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CCC Blog |
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Choosing a Birthplace 1/12/10 As a seasoned instructor, I feel that the biggest struggle couples face in their quest for a natural childbirth is the lack of support or education from their caregivers. There is a big difference between a care provider who is supportive and encouraging of a natural birth and someone who is tolerant or “willing to go along with it”. A mother faces an uphill battle if her choice of where to give birth and who to give birth with do not match up with her ideals for what her birth should be like. In the Denver Metro Area there are many choices of birth locations and care providers. Some hospitals see a greater number of women giving birth naturally. Some see very few. Some have very high cesarean section rates and some are unwilling to divulge their statistics on birth (which should be a red flag to anyone wanting something other than a managed/medicated birth). Often women are not sure of their care providers approach to birth. The typical five minute prenatal appointment does not give a mother-to-be much time to get to know her care provider. There are plenty of “nice” doctors and midwives, but nice isn’t enough if you want someone to support your choices (especially if they differ greatly from the way a care provider typically approaches birth). So here are some questions you can ask your provider, hospital or anyone you interview (should you decide to find someone new): · What percentage of your patient’s births do you attend? (This is usually a lower number in a large practice. You might end up giving birth with someone you don’t know well.) · What percentage of women have a cesarean section in your practice? (They should be willing to share this detail… be careful if they are not.) · What percentage of women have episiotomies? What is your suture rate (for perineal tears)? (Care providers who promote alternative birthing positions such as squatting or hands and knees may have lower rates of tearing.) · What is the most common choice for pain relief amongst women in your practice? What percentage of women have natural, spontaneous childbirth? (How often do they actually see a natural birth. If it is rare, there is likely a reason.) · What percentage of women who have previously had a cesarean have successful VBAC's (Vaginal birth after cesarean)? (Care providers who support VBAC’s tend to be more supportive of natural births and may be more trusting in women’s bodies.) · What is your protocol for women who have past their due date (“overdue”)? (Be leery of inflexible policies for induction, especially if it is at 41 weeks or earlier.) · What is your protocol for preventing and managing a breech? (If they employ alternative methods for breech turning such as acupuncture and positions, this may mean they are more open-minded.) · What is your protocol for preventing and managing a posterior position? (The use of positions, movement, and prevention are complimentary to a natural birth.) · How many vaginal twin births have you attended? (Again shows open-mindedness and a trust in a woman’s body. Note: women carrying multiples have a much higher rate of cesarean births, but some providers automatically schedule a cesarean without a trial of labor.) Take charge of your birth. Find the answers that you seek and be rewarded with an amazing, life-changing experience that you will never forget. |
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Car Seat Primer 1/24/10 Seat belts were designed for adults, so we tend to take them for granted. But they weren’t designed for children so adjustments have to be made. Statistics are that 70-90% (or more) of car seats are installed and used incorrectly. Here are some things to help you be in that 10-30%! Many parents want to know what car seat is the safest. The simple answer is: a seat that fits your car, fits your child, and one that you will use correctly 100% of the time. |
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To find out if a seat will fit your needs, read the manual! In our culture that seems to be a sign of weakness, to have to pull out the directions. Yes, car seats are pretty darn simple – but please please please read the manual! Pull out the manual for your vehicle and read the sections on child restraints and airbags too. They aren’t that long and you may be surprised with what you find. If it’s not in the manual, don’t do it! Even if it looks safer, even if it’s easier, even if it seems to offer more protection – just don’t. The manufacturers have tested the seats, stepping away from how they were tested will lessen their effectiveness in a crash. One of the most common mistakes is to not have the seatbelt locked. For many newer cars, the seatbelt doesn’t lock unless there’s an emergency. To get it to lock, pull the belt out all the way to the end, then it will ratchet back in. Now it’s locked. Just pulling on the belt fast may get it to lock temporarily, but it won’t necessarily stay that way – this is where the error occurs. Make sure the belt is locked and get the child restraint snug. If you pull on it at the belt path (where the belt goes through, not at the front) it should move less than one inch side to side and forward and backward. Pull with your less dominant hand with about the force used to open a car door. A little give is good, but less than one inch. If the seat is too tight, it can actually add stress to the shell before an impact. Convertible car seats will go rear facing and forward facing. Make sure you’ve picked the correct belt path for the direction of the seat. The belt path will be marked, it will be the one closest to the back of the seat in the vehicle. Some restraints have creative paths, most are straight forward. Check your manual to make sure. Newer cars will have LATCH (Lower Anchors and Tethers for CHildren) and many parents find this easier to use. LATCH and the car seatbelt are equally safe. Whichever one works better with your car and your restraint that you will use correctly 100% of the time is the right one for you. Please, read your car manual as LATCH will have a weight limit. Seat belts do too, but that limit is 3000 pounds so we usually don’t have to worry about that. Never use the seat belt and the LATCH belt at the same time (unless your manual says it’s OK, but no car seat yet does). When your kiddo is in the seat, make sure the harness is tight. If you can pinch the belt and hold on to it, it’s too loose! The clip should be at armpit level, over the sternum. Bones are much sturdier than guts. For a rear facing child, the harness should be at or below the shoulders; for a forward facing child, the harness should be at or above. If you’re walking around with your baby in the infant carrier, keep the harness tight. There’s no need to demonstrate that the straps are loose sometimes and tight others, if they’re always tight then there’s no expectation of them being loosened at inappropriate times. Rear facing seats can NEVER be in front of an air bag. Period. End of story. Read your manuals to find out about side airbags in your car and the seat you’ve purchased. So when can your baby go forward facing? Well, Colorado law says 1 year AND 20 pounds (as do many other states). So the 16 month old 18 pounder still needs to be rear facing as does the 25 pound 10 month old. But the law really is minimalistic. As long as your kiddo can be rear facing, do it. It is so much safer! Best practice recommends a child be rear facing until 2 years or as long as the seat will allow (read the manual, many seats have lower weight limits for rear facing than they do for forward facing). For more information, go to NHTSA or Car Seats Colorado or you can contact me if you have questions. (Melissa Evans, Melissa@BellyBeginnings.com, 720-207-0358). |
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Recommended Reading in Preparation for Birth 2/11/10 There is certainly a lot of information for parents-to-be out there about labor and birth, so this post can help to guide you to some of our favorites. Please see the full Suggested Reading list on our web site, which also includes books about breastfeeding and infant care in addition to labor and birth. |
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The Birth Partner by Penny Simkin - This book was written for anyone who wants to help a mom through labor - dads, partners, friends, sisters, or anyone else. It offers clear information specifically geared towards partners, about what to expect during labor and birth, and how to support the mother. The Business of Being Born is a DVD by Abby Epstein and Ricki Lake - This documentary will open your eyes about maternity care in America, as well as provide you with information and interviews from birth professionals as well as parents who have gone through labor and birth. Your Best Birth by Abby Epstein and Ricki Lake - This book is somewhat of a companion to the DVD, that gives great information about all of your choices in labor and birth, in a clear and easy-to-understand format. The Thinking Woman's Guide to a Better Birth by Henci Goer - Have you ever wondered what the medical studies say about what is best for moms in labor and birth? Henci Goer has, and she summarizes all of the studies in this book. From IV's to pain medication to induction of labor to Cesarean birth, this book covers it all! She also provides references to the studies if you wanted to go and look them up for yourself. Ina May's Guide to Childbirth by Ina May Gaskin - The first half of this book is filled with short, inspirational birth stories. The second half covers some general information about labor and birth, with interesting details from America's most famous midwife. A must-read for anyone considering a natural birth. |
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Around 7:00 that evening, I started feeling troubled in my digestive system. An hour later, my body decided to start purging everything it had taken in over my entire life (or so it seemed). I moaned as pains wracked my abdomen, worse than anything I had ever experienced in either of my two labors. I used every coping technique I had brought to bear in those two natural births, and some I hadn’t even thought of before. I simply prayed that I could hang on until my husband came home a little after 2. Around midnight, I just couldn’t take it anymore. This was no transition-induced self-doubt – I knew myself, I knew pain, and I was suffering. There was something truly wrong. I called my husband at work – something that, due to the nature of his job, I never did except in an emergency. He was home in less than half an hour. We packed up our kids, and he drove me to the emergency room. After much ER annoyance that I won’t even go into, along with hours of waiting before I could even get an IV (much less any other help), my stomach was calmed down. However, since my abdomen was still tender, the doctor wanted to do a CT scan. This involved using a contrast that was not compatible with nursing. Discussion revealed that a CT was, medically, the proper thing to do here, but I was concerned about the nursing angle. How long would I have to “pump and dump” my milk? I asked. “Twelve hours should be fine,” the doctor told me. “If it makes you more comfortable, you can wait 24.” I had just enough milk in the freezer to cover 24 hours, so I consented to the CT. About half an hour after I drank the contrast, a new nurse came into my room. I mentioned something about not being able to nurse for 24 hours, and the nurse said, “Oh no, honey, you can’t nurse for at least 48 hours,” then left the room. After pitching a 5-minute fit, I sat down and thought things through. Due to a friend who had experience with this sort of testing while nursing, I knew that injectable contrast meant no nursing for 48 hours, but I’d only had the drinkable one, and the doctor had assured me on the time until I could nurse my baby again. When I was taken down to radiology, I spoke to the technician there. I asked if there had been some misunderstanding, since I had only taken the drinkable contrast. I’d be able to nurse again in 12 to 24 hours, right? “Well, that’s true if you only drink the contrast, but we’re going to do the injectable, too.” Why? I asked. What will the injectable contrast show that the drinkable won’t? “The drinkable contrast highlights your intestines, and the injectable contrast shows your blood vessels. We can’t get a complete study unless we have both.” But what the doctor is looking for is in my intestines, I said. Do we really need to see my blood vessels? “To get a complete study,” the tech repeated, “we need to use the injectable contrast.” I don’t mean to be a pain, I said, but I have a strong reason for not wanting to use the injectable contrast. Can we speak to the doctor, and see whether it is truly necessary? So the tech got on the phone, and sure enough, the doctor confirmed that the injectable contrast would not be necessary for what we were examining – with the understanding, the tech had to emphasize, that it would not be a “complete study.” I was okay with that. I had the scan, fed my baby pumped milk the following day, and happily resumed nursing afterwards. Strange as it may sound, I attribute the way I handled that incident directly to my childbirth education classes that I had taken for my first baby – the classes that I now teach to others myself. In those classes, I learned: I am not just a number. The hospital has their protocols and checklists, and they are an institution, designed to treat everyone the same. But I’m not everyone else – “everyone else” may be given that contrast in order to get a “complete study,” but I didn’t need it for my personal health circumstance. I am the decision maker in my health care. The medical staff provides me with necessary services and expert advice and opinions, but ultimately, I decide what will and will not be done. Nobody can “make me” or “let me” do anything. It is my responsibility to ask the right questions in order to make an informed decision. Since I am making the decisions, they have to be good ones that I can live with – that only happens if I act on the best and most complete information available. It is important, whenever facing a medical decision, to ask: Is this an emergency, or do we have time to talk about it? What is the benefit of this test/procedure? What are we looking for? What are the risks associated with this test/procedure? Are there any alternatives that can accomplish the same goal? If so, what are their benefits and risks? What would happen if I do nothing? If I agree to this test/procedure, what other tests/procedures am I also signing up for? May I/we have a moment alone to think about/discuss this? I need to listen to my instincts, and take that into account when making my decisions. Sometimes we have a “gut feeling” about what is the right or wrong course of action. Some people think this is intuition, some “other” source of knowledge; some think it is simply subconscious processing of observations that we have made. Whatever the source, we need to listen to that, and use it as one factor – along with the information we have gathered – when making a decision. If I had not learned these important lessons – lessons that I now teach to others – I would have accepted the “complete study,” fed my baby formula for a day after my pumped milk ran out, and cried the entire time. Instead, I was able to tailor my health care to my specific needs, and my baby never had to eat anything except the best stuff on earth! This is an important example of how the benefits of our childbirth classes go well beyond the birth of our babies. Concepts such as informed decision making are not isolated to childbirth – they benefit us throughout our life. |
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Informed Decision Making: Childbirth Education, or Life Lesson? 3/3/10 It was a dreary October night. My husband was covering half of a night shift at work, and was not due to get off until 2:00 in the morning. |
