Tuesday, October 28, 2008

Evidence-Based Healthcare

Many people want to be informed consumers of healthcare.  We all want to make the best decisions about our care and our family's care.  How do you find the best information?  How do I know that what my doctor is telling me is the most up-to-date information?  

Cochrane.org is the website of The Cochrane Collaboration.  They are an organization that is dedicated to improving healthcare decision-making globally, through systematic reviews of the effects of healthcare interventions.  They do not accept "conflicted funding" and are funded through grants and donations.

What does this mean for you as a pregnant woman?  It means that you have a place to go and find the studies to back up your choices!  You can find out if your doctor's advice is based on the evidence!  You can make your own best choices.  The site is free.  Check it out!

Friday, August 8, 2008

Practical Ways to Avoid Back Labor

I have been discussing optimal fetal positioning with a client and thought it was something that I should write about!  

One of the positions that you hear about a lot among mamas is the occiput posterior position (OP).  OP is the position that is responsible for the often painful "back labor" that is the subject of so many labor horror stories.  You probably know someone who has had back labor.  Here are some practical ways to avoid it yourself!

Your baby's back is the heaviest side of its body. This means his back will naturally gravitate towards the lowest side of your belly. So, if your belly is hanging lower than your back (you are sitting on a chair leaning forward) then the baby's back will tend to swing towards your belly. If your back is lower than your belly (you are lying on your back or leaning back in a recliner) then the baby's back may swing towards your back.

Avoid positions which encourage your baby to face your belly. The main culprits are said to be reclining chairs, sitting in car seats where you are leaning back, or any position where your knees are higher than your pelvis.

The best way to avoid the wrong positions is to spend lots of time kneeling upright, or sitting upright, or on hands and knees. When you sit on a chair, make sure your knees are lower than your pelvis, and your trunk should be tilted slightly forwards.

  • Watch TV while kneeling on the floor, over a beanbag or cushions, or sit on a dining chair. Try sitting on a dining chair facing (leaning on) the back as well.

  • Use yoga positions while resting, reading or watching TV - for example, tailor pose or lotus pose (sitting with your back upright and soles of the feet together, knees out to the sides)

  • Sit on a wedge cushion in the car, so that your pelvis is tilted forwards. Keep the seat back upright.

  • Don't cross your legs! (not that you can anymore anyway) Crossing your legs reduces the space at the front of the pelvis, and opens it up at the back. For good positioning, the baby needs to have lots of space at the front.

  • Don't put your feet up! Lying back with your feet up encourages posterior presentation.
  • Sleep on your side, not on your back.  Switch sides whenever you wake up (and I know you wake up a lot!!)

  • Avoid deep squatting, which opens up the pelvis and encourages the baby to move down, until you know he/she is the right way round.  Sitting on a birth ball or a low stool with your legs in a deep spread is a good way to open your pelvis. 

  • Swimming with your belly downwards is said to be very good for positioning babies- not backstroke, but lots of breaststroke and front crawl. Breaststroke in particular is thought to help with good positioning, because all those leg movements help open your pelvis and settle the baby downwards. A mask and snorkel may be helpful.

  • A Birth Ball can encourage good positioning, both before and during labour. Doing "hula" movements is particularly helpful.

  • Various exercises done on all fours can help. Wiggling your hips from side to side, or cat/ cow (arching your back like a cat, followed by dropping the spine down). 
Helping your baby into the proper position before labor begins is the best way, but if you find yourself in a tremendous amount of back pain during labor, try these techniques again!  They may keep you from having one of those horror stories!

Wednesday, April 30, 2008

10 Natural Childbirth Myths

This is one of my favorite Monty Python skits!  While farcical, it hits pretty close to reality in many hospitals!  

Did your first birth experience go more like this than you had hoped?
Are you wondering where the bliss of the best moment of your life went?
Were you disempowered by your experience?

Are you trying to avoid this scenario with your first birth?
Are you fearful of the "natural" birth alternative?

Here is an interesting article from birthingnaturally.net:

10 Natural Childbirth Myths

When weighing your options for childbirth, it helps if you have accurate information about the options available to you. Unfortunately childbirth is an area where myth often pervades fact. What you hear may have started as truth, but has become such a distorted version, there isn’t much truth left. Here are ten of the most common misunderstandings about natural childbirth and the truth behind them.

1. You have to have a super-high pain tolerance.

Almost nobody likes pain, and it is easy to assume giving birth causes large amounts of pain so only the most pain tolerant women can do it. What is less well known is how a woman’s body increases endorphin levels during labor. This means as the intensity of the contractions build, so does her ability to handle them. Also, contractions peak at about 30 seconds. This means once your contractions become about a minute long they may increase in duration (get longer), but they do not tend to continue building in intensity.

2. You have to do HEE HEE HOO HOO panting the whole time.

While Dr. Lamaze did include patterned breathing for distraction in his natural childbirth training, it was one of several tools and his was the only program that recommended it. Dr. Dick Read, Dr. Bradley and others recommended natural deep breathing relying instead on positioning and relaxation. Patterned breathing remains one of many tools a woman can use in labor if she finds it helps her manage contractions, but most women use normal breathing.

3. It feels like pulling your lower lip over your head.

I enjoy a good comedy routine, but we shouldn’t base our understanding of childbirth on stand up comedy. After having given birth without medication twice, I can most assuredly promise you it feels nothing like pulling on your lips. The parts of the body needed for childbirth are designed to stretch and make room for baby – your lower lip is not designed to be pulled over your head.

4. You have to be at home to do it.

Homebirth is an option, but it is only one option. Women interested in natural childbirth can also give birth in birth centers or hospitals. It is not the location that matters, but the support you have to help you through contractions. While hospitals have access to medications and emergency equipment, many also have birth tubs, balls and flexible staff who will work with a family to achieve the birth they desire. Hiring a doula gives you even more support and increases your chances of giving birth naturally.

5. Women become screaming lunatics, yelling at their husbands.

Childbirth is not a psychosis where a woman suddenly takes on a new personality. Although in the earlier half of the 20th century women were given labor drugs that made them act very strange indeed, becoming crazy isn’t a part of the natural childbirth process. What does happen is a woman uses all her energy to focus on the work she is doing and distraction makes this harder. Women in hard labor will use the least amount of energy to communicate – this may mean body language, grunts or one word commands. Without the understanding this behavior is normal, a support person can feel as if they have somehow upset the laboring mother.

6. Childbirth is the worst pain you will ever feel.

A childbirth educator’s husband figured out from her normal 12 hour labor that the time she spent in pain in contractions totaled to about 3 and a half hours. You can be in pain longer than that for a migraine. And unlike other types of pain, contractions build to a peak, release from the peak and then give you a break. Even in a longer than average labor, there are breaks between contractions. In a 12 hour labor, you might not even need to work through contractions until the last 2 or 3 hours before pushing because most of the time you spend in labor is early labor.

7. If they know you want a natural childbirth, the nurses won’t give you anything for the pain.

Wanting a natural childbirth and achieving a natural childbirth are two different things. While most doulas, nurses and midwives will work with you to achieve your goal of a natural childbirth, they never force you to give birth without medication. Whether or not to use medical pain relief remains your choice regardless of what type of labor you prepared for.

8. There is no reason to go through labor pain anymore.

There have been ointments and herbs to treat labor pain as far back as the Roman Empire, and probably further back than that. There are also positions and non-medical techniques that work extremely well for keeping mothers comfortable and helping labor progress. It isn’t so much the use of a treatment to manage pain that bothers modern women as much as it is the possible side effects and risks of using the treatments. There is a big difference between the risks of having a massage in labor and having an epidural. Although the massage may not eliminate all the pain, if it allows the woman to labor without having to add the risks of an epidural then why not use it? Studies show just the change of using a doula for additional support decreases requests for pain medication while also decreasing needs for additional medical interventions. It should more rightly be said that with all we know today, there is no reason to add the risks of medical pain relief to manage labor pain anymore.

9. Women used to die giving birth.

Yes, and women still die giving birth. It has nothing to do with the natural childbirth process. Instead factors such as poor nutrition, infection and inadequate sanitation are the causes of high mortality rates. In fact, the highest childbirth mortality rate happened because birth was moved to the hospital and infection spread quickly among laboring women when doctors didn’t wash their hands. Pain medications increase the risks of having a problem in labor, not reduce them. Cesarean birth adds the increased risks of surgery to childbirth, which means for a normal, healthy pregnancy your risk of dying from childbirth goes up.

10. I don’t need to prepare to give birth, it’s a natural process.

While your body is doing the work with or without you, how you respond to labor will have a large impact on how well labor progresses and the amount of pain or discomfort you feel. Knowing positions, tricks and techniques for labor greatly improves your chances of being successful at giving birth naturally, and greatly improves your chances of staying comfortable during labor. It takes physical and mental energy to labor; if you haven’t practiced natural childbirth techniques enough to use them without thinking you won’t be able to use them during labor. Preparing for a natural childbirth doesn’t necessarily guarantee you will give birth without medications, but not preparing almost always guarantees you will use medications.

Jennifer Vanderlaan is a childbirth educator and doula who helps families learn tools, tips and techniques for natural childbirth at http://www.birthingnaturally.net

Wednesday, March 26, 2008

Birth Talk

The next Birth Talk will be on Monday,November 4th at 7 pm! Hope you can make it!

Birth Talk Mission: To form an inclusive circle of trust and support for pregnant and postpartum women by:
SHARING stories of pregnancy and birth, as well as options for local providers, birth locations and birth educators;
INSPIRING power and confidence throughout the experience of pregnancy, birth and parenthood;
DISCOVERING how to become your own birth advocate in order to experience the birth you desire;
and CELEBRATING the life-changing experiences of pregnancy, birth and parenting.

Birth Talk will meet the first Monday of each month at 7 pm at Franklin Goose in Carytown. Come at 6:30 for special speakers.

Contact Jennifer Kyzer at 440-2498 or e-mail safe-n-happy@iglide.net.

Saturday, January 12, 2008

The Business of Being Born comes to The Byrd!

This is a powerful film. It is coming to back to
Richmond after 2 sold out shows in November.
It will be showing at Richmond's Byrd Theatre on
February 3rd at 12:30pm. There will be a question
and answer time following. Tickets are only $2 (free
with a student ID)!
Buy your tickets here.

The Birth Talk meeting for the month of February
is scheduled for the 4th. Come to the show and then
to the Talk!