I stared blogging on the CT Media Group in mid August, and since then, I continue to amaze myself with the comments, and amount of people that read and follow my blog. So, because of this I decided today I would do a top 10 blogs of 2009. Blogs I enjoyed writing, and blogs that you enjoyed reading!
I hope you continue to enjoy my blog in 2010 as I have lots of big plans for it!
#10 – The Balance Between Parenthood and Music – This blog featured local musician Rob Taylor, and how he balances his music, as well as being a father to two young sons. His music is a great blend of pop rock with a mix of light listening, and makes a great CD to keep in your car and sing along to. I certainly know I do!
#9 – Home birth in Connecticut – It seems as though with the increasing popularity of Home Birth across the country as the choices in maternity care start to get smaller and smaller, more mothers are turning to birthing in the comfort of their own home. I interviewed local Home Birth Midwife Nancy Farr about birthing at home, and how to know if it is the right choice for you. There are several midwives currently delivering babies at a larger number than we really think! Check out the interview to learn more about birthing at home in Connecticut!
#8 – Labor Induction : What You May Not Know! – With the large number of mothers having their labor induced, I thought it would be good to take the time to write about some of the risks that women aren’t being fully informed about when it comes to making this choice. During the next year of 2010, a joint commission is going to be putting into place stricter inductions practices for hospitals nationwide, starting with no inductions before 39 weeks gestation. Which is a great thing for mothers nationwide.
I will certainly post about these changes for the new year!
#7 – Does TV Cause the Fear of Childbirth? – An age old debate about the modern day media, whether it be reality tv or your days episode of General Hospital influencing our young women on what childbirth is or should be. In reality, these shows are giving our youth a distorted picture of what birth is and causing panic and fear about the experience which we see in so many young women today. Turn off the TV!
#6 – Once a Cesarean, Always a Cesarean : The Tides Should Change – In Connecticut, currently 94% of women with a previous cesarean section consent to a repeat cesarean section instead of attempting a vaginal delivery. Is it because of misinformation? Fear? Lack of providers that will attend a Vaginal Birth After Cesarean? I take the risks of repeating major abdominal surgery, and weight it against the risks associated with the recently uncommon practice of VBAC. You would be alarmed at the risks that most women are taking, many unknowingly.
#5 – United States Scores a D on Premature Birth Report Card – With the increase in twins, and multiple pregnancies, early deliveries for elective reasons, such as inductions or scheduled cesarean births before estimated due dates, The United States is seeing increased premature births which are having an impact on our countries health care, the long term health of these children, and our infant mortality rate on an national level. I discuss all the factors in this blog.
#4 – Consumer Reports At It Again – Consumer reports takes on 12 surgeries you should skip, listing a cesarean section as one of them! I go into detail on elective repeat cesarean sections and the risk factors, along with statistics on local Connecticut Hospitals and their rates for repeat c-sections.
#3 – A Healthy Baby Isn’t All That Matters – Today many people think as long as mother and baby are alive and healthy, no other factors of the birth experience should matter, when in reality, more women than we care to discuss are being traumatized during childbirth, whether it is an over medicalized vaginal birth, or major abdominal surgery. I talk about child birth and trauma, and how the statement “A healthy baby is all that matters” is a hurtful comment to a large portion of women.
#2 – The CDC Releases New Report Comparing US to Europe Infant Mortality – A report from the CDC is detailed about how the United States is failing in terms of Infant Mortality when compared to European nations. We see a huge difference in our country, our maternity care system, and how we do things as apposed to what Europe does. The United States certainly could start cutting these mortality rates back if we stepped back and looked at the way things are being done in Europe and took some pointers.
#1 – A Very Close Loss – The loss of a good friend, amazing woman, and valuable resource to the birthing community in Connecticut. Karen Kilson lost her life in early October, but she will never be forgotten. She was a mentor to me, a second mother, and the doula for the birth of my second child. I cry often when I go through my cell phone to give her a call, or Look at the mini picture frame she left me with a poem inside. “Promise me you’ll always remember : You’re braver than you believe… Stronger than you seem… And smarter than you think” She will live in my heart, and the hearts of all the women in our birth community forever. Anyone who was privileged enough to know her and share her friendship, and truly a lucky person.
In light of the popularity of my post on epidurals, I thought I would write about alternative types of pain relief during labor and birth because it seems to be a topic some do not know very much about. During my labor with my second child, I opted to stay at home as long as I could, and even when I got to the hospital, use a lot of these methods to avoid any type of intervention or artificial pain relief because it was simply not what I desired. Of course eventually I did have an epidural to sleep at nearly 24 hours of labor though.
When it comes to pain in labor and childbirth many women have very different experiences, pain tolerance levels, and the desires and risks you would like to take with your medical care. We cannot expect all women to feel the same way about labor pain or the pain of childbirth in general.
A couple tips on having a positive labor experience, no matter what your choice for pain relief is :
Have a positive and supportive environment. If someone is being negative, or bothering you in any way, ask them to leave, and if they are a hospital staff member, ask for an alternative person.
Use things that make you comfortable in general. A couple examples are music, blankets or pillows from home, or other objects that make you feel comfortable and relax.
If you choose to labor without pain medication, some tips on avoiding the temptation of using pain medication are :
Labor at home as long as you can.
Walk
Stay active during labor, including early labor, do light housework or go about your normal routine.
Some physical ways to help reduce and cope with your labor pain are :
Walk
Climb Stairs
Slow dance, yes, like you did at your wedding or with your parents as a kid
Pelvic Rocking
Sitting/swaying on a birth ball
Use pillows to help get you into a comfortable position
Rock in a rocking chair
Labor in the water (Some facilities offer Birth Tubs)
Many women feel as though they benefit from being in physical contact or physical touch with another person, whether it be their husband, support person, or even a doula. Some of the options for this are :
Massage
Stroking
Acupressure
Counter pressure against the lower back (helped me a TON during my second labor)
Cuddling
Some other methods of pain relief are mental strategies. The mind is a very powerful thing that we often do not take into consideration for something like pain relief during childbirth. Some of the mental strategies that can be used are :
Visualization – Such as repeating a phrase in your head such as “I can birth”, then there are also tapes and meditations you can listen to. Helping to picture yourself on a beautiful warm beach, or in an exotic jungle, or really whatever works for you.
Focus on your breathing
Breathing Techniques – Also often refereed to as Lamaze breathing.
Vocalization - Low moaning, groaning, even singing. But remember, screaming, and high pitched type vocalization, can be and often are counter productive.
Music – Focusing on certain song lyrics can also be very helpful
Hypnosis – Program such a hypnobirth
Prayer
While the mental strategies may not help with the pain, they certainly do help to take your mind off of the pain for the time being.
Of course all of the above may not work for everyone, they are a great start for those women who wish to have a medication free childbirth experience!
Many women today are under the impression that Epidurals are perfectly safe with no risks or side effects on mom or babies, and there are many providers out there who will not take the time to help educate mothers to the contrary. So I thought I would put together a post about epidurals and the risks and benefits for mothers and their babies. Now before I start, I just want to get it out there that with both of my children, I had an epidural. The first time I was not aware of any of the risks or side effects, and the second time I labored naturally for around 24 hours before getting the epidural to help allow me to sleep. Being a benefit to me. I needed to “re charge” so I could again focus on what was important and that was getting my baby here. Unfortunately the experience ended in a cesarean section, but I did not have to go through getting an epidural, waiting for it to work, and then possibly having it not work once we were in the operating room.
If I could do it all over again, I wouldn’t have had an epidural either time, but third time is a charm right?
Epidural
According to the website for the American Pregnancy Association, some of the benefits of epidural anesthesia include :
Allows for rest in prolonged labored (As was my case)
Relieving the discomfort of childbirth can help some woman have a more positive birth experience
When other types of coping mechanisms are not helping any longer, an epidural may be what you need to move through exhaustion, irritability, and fatigue. An epidural may allow you to rest, relax, get focused and give you the strength to move forward as an active participant in your birth experience.
If you deliver by cesarean, an epidural anesthesia will allow you to stay awake and also provide effective pain relief during recovery
And in most cases, when using epidural anesthesia compared to other types of pain relief, you will remain more alert and aware of what is going on.
But like everything in life, there are risks. According to the website for the American Pregnancy Association, some of the risks of epidural anesthesia include :
Epidurals may cause your blood pressure to suddenly drop. For this reason your blood pressure will be routinely checked to make sure there is adequate blood flow to your baby. If this happens you may need to be treated with IV fluids, medications, and oxygen
You may experience a severe headache caused by leakage of spinal fluid. Less than 1% of women experience this side effect from epidural use. If symptoms persist, a special procedure called a “blood patch”, an injection of your blood into the epidural space, can be done to relieve the headache
After your epidural is placed, you will need to alternate from lying on one side to the other in bed and have continuous monitoring for changes in fetal heart rate. Lying in one position can sometimes cause labor to slow down or stop
You may experience the following side effects: shivering, ringing of the ears, backache, soreness where the needle is inserted, nausea, or difficulty urinating
You may find that your epidural makes pushing more difficult and additional interventions such as Pitocin, forceps, vacuum extraction or cesarean may become necessary
For a few hours after birth the lower half of your body may feel numb which will require you to walk with assistance
In rare instances, permanent nerve damage may result in the area where the catheter was inserted.
Though research is somewhat ambiguous, most studies suggest some babies will have trouble “latching on” which can lead to breastfeeding difficulties. Other studies suggest that the baby may experience respiratory depression, fetal malpositioning; and an increase in fetal heart rate variability, which may increase the need for forceps, vacuum, cesarean deliveries and episiotomies.
There are also some things that their website does not touch on such as the increased risk of cesarean section due to stalled labor, or epidurals causing labors to become prolonged. The problem with this is, today in most hospitals there are strict time limits on the amount of hours a woman can labor. If you exceed, 12, 18, or even 24 hours in some cases, you are looking at a vaccum assisted delivery or even a cesarean section for something that has become very common called ‘failure to progress” which is what lead to my first cesarean section, after a short 6 hours in labor. Yup, you heard it folks, I was induced for 6 hours before being wheeled off to the operating room.
Some of the other commonly untold risks, taken from Kim James Website, birth doula, include…
Prolonged 1st stage of labor
Increase of malpresentation of baby’s head
Increase in the need for pitocin augmentation
Prolonged 2nd stage of labor
Decrease in the ability to push effectively.
Increased likelihood of an episiotomy
Increase in cesarean section delivery
50% Increase at 2cm
33% Increase at 3cm
26% Increase at 4cm
After 5cm there was no difference
Urinary Retention that can lead to postpartum bladder dysfunction
Hyprotension (drop in blood pressure as earlier stated)
Itching of the face, neck and throat
Postpartum headaches (which I experienced very badly after the birth of my second child. I could not leave my bedroom with the curtains drawn without my head pounding uncontrollably.)
Maternal Fever (Sometimes blamed on the woman’s waters being broken too long instead of the epidural itself)
Feeling of emotional detachment
Inability to move freely on your own
There are also more serious risks as maternal death, but these are in extreme cases, and are not as common as the others already discussed.
Then we cannot forget the risks to your baby… which include :
Fetal Distress also known as an abnormal fetal heart rate
Drowsiness at birth
Poor sucking reflex due to the anesthesia (which can directly impact breastfeeding)
Poor muscle tone or strength in the first hours of life
Low Apgar scores
Be sure to become educated yourself before consenting to any kind of medical intervention during labor, you may not get all of the information that is available to you!
Information for this blog have come from the following websites :
When a woman learns she is expecting, she will often have a lot of expectations for her pregnancy and birth experience. Which is completely natural.
Finding a provider is always the first step in your birth plan. Making sure that your desires for your experience are going to be respected is like laying the ground work for not only your birth, but also for your pre natal care during your pregnancy. If you do not have someone who is friendly to patients “calling the shots” then you may run into some issues along your journey.
There are a lot of misunderstandings when it comes to birth plans. They are not a final blue print of the birth you will have because in some cases there are situations or emergencies that come up that we could never imagine planning for, but there are some things Moms can do to help avoid those emergencies arising as some of the commonly seen emergencies can and are caused by frequent intervention in the birth process.
But to get started on writing what you want, you should sit down with your partner, or by yourself, or maybe even with your doula to see what you have in mind for your birth experience. A couple questions you can start with to help lay your ground work are…
Where do you want to give birth?
Hospital
Home
Birth Center
During labor do you want to be mobile or remain in bed?
Do you want an IV in place during birth, or an alternative such as a heparin/saline lock or nothing at all.
Be sure to find out what your hospitals policy is about IV’s being in place during labor and birth. Many today require mom’s to have a line of access at all times. This also makes it easier for labor drugs such as pitocin to be used.
Do you want to wear your own clothes?
Would you like to use the shower, or even a bath tub while you are in labor?
Finding out what kind of luxuries your hospital labor and delivery rooms have available is also key. Many hospitals do NOT offer birthing tubs for laboring mothers.
Would you like to listen to music?
Then there are the more “medical” questions that you need to take into consideration.
How do you feel about labor induction?
What methods of pain relief are you comfortable with?
Epidural Anesthesia
IV Pain relief such as a narcotic
Acupressure
Massage
How do you feel about episiotomies?
Would you rather tear naturally than receive an episiotomy?
Are you planning on breastfeeding?
If you are planning to breast feed, it is a smart idea to put a sign or something small in the bassinet of the baby telling hospital staff the baby is breast fed only, and you do not wish for the baby to have any bottles or pacifiers.
Also, if you are planning on breastfeeding, you should look into the lactation consultant services at the specific hospital to help make your experience easier for you and your baby!
If you expect hospital staff, including your provider to discuss all procedures with you before doing them, make sure you include this in your plan.
If you would like to be able to eat, and drink during labor, be sure to discuss this with your provider prior to labor also.
Some mothers may need special attention due to conditions such as gestational diabetes or group B strep. If you are one of these mothers, be sure to include this in your birth plan so that hospital staff knows these things and provides you care accordingly.
Be sure to go over your wishes before entering the hospital for your birth. If your provider is already aware of your wishes, and has a copy of your birth plan in your medical chart it will make the experience easier on you, as well as the hospital staff.
In the case that your provider does not or will not go by what you would like for your birth plan, it may be a wise idea to look into switching providers. It is never too late to change during your pregnancy, and if you cannot agree with simple requests that may be important to you, it may only cause more harm than good in the long run.
Remember, this is your birth experience, you are the boss and you make the calls!
Recently I came across a great video on Youtube which features Dr. Stuart Fischbien speaking about the safety of Vaginal Birth after Cesarean which has turned into such a hot button topic in our society today since the VBAC rate took a nose dive in the past decade.
In 1996, the VBAC rate was upwards of 28.3%, the highest it ever has been. Now we are seeing VBAC rates in some states of 6% or less which is really sad.
Between misinformation given by word of mouth, and even some health care providers women are making the choice to have elective major surgery over attempting for a natural birth. Another problem is the amount of hospitals that are taking on unlawful bans on VBAC, which leaves many mothers with no choices other than birth at home, birth alone, or sign up for surgery. It is estimated that half of the Nations hospitals currently ban VBAC.
But what is the problem with the misinformation about this procedure? It is not only putting mothers at risk, but also their babies.
Many women are under the impression that having a repeat cesarean section is the safest option, but in reality for the vast majority of low risk mothers, that is not the case. The safest option would be a vaginal birth after cesarean section. But many factors sway women away from this choice.
One being the risk of uterine rupture, which in healthy, low risk women is less than 1%. What is not being told to these women that any time after you have a cesarean section, during a pregnancy you run the risk of uterine rupture, not just if you go into labor, or try to give birth.
But the risks of VBAC do not outweigh the risks of major surgery.
In the video below, Dr. Stuart Fischbein, a California based OB/GYN who has been in practice for years talks about the safety of VBAC and common misconceptions in our society today.
Why is it so important in our society today to teach our children the lessons of tolerance? Well the actions of three cowardly men hiding their faces behind masks and nazi flags showed us why we need to teach our children to be accepting of all people this past Sunday night while a small group of families gathered on the Fairfield green to celebrate the third night of Hanukkah and light the menorah. In an attempt to intimidate the families peacefully celebrating their holiday, they did nothing but bring attention to themselves. Which is for sure what they were doing for.
But we have to step back and ask ourselves, what breeds this kind of ignorant hate? Nearly 70 years after the disgusting genocide of the Jewish in Nazi Germany, we still have people today, who were not even a thought during this mass murder, who are following the hate that was instilled in ignorance. Where do these people learn these lessons from, because babies are not born with hate in their hearts, it is something they are taught over time.
With the melting pot we call America, we need to step back and teach our children to be accepting and loving of all people from all walks of life, not just those who are like us, if we don’t, what kind of world will we create for our children? There is already enough hate, violence, and war, why teach more?
Lately I have taken a lot of time to sit down and look at some numbers for the past almost 40 years.
Maternity, cesarean section, Vaginal Birth After Cesarean (VBAC) and Maternal Mortality numbers, and I found some shocking patterns. While I am not statistics professor and I am clearly not a medical professional, the patterns that some of these numbers show us is alarming to say the least.
Because of lack of standardized reporting, many of the numbers before 1980 were not regulated or actually accurately kept, so this is all I was able to find through the CDC.
Starting around 1980, we see the maternal mortality rate start to decrease, while the number of cesarean sections increase, as well as the number of VBAC’s. Which is a good thing, anytime the maternal mortality rate decreases, it is good. Sadly we still lack behind the majority of other industrialized nations in the world when it comes to Maternal, as well as neo natal mortality rates.
During 1996 we see two things that stand out the most, the lowest maternal mortality rate, as well as the highest number of Vaginal Birth’s after cesarean sections, although the c-section rate is still too high according to the World Health Organization standards. But then once 1997 comes we not only see an increase in maternal mortality, but we start to see a decrease in VBAC’s which never recovers.
1998 till the represent numbers in 2003 how how not only the VBAC numbers suffered, dropping over 17% but also the maternal mortality rate started to increase again, but to an alarming 12.1 per 100,000 live births in the United States.
The decrease in VBAC’s as well as VBAC access is a controversial issue. Not only are hospitals decreasing access to VBAC, but they are doing it at drastic rates. Here are a couple alarming numbers for you.
Since 1996 the c-section rate in the United States has increased 50%.
8% of women who previously had c-sections had a VBAC in 2006.
28% of hospitals in the United States do not ALLOW VBAC.
0.7% of women rupture their uterus while attempting a VBAC.
The last number is something I want to focus on because this is the main risk that Doctors use in discouraging mothers to choose VBAC. They do not tell you that according to this statistic, you are more likely to get struck by lightening twice in your lifetime, or you are two more times likely to be murdered, or even twice as likely to have your car stolen in ONE year. But they are using this as a big scare tactic for discouraging women to sign up for surgery.
The problem is, the huge risks of repeat cesareans are being sugar coated. They are not discussing the risk of uterine rupture any time during pregnancy with these women. Uterine rupture can and does happen to women any time during pregnancy, not just while attempting to deliver vaginally. They do not tell you that you are more likely to be re-hospitalized in the following weeks after your surgery, suffer infection, increased risk of your uterus adhering to other organs such as your bladder, and the laundry list of problems that comes with abdominal surgery after abdominal surgery.
What else? Increases your risk of a blood transfusion, hysterectomy, Placenta accreta which is when the placenta actually grows into the walls of the uterus making a hysterectomy a common result. And these are also things we are seeing in increased numbers over the past 30 years.
In a recent blog, Michele Demont of BirthCut a website for post cesarean section mothers to express their feelings, blogged about ‘The Gift that Keeps on Giving” which details the amount of complications mothers are experiencing due to cesarean sections, but now we are just starting to see the long term effects because in the past 30 years, the cesarean section rate has drastically increased.
“Another article talks about one study where the rate of placenta accreta in women that had placenta previa with no prior cesareans was 5%, but if she had one prior cesarean it was 25%, 2 or more prior cesareans, the rate jumped to 50%.”
Frightening numbers that women are not being informed about up front when signing up for their cesarean sections, or repeat cesarean sections.
The problem we are seeing is defensive medicine, not evidence based medicine being practiced and sadly the women of childbearing age are becoming the victims of this system. Another article that I came across in the past couple weeks is from Jill who writes her own blog called The Unnecessarean. She discussed Multiple Cesarean Sections and the Long Term problems. In the piece, Jill discusses an e-mail she got from a reader regarding their mothers health after having two cesarean sections almost 40 years ago.
“Twenty or so years later, I had to rush my mother to the emergency room, and then consent to surgery (she was already comatose) to address what turned out to be a direct result of her two C-sections. The scar had opened up on the inside and her small intestine got tangled into the incision, causing a blockage severe enough that she nearly died.
A year later, it happened again with a different part of the incision. At that point, the surgeon elected to go ahead and open the entire incision back up and then re-sew it with a reinforcing plastic-type mesh to prevent it from opening again.
So my mother’s two major surgeries for having children ultimately resulted in two *more* major surgeries, when she was twenty years older and thus less able to bounce back. It was the beginning of a downhill spiral in her overall health.”
Shared the reader who chose to share this situation with Jill. Still we are not seeing this at large enough number for concern YET because we look back to the 1970′s and c-sections were not nearly as wide spread as they are today. 5.5% in 1970 compared to 31.8% in 2007 is a huge difference. What are we going to see over the next two decades in Maternal Health?
Last I just want to address VBAC Vs. Elective Repeat Cesarean Section. No matter how many studies, reports, information, or even just internet websites, they all say the same thing, VBAC is safer than repeat surgery. There are cases in which mothers have specific health issues, or results from their previous cesarean section that make VBAC a riskier choice, and a repeat cesarean may be warranted, but in Connecticut, only 6% of women in 2007 chose a VBAC over having a repeat cesarean section.
That may have to do with the strict rules local hospitals have put in place, or the hospitals such as Charolette Hungerford, St. Vincent’s Medical Center, Day Kimball Hospital, and Johnson Memorial Hospital. All of which do not allow women to make informed choices about their own maternity care, instead they are forced into a repeat cesarean section if they would like to birth there.
Sometimes, as much as I hate to even think about it, you need to let a baby cry. I hate this and I never thought in a million years I would be a “cry it out” parent. With my oldest I never let him cry, and he has turned out fine, not spoiled, no issues. But it seems as though this time around we need to allow our youngest to cry. Nap time, bed time, really any time he is tired it has turned into a screaming fit until he falls asleep. Not by my choice, but by his own.
I never thought a almost 7 month old would be able to make his own decisions about things, but he certainly has picked his own route and that is to cry till he falls asleep.
He could be in his swing, being held, rocked, in the bouncer, or anyplace, he just wants to scream until he finally falls asleep.
It breaks my heart to hear him cry, like a crying baby should do to any parent, but sometimes we just have no other choice as parents. Hence picking your battles.
I hate hearing him cry, but sometimes it just what HE needs and I need to tell myself that, just like any parent needs to tell themselves.
We all will have these moments like I have had dealing with this the past couple days. Moments where we feel like bad parents, it happens. No one is perfect and no matter what we do as parents, we are not going to be the worlds best parent, but we are certainly all the best that we can be for our children, and that is what should matter at the end of the day.
Moral of the story, sometimes the kids win the battle.
