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!

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!

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 Article Source: http://EzineArticles.com/?expert=Jennifer_Vanderlaan

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.

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!

from The Coalition for Improving Maternity Services

Having a Baby? Ten Questions to Ask

Have you decided how to have your baby?

The choice is yours!

First, you should learn as much as you can about all your choices. There are many different ways of caring for a mother and her baby during labor and birth.

Birthing care that is better and healthier for mothers and babies is called "mother-friendly." Some birth places or settings are more mother-friendly than others.

A group of experts in birthing care came up with this list of 10 things to look for and ask about. Medical research supports all of these things. These are also the best ways to be mother-friendly.

When you are deciding where to have your baby, you'll probably be choosing from different places such as:

• birth center,

• hospital, or

• home birth service.

Here's what you should expect, and ask for, in your birth experience. Be sure to find out how the people you talk with handle these ten issues about caring for you and your baby. You may want to ask the questions below to help you learn more.

1. Ask, "Who can be with me during labor and birth?"

Mother-friendly birth centers, hospitals, and home birth services will let a birthing mother decide whom she wants to have with her during the birth. This includes fathers, partners, children, other family members, or friends.

They will also let a birthing mother have with her a person who has special training in helping women cope with labor and birth. This person is called a doula or labor support person. She never leaves the birthing mother alone. She encourages her, comforts her, and helps her understand what's happening to her.

They will have midwives as part of their staff so that a birthing mother can have a midwife with her if she wants to.

2. Ask, "What happens during a normal labor and birth in your setting?"

If they give mother-friendly care, they will tell you how they handle every part of the birthing process. For example, how often do they give the mother a drug to speed up the birth? Or do they let labor and birth usually happen on its own timing?

They will also tell you how often they do certain procedures. For example, they will have a record of the percentage of C-sections (Cesarean births) they do every year. If the number is too high, you'll want to consider having your baby in another place or with another doctor or midwife.

Here are some numbers we recommend you ask about.

• They should not try to start labor for more than 1 in 10 women (10%).
• They should not do an episiotomy (ee-pee-zee-AH-tummy) on more than 1 in 5 women (20%). They should be trying to bring that number down. (An episiotomy is a cut in the opening to the vagina to make it larger for birth. It is not necessary most of the time.)
• They should not do C-sections on more than 1 in 10 women (10%) if it's a community hospital. The rate should be 15% or less in hospitals which care for many high-risk mothers and babies.

A C-section is a major operation in which a doctor cuts through the mother's stomach into her womb and removes the baby through the opening. Mothers who have had a C-section can often have future babies normally. Look for a birth place in which 6 out of 10 women (60%) or more of the mothers who have had C-sections go on to have their other babies through the birth canal.

3. Ask, "How do you allow for differences in culture and beliefs?"

Mother-friendly birth centers, hospitals, and home birth services are sensitive to the mother's culture. They know that mothers and families have differing beliefs, values, and customs.

For example, you may have a custom that only women may be with you during labor and birth. Or perhaps your beliefs include a religious ritual to be done after birth. There are many other examples that may be very important to you. If the place and the people are mother-friendly, they will support you in doing what you want to do. Before labor starts tell your doctor or midwife special things you want.

4. Ask, "Can I walk and move around during labor? What position do you suggest for birth?"

In mother-friendly settings, you can walk around and move about as you choose during labor. You can choose the positions that are most comfortable and work best for you during labor and birth. (There may be a medical reason for you to be in a certain position.) Mother-friendly settings almost never put a woman flat on her back with her legs up in stirrups for the birth.

5. Ask, "How do you make sure everything goes smoothly when my nurse, doctor, midwife, or agency need to work with each other?"

Ask, "Can my doctor or midwife come with me if I have to be moved to another place during labor? Can you help me find people or agencies in my community who can help me before and after the baby is born?"

Mother-friendly places and people will have a specific plan for keeping in touch with the other people who are caring for you. They will talk to others who give you birth care. They will help you find people or agencies in your community to help you. For example, they may put you in touch with someone who can help you with breastfeeding.

6. Ask, "What things do you normally do to a woman in labor?"

Experts say some methods of care during labor and birth are better and healthier for mothers and babies. Medical research shows us which methods of care are better and healthier. Mother-friendly settings only use methods that have been proven to be best by scientific evidence.

Sometimes birth centers, hospitals, and home birth services use methods that are not proven to be best for the mother or the baby. For example, research has shown it's usually not helpful to break the bag of waters.

Here is a list of things we recommend you ask about. They do not help and may hurt healthy mothers and babies. They are not proven to be best for the mother or baby and are not mother-friendly.

• They should not keep track of the baby's heart rate all the time with a machine (called an electronic fetal monitor). Instead it is best to have your nurse or midwife listen to the baby's heart from time to time.
• They should not break your bag of waters early in labor.
• They should not use an IV (a needle put into your vein to give you fluids).
• They should not tell you that you can't eat or drink during labor.
• They should not shave you.
• They should not give you an enema.

A birth center, hospital, or home birth service that does these things for most of the mothers is not mother-friendly. Remember, these should not be used without a special medical reason.

7. Ask, "How do you help mothers stay as comfortable as they can be? Besides drugs, how do you help mothers relieve the pain of labor?"

The people who care for you should know how to help you cope with labor. They should know about ways of dealing with your pain that don't use drugs. They should suggest such things as changing your position, relaxing in a warm bath, having a massage, and using music. These are called comfort measures.

Comfort measures help you handle your labor more easily and help you feel more in control. The people who care for you will not try to persuade you to use a drug for pain unless you need it to take care of a special medical problem. All drugs affect the baby.

8. Ask, "What if my baby is born early or has special problems?"

Mother-friendly places and people will encourage mothers and families to touch, hold, breastfeed, and care for their babies as much as they can. They will encourage this even if your baby is born early or has a medical problem at birth. (However, there may be a special medical reason you shouldn't hold and care for your baby.)

9. Ask, "Do you circumcise baby boys?"

Medical research does not show a need to circumcise baby boys. It is painful and risky. Mother-friendly birth places discourage circumcision unless it is for religious reasons.

10. Ask, "How do you help mothers who want to breastfeed?"

The World Health Organization made this list of ways birth services support breastfeeding.

• They tell all pregnant mothers why and how to breastfeed.
• They help you start breastfeeding within 1 hour after your baby is born.
• They show you how to breastfeed. And they show you how to keep your milk coming in even if you have to be away from your baby for work or other reasons.
• Newborns should have only breast milk. (However, there may be a medical reason they cannot have it right away.)
• They encourage you and the baby to stay together all day and all night. This is called "rooming-in."
• They encourage you to feed your baby whenever he or she wants to nurse, rather than at certain times.
• They should not give pacifiers ("dummies" or "soothers") to breastfed babies.
• They encourage you to join a group of mothers who breastfeed. They tell you how to contact a group near you.
• They have a written policy on breastfeeding. All the employees know about and use the ideas in the policy.
• They teach employees the skills they need to carry out these steps.

© 2000 by The Coalition for Improving Maternity Services (CIMS).

Permission granted to freely reproduce in whole or in part along with complete attribution

Beautiful Birth Video!

This video is a picture of what birth can be if left to happen 

without unnecessary medical intervention.

It contains photos of actual births.

Circle of Life Midwifery