This Just In : Another study confirms that Vaginal Birth After Cesarean is a Reasonable Choice

STUDY:  VAGINAL BIRTH AFTER CESAREAN
A study in the June edition of the journal Obstetrics and Gynecology reviews evidence about maternal and neonatal outcomes relating to vaginal birth after cesarean (VBAC).  The authors identified relevant studies from multiple searches of MEDLINE, DARE and the Cochrane databases (1980 to September 2009) and recent systematic reviews, reference lists, editorials, Web sites and experts.  Overall, there were low rates of maternal harm for both trial of labor and elective repeat cesarean delivery.  Maternal mortality rates were higher for elective repeat cesarean delivery at 0.013% compared with 0.004% for trial of labor.  Rates of maternal hysterectomy, hemorrhage and transfusions were similar for both trial of labor and elective repeat cesarean delivery.  Perinatal mortality was increased for trial of labor (0.13% compared with 0.05% for elective repeat cesarean delivery.  The study authors concluded that VBAC is a reasonable choice for the majority of wome
n, since adverse outcomes were rare.  To access the full study online, go to http://journals.lww.com/greenjournal/Fulltext/2010/06000/Vaginal_Birth_After_Cesarean__New_Insights_on.25.aspx.

Available Online: New RSV Video for Parents

Available Online: New RSV Video for Parents
Children's Hospital St. Louis is sharing a new, web-based, two-minute informational video about respiratory syncytial virus (RSV). In addition to identifying the signs and symptoms of RSV, the video offers prevention tips with useful information. Premature infants are at a greater risk for developing life-threatening complications of RSV, a major cause of respiratory illness in young children. View the video and learn more about RSV on the hospital's "What is RSV" page
or visit the CDC website here : http://www.cdc.gov/rsv/ 

Breastfeeding Shown To Decrease Incidence of Fever After Immunization

A recent study conducted at a vaccination center in Naples, Italy evaluated the effects of breastfeeding on the risk for fever after routine immunization. Mothers of babies scheduled to receive routine immunizations were instructed how to measure and record infant temperature on the evening of the vaccination and the next three days.  Information about the incidence of fever was gathered by telephone on the third day after vaccination.  450 infants were included in the study.  Fever was reported for 25% of infants who were exclusively breastfed, 31% of infants who were partially breastfed and 53% of those who were not breastfed.  The authors of this study noted that the protection that breastfeeding provided “persisted even when considering the role of several potential confounders.”  They conclude that, in this study, breastfeeding was shown to be associated with decreased incidence of fever following immunization.  To read the study online, go to http://pediatrics.aappublications.org/cgi/content/abstract/peds.2009-1911v1.

Childbirth And Spirituality

A new study has examined childbirth and spirituality.  The study, which appears in the spring edition of the Journal of Perinatal Education, shows that there may be a role for spiritual beliefs in the clinical assessment of women having babies.  The authors recommend that caregivers ask mothers, “Do you have any spiritual beliefs that will help us better care for you?” during their clinical assessment.  Researchers conducted a secondary analysis of published and unpublished narrative data collected over the past 20 years from 250 culturally diverse women.  Themes in the study included:  childbirth a as a time to grow closer to God, the use of religious beliefs and rituals as powerful coping mechanisms, and childbirth as a time to make religion more meaningful.  To access the full study online, go to Childbirth & Spirituality Study.

Acupuncture in Pregnancy Podcast

Acupuncture in Pregnancy Podcast

Acupuncture is a drug-free therapy well suited to pregnancy. It has a high degree of patient satisfaction, and an increasing body of evidence supporting efficacy for a range of common pregnancy complaints.

Conditions which may be effectively treated include morning sickness, backache, insomnia, hemorrhoids and exhaustion. Treatment of pelvic girdle pain with acupuncture can be effective in just a few sessions, a condition for which allopathic medicine offers little help.

There is growing interest and supporting evidence for the use of moxibustion to encourage babies in the breech position to spontaneously turn to a cephalic presentation, to avoid an elective cesarean section. Moxibustion involves heating an acupuncture point at the corner of the little toe (Bl 67) twice a day for 7-10 days.

Acupuncture may be safely used in pregnancy, although it is important to avoid contraindicated acupuncture points and points that may induce the onset of labor before term.  

Similarly, babies have benefited greatly from treatment of common conditions such as colic, vomiting, poor sleep, teething and eczema. 

 To access this and other MIDIRS podcasts visit www.midirs.org/podcast.

Lyndsey's Journey To VBAC

My Journey to a VBAC from Lindsey Meehleis on Vimeo.

If a picture paints a thousand words, then this says it ALL.

I am Kathryn. I am a Doula. I make a Difference.

I am Kathryn. I am a doula. I make a difference, a beautiful, vital difference.
I can take the hand of a woman who has not yet walked the path of labor and giving birth, and I can say will all sincerity "I know it is overwhelming. I know it's hard. Every birth is unique, but there are things that every woman who has given birth before have in common. I have walked my own paths path of labor and birth, and I will walk yours with you now. I can show you some of the ledges and roadblocks, and I know some detours. Look into my eyes and know that I have personally experienced many of the things you are feeling right now and I can completely sympathize with you. I have felt the power of babies moving through and out of my own body and into my arms. I have nursed babies at my breast. You are not alone in what you are feeling. I will not leave you. Come now, and let's walk this path together."

Caffeine Intake During Pregnancy Associated With Impaired Fetal Length

 Caffeine intake of 6 or more units per day during pregnancy is associated with impaired fetal length growth, according to the results of a cohort study reported online April 28 in the American Journal of Clinical Nutrition.
 
"Caffeine is a widely used and accepted pharmacologically active substance," write Rachel Bakker, from Erasmus Medical Center in Rotterdam, the Netherlands, and colleagues from the Generation R Study. "The effect of caffeine intake during pregnancy on fetal growth and development is still unclear."

The goal of the study was to evaluate the associations of maternal caffeine intake from coffee and tea with fetal growth measured during each trimester of pregnancy and with the risks for adverse birth outcomes. From 2001 to 2005, a total of 7346 pregnant women in the Netherlands participated in a population-based prospective cohort study from early pregnancy onward.

Questionnaires were used to determine coffee and tea consumption in the first, second, and third trimesters. Serial ultrasound studies allowed determination of fetal growth characteristics, and hospital record review allowed determination of birth outcomes.

A regular serving of 125 mL of coffee in the Netherlands contains approximately 90 mg of caffeine (caffeinated), decaffeinated coffee contains 3 mg, and tea contains 45 mg per 125-mL serving. This was used as the standard for calculation of daily caffeine consumption. Each unit of caffeine exposure was based on 1 cup of coffee (90 mg of caffeine), and total caffeine intake was categorized as less than 2 units, 2 to 3.9 units, 4 to 5.9 units, and 6 or more units per day.

Caffeine consumption was not consistently associated with fetal head circumference or with estimated fetal weight in any trimester. In contrast, higher caffeine consumption was associated with smaller first-trimester crown-rump length, second- and third-trimester femur length, and birth length (P for trend < .05). The risk of having a small-for-gestational-age infant at birth was increased in mothers who consumed at least 6 caffeine units per day.

"Our results suggest that caffeine intake of ≥6 units/d during pregnancy is associated with impaired fetal length growth," the study authors write. "Caffeine exposure might preferentially adversely affect fetal skeletal growth. Further studies are needed to assess these associations in non-European populations and to assess the postnatal consequences."

Limitations of this study include observational design with possible residual confounding; and missing data on coffee and tea consumption, which may have led to loss of power.
"Length- or skeletal-related fetal growth characteristics seemed to be most consistently affected from the first trimester onward," the study authors conclude. "Further structural and functional studies are needed to assess organ-specific effects. Our results suggest that pregnant women should be advised to not consume ≥6 caffeine units (.540 mg) per day during pregnancy."

The Erasmus Medical Center Rotterdam, the Erasmus University Rotterdam, and the Netherlands Organization for Health Research and Development (ZonMw) financially supported the first phase of the Generation R Study. One of the study authors was supported by the Netherlands Organization for Health Research. Am J Clin Nutr. Published online April 28, 2010.

Birth Takes Time !

Birthwhisperer finds it mildly amusing that it takes an MD, PhD to explain what midwives and women have known for years, BIRTH TAKES TIME !

Friedman's Curve, the so-called gold standard for rates of cervical dilation and fetal descent during active labor, was developed almost 50 years ago, and is a completely worthless and obsolete method of defining safe and healthy labor. Every labor and birth are unique and women should be given adequate time to allow their labors to unfold and progress at their own pace. Every obstetrician should heed the words of their colleague on this video. And when it is time for your baby to be born, don't let anyone rush you. Trust birth.

Pain vs Suffering In Labor & Birth

In this video, Doula and author Penny Simkin contrasts the concepts of pain and suffering in labor and birth. When I teach prepared childbirth classes, I like to talk about how labor often involves "pain with a purpose." Pain in labor signals the mother that it is time to get to a safe place to birth. If the mother is open to the sensations of labor and tunes in to her body, the pain of labor can help to guide her in moving and assuming certain postures that facilitate the process of labor, helping the baby descend through her pelvis. Pain is purposeful.

Pain in labor can be anticipated. Since you know it is coming, you can plan your strategy by choosing your favorite coping techniques. Many women find that massage, movement, visualization, relaxation and hydrotherapy work very well. Experiment and find what works for you,

The pain of labor is intermittent. You have periods of relaxation between contractions. In active labor, there are about 15 minutes of contractions and 45 minutes of rest per hour. Maximizing the periods of rest are key to avoiding fatigue in labor.

And finally, pain in labor is completely normal. Because we think of pain as being associated with injury or illness, it can help to reframe the way be think about pain in labor. Birth is a normal physiological process of the female body. Nothing is wrong or abnormal. Just as there is some discomfort associated with running a marathon, so is there with giving birth. If we work with our body's signals and surrender to the process, we can prevent pain from turning into suffering.

YOU have a choice !

Hear the voices of birthing families talk about the choices they made for their births and why they made them. Contrast that with the information that the L&D nurse shares in the beginning of the video.
Is birth a medical event or a normal physiological process ?
Is pregnancy a pathological state or a healthy state of being ?
Are birthing women passive victims of labor, or can they be powerful, present and in control ?
You have a choice.

Happy International Day of the Midwife !

It's International Midwife Day, and sadly, here in the state of NC, women do not yet have legal access to a Certified Professional Midwife. The above video was made by women in Alabama to raise awareness about the need for access to a qualified attendant for out of hospital birth. Studies have shown that home birth with a trained midwife is as safe or even safer than hospital birth. In my town, women enter a hospital to give birth and 42% of them have their babies surgically delivered and if they conceive again, they are denied access to a VBAC, or Vaginal Birth After Cesarean, even though studies show it is safer than a repeat cesarean.

I hope that the climate is better in your community, but if it isn't make your voice heard and demand the quality of care you deserve.

Every Woman Deserves a Doula

Since May is "doula month" I have posted another video offering that highlights the value of having a doula for your birth. A doula is the only person, besides a woman's partner, who is there just for her. The doula provides continuous support from start to finish. She doesn't change shifts. She doesn't have other patients to care for. She is completely and utterly focused on you.

A great doula is a benefit to the other members of the birth team as well. Since she does not provide a clinical role, she frees the medical team to focus on the clinical aspects of their roles. She helps to make the mother calm and comfortable.
She facilitates communication between the mother and her clinical caregivers.

I hope you will consider giving birth with a doula, because when you are supported and cared for, you will be better equipped to care for your new baby.

What DO DOULAS Do ?

Doulas give support.

What is Support ? Support is unconditional. Support is letting a woman know that you are there for her, and that your acceptance of her does not depend on your expectation of her behavior or choices.

Support is listening, and not offering advice unless you are asked. Support is helping a woman work through her own feelings, emotions and choices at her own pace.

Support is caring, offering a touch, a hug, a smile. Support is showing you care in personalized ways, like finding out what makes her feel safe and cared for, or making her favorite food.

Support is helping women identify their options, not telling them which options to take.

Support is helping women discover their own God-given abilities and strengths in birth. Support is reaffirming a woman's value as a beautifully unique creature who has been gifted and equipped by a loving God to give birth to her baby.

Support is reminding women that they can make informed choices about the environment in which they will give birth, and the the caregivers who will attend her.

Support is sharing your knowledge and experience with compassion and sincerity.

Support is what Doulas do !

Kathleen Kendall-Tacket talks about Breastfeeding Made Simple

In this fascinating interview, Dr. Kendall-Tackett talks about the Seven Natural Laws of Breastfeeding and how to keep it simple !

Listen Now

Get Me Out : A History of Childbirth from the Garden of Eden to the Sperm Bank

Randi Hutter Epstein, MD has done a fabulous job of cataloging a brief and bizarre history of birth in Western Civilization.

Did you know that :

There was a time in the 1900's when feminists demanded their right to be completely knocked out with drugs for delivery ?

History bears clues about how women and their doctors view health and disease ?

In 1522, a German doctor was sentanced to death when he was caught dressing as a woman and sneaking into the delivery room ?

In 16th century France, pregnant women rarely left the house after dark because they were told that if they looked up at the moon, their babies would become lunatics or sleepwalkers ?

That Soranus was a famous Greek physician who wrote the definitive book on gynecology in the second century that became THE leading text for the next thousand years ?

Many of the earliest women's health books were written by MONKS, the very people that you would think would have the least use for such information ?

That the blockbuster pregnancy guide of the Middle Ages was penned by Dr. Eucharius Rosslin, a government doctor who was responsible for licensing midwives. No matter that he never saw a baby born, he published a book called "The Rode Garden for Women & Midwives" published in 1513 and translated into at least five languages. it was a best seller for 200 years. In it, he wrote this poem: 

"I'm talking about the midwives all

Whose heads are empty as a hall

And through their dreadful negligence

Cause babies' deaths deviod of sense

So thus we see far and about

Official murder, there's no doubt"

That Peter Chamberlen, the inventor of forceps published, in 1647, a diatribe against midwives called "Voice in Rhama, The Crie of Women and Children" claiming that midwives were ignorant and wreaked havock on childbirth. After he retired from being an obstetrician, her hid the original Cahmberlin forceps under the floor of his country mansion, trying to preserve the secret, forever. 

That Italians invented the silliest device of all, do-it-yourself-forceps. The fad never took off...

That in 1836 The Lancet, a British medical journal claimed that rotten breastmilk leaked down and caused the deaths of thousands of women who were really dying of childbed fever, an infection caused by doctors going from woman to woman in maternity wards and not washing their hands. 

These amazing tidbits don't even begin to scratch the surface of the wealth of "truth is stranger than fiction"  in this fascinating book. If you have any interest in how modern maternity care came to be, this book will perplex, shock and entertain you, Birthwhisperer promises ! 

Whether you are an expectant woman or a birth professional, this book will not disappoint. I think it would make for a great documentary film.

Maternal Deaths On The Rise In The US And Canada, While Decreasing in Other Countries

Maternal mortality data show accelerated decreases in China, Egypt, Ecuador, and Bolivia, but very alarming increases in the United States, Canada according to the results of a database analysis reported online April 12 in The Lancet.
In the United States, there was an increase of 42% from 12 maternal deaths per 100,000 live births in 1990 to 17 in 2008, which is more than double the rate in the United Kingdom, 3-fold the rate in Australia, and 4-fold the rate in Italy.

Carol Sakala, PhD, MSPH, Director of Programs for Childbirth Connection, and co-author of Evidence-Based Maternity Care, spoke with Medscape (www.medscape.com ) about childbirth in the United States, and the Transforming Maternity Care project.

Medscape: Although many women say they want a "natural" birth, most still choose obstetricians for maternity care, rather than midwives or family-practice physicians. Do you think that women are adequately informed about the differences between the obstetrician's view and the midwife's view of birth?
Dr. Sakala: Differences do exist in the practice styles of obstetricians, family physicians, and midwives. It is also important to recognize that practice style can vary greatly within these groups. It's a complicated situation. Consideration must also be given to differences in the make-up of their respective case loads.
That said, most childbearing women are healthy and at low risk and have good reason to expect an uncomplicated childbirth. In the Milbank report, we support providing "effective care with least harm." For healthy women and newborns, this means avoiding invasive interventions with potential adverse effects whenever possible; and promoting, protecting, and supporting women's and newborns' innate capacity for birth, breastfeeding, and attachment.
However, the present maternity care system has quite a few incentives for technology-intensive childbirth. As a result, 6 of the 10 most common hospital procedures are performed on the largely healthy population of childbearing women and newborns. We know from our national Listening to Mothers surveys that this style of childbirth is now the norm for nearly all women who give birth in US hospitals.

Medscape: If you had a wish for the future of maternity healthcare, what would it be?
Dr. Sakala: I’d like to answer this question by paraphrasing the final paragraph from the Transforming Maternity Care Vision paper, and I encourage Medscape readers to read that paper and the blueprint as well, and consider becoming involved in blueprint implementation.
In describing the vision, the Vision Team says that:

The 2020 Vision for a High-Quality, High-Value Maternity Care System will be actualized through concerted multi-stakeholder efforts ensuring that all women and babies are served by a maternity care system that delivers safe, effective, timely, efficient, equitable, woman- and family-centered maternity care. The US will rank at the top among industrialized nations in key maternal and infant health indicators, and will achieve global recognition for its transformative leadership.

 It is the opinion of Birthwhisperer, that the failure of every community in the US to ensure that women have access to practitioners who practice the according to a midwifery model vs a medical model
is much to blame for the fact that many more women are dying in pregnancy and birth.

When choosing a maternity care giver, give careful consideration to whether or not he or she views pregnancy and birth as normal healthy physiological states, as opposed to the view that they are states of being, fraught with dangers from which a woman should be medically "delivered."

As a clever women once said "Pizza is delivered, grapefruit is sectioned, but women give birth !"

Birthwhisperer's Top Picks for Spring Maternity Footwear

As a Certified Integrative Reflexologist, I know the importance of what my mother's generation called "sensible shoes." I cringe when I see pregnant women, waddling around on heels and platforms. During pregnancy, our center of gravity is changed, and walking around in heels can pose a serious risk to your health. It's easier to trip and fall, and the hormonal changes that occur make our joints hyper-mobile, which means we are more prone to injuries from sprains and strains.
In addition to these changes, pregnant moms tend to hold some extra fluid in the feet and legs because of an expanded blood volume around 28 weeks of pregnancy. This can be especially true in the summer months. Many women find it hard to wear shoes that are comfortable when they are in a non-pregnant state.

I would like to share three styles of shoes that I think might fit the bill for a summer pregnancy.

The first two styles are by by ecco. I personally own them both. And I love them !

This one is the ecco "Wave" sandal in black. Mine are black and have three straps across the top instead of the two shown here. They come in brown and black. They are much cuter on your foot than they look in this photo. They are adjustable in the heel and ankle and toe with velcro for a totally custom fit. The first time I tried them on, they felt totally broken in ! They retail for 79.99.

This is the "Yucatan Performance Sandal", also by ecco. I have these in brown/pink but they come in several color combos. These shoes are the best feeling shoe I have EVER put on my feet. Like the "Wave" pictured above in black, these are totally customizable in the heel, ankle and toe with velcro. And also, this photo makes them look much "clunkier" than they really are. The look really great on your feet, and you can walk around all day and be incredibly comfortable and sure footed because they have a non skid sole. They retail for $130.00 and are worth every penny.

The third shoe I want to mention is by OKAb. I am not a huge thong or flip-flop fan, but if you are addicted to them, this shoe may work well for you. They are absolutely adorable, and OKAb was kind enough to send me a sample of the "Lucy" style to review.

They come in a variety of colors. Mine are dark grey with the mother of pearl/shell flower motif, like these have. They have great arch support, and while probably not sturdy enough for a long walk, these would be a great "date" shoe if you weren't planning to be on your feet much. They retail for $40.00.

Check out www.ecco.com and www.shoesthatloveyou.com for more information on how to purchase these, and other wonderful shoes. Now you know the secret to happy, healthy and adorable feet for your summer pregnancy !

Momma Friendly Swimwear

While on my never ending quest for "momma-friendly" products, I was introduced to these fantastic garments and immediately thought "Where have you been all my life?" 

For those of us who are not quite bikini ready, or wouldn't wear one anyway because of modesty,

girltrunks were designed for the everyday woman in mind. For the newly postpartum and breastfeeding Mom, girltrunks are a great alternative to a swimsuit that rides up in all the wrong places and doesn't properly accommodate an abundant, lactating bosom. But really, girltrunks are a great solution for moms in any season of life !

"girltrunks will forever change the way you look and feel at the pool, the beach, the gym or on the go."

 Indeed, they will. 

 girltrunks’ bottoms combine quick-drying polyamide material with  a mesh lining. They are available in two lengths so YOU can choose how much, or how little, of your legs you want to show. You won’t find side pockets on these trunks as they were designed to flatter a woman’s body with a more tailored look.

Above, you see the 'long on short" option, which has an 11 inch inseam for a little more coverage. 

And here, you see the "meet me in the middle" option with a 7 inch inseam. 

The tops are great too. There are two options, the halter and the tank and both are available in the black and white or the polka dot print.  Trunks and tops are sold separately, for a customized fit. While a bit pricey, the bottoms are 79.00 and the tops are 59.00, they are superior in quality and design.

I was sent some samples to review, in my size.  I chose the "long on short" with the halter top in black and white and I was really impressed with the fit, and attention to detail. The great thing about this swimwear is that it can take you straight from the pool or the beach to out to lunch or the grocery store without skipping a beat, and to a busy Mom, this is a dream come true. 

You can move about freely without having to wonder if something is showing that shouldn't be, or worrying about your swimsuit bottom giving you a wedgie. I think the design would also be very conducive to breastfeeding at the pool or on the beach because the trunks are separate from the tops.

Birthwhisperer is all about finding simple, safe and healthy solutions for mothers and this one passed our scrutiny with flying colors. 

They also come with an unconditional 30 day money back guarantee !

Check them out at www.mygirltrunks.com

*Birthwhisperer does not receive payment for product endorsements and only endorses products that have been found to be of superior quality and value.

Momma friendly body shapers !

Birthwhisperer is back, after a short hiatus, with the skinny on momma friendly shapewear. It is no secret that becoming a mother changes everything, not the least of which is our bodies. And just as it takes many months to grow a baby, it can take a while to return to our previous states of being. Some of us remain forvever altered, but we can be proud of what our bodies have accomplished through the heroic act of giving birth !

As we transition to our new physiques, it can be helpful to have some foundation garments that "batten down the hatches", if you get my drift. Sometimes we just don't want to too much jiggling going on. And if we have had a cesarean, our tummies may need tender loving care, in the form of gentle support.
In light of all that, I want to share two products that I have found to be extremely helpful, even though I am 19 years postpartum !

The first is ASSETS by Sara Blakely. The photo above shows a woman wearing the footless tights while obviously pregnant. They are so comfortable and give great control without strangling you. They do NOT do that annoying "roll at the waist thing" and come in many different lengths, from thigh length to the style you see here. I love the "Lucky Leggings" style and wear them year round. They are designed by the same woman who designed SPANX but are a little more affordable. I buy mine at Target.

The next product that I have tried is the Kymaro body shaper.

They make upper foundation garments ( like the one pictured here ) and lowers, similar to the one pictured above. I think the quality is very good, although I prefer the first product I reviewed. I think the Kymaro is a little lighter in the control factor, but if that is what you are looking for, this may be the product for you. The Kymaro may be more comfortable in warmer weather.

I hope to be reviewing more apparel for mothers in the coming weeks. Stay tuned !
I have not received any compensation for this endorsement, although I did receive a sample of the Kymaro garments to review.