OB common practices often based on opinion

In new study by Dr. Jason Wright and colleagues of Columbia University in New York, it is found that of 717 common OB-GYN practice recommendations from ACOG (American College of Obstetricians and Gynecologists), just 30% are based on top-notch research. Another 38% are based on observational studies, and another 32% are just expert opinion.

The study is a call for better evidence and, as it relates to you, the consumer, can be an alert to the fact that the jury is still out on many of the common practices that are perceived as ‘the only way’ childbirth operations can work in the US. Here is the link to the full article from it’s original publisher.

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Getting to the nitty gritty of the Cesarean Rate

The c-section rate is still on the rise, up to 34%, and Dr. John Queenan predicts the rate will soon approach 50% in his article “How to Stop the Relentless Rise in Cesarean Deliveries,” published in August in Obstetrics and Gynecology. Queenan is deputy editor of said publication, and his editorial is a call to care providers to rein in the rate before stakeholders or governmental action take them by force. Queenan offers two solution to his complex question: 1)”make VBAC more accessible and more desirable” and 2)”prevent primary deliveries in the first place.”

His strategies include

  • implementing hospital quality improvement programs,
  • increasing utilization of midwives,
  • addressing problems in the liability system, and
  • improving shared decision making.

Woman, take note. The decision makers are hearing the alarms, too.

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Alpha Childbirth: New Classes

I may not be able to accept doula clients at this time, but I am happy to be spending some of this sabbatical time delving deeper with Alpha: Christ Centered Childbirth Preparation. Gaylea and I are happy to say that we have trained some wonderful new instructors, and will be able to reach Middle Tennessee with more class offerings. Classes will now be available in Hendersonville, Nashville, Franklin, Clarksville and Murfreesboro. For more info, click on over to alphachildbirth.com .

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Where am I?

I have been on a pregnancy and birth journey. I’m sorry to have been missing for so very long. The journey has been marked by hills, along with their coinciding valleys, which culminated in the birth of a beautiful baby girl, Olive Wren. Our journey began almost exactly a year ago, on Labor Day 2010, when two lines appeared on a home pregnancy test! The fall and winter were exciting, yet also marked by severe all day sickness. I took comfort knowing that my hormones were very strong with the pregnancy, but also wondered at how much sicker I felt with this pregnancy than with my first. February was tumultuous in that I came down with appendicitis, and underwent surgery to have the offender removed. At 25 weeks pregnant, it was quite a roller coaster. Most often people want to know if I was scared. I was scared, but painkillers certainly dulled my emotions. Our friends and family surrounded us with love and prayer, and thankfully we both came out safe on the other side of surgery, just appendix-less. All day sickness continued throughout the duration of pregnancy, and I really focused on spending time as our family of three, as I knew that our daughter’s arrival would change everything.

We had a beautiful, uplifting labor that we spent together as a family of three, and Olive arrived early on a Sunday in May at Infinity Birthing Center. Our family is a little larger, but not large, and we are absolutely on cloud nine watching our children grow, learn, and love.

I hope to incorporate posts from our personal pregnancy journey in the next few months, so stay tuned. And for now, August 2011, I am not able to serve as a doula. Breastfeeding a three month old and doula-ing are not compatible for me. However, I have some wonderful doulas I can refer you to, and I hope to continue to bring you information about healthy pregnancy, childbirth, and newborn-ness during this doula hiatus. Thank you for being a friend.

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Doing your kegels? Great, now stop and move on to squats.

This is relatively an old article. As in over a year, but less than two. To me, the layman, the argument makes sense. The interviewee, Katy Bowman, is a biomechanical scientist, who applies her knowledge to the human body. I started paraphrasing Bowman’s argument here, but it is such a step by step, thorough argument, that a quote does it better justice (an better understanding for you!)

A kegel attempts to strengthen the PF, but it really only continues to pull the sacrum inward promoting even more weakness, and more PF gripping. The muscles that balance out the anterior pull on the sacrum are the glutes. A lack of glutes (having no butt) is what makes this group so much more susceptible to PFD. Zero lumbar curvature (missing the little curve at the small of the back) is the most telling sign that the PF is beginning to weaken. Deep, regular squats (pictured in hunter-gathering mama) create the posterior pull on the sacrum. Peeing like this in the shower is a great daily practice, as is relaxing the PF muscles to make sure that you’re not squeezing the bathroom muscle closers too tight. Just close them enough…An easier way to say this is: Weak glutes + too many Kegels = PFD.

To see the full article from the blogger Mama Sweat: Pelvic Floor Party: Kegels are NOT Invited.

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The Natural Cesaraean by Jentle Childbirth

I post what I see. I saw this, and found it to be an intriguing alternative to our traditional cesareans performed routinely. I particularly am intrigued by their description and execution of “a ‘natural’ approach that mimics the situation at vaginal birth by allowing (i) the parents to watch the birth of their child as active participants (ii) slow delivery with physiological autoresuscitation and (iii) the baby to be transferred directly onto the mother’s chest for early skin-to-skin.”

Is it possible to have this experience here in the States? I don’t know. I don’t know if they are able to perform this kind of surgery on every cesarean candidate or only certain candidates that meet certain criteria. I am not a medical professional. I DO know that there are some striking differences between these care provider’s practices and many of our local ones. My initial reactions are 1) the OB is performing the surgery, but it is the midwife’s responsibility for the overall well-being of baby and mum; 2) delayed cord clamping is compatible with cesarean birth!; 3) I love the slow delivery from the uterus to help force the fluid out of baby’s lungs.

Under more scrutiny, this video is from the UK’s leading midwife, Jenny Smith. Here is her website: jentlechildbirth.org

Posted in In the News, Medical Interventions, VBAC & Cesarean Birth | Tagged , | 2 Comments

Their Birth Plan

This is old news. But some folks have been recently been interested in this. I had found their birth plan shortly after their letter about ‘no birth plans,’ but somehow failed to follow up with their plan for patients. So, in the interest of completion (better late than never), here is their birth plan:

Kingsdale Birth Plan

The physicians at Kingsdale Gynecologic Associates congratulate you on your pregnancy and hope that your journey through pregnancy, labor, delivery and beyond is exactly what you wish for.  Our primary goal is to provide you and your baby with the medical expertise, experience and support you need to have a healthy pregnancy, a safe delivery and a wonderful experience.

We recognize that this is a very busy time for you and your family and wish to help minimize the work ahead of you by providing our advice and philosophy in this “birth plan.”  By understanding how we practice and why, we feel that any other formal birth plans (often recommended by books and websites) are unnecessary.  If you have specific requests not discussed in this birth plan, please speak directly with your care provider about them.

IV’s: Patients often ask us if IV’s are necessary in labor.  The answer is “yes.”  Although we usually give IV fluids through the “hepwell” to keep you hydrated and nourished through the labor process, the most important part is the “hepwell” itself.  If we run into an emergency situation where your life (and the life of your baby) is in jeopardy, we do not want to lose time to intervene by not having IV access.  This is obviously a rare occurrence, but often an unexpected one.

Nourishment in labor: We usually limit women to ice chips and popsicles during labor.  This is not designed as an attempt to starve you.  Women often get nauseated, and sometimes vomit, during labor, which can be not only miserable but also dangerous.  In addition, if emergency surgery is required, an empty stomach will predispose you to much less risk.  Of course, we will give you nourishment and hydration through the IV as necessary.

Anesthesia: We respect a patient’s desire for pain control, or lack thereof, in labor.  The hospitals have multiple options for pain control including positioning techniques (birth balls, etc.), IV pain medication, and regional anesthesia.  Labor, unfortunately, is a painful process.  It is also an unpredictable process and we thus encourage you to have an open mind about your pain control needs.  Some labors are quite rapid and tolerable while others require a great deal of patience and intervention.

Labor without anesthesia: If your goal is to labor without an epidural, we do recommend that you attend an in-depth birthing class that teaches you about focal points and breathing techniques.  The labor and delivery nurses are also quite skillful at helping women with alternative positioning that will help both with the labor and the birthing processes.  Although you will always be supported in your decision to labor without pain control, you can always change your mind if necessary.

IV pain medication: IV pain medication if available for use during labor.  The medication can often make women a little sleepy and is said to “take the edge off.”  It will not completely alleviate the discomfort of labor.  We try not to use IV pain medication close to the time of the actual delivery as it depress the baby’s drive to breathe.

Epidurals: Both Riverside Methodist Hospital and The Ohio State University Medical Center have anesthesiologists assigned to the labor and delivery unit who are readily available for the placement of epidurals.  There are unfortunately occasional delays in placement secondary to demand, but the anesthesiologists will always respond as quickly as possible.  The epidural anesthesia is the most common form of anesthesia for labor and delivery because it provides good pain control with little or no effect on the baby.  The epidural will make you somewhat numb from the waist down, therefore you are generally not able to walk after placement.  The nurses will continue to help you with position changes that will facilitate the birthing process.

The choice to use anesthesia or not is ultimately your choice.  There may be situations where we will recommend certain pain management options for you in order to provide the healthiest and safest option for you and your baby.  Ultimately, we want the birthing process to be one you can enjoy and remember fondly.

Fetal monitoring: In order to provide the safest possibly delivery, we feel that fetal monitoring is important during labor in order to assure that your baby is tolerating the process well.  We often accomplish this with continuous external monitors that are placed against your abdomen with elastic belts.  We will occasionally allow intermittent monitoring during walking and the hospitals have protocols for these times.  If we are concerned about the adequacy of labor or fetal wellbeing, we occasionally use internal monitors, which are more precise.  The intrauterine pressure catheter (IUPC) is a device that goes next to the baby to monitor the strength and frequency of contractions.  The fetal scalp electrode is applied superficially to a baby’s scalp to get the most accurate fetal heart monitoring.  We will not use these internal devices unless we feel they are medically indicated.

Labor support: We do recommend that you have a good support person or two during labor.  We recommend this person to be a spouse, partner, family member or close friend that you feel comfortable sharing such an important event with.  We recommend that you choose someone who will give you comfort when needed, let you rest when needed and who will add to your experience, not take away from it.  The labor and delivery nurses and doctors together act as “doulas” in a sense that we will be your advocate to provide positioning options, pain control and pushing techniques to make the process as easy as possible.  Your support person should be there to do just that–give support.

Mode of delivery: Our goal is to provide you and your baby the safest delivery.  We do occasionally need to do c-sections for delivery when it is necessary for you or your baby.  We never do c-sections for our own convenience.  If it looks like this may be needed for delivery, we will of course discuss this with you and your support person in detail.  We occasionally need to use forceps and vacuum extraction devices to facilitate vaginal birth, but again, this is always for maternal or fetal indication and will be discussed with you and your support person at the time.

Episiotomies: During the pushing process, the labor and delivery nurse and/or physician will likely perform perineal massage in order to stretch the tissue to accommodate the baby’s head and reduce the risk of tearing.  Although we try to avoid cutting episiotomies, this safe procedure is sometimes required to facilitate birth and to avoid severe tearing.  We promise to use our medical expertise and experience to make the best and safest decision for you and your baby.  The physicians at Kingsdale do not cut episiotomies solely due to “routine” practice.

After delivery: The birth of your child is truly an amazing event.  We want you to be able to bond with your baby as quickly as possible.  If the baby does not require immediate resuscitation, we will usually place the baby on your abdomen or chest, stimulate the baby there, and allow your support person to cut the umbilical cord.  Unfortunately there are situations that necessitate quick response from the pediatric staff in order to care for your baby.  This usually occurs in your room at the infant warmer.  If you and your baby are doing well after delivery, we will try to keep the baby in your room with you as long as possible, often transporting both of you to the postpartum floor together.  If desired, you may attempt “skin-to-skin” care and breastfeeding at this time.  With c-sections it is often necessary to take the baby to the nursery prior to your own transport.  In these situations, we will try to get you to your room as quickly as possible to reunite you and your baby.

We hope that this clarifies many of the questions about the birthing process that you may have along the way.  Please feel free to ask questions and obtain clarification if needed from your individual provider.

“Birth is the sudden opening of a window, through which you look out upon a stupendous prospect.  For what has happened?  A miracle.  You have exchanged nothing for the possibility of everything.”   -William MacNeile Dixon

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Nitrous Oxide on it’s way back to the US market for laboring women

I was thrilled to have heard this on the radio news report yesterday! In the past year I have had more than a few clients asking me about it’s availability for their hospital births. Laughing gas takes the edge off of labor pain, can be self-administered, and is covered by insurance. It could take the middle ground between an epidural or nothing at all. Laughing gas is used commonly in the UK and Canada to help women cope with labor pains, but it is currently only in two hospitals in the US.

That’s about to change. Special recognition to Vanderbilt Nurse Midwife Michelle Collins for her quote in the article and undoubtedly the many hours of work she has logged getting this change to occur. Vanderbilt patients, it sounds like the road for laughing gas has been paved, and you could reap it’s benefits during your labor soon (purely my inference on reading the article).

So here’s the full article from abc news: Not Just for the Dentist: Nitrous Oxide Returning to Delivery Rooms .

Posted in Managing Labor, Medical Interventions | Tagged , | 2 Comments

What is safe during pregnancy?

And now, another informational resource for the preggers among us. The Organization of Teratology Information Specialists (let’s call them OTIS, and as if either of these titles have given you any clue as to what they do) has a wealth of information for us to, as they say “raise mom’s awareness and reduce baby’s risk.” And here’s your factoid for the day: Teratology is the study of birth defects caused by exposures during pregnancy.

So how can OTIS help you? Have you been wanting to get to the bottom of the caffeine confusion for pregnant women? Can you remember which over the counter drugs are safe during pregnancy or for lactation? What about a disease that you’ve been exposed to while pregnant? You can read factsheets written in layman’s terms on OTIS’ comprehensive website. Their factsheets cover medications, herbal remedies, infections and vaccines, medical conditions in the mother, illicit substances and common exposures, such as alcohol, caffeine, hair products, etc. Overall, I’m impressed and love this resource.

To answer one of my hypotheticals above, see this blog post on caffeine consumption. “ACOG concluded that moderate caffeine intake, no more than 200mg of caffeine per day, during pregnancy does not seem to be a factor in increasing a women’s risk for having a miscarriage or a preterm delivery.”

And how much is 200 mg? Here are your common caffeine amounts per the USDA:

Dark Chocolate 1.45 oz = 30mg
Milk Chocolate 1.55 oz = 11mg
Coffee 8oz = 137mg
Tea 8oz = 48mg
Soda 12oz = 37mg
Hot Cocoa 12oz = 8-12mg

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Breastfeeding Legislation Needs Your Help and NOW

This bill deletes the age limitation in the statute that permits mothers to publicly breastfeed their children who are age 12 months or younger. ”

Here is a link to the actual bill: http://www.capitol.tn.gov/Bills/107/Bill/SB0083.pdf

Sen Faulk is the sole sponsor of this important legislation. Unless they find a sponsor in the House this bill will not be heard this year. Please contact your local House Rep and ask them to sign on as a sponsor, and at the very least support the bill when it comes before them. All bills have to be filed by next Thursday, the 17th, so we have a lot of work to do!

You can find your State House and Senate Reps here : http://www.capitol.tn.gov/districtmaps/, or by going here http://www.capitol.tn.gov/legislators/ and entering your street address.

Also, Sen. Faulk’s assistant said that they have gotten a lot of calls on this legislation and that the feedback is only slightly in favor of breastfeeding. That means that more people need to call his office and express their support. Please call Sen. Faulk’s office at (615) 741-2061 and tell them that you support SB0083.

Please share this with anyone who might help!!

From Megan Morton, Co-Leader of Nashville Birth Network

Posted in Breastfeeding, Nashville Resources | 2 Comments