Friday, October 30, 2009

The Waterfall Effect

In my experience as a birth doula and childbirth educator, I have observed something, known to those in our profession, as the "Waterfall Effect." It's kind of like when you set out on a journey, and you expect a beautiful trip. You are sailing along and you think everything will go smoothly, when things start to take a turn in a direction you hadn't really wanted to go. And the more you start paddling, trying to correct your direction, the more you start drifting toward the place that takes you over the waterfalls, plunging you into the depths below.

Here's how it typically starts.

Let's say you are a week past your due date. 
So your doctor says, " I think your baby is too big to wait any longer. Besides, the longer we wait, the higher the risk for stillbirth."
So he says, "Let's induce you tomorrow morning." And because you trust your doctor, and are afraid, you say. "O.K"

So you arrive at the hospital and they start an IV, and tell you that you can't eat.
Then they hook you up to an external monitor and break your water and start you on pitocin.

You want to move around, and get in the tub like you learned in childbirth class, but you are confined to the bed, because when they broke your water, the baby's heart rate went down a little.
They tell you that they want to" watch and wait a little while" and keep you in the bed.

The heart rate looks better in the monitor but you aren't having many contractions so they "up" the pitocin.

Three hours later, you are having a few regular contractions but they are not strong enough to change your cervix, even though they are really hurting because you can't move around.  And you are getting a headache from not eating, and because your head is hurting and the contractions are hurting, it is making you nauseated, and so you throw up. Three times. And so they give you some phenergan and it makes you woozy and sleepy but at least you aren't nauseated anymore. But the contractions still hurt. A lot.

So then they say to you," Let's just give you a walking epidural". You hadn't wanted an epidural at all, but these pitocin contractions feel so terrible and your head is hurting from not eating and you just want to do anything to feel better. And you say "OK".

All the while you are thinking "This isn't the way I wanted it to be, but what was I thinking? I must have been crazy to think I could have done this without drugs."

So the anesthesiologist walks in and you say, "Man, am I glad to see you !" and he says "That's what everybody says!" and he gets busy putting the medicine through the catheter into your back.

When he finishes, you lie back down and he leaves the room, promising you that you will feel better very soon. And he was right......except your labor stops completely ! And you still have a headache and now you have the shakes and you are still only 4 cm. You know this because they just put in an internal monitor.

So the nurse comes in and ups your pitocin again. But you can't feel it and you are glad.
Another 8 hours goes by and you doze on and off except for the occasional vaginal exam and the blood pressure cuff squeezing your arm wakes you up often enough that you never really rest.

And they come in an check again and announce that you are only 8cm. And then they say, "While you were dozing, we noticed that the baby's heart rate patterns were not assuring. So we have gone ahead and prepped the OR for a cesarean. We are going to watch you carefully, but if you don't make really good progress within the next hour, we are going to do a cesarean".

And you don't, and they do.

And you have complications, including excessive bleeding, and an allergic reaction to one of the antibiotics.
Your baby is fine with good strong apgars, in spite of what the heart rate monitors indicated.
But you feel too sick to interact with your baby or try to nurse him.
So the hospital gives him formula for his first feeding.....and his second and his third.
So you feel horrible, physically and emotionally and you cry.

And when you finally get to put your precious baby to your breast, he won't latch on.
And your milk isn't coming in well. And you are afraid that it never will.
And for many months afterward you second guess your insticts about everything when it comes to mothering your baby. You feel sad, alone, confused and defeated, but you don't know why.

Please don't let the waterfall carry you away and plunge you into the depths of depression. There is help for you. Many, many women have been swept away by the Waterfall Effect and have found their way home again.

Thursday, October 29, 2009

Good Night, Sleep Tight

Yesterday's blog entry was inspired by a comment on facebook to a new mother who was  happy that  her baby had  finally slept long enough that she could get some much needed rest. One of her friends chimed in with something along the lines of "Oh, have you read BabyWise?" which led me into a diatribe of why I think BabyWise isn't. But, I digress.

So, today is the day I do reviews of resources I find helpful in my work with parents as a certified postpartum doula.  I want to heartily recommend The Baby Sleep Book, The Complete Guide to a Good Night's Rest for the Whole Family, by four supremely qualified individuals, all belonging to the Sears family. They are all health care professionals AND parents. This book is everything you need to know about getting your baby or toddler to sleep, from some of America's foremost baby and childcare experts.
The forward is written by Dr. James McKenna, director of the Mother-Baby Sleep Laboratory at the University of Notre Dame.
I like the way that the authors give parents practical tips and tools while understanding that every parent and baby are individuals. Their tips will help you form your own style and how to become an expert in your own baby.  
I like the fact that the authors write to both parents, and include tips for mother and fathers.
Instead of recommending a rigid approach, they explain how you can create a sleep plan that meets the needs of your unique family. Instead of claiming that parents are "in bondage" to their baby ( like the Ezzo book ) the Sears books offers a flexible and sensitive approach to helping the entire family meet their needs for restful sleep.

The Sears also offer tips on their online Sleep Forum

I hope you will also find this resource helpful with your baby or toddler.

Wednesday, October 28, 2009

Is Babywise a Trick or Treat ?

Trick or Treat ? It's Babywise !

OK, so it's Halloween week and it doesn't surprise me that one of my pet peeves seems to be raising it's ugly head, kind of like a vampire or zombie that refuses to die or Glenn Close jolting up out of the bathwater in Fatal Attraction.

But as an advocate of healthy and safe parenting, I am here today with my "Wac-a-Mole" mallet to beat this menace down, yet again.  "How militant!" you might say. Let me be clear. When I see this book for sale, I have made it my personal mission to buy it JUST  for the sheer pleasure of throwing it away.

Growing Families International [GFI] has been controversial within the Christian church for a long time, but more recently within the secular realm. With the publication of Babywise, Gary Ezzo extended his controversial parenting method into the secular world. 

Many, many keystrokes of parents and professionals have been logged on the internet about this controversy, and I am only nicking the surface of it in my blog post today. For more than you would ever want to know, please visit these sites.

Here's a little history.
Circa 1985 -- Anne Marie Ezzo, Gary's wife, authored and circulated a 4-page paper titled "Parent Controlled Feeding". Although contradictory at some points, it included:
  • a sample timetable for "the first four weeks" which laid out feedings at 4 hour intervals
  • advice to consider formula supplementation if the baby, by three weeks of age, isn't able to go 3-4 hours between feeds
These practices are not based in scientific evidence and have not been endorsed by leading authorities in infant feeding and health.

1989 -- The version of Preparation for Parenting that was circulating at this time including teachings which:
  • criticised demand feeding (the practice endorsed by the American Academy of Pediatrics),
  • criticised mothers who respond to their babies' cries, calling these practices incompatible with scripture, practiced by an "extreme fringe," primitivistic, humanistic, based in evolution, emotional, idolatrous, unhealthful, harmful to marriage, and the cause of health and developmental problems.
  • advised parents that by three weeks the baby should only be feeding every three to four hours, with formula supplementation as necessary to achieve those intervals.
  • instructed that the baby was to be sleeping through the night by six weeks, enforced by letting the baby cry it out if necessary.
    Source: quotes on file from Preparation for Parenting c 1989

1993 – 1st edition of Babywise was self-published by Growing Families International. This edition was nearly identical to Prep for Parenting, except that:
  • The explicit religious language was removed ( thank God )
  • Dr. Robert Bucknam added a foreword, praising the earlier Ezzo material which had so impressed him, and denigrating "instincts," advice to feed more often as a solution to hunger, and the practice of feeding at two hourly intervals (p.11)
  • For babies from 0-8 weeks of age, the book recommended 3 to 4 hour feedings.
  • This edition touts a benefit of fewer feedings: fewer diapers to change. (pp. 133-134.)

May 14, 1996 –The Child Abuse Council of Orange County appointed a  task force to evaluate following complaints by area health care professionals who had observed dehydration, slow growth and development and failure to thrive among babies on Ezzo programs.
The Ezzos also published so called "Christian" Parenting materials called : Growing Kids God's Way.
First of all, many Christians, myself included, find it odd that Gary Ezzo should pontificate and define for the rest of us what "God's Way of parenting should look like, especially in light of all of the bad outcomes which have been reported. Critics who have evaluated Growing Kids God's Way, Childwise, Babywise, Reflections of Moral Innocence (the Ezzos' sex ed curriculum) and other Ezzo books and curricula have shared several concerns about the expectations of child behavior these books promote.

  • Lack of age appropriateness. Requirements of child behavior do not consider age appropriateness or basic principles of child development.

  • May support parental failings and selfishness. Warnings against being "child-centered" are insufficiently balanced by acknowledgment of the extent to which parenthood involves self-giving and self-sacrifice or by awareness of the parents' own fallibility.

  • Lack of proportion. Big issues and small are treated as equally urgent matters over which parents must have control. Insisting on tight control over all matters can lead to power struggles.

  • Limited interpretation of behavior. Behavior is viewed through the lens of obedience/disobedience without adequate consideration of factors such as teething, illness, developmental stages, and emotions such as fear, loneliness, etc, that might cause or influence the behavior.

  • Undermines the developing relationship between parent and child. The level of control required by the program tends to create an adversarial relationship between parents and child, which may interfere with attachment.  Experts regard attachment as the foundation of mental health and say it develops as parents respond to the baby's cues, rather than in the context of parental control. 
Secondly, Ezzo's warped theological perspective produces this "jewel" of exegesis.
When using the crucifixion of Jesus to justify letting an infant cry. ``Praise God that the Father did not intervene when His Son cried out on the cross,'' in Preparation for Parenting.

Here are some quotes I have found from mothers who have used the program.

"I, being a first-time mom, terribly unconfident, and eager for something structured and quantifiable, bought into [the book], wholeheartedly. It was a disaster. The first three months of my firstborn's life were filled with frustration"

""My frustration is that it seems the Ezzos never took into consideration the moms who suffer from PPD. My depression was pretty debilitating and when my son wasn't "following the program" so to speak, it created a lot of additional stress."

"I took her to the hospital where she was diagnosed as FTT ("failure-to-thrive").   She spent three days in hospital.  I was told to burn Babywise and that babies should be fed on demand, that breastfeeding was a supply and demand process."

"In my mind, I knew that I should call La Leche League for help, but after reading the warnings in [Babywise], there was no way I wanted to get mixed up with those "attachment-parenting types," so I chose to give up and exclusively formula feed."

"When J. was about 3 and a half months old, I started thinking he looked a little skinny."

"I remember laying on the couch listening to her cry and cry thinking motherhood wasn't supposed to be like this."

"I would have said that we were happy following Ezzo, but I can honestly say that we are much happier now. I am so much less stressed out! I didn't realize how much stress Babywising put on me until I quit..."

"I want to share our story in the hope that it may perhaps help to warn others who are heading down the Growing Kids God's Way path. We still ask ourselves, how could we have been deceived for so long?..."

"I would give anything in the world to be able to turn back the clock and learn about the concerns and controversy surrounding Ezzo's methods *before* my dear daughter was born..."

"But even if Babywise and Prep may have a few helpful ideas, there is more chaff than wheat. As someone else has said, "What is good is not unique--you can find it in other safer books. What is unique is not good." In spite of the few helpful ideas I NEVER recommend the books to anyone. Why? Too much possibility that someone could be seriously hurt from them. I don't want that responsibility"

"Please, don't just take our word for it. Do your own research. When you are finished, we be-lieve you will draw the same conclusions we have. We thought we were following sound parent-ing information and doing what was proclaimed to be in the best interest of our son. We could not have been more wrong, and we will always live with that knowledge. We now believe nurs-ing on demand, especially in the early months of life, is among the most critical things one can do for the long-term health and well-being of their child. The harm that has been associated with the Ezzos' parent-directed feeding schedules is not always easily undone, and is simply not worth the potential risks. No other child or parents deserve to endure what we have suffered."
"With both boys I lost my milk between 4 and 5 months. I was unable to get it to come back, I tried all the tricks. Every 3 hours is not enough stimulation for my milk supply in the early months and it affected my supply later on. We were also very heavy into using punishment
(spankings) but now we are not. Our children are now better behaved since we stopped using those tactics with them."

"What was the worst we suffered from the materials?
Believing that every night waking, every phase, everything our kids did, was because they were trying to manipulate us or control us, or defy us. That everything had to be "handled". It's a twisted, sick mindset against your own children - and it's simply not true. We have come a long way - and still have a long way to go. We are far removed from that mindset now, but it haunts us. We find more and more that the truth is that children are new, all that they do is experimentation, and normal. A good dose of guidance, understanding and teaching goes 10 times farther than one punishment."

If you have questions or are frustrated with infant feeding issues, especially breastfeeding, please talk to a qualified professional, and seek the time trusted advice of someone like Dr. Sears.  

Dr, Sears has authored numerous books of preganancy, birth, breastfeeding and parenting, including great books on nghttime parenting, fussy babies, discipline and many, many more.

Here is an excerpt from Nighttime Parenting by Sears  published on the La Leche League website that talks about SIDS. ( Sudden Infant Death Syndrome )

Tuesday, October 27, 2009

"V Section" is often as Traumatic as "C Section" for Many Woman

Did you know that for many women, a vaginal birth with an episiotomy can be just as traumatic and painful as birth with a cesarean ? It's true. The birth of my oldest child, who weighed on 5lbs and 5 oz was delivered via a mediolateral episiotomy and forceps. It was extremely painful. I refer to that birth as my "V-Section" because that's how it felt to me. I felt sliced and diced. And I WAS !

I had many, many stitches that itched and burned and nothing made it go away. This continued for several weeks. I was breastfeeding and it was all I could do to turn over in the bed without pain so intense that it made me nauseated and faint feeling. I had to have someone "spot" me every time I got up to use the bathroom because I was afraid I would faint. I was completely incapacitated.

In case you are unfamiliar with the term "episiotomy", here is some information, and illustrations.

Patient Information on Episiotomy


Here is what some other women have said about their  experiences with episiotomies :

"My husband and I had a baby boy on Christmas day. The doctor performed an episiotomy and it has been 8 weeks. I thought it had healed just fine but last week on Valentine's Day my husband and I tried to make love and I was unable to due to pain in the area of the episiotomy."

"I had my only child four years ago and I had an episiotomy.  Now, four years later, my scar is itchy, swollen and irritated.  I also have been having strange feeling in my right leg that feels like something is cutting off the circulation at my upper thigh."

"My episiotomy was not slight. It was severe and not only did it take me weeks before I could pee without crying, but it took me a year before I stopped itching my crotch. It was like a yeast-infection on speed as it was healing. Not fun at all. Not only that, but it STILL doesn't feel the same down there. He cut through the muscle tissue so the whole vag-area feels just very funky and sad."

And here's a sad report about a death from episiotomy:

New Mother Dies from Episiotomy Infection

Aug. 2, 2001 - El Paso, Texas - Eight days after giving birth, a new mother died from toxic shock, due to an infection at the site of the episiotomy done while she was giving birth.  Treatments were unable to halt the progress of the infection, resulting in kidney failure, pneumonia and ultimately heart failure.  She leaves a grieving husband, baby daughter and other family.

I have known women who have developed rectovaginal fistulas after episiotomies.And I know a woman who developed a MRSA infection in her episiotomy.
These women have had to search out services like these:

Urogenital Repairs

Even though the practice of episiotomy has not been supported by the medical literature as providing any benefit in a normal vaginal delivery, many doctors still perform them routinely. Talk to your doctor or midwife about episiotomy and make an informed decision. If it were me, I would just say. "NO"!

I want a bumper sticker that reads: 


Monday, October 26, 2009

How (NOT) to Birth

Nurses at the Manitoba School of Nursing use a birth manikin simulator to learn how (NOT) to help a woman have a healthy safe birth. CRINGE.

Several things stand out to me as I watch this. First of all, research shows that it is safer and healthier to give birth in an upright or gravity enhancing position. Not only is it easier to push the baby "down" instead of "out" but lying on your back compresses blood vessels that carry oxygen rich blood to the baby. In addition, lying on your back increases the risk that you might have a vaginal or perineal tear or need a vacuum or forceps assisted delivery. Or maybe even a cesarean.

Secondly, we see better outcomes and less incidences of fetal distress when Mom is allowed to push spontaneously, as her body directs her, and it is never advised to hold your breath when pushing. This also deprives the baby of oxygen and makes the mother very tired. In the profession, we call it "purple pushing".
It can also increase the incidence of perineal lacerations.

Thirdly, while I was happy to see that they didn't whisk the baby off to a warming table, the baby should have been placed skin to skin on the mother's abdomen or breasts. This helps to colonize the baby with the mother's bacteria and facilitates bonding by increasing oxytocin levels, breastfeeding and a safe delivery of the placenta.

When will we ever learn ?

Friday, October 23, 2009

Skin to Skin is IN

Did you know that the safest and best place for your baby to be immediately after birth,  is on your skin ?
The Cochrane database, which is the best source of evidence based maternity care has this to say about having babies skin to skin with Mom, after birth:

Early skin-to-skin contact for mothers and their healthy newborn infants

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.

In many cultures, babies are generally cradled naked on their mother's bare chest at birth. Historically, this was necessary for the baby's survival. In recent times, in some societies as more babies are born in hospital, babies are separated or dressed before being given to their mothers.

It has been suggested that in industrialized societies, hospital routines may significantly disrupt early mother-infant interactions and have harmful effects. The review was done to see if there was any impact of early skin-to-skin contact between the mother and her newborn baby on infant health, behavior and breastfeeding. The review included 30 studies involving 1925 mothers and their babies. It showed that babies interacted more with their mothers, stayed warmer, and cried less. Babies were more likely to be breastfed, and to breastfeed for longer, if they had early skin-to-skin contact. Babies were also, possibly, more likely to have a good early relationship with their mothers, but this was difficult to measure.

This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2009 Issue 4, Copyright © 2009 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
This record should be cited as: Moore ER, Anderson GC, Bergman N. Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.: CD003519. DOI: 10.1002/14651858.CD003519.pub2

Here's a great place to learn more about "Kangaroo Care" and a learn about a beautiful and unique line of clothing that can make breastfeeding easier too !

Precious Image Creations

Thursday, October 22, 2009

Birthwhisperer : Reviews You Can Use

I have decided that Thurdays will be my day to post reviews of resources that I have found to be extremely helpful in helping mothers have safe and healthy births. I like to keep things simple, not to mention frugal !
There days everyone is looking for a bargain. But frugal doesn't mean cheap!
Frugality implies big value for the money. And that is what today's resource will give you.
The book, The Official Lamaze Guide to Giving Birth With Confidence, is the single best resource I have encountered in my many years of teaching about birth. It is concise, but the information that is shared is the bottom line, nitty gritty, go-to-know stuff about birth, especially if you plan to birth in a medical setting.

Some of you might relate to this comparison. I would say that this book is to birth what The Womanly Art of Breastfeeding is to breastfeeding. Formatted in a similar, easy to read way, with beautiful photos and strategically placed nuggets of  wisdom, this book will give you the information you need to plan your birth, from choosing a place of birth and a caregiver, to comfort measures that really work without compromising you or your baby's health. It will help you ask the right questions of your caregiver, so that you will not feel intimidated by all of the options and interventions.

This book is worth it's weight in gold, but for a mere $12.00, you can obtain a treasure trove of confidence, an investment that will continue to pay off for many years to come.
Click the link to order

Wednesday, October 21, 2009

Still feeling BLUE after bad birth experience ? There's help !

Many women today find themselves in a difficult emotional place, even for months after the physical effects of pregnancy, labor and birth are over. They may be afraid to talk with anyone about it. They may even question their own feelings. They may look at their baby and say to themselves" I have a beautiful, healthy baby. So why am I so sad?" Their friends and family may wonder the same thing. They may say" Why are you so down ? At least you have a healthy baby." Unfortunately, these comments, well meaning as they are, only compound the complexities of the mother's emotions and ability to talk about them. 

Some women actually experience symptoms of Post Traumatic Stress Disorder ( PSTD) after a birth experience that she perceived as threatening. 

When should a woman suspect that she has a trauma-based postpartum mood disorder as opposed to postpartum depression? When she:

• experienced an event perceived by her to be traumatic
• experiences flashbacks of the event, with vivid & sudden memories
• has nightmares of the event
• finds an inability to recall an important aspect of the event
• has an exaggerated startle response, constantly living “on edge”
• finds hyper-arousal, always being “on guard,” won’t go away
• is hypervigilant, constantly looking around for trouble or stressors
• notices herself avoiding all reminders of the traumatic event
• experiences intense psychological stress at exposure to events that resemble or remind her of the trauma
• has physiological reactivity on exposure to events resembling the traumatic event, such as panic attacks, sweating, palpitations
• is plagued by fantasies of retaliation
• finds herself to be uncharacteristically experiencing cynicism and distrust of authority figures and public institutions
• may be hypersensitive to injustice

When PTSD goes untreated or persists, one or more of the following cover-up symptoms may develop:
• Alcohol and drug abuse
• Eating disorders: bulimia nervosa, anorexia nervosa, compulsive eating
• Compulsive gambling or compulsive spending
• Psychosomatic problems (body symptoms of an emotional origin)
• Homicidal, suicidal behavior
• Inflicting injury to herself
• Phobias
• Panic disorders
• Depression or depressive symptoms
• Dissociation symptoms
• Fainting spells

In the last few years, a couple of efforts have srung up to help women identify, validate and heal from these negative feelings. 

One of them is SOLACE for Mothers
Check them out if you think you might need help.  

Another resouce is International Cesarean Awareness Network (ICAN)
They may have a local chapter near you.

Tuesday, October 20, 2009

Unhappy with your Maternity Care ? File a Complaint !

The photo below depicts a heartwrenching scene in the play BIRTH by Karen Brody, in which a mother had a cesarean she didn't want and didn't believe she needed.She felt very sad and violated and angry, and very much alone.
Today, the web is all abuzz with talk about the sign I, and many other concerned professionals and consumers, posted yesterday that reflected the attitude of one maternity care provider. At best the sign denoted ignorance beyond words, and at the worst, it was just plain malpractice and abuse. Either way, I hope that women will leave them in droves.

So many women have confided in me about their unhappiness and even outrage at things that their caregivers said or did, during prenatal care, labor and birth, or postpartum. Many women today do not know where to turn when they need help holding a caregiver accountable for their unethical behavior. Today I have included a link from the Citizens for Midwifery page that gives you very practical tips on how to file a formal complaint if you feel you have been the victim of an abusive or incompetent caregiver.

Here is the link :

YOU have power as a consumer of maternity care !
Also, if you have not filled out the birth survery, please do so.
Here is the link. This confidential survey records details about mothers' feelings about their births, and the care they received. The information will soon be available to women so that they can make an informed decision about choosing a place to give birth. Invite all women who have birthed within the last three years to take the survey.

Here is the link:
Fill Out the Birth Survey

And if you are still emotionally raw from your experience, you are not alone. There are groups that can help. Tomorrow I will be posting about resources for emotional healing after a traumatic birth experience.

Today's Mantra:

Monday, October 19, 2009

The Bullying of Pregnant Mothers

Here's a little secret. If you, as a pregnant woman see a sign such as this in your OB's office, please know that you are likely to have encountered a "caregiver" who is a bully.
And, if your OB asks you to sign something like this :

Turn on your heels and leave immediately. You and your baby's life could be in danger from the care "plan" proposed in this document. There is not one shred of evidence to show that this practices will produce a safe or healthy birth for you and your baby. In fact, just the opposite is true !

These types of OBs do not want informed patients. They want to be in total control of their patients and their births. They will not tolerate a well informed woman who has done her research and wants to be an active participant in her birth experience and the health and safety of her baby.

These types of OBs are a direct cause of the high maternal and infant mortality rates we see today.
Be afraid. Be very afraid.

Friday, October 16, 2009

The Lamaze Breathing Rap

OK, this was silly, but perhaps the "hee-hee-hoo-hoo" rhythmic breathing is precisely what you think of, when someone mentions the word Lamaze.
It's important to know that Lamaze is not a method of birth but a philosophy of birth. So having a Lamaze birth doesn't mean you have to breathe a certain way.
So, how important IS breathing in labor anyway ? Do breathing techniques help ?

Well, it IS important to make sure you ARE breathing in labor, and not holding your breath, especially during pushing. Many people don't breathe fully and therefore don't reap the benefits of deep abdominal breathing. Most people breathe up high in their chests and don't fill the lungs to capacity. When taking a deep breath, you should see your abdomen rise and fall as you inhale and exhale.

Often, when I am with clients in labor in my doula work, I will remind a Mom to "breathe down to the baby". This means, breathe deeply, to make sure plenty of oxygen is getting to the baby and also the uterus so that it can do the hard work of contacting and bringing the baby down.

Sometimes, quick, shallow breaths can be helpful at the peak of a contraction, but you must listen to your body and not hyperventilate. Most women know how to breathe during labor and only need gentle reminding or coaxing if they loose focus or become overwhelmed. Talk to your doula or childbirth educator about how to use breathing to your advantage during labor and birth.

Doula, Penny Simkin has a great DVD that demonstrates breathing techniques and other comfort measures for labor. You can order it here :

Thursday, October 15, 2009

Howling through labor ?

This mother was given medication to help her with pain during contractions.
While I found this video clip quite humorous at first glance, it's not so funny when I consider what the baby could be feeling, because this kind of medicine does cross the placenta. In early labor, narcotics may not pose as much of a risk to the baby, but given late in labor, they can cause severe problems with the baby's breathing and ability to feed. Narcotics can also have a very unpleasant effect for the mother such as frightening hallucinations and/or nausea, headache or vomiting.

When considering ways to cope with pain in labor, it is safer to start with drug free methods, such as soaking in a warm tub of water with the jets on, or having someone give you a great massage. And howl if you must :)

Wednesday, October 14, 2009

Not all childbirth classes are created equal !

Did you know that not all childbirth classes are created equal ? There are many excellent teachers out there, but there are a few questions you should ask.
1. How long have you been teaching ?
2. Do you believe birth is natural and healthy ?
3. Can you come to my home to teach, or do we have to travel to you?
4. If you work in a hospital, do you advocate for low intervention births ?
5. Are you certified to teach childbirth classes and if so, with which organization ?
6. Can you teach us how to choose a care provider that supports safe and natural birth ?
7. Can you teach us how to choose a birth place that supports safe and natural birth ?

You can be sure that Lamaze Certified Childbirth Educators have been trained to help you prepare for a normal, safe delivery. Lamaze provides exceptional training and continuing education as well as timely research updates to all of it's certified professionals.

You can find a Lamaze class here:

Tuesday, October 13, 2009

There's no place like home, for birth !

Did you know that for most women, birth at home is as safe or MORE safe than hospital birth ?
In my state, NC, many women choose to give birth at home with a midwife.
You can read about home birth here :

I have witnessed many births, in homes, hospitals and birth centers and there is nothing more beautiful than a birth where the mother has the freedom to do whatever makes her feel most comfortable and safe. She can move around, or not. She can eat if she likes. She can get in the shower or tub. She can even bake a cake or can peaches in early labor !  I have seen it !
She can go outside and take a walk in the sunshine with her husband. A mother who is at peace in her own home tends to labor more efficiently because she does not have stress hormones flowing through her body, inhibiting the natural flow of labor. She can listen to the subtle, and not so subtle cues, that her body gives her and go with it.

Midwives are guardians of safe and healthy birth. They do not view birth as something that is abnormal or something to fear. They view it as a completely normal process in a woman's life, something to be embraced and respected. Midwives are trained to spot possible complications but not to expect them. There is a difference.

Midwives know what NORMAL looks like. Because they have seen it so many times, they can more easily spot what is not normal, and respond appropriately.

Home birth is wonderful for babies too. Babies born in their own homes are at lower risk for infections and breastfeeding difficulties because they are not separated form their mothers after birth. Keeping mothers and babies together after birth has been proven by studies to keep babies healthy and safe.

Home birth is a perfectly reasonable and safe option for many women today.

Monday, October 12, 2009

Having a Baby? Ten Questions to Ask

Having a Baby? Ten Questions to Ask
Have you decided how to have your baby? The choice is yours!

First, you should learn as much as you can about all your choices. There are many different ways of caring for a mother and her baby during labor and birth.
Birthing care that is safer and healthier for mothers and babies is called "mother-friendly." Some caregivers or settings are more mother-friendly than others.
A group of experts in birthing care came up with this list of 10 things to look for and ask about. Medical research supports all of these things and it is reasonable to ask for them and expect this kind of care when you are giving birth.

When you are deciding where to have your baby, you'll probably be choosing for different places such as:
  • birth center,
  • hospital, or
  • home birth 
  •  Be sure to find out how the people you talk with handle these 10 issues about caring for you and your baby. You may want to ask the questions below to help you learn more.

1. Ask, "Who can be with me during labor and birth?"
Mother-friendly birth centers, hospitals, and home birth services will let a birthing mother decide whom she wants to have with her during the birth. This includes fathers, partners, children, other family members, or friends.
They will also let a birthing mother have a person who has special training in helping women cope with labor and birth. This person is called a doula or labor support person. She never leaves the birthing mother alone. She encourages her, comforts her, and helps her understand what's happening to her.
They will have midwives as part of their staff so that a birthing mother can have a midwife with her if she wants to.

2. Ask, "What happens during a normal labor and birth in your setting?"
If they give mother-friendly care, they will tell you how they handle every part of the birthing process. For example, how often do they give the mother a drug to speed up the birth? Or do they let labor and birth usually happen on its own timing?
They will also tell you how often they do certain procedures. For example, they will have a record of the percentage of C-sections (Cesarean births) they do every year. If the number is too high, you'll want to consider having your baby in another place or with another doctor or midwife.
Here are numbers we recommend you ask about.
  • They should not use oxytocin (a drug) to start or speed up labor for more than 1 in 10 women (10%).*
  • They should not do an episiotomy (ee-pee-zee-AH-tummy) on more than 1 in 5 women (20%). They should be trying to bring that number down. (An episiotomy is a cut in the opening to the vagina to make it larger for birth. It is not necessary most of the time.)
  • They should not do C-sections on more than 1 in 10 women (10%) if it's a community hospital. The rate should be 15% or less in hospitals which care for many high-risk mothers and babies.
A C-section is a major operation in which a doctor cuts through the mother's abdomen, into her womb and removes the baby through the opening. Mothers who have had a C-section can often have future babies normally. Look for a birth place in which 6 out of 10 women (60%) or more of the mothers who have had C-sections go on to have their other babies through the birth canal.

3. Ask, "How do you allow for differences in culture and beliefs?"
Mother-friendly birth centers, hospitals, and home birth services are sensitive to the mother's culture. They know that mothers and families have differing beliefs, values, and customs.
For example, you may have a custome that only women may be with you during labor and birth. Or perhaps your beliefs include a religious ritual to be done after the birth. There are many other examples that may be very important to you. If the place and the people are mother-friendly, they will support you in doing what you want to do. Before labor starts tell your doctor or midwife special things you want.

4. Ask, "Can I walk and move around during labor? What positions do you suggest for birth?"
In mother-friendly settings, you can walk around and move about as you choose during labor. You can choose the positions that are most comfortable and work best for you during labor and birth. (There may be a medical reason for you to be in a certain position.) Mother-friendly settings almost never put a woman flat on her back with her legs up in stirrups for the birth.

5. Ask, "How do you make sure everything goes smoothly when my nurse, doctor, midwife, or agency need to work with each other?"
Ask, "Can my doctor or midwife come with me if I have to be moved to another place during labor? Can you help me find people or agencies in my community who can help me before and after the baby is born?"
Mother-friendly places and people will have a specific plan for keeping in touch with the other people who are caring for you. They will talk to others who give you birth care. They will help you find people or agencies in your community to help you. For example, they may put you in touch with someone who can help you with breastfeeding.

6. Ask, "What things do you normally do to a woman in labor?"
Experts say some methods of care during labor and birth are better and healtheir for mothers and babies. Medical research shows us which methods of care are better and healthier. Mother-friendly settings only use methods that have been proven to be best by scientific evidence.
Sometimes birth centers, hospitals, and home birth services use methods that are not proven to be best for the mother or the baby. For example, research has shown it's usually not helpful to break the bag of waters.
Here is a list of things we recommend you ask about. They do not help and may hurt healthy mothers and babies. They are not proven to be best for the mother or baby and are not mother-friendly.
  • They should not keep track of the baby's heart rate all the time with a machine (called an electronic fetal monitor). Instead it is best to have your nurse or midwife listen to the baby's heart from time to time.
  • They should not break your bag of waters early in labor.
  • They should not use an IV (a needle put into your vein to give you fluids).
  • They should not tell you that you can't eat or drink during labor.
  • They should not shave you.
  • They should not give you an enema.
A birth center, hospital, or home birth service that does these things for most of the mothers is not mother-friendly. Remember, these should not be used without a special medical reason.

7. Ask, "How do you help mothers stay as comfortable as they can be? Besides drugs, how do you help mothers relieve the pain of labor?
The people who care for you should know how to help you cope with labor. They should know about ways of dealing with your pain that don't use drugs. They should suggest such things as changing your position, relaxing in a warm bath, having a massage and using music. These are called comfort measures.
Comfort measures help you handle your labor more easily and help you feel more in control. The people who care for you will not try to persuade you to use a drug for pain unless you need it to take care of a special medical problem. All drugs affect the baby.

8. Ask, "What if my baby is born early or has special problems?"
Mother-friendly places and people will encourage mothers and families to touch, hold, breastfeed, and care for their babies as much as they can. They will encourage this even if your baby is born early or has a medical problem at birth. (However, there may be a special medical reason you shouldn't hold and care for your baby.)

9. Ask, "Do you circumcise babies?"
Medical research does not show a need to circumcise baby boys. It is painful and risky. Mother-friendly places discourage circumcision unless it is for religious reasons.

10. Ask, "How do you help mothers who want to breastfeed?"
The World Health Organization made this list of ways birth services support breastfeeding.
  • They tell all pregnant mothers why and how to breastfeed.
  • They help you start breastfeeding within one hour after you baby is born.
  • They show you how to breastfeed. And they show you how to keep your milk coming in even if you have to be away from you baby for work or other reasons.
  • Newborns should have only breastmilk. (However, there may be a medical reason they cannot have it right away.)
  • They encourage you and the baby to stay together all day and all night. This is called "rooming-in."
  • They encourage you to feed your baby whenever he or she want to nurse, rather than at certain times.
  • They should not give pacifiers ("dummied" or "soothers") to breastfed babies.
  • They encourage you to join a group of mothers who breastfeed. They tell you how to contact a group near you.
  • They have a written policy on breastfeeding. All the employees now about and use the ideas in the policy.
  • They teach employees the skills they need to carry out these steps.
Would you like to give this information to your doctor, midwife, or nurse?
This information is taken from the Mother-Friendly Childbirth Initiative written for health care providers. You can get a copy of the Initiative for your doctor, midwife, or nurse by mail, e-mail, or on the World Wide

To Get a Copy on the Web
@2000 by The Coalition for Improving Maternity Services (CIMS).

Saturday, October 10, 2009

I Birthed Him MY WAY

And now, my baby's here
and so I'll close the bedroom curtain
My friend, I'll say it clear
 I'll state my case, of which I'm certain
I've had a birth so sweet, on Simkin's map
my labor highway
Oh but more, much more than this
I birthed him my way

Regrets, I may have few
but then again, too few to mention
I did what I had to do
for normal birth was my intention
I chose what worked for me and let the rest
pass down the byway
Oh but more, much more than this
I birthed him my way

Yes there were times, I'm sure you knew
When I bit off more than I could chew
But through it all, when there was doubt
I stood right up and pushed him out
I faced it all, and I stood tall
And birthed him my way

I've loved I've laughed I've cried
I've reaped rewards of all my choosing
And now, as I look back I find it all so darn amusing
To think I did all that
And may I say, in not a shy way
Oh no no no, oh no not me
I birthed him my way

For what's a woman, what has she got
If not herself, then she has naught
to say the things she really truly feels
it felt so good, it felt so real
let the record speak, I am not weak
I birthed him my way !

Kathryn Berkowitz, 2009 LLLof NC Conference Session
"Your Birth, Your Way"

Friday, October 9, 2009


Have you ever heard of the play called "BIRTH" ? It is the true story of eight women and their feelings about childbirth and it's very powerful ! You can laugh and cry with the characters and learn the secrets of how a woman is impacted by her own unique experience of birth.

Check out the Bold Action website and see if the show will be playing in your area. Or, if you would like to put the show together for your own community, you can find out how to do it. BE BOLD ! Even if you have never acted before, go for it ! Some of our actors last year had never been on the stage and they were fantastic. One of them loved it so much, she is going to grace us with another superb performance this year.

If you live in the NC area, you can see the play at Queen's University in Charlotte in November 13, 14 and 15, 2009. Here are a few photos from last year's performance. Oh, and let me leave you with a powerful birth mantra from the play: MY BODY ROCKS !

Thursday, October 8, 2009

The Healing Touch : Massage in Pregnancy & Labor

Did you know that massage during pregnancy and labor is very beneficial in achieving a safe and healthy birth ?

Dr. Tiffany Field, of the Touch Research Institute has conducted many studies on the effects of  massage in pregnancy and labor.

She has found that massage during pregnancy and labor can decrease the amount of stress hormones (cortisol and norepinephrine) in the body and raise the level of (dopamine and serotonin), lessen anxiety, and improve sleep patterns. Women who received prenatal massage had fewer complications and premature births. In addition, women who received massage during labor experienced shorter labors, shorter hospital stays, and less postpartum depression.

I heard her speak at the Lamaze conference last weekend, and it was fascinating. In the studies on labor, they  had the laboring woman's partner do the massage, and the results were amazing. So treat yourself to the healing touch of massage.

Question to Ponder: How do you feel about your pregnant body ?

Wednesday, October 7, 2009

You have an Advocate !

Have you heard about Mother's Advocate ? It's a fabulous resource, and it's FREE !
On the website you can find information on six simple steps to a healthy and safe birth. There are even short video clips to illustrate all six steps, and downloadable information to print and share with your caregivers.
It's "birth made simple" and I like that, don't you ?

I would like to leave you with today's affirmation :


Tuesday, October 6, 2009

Broken Maternity, A Sisterhood of Sorrow See Page 25 of the September 09 ICEA Journal

 Did you know that loosing a baby through abortion is very traumatic for some women? Were you aware that many women have found unresolved feelings and emotions catching them off guard in subsequent pregnancies ?
I would like to share my story with you.
This is not about judgment or politics. This is about getting real and finding healing.

Have You Taken the Birth Survey ?

Take the survey

Trust Your Instincts

There is a little known secret about pregnancy, birth, breastfeeding and mothering. I'd like to share it with you now. Here it is :

YOU are the best "expert" for yourself and your baby. I believe that you have been given maternal instincts that will serve you well if you will listen to them and let them lead you along the way.

There is so much information out there and it can be overwhelming. But women have been giving birth and caring for children for thousands of years, so rest assured that you will be able to do the same. All information is not equal, however, when it comes to having a safe and healthy birth.

I'd like for you to think about what that means for you, and ponder these questions.

What does a safe and healthy birth look like ?

What would it feel like ?

Who would be there ?

What would they be doing?

What would you need to make you feel safe ?

I will be sharing my thoughts about these things in the coming days, and sharing some resources with you that have been proven to lead you on a path to a safe and healthy birth. In the meantime, I would like to leave you with the daily mantra, coined by the amazing birth doula, Penny Simkin.