Chandler, Arizona
Sweet Pea ​Births
Sweet Pea ​Births
...celebrating every swee​t pea their birth
...celebrating every swee​t pea their birth
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Uterine Rupture: Assessing the Risks
Posted on April 26, 2016 at 10:18 AM |
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Uterine rupture is a topic that came up when I was pregnant with
Otter that I was not ready to allow into my consciousness until she was
safely in our arms. After enough time
had passed and we have proven to ourselves that homebirth can be a safe option
when a person is healthy and low risk, I am ready to write about it.
I gave Stephanie Stanley, former facilitator of the East Valley
ICAN group, byline credit for this because I am using her research from a
uterine rupture presentation she did at a meeting for my post today. ICAN, the International Cesarean Awareness
Network, is a non-profit organization that strives to improve maternal-child
health by preventing unnecessary cesareans through education, providing support
for cesarean recovery, as well as educate about Vaginal Birth After Cesarean
(VBAC) and options for what is called a "gentle cesarean" where the event is honored as a birth even though it's via a surgery. ICAN’s goal is to see a healthy
reduction of the cesarean rate that is patient-driven. By providing education and support, they hope
that more women making evidence based, risk appropriate childbirth decisions
will lead to an overall reduction in the rate of cesareans performed.
Uterine rupture seems to be the leading reason why care providers are
hesitant to allow a mother to have a trial of labor (TOL) after a previous
cesarean. In Arizona, a licensed midwife or certified professional midwife can attend a homebirth
with a mom who is striving to have a VBAC only if the mother meets certain criteria. Arizonana for Birth Options is leading a grassroots efforts to change this so
that as per the ICAN vision, women living here can make evidence based and risk
appropriate decisions. They want all
options to be available: for a hospital birth if mom feels that is the best
option, or a homebirth if both mom and midwife agree that they are a good
candidate for VBAC.
Uterine rupture is defined as an anatomic separation of the
uterine muscle with or without symptoms.
What this means for baby is that the uterus ceases to function as a sealed protective container from the rest of the blood and organs surrounding the baby. The function of the placenta and umbilical
cord may also be compromised. Mom is
subject to blood loss and shock. A
decision also has to be made about repairing the uterus or performing a
hysterectomy.
Another term used when talking about uterine rupture is
“dehiscence”. A dehiscence is the
splitting or incomplete opening of the cesarean scar. It can happen without complication for mom or
baby and sometimes it is only discovered after the delivery. It is also called a “window” by some care
providers.
As it turns out, while uterine rupture is a consideration when you are preparing for a birth after a cesarean, it's not the only one your care provider should be having a conversation about. You can read THIS post to see where the risk for uterine rupture falls in comparison to other risks of pregnancy and labor. So what does the research say?
Here is the overarching conclusion: anyone can be at risk,
whether you have an unscarred or scarred uterus. At most, your risk rate is 2%. 2 percent!
Why then is it that this is such a big deal? I believe it lies with the potentially
devastating circumstance a family will find themselves in if the uterus does
rupture. While 98% of the population
may have a successful VBAC, the worst case scenario of a uterine rupture is
the loss of the baby and possibly a hysterectomy for mom which makes future
pregnancies impossible.
Another point to ponder is that the statistics listed below
are close to other statistics for labor emergencies, such as placenta accreta,
placental abruption, miscarriage; for a longer list click here.
Statistics for the risk of uterine rupture – see links at
the end of this post for references: VBAC: .5% - .7% VBA2C: 1.7% (vaginal
birth after 2 cesareans) VBAMC: 1.2% (vaginal
birth after multiple cesareans) Previous VBAC: .4% - .5%
(if you had a previous successful VBAC) VBAC + Augmented labor:
.9% (stats for first attempt) VBAC + Induced labor: 1%
(stats for first attempt)
Here is a link to the comparison of risk rates for VBAC,
CBAC (a cesarean birth after a trial of labor) and ERC (elective repeat
cesarean)
http://www.sciencedirect.com/science/article/pii/S0002937808004213
The risk factors when considering whether or not to do a
trial of labor after a cesarean are: The type of scar you have: the most favorable is a low
transverse scar. Classical T-shaped
scars, vertical scars or high uterine scars are said to have a higher risk of
rupture.
Induction of labor using cervical ripening agents, i.e., Cytotec,
Cervidil: the prostaglandins that soften the cervix may also soften the scar
tissue. In addition, ripening agents can
cause uterine hyperstimulation, meaning contractions that are much more intense
and frequent than the uterus is designed to withstand in the course of an unmedicated
labor.
More than one cesarean: as you can see from the statistics
above, there is a slight increase of risk.
Among factors that are disputed in medical literature are: - Age of mother: if a mother is over 30 she may be considered
at higher risk for uterine rupture. - Obese women - Size of baby: more than 8 pounds, 14 ounces - Post-term baby: 40+ weeks gestation from last menses To compare, here are the stats and risk factors for an
unscarred uterus: “The normal, unscarred uterus is least
susceptible to rupture. Grand multiparity, neglected labor, malpresentation,
breech extraction, and uterine instrumentation are all predisposing factors for
uterine rupture. A 10-year Irish study by Gardeil et al showed that the overall
rate of unscarred uterine rupture during pregnancy was 1 per 30,764 deliveries
(0.0033%). No cases of uterine rupture occurred among 21,998 primigravidas, and
only 2 (0.0051%) occurred among 39,529 multigravidas with no uterine scar. A meta-analysis
of 8 large, modern (1975-2009) studies from industrialized countries revealed
174 uterine ruptures among 1,467,534 deliveries. This finding suggested that
the modern rate of unscarred uterine rupture during pregnancy is 0.012% (1 of
8,434). This rate of spontaneous uterine rupture has not changed appreciably
over the last 40 years, and most of these events occur at term and during
labor. An 8-fold increased incidence of uterine rupture of 0.11% (1 in 920) has
been noted in developing countries. This increased incidence of uterine rupture
has been attributed to a higher-than-average incidence of neglected and
obstructed labor due to inadequate access to medical care. When one assesses
the risk of uterine rupture, this baseline rate of pregnancy-related uterine
rupture is a benchmark that must be used as a point of reference.” If you choose to have a VBAC, or realistically for any woman
in labor since the statistics show she has a slight risk, here are the signs that may
help you recognize that a uterine rupture is occurring or may have occurred: - Excessive vaginal bleeding - Extreme pain between contractions – these may or may not
be felt through an epidural block, though due to severity of pain it’s possible
they may be felt - Contractions that slow down or become less intense - Abdominal pain or tenderness - Baby’s head moves back up the birth canal - Bulge in the abdomen, bulge under the pubic bone, or
pressure on the bladder where the baby’s head may be coming through the tear in
the uterus - Sharp onset of pain at the site of the previous scar - Uterus becomes soft - Shoulder pain - Heart decelerations in the baby - Maternal tachycardia (rapid heart rate) and hypotension
(low blood pressure)
If you have a true uterine rupture, then an emergency
cesarean will be required. A Chandler
doctor told the ICAN group that the care provider has 5 – 7 minutes to get the
baby out safely, although in reading for this post I saw some estimates as 10 –
37 minutes. According to a 2010 National Institutes of Health study,
there have been no maternal deaths in the US due to uterine rupture. Overall,
14 – 33% will need a hysterectomy. 6% of
uterine ruptures result in perinatal death, and for term babies this risk was
put at less than 3%. **
If you do have a uterine rupture, it will have an effect on
your future pregnancies. Each cesarean a
mother has increases the risk for future complications of cesarean
surgery. If you have a hysterectomy, you
will not be able to carry any more children.
In today’s medical climate, a uterine rupture will most likely result in
all future pregnancies being delivered via repeat cesarean.
There are a lot of points to ponder as a new mom or as a mom
considering a VBAC. Our Bradley® mantra
is: Healthy Mom, Healthy Baby. We teach
that as long as you make all your decisions with those two goals in mind, you
are likely to make the choices that have a positive outcome for both Mom and
Baby. What are your thoughts on VBAC and/or uterine rupture?
**NOTE: Stephanie’s presentation called out these statistics
as inflated as the Landon study (2004) included women who had pre-labor
stillbirths included in the statistics.
IN other words, women whose babies had passed away before labor and
still delivered via VBAC rather than choosing a repeat cesarean were counted in
the perinatal death statistics. Please
read Henci Goer’s analysis for more information
For the resource list, click here. Disclaimer: The material included on this site is for informational
purposes only. It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult her or his healthcare provider to determine the appropriateness of the information for their own situation. This blog contains information about our classes available in Chandler, AZ and Payson, AZ and is not the official website of The Bradley Method®. The views contained on this blog do not necessarily reflect those of The Bradley Method® or the American Academy of Husband-Coached Childbirth®. |
To Eat or Not To Eat…
Posted on November 5, 2015 at 8:07 AM |
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We love it when science catches up to Dr. Bradley. Anecdotally, we could tell students that it was safer to eat before/during labor since anesthesia has changed from the days of "knock'em out, drag 'em out" birth, as Dr. Bradley called it. Women used to be under general anesthesia, which is administered differently than today's spinal or epidural blocks. We are so excited to update this post (and our class info!) with a press release from the American Society of Anesthesiologists (ASA):
Now...how long will it take for hospital protocols to change and reflect these recommendations from ASA? As we found out the hard way, sometimes the doctor approves something but if it is not in writing and signed off on the birth plan, it probably isn't going to happen in the hospital setting. The nurse will follow the hospital protocol or they may invent their own interpretation if none exists to cover their liability. If you are going to have a hospital birth, I have a strong opinion about getting your wish list signed so that the nursing staff has “permission” to “break the rules” if they feel that something you are requesting is out of the ordinary. Maybe you could ask for a copy of the ASA press release to be included in your chart that goes to the hospital. Dr. Bradley always advocated that a healthy mom should eat if she is hungry and drink if she is thirsty. As he said, “Birthing is like playing a full game of football without any substitutions.” He recognized that labor is an athletic event, and that a well-nourished athlete would perform better than a hungry one.
A Note About Hospitals and Nourishment If you are having a hospital birth, you need to find out how your care provider feels about nourishment during labor, even with this announcement by the ASA. If your care provider is on board with mom eating and drinking as her body directs, great! Get it into your birth plan, aka "wish list", that you have permission to eat and drink. If they restrict intake, you need to think about your options. You may question whether or not your care provider is truly supportive of your plans for a natural birth. You should also ask what the hospital policy is on food and drink during labor when you do your hospital tour. It helps to know what kind of potential situations you may be facing so you can avoid stress-inducing encounters during labor. The potential conflict between a laboring mother’s needs for nourishment and her care provider or hospital protocol comes from the days when general anesthesia was standard for hospital births. There was a very real danger of a mom “aspirating”, meaning that food or drink the mom had consumed before labor would be regurgitated and accidently enter the trachea and lungs, creating a life-threatening condition to mother and baby. [See reference 1]
Although very few women have births under general anesthesia nowadays, the practice of restricting food and drink still persists. You may hear it called “NPO”, which stands for the Latin, “non per os”, meaning nothing by mouth. With the press release from the ASA, we can keep our fingers crossed that hospitals will start to change their practice protocols. In the past, it was likely that you would only be allowed ice chips if you opted for an epidural. The chance of needing general anesthesia was within the realm of possibility since some moms and babies “crash” after the epidural dose is dispensed. As with all labor interventions, you don’t know how you will react until it’s administered. Although it’s a small percentage of women that have life-threatening complications, the prospect of the drugs dropping your heart rate, blood pressure or respiration to dangerously low levels exists once they are in your bloodstream. In the instance of a “crash”, you would need general anesthesia to perform an emergency cesarean to save your or your baby’s life, thus your nourishment options become limited to ice. Eating and Drinking During Labor Have your refrigerator stocked with your favorite healthful foods and/or meals as you near your estimated due date. Labor is a funny thing – you never know what your body is going to like. If you think you are in labor, you can go through Dr. Bradley’s list of things to do to see if you are in pre-labor (contractions slow down or stop) or actual labor (contractions continue at same pace or get closer and harder despite the change in position or activity). To "test" for labor, he suggests that a woman should eat, drink, go for a walk, shower and nap – in that order. When you start with the “eat” part of the list, it will be more satisfying to eat something you really enjoy. If you are not in labor, at least you ate something you like and you can move on with your day with a tummy-full of your particular “comfort food”. If you are in labor, then you have eaten something that is fueling your body for the labor. It will put you in a good frame of mind if you ate something that is a favorite and you create a positive emotional state. The best drink during labor is water. Water is a key to staying hydrated and avoiding the slippery slope of interventions. A hydrated body has the energy for the work of labor. Ample water also allows for effective hormone distribution throughout the body: the chemicals and hormones being made to stimulate and progress labor are able to circulate freely. If you have a longer labor, consider an electrolyte replacement: trace minerals added to the water you are drinking, Emergen-C makes a powder, or coconut milk is a "natural" version of sports drinks. Dehydration causes a spike in temperature and blood pressure, while at the same time depleting your energy by as much as 30%. Can you see that simple dehydration can also be interpreted as the mom being “in distress”? Your care team will not want to take a chance of making the wrong call, so they are likely to intervene or suggest drastic measures to “save” mom and baby. Whether you are laboring at home, a hospital or birth center, small-portioned, protein rich snacks are nice to have on hand. As your labor progresses, a laboring woman’s appetite will naturally decrease as the body shuts down other functions such as digestion to allow for full focus on the progression of labor and birth. Here are some foods that we and other students have found useful for quick energy boosts when mom doesn’t have the desire to eat a full meal. These snacks are also handy for the coach to get the energy boost he needs to be a great support person for mom. We don’t want hungry, cranky coaches during labor!!
- Handful of nuts. If you have a favorite nut (besides your coach-lol), bring some with you. You can eat 1 or 10, whatever you are in the mood for. I like nuts because you get the energy boost in whatever quantity you are in the mood to chew and swallow. Trader Joe’s sells packages nuts in handy single serve packets. I usually eat 2 or 3 pieces, and Bruss would finish off the bag for his energy boost. - Banana. Another source of potassium that is portable and easy to eat. To prevent a sugar burst, pair this with a cheese stick to balance out the carbs. - Single serve smoothies or juice drinks. I am thinking along the lines of Stonyfield Farm Smoothies or Drinkable Yogurts for a liquid protein boost, or the Odwalla line of Protein Beverages. It’s a little sip of something sweet with carbs that still offers a protein source for energy. As you noticed from the list, some of these foods need refrigeration or a heating source. These are considerations if you are having a hospital birth. It stands to reason that if you will not have access to a refrigerator or microwave, the items that won’t stay cool with an ice pack or the foods that need to be heated need to left out of the cooler. The bottom line: eat to appetite and drink to thirst for the best labor possible! I hope this list gives some ideas with which you can fill your refrigerator or cooler. What did you eat during your labor? Disclaimer: It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult her or his healthcare provider to determine the appropriateness of the information for their own situation. This blog contains information about our classes available in Chandler, AZ and Payson, AZ and is not the official website of The Bradley Method®. The views contained on this blog do not necessarily reflect those of The Bradley Method® or the American Academy of Husband-Coached Childbirth®. References: [1] http://en.wikipedia.org/wiki/Pulmonary_aspiration [2] http://www.honey.com/nhb/benefits/natural-energy/ |
Natural Oxytocin Boosters
Posted on October 23, 2015 at 9:27 AM |
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In addition to being the “love” hormome, oxytocin is also produced in great
quantity when a woman is in labor. The
hard contractions can only happen if the woman’s body is producing ample
oxytocin. I find it so ironic that the physical
pain and the emotion of love are happening at the same time. That must be the combination
that makes natural birth possible, that helps bond us to our Sweet Peas, and why people sign up for the experience
more than once. I can honestly say that
I am really going to miss being in labor. Call me crazy! Anyway.
I wanted to call out their suggestions for non-medical ways to boost oxytocin
production and talk about how they may be options to consider while you are in
labor since the article was not birth specific. Oxytocin production in labor suggestions offered by Sweet Pea Births, instructor in the Bradley Method® natural childbirth classes offered in Arizona: Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale, PaysonPet you furry friend: One of the many
benefits of laboring at home. Do you
have a four-legged friend that wants to cuddle? Go for it! Love on them, speak in
gentle tones…it will be calming for both of you.
As I leave you with these ideas, I want to remind mamas and coaches that even if you are doing all of these things, labor cannot progress by oxytocin levels alone. One of the key components of birth is surrender. Do the things that boost your oxytocin and then let go, give in, and open up to the whole experience of labor and the birth journey. The best gift is at the end when you meet your baby – it is SO worth it!
Best wishes for your upcoming birth – we hope some of these natural oxytocin
boosters will help you stay on course with your wish list! Which one of these do you like and/or have you used? Please leave us a comment - it will be moderated and posted. *I think* that the amount of traffic you so generously
generate has led to a lot of spam posting. In an effort to keep the spam
to a minimum, I am taking the time to moderate comments now.
Disclaimer:
It is not intended nor implied to be a substitute for professional medical
advice. The reader should always consult her or his healthcare provider to
determine the appropriateness of the information for their own situation. Krystyna and Bruss Bowman and Bowman House,
LLC accept no liability for the content of this site, or for the consequences
of any actions taken on the basis of the information provided. This blog contains
information about our classes available in Chandler, AZ and Payson, AZ and is
not the official website of The Bradley Method®. The views contained on this blog do not necessarily reflect those of The Bradley Method® or
the American Academy of Husband-Coached Childbirth®. |
Patient Rights
Posted on September 25, 2015 at 9:39 AM |
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What is natural birth?
Posted on September 4, 2015 at 9:37 AM |
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The night we started our seventh Bradley Method®
class series in December 2011 played out like all other "first nights" of class. I am on edge all day long. I get nervous before our students
arrive: What if I forget anything? Will they like our class? Will our class run smoothly? What if I leave something I need for class at home? It made me pause and think for a moment. My short answer in class was, “Well, I guess
that depends on the person and their definition of natural birth.”
I pondered that question all night. Up until three months before that class, I would have said
that we had three natural births and were preparing for our fourth. And then we had our home birth experience,
which re-defined “natural birth” for me.
It turned out to be the most natural birth experience we had.
I can’t say our hospital births were completely intervention
free since we were always poked and prodded by something or someone. Heck, they weren’t even “un-medicated” – I
was administered some kind of medication with each one. With Puma, I had penicillin, Pitocin and an
episiotomy; I had penicillin with Night Owl; and penicillin and Pitocin with Charger. We did achieve three epidural-free vaginal births
with a very supportive OB, though, and for that I am grateful.
Otter’s birth gave us a new definition of “natural”. Here are all the things we DID NOT experience
during our low-risk home birth: - A transfer from our home to another location during active
labor - Forms to fill out - A wait in the triage area with other families in varying
states of apprehension - Vaginal exams to check the progress of labor - Heparin lock for access to veins “just in case” - Electronic fetal monitoring - Mommy-monitoring
Nurse coming in to check vitals - Calls to the doctor to report on my “progress” - Restriction of food or drink - Beeping sounds and hospital smells that inhibit rest or
sleep - Time on back for the convenience of the hospital staff - Episiotomy
Our midwives were called when my water broke and they came
to see how we were doing. The baby was
low and things seemed to be progressing, so they stayed. To this day I do not know what the deciding
factor in their staying was when our labor hit the start-stop mode…I do know I
am grateful that they didn’t leave us. I
would have felt like another “failure to progress” and who knows what that
would have done to my emotional state and our labor. (Click here for our homebirth story.)
At first, they checked on us every thirty minutes. They would monitor the baby with a Doptone to
assess her heart rate, and they would check my blood pressure to see how I was
doing. When it was clear that we were
both handling the labor well, they checked on us with less frequency while
still maintaining a trained eye on us to judge our fitness and make sure we
were still low-risk and doing well.
They asked questions.
They let me eat. They made sure I
was drinking. They checked in with Bruss
to see how he was doing and how he thought I was doing. They offered moral support and encouragement
that everything was fine although we were clearly not going to be one of those families
who can say their homebirth was their shortest labor. In an ironic twist of fate – this happened to
be our longest labor, and we were so grateful to be at home with trained care
providers who allowed my body and our baby the time they needed to figure out
the process and have a healthy mom, healthy baby outcome.
So now we know what all the possibilities are when a person
imagines “natural birth”. A woman and
her partner work together to welcome their child, free of interference or
invasive probing, supported by a team that completely believes in your
abilities and will help you welcome your baby gently and lovingly into the
world. It makes me wish that there were
no pregnancy complications so that every woman could have a gentle birth.
The reality is that the majority of our students coming
through class are just like we were with our first baby. They believe that a hospital is the safest
place to give birth and that an OB is the only person qualified to safely
deliver your baby. It would be irresponsible
to have a baby at home, outside of the “safety net” if something were to go
wrong.
I am so grateful that now there are many more Certified
Nurse Midwives ("CNM") working in hospitals.
They provide the level of belief in the natural process that we found at
our home birth, while still working at the hospital setting in which most people
feel comfortable.
If a student’s care practice does not offer midwifery care,
I hope that like us, they will find a supportive OB who respects their
proactive approach to achieving a natural birth and helps them find a way to
have the birth experience they want in the hospital. We have a very tender spot in our hearts for
our OB. Not only did she deliver our
biggest baby without an episiotomy, she also helped us have our most natural
hospital birth because she believed in our ability to birth.
There is also another option available to families in the Phoenix area. We now have several birth centers. Birth centers strive to be the happy medium between home and hospital for families that want to have the "compromise option". They can offer a more relaxed atmosphere similar to the home environment, and some provide medical options at the center that would not be present in a home birth. I feel it is our role as Bradley Method® instructors to help
every couple achieve the best birth possible for their children with a healthy
mom, healthy baby outcome. “Natural
birth” will be different for each of them based on their pregnancy and their
choices. What can you "control" in the childbearing year? A couple will probably have more options availabel to them in labor if the mother has good nutrition, maintains a daily exercise regimen to tone their back, belly and
bottom, and does some form of exercise for stamina. By attending classes every week they learn a
new relaxation technique that they can put in their labor toolbox. We explore many, many options available to
birthing couples today. What can you influence during the childbearing year? We work on
communication every class so that the couple is prepared to respectfully ask questions of their care
provider if they feel something they recommend goes against their dream of a natural birth, or to better understand their recommendations so that
they can make an informed decision. The choice of care provider will also play a role in the way to birth plays out - are you getting red flags during your prenatal visits? Do not ignore them - ask around and find the provider that respects your rights and your knowledge as a birthing parent of *your* child. They may be the expert in birth; you are the only one that knows your baby. Beyond that, the rest is up to what we would call God, or a Higher Power; some people call it Fate...whatever the belief system, we encourage our students to focus beyond the "how" of their birth story: - What will you learn from this birth journey? - Where will the transformation from Maiden to Mother happen for the woman? Where will the transformation from Stag to Father happen for the partner? - How will your partner disappoing you? How will they rise to the occassion, and maybe even surprise you? - What was your most brilliant moment? We look forward to sharing the information taught in Bradley
Method® classes with our students. We strive
to equip them with the tools they need to assess situations that present
themselves in pregnancy and labor. When we hear that a baby is born and nurses
readily at the breast, we know those parents worked together to achieve the
ultimate Bradley Method® outcome: Healthy Mom, Healthy Baby. What does "natural birth" mean to you? Disclaimer: The
material included on this site is for informational purposes only.
We are now enrolling for our Spring 2016 Series For more information or to register, please call us at 602-684-6567 or email us at |
Q&A with SPB: Midwifery Care
Posted on May 5, 2015 at 7:49 PM |
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Happy International Day of the Midwife to the midwives of the world. Facebook image - source: KNOW YOUR MIDWIFE We are so blessed with so many amazing midwives in our birth community. Here is a little more about why Sweet Pea Births advocates for midwifery care to be an available option to all birthing families: ~~~ Here is a little more about the different ways a health practioner can certify to become a midwife - excerpt from THIS article:
For a good explanation of the way a midwife is different from a doula read this excerpt from the bump:
In the Phoenix, Arizona area, home birth families have the choice of doing co-care with Certified Nurse Midwives in the hospital setting, and still maintaining the midwifery model of care. This allows for families to continue with "watchful waiting" and preserve their autonomy as consumers of healthcare. Why hire a midwife? "After controlling for a wide variety of social
and medical risk factors, the risk of experiencing an infant death was 19
percent lower for births attended by certified nurse midwives than for births
attended by physicians. The risk of neonatal mortality (an infant death
occurring in the first 28 days of life) was 33 percent lower, and the risk of
delivering a low birthweight infant was 31 percent lower. Mean birthweight was
37 grams heavier for the certified nurse midwife attended than for the
physician attended births. Low birthweight is a major predictor of infant
mortality, subsequent disease, or developmental disabilities. Certified nurse midwives attended a greater
proportion of women who are at higher risk for poor birth outcome: African
Americans, American Indians, teenagers, unmarried women, and those with less
than a high school education. Physicians attended a slightly higher proportion
of births with medical complications. However, birth outcomes for certified
nurse midwives were better even after sociodemographic and medical risk factors
were controlled for in statistical analyses." Excerpt from http://www.cdc.gov/nchs/pressroom/98news/midwife.htm For the study abstract, click HERE To read the study, click HERE Is homebirth safe?
There are several studies that have been conducted around the world that show midwifery is safe - find a reference list HERE. The big question remained: would outcomes be comparable in the US, where we do not practice socialized medicine? The MANA study found that:
Are you curious about midwifery care?? Here are some posts where we share our birth journey with midwives: Our Midwifery Care Experience - Second Trimester Midwives Make a House Call - Third Trimester Preparing for our Homebirth - Third Trimester Link List 1998 Midwifery Study http://www.cdc.gov/nchs/pressroom/98news/midwife.htm
http://jech.bmj.com/content/52/5/310.abstract?sid=52c15f2a-a71c-45d5-a827-c403cb953fa1
http://jech.bmj.com/content/52/5/310.full.pdf+html?sid=52c15f2a-a71c-45d5-a827-c403cb953fa1
MANA Homebirth Study http://mana.org/blog/home-birth-safety-outcomes
Homebirth Studies Reference Page http://mana.org/research/section-a-best-available-studies-grouped-by-design-level-of-evidence The material included in this blog and video is for informational
purposes only. It is not intended nor implied to be a substitute for
professional medical advice. The viewer should always consult her or his
healthcare provider to determine the appropriateness of the information for
their own situation. Krystyna and Bruss
Bowman and Bowman House, LLC accept no liability for the content of this site,
or for the consequences of any actions taken on the basis of the information provided. This blog and video contain information about
our classes available in Chandler, AZ and Payson, AZ and is not the official
website of The Bradley Method®. The views contained in this video and on our
blog do not necessarily reflect those of The Bradley Method® or the American
Academy of Husband-Coached Childbirth®. |
The Family-Centered Cesarean
Posted on April 30, 2015 at 9:40 AM |
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A "Family-Centered" cesarean? A "gentle" cesarean? A procedure that is Woman and MotherBaby-centered? What? Did you just read that correctly? Yes, you did. There is a "new" trend in cesareans that is hitting the mainstream consciousness here in the United States. While a lot of the focus during Cesarean Awareness Month tends to center on Vaginal Birth After Cesarean (VBAC), I also want to acknowledge that a VBAC is not the choice that all mothers want to make. Here is an option for mothers who know they want, or are considering, a repeat cesaran birth. It is also an option if a healthy, low-risk labor starts to change it's course and there is time for non-emergent cesarean. I have linked to THIS post about a "natural" cesaran more than once in previous posts, and today I want to be a little more specific about what a "natural" cesarean is and why a family might opt for this. To quote the article:
A family-centered, or natural cesarean strives to capture these components of a vaginal birth:
The idea of "seeding the microbiome" is a new concept. Here is a quote from THIS article:
And one from THIS article:
So while your initial reaction might be one of surprise and disgust, think about it. Please take a minute to read both of the excerpted articles and have a discussion with your partner and your care provider before you make up your mind one way or another. Here are some of the benefits that are causing mothers to request this kind of cesarean option:
If you would like to have a conversation with your care provider about planning for a gentle cesaean as your birth plan or "just in case" plan, HERE is a list of options for you to discuss with them, provided by ICAN of Phoenix chapter leader Jenni Froment. I also want to mention: these are evidence-based recommendations. If your care provider scoffs at you and laughs you out of the room, thank them very much for their time and go have a conversation with another provider in your area. Your local ICAN chapter or ICAN international are great resources for respectful, family-centered providers. What do you think? Please leave us a comment - it will be moderated and posted. *I think* that the amount of traffic you so generously generate has led to a lot of spam posting. In an effort to keep the spam to a minimum, I am taking the time to moderate comments now. Link List: http://www.youtube.com/watch?v=m5RIcaK98Yg ARTICLES ICAN http://blog.ican-online.org/2012/04/14/the-family-centered-cesarean/ MIDWIFE THINKING http://midwifethinking.com/2014/01/15/the-human-microbiome-considerations-for-pregnancy-birth-and-early-mothering/ MAMASEEDS http://mamaseeds.com/blog/antibiotics/how-seed-your-baby-healthy-microbiome-last-lifetime/ The material included on this site is for informational purposes only. It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult her or his healthcare provider to determine the appropriateness of the information for their own situation. Krystyna and Bruss Bowman and Bowman House, LLC accept no liability for the content of this site, or for the consequences of any actions taken on the basis of the information provided. This blog contains information about our classes available in Chandler, AZ and Payson, AZ and is not the official website of The Bradley Method®. The views contained on this blog do not necessarily reflect those of The Bradley Method® or the American Academy of Husband-Coached Childbirth®. |
Q&A with SPB: Healthy Pregnancy How-to
Posted on March 17, 2015 at 4:31 AM |
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Today's VLOG is all about the things that you *can* control in the very unplannable process of pregnancy, labor, birth and the childbearing year. LINKS What can you control? 1. Pay attention to your nutrition This is just as important for the father as it is for the mother. A better diet creates higher quality sperm, and a well-nourished mother can feed her growing embryo-fetus-baby as it develops from zygote stage through pregnancy. A breastfeeding mother is also growing her infant's brain - mindful nutrition is just as important after the Birth-Day. HERE is the pregnancy nutrition program that we teach in The Bradley Method®. 2. Engage in an exercise program Your ability to give birth does not hinge on whether or not you are an exercise fanatic before you conceive. A mother who wants to prepare her belly, back and bottom to give birth can follow a pregnancy-specific exercise program. Even doing a few minutes a day of this low-impact, low-stress program can be a game-changer for mamas and their overall strength as they go into their labor. My favorite resource is Rhondda Hartman's "Natural Childbirth Exercises". What can you influence? 1. Your experience You have the responsibility to choose the right care provider and the right birth setting for you. If you have a nagging feeling that persists, or if you see/hear/feel red flags at your prenatal appointments that your provider is not right for you, GO WITH IT. Believe in yourself and your instinct. Ask people you respect and who felt supported in their births who they chose and why...and then, maybe take a risk! Go on some interviews to see if maybe you want to make a switch. 2. Relaxation and Pain Coping We do not know what kind of labor card you are going to draw. What we do know is that all labors and births can benefit from mindfulness. Whether you have a natural birth, a cesarean birth, or anything in between, there is a surrender. There is a point when you will have to dig deep and say YES to the journey that you are on. There are many ways to prepare for your journey - HERE is an info sheet that explores the variety of classes available to birthing families. What is part of the journey? The rest of your story is entirely up to your baby, your body, and The Fates. A story is about to unfold - and what a story it will be. However you birth, that day is one day in the rest of your lives as a family. Be open to the experience, look for the joys, and also watch for the surprises. It is in the unexpected and the trials that growth and transformation happen...a transformation that is necessary as we experience a rite of passage. Before children, you are you. After they are in your lives, you are now Mother, Father, or which ever name you choose for yourself. I wish you a childbearing year that surprises you, grows you, and leads you to discover more about yourself than you knew when you started. The material included on this site is for informational purposes only. It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult her or his healthcare provider to determine the appropriateness of the information for their own situation. Krystyna and Bruss Bowman and Bowman House, LLC accept no liability for the content of this site, or for the consequences of any actions taken on the basis of the information provided. This blog contains information about our classes available in Chandler, AZ and Payson, AZ and is not the official website of The Bradley Method®. The views contained on this blog do not necessarily reflect those of The Bradley Method® or the American Academy of Husband-Coached Childbirth®. |
Birth Story: Baby P Born At Home
Posted on January 29, 2015 at 10:02 PM |
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We are thrilled and honored to share a very special birth story today. Our guest blogger, Cassandra is a newly minted mother of two - congratulations!! Today she shares the story of Baby P's arrival. It is the complete opposite of last week's marathon labor birth story. She and Baby P definitely had a different path! Baby P is baby #2 for our family; you can read my son’s home birth story from 2012 here on the blog. I have been blogging about certain aspects of my second pregnancy on Sweet Pea Families over the course of the last few months; fears, affirmations, newborn essentials, and most recently musings over my labor, what it would be like and who would be there. I had grand visions of a coming together of many women in the late afternoon or evening, laboring peacefully in the birth tub with plenty of laughter and wearing the cute new bra and panty set I purchased to look nice for the photographer that would be there. My daughter would definitely be born in the water since coincidentally her brother, even though we were in the tub, was born over the water. But, as it turns out (again!) babies decide things for themselves and we, as mothers are simply a vessel for whatever their life holds for them. My son was born at 43 weeks 3 days from my LMP. Dates were ambiguous due to irregular cycles and lack of ultrasounds, but with no vernix, long fingernails and an aging placenta at birth he was definitely a longer cooked baby. Going that far past my “due” date was definitely an emotional time: not knowing what to expect as a first time mom, worrying, comments from family/friends/strangers, etc. etc. Baby #2 was surprisingly conceived after my first cycle at 25 months postpartum. I got a positive pregnancy test on cycle day 30 and a twelve week and then twenty week ultrasound both matched up with my LMP due date. So, this time was different, we knew! It was always in my mind that maybe I just cooked babies a little slower than most but as the pregnancy progressed I didn't really think there was any way I was going to go past my due date. I was so cramp-y this time, so much more pressure down low, so much more active, I had a completely different lifestyle chasing an almost 3 year old every day than during my first pregnancy. But alas, my due date came and went and then a whole other week passed. At 41 weeks I was having doubts about the baby coming out any time soon and really just couldn’t believe I had gone so far again. At 41 weeks 1 day, a Monday, I was feeling good and talked with my midwife about just waiting it out another week and seeing what the weekend held. At 41 weeks 2 days, Tuesday, I was totally done being pregnant. My son and I had a great, exhausting day that day. We played at home, went grocery shopping, had a coffee and muffin date and met with a friend at the park to play in the sunshine for 3 whole hours. We came home and made dinner and he stayed up past his bedtime while my midwife came over for our weekly appointment. We chatted about the risks of the pregnancy progressing past 42 weeks, how we (my husband and I) each felt, what natural induction methods she likes to use and ultimately I decided I really just wanted a membrane sweep right then. I had one with my son that resulted in losing my mucus plug and then starting labor two days later and I was ready. It was the night of a super new moon and I finally felt at ease to try and do something (at this point we weren't employing any kind of help labor start tactics). If my baby and body weren’t ready I trusted that nothing would happen anyways and we would continue waiting. We were done with the sweep around 7PM with caution from my midwife that there could be spotting and cramps during the night, all totally normal and to try some nipple stimulation if I wanted. My son went to bed and my husband and I settled in on the couch for some Netflix while I hooked up to my breast pump for exactly ten minutes. We went to bed shortly after as we were both really tired from a long day and I fell asleep pretty quickly. I felt cramps on and off through the night in a very sleepy haze, my son slept horribly and was crying most of the night but thankfully my husband was comforting him and I spent most of the night able to drift in and out. I woke up at 6:40AM and had what felt like bad period cramps, sharp, painful cramps super low in my pelvis that went away very quickly. I wondered if I should still be having cramps 12 hours after the sweep (?) and hoped they would go away soon. I got up to go to the bathroom and brush my teeth and had lots of bowel movements. This used to happen to me every time I had period cramps so I wasn’t surprised; and afterwards laid back down to try and sleep some more until my son woke up. He was up a little bit after 7AM and I was still having the cramps so I text my husband around 7:15 and asked if he could come home for a little bit to be with our son until these cramps went away. I was fine in bed but T was asking for breakfast, etc. and I just felt icky and wanted to stay resting. He didn’t respond so T and I read books in bed and then looked at photos on my phone. Around 7:45 I was still having them so I called my husband (he hadn’t seen the texts) and asked him if he would just come home from work for a little bit. T and I stayed in bed cuddling, goofing off, laughing and watching videos of him on my phone. Around 8:30AM my husband finally walks in just as I was about to call him again, he had brought breakfast and I was so happy because I was starving! I used the opportunity to finally get up and go to the bathroom again and the cramps were still coming, fairly frequently and kind of radiating down and out into my pelvis. Definitely still cramps though, did not feel anything like a “contraction”. We decided to call the midwife as she emphasized calling her as soon as I suspected anything since my son was born fairly quickly after active labor began. I dialed her at 8:37AM and left a message. She instructed on her voicemail that if she didn’t call back in 15 minutes to call our other midwife. Right afterwards I text our photographer, she has a son that she needed to make arrangements for so I wanted to give her as big of a heads up as possible if there was any chance I was going to be in labor today. “Hi it’s Cassandra, I might be in labor today!” I told her about the sweep the night before and that I was just having cramps so I wasn’t sure and I had called my midwife but was just waiting to hear back and that I would keep her updated. After that I came out of the bathroom and tried to lean into our hallway wall during one of the cramps to see if that alleviated the pressure, it didn’t so I headed back to the bathroom. I was starting to think this was a membrane sweep gone horribly wrong and I had brought these insane cramps on myself and now who knew what was going to happen! I felt much better on the toilet. I would push down into the sides of the toilet seat during the cramps and kept having to pee or poo so it was better anyways. 15 minutes passed so I called our second midwife at 8:51AM. We talked for 8 minutes about what was happening (cramps, mucus tinged with blood, bowel movements) and I had two of the cramps while I was on the phone with her. She said she couldn’t tell I was having them and it sounded like early labor stuff and to try and lie down and rest between them, eat something and to let her know when they seemed to undergo a change. So I got off the toilet and lay down in bed and asked my husband to bring me some pancakes. I was still so hungry and so happy to be eating, I had two bites and then another cramp came and I immediately needed him to take the food away from me. I also did not want to be lying down. There was NO way I could rest; so back to the toilet I went. I listened to my husband and son playing a Frozen matching card game in the other room and was still trying to understand what might be happening to me. The cramps got stronger and I asked for a chair from the kitchen to put backwards in front of the toilet so I could drape my arms over the back and press into it during the cramps. At 9:17AM I had a cramp that left me shaking and immediately breaking out into sweat all over. This was intense! I text my midwife “Ok getting hot and sweaty and shaky. Can’t rest” and she responded she was on her way. There was also a lot of blood after that and I finally knew this was definitely labor. Midwife called at 9:21 while she was driving and I couldn’t even really talk to her. I text my photographer at 9:24 and said “Ok def in labor. Midwife coming over now, 15 mins away.” She wrote back that she would be over in about 15 or 20 minutes too! This was when I told my husband to start filling up our tub – it had been inflated and ready to go for weeks and he just needed to fit the cover on it and then add water. I had wanted to alert my friends from my blessingway when I was in labor and now that midwives and photographer were out of the way I could finally let them know. I sent out a text to everyone in the group at 9:27AM that said “Baby’s coming, send love – need it already <3” I remember trying to make sure that I included everyone and that I was trying to count the names and count the girls in attendance and it was hard for me to concentrate, but I did get everyone! The responses were just starting to come in when my midwife walked in about 9:30AM. Just before then I was starting to get worried about continuing to do this on my own as my husband was tending to the tub and playing with our son so I was really happy to see her. She asked if I was pushing and I was kind of caught off guard, pushing!? No way, what? I was definitely not pushing! Then another wave came and AH! There was a head! I was pushing!? I half yelled out that I was pushing and she asked if I could feel the baby’s head. I said no but then I barely reached up and the head was right there. She told me I needed to get off the toilet, which was seriously the last thing I wanted to do. She helped me down onto the birth stool where I tried to sit and then hold myself up against her but it was really unstable and I needed to get down. This entire time I could feel baby’s head right there. When I got off the stool I felt her head kind of suck back up a little and wasn’t sure where I was going or what I was doing but I heard hands and knees and I just kind of fell onto the floor in that position, head facing the corner, butt facing the doorway. This all happened in a couple of minutes and soon our photographer, Kirsten, walked in. She was greeted in the bathroom doorway to my bum and then a little bit of baby’s head starting to come out. On the next push I moaned out so loud and low, it didn’t even really sound like me, I think this was the first noise I made the entire time. I was proud of myself that it was loud and low and not high pitched screaming (like I was with T). I knew I had to keep it that way and gosh the burning, ah! I literally just gave way to the burning, told myself it was happening and just feel it, don’t fight it and then her head was out! I said I wanted the rest of her out, just get her out! but I knew that wasn’t what I really wanted. Tearing so badly again was one of my biggest fears around labor and I knew this was the moment. My midwife told me to pant and I tried but couldn’t really so I started just breathing shortly and blowing raspberries, I could do that and it calmed me down and gave me something to focus on while I just stayed in hands and knees with her head out. I heard my husband say something like oh my gosh eyes! A little nose and mouth, awww! I kept up my breathing/blowing and then all of a sudden her body was out! She handed her to me and I sat back on the bathroom floor and held her, it was 9:51AM. Not even an hour and a half from when my husband walked in the door with breakfast and our baby was here, so mind blowing. I felt fantastic. I had so many emotions rush me all at once and I felt energized and ecstatic and it will definitely be engrained in my mind as one of the best moments of my life. I got up and walked to the other room to lie down in bed and seriously just could not believe how great I felt. T was right there in the doorway watching the entire time and once I got settled in bed he climbed right up to touch and kiss his new baby sister. Needless to say the tub was not filled up enough for me to get in it once I had to get off the toilet and the pictures are not going to be anything like I had imagined. I did not get to diffuse my Serenity blend or light my beeswax candles or stare at the affirmation wall I had created in the bedroom, but I wouldn’t change anything about it. So intense, but so quick and so perfect. It was a beautiful sunny day and after everything was cleaned up we all hung out in bed as a family of four watching movies, reading books and playing games and I couldn’t have even imagined the amount of bliss I felt. I learned so much from baby P’s birth, there was not a single sensation that felt the same as my last labor and birth. Again, mind blowing. It was a great reminder to throw out any and all expectations I may have surrounding this little girl and being her mama, as we truly are never in control. Congratulations, Cassandra, Eric, and new big brother T !! Please leave us a comment - it will be moderated and
posted. The material included on this site is for informational purposes only. It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult her or his healthcare provider to determine the appropriateness of the information for their own situation. Krystyna and Bruss Bowman and Bowman House, LLC accept no liability for the content of this site, or for the consequences of any actions taken on the basis of the information provided. This blog contains information about our classes available in Chandler, AZ and Payson, AZ and is not the official website of The Bradley Method®. The views contained on this blog do not necessarily reflect those of The Bradley Method® or the American Academy of Husband-Coached Childbirth®. |
Labor Tools: Water
Posted on April 15, 2014 at 11:06 AM |
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