Birth Plans and Birth Essays

"...inquire with your provider about the rates of various procedures the use, including rates of natural birth, epidurals, VBACs, and cesareans..." (p. 200)

Interview providers to find one whose approach matches your own. (p. 200)

"To search for information about your provider or hospital, or to share your experince, visit" here. (p. 201)

"Have your doula make sure that each doctor, midwife, and nurse who is caring for you takes a look at your plan." (p. 202)

"...fetal scalp blood sampling to determine fetal distress before doing a cesarean." (p. 207)

ACOG, "3 percent of all births consist of multiple babies." (p. 211)

"ACOG has stated: 'there are retrospective case series that validate vaginal delivery as a potential mode of delivery, especially for triplet gestation.'" (p. 212)

"ACOG and the Society of Obstetrics and Gynecologists of Canada, most of these protocols are not suppored by scientific research, but have nonetheless come to be accepted as the standard of care... Routinely inducing labor before thirty-seen weeks... Routinely inducing labor at thirty-seven weeks... Requiring and epidural... Requiring the mother to be constantly attached to a monitor for the babies' heartbeats, rather than listening at regular intervals... Routinely scheduling a cesarean even when the first baby is head down... For a vaginal delivery, having the mother push in the operating room rather than a normal labor room, because of a slightly increased need for cesearean sectins. Routinely using interventions to speed up pushing of the second twin... You have the right to decline their routine use after discussing the benefits, risks, and alternatives with your provider." (p. 212-213)

"Parents of twins may want to consider having two doulas (for) additional emotional support may help diffuse some of the extra tension that can be present." (p. 214)

For support with a multiple pregnancy, especially twins, visit here.

THE BIRTH ESSAY

A birth essay allows/encourages a mom-to-be to write all of her feelings about her pregnancy and upcoming labor down and then share them with those who are/will be caring for her throughout this time. Questions to get you writing... "What do you imagine it will be like going into labor, giving birth, and being with your new baby right after birth? What will giving birth mean to you, your baby, and your family? What are your dreams for your birth? What are your fears giving birth?" Moms should be encouraged to fill more than a "page or two." "Many providers are not familiar with the idea of a birth essay. However, it is fine to let your caregiver know that you have emotional concerns you would like to discuss, which may arise from writing your essay. You might want to read the essay aloud, or tell your provider what you wrote about, without presenting the actual pages to her." (p. 215-216)

When Epidurals and Cesareans Are Unplanned

"...cesarean is scheduled in advance for medical reasons, studies show her chances are also good for feeling positive after her birth." (p. 175)

"...natural childbirth...at home, where 90 percent do so..." (p. 178)

"Approximately 80 percent of mothers birthing in hospitals have epidurals." (p. 178)

"...whether a mother sees her birth as positive, negative, or traumatic. The most important factors are:
1 Whether a woman's expectations of birth match the reality of what happens
2 Whether a woman feels involved in decisions about her care, even if her expectations cannot be met" (p. 178)

"In fact, a potential risk of any surgery is depression..." (p. 181)

From Dr. Gayle Peterson...
Acknowledge fear can deepen our reserves and help us discover fresh meaning and commitment in our lives. Do not judge your fear or anxiety. Confront and befriend the fear, and it will yield an inner treasure.
Ask yourself these questions:
1. Imagine that an epidural is necessary during your birth. What feelings do you think would arise for you?
2. If an epidural is needed, what would help make this the best possible scenario for you?
3. Now imagine that a cesarean is necessary. What emotions do you think would arise?
4. If a cesarean is needed, what would help make this the best possible situation for you?
5. What fears or anxieties do you have about these situations? (Be sure to give them a voice before your actual birth.)
6. How have you (and your partner) responded to unexpected stress at other times in life?
7. What would you want your doula, and your doctor or midwife, to remember about your needs in case of unplanned events during birth?" (p. 182-183)

"...90 percent of U.S. mothers are instructed to lie on their back or recline during pushing. Only 4 percent push on their sides; yet side-lying may result in more successful pushing, according to New Zealand midwifery expert Jean Sutton." (p. 184)

"...remember to continue incorporating labor support techniques after an epidural, especially massage." (p. 184)

Take time, if it is not an emergency, to, "process the decision...provider to take additional time to explain the need for the procedure, its benefits and risks, and details about how it will be performed...want extra reassurance that the baby is still healthy, and a pep talk to help you keep going in good spirits." (p. 185)

Some mothers may feel "empowered moving forward quickly." (p. 185)

"A mother who has general anesthesia can ask for her medical records later." (p. 186-187)

"As for a cesarean section, whether it is needed due to a medical problem or because today's intervention rates are unavoidably high, it is never the mother's fault when it occurs." (p. 188)

"To underscore this point, in 2008 the journal Midwifery Today hosted a seminar with doula leader Penny Simkin titled 'There's More to Birth Than Coming Out Alive.' A woman's feelings of dignity, emotional security, and her need to experience birth as the celebration of a major life passage are also important. When these aspects of birthing are compromised, her confidence about functioning as a new mother can be weakened." (p. 188-189)

"Post-traumatic stress disorder (PTSD) after a difficult birth is getting attention as a condition that affects as many as 7 to 18 percent of new mothers..." (p. 189)

"Ways to assist with healing include the following:
1. Speak to a counselor or therapist...
2. Contact organizations that offer support... (iCAN)
3. Write your birth story...
4. Share your story with other moms...
5. Talk with your doula, your midwife, or doctor..." (p. 191-192)

Epidurals and Cesareans affects on nursing...
"Milk can be delayed from coming in, and babies' behavior can be more disorganized for several weeks." (p. 193)

"When it comes to unplanned interventions, open communication is one of your greatest tools..." (p.194)

(Note to self: Check out the self-evaluation scale in appendix. Possible tool to give at reunions?)

Co-Sleeping

Pro co-Sleeping article.

Labor Techniques Anyone Can Use

"Studies show that nurses need to spend 90 percent of their time on medical procedures and note-taking, with little left over for labor support." (p. 157)

"The most basic technique...get out of bed. Yet over 75 percent of U.S. women report that after they are admitted to the hospital, they never leave their beds." (p. 157)
Childbirth Connection survey found, "women who walk in labor report fewer cesareans." (p. 158)
"The positions and movement options available are many, including standing, walking, climbing stairs, swaying, lunging, sitting, crouching or squatting, leaning forward, being on hands and knees, kneeling, and side-lying." (p. 159)

Only 10 percent of American mothers ever try a warm shower, bath, or jacuzzi for pain relief...For the most pain relief...stay in for up to ninety minutes at a time. (p. 165)

Only 20 percent of women try touch and massage...although, by "Mothers who use touch and massage rate it the second-most effective natural birth relief method." (p. 166)
"Touch Research Institute at the University of Miami show that women receiving massage in labor report less pain, less anxiety, and have shorter births." (p. 167)

*Note to self try page 161

Labor Is Not About Dilation

2003 study in the Journal of Maternal-Fetal & Neonatal Medicine, "doctors are incorrect about determining the baby's head position almost 70 percent of the time." (p. 126)
Caput - in labor, the skin on a baby's head undergoes some normal swelling (p. 127)
"Studies show that women who are admitted to the hospital early are subject to more interventions, including more cesareans." (p. 128)
"Cesarean rates are at an all-time high of over 31 percent in the United States, and over 23 percent in nations including Australia, Canada, and the U.K. The U.S. has one of the highest cesarean rates in the world--with these surgeries mostly being performed on healthy mothers and healthy babies--yet ranks nearly last in preventing infant mortaliy among developed nations. Hence the controversy about how commonly they are being used." (p. 129-130)
2005 ACOG "estimated that 60 percent of cesareans are based on a diagnosis of failure to progress." (p. 131)
"In natural labors, contractions and dilation normally speed up, slow down, plateau, stop, and speed up again. And while it may seem that the use of Pitocin would result in shorter births than natural labor, studies have shown that the presence of a doula, or preserving the mother's freedom to sit up and walk around, may result in shorter labors than those with Pitocin." (p. 132)
"Researchers estimate 30 to 50 percent of slow labors may be due to a cervix that is more firm or rigid, not due to 'inadequate contractions' that need Pitocin." (p. 132)
Reasons for a firmer cervix:
birth control pills
scarring on the cervix resulting from
"1. Removal of tissue after a miscarriage (D&C)
2. Previous births in which the cervix sustained tiny tears during pushing
3. Abortion
4. Insertion of an IUD
5. Treatments for abnormal pap smears or genital warts, such as cryosurgery (freezing)
6. Taking a biopsy from the cervix or inside the uterus
7. Removal of polyps
*Not all women with scars will necessarily have longer labors, though." (p. 132-133)
April 2004...journal Obstetrics & Gynecology...University of Liverpool.."Sometimes a buildup of lactic acid in the body can happen during birth...this can temporarily slow labor...woman's body needs to rest. Once lactic acid clears from the system, labor will usually naturally resume." (p. 134)
Contractions rated in units called millimeters of mercury or mm Hg. Getting mom upright can increase contractions by 35 mm Hg. (p. 135)
2004 Journal of Obstetrics, Gynecologic, & Neonatal Nursing..."women pushed safely for up to eight hours." (p. 137)
" a healthy second stage can take much longer, lasting as many as ten to twenty hours." (p. 137)

Signs of progress
1. Changes in Contractions
2. The Height of the Belly
3. Bloody Show
4. "The Bottom Lin"
5. Descent of the Baby
6. The Baby's Heartbeat (For a fun way to see progress, a pen can be used to mark the belly with an X each time the heartbeat moves lower.)
7. Bag of Waters Breaking
8. Ultrasound
9. Rectal Pressure
10. Involuntarily Having a Bowel Movement
11. "Opening the Back"
12. Seeing the Head (p. 138-140)

"With three vaginal exams, the risk of infection doubled; with nine exams, the risk of infection soared five times higher. Scientists also conclude that risk of infection increases based on hours between the first vaginal exam and delivery (not between water breaking and delivery)." (p. 142)
"However, even the presence of GBS is a much lower risk factor than having multiple vaginal exams in labor!" (p.143)
World Health Organization says, "infection might be caused by vaginal exams not only in labor but during prenatal appointments with your midwife or doctor; if you are GBS positive, you may want to avoid exams during pregnancy or inserting anything else into your vagina (e.g., use lovemaking options that don't involve penetration). (p. 143)

Bag of Waters
pH strip to test fluid if thinking water has broken. (p. 143)
feel and see periodic gushes of clear fluid (p. 144)
check for baby's umbilical cord did not slip out when water broke, "listening to the baby's heartbeat can reveal the condition of the cord instead." (p. 144)
signs of infection: fever in the mother, rapid heartbeat of mother or baby, foul-smelling vaginal discharge, tenderness in the belly (p. 144)

"Cochrane Collaboration, 70 percent of women have contractions within twenty-four hours, 90 percent by forty-eight hours, and it can be safe for women who take longer if they're watched by their providers." (p. 144)

Epidural fevers "not caused by an infection." (p. 146)

"During pushing...posterior or misaligned...technique is known as digital or manual rotation...By using this technique, in a pilot study in the March 2007 European Journal of Obstetrics, Gynecology and Reproductive Biology, the cesarean rate for malpositioned babies was reduced from 23 percent to zero." (p. 148)

"Cochrane Collaboration, 70 to 90 percent of the time when brain damage occurs in newborns it is not caused by events in labor and cannot be stopped by the birth provider. And while cesareans for fetal distress have increased, the rate of cerebral palsy has not changed, as reported in the Journal of the American Medical Association. (p. 150)

fetal scalp blood sampling should be used to check for fetal distress. This is a test that allows baby's pH to be checked for acidity (p. 150)

Cochrane Collaboration..."the increase in cesarean section rate is much greater when scalp pH estimates are not available." (p. 150)

"A full-term baby's normal baseline rate is 110-160 beats per minute...a change of more than five beats per minute is normal variability, while variability of less than five beats is cause for concern...provider looks for accelerations and decelerations...Williams Obstetrics states, '...epidurals and Pitocin cause the most decels...'...It is considered acceptable for the baby's heartbeat to go as low as seventy beats per minute before it is seen as worrisome, as long as this does not happen repeatedly or for long periods of time." (p. 150-151)

Obstetrics & Gynecology journal, "women who had sexual intercourse an average of four times in the ninth month of pregnancy gave birth sooner and were half as likely to be induced as women who did not have sex." (p. 152)

"The Cochrane Collaboration reports that breast stimulation is as successful as Pitocin for starting labor within three days." (p. 153)

Pitocin tips:
"Request a low dose of Pitocin that is increased more slowly (a.k.a. a "whiff" of Pitocin). (p. 153)
"Ask for a portable wireless monitor" (p. 154)
"Once contractions are two to three minutes apart ask to have Pitocin turned off (p. 154)
"Watch for extremely long contractions that go on for more than ninety second each, or contractions that seem to have only a tiny break of a few seconds between them. Pitocin needs to be turned down or off in these situations for safety, and although providers should be checking on this, studies and doulas report that they don't always notice." (p. 154)
"British Medical Journal..women with 'stalled' labors got into a tub for up to four hours, one in three mothers who would have gotten Pitocin didn't have to." (p. 155)
Pitocin time to work..."According to scholar and doula Henci Goer, research shows that women who are given only two hours on Pitocin to achieve increased dilation receive three times as many cesareans, compared to women allowed to continue laboring for four hours or longer with Pitocin.

When Should You Really Go to the Hospital in Labor?

"In Review: When To Go To The Hospital In Labor
3-1-1
5-1-1
3 or 5 minutes apart, 1 minute long, and have been that way for 1 hour.
For mothers having their second or subsequent baby, when contractions are five to sever minutes apart.
When you can no longer talk between contractions, not just during contractions.
If you feel the urge to push.
If you have heavy bleeding, pain between contractions, if green or brown fluid is leaking from your vagina, if the baby is not moving, or the baby's umbilical cord slips out of your vagina.
If you intuition tells you to go, regardless of other signs.
When if doubt, or if you are high risk, consult with your medical provider." (p. 124)

More debate coming in chapter 8.

Doulas and Medical Providers

"As one doula put it, 'I am there to slow down time so you have time to make your own decisions...I want mothers to be active decision-makers in their births.'" (p. 106)
"Ask your provider specifically how she feels about doulas. How many births has she been to with a doula present? Does she have any questions or concerns about doulas?" (p. 106)
When looking for a doula ask specific questions. Like "how she might handle a situation in which she and the doctor or midwife have differing opinions...her experience supporting women who opted for pain medications or who had C-sections." (p. 106)
Once you have picked a doula, ask:
Has she ever attended a birth with your doctor?
What was that like?
Has she been welcomed at your hospital? Or ignored? (p. 107)
"Dr. William Camann...Brigham and Women's Hospital in Boston...invited doulas to remain with the laboring mother in the operating room during a C-section, and to stay by the mother's side during the insertian of the needle for an epidural. 'I think it's totally compatible for a woman to get pain medication and have a doula.'" (p. 108)

Find Your Doula! Ch 5 Lowe & Zimmerman

Dr. Marshall Klaus, "touching and stroking of your arm or thigh, the looking into your eyes, what we have seen is that this reduces most of the problems and difficulties with labor--reduces the need for cesareans, the need for drugs and a host of other things." (p.85)
Page 80, 81,89 have lists of ways to find a doula. One for me, for some day, Christian Midwives International (U.S.A.) Referrals to Christian midwives and doulas.
Adoptive parent "breastfeeding expert Lenore Goldfarb." (p. 92)
Support services for birth families. (p 94)
"For more information about doulas and surrogacy or adoption, contact the Childbirth and Postpartum Professionals Association, at 888-MY-CAPPA" or click here cappa. (p. 94)
Questions doulas ask,
"Have you been learning about birth, or do you need basic information? Have you taken birth classes or read books about birth?"
Who will be with you at your birth? What kind of support would they like to offer, and what kind of support will they need?
If you have given birth before, what was your experience like?
How do you wish to handle the potential pain of labor?
Do you have health concerns or emotional concerns you would like to share? If you have an unusual health condition, can you supply your doula with information about it?" (p.98)
Doula fees, "Typical fees for a newly trained doula in North America are in the range of $300. Fees for an experienced doula start at approximately $600 in smaller towns, and can reach about $2,000 in cities with the highest cost of living, such as San Francisco or New York City." (p. 97)
Couples can ask for a doula as a gift registry item. For cash gifts, some websites to check-out are:
www.felicite.com
www.gogift.com
www.myregistry.com

Drugs, Lamaze, and Beyond Ch.4 Lowe & Zimmerman

Drugs, Lamaze, and Beyond
Lying flat on your back in labor produces more painful contractions that are "less effective at opening the cervix." (p 61)
Contact you doctor or midwife immediately if you experience "stabbing pain in the abdomen that does not disappear between contractions...bleeding heavier than a menstrual period." (p. 61)
"High stress and excess adrenaline in labor may cause the lower portion of the uterus to close rather than open." (p. 61-62)
"If a birthing woman feels very fearful of the pain of labor, if she feels unsafe, or if support and guidance are not available to her, it is logical that the body tension and doubts will increase, and the pain may indeed become unmanageable." (p. 62)
"...2006 study from the University Hospital Nice, France, published in the International Journal of Obstetric Anesthesia, mothers who received a very low-dose epidural were able to walk safely without falling or stumbling. (The medication used was 0.0625 percent bupivacaine, a lower amount of the standard drug used in nearly all epidurals." (p. 65)
If you want an epidural and the ability to change positions in labor, begin conversations with your care provider at your prenatal appointments. When at the hospital ask nursing staff to help you switch positions and encourage you to do so. (p. 66)
If an epidural seems to be not working, try changing positions before upping the dose. Give the new position 15-30 minutes to work. (p. 66)
"...approximately 95 percent of birth classes are affiliated with hospitals or clinics; these are sometimes thought of by childbirth advocates as 'obedience classes,' because they may teach you to be more of a passive patient than an active informed consumer." (p. 68-69)
"...Touch Research Institute at the University of Miami, if you are able to go to a massage therapist a half-dozen times while pregnant, the relaxation effects can carry over to help you have an easier labor." (p. 70)

Blogs for Brio Classes

Navelgazing Midwife Blog has a wonderful post about birth plans.
To see how baby turns as he/she decends I like to show this clip.
To see a real live human being born without meds and out of water I discovered this post.
Just for the fun of showing LOTS of positions.