Mar 12 – Meet the Doulas Night (Wash Park)

house-of-doula

Thursday, March 12
6:30 pm

Green Monkey Baby
1511 S. Pearl St.

RSVP

House of Doula is a great company that allows you to register for doula services just like you would register for a stroller or carseat.  This mixer is a place where you can mingle with the House of Doula doulas (myself included!) and find one you’d like to interview one-on-one at a later time.

Light refreshments will be served, bring your husband and/or children!

Call Amanda Glenn with any questions, 720.219.8482

Scheduled Inductions/C-sections – Why Every Week Counts

I recently read a great article in the Wall Street Journal about some new trends to induce or schedule c-sections prior to an estimated due date.  Past 34 weeks the baby’s lungs are done “cooking” and the chance that Baby will survive is pretty good, but scientists are finding more and more evidence that those precious few weeks mean more to fetal development than we previously thought.

A word on starting labor:

  • Labor is usually started by the BABY when Baby’s lungs are ready and Baby has reached good maturity in the womb
  • It is well within normal limits for babies to be born healthy anywhere between 37 and 42 weeks (and sometimes beyond!)
  • The average length of pregnancy for a first time mom is 41 weeks, 3 days (or 10 dates past estimated due date)
  • Methods of induction can seriously mess up natural body chemistry and function and cause other serious measures (failed induction, infection, c-section, etc.)
  • If your body isn’t ready to go into labor, it won’t.  Oftentimes inducing labor (either natural remedies or with drugs) will fail if your body and your baby aren’t ready

Here is that great article from the Wall Street Journal:

This time of year, some hospitals see a small uptick in baby deliveries thanks to families eager to fit the blessed event in around holiday plans or in time to claim a tax deduction. Conventional wisdom has long held that inducing labor or having a Caesarean section a bit early posed little risk, since after 34 weeks gestation, all the baby has to do was grow.

But new research shows that those last weeks of pregnancy are more important than once thought for brain, lung and liver development. And there may be lasting consequences for babies born at 34 to 36 weeks, now called “late preterm.”

[Why Every Week of Pregnancy Counts] New research shows that the last weeks of pregnancy are more important than once thought for brain, lung and liver development.

A study in the American Journal of Obstetrics and Gynecology in October calculated that for each week a baby stayed in the womb between 32 and 39 weeks, there is a 23% decrease in problems such as respiratory distress, jaundice, seizures, temperature instability and brain hemorrhages.

A study of nearly 15,000 children in the Journal of Pediatrics in July found that those born between 32 and 36 weeks had lower reading and math scores in first grade than babies who went to full term. New research also suggests that late preterm infants are at higher risk for mild cognitive and behavioral problems and may have lower I.Q.s than those who go full term.

What’s more, experts warn that a fetus’s estimated age may be off by as much as two weeks either way, meaning that a baby thought to be 36 weeks along might be only 34.

The American College of Obstetricians and Gynecologists, the American Academy of Pediatrics and the March of Dimes are now urging obstetricians not to deliver babies before 39 weeks unless there is a medical reason to do so.

“It’s very important for people to realize that every week counts,” says Lucky E. Jain, a professor of pediatrics at Emory University School of Medicine.

It’s unclear how many deliveries are performed early for nonmedical reasons. Preterm births (before 37 weeks) have risen 31% in the U.S. since 1981 — to one in every eight births. The most serious problems are seen in the tiniest babies. But nearly 75% of preterm babies are born between 34 and 36 weeks, and much of the increase has come in C-sections, which now account for a third of all U.S. births. An additional one-fifth of all births are via induced labor, up 125% since 1989.

Many of those elective deliveries are done for medical reasons such as fetal distress or pre-eclampsia, a sudden spike in the mother’s blood pressure. Those that aren’t can be hard to distinguish. “Obstetricians know the rules and they are very creative about some of their indications — like ‘impending pre-eclampsia,'” says Alan Fleischman, medical director for the March of Dimes.

Why do doctors agree to deliver a baby early when there’s no medical reason? Some cite pressure from parents. “‘I’m tired of being pregnant. My fingers are swollen. My mother-in-law is coming’ — we hear that all the time,” says Laura E. Riley, medical director of labor and delivery at Massachusetts General Hospital. “But there are 25 other patients waiting, and saying ‘no’ can take 45 minutes, so sometimes we cave.”

There’s also a perception that delivering early by c-section is safer for the baby, even though it means major surgery for the mom. “The idea is that somehow, if you’re in complete control of the delivery, then only good things will happen. But that’s categorically wrong. The baby and the uterus know best,” says F. Sessions Cole, director of newborn medicine at St. Louis Children’s Hospital.

He explains that a complex series of events occurs in late pregnancy to prepare the baby to survive outside the womb: The fetus acquires fat needed to maintain body temperature; the liver matures enough to eliminate a toxin called bilirubin from the body; and the lungs get ready to exchange oxygen as soon as the umbilical cord is clamped. Disrupting any of those steps can result in brain damage and other problems. In addition, the squeezing of the uterus during labor stimulates the baby and the placenta to make steroid hormones that help this last phase of lung maturation — and that’s missed if the mother never goes into labor.

[Why Every Week of Pregnancy Counts] Gail Zuniga/WSJ

“We don’t have a magic ball to predict which babies might have problems,” says Dr. Cole. “But we can say that the more before 39 weeks a baby is delivered, the more likely that one or more complications will occur.”

In cases where there are medical reasons to deliver a baby early, lung maturation can be determined with amniocentesis — using a long needle to withdraw fluid from inside the uterus. But that can cause infection, bleeding or a leak or fetal distress, which could require an emergency c-section.

Trying to determine maturity by the size of the fetus can also be problematic. Babies of mothers with gestational diabetes are often very large for their age, but even less developed for their age than normal-size babies.

Growing beyond 42 weeks can also pose problems, since the placenta deteriorates and can’t sustain the growing baby.

Making families aware of the risks of delivering early makes a big difference. In Utah, where 27% of elective deliveries in 1999 took place before the 39th week, a major awareness campaign has reduced that to less than 5%. At two St. Louis hospitals that send premature babies to Dr. Cole’s neonatal intensive-care unit, obstetricians now ask couples who want to schedule a delivery before 39 weeks to sign a consent form acknowledging the risks. At that point, many wait for nature to take its course, says Dr. Cole.

Join a Discussion

Are parents too eager to induce labor or schedule an early C-section for sheer convenience? Are doctors too willing to go along? Share your views.

Great Midwifery Article in the LA Times

Here’s a wonderful pro-midwifery article in the LA Times!

I also have the text here:

Midwives deliver

America needs better birth care, and midwives can deliver it.

By Jennifer Block
December 24, 2008
» Discuss Article (23 Comments)

Some healthcare trivia: In the United States, what is the No. 1 reason people are admitted to the hospital? Not diabetes, not heart attack, not stroke. The answer is something that isn’t even a disease: childbirth.

Not only is childbirth the most common reason for a hospital stay — more than 4 million American women give birth each year — it costs the country far more than any other health condition. Six of the 15 most frequent hospital procedures billed to private insurers and Medicaid are maternity-related. The nation’s maternity bill totaled $86 billion in 2006, nearly half of which was picked up by taxpayers.

But cost hasn’t translated into quality. We spend more than double per capita on childbirth than other industrialized countries, yet our rates of pre-term birth, newborn death and maternal death rank us dismally in comparison. Last month, the March of Dimes gave the country a “D” on its prematurity report card; California got a “C,” but 18 other states and the District of Columbia, where 15.9% of babies are born too early, failed entirely.

The U.S. ranks 41st among industrialized nations in maternal mortality. And there are unconscionable racial disparities: African American mothers are three times more likely to die in childbirth than white mothers.

In short, we are overspending and under-serving women and families. If the United States is serious about health reform, we need to begin, well, at the beginning.

The problem is not access to care; it is the care itself. As a new joint report by the Milbank Memorial Fund, the Reforming States Group and Childbirth Connection makes clear, American maternity wards are not following evidence-based best practices. They are inducing and speeding up far too many labors and reaching too quickly for the scalpel: Nearly one-third of births are now by caesarean section, more than twice what the World Health Organization has documented is a safe rate. In fact, the report found that the most common billable maternity procedures — continuous electronic fetal monitoring, for instance — have no clear benefit when used routinely.

The most cost-effective, health-promoting maternity care for normal, healthy women is midwife led and out of hospital. Hospitals charge from $7,000 to $16,000, depending on the type and complexity of the birth. The average birth-center fee is only $1,600 because high-tech medical intervention is rarely applied and stays are shorter. This model of care is not just cheaper; decades of medical research show that it’s better. Mother and baby are more likely to have a normal, vaginal birth; less likely to experience trauma, such as a bad vaginal tear or a surgical delivery; and more likely to breast feed. In other words, less is actually more.

The Obama administration could save the country billions by overhauling the American way of birth.

Consider Washington, where a state review of licensed midwives (just 100 in practice) found that they saved the state an estimated $2.7 million over two years. One reason for the savings is that midwives prevent costly caesarean surgeries: 11.9% of midwifery patients in Wash- ington ended up with C-sections, compared with 24% of low-risk women in traditional obstetric care.

Currently, just 1% of women nationwide get midwife-led care outside a hospital setting. Imagine the savings if that number jumped to 10% or even 30%. Imagine if hospitals started promoting best practices: giving women one-on-one, continuous support, promoting movement and water immersion for pain relief, and reducing the use of labor stimulants and labor induction. The C-section rate would plummet, as would related infections, hemorrhages, neonatal intensive care admissions and deaths. And the country could save some serious cash. The joint Milbank report conservatively estimates savings of $2.5 billion a year if the caesarean rate were brought down to 15%.

To be frank, the U.S. maternity care system needs to be turned upside down. Midwives should be caring for the majority of pregnant women, and physicians should continue to handle high-risk cases, complications and emergencies. This is the division of labor, so to speak, that you find in the countries that spend less but get more.

In those countries, a persistent public health concern is a midwife shortage. In the U.S., we don’t have similar regard for midwives or their model of care. Hospitals frequently shut down nurse-midwifery practices because they don’t bring in enough revenue. And although certified nurse midwives are eligible providers under federal Medicaid law and mandated for reimbursement, certified professional midwives — who are trained in out-of-hospital birth care — are not. In several state legislatures, they are fighting simply to be licensed, legal healthcare providers. (Californians are lucky — certified professional midwives are licensed, and Medi-Cal covers out-of-hospital birth.)

Barack Obama could be, among so many other firsts, the first birth-friendly president. How about a Midwife Corps to recruit and train the thousands of new midwives we’ll need? How about federal funding to create hundreds of new birth centers? How about an ad campaign to educate women about optimal birth?

America needs better birth care, and midwives can deliver it.

Jennifer Block is the author of “Pushed: The Painful Truth About Childbirth and Modern Maternity Care.”

MY FIRST BIRTH!!!

Look at the beautiful mama!

Look at the beautiful mama!

MERRY CHRISTMAS TO ME!!!  I just came back from my first birth this Christmas Eve, and it was the most perfect first birth ever!

Mama had a few hours of early labor, then things really got crankin’ around 1 pm.  She got down to the hospital at 3:30 pm and baby was born at 4:22!  We all arrived at the hospital at the same time, mom was checked and at 8 cm, then she got in the tub for only about 20 minutes.  It was just a few contractions in the tub when she started feeling tons of pressure and the urge to push, so we got out and she got on all fours on the bed.  The midwife had to step out to attend another birth so a resident that mama hadn’t met before came it.  She was wonderful!!  Basically she said, “You feel good in that position?  Ok, I can work with that!”  Two or three pushes and beautiful baby was born.

Mama did so terrific dealing with contractions.  She was joking in between and looked really relaxed.  When a contraction would hit she would just go limp, groan a bit, let it wash over her, and be totally in the moment.  I was so proud of her!  She did it naturally, just like she wanted (and she doubted to the end, but everyone else had faith!  she is so strong!).

It’s so funny, she said she couldn’t have done it without us (Lauren Williams and I) and I’m like, “Really??  Because you give birth like a rockstar!”  I know a doula doesn’t have to *do* something all the time, but I was only there under an hour before baby was born and I didn’t do too much.  Mom just totally rocked!

Mostly I feel privileged and honored to be a part of this day with them.

Merry Christmas All!

Amy

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VIDEO – Vacuum Extraction (WHO)

Here is a video put out by the World Health Organization regarding the practice of vacuum extraction versus forceps delivery.  This is commonly used when mom has an epidural and can’t push effectively, when the baby is presenting in a less than optimal position (ie not facing mom’s spine), and when the baby needs to be born immediately.

who-vacuum-e(Windows Media Player Required)