Learning From the Amish

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Yesterday, my midwife posted a very fascinating article on birth stats and the Amish community that was published by no other than Fox news. It talks about several things that I will list in bullet form:

• "The study examined 418 Amish women who delivered 927 babies at a birthing center in Southern Wisconsin, a facility that lacked an operating room."
• Only 4% where born by c-section (they were transferred to a hospital if a problem was detected) whereas nearly a third (approx. 33%) of all babies are born via c-section across the US.
• Only 5.4 per 1000 infant deaths in the Amish community (mostly because of little to no prenatal care) compared to 4.5 per 1000 infant deaths across the US (which most usually get great prenatal care) 
• No mothers in the study died 
• In the Amish community 95% had VBACs (vaginal birth after cesarean) whereas only 8% of women have VBACs across the US
• "Historically, doctors have had concerns that a vaginal birth after a C-section, a so-called VBAC, would increase the risk of a rupture of the uterus. But in the study, no women experienced this complication." (emphasis mine)
• " In 2010, the National Institutes of Health recommended that women with previous C-sections attempt, in subsequent pregnancies, to delivery vaginally first, before resorting to a repeat C-section."
• They worked to turn breech babies before resorting to a c-section. This worked most of the time. Whereas in the US 92% of women whose babies are breech end up have a c-section. The article implies no one ever tries to turn the baby before resorting to c-section. I find that hard to believe but clearly they are either not trying or not using effective techniques. 
• " A national Institutes of Health analysis showed that 3.8 maternal deaths occurred for every 100,000 VBACs, whereas 13.4 deaths occurred for every 100,000 repeat C-sections." (emphasis mine)

*There are a couple things that the study notes that I think are important to add:
1) No high-risk pregnancies gave birth at the birth center therefore the statistic may have been higher if these women had been added to the study
2) Of the 19 babies that died only one of the babies died of a condition that could have possibly been prevented at a hospital.

I include both of those things not because I believe hospitals are safer (because I don't think that is always true. In fact I always wonder how many maternal and baby deaths could have been prevented if "interventions" had been minimized) but, rather, because I am not in the business of withholding facts that could influence a persons decision.  

I hope you will read the article yourself and tell me your thoughts. : )

The Family Centered C-Section

There are three different kinds of cesarean sections (c-section).

• The first would be the Emergency C-Section. This term is usually the one that is most misused. An emergency c-section will be done in the case of emergency (ie. within minutes of being diagnosed)  if there is time to sit around and discuss it then at that moment it is NOT an emergency c-section (we will get to what type that is momentarily). Those types of c-sections can turn into an emergency, but in the case of most emergency c-sections general anesthesia will be used and you will be being wheeled to the OR as they tell you what is happening because the situation is so serious.   
• The second would be a Medically Necessary C-Section. These are usually scheduled in advance or are done for things like "failure to progress" quickly enough to a doctors wishes. They are not elective (that is the third kind) but they are done because of a condition either the mother or baby suffer from. 
• The third is an Elective C-Section. This is one where it is not an emergency and there is no medical indication for it but for whatever reason a mother has chosen this as the manner in which she would like to birth her baby.

The most common forms of c-sections are elective and medically necessary (medically can often be misnamed emergency). Emergency c-sections are thankfully pretty rare. In the case of an emergency c-section a family centered style is usually not going to be an option because the mother is usually unconscious and the father is not permitted in the OR. For medically necessary and elective a family centered will often be available if requested. This video is of a "family centered c-section" I do not own this video, I found it on YouTube you may find the link here if you wish to look up more info.

There are very rarely going to be any reasons why a hospital cannot offer a family centered c-section, but you still may find it difficult if you are the first person at your hospital to request one. However, these are clearly more beneficial for the mother, baby and father. If your hospital of choice or OB doesn't offer family centered births there are several options:
1) Find a new hospital
2) Ask your OB if they know what a family centered c-section is and if they have ever done one (write out specifically your wishes and show them this video). Depending on their answers you may need to find a new OB. However, if an OB is interested in doing one and you feel like they will really honor your wishes (and you have a doula present to help advocate for you) there is no reason not to let them (unless of course you just don't feel comfortable).
3) Talk to the administrators at your hospital of choice. Sometimes they simply have never thought of changing their systems because they don't know there is a better way. If you can get hospital policy changed that will benefit many women to come.

Sometimes a c-section is not only necessary but also beneficial to mother and baby. If more hospitals across America will begin implementing this system I believe we will see more women satisfied with their births, and more confident in breastfeeding as well as mothering in general.

Sorry...

I had been doing so good to publish an article everyday until last week. Our dog unfortunately passed away and I did not have the emotional energy to focus on this blog. However, I am feeling better and will get back to posting regularly. (I may even do some catch up posts!) If you notice I just posted a new blog below! I'm pretty excited about it! Check it out! : )

-The Cowgirl Doula

When Your Significant Other Isn't On Board...

When a couple finds out they are having a child several things happen. One is that for the woman she begins thinking about how to preserve the pregnancy and keep herself and the baby as healthy as possible. She will try to see how she can limit the chances of miscarriage, she will improve her diet, maybe change her music choices, or how she speaks about herself and to others. She will see radical changes in her body and get to know the baby inside of her. From the moment she knows she is pregnant she will begin preparing for birth. She will start deciding where she feels safe, who she feels safe with, and what she will need during labor.

This will not be the same for all women, but while I was pregnant I looked at spaces completely differently. I felt better in tight well lit places with only one entrance and an easy escape route. I know crazy, but I put it to the idea that at one time we didn't live in nice little houses and that as a pregnant woman I could not move as quickly or effectively as I once could, so I had to be more careful of my environment. 

In a similar way you significant other will begin also preparing for the birth. They may help you (or try to be helpful) by doing everything for you, fretting over every move you make, being more defensive about you/your honor/who you hang out with/where you go/etc. And in their own way they will begin to prepare for you to give birth.

Now some of you may be lucky enough to agree on where, with whom and how you would like to birth. That was the case between me and my husband, and if you are in that situation then congratulations! 

However, many will find that they and their significant other disagree on one or maybe all three points. If that is the case for you then I encourage you to read this blog post at BWF. While it is specifically aimed towards natural/midwife births it will still give good advice for speaking with your significant other even if you are not wanting that kind of birth.

I have several pieces of advice though too (coming from a lady who has given birth):

1) A woman NEEDS to feel safe during labor. I don't just mean would like to feel safe, I mean NEEDS to feel safe. And where you and her feels safe may be completely different, but its ok, because she needs to feel safe, not you. You can support her anywhere, she however, can only give birth effectively if she feels safe (notice I said feels-where she feels safe may not seem rational, but that doesn't matter. Labor is NOT rational. It is pins and needles, excitement  emotion all running through your body with rushes and contractions and love and fear and hope and joy and energy all wrapped up into one- remember women tend to be more emotional creatures and birth is very primal)

2) You may feel safer in "X" location because of their training, or their safety equipment, or their lack of interventions, or their lack of scary equipment or whatever (depending on whether you are afraid of hospital or out-of-hospital births) but it is her body (and trust me she doesn't want anything bad to happen to that baby any more than you do- she has 40+ weeks invested remember) and she is the one that is going to have to either push that baby out of have major abdominal surgery (a c-section) to get the baby out. So give her, her body and mind some credit in picking out where they would like to birth.

3) Your significant other loves you and that is why they are being difficult whether you believe it right now or not. Try to be sensitive to that.

4) Hear her out. You may think she is crazy. You may  think she is wrong. You may think its her hormones. But no matter what hear her out. Go talk with the healthcare professional she wants to go with. Ask questions. Be open minded. Find out why she would prefer them over options x, y, or z.

5) Rebuild bridges if you have burned them. If you have already had this talk but it went horribly wrong try to start over from a friendly place, a place of mutual love and respect and wanting whats best for you and your baby.

6) Find out why the other is afraid or adamantly refusing the options you are considering. Are they basing all their knowledge on an old TV show? Or did a friend lose a baby because of reason x? Did their Dad tell them something that has freaked them out about child birth? Did they have a bad experience with doctors or hospitals? etc. 

7) Base your decision on what is best for YOU not what is "normal" or what is "popular" or fear of "what ifs" or fear of the other options. Its not black or white, right or wrong. Birthing in a hospital with OBs has its place just as birthing with a midwife at home does and just as birthing unassisted does. But birthing one way over another because you are scared is not a good idea. And forcing someone else (even your darling wife) to birth somewhere just because you are scared of other options is NOT a good idea.

8) If you are worried about your wife's body not being capable then stop. Stop right there. She knows you are thinking it and you are wrong. (And if your not thinking it then tell her! Tell her everyday you know she is strong and capable and able to give birth the way she wants!) Her body was MADE to do it (even if she has had 100 c-sections). Believe in her. Give her a chance. Give her support. How would you like it if you thought your body was broken? Or if you thought your spouse thought your body was broken?

Supporting her in her decisions will show her that you will support her no matter what. However, not supporting her will confirm every fear she has ever had about leaving her and thinking she isn't good enough. With all the options out there find what works for you and your family! Don't be short changed by fear or a lack of options or what others may think. Find people that will support you in the decisions you make! 

The Toddler Cup and More: Helpful Tips for Comfort During Labor

http://www.meijer.com/s
/bornfree-set-of-2-straw-cups-pink-and-purple/_/R-213173

Well, I am finally beginning to feel like I am getting on top of this whole blogging thing.

So I am going to write one of my first posts from scratch (be impressed).

These are some ideas that I have come up with or have heard of that can help during labor:

First is the most brilliant one I just heard today: Use a Toddler cup for water (or other drink- such as coconut water or poweraid) one of those that has a bendy straw attached to the lid. It allows ease for           mother to drink while in interesting labor positions.

Rice Packs- this one comes from my midwife's facebook page. She took pieces of cotton cloth and put rice in them (and some lavender) and sewed the edges after using a "quick stitch" adhesive on the fabric. These can be put in the microwave to heat up and applied to whatever part of the body mother wants

Peppermint Oil- peppermint can help relieve pain, help the cervix dilate and calm the mind. Worked wonders in making me feel better during labor. Just use as directed on the bottle (I found using it on my forehead and neck helped the most) I wonder if having some soft peppermint to chew on would have been a good idea or not for early labor?? Any thoughts? I will have to look it up.

And then lastly music, some women enjoy a nice tribal rhythm while in labor. It helps them connect to their bodies and all the women that have gone before them in labor and birth. Some women will also go to a place of wildness, almost a primeval place to gain strength to push their baby out. Tribal music can often help them connect to that part of their brain.

Of course always listen to your body and what is says you need. And if you have an questions of concerns ask your healthcare professional and do research! : )

-The Cowgirl Doula

Switching Providers (Especially Late in Pregnancy)

Everyone has thoughts about their doctor/midwife and how happy they are with them.

And sometimes during a pregnancy you realize that you and your care provider do not agree. I'm not talking about on whether they think taking castor oil to induce labor is a good idea or not, I'm talking about big things like: whether they approve and support VBAC or not. Will they "let" you have your breech baby vaginally? What about pre-eclampsia, will they let you try to induce naturally or not? Or what about doctors that are TOO naturally minded for your taste. Won't do an extra ultrasound to calm your fears about the baby being breech. Won't take your blood pressure or listen to your complaints about headaches. Wants you to only induce naturally and will not give you the meds to induce. What do you do when these things come up?

Hopefully at your first consultation you got a lot of these things cleared up, but what happens when you are at 25 weeks? 30 weeks? or worse 36+ weeks? and something like this comes up?

Well, there really is only one thing to do: fire your care provider and go find someone else. If you are 36+ weeks this can be a scary proposition but it is the only thing to do. You DO NOT want to have to fight with your care provider during labor. It is better to just switch before it actually becomes a problem. As long as you have had prenatal care most doctors/midwives will take you, especially if they are pro what you are pro.

If you are needing to switch care providers ask like minded friends and organizations. Also ask your doula for their thoughts.

This blog post also gives some other thoughts and ideas and was my inspiration for this post.

-The Cowgirl Doula

Asking Questions and Using Your B.R.A.I.N

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This blog post talks about asking questions and getting answers while in labor and looking at using possible interventions. You are to use your "B.R.A.I.N" which is an acronym to remind you of the things to ask before consenting to a routine or emergency procedure (by the way I find this very helpful not only with labor/birth questions, but also with other medical procedures especially when talking about my daughters health with her pediatrician.)


I saw a blog post like the one above a while back but it had one of the letters a little different.

The link above does:

B- benefits

R- risks

A- alternatives

I- intuition

N- negotiate

but it misses a very important question I prefer the N to stand for nothing as in "what if we do nothing?" Of course it is important to know the risks and benefits of a procedure and knowing your alternatives is necessary for informed consent. And in general it is always good to go with your gut, but sometimes we get so caught up in wanting to DO SOMETHING that we forget in some cases doing nothing-even if its just for a certain amount of time- is the best option.

-For example at 40 weeks many doctors/midwives will begin wanting to schedule an induction (if you weren't already). If you think you might be interested in an induction at that time then you will want to discuss risks and benefits of inductions. Alternatives would be a good discussion since there are many natural ways to induce labor and many options of induction methods (remember you need to discuss the risk and benefits of each procedure. All natural induction methods and medical induction methods have different risks and benefits). Following your intuition if you think there is a problem or not would also be wise since you know your cycle, baby, body and situation the best. You will also want to ask what about doing nothing. According the the ACOG you are not "overdue" until at least 42 weeks. Therefore, inductions are not automatically necessary at 40 weeks (or even 41 weeks).

It would be better to ask if you can "do nothing" until 42 weeks. Then at your 42 week appointment you can reevaluate the issue (however I will tell you that there are many women that have gone to 43 weeks + and had perfectly healthy babies even though the doctors/midwives didn't think it was possible...but that was their situation and you will need to evaluate your own situation and comfort level).

The negotiating is a helpful tool but it sort of gives the impression that your doctors/midwives have some sort of say over you. You have the right to birth how you feel comfortable. As I heard one person say "This is America, they can't make you do anything you don't want to do. And if they ever do force you to do something you don't want to then you have the full backing of the law and usually the hospital to complain or sue and get justice." Negotiating can be helpful but only if they are willing to cooperate. Don't ever be afraid to put your foot down. They don't have to live with the consequences of your labor experience but you and your baby do.

-Also always remember to do your own research. The internet is a beautiful place. Be careful to only use reliable websites though. Also read the inserts given and websites made my pharmaceutical companies. They have a lot of information and can help you in asking questions to your doctor. But also look at independent websites. Read lots of books (if you are using me as your doula I have books you can "check out" and read) Take control of your birth by being as informed as possible. Sure it takes work, but its worth it.

-Some doulas can help you in this research. (they however CANNOT give medical advice, but they do know of websites to help you find information and get questions ready for your healthcare professional). I offer this help to my clients when they ask for it.

May you always feel free to ask questions and get the answers you need.
-The Cowgirl Doula