Thursday, October 23, 2014

DC Birth Doulas

I am excited to announce that I will be joining two other experienced doulas, Amy Ard and Sara Baum, to form a new group doula practice: DC Birth Doulas. When you sign a contract with DC Birth Doulas, you hire three doulas as a team.  You have an opportunity to get to know all of the doulas through the monthly Meet the Doulas event, Create Your Birth Plan Workshop, emails and phone calls. One of the three doulas will meet you in your home for a prenatal visit. Depending on the on-call schedule, this same doula or a different doula will provide you with full labor support and immediate postpartum assistance with breastfeeding in the hospital. You will also receive a postpartum visit at your home by the doula that attended your birth.
Working with a small-group doula practice has significant advantages over working with an individual doula. When you choose to work with the DC Birth Doulas group, you benefit from:
  • The reassurance that comes with meeting and developing a relationship with several doulas; you can be confident that you will not have to work with a backup doula you have not met.
  • Support for very long labors: Most of the time, the doula that arrives for your birth will be the one who stays all the way to the end. But if you have a very long labor, a new doula with fresh ideas and energy can come to assist.
  • The peace of mind that comes with knowing that the doula who attends your birth will be well rested and fully available to be with you – you don’t have to worry about getting a doula who is tired from a previous birth or who has another client in labor at the same time
  • Nearly 30 years of collective experience working with women from diverse cultures, professional backgrounds, family structures, ages, orientations, birth preferences, and birth outcomes
  • A wide base of knowledge and training, including labor support, birth, prenatal yoga, childbirth and reproductive health education, breastfeeding, newborn care, and child rearing

Tuesday, September 16, 2014

Lamaze, Doula, and Breastfeeding Training in The Arabian Gulf Oct 14-18, 2014












Course Descriptions

Breastfeeding Counselor (Course Fee 160 KWD) Oct 14-17, 9am-5pm
This educational workshop provides foundational, evidence-based training as a breastfeeding counselor. Counselors are equipped to provide breastfeeding support by telephone or in person to mothers who initiate contact. Counselors may also present educational topics at mothers’ groups and other related functions. A two-hour practicum is part of the training experience to allow participants an opportunity to immediately use their skills to provide phone support for breastfeeding mothers. Lamaze International approves this training program for 12 continuing education credits.

Topics include:
·      Personal Philosophy of Breastfeeding
·      Benefits of Breastfeeding
·      Barriers to Breastfeeding
·      Breastfeeding Basics
·      Effective and Pleasant Milk Exchange
·      Early Challenges and Establishing Milk Supply
·      Feeding the Infant from Newborn to 6 months
·      Feeding the Infant 7 to 12 months
·      Expressing Milk
·      Communicating with Mothers
·      Documentation/ Record Keeping/Follow up

Breastfeeding Your Baby-Lactation Educator Training (Course Fee 110 KWD) Oct 18, 9am-5pm
For Experienced Breastfeeding Counselors, Midwives, Doulas, Physicians.

Breastfeeding Your Baby is a comprehensive lactation education course for expectant parents. This one day training seminar prepares the participant to confidently offer lactation education privately or in a group setting. A complete curriculum and all teaching models are provided. Lamaze International approves this program for 7 continuing education credits.

Topics Include:
·      Benefits of Breastfeeding
·      Breastfeeding Basics
·      Latch
·      Common Problems
·      How to Know Baby is getting enough Milk
·      Expressing and Storing Milk
·      Partners Role
·      Resources for Support

DONA Doula Training (Course Fee 160 KWD) Oct 16-18, 9am-5pm

This 3-day workshop is open to anyone passionate about helping women have their best birth possible.  It is highly recommended that attendees observe a full series of childbirth education classes in their community (one that promote healthy birth practices)  before attending the workshop. If participants are unable to observe a full class series before the workshop, an Intro to Childbirth for Doulas will be offered the first day of the training.

In the Birth Doula Workshop, you will learn:
  • What a doula is and the importance of their contribution to maternity care;
  • How to support a laboring mom through the normal processes of birth;
  • How to support moms in challenging birth situations;
  • How to support new families with their newborns & breastfeeding;
  • Communication and listening skills;
  • Details regarding certification & the business of being a doula.
Participants will leave the workshop with the practical skills needed to operate as a birth professional, offering competent informational, physical, and emotional support to expectant mothers in their communities.

Lamaze Childbirth Educator Training (Course Fee 210 KWD) Oct 14-18, 9am-5pm

Lamaze education and practices are based on the best, most current medical evidence available. They can help reduce the use of unnecessary interventions and improve overall outcomes for mothers and babies. Working closely with their families, health care providers and Lamaze educators, millions of pregnant women have achieved their desired childbirth outcomes using Lamaze practices.  The purpose of the Lamaze Childbirth Educator seminar is to enable the learner to develop the knowledge and skills to plan, facilitate, and evaluate a childbirth education program.

This seminar will equip attendees with a fully developed curriculum and teaching supplies that will enable the learner to start teaching shortly after the childbirth educator training. The Lamaze Childbirth Educator training will meet the following objectives over the 4 1/2 days of training:

  • Explain how the Lamaze Philosophy of Birth and Six Healthy Birth Practices promote and support the physiological model of normal childbirth.
  • Describe how history and culture influence birth today.
  • Develop a teaching plan to promote healthy lifestyles for childbearing families.
  • Develop a teaching plan to prepare expectant women and their partners for the flow of normal labor from pre-labor through the fourth stage of labor.
  • Develop a teaching plan to help expectant parents identify the role of pain during labor and birth.
  • Develop a teaching plan to promote the use of non-pharmacologic pain management strategies.
  • Develop a teaching plan to present information about the importance of continuous labor support.
  • Develop a teaching plan to promote successful breastfeeding.
  • Develop a teaching plan to promote healthy infant attachment.
  • Develop a teaching plan to prepare expectant parents for the normal physical and emotional adjustments of the early-parenting period.
  • Develop a teaching plan to present information about common medical interventions.
  • Develop a teaching plan for presenting unexpected outcomes.
  • Develop a teaching plan to help students make and communicate informed decisions.
  • Describe how childbirth educators can advocate for natural, safe and healthy birth.
  • Identify and evaluate evidence-based information for use in childbirth education courses.
  • Describe and evaluate effective teaching strategies for adult learners.
  • Identify strategies for promoting effective group dynamics.
  • Describe how childbirth educators can meet the needs of diverse populations.
  • Describe effective strategies for evaluating childbirth courses.
  • Demonstrate teaching a Lamaze-recommended topic.
  • Design a childbirth course that incorporates the Lamaze Six Healthy Birth Practices and  Lamaze-recommended topics using a variety of teaching strategies.
  • Identify strategies to increase a woman’s confidence in her ability to give birth.
  • Discuss the criteria for becoming certified by Lamaze International and maintaining certification.
  • Discuss professional and ethical responsibilities of a Lamaze Certified Childbirth Educator.
  • Describe options for establishing, sustaining and growing a career as a Lamaze Certified  Childbirth Educator.
Trainers

Jennifer Carroll holds a BA in Education, is a Lamaze Certified Childbirth Educator, a Certified Doula (DONA) and a Fellow of the American College of Childbirth Educators. She is a Lamaze International Trainer with Duke University Lamaze Childbirth Educator Training Program.  She has trained with USDA –WIC in lactation support and RTS in supporting through perinatal loss. She is the founder of Elizabeth Project International and has been active in developing Lamaze Childbirth Education and other maternal support programs internationally since 1999. 





Sarah Paksima has worked in the field of Public Health for over 15 years as a Certified Doula, Lamaze Childbirth Educator and Pre-Natal Yoga Teacher, and holds a B.A. in International & Near Eastern Studies. She is one of the original Co-Founders of BirthKuwait and is currently running her own business, EngagingBirth, out of the Washington, DC-Maryland-Virginia area where she recently moved with her husband and five children. Sarah has practiced in Jordan, India, Oman, Kuwait and the US. She is passionate about improving access to pregnancy-related education, resources, and support for families all over the world.


Tara Owens Shuler, M.Ed., LCCE, FACCE has a Bachelor of Science degree in Health Behavior and Health Education from the University of North Carolina at Chapel Hill School of Public Health and a Master of Education in Health Promotion from the University of North Carolina at Charlotte.  She became a Lamaze Certified Childbirth Educator (LCCE) in 1996 and a Fellow of the American College of Childbirth Educators (FACCE) in 2001.   She is also certified DONA birth doula.

Currently, she is the Director of Continuing Education & Lamaze Childbirth Educator Program for the Duke AHEC Program at Duke University Medical Center for the past 11 years. As the Program Director for the Duke AHEC Lamaze Childbirth Educator Program, which is located on the campus of Duke University Medical Center. 

Tara is currently the Past-President of Lamaze International and has served on the Lamaze International Board of Directors for the past 5 years. Tara also teaches Lamaze childbirth education classes at Rex Hospital in Raleigh, NC as well as provides doula services for women in the Triangle area.  Tara and her colleague, Tonya Daniel, are working to develop a volunteer doula program in a rural community in North Carolina to make doula services available for minority and underserved women in the community.

Tonya Daniel is a Lamaze Certified Childbirth Educator, Fellow of the American College of Childbirth Educators, Lamaze Childbirth Educator Trainer with the Duke AHEC Lamaze Educator Training Program, a DONA- approved Birth Doula Trainer & International Board Certified Lactation Consultant. Accompanying families through their birth journeys since 2000, she provides education, labor support and lactation services to women in her community. Tonya enjoys spending family time with her husband, her four energetic kids, and dog, Bella.




Verda Murphy is a Certified Breastfeeding Peer Counselor with the Virginia Department of Health; Women, Infants and Children Program.  She has been providing service to  her community for eight years.  Verda provides breastfeeding support and information to pregnant and breastfeeding clients and their support.  She is a qualified trainer for the Loving Support through Peer Counseling and semi-annually provides training.  Verda bring with her 5 years combined of personal breastfeeding experiences.  She is also a Founding Board Member and Lead Breastfeeding Facilitator of the Elizabeth Project International.  Verda is always eager to share breastfeeding with anyone.  She loves to help families make educated decisions about feeding options for their newborns.  Verda delights in quality time with her husband and their four active children.

Wednesday, July 23, 2014

What to look for in a good Childbirth Education Class?

First of all, what is Lamaze?


"Lamaze...that's that breathing thing for natural childbirth, right? Hee, hee, hooooooo...." I have to smile to myself everytime someone asks me this question. At the beginning of each new series, I find that the first thing I need to do as a teacher is dispel some common myths about Lamaze classes. 

Lamaze was originally created as a method for mothers to birth fully conscious and aware- as opposed to the common way to birth in the 1950's- unconscious in twilight sleep. Before the advent of epidurals, the only way to be conscious and aware during birth was through natural childbirth, and of course learning how to breath and relax is critical to laboring without pain medications- thus the common misnomer that Lamaze is all about a particular breathing pattern.


Today however, Lamaze has evolved into so much more. Lamaze has taken the goal of birthing fully conscious and aware far beyond the original goal- to be awake rather than asleep. Today, a Lamaze prep class means having the facts, information, confidence, and tools that you need to make informed decisions about the safety and health of you and your baby; it also means understanding the deeper psychological and emotional impact that birth has on mothers and their families; and finally, it encourages mothers to learn how to reconnect with their bodies so that they can be present during the birthing experience rather than trying to escape from it. Rather than a focus on natural childbirth as an ultimate goal, the purpose of a Lamaze class is to teach couples how to be active and informed participant as they make decisions- whether they choose to have a natural birth, an epidural or a cesarean.

What Should You Look for in a Good Childbirth Class? 

Lamaze isn't the only childbirth class available (although it is my favorite). Today, in contrast to the 1970s when Lamaze was first founded, there are many different types of childbirth classes available. So what should you look for when you are trying to choose a childbirth class that's right for you? 


Comprehensive Childbirth Education:

While it might be tempting to choose a class that fits your current thoughts about childbirth, (i.e. a hospital tour that explains how early you can get your epidural, a class that focuses only on natural childbirth, or a quick weekend class that is convenient for your busy schedules) you might be doing yourself a disservice. Taking the time to find and attend a comprehensive childbirth class ensures that you have the broad knowledge base needed to explore and evaluate your values and ultimately make truly informed decisions. 


A comprehensive childbirth class will provide you with 1) a general overview of pregnancy, labor, birth, early breastfeeding, basic infant care, and postpartum recovery, 2) an in-depth presentation of common interventions used during labor and birth, including the tools to evaluate their potential benefits, risks, and alternatives, 3) a variety of labor coping techniques and time to practice using them, 4) and the information required to create your own birth and postpartum plans. The emphasis is on pregnancy, labor, and delivery, with general overviews of pregnancy, breastfeeding, parenting, and postpartum recovery. I would highly recommend taking comprehensive classes on breastfeeding and parenting as well, and signing up for a breastfeeding and postpartum support group after the birth, but for many a general over-view is enough. A comprehensive childbirth class takes time: don't expect the same quality from a 5-hour weekend crash course that you would from a 12 hour multi-class series. (Although a 5-hour crash course is better than nothing! These classes have their place as well.)


Evidence Based Principles:

Evidence-based childbirth educators take into consideration good research and are constantly re-evaluating what they teach to make sure they are in harmony with solid evidence. Evidence-based educators take into consideration not only good research, but also the experience and knowledge of care providers and the intuition and wishes of mothers and fathers, especially where there is little research available. Be wary of childbirth educators who teach according to their opinion, hospital policy, or studies conducted by their own organizations. A reputable and reliable source for studies that evaluate childbirth related research is the Cochrane Database; this database compiles studies from all over the world and combines and evaluates their findings- throwing out poorly designed studies or at least acknowledging their limitations. A good educator will refer to credible sources, such as the Cochrane Database, regularly.


A Variety of Teaching Methods:

Steer clear of lecture styles classes. Everyone learns differently, and very few prefer to be lectured. Some learn best by reading or looking at graphs, others through talking or discussing new ideas or experiences, some through actively doing or creating something new, and others through watching a visual presentation or video. A good teacher uses games and a variety of engaging activities, ignites lively discussions, and engenders laughter. Learning should be fun. Search for a teacher who not only knows about childbirth, but who is also a good teacher. 


Shared Social Experiences:

I know it's tempting to just sign up for a private class or read about childbirth through books when our schedules are busy. Instead, take advantage of a group class that allows you to get to know a cohort of couples over time. You will benefit from the shared experiences and discussions organic to these types of class settings. 


In addition, you gain access to a referral network rich with tips on where to find things locally, evaluations of local care providers, and local services such as placenta encapsulation services, chiropractors or massage therapists that specialize in pregnancy, a great prenatal yoga class etc. Many of the couples in my classes meet outside of class on the weekends or for dinner right before class. They also provide essential postpartum and breastfeeding support and encouragement for one another, and enjoy lasting friendships.


False Guarantees:

If your prospective teacher tells you to expect anything definitively (i.e. "You are going to want that epidural, believe me!" or "If you do these things, you will have a natural birth") run away!! There are no guarantees in childbirth. No matter what you do to prepare, you never know what crazy journey awaits you. I always tell my classes to keep an open mind and to expect childbirth to be nothing like they expected. It's just the beginning of a long adventure into parenthood, and the sooner you let go of trying to control every aspect of it the happier you will be.


My Lamaze Classes:

My Lamaze classes are designed to provide parents with the most current information about healthy birth practices, the tools to process that information in the proper context, and the confidence to make decisions that are in the best interest of their own and their baby's well being. I also strive to help parents develop their own understanding of what the birthing experience will mean for them and their family and how to incorporate their own culture, beliefs, and traditions into the experience to make it more meaningful. In addition, I guide my classes through an exploration of what it will mean to be a parent and provide a context for parents to discuss how they will approach parenting. We spend considerable time practicing new skills for laboring and birthing, including relaxation, movement, breathing, massage and counter-pressure, and rebozo/birth-ball techniques. Couples also learn about breastfeeding, caring for newborns, and postpartum recovery. 

My next class series will be October 23,30, & November 6, 13, 20 in Poolesville, MD 6:30-8:45pm (a 5-week series). 


Email me at sarah@engagingbirth.com for registration information and availability.  


















It's a race: Moms vs Dads, Who Can Remember the Stages of Labor?

Tuesday, July 8, 2014

The Basic Elements of Paternal Bonding



Sometimes Dads may feel a little left out during the pregnancy and birth of their child. Afterall, during the first 9 months all the “action” is happening in mom! But fathers who spend time close to their wife during pregnancy undergo critical changes as well, that only continue once the baby is born. These changes ensure that Dad will be a committed protector and provider and play a critical role in helping a new infant develop emotional and social behaviors through healthy bonding.

Once born, baby's hormonal control systems and brain synapses begin to permanently organize according to the human interactions she experiences. Unneeded brain receptors and neural pathways are disposed of, while those appropriate to the given environment are enhanced. Fathers, you are essential to this new environment!

Oxytocin: A Bonding Hormone
Oxytocin is a chemical released in the brain providing health benefits and promoting bonding patterns that create desire for further contact with the individuals inciting its release. We tend to talk a lot about oxytocin in the mother, but father’s also have a significant role to play. 
For example, mother’s tend to prefer whichever male is closest during periods of high oxytocin release (pregnancy and labor!) In addition, prolonged high oxytocin in mother, father, or baby also promotes lower blood pressure and reduced heart rate as well as certain kinds of artery repair, actually reducing lifelong risk of heart disease.

Persistent regular body contact and other nurturing acts by parents produce a constant, elevated level of oxytocin in the infant, which in turn provides a valuable reduction in the infant's stress-hormone responses, and the resulting high or low level of oxytocin will control the permanent organization of the stress-handling portion of the baby's brain -- promoting lasting "securely attached" or "insecure" characteristics in the adolescent and adult. (Insecure characteristics include anti-social behavior, aggression, difficulty forming lasting bonds with a mate, mental illness, and poor handling of stress.)

When an infant does not receive regular oxytocin-producing responsive care, babies can develop permanent brain changes that lead to elevated responses to stress throughout life, such as higher blood pressure and heart rate.

It has also been shown that a live-in father's oxytocin levels rise toward the end of his mate's pregnancy. When the father spends significant amounts of time in contact with his infant, oxytocin encourages him to become more involved in the ongoing care in a self-perpetuating cycle. Oxytocin in the father also in-creases his interest in physical (not necessarily sexual) contact with the mother, encouraging the father to become more interested in being a devoted and satisfied part of the family picture –all through his involvement with the baby.

Vasopressin & Protection
Although present and active during bonding in the mother and infant, vasopressin plays a much bigger role in the father. This hormone promotes brain reorganization toward paternal behaviors when the male is cohabitating with the pregnant mother. The father becomes more dedicated to his mate and expresses behaviors of protection.

Released in response to nearness and touch, vasopressin promotes bonding between the father and the mother, helps the father recognize and bond to his baby, and makes him want to be part of the family, rather than alone. It has gained a reputation as the "monogamy hormone." Dr. Theresa Crenshaw, author of The Alchemy of Love and Lust, says, "Testosterone wants to prowl, vasopressin wants to stay home." She also describes vasopressin as tempering the man's sexual drive (not sexual functioning).

Vasopressin reinforces the father's testosterone-promoted protective inclination regarding his mate and child, but tempers his aggression, making him more reasonable and less extreme. By promoting more rational and less capricious thinking, this hormone induces a sensible paternal role, providing stability as well as vigilance.

Prolactin & Behavior
Prolactin is released in all healthy people during sleep, helping to maintain reproductive organs and immune function.

Prolactin promotes caregiving behaviors and, over time, directs brain reorganization to favor these behaviors . Father's prolactin levels begin to elevate during mother's pregnancy, but most of the rise in the male occurs after many days of cohabitation with the infant.
As a result of hormonally orchestrated brain reorganization during parenthood, prolactin release patterns are altered. It has been shown that fathers release prolactin in response to intruder threats, whereas childless males do not.

Elevated prolactin levels in both the nursing mother and the involved father cause some reduction in their testosterone levels as well, which in turn reduces their libidos (but not their sexual functioning). Their fertility can be reduced for a time as well. This reduction in sexual activity and fertility is entirely by design for the benefit of the infant, allowing for ample parental attention and energy. When the father is intimately involved with the infant along with the mother, there should be some accord between the desires of the two, and oxytocin and other chemicals provide for heightened bonding and non-sexual interest in each other, which serves to retain a second devoted caretaker for the infant.


Fatherhood

Fathers are essential to a healthy mother and baby. Fathers foster healthy development by supporting and becoming equal partners with their mates, providing frequent skin-to-skin contact, holding, and offering facial cues for their babies. 

Play, smile, soothe, cuddle, bathe, and rock. Even if you feel new or clumsy as a new parent, all your efforts will pay off and help you to become a better father, and contribute to the healthy development of your child.

Friday, May 16, 2014

Creating a Birth Plan That's Right for You

When it comes to the big event, the birth of your baby, you (the parents) and your baby are the Stars of the Show. Your preferences and wishes for labor, birth, and your early postpartum care for you and your baby are important. While you have placed your confidence in your care providers to ultimately be responsible for you and your baby’s well being, they can do so while also honoring and respecting what is important to you. Writing a “Birth Plan” allows you to 1) think through the process of birth so that you are aware of what needs to be considered, 2) use the birth planning worksheets as a tool to communicate with your partner and your birth team about what is important to you, 3) picture your ideal birth in addition to contingency plans if birth doesn’t go the way you originally planned.

The process of writing your birth plan encourages you to learn about your different options, including: how labor begins, different comfort measures and pain relief, labor support (your partner, family member or a doula), different methods of augmenting a slow labor, positions for birthing/pushing, common medical interventions, common newborn procedures, benefits and tips for successful breastfeeding, postpartum care options, and much more. You can learn about these options by reading books about childbirth, attending a childbirth education class, asking your doctor, midwife, or doula, or searching online. Be careful where you get your information. While the Internet seems easily accessible, it is not always extensive or based on current research.  A childbirth class is the best way to learn about your options, ask questions in an open format, and discuss concerns and thoughts with other parents who are considering the same issues. If a class is not available in our area, perhaps consider private mini-classes with your doula or a midwife. While your care provider is available to answer specific questions, they do not always have the time to provide you with thorough childbirth education.

While you are learning about all of your different options and deciding what is important to you, be sure to consult and discuss with your partner. He will likely have questions that need to be answered and preferences that need to be considered as well, and the birth plan is a great tool to get the ball rolling on these discussions. You can also use the birth plan to red flag any unanswered questions you might need to bring up to your care provider. As you move through your birth plan with your care provider, be open to discuss why something is particularly important to you and share that with your care provider, while also assuring your care provider that you are open to changes as the need arises.

As you think through all of your different options and possibilities, a “perfect birth scenario” begins to take shape in our mind. This is normal and perfectly fine. However, take time to consider “what-if” scenarios as well so that you have contingency plans in place.  For example, what will you do if your labor is unusually long- what pain relief options would you prefer? Or what if you end up needing a cesarean delivery- how might that change your preferences for immediate postpartum time with your baby?

Remember that your birth plan is not a check-list for what will happen during your birth.  It is a plan that includes your wishes and preferences so that your labor support team can tailor their care for you. I like to encourage the students in my childbirth education classes to:

Keep it positive. Long lists of “don’t” and “I don’t want” are not very helpful. Instead keep your phrases positive and open ended. “I would like a natural birth with as few interventions as possible.” Or, “I would like to know what all my pain relief options are throughout my labor.” Or, “We would like to keep our baby with us throughout our hospital stay. We would appreciate your support."

Keep it brief. What are the 3-4 most important things to you? Can you summarize them into brief phrases? Sometimes we need more detail to explain something specific, but your birth support team is much more likely to refer to a birth plan that is brief. “We have prepared for a natural birth. Thank you for helping us reach our goal."

Personalize it. Use pictures, drawings, photos, or colorful writing to help personalize your birth plan. Perhaps you can hang it outside your hospital door or distribute it to the nursing staff when you arrive in addition to leaving a copy with your doctor or midwife.

Be open. We never know exactly how birth will unfold. Your wishes and preferences might change if you were expecting a short labor and ended up with a particularly long one or one that includes back labor. Allow yourself to change your mind. Be open to your birth teams advice.


Above all, appreciate your personal birth experience as perfect for you and your baby. It is a time of growth, a time of learning, and a beautiful rite of passage, whether this is your first or tenth baby. Savor each unique birth experience and remember that our plans and wishes are not necessarily our babies. Allow your birth plan to help your learn, process, communicate, and prepare. And then sit back and allow your birth to unfold.  

Friday, February 14, 2014

The machine that goes PING! Part I: EFM, IV, Cut!



Every woman whose ever given birth at a hospital looks around her at one point or another and asks herself the following questions: What the heck are all these machines for? And, what should I be doing?

Of course the answer is, "Nothing dear, your not qualified!"

But in case you are still wondering what the machine that goes PING is for, or if you expect to birth like the majority of women in the US at a hospital, you will likely experience one or more of the following PINGS during your birth ~ so you might want to learn a bit about them. (You know, just to become qualified to do something during your own birth!)

  • Continuous electronic fetal monitoring (EFM)(93 percent)
  • Restrictions on eating (87 percent)
  • IV fluids (86 percent)
  • Restrictions on drinking (66 percent)
  • Episiotomy (35 percent)
  • Epidural anesthesia (63 percent)
  • Artificially ruptured membranes (55 percent)
  • Artificial oxytocin augmentation (53 percent)
  • Cesarean surgery (24 percent)


(Declerq et al. 2013)

Continuous Electronic Fetal Monitoring (EFM):

This really is the machine that goes PING! You know the machine they hook you up to by wrapping stretchy cloth around the top and bottom of your belly to hold in place two little circles? Yep, that is the EFM machine. The EFM was designed to continuously monitor the baby’s heart rate in an effort to detect fetal distress and prevent injury. Sounds innocuous, yes? However, research shows that one of the unintended consequences of the routine use of continuous EFM is an increase in cesareans without any improved outcomes for babies. (Translation: harmful for mom, no benefit to baby.) (Goer et al. 2007)

The key words are: Routine and Continuous. The WHO and ACOG recommend intermittent monitoring with a Doppler or stethoscope during labor for low-risk healthy moms, every 30 minutes during active labor and every 15 minutes during pushing. (ACOG 2005) This also allows mom to be active and upright during labor which will help keep her comfortable and move things along. 

When is a good time for continuous monitoring? Research shows that there are benefits to continuous EFM if you are using Pitocin, have an epidural, your baby is experiencing changes in heart rate, or if your or your baby are not in good health. But if you are a healthy low-risk mom, research shows that you would benefit more if your doctor monitored you and your baby intermittently with a Doppler or stethoscope.

IV:

Many hospitals restrict normal eating and drinking, but then trying to keep mom nourished through an IV. Yes you read that correctly. The practice of restricting moms eating and drinking began when the majority of moms gave birth under anesthesia and the accompanying fear of aspiration. However, many studies have confirmed that that are no medical benefits to routinely restricting eating and drinking during labor. Instead it deprives a woman of energy when she needs it most. In addition, routinely hooking up moms to an IV during labor restricts movement, may adversely impact labor progression if mom becomes over-hydrated, and increases risk of low blood sugar in babies. (Enkin et al. 2000) The WHO and ACOG recommend fluids be offered to mom by mouth, and the routine use of IV fluids be eliminated. If you are a healthy low-risk mom ask your doctor about a hep-lock, an IV started in your hand/arm that is capped off so that it is in place and available but does not interfere with your movement and normal labor progression.

Episiotomy:

This word often makes women cringe. As it should. For those who don't know what an episiotomy is, it is an incision that a care provider makes to widen the birth canal (yeah- they cut down there!) This is a controversial procedure because research has provided no evidence that routine episiotomy reduces the risk of perineal injury, improves perineal healing, prevents birth injury to babies, or reduces the risk of future incontinence (these are all reasons cited by doctors for the routine use of episiotomies) (Goer et al 2007)(Hartmann et al 2005). Research does show that routine or liberal use of episiotomy is likely to be ineffective and harmful to mother (the list of risks to mom are too long for this article) (Klein et al 1994). The WHO also recommends eliminating routine or liberal episiotomy.

Of course there are times an episiotomy would be beneficial. For example, if a change of position or taking a break from pushing does not resolve signs of distress in your baby, or if your baby is very large or in an unusual position (again, first try changing your positions to see if it helps) an episiotomy might be necessary (i.e. in an emergency). 

If you want to avoid an episiotomy (who doesn't?), discuss your concerns with your doctor or midwife before hand and choose your care provider carefully, push in an upright position that lets your birth canal stretch gently as your baby descends, change positions often while you’re pushing, push spontaneously when you feel urges rather than directed, and remember your body knows how to give birth and be patient!

Look for The machine that go PING! Part II: Pit, Epidural, and Cesarean



_____________________________________


American College of Obstetricians and Gynecologists [ACOG]. (2005). ACOG practice bulletin #70: Intrapartum fetal heart rate monitoring. Obstetrics and Gynecology, 106(6), 1453–1460.

Declerq ER, Sakala C, Corry MP, Applebaum S, Herrlich A. Listening to MothersIII: Pregnancy and Birth. New York: Childbirth Connection, May 2013

Enkin, M., Keirse, M., Neilson, J., Crowther, C., Duley, L., Hodnett, E., et al. (2000). A guide to effective care in pregnancy and childbirth. New York: Oxford University Press.

Goer, H., Leslie, M. S., & Romano, A. (2007). The Coalition for Improving Maternity Services: Evidence basis for the ten steps of mother-friendly care. Step 6: Does not routinely employ practices, procedures unsupported by scientific evidence. The Journal of Perinatal Education, 16(Suppl. 1), 32S– 64S.

Hartmann, K., Viswanathan, M., Palmieri, R., Gartlehner, G., Thorp, J., & Lohr, K. N. (2005). Outcomes of routine episiotomy: A systematic review. Journal of the American Medical Association, 293(17), 2141–2148.

Klein, M., Gauthier, R., Robbins, J., Kaczorowski, J., Jorgensen, S., Franco, E., et al. (1994). Relationship of episiotomy to perineal trauma and morbidity, sexual