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Sweet Pea Births

Chandler, Arizona

Sweet Pea Births

...celebrating every swee​t pea their birth

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Meet the Doula: Kelly Sunshine

Posted on August 8, 2016 at 5:49 PM Comments comments (0)
This month's featured doula is Kelly Sunshine, of Sunshine Doula Services.  We have had the pleasure of being vendors together at several different local birth events. It is our pleasure to introduce you to her this month in our Meet The Doula feature.

 
When was the first time you heard the word, “doula”?
I don’t remember the first time I actually heard the word, however, as my sister-in-laws and friends were having kids I would always go be with them while they were in labor and help them. I had already had a few of my kids so they thought I would be helpful. I was essentially being a doula without realizing it. Then one day a little over 5 years ago, I meet a gal who was a doula and the dots all connected for me. I remember thinking how I wish I would have had a doula with me at my 4 births.
 
How did you decide that becoming a doula was part of your journey?
I’ve had a passion for labor and delivery for years. I contemplated getting my nursing degree at one point. But the more I thought about it I realized I really enjoy helping moms through the entire birth process and building relationships. I had heard about doulaing before. Then about 5 years ago I met a gal who had been a doula for a few years and I learned a lot more about the profession. At that moment I knew that was exactly what my heart had been wanting to do. My husband, who saw my enthusiasm, strongly encouraged me to “do it”. Before I even had a chance to make a decision, he had already enrolled me in a doula certification training that was happening in Phoenix 2 weeks later. I’ve never looked back since then.
 
Are you a birth and/or a postpartum doula?
Birth.
 
How long have you been a doula?
I have been a doula for almost 5 years. I am DONA Certified. I have been fortunate to have a very active career and have been blessed to work with over 350 families since I started.
 
What do you enjoy the most about being a doula?
So many moms have a vision of what an ideal birth would be like. I like to help them develop the confidence to trust in their bodies and themselves. There is nothing more rewarding than to support a mama and for her to realize how strong and awesome she really is. I also truly love the relationships I form with the couples.
 
What is your philosophy when you go to a birth space?
Empowering moms with the philosophy of, “its their agenda not mine”; and using my skills to create an optimalenvironment that they envisioned. Also helping them stay on course with their plan even when they don’t think they can do it anymore.
 
How do you work with and involve the birth partner?
This is very important to me. I am not there to take their place but to work together to help support the mom.  I adjust my involvement based on how comfortable their coach is and how involved the coach wants to be. If I see they are feeling uncomfortable or nervous I show them things they can do to support the mom. Once they get a little confidence then they step up and want to do more. It really cool to watch.
 
What is the toughest situation you have ever dealt with?  How did you handle it?
Believe it or not the mamas are pretty easy to deal with. By the time we get to a birth we’ve made a pretty strong connection and I generally know what they need. As soon as you bring the extended families in, not the daddy’s or partners, it can sometimes get challenging. My most notable situation was with very vocal and disruptive family members in the room. They were creating a lot of tension and drama and I could see it was upsetting the mom. In fact, despite her requesting them to leave the room they simply weren’t respecting her.
 
I stepped in and with kind firmness asked them to step outside into the waiting area. I explained that I wanted to take some time to help the her get more comfortable and focused. They understood and spent the rest of the birth in the waiting area. 
 
What keeps you working as a doula?
I suppose the best way I can describe it is that being a doula is in my blood. I just love it. It’s challenging work. It keeps me on my toes. Every birth has its own unique dynamic. And I guess I am pretty good at it. Perhaps it’s my gifting and a way of serving the world.
 
What does your fee cover – how many visits or hours?  Is there a different charge for a shorter labor or longer labor?
My fee covers a prenatal visit which generally last an hour to 90 minutes. It also includes unlimited pre-birth support by phone, email and text leading up to labor. Obviously I am with the family from the beginning of active labor through approximately a couple hours after birth to help the mom and baby get comfortable, and establish nursing if that is their desire.
 
I also take photos of the entire labor, birth and after.  I provide the family with the edited digital copies, as well as a printed 4x6 set. I also write the family a birth story and then meet them for a postpartum visit as well. My fee is the same regardless of the length of the labor.
 
Do you offer any other services to your clients?
Yes. I do placenta encapsulation and have processed over 650 placentas. I also have some other pre- and post-birth products that are designed to help moms prepare for labor and heal following the birth.
 
Just for fun, what do you do when you are not doula-ing?
Well being a doula occupies a good portion of my life. When I am not doulaing, I love to travel with my husband and do family vacations with our four kids. We entertain at our home frequently with family and friends, which I love to do!


 
Would you like to Connect with our featured doula?  Here is her contact information:
Kelly Sunshine
602-410-5968
 
Find Kelly on social media HERE and on Instagram HERE


Disclaimer:
The material included in this blog 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 and related videos 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®.
 
  Bradley Method® natural childbirth classes offered in Arizona: convenient to Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale, Payson


 

 

Q&A with SPB: What do I bring to the hospital?

Posted on June 22, 2016 at 9:38 AM Comments comments (0)



What do I need to bring with me to the hospital?
 
This is one of the topics we cover briefly in our classes.  The short answer is: Anything you would regret leaving behind…
 
As one dad in our last class said, “I was picturing a small duffle bag, now it seems like we are going to be packing suitcases!!”
 
Whatever size your bag ends up being really depends on what it’s going to take for the mother to feel safe and secure in her birth space. One of the many benefits of homebirth is that “all the comforts of home” are built in!
 
The degree to which the mother wants to re-create the home environment in her birth space will determine how much you are bringing with you to a birth space outside of the home.
 
The bare minimum of what you will be packing:
 
Mom:
  • Clothing to labor in if you will forgo the hospital gown
  • Nursing bra (Click HERE to read about buying nursing bras)
  • Clothing to go home in – plan to wear the size of clothing you were wearing around 6 months into your pregnancy.
  • Toiletries
  • Any daily medication
  • Phone Charger
 
Partner:
  • Change of clothing
  • Toiletries
  • Breath Mints
  • Swim Trunks
  • Two pairs of shoes/socks
  • Phone charger
 
Baby:
  • An outfit for hospital pictures
  • An outfit to wear home (may be the same as picture outfit)
  • Car seat
 
It was our experience that the hospital will provide diapers, blankets to swaddle and to be used as burp cloths, and other miscellaneous baby items (shampoo, lotion, etc.). If you want to go organic from the start, plan to bring your own.
 
 
The bags get bigger when the mother wants to bring flameless candles, music player and speakers, her own blankets, her own pillows, pictures, affirmation cards and/or signs, camera and camera bag, her own birth ball, a yoga mat…I won’t confess to taking all of these with me to our hospital births…about 80% of this list did get carried in to the hospital by my amazing husband. He really is an angel when it comes to supporting me in labor!!
 
The last idea I mention in reference to making the birth space “like home” are family heirlooms. If there is anything special from your family history that you want in your birth space, I encourage you to take a picture of it, print it at a minimum of 5”x7” format, and bring the picture with you.  You do not want to bring anything that you could not stand to lose. 
 
While you will probably be left alone for most of your labor, save for hourly check-ins by your nurse, once it’s baby-time, the whole room is going to fill up with people and activity: your nurse, your care provider, an assistant nurse, the baby nurse, maybe a student or two…it gets crazy.  And since it is still standard practice for you to be moved to a recovery room within 2-3 hours of the birth, there is a lot of opportunity for things to get left behind or lost in the shuffle. Other possibilities for misplacement happen with things accidently get swept into the garbage or laundry bin as soiled items are replaced with clean items; or in what I hope are rare instances, they fall victim to sticky fingers.
 
The fact remains that even when I packed everything that I thought I wanted, we used maybe 30% of what I packed. I wouldn’t change how or what I would suggest people pack, because having those things available gave me peace of mind that I was prepared for the “just in case” scenarios that were playing out in my head.
 
I would love to hear from you: did I forget anything in the essentials list? What else did you bring from the “extras” list?
 

 Disclaimer: 

The material included in this video and blog is for informational purposes only. It is not intended nor implied to be a substitute for professional medical advice. The viewer and/or 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 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®.

Bradley Method® natural childbirth classes offered in Arizona: convenient to Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale, Payson
 

Uterine Rupture: Assessing the Risks

Posted on April 26, 2016 at 10:18 AM Comments comments (0)
Uterine Rupture: Assessing the RisksThis was in posted April 2012 - updated April 2016
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®.    

Bradley Method classes offered in Arizona: convenient to Chandler, Tempe, Mesa, Gilbert, Ahwatukee, Scottsdale, Phoenix and Payson, Arizona



In Their Own Words: Isla's Birth Story

Posted on April 8, 2016 at 8:03 AM Comments comments (0)
April is Cesarean Awareness Month.  As such, the blog topics this month will focus around cesarean birth journeys, and options that cesarean birth warriors have for subsequent pregnancies.  

I am pleased to open this month's In Their Own Words series with a share from a friend of ours from Texas.  Her story is shared with permission from her blog, The Carey Haus, Here is the story of their second daughter's birth.


Isla's birth story
Upon finding out we were expecting, I had a tough decision to make. Since I had a [cesarean birth] with Sadie, I had to decide if I wanted to try for a VBAC (vaginal birth after cesarean) or to opt for a repeat [cesarean birth]. I went back and forth for a good 8 months before finally deciding that I was more comfortable with a repeat [cesarean birth]. 

Yes, it is major surgery, but I liked knowing there would be less variables and I could have a little more control. (Can you say type A???) This turned out to be a good decision because my blood pressure started to creep up around the 35-36 week mark. We knew going into it that this would be a possibility, as I had severe pregnancy induced hypertension with Sadie.

We had originally scheduled a repeat [cesarean birth] for my EDD, which was 11-25. When the blood pressure started rising we moved it to 11-18. This was not good as Adam was in the midst of a crazy school schedule. We tried to move it to Friday the 20, but the Dr could not find anyone to operate with her. We wound up moving it to Tuesday the 24 and agreed to keep a very close eye on my blood pressure. The 16 the Dr went ahead and put me off work to keep me lying around the house. Thursday my friend Dory came in to hang out for a couple days before the baby would arrive. Well, my blood pressure started getting really high on my readings at home and the Dr had said I needed to call her if it was not going down. Friday morning the 20 I went in for them to check it. I was 39 weeks and 2 days at this point, so already 9 days further than when I delivered Sadie. 

The Dr decided that based on the reading we would be moving the delivery to the following day, Saturday, November 21. It was a very surreal feeling being told that the next day I would be having a baby. We knew all along that was a very real possibility, but hearing the words made it that much more real. It took me right back to the moment when my Dr with Sadie told us we would be having a baby later that day. My Dr told me to be at the hospital at 7am and we would plan on going into the OR at 9:15. I left and called Adam to let him know that the next day we would have a baby. 

The rest of Friday I had to lay low to keep my blood pressure from skyrocketing so Dory and I watched movies until it was time to get Sadie from school. I had promised Sadie that before her sister arrived we would go get a pedicure, so when Dory and I picked her up from school we went straight to do that. She was so excited that she would be meeting her sister the next day! 

That night I finished packing our bags and went to bed around 10. I slept well, surprisingly. We got up and got everything loaded in the car. It worked out so well that Dory wound up being there still since she was able to watch Sadie while we had the baby. Dory and Sadie followed to the hospital so they could see where to go and get the stickers that would allow them in the room to visit me later on. 

I had asked my photographer friend, Cally, to be there to photograph the birth. She met us in the lobby and took some very sweet photos of Sadie hugging on my belly and kissing me goodbye. I should have them from her in the next few days. What sweet moments to have captured! We said bye to Dory and Sadie and headed up to labor and delivery. EEK!
We got to labor and delivery and I changed into my hospital gown. 

They then allowed Adam and Cally to come in. They went through 50 million questions and started my I.V. The I.V. was probably the worst part, as the first attempt did not take and she kept digging around. It was awful. The other nurse came and got one started in my other arm. I had a couple bags of fluid, which made me sooo cold! They gave me some blankets and I tried to just relax. The Dr came in and said hello and we calmly chatted. She has the most relaxed personality ever, which is nice when you are about to be cut open! Soon after, the anesthesiologist came in to chat as well. I was very hopeful that they would allow me to have my husband AND Cally in the OR, but that was a no go. They did however agree to allow them to swap places halfway through-yay! Cally set my camera up for a nurse and showed her how to use it so that we could have some photos before they allowed her in. The photos actually came out great!

Anyway, right around 9:15 they had me climb in a wheelchair and we made our way to the OR. Let me tell you, it is the most surreal feeling walking into a freezing cold operating room knowing you are about to have surgery, let alone have a BABY! It really hit me that we were having a baby when I walked in there and saw all the equipment to take care of her. I told the CRNA [Certified Registered Nurse Anesthetist] that I wanted to change my mind and not do it! Ha! He was very sweet and reassuring that all would be ok.

I got situated on the table and the CRNA had me lean over a pillow into a nurse while he started my spinal block. It did not hurt when I had it with Sadie, but this time it hurt for a few seconds on the right side of my back, but went away pretty quickly. They got me situated on the table and then the rest of the surgery team started coming in. Luckily there is something in the spinal that relaxes you and warms you up, because I began to feel a little calmer. Everyone got prepped and they did a little test to make sure I was numb. I was, so they got started. 

It seemed like it took FOREVER for them to get to the baby. I kept asking Adam if they were close. Finally they said it was time and I would feel a lot of pulling and pressure. Boy did I! It was intense. It was not long and she was out! At 10:00am on the dot she was here! She cried right away, which is the best feeling ever. The Dr lifted her up over the curtain for me to see and the nurse captured some great photos of that moment! I feel like the image shows that a c-section is just as beautiful as a natural birth. The smile on my face is priceless.


Cesarean Awareness Month - Cesarean Birth Story http://thecareyhaus.blogspot.com/2015/12/islas-birth-story.html?m=0
They started getting Isla all cleaned up and Adam swapped places with Cally. They brought Isla over to me to see and cuddle, but it is hard to hold a baby when you are laying down flat, even with a nurse helping. I told them to go ahead and take her out to my husband. Cally followed them out and I am sure got some great photos of that time. The CRNA told me he was giving me something in my IV to relax me and that it might make me sleepy. It did relax me and I was a tad sleepy, but too excited to go to sleep. I talked to the Dr while she put me back together. It was a very relaxed environment.

Once they finished stitching me up, they wheeled me into the recovery room where I immediately got to do skin to skin and start nursing Isla. This was SUCH a different experience from Sadie, as I was not stable enough to be with her in recovery. Isla took to nursing right away and it made being in the recovery room so great. I shook quite a bit in recovery, but I don’t think nearly as much as with Sadie. The spinal started to wear off so I asked for some pain meds. Whatever they gave me did not work great, but I was ok since I had the distraction of a new baby! After about an hour or so they cleared us to go to my room. We called Dory and told her to head on up to the hospital with Sadie.

We got to the room, which was so pretty and spa like for a hospital! Sadie and Dory arrived right after we got settled. It was so sweet introducing Sadie to her new sister. She did not want to hold her right away, but was certainly in awe. I think it was an hour or so later that she asked to hold her. They hung out for a bit and then Dory took Sadie home. Adam and I relaxed with Isla for an hour or two and then Adam headed home to get Sadie ready to spend the night at her friend Molly’s house. Isla and I enjoyed skin to skin for the rest of the day. It was the sweetest time ever. Adam got Sadie situated at Molly’s house and then came back so he could spend the first night with me. Isla and I stayed in the hospital for 3 nights. It was the best time, believe it or not. I never once turned the tv on. I just enjoyed the peace and quiet. It was such special bonding time with my baby. It was also very healing for me to have a better recovery this go round.

I finally was discharged Tuesday and sent home on blood pressure medicine. It seemed like I would escape the post partum hypertension this time, but it started going up while I was still in the hospital. I was glad we caught it before going home, and am confident that it will correct itself in time.
The time at home has been tiring, but wonderful. We kindly asked for some time before we were ready for visitors and I am thankful for that. It has been the most wonderful time to bond and establish nursing privately. I can honestly say that this time has been the best experience. We are so in love with sweet Isla and cannot imagine our family without her.

Cesarean Awareness Month - Cesarean Birth Story - http://callynthphotography.com/

Thank you, Marissa, for sharing your family's birth story.  It so important to honor all birth journeys, for they transform us into the mothers and fathers that we are.

If you would like to share your birth story this month, please email it to me, along with a statement that I have permission to share your story on social media. You can email it to me at krystyna{at}sweetpeabirths{dot}com.


Disclaimer: 
The material included in this 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®.
 
Bradley Method® natural childbirth classes offered in Arizona: convenient to Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale, Payson


To Eat or Not To Eat…

Posted on November 5, 2015 at 8:07 AM Comments comments (4)
To eat or not to eat…That was the question for families planning a hospital birth.  When you are laboring at home or a birth center, you have the freedom to eat as your appetite dictates.  If you choose to have a hospital birth, you are at the mercy of your doctor’s orders and the nurse’s interpretation of the hospital protocol.  

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):

"Most healthy women can skip the fasting and, in fact, would benefit from eating a light meal during labor, suggests research being presented at the ANESTHESIOLOGY® 2015 annual meeting. Improvements in anesthesia care have made pain control during labor safer, reducing risks related to eating, researchers note."
ASA Press Release, "Most healthy women would benefit from light meal during labor", October 24, 2015

For other reading,  HERE is some research I had found before this 2015 press release to make the case for eating and drinking in labor (in case you want to do more poking around the subject).

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.

Science and the ASA catch up to Dr. Bradley:
"The research suggests that the energy and caloric demands of laboring women are similar to those of marathon runners, Harty said. Without adequate nutrition, women’s bodies will begin to use fat as an energy source, increasing acidity of the blood in the mother and infant, potentially reducing uterine contractions and leading to longer labor and lower health scores in newborns. Additionally, the studies suggest that fasting can cause emotional stress, potentially moving blood away from the uterus and placenta, lengthening labor and contributing to distress of the fetus."  

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]

From the press release:
"Researchers said aspiration today is almost nonexistent, especially in healthy patients. In the United States, there was only one case of aspiration associated with labor and delivery between 2005 and 2013, involving a complicated case of a woman who was obese and had pre-eclampsia (a precursor to eclampsia, or high blood pressure that can lead to seizures), according to the American Society of Anesthesiology’s Closed Claims Project database. Researchers also noted that no cases of death due to aspiration were reported in the United Kingdom between 2000 and 2005, compared to 1.5 cases per 1,000 during the 1940s. They say this is likely due to advances in anesthesia care, including increased use of epidurals and spinal blocks in place of providing anesthesia through a mask over the nose and mouth. Before these improvements, women were more likely to need a tube placed in the windpipe for breathing, which potentially increased the risk of aspiration." 

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!!

What the ASA recommends:
"A light meal could include fruit, light soups, toast, light sandwiches (no large slices of meat), juice and water. Most women lose their appetites during very active labor, but can continue to drink fluids such as water and clear juices, researchers said." 

- Honey sticks.  According to honey.com, “Honey is also a rich source of carbohydrates, providing 17 grams per tablespoon, which makes it ideal for your working muscles since carbohydrates are the primary fuel the body uses for energy. Carbohydrates are necessary in the diet to help maintain muscle glycogen, also known as stored carbohydrates, which are the most important fuel source for athletes to help them keep going.” [2]

- Trail mix.  You get the nice variety of nuts, dried fruits and if you want, candy, in one bag.  I found myself picking out my favorite nuts and fruits and snacking on them – literally one or two at a time – as we got into the active phase of first stage labor.

- Protein bars or chews.  Look for bars that are low in carbs and added sugars –the key is to provide an energy boost without an energy crash afterwards. We have had students that use the “PowerBar” brand Energy Bites, as well as Gel Blasts that are bite size energy foods.

- 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.

- Popsicles.  While working hard in labor, a popsicle can be refreshing.  To prevent an energy crash, look for a brand that uses natural fruit as a sweetener instead of added sugars.  Added bonus: you can also push it against the top of your palate to stimulate oxytocin production.

- Applesauce cups.  Provide potassium along with a little protein.  The nice thing about applesauce is that while some people prefer them cold, they don’t need to be refrigerated.  Again, look for naturally rather than artificially sweetened sauces.

- 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.



- Soup or clear broth.  Campbell’s came out with the “Soup at Hand Cups” that are single serve, portable and microwaveable.  They were a God-send during our third birth.  The nurse didn’t want me to eat “just in case”, but she was okay with me drinking – hence, I could drink my meal and stay nourished through our 34 hours at the hospital.

- 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:
Bradley Method classes offered in Arizona convenient to Chandler, Tempe, Gilbert, Mesa, Ahwatukee, Scottsdale, Phoenix and Payson, AZThe 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®.

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 Comments comments (0)
I am going to direct you to THIS article about how oxytocin helps to reduce stress and promote peace.  It's no surprise that oxytocin is the same hormone that is released when we make love, arguably a great stress reliever and a promoter of peace for couples.  A lovely consequence of making love when the timing is right: welcome, baby, some 36+ weeks later!

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, PaysonBreastfeeding:  If you have an older sibling who is nursing, you can nurse them during labor.  Nursing stimulates the production of oxytocin, so I encourage you to be mindful of any contractions it stimulates.  You do not want to trigger an early labor, so pay attention if you feel a pattern developing and it’s not time for baby to make an appearance just yet.



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, PaysonTouch: one of the cornerstones of The Bradley Method® is relaxation.  Among the 11 specific relaxation techniques that we teach during the course, two of them are massage and stroking.  Even if a mother does not want to be spoken to, a Coach can use those techniques.  If she doesn’t want that either, the simple act of holding her hand is listed as a way to boost oxytocin.


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, PaysonDaydream:  Another relaxation technique we teach is related to daydreaming.  We ask coaches to recount a past experience or a future dream that makes mother feel like she is in her “happy place”.  It might be a trip, an experience, dreams you have about your life as a family together...anything that is calming, encouraging and would elicit a smile.


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.



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, PaysonPleasant smells:  This one has the added benefit of paying dividends at your birthplace.  One of the suggestions we make in Bradley™ class is to eat your favorite meal when you think you might be in labor.  The other one is baking some yummy treats to share with your care providers.  Hopefully both of those things will generate smells that you welcome in labor.  Either way: you are producing oxytocin, mama is well fed if it’s the beginning to have energy for the duration of labor, and your care providers get treats.  We found that feeding them kept them happy and that always made for positive birth experiences for us.


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, PaysonMusic:  Mamas or Coaches can take the time to generate a play list to use in their birth space.  I have seen couples use a music app to choose the music for them in labor – it saved them from the planning/organizing time at the outset while still providing the music that was soothing to mama.  Find something that works for you and remember to put it on your packing list so the music makes it to your birth space. 
P.S. Doula and Music Therapist Laura Pruett offers playlist creation as a stand-alone service or as part of her doula service.


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:
Bradley Method® natural childbirth classes offered in Arizona: Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale, PaysonThe 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®.

Patient Rights

Posted on September 25, 2015 at 9:39 AM Comments comments (3)
Thank you to one of my colleagues, Rachel Davis, for suggesting this topic.  

I originally shared this after one of our couples had an unplanned unassisted birth couple encountered in the hospital, and they were not treated very kindly upon arriving or throughout their hospital stay.
 
Most people would not expect their baby to be born at 35 weeks.  In addition, they had not counted on dealing with hospital protocols since they had planned a homebirth.  The other situation they hadn’t planned on was giving birth away from their community.   They were familiar with their local hospital in northern Arizona - it was beyond their imagination that they would spend their first week of their child's life having to deal with a major hospital in central Phoenix.
 
Their situation underscores the importance of having a well-thought out and written birth plan no matter what kind of birthplace you have chosen.  Wherever you are planning to give birth, Bruss and I suggest that you think about writing two birth plans.  Write one for a normal, uncomplicated birth at your chosen birth place. Also consider writing one that has your wishes written down in the event of complications, and that factors in hospital care if you are planning to birth at home or birth center..  Once you have talked these out between yourselves and your care providers, write them down and have a copy handy at all times.
 
You just never know how the birth journey will unfold…in the event of unforeseen circumstances, your birth plan can act as a compass for your decisions.  It can also remind you of the decisions you made when you took the time to research your options and when you were not under pressure.  You can then evaluate the current situation with a little less emotion and a little more reason.

There are two sections to this post.  First, I highlight the main points of your rights as a patient in the hospital. I encourage you to remember that you are the CONSUMER of health care, not a helpless being at the mercy of the staff.  The second section reviews some basics of informed consent so that you have an idea of how to receive the right care for you after asking questions that other people have found helpful to gather complete information before accepting or declining treatment.
 
PATIENT RIGHTS
For a full Pregnant Patient and Obstetric Patient Bill of Rights, I am going to refer you to a link on Doris Haire’s Alliance for the Improvement of Maternity Services (AIMS):
http://www.aimsusa.org/ppbr.htm
 
One of the reasons so many of us feel pressured to make choices against our instinct or desire for as natural experience as possible is that sometimes information is relayed in such a way that implies that you are a bad parent if you deny treatment to your child, or they imply that by not choosing something you could harm your child.  How many parents are strong enough to follow their instinct with pressures like time, fatigue and shock also factoring into the situation?
 
Whether you are planning to give birth at home, in a birth center, or a hospital, I encourage all pregnant mothers and their coaches to become familiar with the AIMS Pregnant Patient Bill of Rights in the event that you end up in a hospital for whatever reason.  I suggest that you print out the American Hospital Association's "Patient's Bill of Rights," (http://www.patienttalk.info/AHA-Patient_Bill_of_Rights.htm)  as well as the AIMS Pregnant Patient Bill of Rights and bring them both with you in the event of a hospital visit during your pregnancy and labor.

I will summarize some of the points here and encourage parents everywhere, that pregnant or not, if you are in a hospital, there is very little that you can be forced to do or take for yourself or your child.  You have every right to ask and be told the benefits and the risk of EVERYTHING they recommend as treatment, and you have the right to refuse.

These are what I chose to pull our from both of the Bill of Rights documents as your rights as a pregnant and an obstetric patient:
- to considerate and respectful care.
- to obtain from physicians and other direct caregivers relevant, current, and understandable information concerning diagnosis, treatment, and prognosis. 
- to ask and be informed of the existence of business relationships among the hospital, educational institutions, other health care providers, or payers that may influence the patient's treatment and care.
- to make decisions about the plan of care prior to and during the course of treatment and to refuse a recommended treatment or plan of care to the extent permitted by law and hospital policy and to be informed of the medical consequences of this action.
- to be informed of any potential direct or indirect effects, risks or hazards to herself or her unborn or newborn infant which may result from the use of a drug or procedure prescribed for or administered to her during pregnancy, labor, birth or lactation.
- to be informed, not only of the benefits, risks and hazards of the proposed therapy but also of known alternative therapy.
- to be informed about how a drug or procedure may adversely affect her unborn baby, directly or indirectly, and that there is no drug or chemical which has been proven safe for the unborn child.
- if Cesarean birth is anticipated, to be informed that minimizing her intake of nonessential pre-operative medicine will benefit her baby.
- to be informed of the areas of uncertainty if there is NO properly controlled follow-up research which has established the safety of the drug or procedure with regard to its effect on the fetus and the later physiological, mental and neurological development of the child.
- to be informed of the brand name and generic name of the drug in order that she may advise the health professional of any past adverse reaction to the drug.
- to determine for herself, without pressure from her attendant, whether she will or will not accept the risks inherent in the proposed treatment.
- to know the name and qualifications of the individual administering a drug or procedure to her during labor or birth.
- to be informed whether that procedure is being administered to her because a) it is medically indicated, b) it is an elective procedure (for convenience, c) or for teaching purposes or research).
- to have her baby cared for at her bedside if her baby is normal, and to feed her baby according to her baby's needs rather than according to the hospital regimen.
- to be informed if there is any known or indicated aspect of her or her baby's care or condition which may cause her or her baby later difficulty or problems.
 
INFORMED CONSENT
What is informed consent?  According to Doris Haire:
 "Most courts consider that the patient is 'informed' if the following information is given:
•    The processes contemplated by the physician as treatment, including whether the treatment is new or unusual.
•    The risks and hazards of the treatment,
•    The chances for recovery after treatment.
•    The necessity of the treatment.
•    The feasibility of alternative methods of treatment.”

You can ascertain this information by asking questions.  For a more comprehensive look at positive communications and informed consent, refer to page 55 of The Bradley Method® Student Workbook.
 
I suggest that you start with questions that establish how the mother and the baby are doing.  Always use names to remind the care providers that they are making recommendations for another human being, not an ambiguous test case:

  • “How is (Mother’s Name) doing?  Are her vitals still within an acceptable range?”
  • “How is (Baby’s Name) doing?  Are his or her vitals still within an acceptable range?”
  • “Do we have to make a decision right now?  How much time do we have?”

 
If both are well enough and there is time, then you can continue with questions such as:

  • “What is the problem?”
  • “What are the symptoms or test results causing concern?”
  • “Could this be normal?”
  • “What is the most likely cause?  Are there any other possible causes?”

 
If the care provider agrees that Mother and Baby are well enough to let labor proceed and let nature take her course, continue to trust that Mother and Baby are working together and that you will be meeting your baby in due course.  You can address other probable causes – is mom hydrated?  Is she emotionally ready and relaxed enough to accept her labor?  Are you using the best positions in the appropriate stage of labor to allow gravity and physiology to move things along?
 
If after asking this series of questions Mother and Coach decide that further action is worth exploring, then you can continue with these questions:

  • Paraphrase it back to ensure you understand what the recommendation is.


  •  You want to listen well, and paraphrase again.  You can also ask if their opinion is based on fact or observation.


  • Ask to see the insert if it is a drug and there is time to read it – you may be surprised at what is in the fine print and the care provider fail to mention.


  • Side effects are very important to know, especially if it is something whose short-term or long-term effects on an unborn child or a newborn are unknown.


  • Again, care providers have routines based on what their protocol is – sometimes there are other options that they don’t mention, not from malice, it could be simply because they are not accustomed to being asked for alternatives.


  • Who are you talking to?  Nurses come in many varieties: a student nurse, an LPN (one year of schooling), an ASN nurse (two years of schooling), a BSN (four years of schooling).  Beyond that, how long have they been working as a nurse?  If you are talking to a doctor: are they a resident (student) doctor, or an attending (more experienced) physician?  How long have they been a resident or an attending? 


  • Knowing the level of experience of the information giver is an especially important question to ask if you are in a teaching hospital.  Every family needs to make a decision regarding their comfort level with students literally practicing on you based on their individual preferences.  On a personal note, while I am all for medical students learning, when it come to my body and our child, I want a trained and experienced professional to work on us.  I am okay if a student wants to observe, however, only someone with extensive experience and knowledge is going “to do” something or administer something to us.


  • In the interest of full disclosure, here are other very important questions:  1.) You want to know how they will measure the efficacy of the intervention.  2.) When you accept one medical intervention, it is likely that other interventions or compromises will follow.  If there is time, you want to hear all of the other interventions or protocol they will have to follow that may be a result of the first intervention you agree to have. 


  • Back to full disclosure – there are ways to phrase things that force you to make an immediate decision.  If you ask "how will you know it's working, and what happens next" questions, it provides the opportunity for the care provider to tell you the other side of the story, or the whole story in regards to their recommendations.

 
One of the reasons it is so important to take care when choosing your care providers and medical facilities is that sometimes there isn’t time to ask all these questions.  If Mother and Baby are already compromised and there is no time to ask questions, you must trust that the care providers and the birthplace will do the best for your family.  Do you have this level of trust with your care provider?  Do you have this level or trust with the birthplace?  If you answered “no” to either of these questions, it’s time to seriously consider making a change.  Although true complications are rare, if you are part of the small percentage, you want to ensure that you have the best chance for a good outcome despite any complications that may arise.
 
You have a couple of options in a hospital setting in the event that you want to choose differently than your care providers are recommending and/or if you feel like your concerns are not being heard by your care provider.
 1.  If you have done your research and you have heard the benefits and the risks of a procedure or drug, and you are confident in your decision and want to refuse, hospitals have documents called “Against Medical Advice” that you can sign.  You accept the risks inherent in your decision and relieve the hospital of liability.

2.  You can ask for an Independent Patient Advocate.  This person acts as a liaison between the patient and the care providers.  It puts someone in between you and the care provider, and it is implied that they would convey information in a neutral way.  Sometimes taking away the “authority” of the person conveying the information relieves the pressure and lets a patient make a decision without feeling the pressure of “The Doctor” or “The Nurse”.
 
There is no decision, big or small, that you will regret making as long as you keep in mind Dr. Bradley’s ultimate outcome: Healthy Mom, Healthy Baby.  As long as your decisions are made with the best results for these two people in mind, then you can find peace of mind that you are making the right decision for you and your family.
 
 
Bradley Method classes offered in Arizona. Convenient to Chandler, Tempe, Gilbert, Mesa, Phoenix, Ahwatukee and PaysonDisclaimer:  
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®.
 

What is natural birth?

Posted on September 4, 2015 at 9:37 AM Comments comments (2)
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?   

The class went well, and we got a question that we have never gotten before: “What is natural birth – is it anything that doesn’t end in a C-section?”  

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.
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®.  


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Q&A with SPB: Midwifery Care

Posted on May 5, 2015 at 7:49 PM Comments comments (0)
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:

There are two types of midwife in the United States:
**Nurse-midwives are educated and licensed as nurses first, and then complete additional education in midwifery. They are known as Certified Nurse-Midwives (CNMs). CNMs are licensed to practice in all 50 states. They are usually licensed in individual states as Nurse Practitioners (NPs).
**Direct-entry midwives are educated or trained as midwives without having to become nurses first. They may be Certified Professional Midwives (CPMs) or Certified Midwives (CMs). The legal status and requirements for direct-entry (non-nurse) midwives vary from state. They are usually licensed in individual states as Licensed Midwives (LMs) or Registered Midwives (RMs). The Midwives Alliance of North America tracks the laws and regulations in each state for direct-entry midwives.

For a good explanation of the way a midwife is different from a doula read this excerpt from the bump:
"A midwife is…a health care provider and a doula is more of a childbirth coach. You might choose to have a midwife instead of an OB for prenatal care and to deliver your baby — midwives can deliver babies in hospitals, birthing centers or even in your home. A doula, on the other hand, doesn’t replace your healthcare practitioner but rather can add extra services, such as helping you with techniques to manage pain during labor and even providing support and help during baby’s early days." 

A midwife's main scope of practice is the health and well-being of the Mother and the Baby.  She is doing "watchful waiting" through the pregnancy and birth, ensuring that everything is proceeding and staying healthy and low-risk.  If things start to vary or complications develop, depending on the midwife and whether they are home- or hospital-based, they may encourage the family to seek co-care or transfer care to an obstetrician who is trained to manage pregnancy that is moving away from low-risk.  

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?
The first study to compare birth outcomes between midwifery and obstetrical care was published in 1998.  Here are the conclusions:

"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:
"Among 16,924 women who planned home births at the onset of labor, 89.1% gave birth at home. The majority of intrapartum transfers were for failure to progress, and only 4.5% of the total sample required oxytocin augmentation and/or epidural analgesia. The rates of spontaneous vaginal birth, assisted vaginal birth, and cesarean were 93.6%, 1.2%, and 5.2%, respectively. Of the 1054 women who attempted a vaginal birth after cesarean, 87% were successful. Low Apgar scores (< 7) occurred in 1.5% of newborns. Postpartum maternal (1.5%) and neonatal (0.9%) transfers were infrequent. The majority (86%) of newborns were exclusively breastfeeding at 6 weeks of age. Excluding lethal anomalies, the intrapartum, early neonatal, and late neonatal mortality rates were 1.30, 0.41, and 0.35 per 1000, respectively."
~Excerpt from THIS article




Are you curious about midwifery care??
Here are some posts where we share our birth journey with midwives:

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

Bradley Method® natural childbirth classes offered in Arizona: convenient to Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale, PaysonDisclaimer: 
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 Comments comments (0)
For today...another one from the archives, originally published in April 9, 2013.  Updated April 30, 2014 to include information about microbiome seeding; and a gentle cesarean checklist of options to review with your provider and prepare for a cesarean birth journey.

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:
"The natural cesarean, or family centered cesarean, is a procedure developed in the UK which takes a “woman centered” approach to the surgery that now accounts for one third of all births in America, a cesarean. This approach to a c-section incorporates many important aspects of a vaginal birth, parent participation for one."

A family-centered, or natural cesarean strives to capture these components of a vaginal birth:

  • Mother watches the birth of her child by having the surgical screen lowered at the time of delivery
  • Baby is delivered slowly so that they can get some benefit from uterine contractions to clear fluid from the lungs and nasal passages
  • Immediate skin-to-skin contact between mother and baby
  • Delayed cord clamping
  • Breastfeeding soon after birth
  • Continuous contact between mother and baby
  • "Seeding" of the mother's microbiome - read more about that HERE and HERE.

The idea of "seeding the microbiome" is a new concept.  Here is a quote from THIS article:
There is a difference between the microbiome of a baby born vaginally compared to a baby born by c-section (Azad, et al. 2013Penders et al. 2006Prince et al. 2014). During a vaginal birth the baby is colonised by maternal vaginal and faecal bacteria. Initial human bacterial colonies resemble the maternal vaginal microbiota – predominately Lactobacillus, Prevotella and Sneathia. A baby born by c-section is colonised by the bacteria in the hospital environment and maternal skin – predominately Staphylocci and C difficile. They also have significantly lower levels of Bifidobacterium and lower bacterial diversity than vaginally born babies. These differences in the microbiome ‘seeding’ may be the reason for the long-term increased risk of particular diseases for babies born by c-section.
~Rachel Reed, Midwife Thinking

And one from THIS article:
  • In the event of a c-section, be proactive. Mamas, we know this recommendation is not without its “icky-factor," but WOW it makes perfect sense when you think about it, and some believe it will be a standard recommendation in the future. Here goes: if your baby is born via c-section, consider taking a swab of your vaginal secretions and rubbing it on your baby’s skin and in her/his mouth. I know, ick. But when babies traverse the birth canal, they are coated in and swallowing those secretions/bacteria in a health-promoting way, so all you’re doing is mimicking that exposure. Don’t be afraid to ask your midwife or OB to help you collect the vaginal swabs—or do it yourself, if you’re comfortable. You have all the available evidence on your side.
    ~Michelle Bennet, MD, mamaseeds blog

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:
  • Less traumatic birth experience
  • Moms get to *see the birth* of their baby
  • Greater sense of satisfaction in regards to their birth
  • Establishment of the MotherBaby dyad immediately after the birth
  • Better breastfeeding outcomes
  • Someone who had an emergency cesarean with a previous child and does not feel comfortable with anything other than a repeat cesarean
  • A family with a known complication who wants to allow labor to start on the day of baby's choosing, but knows they will have a cesarean delivery
  • A family who planned a natural birth and had their course of labor  change before they were in an emergent situation

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/

Bradley Method® natural childbirth classes offered in Arizona: Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale, Payson 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.  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®.