Category Archives: interventions

Utah Cesarean Rates

I hosted the Utah Count chapter of ICAN last night at my home. Today I have been thinking about the wonderful women I know who have had c-sections. I’ve been thinking about their stories, both positive and negative. Thinking about their experiences made me wonder about the cesarean rates at the hospitals where most of my moms give birth. It got me wondering what the latest cesarean statistics are for Utah. This information can be found by clicking HERE. Utah’s cesarean rate (23.2%) is lower than the national average (32.8%), which is good. The rates, however, are still higher than the World Health Organization (WHO) recommendation of between 5% and 10%. Their recommendation is supported by the most recent studies. The studies show that c-section rates above 15% do more harm to moms and babies than good. 

Cesarean births are sometimes necessary and are a useful tool for birth. They are being overused. This creates unnecessary risks to moms and babies. Although, I believe it is important for the medical community to make an effort to look at the studies and see how they can improve, I think the biggest changes will come when birthing women are more informed about their options. When women know what options they have and start asking questions about their care, they become empowered to make informed choices. I found a helpful, informative online booklet from Childbirth Connection. In it they answer the questions:

  • Which is safer, vaginal birth or c-section?
  • What are the possible benefits and harms of vaginal birth and c-section?
  • What is it like to have a c-section?
  • If my doctor or midwife suggests a c-section, how should I decide if it is right for me?
  • Is it possible to safely prevent a c-section?
  • What happens if I need a c-section?

To view this booklet click HERE.

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Exploring Your Options Series

The focus of my doula business is to help birthing families know what their options are.

For this reason I’ve decided to write a series of posts about how to make informed decisions and what different options there are.

There was a study done in the 60s and 70s to evaluate the factors that influenced a woman’s level of satisfaction in her childbirth experience. In the study, women rated their level of satisfaction, filled out a questionnaire, and related their childbirth experience. Then home water birth, opiefoto.com15 to 20 years later the researchers followed up with these same women. What they found was that women remembered the details of their childbirth experiences very vividly and felt the same emotional intensity several years later. The research showed that the thing that made the difference in the level of satisfaction was whether a woman felt like she had a say in the care she received. Women who had a say in the decision making process reported to have the highest level of satisfaction in her childbirth experience. This is one reason why I believe women need to feel empowered and supported in making informed decisions for their care.

The first thing I would like to talk about is making decisions about your care. This formula is not just for pregnancy and birth. It can be applied to any situation where medical decisions need to be made. Think of the acronym “BRAIN”.

“BRAIN”

  • B – Benefits?
  • R – Risks?
  • A – Alternatives?
  • I – Intuition? (How do I feel about this?) Prayer.
  • N – Not now, but wait?

Take time to discuss. Ask your care provider and/or nurse to give you a moment to discuss your options. Very rarely do decisions need to be made so quickly that you do not have time to ask questions and discuss it privately. In the event of a time sensitive

Midwife - careprovideremergency ask for 1 minute alone to discuss it, if a minute is too long, ask for 30 seconds.  In a situation before the birth, you can get a second opinion. If you aren’t comfortable with what your care provider is telling you, you can change care providers. Don’t be afraid to fire your care provider. They work for you and you can find another one who you are more comfortable with and will honor your wishes. During your birth you can ask for another nurse, if you don’t feel supported by the one assigned to you.

More in depth questions you can ask your care provider:

As you ask questions about your care, you will become a responsible consumer and will gain greater satisfaction in your childbirth experience.

 

When a test is suggested:

  1. Why should I have the test? What problem are we looking for?
  2. What will the test tell us? How accurate are the results?
  3. What are the risks/side-effects of the test?
  4. If the test detects a problem, what will happen next?
  5. What is the cost of the test?

When a treatment or intervention is suggested:

  1. What is the problem? Why is it a problem? How serious is it? How urgent is it that we begin treatment?
  2. Describe the treatment: How is it done? How likely is it to detect or solve the problem?
  3. If it does not succeed, what are the next steps?
  4. What are the risks or side-effects to the treatment?
  5. Are there any alternatives (including waiting or doing nothing?)
  6. Ask questions b,c, and d about any alternatives.
  7. What is the cost?

–adapted by Kristi F. Ridd (originated by Penny Simkin)

Coming up we’ll talk about choosing a care provider, the pros and cons of different care providers, choosing a birth place, and a doula.

Photos take by opiefoto at the birth of my 3rd child.

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Planning to Have an Epidural? Bring Some Extra Tools

I learned something new at a birth yesterday. If you have low blood platelets, you cannot get an epidural. I don’t think low blood platelets is common, but what I learned was that sometimes a woman may not know she won’t have pain medication as an option until she goes into labor.

I believe it is important for all birthing women to be educated in the normal process of birth, basic comfort measures, and have trained birth support (and don’t count on the L&D nurse being able to provide this, they are busy and many of them do not have a lot of training or experience in natural birth). You never know when you won’t be able to have an epidural, they don’t always work, and sometimes you have to wait a significant amount of time before you can get one.

Epidurals can be a positive tool used during birth, just make sure you have other tools as well.

A doula has many tools, if you hire one it can make your birthing experience more positive, no matter what happens.

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Delayed Cord Clamping

Delayed Cord ClamingA common routine practice within hospitals is to immediately clamp and cut the umbilical cord following the birth of the baby. Although care providers (doctors and midwives) give many excuses for this practice there is no evidence to support it. In fact, there is much evidence to support delaying clamping of the cord.

Below is some of the evidence I’ve collected that shows the benefits of delayed cord clamping. As you read through and view this information you can learn about the benefits for yourself and make the best choice for you and your baby.

Science and Sensibility, a blog by Lamaze International, has gathered a plethora of information on delayed cord clamping. Here is a post in which they refute, with evidence, some of the common objections care providers use in regards to delayed cord clamping.

“In some cases this continued practice is due to a misunderstanding of placental physiology in the first few minutes after birth. In others, human nature plays a role: We are often reluctant to change the way we were taught to do things, even in the face of clear evidence that contradicts that teaching.”

Click HERE to read the full article.

To view all the articles they have on the subject of delayed cord clamping, click HERE. They have a really informative video series about delayed cord clamping given by Dr. Nicholas Fogelson, MD A.P. Department Obstetrics and Gynecology USC School of Medicine. To watch this series click HERE.

Dr. Judith Mercer, PhD, CNM, FACNM, a member of the faculty at the University Rhode Island, is the Principal Investigator on a randomized controlled trial at Women & Infants Hospital examining the effects of delayed cord clamping on outcomes of preterm, very low birth weight babies. She was interviewed over at Science and Sensibility blog. She relates an amazing experience she had at a homebirth in 1979 that helped to influence her decision to research delayed cord clamping.

“I had an epiphany at a home birth in 1979. An infant was born very rapidly with the cord 2 and 1/2 times around his neck. He was as pale as the white sheet his mother had on her bed and limp and breathless. I was very afraid that I would not be able to resuscitate him.  I placed him on the bed and immediately unwrapped the cord from around his neck and dried and stimulated him with no response. His heart rate was well over 100 and the cord was pulsating vigorously.  I noticed that his color was changing from the pale white to pink as his body gained the blood back into it. His heart rate was always over 100. In about 1 and 1/2 minutes, he flexed his extremities, opened his eyes and took a gentle breath.  He looked at us like “What is the fuss?” and never cried.  I tried as hard as I could to get him to cry as I believed at that time that he should do but I could not get him to.  He nursed very well and was a normal child at one year of age when I last saw him.

I knew that I had seen a miracle and one that I would never have seen in the hospital.  In the hospital, we would have cut the cord and taken the infant to a warmer to resuscitate him. In doing so, we would have denied him exactly what he needed – the opportunity for the blood squeezed out of him in the birth process due to the tight cord around his neck to flow back into his body.  This event marked the beginning of my research career.  I vowed that at some point in my life I would research what I had seen but did not fully understand.”

To read the rest of her interview, click HERE.

Below is a video where Penny Simkin talks about the amount of blood lost when we practice immediate cord clamping. She talks about the benefits of delayed cord clamping in a visual way that really helped me understand the way it works. Watch the video, it’s a really great way to spend 5 minutes and you’ll walk away with some beneficial information on this important birth option.

Along with all of the clinical benefits and researched evidence noted in the above links, a benefit that I have seen is the way delayed cord clamping slows down the birthing process. Sometimes in the hospital there is so much routine that is practiced by the doctor/midwife and nurses everything happens so quickly. I believe it is important to slow this process down. When the birth of a baby is slowed down the mother and her partner have the chance to savor the moment and the experience is etched into their memory. Slowing down the birth process is one way to improve and protect the memory of the birth.

As you consider your birth options and preferences, I hope you will research the information available on delayed cord clamping to make the best choice for you, your baby and your situation.

The midwives that I know of who attend home births regularly practice delayed cord clamping. It is important to talk to your care provider to find out their regular practices.

Picture above take by OpieFoto. Taken at the home birth of my 3rd child.

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Birth Declaration by Babies & Bellies

I thought this declaration was wonderful. It describes much of how I feel about how I feel about birth.  CLICK HERE to read the entire declaration

excerpt from declaration:

“Birth, more than any other experience, has the potential to transform the world. It is time that we support women in experiencing birth as a peaceful, positive, and powerful event.

Birth has the potential to be the most powerful driving force on the planet. The healing of birth will surely change the world.

We must reframe the way we conceptualize birth. We must share this wisdom with the world.

Birth is something to be embraced—not controlled.

Birth is something to be welcomed—not dreaded.

Birth is something to be loved—not feared.”

 

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