Monday, June 24, 2013

"Have it Your Way" - Choosing an Appropriate Care Provider for Your Birth by Rachel Zimmer, CNM

Rachel Zimmer, DNP, CNM

If you want a hamburger, do not go to a vegan restaurant.  If you do choose to go to a vegan restaurant, arguing with the chef about making you a hamburger will do no good. Therefore, do not be surprised if you choose to stay at the vegan restaurant if you do not get a hamburger. You just set yourself up to be disappointed. Sounds silly right? 

If you are an expectant mom who wants an un-medicated birth, or a birth without interventions, this is exactly what you are doing by staying with your current provider (assuming your current provider is not supportive of your birth preferences).  Let me tell you how it goes. Mom says to her OB: I would really like to have freedom of movement during my labor and deliver in a position other than my back.  OB says: “OK, we’ll see how it goes. We want to have a safe delivery.”   So what is the reality here? The reality is mom has done some reading and knows that changing positions during labor and birth can help promote a good position for baby as well as decrease her discomfort…  This OB does not care one way or another what mom does during labor and believes she will be just like 90 percent of the moms in the practice and end up with an epidural and on her back anyways.  Want to hear a response from a provider supportive of your low intervention birth plan? How about: “That sounds like a great plan, intermittent monitoring is part of my routine practice. Let’s talk about ways to help keep this pregnancy low-risk so that you can avoid an induction and meet your birth goals.” So moms I am here to tell you, if you don’t get the answer that you are looking for……FIND ANOTHER PROVIDER!  So why do women stay? These are some answers I hear…

“I’ve seen my OB since my very first pap smear…” ie loyalty. I guarantee that this means nothing to your provider. They will still check out at the end of the day and let one of their partners catch your baby.  I am not saying there is anything wrong with that, no one can work 24/7. The point is, so what? Your provider does not remember any of the pap smears that they have done for you and will not miss doing them in the future. That is assuming they will even notice you are gone, which they probably will not. Most OBs see 150-200 women every week and you are not special to them.

“I need to deliver my baby at such and such hospital because it is closest to my house….or because they have a special postpartum suite that I want to have”. Most first time moms are in labor an average of 18-24 hours. Unless you are planning to deliver in El Paso, you will have time to get there.   Your baby will benefit from the decisions you make surrounding your birth and none of this has anything to do with the size of your postpartum room, color of the walls, or if they serve you lobster after your birth.

“My OB delivered my last baby…..or all the babies in my whole family”… This is great, you know what to expect! If you were happy with your previous birth experience then by all means stay right where you are! If you are looking for something different, go elsewhere! Your OB has not changed their practices recently.

“It will be fine, I have a doula this time who will make sure my birth plan is followed”… I LOVE doulas and I think all 1st time moms, if not all moms should have one! BUT most OBs don’t understand the role of the doula and don’t like them let alone respect them. Nor will they pay any attention to them as they advocate for your birth plan.  It’s like arguing with the vegan chef to make you a burger… pointless. And, why do you want to fight to get what you want???? Birth should be a time where your birth team is supporting you and working with you, not against you. Doulas are truly amazing BUT your birth experience will be a million times better if you also have an OB or midwife who is ALSO on board with your plan!

“My family is not supportive of me seeing a midwife”… No one said you have to switch to a midwife. There are some great OBs out there who will support your plans for birth. It is absolutely true that midwives are generally less interventional than OBs and more supportive of practices that promote un-medicated birth. But, there is something different for everyone! Ask about interviews, many midwives will offer “meet and greet” visits or interviews that are free and are an opportunity for you and your partner to meet them, see that they’re not crazy witch doctors, and find out if they are right for you. If not, keep moving on!
As OB providers, we attend anywhere from 50-300 births per year…sometimes more! You as an expectant mom, will experience childbirth once, twice, or sometimes more in your whole lifetime. This is YOUR experience. Don’t let any of the above reasons stop you! Choose people to be part of your birth team that want to help support your goals. C’mon moms! YOUR BIRTH MATTERS! Your OB provider MIGHT remember if the baby they put onto your chest (hopefully) was a boy or a girl. You will remember your birth experience for the rest of your life…

Rachel grew up in the Dallas area and is a graduate of The University of Texas at Arlington majoring in nursing. Rachel has a special interest in music, sports, and Spanish. Rachel attended Baylor University Louise Herrington School of Nursing beginning 2008 and graduated in 2011 with her Doctor of Nursing Practice (DNP) degree in Nurse-Midwifery. Baylor University was the first school in the United States to offer the DNP/Nurse-Midwifery program. She then received certification through the American Midwifery Certification Board (AMCB) and is an active member of the American College of Nurse-Midwives (ACNM). During her graduate studies she performed clinical rotations at Parkland Health and Hospital System in Dallas and completed her residency here at MacArthur OB/GYN and Baylor Medical Center at Irving. The focus of her graduate project was utilizing social media to provide childbirth education to women.

Monday, June 17, 2013

Come to the Dark Side, We Have Breast Milk AND Cookies

So excited about this guest post from Karen Orchard.  In addition to being a great writer, she is a home-birthing, breastfeeding, cloth diapering PHARMACIST!  She also does some cool things with yarn (links can be found at the bottom of her cleverly written post).

Honestly, I was never much of a Star Wars fan.  Star Trek was where it's at for me.  The entire pursuing knowledge for the sake of discovery is more my style.  Ideas and learning motivate me.

I want to share with you how someone as unlikely as myself would turn into a home-birthing, extended breast feeding, and cloth diapering mama.

Berry Patch Mama - The Pharmacist 
Actually, I think me becoming a pharmacist is stranger than me becoming everything else I am.  Yes, you read that right, I am a pharmacist.  Honestly, I know perhaps one other pharmacist who gave birth without an epidural and insisted on taking breaks at work for an entire year to pump.  I am a strange bird in my habitat.  Most other pharmacists I know gave up on pumping after a week.  Not me!  I viewed it as my right, my baby's right.  Don't mess with Mama Bear!  I didn't back down, even when ten years ago my district manager wouldn't arrange a private place for me to pump.  My solution?  I sat in the corner out of view of customers, facing the wall.  It was a terrifying thought at first, but it became a routine and my coworkers got used to it.  Luckily they were all female.

Honestly, I'd never really wanted children.  I'd never thought much about it, which might have been a good thing.  My head wasn't filled with all sorts of cliched and romantic notions or dramatic portrayals from movies and TV.  Our families shape many of our ideas about things, especially child rearing.  Perhaps it was something of a blessing I was an only child for 7 years.  I had not a single cousin until I was 6!  I was never around other babies or children.  I hadn't all that much to 'go off of'.  As far as medications,  I came from a family where aspirin was the strongest analgesic in the house.  You didn't go to the doctor unless it was serious.  My father routinely believed he could think himself out of a cold.  The man never missed a day of work.  I didn't know any pharmacists and my parents weren't in the medical professions.

My mother was a woman ahead of her time.  She claims it was all the Phil Donahue she watched.  She was determined to have a natural birth and breastfeed in the early 70s, when people weren't doing any of those things, including having children.  You know, the whole Population Bomb thing and all had just come out.  Mom remembers there were no maternity clothes to be found in the department stores.  Modern women were liberated, you didn't need to breastfeed.  Be a modern woman, use formula! Working 9 to 5 and all that.

So, why the heck would I even become a pharmacist?  Poor guidance counseling for one.  I didn't know any pharmacists and my parents weren't in the medical professions.  It was ultimately my love of science and my practicality of wanting a steady, secure pay check.  Originally, I intended to go into pharmaceutical research and development, but I sure am glad I don't work for a pharmaceutical company now.  Maybe that's what makes me different.  I entered into pharmacy under the naive notion that science and concrete facts were what lies behind the pharmaceutical industry.  I think we all know what drives the pharmaceutical industry and health care these days, but 25 years ago in high school I wasn't so enlightened.  As you can imagine I am a tiny bit disillusioned now by it.

When I became pregnant 11 years ago I embarked on my usual strategy to deal with everything.  Research!  I love investigation, research,the thrill of the hunt.  I visited message boards (we were pre-blog and Facebook back in those days).  I found one for Attachment Parenting.  A term I had never, ever heard in my life.  I found it very fascinating and very reasonable.  It made sense!  That's what I like.  You see, I question everything.  I'll never accept anything without knowing the "why".  Then I found the Mother of all Attachment Parenting communities, (pun intended).  I was hooked!  I studied.  I read books.  Not cream puff books, like "What to Expect When You're Expecting".  I read Sheila Kitzinger, Laura Shanley, and Ina May Gaskin.  Unassisted Childbirth really made an impression on me.  I never did have an unassisted birth, but the book is just amazing!

The world would be a much better place if truth and fact were the highest of our pursuits. If exploring strange new worlds and boldly going where no one has gone befo-.... oh I did mention I am a little bit of a Star Trek TNG fan. That's the sort of scientific pursuits and world I'd have liked to live in. I thought someday I'd be Dr. Beverly Crusher. However, this isn't the 23rd century. Really, we aren't that far removed from bleeding people, drilling holes in people's skulls, and the invention of antiseptic. 200 years ago doctors warned not to bathe too often, or else you may let the 'bad airs' in through your pores! Ridiculous, isn't it? Yet today, we aren't that much more sophisticated. There is a plethora of standard protocols in hospitals based on little to no scientific evidence or good reason. Most hospital procedures are based on mitigating liability, not science or medicine. True story. In light of that, I think you, as a lay person, should keep in mind that the medical profession doesn't have the best track record on sound, reasonable advice based on scientific fact. If it doesn't make sense to you, ask "why?". If you don't get a answer that makes sense, do some investigative work and find out the truth. Above all things, I think the truth about things is the most important thing for me. I won't hide behind ideology, or political correctness, or popular opinion, or "because that's the way we've always done it. That's why I believe in natural birthing and all the other things I believe in. Because they are reasonable, rational, and logical. Live long and prosper and have a great birth! Oh hey, PS, I just discovered a woman pharmacist I work with is due this weekend and it's her second birth at the local Midwife Birthing Center! When she told me I believe I did a fist pump and exclaimed "Oh yeah!" Karen Orchard  
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Monday, June 10, 2013

Letter to a Baby Not Yet Conceived - Anonymous Post

The following piece was submitted anonymously as my family and friends do not know that my husband and I would like to try for another child. More controversially, they do not know that we intend to deliver said baby in our home with a midwife. I’m not sure how this will go over with my family and do not want to find out just yet. 

Dear Baby #4:

Last night, Daddy and I watched “The Business of Being Born and our minds were blown away. We had heard of people having homebirths or water births or using midwives instead of OBs but honestly, it all seemed like hippy stuff to us.

I’m almost ashamed to admit it but I often looked at women who did these things as crazy for risking their baby’s life. For all I could tell it was just for a power trip. But last night it clicked. The realization of just how broken our maternity system is was shocking to me. I sat nearly in tears as I thought over my births in a new light. Our experiences would have been exponentially different if we would have been one of these freaks.

#4, I never thought we’d have you. With three big sisters, (and really only planning on two of them) you’d think we were done. And we thought we were. We really did. But you are in our hearts so deeply right now, no matter how crazy it would be. You are the hope we still hang on to. We have to make sure life works out to fit you into it. Finances and space are two big factors. Your sisters are still too young for us to even think of expanding yet. But this gives us time; important time to research everything we want for you.

I’m sorry I didn’t know more when I was pregnant with #1. I took a few basic classes. I wanted to try delivering naturally but it wasn't an overwhelming passion. I had no idea what the body was capable of and I didn't give mine a chance. I made it to 7 cm (which was further than I really thought I’d make on my own but I progressed quickly and reached this point after only a couple hours of labor.) For whatever reason, I gave up; thinking I still had hours to go. The epidural was placed but within minutes your sister was ready to come out. The nurse insisted I hold her in as the doctor wasn’t near. I hadn’t even seen a doctor yet. Heck, I was just getting settled. A few minutes later, an on-call doctor rushed into the room and out came your sister. She was delivered by the hands of a stranger. I tore even though there was no real reason for it. Looking back, I see it was resisting pushing that caused the extra strain.

I had an epiphany this morning as I dreamed of you becoming a real part of our lives. The doctors treated #1 as preterm. I had an early ultrasound with your sister that dated her as being younger than we thought. I had regular cycles and knew when the exact date of conception. The due date shouldn’t have really been negotiable by that much. But for whatever reason, the ultrasound tech moved the due date back by five days. It was no surprise that I measured ahead the entire pregnancy. And when your sister arrived late in the 36th week, she was treated as a preemie even though she very much came on her own time.

She was healthy but the doctors were scared. I should have stuck up for her but I didn't know I could. I didn't know that as a mom, her rights were up to me before she was even born. I wasn't given the chance to nurse her right away nor do kangaroo care. Her apgars were in healthy range. She had good color though and was breathing just fine. But that’s not how they treated us. With no nourishment, they stripped her down and took her from me for several hours. It was no wonder that she then showed low glucose levels and colder than average temps. Without even giving me a chance to help her, she was whisked away to the NICU.

The experience wasn't what we planned but we got home a few days later and settled into a very comfortable routine. I was lucky that after the separation, she still learned to nurse like a champ. I wore her often. The natural side of me came through and I soon forgot about the emotional pain and what if’s from her delivery. The time came a few years later that we decided to try again. The second time around, I knew I wanted things differently. I had it all planned out. 

And then the egg split.

I know now that this shouldn't have ruined my plans. I had more options but I didn't take them. I didn't know then that I even could take them. Instead I laid in a hospital bed for months on bedrest, was cut open without so much as a try for a vaginal birth. I was ripped away from my family and faced with a threat of endangering my babies at my weakest moment. I was limited in my interactions with my tiny newborns born too early.

In those moments I failed your sisters. Yes, they were born early and I am grateful to the NICU for giving them the extra assistance they needed. Yes, I needed to be off my feet and resting to keep my uterus calm but the constant monitoring just lead to more scares, more internal checks, more irritability, more contractions; it was a vicious and stressful cycle. The c-section was possibly preventable. I know this now. Sister #2 was head down and ready to go. My body could have done it. My doctor didn't trust my body. Since Sister #3 was breech, there’s no way to know what would have happened. I’d like to think she would have happily changed positions and come out head first like nature intended but I know maybe that wouldn't have been the case. 

I wish I would have thought ahead and consulted a doctor who was willing to do a breech extraction. Mine was not. I think I have a good doctor but she likes to play it safe. And while I always leaned towards safe equaling better now I realize there’s a wide variety of “safe.” I was afraid of the idea of having a split delivery with my twins but I never considered the emotional aspect of what would happen after the c-section and after not getting a chance to try.

So baby #4, if there is a you at all, I’m going to do it right this time. I want to know all my options and face all my fears. It won’t be easy. Daddy supports me as well as a wide community of online supporters but the ones closest to us don’t seem to understand. They see you as a risk they don’t think I should take. They think the things I want are kooky. I wish they could read my mind, feel my pain and my emotions, and understand the excitement that you bring to Daddy and I even as just a plan or a thought and not even as a conceived baby yet. 

I often think of you as a rainbow baby. Rainbow babies are created after a loss and most often referred to as a baby after an infant is loss, a stillborn or a late miscarriage of a little one. I didn't lose your sisters. I don’t intend for my pain to take away from that type of pain because I do not know it but I lost part of me during their births, part of me that I’ll physically heal from but emotionally will always be with me. So even though we never thought of having another baby, you were put in our minds and hearts as our rainbow baby.
Midwives like to say that homebirths are 90% excitement and 10% fear. So this is me facing that 10%, going outside of the normal.



Mommy is an upper twenty something freelance writer and parenting blogger that stays home with her girls in their Midwest home. Her passions are breastfeeding, babywearing, cloth diapering and holistic medicine. She has three beautiful daughters age 4 years and 18 months x 2.

Monday, June 3, 2013

Extended Breastfeeding - Guest Post by Clarissa Leigh

When I was asking for guest blog posts, I was excited to share this one on extended breastfeeding.  I've nursed my own babies anywhere from 15 months to 28 months.  I have to say, the most rewarding relationships have been the ones that were breastfed the longest.  Maybe that's a coincidence, but I like to think that breastfeeding was good for us both.  Thank you, Clarissa, for being willing to share your story.

My son has just turned one, (sob, how did it go by so fast??) and I knew from the moment I found out I was pregnant that I was going to nurse him. It wasn't even a question. I knew many in my family and many friends who had nursed. The one thing I didn't think about was how long I would nurse for. I don't think I had a goal in mind.

Our nursing relationship got off to a great start, we had no problems, and he quickly grew attached to his milkies, as did I. My favorite times in life are nursing him to sleep. As he got older, I was asked how long I would nurse for, and I started asking myself that as well. I did research, I prayed about it, and I thought about it often.

The more research I did, the more I realized that nursing past a year, or extended breastfeeding, has so many benefits. Once I determined the benefits, I knew I would be nursing longer than the norm, and average so often seen nowadays. However I found other reasons, besides the health and nutritional benefits that I would continue to nurse.

1.) It is comforting. As Wilbur gets older and starts walking, and getting more teeth, he needs comfort. The easiest way to comfort him is to nurse him. It calms him down and makes the pain less. I do not want to take away his lovey, his comforting technique, it would be unfair to him, and I like having the power to quickly calm him down.

2.) It gets him to sleep so quickly and easily. Wilbur has never been a good sleeper, even as a newborn, he just does not like sleep. When he gets really tired, it is so easy to get him to sleep by nursing him, also when he wakes up in middle of the night, we don't have to be up for an hour or more.

3.) It helps him maintain his since of normalcy. He is learning and growing so much every day, why would I want to change something else in his life? He needs something that he can come back to when he is overwhelmed by how much he is learning and changing.

4.) It is quick and easy. We have been giving Wilbur a cup since he was 5 months old, sometimes with some expressed breast milk, sometimes water, most often coconut water. He refuses to hold a sippy cup himself, he wants to drink out of a regular cup. If I stopped nursing at a year, he would still need to drink some milk, and in order for him to drink that, I would have to pour the milk in a cup, and sit and hold him for the hour or so it takes him to drink anything out of a cup. With continuing to nurse him, when he tells me he wants milk, it is very easy to let him have it.

5.) I know it is good for him. Everywhere you look, everyone has a different idea or opinion on what kind of milk is best, is it raw cow’s milk, is it whole milk, is it goats milk, is it coconut milk, is it almond milk, is it rice milk? I do not want to be having mommy guilt or second-guessing myself about another topic, and by now, I know he isn't allergic to anything in my diet, and that my milk is perfect for him.

6.) I have already mentioned this, but the health and nutritional benefits. According an article published by Fitzgerald Health Education Associates, Inc., extended breastfeeding into the second year of life provides 29% of energy requirements,  43% of protein requirements, 36% of calcium requirements, 75% of vitamin A requirements, 76% of folate requirements , 94% of vitamin B12 requirements, 60% of vitamin C requirements - Dewey 2001 (source). That is amazing, there is nothing else I could give him that is that nutritious, that wonderful for him. Breastmilk also contains numerous antibodies. No parent wants to see their child sick, and thankfully, Wilbur has only been sick once, and if I can prevent him being sick, I will, to the utmost of my abilities.

7.) The last reason is a selfish one on my part, and that is I love the snuggles, I love giving him what he needs, I love being the one he wants when he wants milkies, I love seeing him so happy and content while I am nursing him. He is such a big boy, and walking around everywhere, and playing by himself so much, that I don’t get many, so if I am able to do something to insure I get more and more snuggles, I will.

Have you practiced extended breastfeeding? What were the reasons that led you to that decision?