Posts for : February 2014

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Doula, did you know?

Here are some new research outcomes on the benefits and effectiveness of doulas and continuous support from the Cochrane Database

Doula Support

Doula Support

Here are a few important findings from the study.

Numerous types of information to include illustrative materials are within the full Cochrane document, you  can compare all data that was available from all included studies for the specified outcomes. It was found that women who received continuous support were less likely than women who did not to:

  • use regional analgesia
  • utilize any analgesia/anesthesia 
  • vacuum extraction or forceps  used during the birth process
  • to have a cesarean birth
  • have a baby with a low 5-minute Apgar score
  • reported greater birth satisfaction.

Women receiving continuous support were more likely than those who did not to:

  • experience spontaneous birth, this means not forceps or vacuums were used in the birth process.
  • experience shorter labor times

It was found that continuous support did not seem to impact:

  • use of synthetic oxytocin during labor
  • newborn admission to special care nursery, NICU, etc..
  • prolonged newborn hospital stay
  • breastfeeding rates at 1 to 2 months
  • depression in the postpartum period
  • self-esteem in the postpartum period
  • severe perineal trauma
  • labor pain severity

This is a wonderful study to illustrate what supportive care in labor can do, and in addition by omission it shows what can be done with postpartum support to support healing and beastfeeding rates.

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Introduction to Cradleboards- Student Article

Introduction to Cradleboards- Student Article
By: Susan Dlutkowski
cradleboardIn July of 2013 I attended a traditional arts gathering on Drummond Island in Michigan’s Upper Peninsula. There, I heard Earl Otchingwanigan speak about “The Language and Culture of the Cradleboard”. I knew that Earl was a respected Ojibwe elder and I was very interested to hear his presentation. I knew that cradleboards were used for holding infants, but I wondered:
Were they too confining?
Were they comfortable?
Are they still used?
Earl started by explaining the construction of a dikinaagan (cradleboard). He was also instructing another group at the gathering that was building cradleboards. He named several parts, such as the aagwiingwe’onaak -oon (the head protector) and the apizideyaakwa’igan -an (the foot brace). He held two beautiful black velvet bands, each beaded with traditional, colorful floral designs. Each of these miishiiginebizon -an were wrapped around the baby on the cradleboard, one covering the baby’s middle, the other around its legs and feet. With two bands, only the bottom one needed to be removed to change a diaper. These cloth bands were decorative since creating something beautiful for the baby was an important feature of the cradleboard. Infants and toddlers up to the age of three were put in cradleboards where they were kept safe, could sleep, or could observe the goings-on of their families.

Instead of spending time purposely stimulating their baby, families went about their activities; the baby was stimulated through quiet observation. Cradleboards could be hung by a strap so that babies were often at adult eye-level, receiving level eye-contact. This was considered important to a baby’s development and interaction with the group. At first, infants’ arms were swaddled by their sides. Later, arms were left outside of the wrapping. Mothers could sit with their legs outstretched, the cradleboard propped on their toes, so that the babies could see what their mothers were doing with their hands.

One man who attended the talk said that he and his wife used a cradleboard for their now seven-year-old daughter until she was three. She could be brought outside to safely watch wood-chopping and at the table she was at eye-level with her parents when the cradleboard was placed on a chair. The father said that his daughter would crawl to her cradleboard on the floor, for comfort. A woman at the presentation who was expecting her third child thought she would like to use a cradleboard for her new baby and was especially interested to hear of this father’s recent experiences.

I thoroughly enjoyed Earl’s presentation and was grateful for the opportunity to hear his first-hand knowledge of the cradleboard. I gained more of an understanding and a definite appreciation of the benefits of cradleboards. As an Ojibwe culture specialist, tradition bearer and scholar, Earl Otchingwanigan shares his knowledge, learned from family members in his childhood, and later from his own studies.

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Birth Matters- Kara Figueroa 0

 

“Birth Matters”

 

baby Birth is one of the most amazing miracles of this world.  It breathes air into life.  Birth not only brings your baby into this world, it sets the tone for how you look at yourself as a person and a mother.  It greatly affects your life in ways you never imagined it would.  It can set you up for memories filled with love, hope, joy and empowerment or it can break you into pieces.  Birth Matters, you matter.

I began my journey of becoming a doula, a woman who serves, after a less than lovely birth experience with my second child.  I was uneducated, unmotivated to learn and completely trusting of the hospital, my doctor and the nurses I have never met.  I set out to have a baby with complete strangers and was treated as such.  It shook me to my core.  I birthed a beautiful baby boy vaginally after 10.5 hours of labor where threats and scare tactics were used on top of medical interventions that went terribly wrong.  I felt alone, unloved and just a statistic.  I didn’t feel like I mattered and my postpartum experience confirmed how I felt about myself, and my ability as a mother.

Experiencing a labor and birth that caused myself to doubt my abilities, lowered my self-esteem and caused unwanted postpartum depression, motivated me to change the way my clients would experience birth.   “Women’s perceptions about their bodies and their babies’ capabilities will be deeply influenced by the care they receive around the time of birth.” Ina May Gaskin, Birth Matters.  I set out to love on women and their partners, educate them on the labor and birth experience, challenge them to dig deeper and counsel them on their fears.  I want my clients to know they matter and to know that I care about them and their hearts.  I didn’t want them to hear “the baby is here and healthy and that is all that matters”.  It’s not all that matters, it’s a huge part, but that is not all that matters.

Why does birth matter?  Ask your mom about her birth experiences, better yet, ask your grandmother.  Do not be surprised if their birth stories are as detailed as a woman that just had her baby yesterday.  Birth leaves and imprint on your mind and soul.  For every mother, birth is an event that shakes and shapes her in one way or another.  Birth leaves lasting effects such as empowerment, euphoria, depression and disempowerment.  These effects all differ depending on how the women is treated and supported around the time she gives birth regardless of whether the birth is vaginal or a cesarean.

Birth matters because you matter.  Do not for a moment leave your birth in the hands of a stranger.  Take my word for it. Build a birth team that will support you, your desires, educate you and empower you to want better for your birth and yourself.  Choose wisely and seek out a practitioner whom you feel comfortable. You wan them to be encouraging, understanding and will freely educate you on the questions you ask.  Interview with doulas and choose the best fit for your family; one that you feel will serve, love and support you and your partner the best.  It is very important that you are comfortable with your birth team.  Love, support and service are a powerful thing.  It can take even the less than ideal circumstances and turn them into more joy than your heart can contain.  Take control of your birth and let someone love on you and treat you the way you deserve, because YOU MATTER!

Source:  “Birth Matters” by Ina May Gaskin

Bio:

Kara Figueroa is wife, momma of 4 and a doula.  She has been trained by DONA and BAI and is seeking her certification through BAI.  Her passion is to serve, love and support.  She has been a practicing doula since 2008.  http://smiledoula.com

 

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ACOG Recommends Doulas to Lower Primary Cesarean Rates- Angela Rooney 0

ACOG Recommends Doulas to Lower Primary Cesarean Rates

Cesarean

Cesarean

A new publication just released on February, 19, 2014  by the American Congress of Obstetrics and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) announces what a doula already knows!

The articles findings state that from 1996 to 2011 cesarean rates in the U.S. have increased rapidly without a decrease in maternal or fetal injuries or deaths.  This indicates that OB/GYNs have been over using the surgery on first time mothers in non-emergency instances.

In order to invoke change in the rising increase in primary cesareans, one must ask the reasons these surgeons are performing so many major surgeries to first time moms in the first place.

The top five reasons for a primary cesarean in order of greatest to least:

1.  Labor Dystocia

2.  Abnormal Fetal Heart Rate

3.  Malpresentation of the Fetus

4.  Multiple Gestation

5.  Fetal Macrosomia

 

The article then discusses safe measures that need to be taken to decrease the chance of resulting in a cesarean section.  These are not new techniques or guidelines, but we need to see them better implemented.

  1. Labor Dystocia:
    1.  Labor may be a slower process than previously defined and needs to be redefined.
    2. Defining active labor is strongly recommended to change from 4 to 6 centimeters.  Before 6 centimeters, actions for the active phase of labor should not apply.
    3. Physicians should be well trained in operative vaginal deliveries, such as vacuum and forcep delivery,  to utilize them as a safe alternative to cesareans.
  2. Abnormal Fetal Heart Rate:
    1. “Amnioinfusion for repetitive variable fetal heart rate decelerations may safely reduce the rate of cesarean delivery.”
    2. Scalp stimulation is an effective tool when the cervix is dilated to determine the fetal acid-base status.
  3. Malpresentation of the Fetus:
    1. Fetal presentation should be checked by 36 weeks in order to apply an external cephalic version.
  4. Multiple Gestation:
    1. Women with cephalic presenting twins or cephalic/ noncephalic  presented twins should be recommended to deliver vaginally.

5.  Fetal Macrosomia:

a. Ultrasounds are fairly inaccurate at estimating weight in later pregnancy.  Only mothers with estimated fetal weight over 5,000 g. without gestational diabetes or 4,500g. with gestational diabetes should be subject to a cesarean.

b. Women should be counseled on maternal weight gain, diet, and exercise guidelines.

 

The best part of the article comes at the end when it discusses the importance of continuous labor support.  Ahem ;)

“Published data indicate that one of the most effective tools to improve labor and delivery outcomes is the continuous presence of support personnel, such as a doula. A Cochrane meta-analysis of 12 trials and more than 15,000 women demonstrated that the presence of continuous one-on-one support during labor and delivery was associated with improved patient satisfaction and a statistically significant reduction in the rate of cesarean delivery (111). Given that there are no associated measurable harms, this resource is probably underutilized.”

It’s not exactly a new concept that elective cesareans have been overused with 1/3 of U.S. mothers walking around with c-section scars.   Finally research findings are becoming mainstream, and hopefully, new guidelines can be put into effect.  Yes, sometimes a Cesarean is crucial to prevent maternal or fetal morbidity.   We must come together as birth professionals, doulas, midwives, nurses, and OB/GYNs alike, and respect the guidelines for our common end goal– a healthy and happy mother and baby.

 

You can read the full article here:

http://www.acog.org/Resources_And_Publications/Obstetric_Care_Consensus_Series/Safe_Prevention_of_the_Primary_Cesarean_Delivery

 

About the Author:

Angela Rooney has a BA in Psychology, is a professional birth doula, and is a Certified Pre/Postnatal Fitness Specialist.  She’s passionate about helping pregnant women have a memorable childbirth experience. Read more about Angela and her work at [www.mindandbodymama.com]. Follow her at [https://www.facebook.com/mindandbodymama] and [https://twitter.com/mindandbodymama].

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Preparing for Childbirth-Terri Lee-Johnson

Doula Support

Doula Support

Preparing for Childbirth

 

When most women consider childbirth preparation, thoughts are often limited to the method they’ll use such as Lamaze, Bradley, HypnoBirth, etc. Anyone planning to have a baby should, first, do just that: plan to have a baby. I know, I know, how many of us actually do that or even get the chance since many pregnancies are a surprise? Considering that more women are postponing motherhood until their 30s and 40s, taking a moment in the 20s to plan is a great idea. Also, this is a great addendum to the motherhood topic for those mother-daughter talks. While what method and, thus, what type of childbirth class to take is important, there are a few other things to consider.
1. Consider where you want to birth While birth centers and hospitals are covered by insurance, home births involving the services of a midwife are typically an out of pocket expense. As soon as you know that you want a midwife’s services, you should start saving for the fee. If you’re willing to move temporarily to another state where midwives are licensed because they aren’t in your area, include those expenses as well. A great way to get help with those expenses is to add them to your gift registry or turn one of your hobbies like jewelry making or knitting into a small business for which you’ll use the earnings to secure a midwife.
2. Consider the type of birth you want Two words: BIRTH PREFERENCES. No matter where you plan to birth, you should have one. Even someone wanting a home birth but, just cannot seem to acquire the funds to pay a midwife may have to have a hospital birth and home births that may turn into a hospital transfer should have a contingency plan so your wishes are clear. There are tons of examples online to help you map out your “please dos” and “please don’ts” for hospital staff. Your preferences can include everything from whether or not you desire to exclusively breastfeed to requesting no vaccines be administered to no circumcision if your newborn is a boy. Flexibility is just as important when setting birth preferences as birth can be unpredictable and certain things may conflict with your wishes. The goal is to be educated enough on your options to make informed decisions regarding how you give birth.
3. Consider who you want to assist you in birth OB? Midwife? Doula? In Tennessee, you have two options: a home birth with a midwife or a hospital birth with an OB. Midwives do not have hospital privileges here so, your setting determines your attendant. If that is the case where you live and you prefer to work with a midwife, consider having your well woman care being handled by one to begin cultivating that relationship. It is often forgotten that midwives do more than “catch babies.” Start taking advantage of their services before conception. Just remember it will likely not be covered by insurance but, you get what you pay for. *wink wink*
Now, doulas do not provide any medical services but can attend your birth as emotional and physical support. She will also provide tons of helpful information throughout the pregnancy and into the postpartum period. We are found to be most useful in hospital births where the environment is not as easy to control as your home. Doulas are another out of pocket expense for most though, insurance providers are beginning to recognize our value and provide coverage for our services. This is another item that can be added to a gift registry (great for a group of co-workers to give) if you need help with doula fees.
There are many things to consider when planning to start a family but these are the three questions I would answer first regarding prenatal care and the actual birth. Where you birth and who attends that birth will influence how you birth. If you want an out of hospital experience that will require a small investment, start saving now or solicit anxious grandparents-to-be for a donation. Even with unexpected pregnancies and birth being unpredictable, still give yourself the space to plan and create the birth you want.

____

Terri Lee-Johnson is a homeschool mom, wife, doula, and apprentice midwife in Memphis, TN. In her spare time, she reads voraciously, watches historical documentaries, and is artsy craftsy.

www.zoleka.com

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“With Woman” by: Dana Luttrell

“With Woman” by: Dana Luttrell

“It has not been long that I have been a doula. My training is inching toward completion with attendance of a couple births left to be evaluated and as I continue to scrape together time to finish assignments and book reports. I take great pride in my training efforts, read far more than required, watch every film and documentary, listen earnestly to other birth workers and other mothers like myself who have experienced a birth trauma only to redeem their experience with a subsequent birth. I think I can confidently say “I know the basics” just as confidently as I can say “there is so much to be learned”.

As a training doula, I often focus my learning on techniques to be used: massage, Rebozo, essential oils, memorizing positions and their uses. Important stuff, as in most descriptions of a doula these are the highlights of our work. We know how to help you cope, physically. We know the process, and believe in the process, of natural childbirth. We also know about the interventions and how to work with them so they don’t fall into the “cascade” we birth workers fear will take away from the childbirth experience. Ask any lay person what a doula does and if they know anything about us at all, they will know that we can help you deal with the pain of labor.

But despite all the wonderful uses and intentions of those techniques, I fear I have left out focus of a key factor of my work. As a doula can tell you, the most beneficial part of having a doula at your birth is the CONSTANT SUPPORT. I knew this. I believed this true. And yet I still didn’t understand the extreme impact that statement has.

With woman. 

Not “doing it with woman”, not even “helping a girl out”. WITH. With? Such a simple implication of a word. Defined easily, categorized simply.

Not until the last birth I attended did I truly understand the full weight of importance of “with” in my role as labor support.

Although, I should have as I experienced it in my own birth of my second child. In my personal experience of a rather quick labor/birth (6 hrs total), I did not want coping techniques to be used on me. I was fighting off the panic of how quickly my birth approached. I holed myself up in the smallest room of my house and made a small nesting area reminiscent of the dogs my family bread in my childhood used to do. I was offered a simple, and known to be quite effective, hot water bottle, but the presence of the gentle, loving, midwife’s apprentice and the trying of that physical ease made me loose focus. I did not like either, and so I stayed alone in my safe place listening to the conversations of my husband and midwife, my mother crushing ice for me in the kitchen, my father retreating to another area of the house so not to disturb the process, alone and content working internally to handle my labor.

And then, eventually, I came out of my nest because I honestly felt a little out of the loop. I wanted to be near the people. I entered the hardest of my labor there, with them. I needed them there. I did not need them to assist me labor and frankly they couldn’t have anyway. No, I just needed them. After a unfavorable positional change I remember grabbing my midwife’s knee suddenly as a heavy contraction hit before I was ready. Her face was shocked by my sudden grasp as I had until this point labored within myself, not reaching out for help. And then her eyes told me what I needed to know:

“I know it’s hard. I know you’re working harder than you ever have. I know.”

After that moment I felt a new level of trust. Not because she helped ease my pain or even because she said some scholarly fact about transition being the hardest but shortest part, but because she empathized and validated my experience….. all in a look.

With woman.

Yes, a doula can offer you many helpful things to deal with your labor but not all who labor want a massage or a positional suggestion. Some just need you to be WITH them. To hear them when they cry out that they don’t want to do this or that they don’t think it can be done. To know they are suffering. To somehow with your presence tell them you understand. Perhaps a word of “but you are doing this” or “your work is paying off” or even “you are further than you realize and doing more wonderfully than you think” but mostly just WITH.

The last birth I attended was a mother’s 3rd and first attempt at a totally natural and un-augmented childbirth. Much like my own, quickly moving. She fought her labor until she couldn’t fight anymore. She voiced her retreat of intent for this birth so I could hear it, not because she really meant she wanted to give up but because someone had to know how difficult it was. And I did. I knew. It was hard and it was fast and it wasn’t exactly how she pictured herself laboring. Once she had told me and I agreed that it was hard, she stopped fighting it. She danced beautifully the dance of a laboring woman, drawing her baby further through the pelvis. And when her dance was sufficient she found herself a bed to rest in. And when her rest was sufficient, she pushed the baby out in 2 waves without voicing to anyone that it was happening (in fact, in that dark hospital room, we nearly missed that the baby was being born, let alone a doctor to be present for its entirety!). Her birth was beautiful and it was hers. She was strong, even when she tried to say she wasn’t. I did not help her with counter pressure or positions as I so often do. No, instead I was simply “with”.

With woman.

To sum up the whole, the best part, the most important part, is that I, and all the striving birth workers in our present, past and future, are with YOU, woman. Every mother that has ever been is with YOU, birthing goddess. And if you need to be validated while you work to bring your baby earth-side, just look to the woman at your birth-she is WITH YOU in this momentous right of passage and that, I hope, will sooth your soul. ”

 Dana is police officer’s wife, mother of 2 young sons, & Labor         Support Doula in training living in the heart of the Midwest. After the birth of her first son, a hospital experience, she chose to leave her career pursuits as a nurse & join the ranks of stay at home moms while researching & planning the birth of her next son, a midwife assisted home birth. After personally experiencing the difference a birth with professional, loving support can make, she chose to train to be a Doula through Birth Arts International & has joined in volunteering for TBS on their social media fronts. A believer in evidence-based obstetrical care, she most strives to help mothers & families by assisting them in obtaining the birth they desire through education, support, tradition, and mindful presence.”