blog of him speaking at a Grand Rounds on the topic of Delayed Cord Clamping. It is a 50 min talk shown in four parts, check it out if you can make the time.

Delayed Cord Clamping Grand Rounds--Academic OB/GYN

From Dr. Fogelson's conclusion:
Delayed cord clamping clearly increases fetal hemoglobin, blood volume, and iron stores. The evidence supports a clinical benefit of delayed clamping. There’s really no strong evidence against delaying the cord clamping. When we talk about interventions in medicine, really, the burden of evidence is on the intervention. And I think people say. “Delayed cord clamping, you can't prove that that’s an intervention that helps.” And I’m like, oh, no, no, no, no. Delayed cord clamping is what we evolved to do. We evolved to get the blood that’s in the placenta. I don’t have to prove that that’s right. You need to prove to me that phlebotomizing the baby of forty percent of its blood volume is right."
I personally would see it from a perspective of God's design, and not evolution, but I think his point about the burden of evidence is spot-on. I think it would make sense to look the same way at a lot of other common routine maternity care practices.