Raising Awareness with Black Breastfeeding Week! Yes, they deserve a special week in world breastfeeding month! :) Please read on if you have a different opinion or don't understand why. Black breastfeeding moms absolutely face more challenges than other mothers in the US AND they need the benefits of breastfeeding even more because they and their babies are even more at risk. If you don't know, read on. Studies, surveys, CDC reports and more support this. "The barriers are financial, cultural, systemic and logistical. When dominant culture women aren’t aware of the challenges that women of color face, that lack of awareness becomes a barrier of its own." And please remember that race matters not just in breastfeeding, but in life... everyday. Whether you think it does or doesn't or should or shouldn't - race impacts everything.
I almost cannot bear to hear these stories about mothers dying in the OR due to placenta accreta caused by multiple cesareans. Everyday women are told 1) That a primary cesarean is necessary to birth her baby for some reason. In many (dare I say, most, cases is just UNTRUE. 2) That attempting a VBAC is dangerous. Which is also just UNTRUE and NOT what is recommended by ACOG.
These women are left with option to have no more children or put her LIFE at risk to give birth by more cesarean sections. Which isn't usually explained how risky each subsequent pregnancy becomes. If it's explained, it's usually after her second or third cesarean. What kind of choice is that at that point???
And for a doctor, I imagine it is terrible to lose a baby during a delivery. But, a mother? How do they go on? I'm sure they do everything they can and it must be awful to realize you cannot save her. But we need them to STOP doing all of these unnecessary cesareans! Overmedicalizing birth in the first/second pregnancy is the root cause of mother's hemorrhaging on the operating table a few cesareans later.
Maybe I'm especially emotional hearing of these stories because I lost my mother at age 9. I don't want any other child to endure this kind of loss. And because of my work, I know it can be different. Giving birth doesn't have to be risky. It can be healthy, respected, and trusted in most cases. And, women can be trusted to make their own informed decisions when given the right information based in research and allowing that along with intuition to guide them instead of FEAR...
I don't want to post the stories that have deeply saddened me recently. I know I have other mothers reading, some facing cesareans that have become necessary and possibly complicated and scary pregnancies. Or maybe just like me, a motherless mother who's heart breaks to think of any other mother leaving her children behind. So, instead, if you'd like to read about how another mother managed to survive when facing what became a life threatening pregnancy, read her story included in a previous post below about preventing the primary cesarean. Below is a great video on VBAC.
Today I want to say that ICAN is about supporting the first time mom, too, not just those hoping for a VBAC. It is a great resource for preventing that primary cesarean birth. As is the VBAC facts site and Jen Kamels who runs it and teaches a workshop around the country and online.
Our local ICAN of SEPA:
I'm also linking a story here that offers a great explanation as to why we fight so hard to help mothers avoid their primary (and too often unnecessary) cesareans and to birth vaginally. It details the risks and dangers to mothers of multiple cesareans. This mother is not alone, more and more of these examples are making news because they are becoming more prevalent problems in pregnancies and in the OR. Just to be aware, though, I had tears in my eyes the whole time while reading. She does a great job writing so that the reader can almost feel her fears through what was a very scary experience. To clarify, MOST 1st and even 2nd repeat cesareans will be manageable by most hospitals and with what blood they have on hand for possibility of transfusing...I do not want to scare moms facing a repeat cesarean where they NEED to trust and depend on a doctor to keep them safe, but this story also shows how a mother did her homework to do just that - be in the best place with the best team to make sure she'd be going back home to her kiddos. This was simply the situation she ended up in during her 7th pregnancy. Her placenta became deeply implanted into her uterus and cervix after multiple previous surgeries to her uterus.
As a doula, I never want my clients to have any good answer to the question, 'what else could I have done to prevent my first cesarean?' This is especially important when moms desire a larger family. I have had friends and family members tell me that their doctors never once mentioned to them before, during, or after their first cesarean that they'd need to consider limiting family size due to having that surgical birth and the increased dangers of multiple pregnancies and cesarean births following. And not just that, but that they'd not been offered a chance to VBAC and instead told that it is dangerous to try, safer to schedule ANOTHER cesarean, and just accept having 2 children or at most 3 if she really really wants to risk it, but no more! Women are being told this AFTER their second cesareans when their options are nearly nil at that point! It's infuriating. And sad. More women need doula support through their first pregnancies and births, good information, supportive care providers, and to visit their local ICAN group before having their first babies if we want to stop this trend from continuing. Women need the truth! They need their options! They want to make informed choices!
I recently met a nurse who told me there is a doctor on her floor who frequently says all babies should be born by cesarean and has no problem recommending tube tying after the second to all mothers. I seriously hope he is in the extreme minority. But I have a feeling that while we do have docs who truly believe in the safety of and support less medicalized vaginal birth, the number of docs seeing their norm everyday be cesarean deliveries is increasing by the day. This will just continue to have an effect on moms and babies (physically, mentally, emotionally!!!) if we don't advocate for ourselves and surround ourselves with professional support and evidence based information.
And while I'm thinking of it. Hug another woman today. Love her with that hug, if even for just a few seconds. We don't always know each other's journey.
Read the article here.
This is a MUST READ article for all women. What is referred to as the cornerstone of gynecology, the Annual Exam, has just been outed as completely unnecessary and without any evidence to support it in low risk, asymptomatic women. The article notes reason ACOG has been holding onto it as a 'logical procedure' even though they knew there was no reason according to many years of research, is because 'it can build the patient-doctor relationship.' REALLY?!?!?! It kinda sounds like billions of vaginas have been violated without any purpose, our bodies simply learning tools, while our psyche was often confused over it and negatively effected - we were sometimes embarrassed, humiliated, and hurt. Victims of sexual abuse submitting to speculums and fingers under the premise that it was not just good for their health but necessary!?!?! Er! Maybe next time we should ask our doc if we can examine his/her genitalia and internal organs...ya know, to help deepen our doc-patient relationship.
I imagine that some docs will gladly accept the recommended change in care...many do not want to be up in your vagina actually, especially if it's unnecessary. But, some will really try to hold on to this procedure, for one reason or another I imagine. As a woman and doula, with my own experiences and watching/hearing my clients experiences' with their care providers, I think the the GYN-patient relationship could be better fostered by dialogue during that annual 'check up' in the office. Hopefully with time, we will learn that someone doesn't always have to 'DO' something 'to' us in order to serve us as a care provider.
RIP Marsden Wagner, MD, former perinatologist and perinatal epidemiologist from California and director of Women’s and Children’s Health in the World Health Organization for 15 years. He raised four children as a single father. Marsden was an outspoken supporter of midwifery.
Thank you for your work and words that have inspired so many of us doulas and midwives. Here's one of my favorite clips from the Business of Being Born documentary.
More on Marsden Wagner, who at age 84, passed this April...
Here, Gloria Lemay reflects on her friend and mentor:http://wisewomanwayofbirth.com/marsden-wagner-md-remembered/
Wagner's clip on cytotec from The Business of Being Born:https://www.youtube.com/watch?v=DKZAoEPjHbY
Fish Can't See Water: The Need To Humanize Birth:http://www.drmomma.org/2009/08/fish-cant-see-water-need-to-humanize.html
Born in the USA: How a Broken Maternity System Must Be Fixed to Put Women and Children First:http://astore.amazon.com/peacefparent-20/detail/0520256336
Creating Your Birth Plan: The Definitive Guide to a Safe and Empowering Birth:http://astore.amazon.com/peacefparent-20/detail/0399532579
WHERE DO VBACS OCCUR IN THIS STATE?There is no indication as to whether these VBACs were planned or unplanned. While it can be assumed that hospitals with higher numbers "allow" VBAC in their facility, it is best to speak with both your doctor and an administrator at the hospital for information on their VBAC policy.
(Excuse the formatting below, I haven't figured out how to tidy it up yet. But you can scroll, all hospitals are listed alphabetically. Paoli, Lankenau, and Bryn Mawr are all listed under Main Line Health Hospitals.)
Total Repeat CS
Abington Memorial Hospital
Albert Einstein Medical Center
Altoona Regional Health System
Armstrong County Memorial Hospital
Berwick Hospital Center
Bradford Regional Medical Center
Butler Memorial Hospital
Carlisle Regional Medical Center
Charles Cole Memorial Hospital
Chester County Hospital
Childrens Hospital of Philadelphia
Conemaugh Valley Memorial Hospital
Crozer Chester Medical Center
Delaware County Memorial Hospital
Dubois Regional Medical Center
Elk Regional Health Center
Ellwood City Hospital
Ephrata Community Hospital
Evangelical Community Hospital
Excela Health Westmoreland Reg Hospital
Geisinger Medical Ctr
Geisinger Wyoming Valley Medical Ctr
Good Samaritan Hospital
Grand View Hospital
Grove City Medical Center
Hahnemann University Hospital
Hamot Medical Center
Hazleton General Hospital
Heart of Lancaster Reg Medical Center
Heritage Valley Beaver
Heritage Valley Sewickley
Holy Redeemer Hospital & Medical Center
Holy Spirit Hospital
Hospital of The University of PA
Indiana Regional Medical Center
J C Blair Memorial Hospital
Jameson Memorial Hospital
Jennersville Regional Hospital
Lancaster General Hospital
Lehigh Valley Hospital
Lock Haven Hospital
Lower Bucks Hospital
Magee Womens Hospital of UPMC Health Sys
Main Line Hospital Bryn Mawr
Main Line Hospital Lankenau
Main Line Hospital Paoli
Meadville Medical Center
Memorial Hospital Inc Towanda
Memorial Hospital York
Millcreek Community Hospital
Milton S Hershey Medical Center
Moses Taylor Hospital
Mount Nittany Medical Center
Nesbitt Memorial Hospital
PA Hospital of the Univer of PA Health Sys
Phoenixville Hospital Company LLC
Pinnacle Health Hospitals
Pocono Medical Center
Pottstown Memorial Medical Center
Punxsutawney Area Hospital
Reading Hospital & Medical Center
Riddle Memorial Hospital
Robert Packer Hospital
Sacred Heart Hospital
Saint Vincent Health Center
Schuylkill Medical Ctr-S Jackson St
Sharon Regional Health System
Shenango Valley Medical Center
Soldiers & Sailors Memorial Hospital
St Clair Memorial Hospital
St Joseph Medical Center Reading
St Lukes Hospital Allentown
St Lukes Hospital Bethlehem
St Mary Medical Center
Temple University Hospital
Thomas Jefferson University Hospital
Titusville Area Hospital
UPMC Northwest Seneca
Warren General Hospital
Wayne Memorial Hospital
Western PA Hospital Forbes Regional Campus
Western Pennsylvania Hospital
Williamsport Hospital & Medical Center
Freestanding Birthing Center
Let me start by saying I support my doula sisters who make a few extra bucks by encapsulating placentas. Doulas/Childbirth Educators are always hopefully learning some things from each other, either in real life or this wild world of cyber support via blogs, social media, email forums, etc. We wrap our loving arms around each other in times of need, we offer each other our experiences, suggestions, etc, but we also keep each other in check. We provide accountability for each other. Usually it's done with gentleness and understanding. So I want to be careful because I believe with all my heart that most of us, while we make a little income from our important work with families, truly are in it for the love of supporting moms and babies. I cannot shake this feeling of needing to speak up about something that's been bugging me for a while. I do not mind placenta encapsulators advertising their business, but what I do mind is them stating that there is 'research' supporting the benefits of encapsulation. In particular, regarding the reduction of post partum depression and increase of milk production, though especially the former is really bugging me lately. This is a serious claim, on a serious issue. This can and IS giving moms the impression that there is actually evidence supporting that their dried and crushed placenta taken in pill form can prevent them from getting a PPMD. There is no such evidence that I'm aware of. And I've been told by PE, "YES THERE IS - here's the links! Smiley face" Many times, similar posts show up on these various groups. I've looked at everything they've provided and called 'evidence' before - it was not. It is all based on hypothesis. And I don't think it's an unreasonable one either, I just have a problem with how it's being presented sometimes. I know I'm not the only one thinking it. I know a handful of local doulas, even some who encapsulate or have in the past, who agree with me! I read some of these links and think, "You're kidding, right?" This 'research' says things about women quite possibly lacking iron after the expulsion of the placenta and this is the cause of PPMD. Or similarly, the release of all the hormones in the placenta is the cause of it. But none of these links are studies showing that the consumption of the placenta fixes this hypothetical cause of PPMD, let alone consumption through capsules. Some encapsulators are making a great business out of it, too. Teaching classes to other birth professionals on the how to's - there's one coming to Philly soon. Thank goodness for it, honestly, because initially, women were out there bringing other women's blood products into their own homes with not nearly as much information on safe handling or various processing techniques. What this class is going to cover sounds great. And to be perfectly clear - I support my doula sisters who encapsulate, I refer my clients out for this service if they want it, I have my own encapsulated placenta in my freezer, and I understand the theories and why it makes sense. However, can't we just be more upfront with moms about what this 'research' actually says? When I click through to the educator's beautiful website, I don't see any grandiose claims, but I do notice a some resource links on the left side of her site on 'scientific research' and 'benefits' - however, none of the links open to anything. A recent post on a social media site shows a question from a mom asking if there was any scientific evidence for doing placental encapsulation to prevent PPD. Not to my surprise, again, some PE and maybe some other moms pop in with these links that say nothing of what she's asking. I posted this quote from one of the better articles cited. "Evidence is limited in the areas regarding specific hormones and nutrients a placenta may offer, proposed benefits for nutrition, and prevention of postnatal depression and increased lactation. Interestingly, these are the primary reasons sited to support placentophagy." (Beacock, 2012) - From a British Medical Journal article. Some of these articles, from what I've read of the ones that actually studied something related to placentophagy, seem to say that there are hypotheses and theories based on the components in placenta being able to bridge the gap in terms of hormones lost after expulsion of placenta, however, it is stated more than once that 'evidence is absent'. So, to end, I do not believe there is research that specifically supports placenta ingestion through capsule form being proven to reduce PPD. Anecdotally, amongst my clients and many others I know who've ingested their placenta pills, there are mixed reviews. The reason for that could be many. I just ask that if you are advertising your placenta services, teaching how to encapsulate, or simply commenting on posts like the one mentioned, be very upfront with moms about what research actually says and does not say. Be clear about what is anecdotal, what is theory, what is your opinion, experience, and the limited research there is on anything regarding placental ingestion for treatment or prevention of anything. People will still choose it without having to be led to believe there is scientific evidence supporting it. ~
Thank you, Rebecca Dekker, once again! Whether we (speaking for birth professionals) already have an opinion or not, I think we should all know this information to be able to pass onto clients/students who are asking us what we think or know about the possible risks of getting or refusing the vitamin K shot following birth. This was a lot of work, I know it! Thank you again for clearing the myths surrounding this after-birth intervention and bringing light to fact that parents are so often bombarded with misinformation on the net, even perpetuated sometimes by doulas and childbirth educators. Well worth the $5 to purchase the pdf as a handout for clients and classes.
To read an interview with Rebecca Dekker from Evidence Based Birth, visit Science and Sensibility.
To get the pdf, for free or $5 suggested donation, visit here.
For a quick peek without the commentary, scroll down to the Table below.
As it seems half of my clients over the next 6 mos are hopeful VBAC mamas, I am constantly reminded that we have to keep these intervention conversations going not just for them but for our first time moms! Let's please get the word out however we can - PREVENT the PRIMARY CESAREAN! You can do this by informing yourself and other pregnant women of these common maternity practices in the US and how they can change a labor, birth, baby, and woman. The biggie - unnecessary inductions. A woman is not OVERdue just because she has passed her due date. Post term pregnancy begins after the 42nd week, and induction is NOT supported before that date, especially for first time moms, because of the risk of cesarean. Spontaneous labor is your friend! A friend worth the wait!
Below is a table created by Rebecca Dekker from Evidence Based Birth. Citations are available by visiting her post which she also shared on Improving Birth.Org :
Encourage anyone hoping to avoid a cesarean birth to choose their birth location and provider CAREFULLY and hire a doula! It's great to take an out of hospital childbirth prep class, too, but going into the hospital with professional labor support is invaluable in helping women avoid routine interventions that lead to cesarean birth without improving mom and baby safety, according to evidence. So many women don't know! Believe me, I hear the stories from moms during their second pregnancies all the time at consultations. There are way too many women who just don't ever come across this info and don't know what to expect at the hospital during labor and how it can affect their birth, baby, and future! They trust their doctors and that the hospitals wouldn't do anything unnecessary or that could possibly be risky. And while those of us immersed in helping to change things don't believe that many care providers are ill-intentioned, we do know this - standard and routine practices being used in hospital labor and delivery care are not supported by evidence, not even recommended by ACOG! And yet they are still used on women everyday and leading to UNNECESSARY CESAREANS. Take a look at the chart - for you, your sisters, your friends, your daughters. And while you may be uncomfortable offering unsolicited advice, how would you feel wondering if you had gently passed on this information and it having prevented a woman and baby you love from unnecessary harm.
I know we all find ourselves asking...but why? Why do hospitals practice this way? Why would our OB's do these things if not based in evidence? If not backed by their own professional organization? I think the simple answer is that this is just how they are trained. "Managing" every step of the labor process is how they've experienced birth in the hospital setting. Ultimately, it's easier to manage a bunch of women's labors using these routine practices coupled with it being more in their comfort zone. Taking spontaneous labor off the table in the majority of their patients really puts a lot more control in their hands, too, which I believe is a good match for most of their personalities ;) ...and schedules, dare I say. That is, of course, all my opinion. Not based on evidence. ;)
And for local information and support for managing interventions in a "trial of labor after a cesarean" (TOLAC) as a hopeful VBAC mom, please attend the ICAN meeting this Saturday at 10 am at Ohm Chiropractic in Media. It will be a roundtable discussion featuring tips from local doulas, ICAN leaders, and experienced moms! https://www.facebook.com/events/598029813590109/
My husband and I had a baby girl on Sunday, May 26! Overall, it was an amazing experience, and I could not have asked for a better birthing.
I was in the shower at 5 pm on May 25 when my water began leaking. I was 38.5 weeks and feeling huge, but my expectation all pregnancy was that our baby would arrive late. I was kind of shocked when it kept leaking and I started to have irregular contractions. My sister Ellen--my birth partner, in addition to my husband—and her fiancé were already at my house, so we just kind of waited it out knowing we were going to go out to dinner once Garrett got home from work. I threw some things in a bag in case this WAS it and started bouncing on my birthing ball.
I called my doctor at 8:30 as I was leaking more and more. My contractions were all over the place--anywhere from 5-10 mins apart. But they were not painful at all-in fact sometimes I did not even notice them beginning and ending. My OB was on call and asked that I come in immediately so they could confirm whether my membranes had ruptured. I was pretty worried to be going in so early with what felt like such minor contractions, as I anticipated that I would end up on Pitocin immediately. I was admitted to Delaware County Memorial Hospital at around 9:15 and had my first cervical check at 10 pm. My OB confirmed my membranes had ruptured. I was 3 centimeters dilated and 100% effaced (I was 90% effaced at my only cervical check before that at 36 weeks).
My OB said with such erratic contractions she would normally start pitocin, but she knew I really wanted to labor naturally, and agreed to return to check on me in a few hours to see if labor would progress on its own. I moved around a little through the first stage, but my first nurse—who I didn’t really like(!)--really wanted me to stay on the monitor as much as possible, so I spent more time in bed and pacing right next to it, than I would have liked. I also tried resting while my contractions were not painful because I missed dinner and knew I would be up all night. I did eat a couple protein bars and some snacks while I was there, but not much because I knew I was breaking the hospital rule!
I did begin to progress on my own and by around 1 a.m. my contractions were getting more difficult. I used breathing techniques from Lori’s class as well as Hypnobabies tracks. As the contractions got harder, I bounced on a birthing ball for a bit and Garrett or Ellen applied counter pressure on my sacrum. I also drank a LOT of water. My 2 am cervical check revealed I was 4 centimeters dilated.
When the nurse came in to check on me at 4 am, I asked to use the birthing tub. She said no and that because my membranes had ruptured, she didn't "think" it was safe. I was pretty ticked and let her know that! She vowed to "check the policies" but basically did not return until 6 am right before her shift change. I was also checked before shift changes and I was only 5 cm dilated. I honestly thought that was a joke—how had I only progressed 2 centimeters after 8 hours—and a sleepless night of hard work!? :( My contractions were so strong, I felt as though I had to be further along. My OB did inform me I could use the birthing tub though and that my next nurse was going to get it ready for me--that was good because I was feeling a lot of pressure on my back at that point. She also introduced me to the doctor who was taking over her shift.
My new nurse was great and encouraged me to stick to my plan and labor out of bed as much as I wanted to. It was such a relief! I got into the tub around 7am and did not get out until 9. It was great as it relieved the pressure on my back and I think it really helped the baby move down. The only problem is, I continued to drink tons of water and eat lots of ice chips while in the tub...so when I got out, I had to pee a lot! And I couldn't empty my bladder all the way because of the baby's position.
The doctors had wanted me to progress to 7 centimeters dilated after the tub, but I was only at 6. My new doctor recommended Pitocin. We asked for more time to think about it. That's when two unexpected emergency c-sections pulled the doctor away for more than 2 hours. It was really a blessing for me because I was able to labor on my own without a doctor hovering or suggesting I wasn't progressing quickly enough. I stayed out of bed and remained active, laboring in different positions, often using the birthing ball. By 11:30 when she returned, I was 7 centimeters dilated (they wanted me to progress a centimeter an hour at this point). I felt like I needed to pee so badly but I could not.
From around 11 until I started pushing, I was in the most intense pain. My Hyphobabies tracks were no longer helpful. Ellen and Garrett were very supportive, but I could tell they were worried about my pain (and I later found out they were worried about the growing crowd of family and friends in the waiting room). I started talking about getting an epidural and we started weighing the options and asked the nurse about it. I felt like I could handle all the pain, I just couldn't handle the extreme pressure on my bladder and not being able to relieve it by peeing! The thought of "erasing" that with an epidural actually sounded great. I eventually decided against the epidural with my husband's support. I had made it that far and would hopefully be ready to push soon...and I wanted to be able to feel pushing, and get up and walk soon after delivery. And I had prepared for a natural birth for so many months!
I don't remember vividly the time between 11 am and 1:30 pm, except the excruciating pain from having to pee! I got on the toilet so many times but with no luck! At 1:15, I was measured at 9 cm. They suggested a drain catheter to remove some of the urine from my bladder and hopefully get me to 10 cm. Both benefits sounded great to me, so I agreed. It didn't do much to relieve the pressure on my urethra, but it did get me to a 10.
I didn't have an incredible urge to push, but the baby was low enough that I wanted to start pushing. We started around 1:45 pm. I tried several positions for the first few pushes. I ended up laying on my back (which I truly did not expect to like) because that's where the pressure on my bladder was minimal and where I was pushing most effectively (go figure!). I did tilt the bed up slightly so I wasn't completely flat. I was told I was an excellent, controlled pusher, but I attribute some of that to the fact that they normally deal with women who have epidurals and can't feel themselves pushing! The other part I attribute to going in knowing what to expect from Lori’s class!).
The doctor came in at 2:15 -- she offered me an episiotomy, but I declined. I continued pushing while Garrett held my leg and Ellen gave me words of encouragement. I gave birth to our baby girl at 2:55. I had a 2nd degree tear and baby girl came out with her hand up by her face.
She weighed 7lbs 8.5 oz and was 19.5 inches. We wanted to delay cord clamping but compromised with the doctor for about a minute and thirty seconds. (We knew in advance this was something we did not agree on, but they would not allow skin to skin until cord was cut.). She was healthy with 8/9 Apgar scores. We did get skin-to-skin and she latched on right away. She had jaundice in the hospital, but it was on the cusp, so she never needed the light or formula.
Overall, I feel so empowered that I was able to realize my dream for a natural birth. It was so amazing to be able to let my body work just the way it is supposed to without all the interventions that have become the norm in hospital births! Since our baby girl came home, she has been a happy, healthy and thriving baby!