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?
I first thing I want to talk about are 2 very important choices. These two choices will determine what other choices you have surrounding your birth. This week we will talk about the first important choice:
When choosing a care provider, it is important not to make assumptions about the type of care or philosophy based on the sex or type of care provider. You cannot assume that a female care provider will be more caring, flexible and less likely to introduce interventions, than a male. You cannot assume that all midwives practice from the midwifery care model and that OBs or Family Doctors will not. There are some OBs that act as excellent “midwives” and some midwives that offer a more medicalized approach to pregnancy and birth. The pros and cons I will present are generalized. What may be a con to you, may be a pro for someone else and vice versa. It is important to interview several different care providers before choosing one. Ask lots of questions!
Obstetrician/Gynecologist or OB/GYN
Skills and experience to diagnose and treat serious complications during pregnancy and birth
Rarely would require transfer of care
Trained surgical specialist in the pathology of women’s reproductive organs. More medicalized care. Less naturally minded.
Low-risk women often seen as high-risk
Limited repertoire; no experience in other lower risk options
As someone put it “If you don’t want to get cut, don’t go to a surgeon.”
Limited to hospital
Tend to introduce fewer interventions than an OB.
All members of the family can see one doctor.
This creates better doctor/patient relationships and convenience.
Pregnancy or birth complications may mean a transfer of care.
Still have a “high-risk” mentality of pregnancy and birth and introduce interventions more than a midwife.
Limited to hospital
Most midwives practice under the Midwives Model of Care. This model of care is based on the fact that pregnancy and birth are normal life processes.
The Midwives Model of Care includes:
Monitoring the physical, psychological, and social well-being of the mother throughout the childbearing cycle
Providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support
Minimizing technological interventions
Identifying and referring women who require obstetrical attention
The application of this woman-centered model of care has been proven to reduce the incidence of birth injury, trauma, and cesarean section.
Offer flexible, individualized, supportive care rather than introducing medical interventions routinely.
More attentive to emotional issues during pregnancy and childbirth.
Offer many low-risk strategies for correcting problems that may arise during pregnancy and childbirth.
Midwife practices, procedures and tests come closer to the recommended guidelines of official physicians’ organizations, than those of a typical OB.
Many midwives offer well-woman care. This allows women to continue their care postpartum with the same care provider.
Midwives aren’t just limited to hospital care. They attend birth at freestanding birth centers and home births.
Pregnancy and birth complications may mean a transfer of care to an OB.
Different Types of Midwives
There are three different types of midwives that can legally practice in Utah:
LDEM- Licensed Direct Entry Midwife. This is someone who went straight into midwifery and is licensed by the state. He or She is a CPM (Certified Professional Midwife), having met the requirements with NARM (North American Registry of Midwives). LDEMs are licensed with the State of Utah and can carry oxygen, lidocaine (for stitching up your perineum in the case of tears), Rhogam for Rh- mothers, pitocin for a hemorrhage, vitamin K for baby, eye ointment for baby, and with a physicians approval, IV’s if needed, more medications for hemorrhage, and certain antibiotics for labor. They are not under the supervision of a doctor but practice independently.
CPM or DEM- Certified Professional Midwife or Direct Entry Midwife. In Utah no certification or licensure is required to call oneself a midwife. Therefore it is up to you the consumer to determine the skill level and capability of anyone calling them self a midwife. Therefore this midwife may or may not have the CPM credential. Many midwives in this category are very skilled, but once again it is up to the consumer to determine the knowledge and skill level of this midwife. This midwife can carry oxygen, but cannot carry any other medications.
CNM- Certified Nurse Midwife. This midwife has gone through formal nurse’s training and certification as well as midwifery training. Most CNM’s work in the hospital, they can carry medications, and write prescriptions. They are under the supervision of a doctor.
The next important choice we will talk about next week is where you will give birth.
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 15 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”.
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
emergency 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:
Why should I have the test? What problem are we looking for?
What will the test tell us? How accurate are the results?
What are the risks/side-effects of the test?
If the test detects a problem, what will happen next?
What is the cost of the test?
When a treatment or intervention is suggested:
What is the problem? Why is it a problem? How serious is it? How urgent is it that we begin treatment?
Describe the treatment: How is it done? How likely is it to detect or solve the problem?
If it does not succeed, what are the next steps?
What are the risks or side-effects to the treatment?
Are there any alternatives (including waiting or doing nothing?)
Ask questions b,c, and d about any alternatives.
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.
This month I am giving away a $20 Target gift card to one lucky winner! To enter visit my Facebook page and like it! After liking the page, enter your email address. The winner will be chosen May 1st and will be contacted via email. If you share the contest, you will be given an extra entry every time you share!
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.
A 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.”
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.”
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.
My wonderful midwife, Suzanne Smith, helping dry baby Isaac.
Recently I’ve discovered most people do not know what a doula is. People usually know it has something to do with birth. Many people I’ve talked to think it is a midwife. Others think it is a type of nurse.
Hopefully this post will help you understand what a doula is and what she does.
What a doula does:
Provide physical comfort by using massage, breathing and relaxation techniques, position suggestions, as well as pain relief techniques.
Provide emotional comfort with reassurance of normality, mother’s ability to cope, encouragement, validation of feelings.
Inform clients by answering questions with accurate information and seek out information when they don’t know the answer.
Act as an extra pair of hands for parents by getting food for partner, extra pillows, blankets, ice chips/drinks/snacks for mother, take pictures.
Encourage self-determination by supporting clients’ goals, making sure clients understand their choices, translate jargon as necessary.
What a doula does NOT do:
Practice medicine, do exams (no cervical exams) or procedures, make diagnosis or prescribe treatments, give second opinions, assist physician or midwife with medical care (adjust iv, administer oxygen, etc).
Make decisions for clients by advising or persuading clients to follow a particular course, talk about clients outside their presence, withhold approval for using or avoiding pain medications, and speak on behalf of the clients to the medical staff.
In short, a doula is a guide helping the mother and her partner through pregnancy, childbirth, and postpartum.
“When midwives are attending to clinical matters, birth doulas are focusing on the mother and helping her get through her contractions. Where the midwife’s first priority is the safe delivery of mother and baby, the doula’s first priority is the mother’s mental well-being, and the support of the growing family as a unit.”