Thursday, February 26, 2009

Natural Induction of Labor

As a general rule, I try not to post things that I talk about in class. Otherwise, why take my class, right? But repeatedly, the topic of induction gets brought up as a mom approaches or passes that magical 40 week mark. I have determined that when couples are in my class, they are thinking, "That won't happen to me. I'll be early." By the time they are due, often 2 months later, they need a refresher. This is worth repeating, as the induction rate is about 90%.

I know you are sick of hearing me say to trust your body to start labor on its own. But, TRUST YOUR BODY TO START LABOR ON ITS OWN. Now that that is out of the way, what if you really are trusting your body, but you have a threat of induction from your doctor or midwife? As I've said before, your baby has no idea that you have a calendar with his or her "due date" circled in red pen. That same date is also circled on your chart at your doctor or midwife's office. If you have been given a handful of dates, always go with the latest date to buy you more time. You might have to push for it, but it's worth it.

Make sure you are clear about the policy your doctor, midwife, or hospital have on induction. How long will they let you go? It used to be 2 weeks, standard. Lately, I've been hearing 10 days. It keeps getting shorter and shorter. Push for the 2 weeks. Evidence is on your side. Really, the time where there is an increase of stillborn births is closer to 43 weeks, so 42 has been considered safe for years. We have become dangerously comfortable with inductions though.

Near your 40 week mark, your provider will likely want to do a non-stress test to monitor if you are having contractions and to monitor the movement and heartbeat of the baby. There is a wide variance of how long they will require you to do this -- anywhere from 20 minutes to 2 hours. An ultrasound will also likely be done to check the size of the baby and fluid levels. Remember, ultrasound can be off by 2 pounds either way as far as the size of the baby goes. (That is another topic for another day, but we'll get to it.) Just know that in the vast majority of women, despite what the doctor would like you to believe, it is OK to have a big baby.

When all of these things have taken place at once, it is referred to as a biophysical profile. This may be done a few times before you actually start labor.

Ways to start labor include:

1) Nipple stimulation
-- It releases oxytocin, which is the natural form of pitocin. Studies have shown it to be just as effective in causing the uterus to contract as pitocin, with the advantages being that it is free and natural. Your body, and baby, will tolerate these natural contractions significantly better than artificially induced contractions. If nipple stimulation does not bring on contractions, your body is not ready. It is foolish to think that an induction is a good idea at this point. Your doctor does not know more about when your body is ready to give birth than you do.

2) Sex. Not just regular sex, but orgasmic sex. Orgasm causes the uterus to contract. When combined with nipple stimulation, this is very effective. Extra bonus -- prostaglandins, which help soften the cervix, are found in semen. So the more sex, the softer the cervix becomes. This is how 2 of my babies were "induced."

3) Breast pump. You might try this if you have a good pump on hand, like a Medella. Try it every hour or so for about 10 minutes. You don't need to crank it up either. If it's going to work, it'll work at a lower, less intense suction.

4) Castor Oil. Ina Mae Gaskin is a fan of using castor oil, but I would have to be really desperate to go this route, like 41.6 weeks. I did this with our first baby and it was like having the flu in early labor. Throwing up and diarrhea is not how I pictured this exciting time. The idea is that it stimulates the bowels, which stimulates the uterus.

5) Stripping Membranes.
Again, not a fan. It's not a part of the natural process, yet if I were in the 41st week, I would probably think about it. A lot of midwives like doing this and will often suggest it, in my opinion, too early. Sometimes it's even done during a vaginal exam without the knowledge or consent of the mother-to-be. She might find herself bleeding a couple hours later and panic. Sometimes it works, and sometimes it doesn't, just like with anything else.

6) Acupuncture or Reflexology.
It's no secret that pregnant women have pressure points throughout their body that can stimulate and cause contractions. That's why, when getting a massage or pedicure, you need to see someone who is trained to recognize these points and work around them. Your doula will likely be familiar with these pressure points and can work with you.

7) Walking.
Normally I wouldn't list this as one of the methods of starting labor, but I feel that if I don't mention it, someone will think that I just didn't know about it! I laugh when I see women at the mall, obviously very pregnant, out for a power walk, trying to start labor. Walking will not start labor. It will help to keep it going and there are many benefits to walking in early labor but it will not start it. Don't tire yourself out with this method unless you feel up to it.

I do not believe in the artificial induction of labor unless there is a true medical reason to do so. We have gotten so far away from normality when it comes to labor starting on its own. Nurses are shocked when my students show up in labor to the hospital to give birth. I should mention that I have had a couple of students who went past 42 weeks, approaching 43 weeks, who never started labor on their own. Legally, their doctors wouldn't let them continue with the pregnancy and induced labor. It wouldn't be fair if I didn't mention that it does occur once in a blue moon (Dr. Bradley had 2 women remain pregnant for a year before giving birth!), but it is definitely an exception, not the rule.

There are medical ways of starting labor, but I'm not even going there. A woman is twice as likely to have a C-section when she is induced. Think about that for a moment. Why would that be? Simply because her uterus was forced to contract when it wasn't ready. But it's almost always too late to turn around. The parents are expecting a baby out of the ordeal, no matter how he or she gets here. The mother's bag of waters is likely broken. The doctor is just in too deep at that point and has to just get the baby out. Fetal distress in an induced labor is caused from one of two things: either the baby couldn't handle the pitocin contractions or he or she couldn't handle the drugs the mother had to take in order to deal with the pitocin contractions.

Pitocin is evil. Sex, combined with nipple stimulation, is the best way to go. Which would you rather choose?! It's a no-brainer. It's like I always say -- The same thing that got you into this will be the same thing that gets you out.

Sunday, February 22, 2009

"Are you STILL Breastfeeding?"

Just a little challenge for y'all:

When you ask someone "Are you still breastfeeding?" try taking the word "still" out of your question. It implies that they should have stopped by now. They might feel embarrassed by answering yes because of the implications of the word "still."

I was talking with a woman who had had a wonderful unmedicated birth about 18 months earlier. I asked her this question, if she was breastfeeding. The look on her face told me she thought I was insane! Her child was running around the room at the moment. She laughed and said, "She's 18 months! No." I told her that 3 out of my 4 were breastfeeding at that age. The room was silent. It was a rather humorous moment.

I want to encourage women to continue breastfeeding as long as possible and by asking if they are "still" breastfeeding, it does not sound encouraging. Just something I've been thinking about as I've been talking with breastfeeding moms lately, especially as their babies are getting older.

Just a reminder: the World Health Organization recommends breastfeeding until at least age 2. In my experience, those have been my most rewarding breastfeeding relationships -- the one's we went to at least age 2.

Thursday, February 19, 2009

"Doula" Necklace by Moon Over Maize

Moon Over Maize has made another awesome necklace for the doula that helped you through your birth. What a treasured piece of jewelry to receive as a gift from a client. Or, if you are a doula, flaunt it! It's bound to start conversation and spark interesting conversation. I get to talk about my "homebirth" necklace all the time. Very fun! For more information about the different stones used or to order, click here. She has another variation of the doula necklace too. Check it out.

Rumor has it, I believe, that she is making one for the midwife too. Can't wait to see it.

Monday, February 16, 2009

"Will The Baby Be in Our Bed Forever?"

When I talk about the benefits of bedsharing in my classes, I get such a mix of expressions. To many, they have never heard of anyone sleeping with their baby. We just don't do that in America! And for those who do, they probably don't talk about it. They certainly didn't start out with the intent of being a bedsharing family. David says that when I start talking about it, it's funny to watch the dads-to-be. He says they are imagining never having sex again! The moms, on the other hand, are imagining sleep! Oh, yes, this could be a good thing!

For the husbands, you will have sex again! Sometimes it will even be in your bed while the baby is soundly sleeping. As the baby grows, you'll find yourselves getting creative. Summer will become the favorite season because you won't be freezing outside the covers when you are having sex in other places in your house!

There will be nights when the baby sleeps in an "H" position, with you and your spouse on either side of the bed and the baby laying comfortably across the bed. I promise, someday you will laugh about it. Generally, everyone will sleep better this way, but you will have a handful of bad nights over the course of bedsharing. (Not nearly as many as those who do not bedshare.)

Some couples have their baby transition onto a pallet on the floor in their bedroom. Instead of bedsharing, you would now be roomsharing. Don't be surprised if your little one crawls up into your bed during the night for a while. It is a gradual process for most children. Don't be afraid to talk to them about what they are ready for. I had a weaning conversation with my third child at the age of 2. They understand! They will definitely let you know if they are not ready. Respect their decision. Encourage them without forcing them before they are ready. It's like potty training -- you can't make them do it. If you do, you will likely cause a rift between you. No one likes to be forced to do anything, even a toddler or preschooler. Simply mention it every couple of weeks. One day, they will just surprise you and announce that they want to sleep in their own bed tonight. You will likely have mixed emotions.

But it sure is nice to be able to have sex in your bed again, especially in the winter!

Sunday, February 15, 2009

Co-Sleeping, Bed-Sharing, and Room-Sharing -- Oh My!

I have always referred to sleeping with our babies as "cosleeping," but recently there has been some discussion about the differences between the two. Here's a basic definition of each:

Co-Sleeping: This is where a baby sleeps in the same room, usually within arms reach, as his or her parents, maybe in a bassinet or side-sleeper.

Bed-Sharing: This is when a baby sleeps in the same bed with his or her parents.

Room-Sharing: This is when a baby sleeps in the same room as his or her parents, in their own crib, bassinet, or bed.

David and I have done all three. With the first couple of babies, we were probably more co-sleepers than bed-sharers. Over time, we definitely discovered bed-sharing to be easier.

The need to differentiate between the two has arisen because of an anti-bedsharing campaign in NY. They are trying to convince parents that bed-sharing is unsafe. If you have the current issue (Jan/Feb) of Mothering, you have probably read the article. I just want to mention a few key points that were mentioned.

Because the focus is on safety of the baby, I'd quickly like to mention that for every 87 babies that die of SIDS, only 3 of those babies are exclusively breastfed. I'd really like to see the focus for preventing SIDS be in the form of breastfeeding information, encouragement, acceptance, etc. instead of misleading parents to believe that bed-sharing is unsafe.

There are some general guidelines that should be mentioned about safe bed-sharing right off the bat. These appeared in the Mothering article just mentioned:

* If bottle-feeding, without breastfeeding, or if the mother smoked during the pregnancy, it is recommended to use separate-surface cosleeping such as a side-sleeper or bassinet.

* It is best to have the bed away from the wall, even without a bedframe. Mattresses can pull away from the wall and the baby can become trapped between the mattress and the wall.

* If you keep the bed frame on the bed, make sure there are no spaces between the mattress and the head-board and foot-board. Be aware, also, of furniture surrounding the bed, such as a nightstand, that the baby could fall and suffocate.

*No children should sleep in an adult bed with an infant.

*Bedsharing should be avoided under the following circumstances: the adult(s) are overly exhausted, desensitized by drugs or alcohol, or sleeping with an unrelated adult.

*Use a stiff mattress, lay baby on his/her back, avoid using duvets or heavy blankets, and keep baby away from pillows.

* Never bedshare on a waterbed, couch, sofa, recliner, or chair. Do not leave baby alone on an adult bed.

*Both adults should agree to the sleeping arrangement if choosing bedsharing. They should both be responsive to and responsible for the baby.

Now that "the rules" are out of the way...

With all the recent hype, there are some important items to mention about the possible dangers of not co-sleeping or bed-sharing. The American Academy of Pediatrics (AAP) has stated that it is important for an infant to sleep in close proximity to his/her parents. It is called roomsharing. In this situation, the baby and the parent(s) sleep close enough for sensory exchanges, but not on the same surface. Does the room protect the baby? Of course not. But being near the mother does. Babies who room-share are half as likely to die of SIDS as infants who sleep alone or with siblings. Why is this?

For starters, babies are programmed to be in constant contact with their mothers, especially in the early weeks. Their only form of communication is to cry when they are stressed. Generally, babies will protest being "put down" or left alone for long periods of time. They have a need to be with their mothers. It is physical, emotional, and psychological. When a baby is left to cry for long periods of time, that can cause severe stress, raising the cortisol levels in the infant. (This also happens when a male infant is circumcised.) High cortisol levels can lead to permanent changes in brain structures and leave the infant especially vulnerable to stress. (Dr. William Sears, in The Baby Book, said that when you leave a baby to cry, you are teaching him/her to just give up. You are not coming back.)

Other physical reasons that a baby should sleep near his/her mother include: Premature and full-term infants breathe more regularly when next to each other, infants use energy more efficiently, they maintain lower blood pressure, grow faster, and experience less stress, as previously mentioned. Being near the mother also helps regulate the baby's temperature, brain-cell connections, calorie absorption, breathing, sleep, arousal patterns, and heart rate.

These benefits are all well documented. So what's the deal with the "Babies sleep safest alone" (NY State) and "All babies should be placed to sleep in cribs" and "For you to rest easy, your baby must rest alone" (Philadelphia) campaigns? Especially when the AAP has recommended roomsharing, emphasizing close proximity with your infant? Parents are only getting half of the information they need. These public health campaigns are making it sound as though bedsharing in-and-of-itself is unsafe and is disregarding the importance of the mother and baby sleeping near one another.

All families are different. All couples are different. And, yes, all babies are different. You have the guidelines to safe bed-sharing and co-sleeping, if that's what you choose. It's important that your baby sleep, at the very least, in the same room, if not the same bed, with the parents. Maybe someday, AAP will declare that infants should never sleep alone and end all this nonsense. Maybe someday, American babies will sleep safely next to their mothers like they do in other cultures, breastfeeding -- because it's the norm, because there was a wonderful public health campaign that encouraged them to do so, for the safety and security of their baby.

Tuesday, February 10, 2009

Parenting Trials, Part 2

A couple of things I forgot to mention in the last post that I've been thinking about lately:

I think it's good that children have siblings to figure things out with. They learn a lot about sharing, negotiation, problem-solving, cooperation, having fun, and unconditional love by having siblings. Then, I hope, they can go out into the world and be able to relate, or at least get along with, all sorts of people in all sorts of settings and situations.

One of Vena's teachers is doing my class by DVD, so her and her husband come by to pick up DVDs every few weeks. She has seen how Vena acts at home (crazy!) and has assured me that she does NOT act that way at school. What a relief! In fact, she says that Vena is the perfect student.

My point is, home is where we figure things out. Hopefully we can pull things together out in the real world!

Monday, February 9, 2009

A Tough Day of Parenting

I have been writing a post in my head for the last couple of weeks on Co-sleeping vs. Bed-Sharing. There is a lot of info though, and since I have had a tough day of parenting, I decided I need a little therapy to talk myself down! (I will be writing that post though over the next few days.)

I really don't want to make this into a blog about my family. There are some family dynamics, however, that are worth exploring. I, for one, am so sick of hearing myself repeat the same instructions over and over to the same children. I counted 5 times that I had to tell Daymon to practice his trumpet for another 15 minutes before he finally did it. When he actually did practice, he went over by 10 minutes and he sounded great.

Vena just could not get her room picked up the way I wanted it -- and that is the trick! Here is a funny thing about any family willing to fork out the money to have someone come and clean for them: you have to pick up the entire house before the cleaning lady can come to clean. My kids despise that. It creates a lot of stress to have the entire house picked up all at once, but we all love it when it's done. I'm probably not getting a lot of sympathy here, but I am willing to pay for this service so that I can devote my time to other things, such as this blog!

And it's Monday, so the elementary school kids came home with their homework packets for the week. Another thing to do. I'm describing all of our lives, I hope!

But here's an interesting dynamic I have noticed lately. My kids fight. Usually if there's a good fight going in our house, we can assume that Abby is right in the middle of it. She is such a firecracker. She has recently discovered tattling, as she is 7, almost 8. I have started asking the kids if they really want me to solve the problem for them. I will if they want me to, but they probably won't like my solution. (They know I'll make them clean something -- probably together -- and get some work out of them.) So, they are learning to solve their conflicts on their own. I have noticed they are getting better at this. It makes David and I very happy.

Tonight we had a Family Council Meeting about the commandment "Honor Thy Father and Thy Mother" and what that means. Respect, especially from a certain someone who will remain nameless, has become an issue lately and it is disrupting the entire family. I hope things improve in that area.

We have missing assignments from another student, who miraculously pulls As and Bs every six weeks, with a lot of stress in between. People tell me I should just let him fail, but I just haven't been able to do that. And yet, I believe (and of course, he doesn't) that he would fail if I didn't ride him about his assignments. How do you teach integrity and hard work besides by example? We are frustrated by this situation. He's lost the Play Station and computer time, but the problem continues...

The flip side of all this is that it makes me appreciate Darcy more. She'll be 4 in March. She says the funniest things and is so "innocent" -- those who know Darcy are laughing at that description! I hate to end this on a sour note, complaining about my day and parenting trials, so I'll end it with a good bed-sharing story:

We had a big storm last night with lots of really strong wind and rain. Right after it started, Darcy came running into our room and snuggled into her old spot in the middle. She was shaking. She cuddled right up to me and I felt her body relax after a few moments of listening to the storm. She's the only child who ever wakes up to any storm, so this morning as we drove Daymon to school, she was telling him all about it. I tried to remember exactly what she said: "At first I didn't realize (yes, she really used that word!) that it was rain, but then I did and I ran in the dark to Mommy and Daddy's bed. It was scary Daymon! I knew they would keep me safe and warm. That's where I slept until morning."

Hearing words like that, who can argue with bed-sharing and keeping your little one "safe"?

Sunday, February 1, 2009

Why NOTJust a Hospital Childbirth Class?

After the home water birth of our third child, it was becoming evident that I was going to have to teach childbirth classes. I was bombarding every pregnant woman I encountered with information about why natural birth was the best (remember, I have done it both ways) and she shouldn't even consider the epidural. I found myself warning moms-to-be about the interventions in the hospital she was certain to encounter. I loved playgroups and baby showers, as they were places that these topics were certain to arise.

Abby was nearing her 2nd birthday when I finally decided to send in my application to be a Bradley instructor. I was consumed with information on natural birth for the next several months. I lived and breathed it. I had some anxiety about how I would get students in my class. The internet, even in the last 6 years, has come a long way. The Bradley website was in its infant stages, for sure.

I remember calling one of the local hospitals and talking to them about teaching natural childbirth classes there. She laughed and told me, first of all, that no one wants a birth without medication; and second, I would not be allowed to teach Bradley in a hospital. The curriculum was set. I would not be allowed to teach why an IV is not necessary, or why intermittent monitoring is safer for mom and baby than continuous fetal monitoring. The list goes on and on.

Yes, I would have more people in my classes, but I would be working for the hospital. Not for my couples. I could not teach them about evidence-based care. I knew immediately I couldn't teach in a hospital. Women deserve to be informed. I, as an Independent Natural Childbirth Educator, do not work for any doctor, hospital, or even a midwife. I work for the couples I teach. I am not restricted on the information I can teach. Most childbirth educators in the hospitals are extremely frustrated by this, and yet, their hands are tied.

Here is a rare-known fact: A hospital needs to maintain an 80% epidural rate in order to keep an anesthesiologist on the clock 24 hours a day. It's big money. Every intervention racks up a bigger bill. The hospital wants you to have the epidural! They don't want you to have information that will empower you to make better choices that will cost them money. This is absolutely true. U.S. hospital policies are based on financial considerations. They are not based on evidence, research, or good medical care. Birth is the largest source of income for American hospitals totaling more than $50 billion dollars on childbirth, more than any other country in the world, and yet with some of the worst outcomes in infant and maternal mortality.

Don't you see the irony? It's a natural process, that, if allowed, doesn't need intervention. But what a money-maker. It reminds me of "A Bug's Life," where the ants do whatever the grasshoppers say because they are afraid of what might happen if they don't. The grasshoppers know that the ants could overpower them in numbers, but they do everything they can to intimidate the ants to "keep them in their place." The grasshoppers even convince the ants that there are bigger bugs that they will protect them from, but in reality, the only ones they need protecting from is the grasshoppers. Don't you love the end of the movie when Flik sees the fear in Hopper's eyes and he realizes that they are stronger than the grasshoppers, that it is the grasshoppers that need them -- not the other way around?

And so it is with the doctors. They create fear. Childbirth classes in the hospital prepare you to be a good patient, not a good consumer. You are told what to expect when you get to the hospital. There is no preparation for natural birth. It's not "if" you have an epidural, but "when" you have an epidural. Notice the way it is phrased, also. The epidural is given ownership. Women say "my epidural," not "an epidural." The nurses say things like, "Honey, you better get your epidural now while you still can."

If you are giving birth in a hospital, I actually do encourage you to take your hospital's childbirth class so that you know what they expect of you. Learn their policies. I've been told by people who have done this that the hospital is like "training wheels" for my class!

People are reading this blog all over the country. If you are interested in doing my class by DVD, great. I'll get you all set up. Regardless of whether you are able to take my class, you need to be in an independent class, outside the hospital. Be sure your instructor works for you and no one else. You'll get the evidence-based information you need and deserve.

Women don't need all this craziness surrounding birth. We certainly don't need to be spending the kind of money that we do in order to get our babies out of our bodies. Your body will do that all by itself, for free.