I recently attended a birth where the mom wanted to decline getting an IV access. This was not news to her doctor. She had told her doctor numerous times that she wanted to decline this procedure. My client was well informed and knew that evidence did not show this was an essential intervention for a healthy mom birthing. She had done her research and read the articles like this one in Evidence Based Birth.  She had planned to keep well hydrated and felt it would restrict her.

When she arrived to the hospital she was well rested, hydrated and contracting regularly and moving along in her labor. She was put on the monitor for her twenty minute strip and within 40 minutes was told the baby looked great and she would be coming off the monitor. BUT when the nurse went to set up for placing the INT – IV access and the mom declined the nurse changed her tune and she was told she had to remain on the monitor until the doctor who was in a delivery would come in to talk to her.

choppy waters

So we waited another twenty minutes or more for the doctor to arrive. She sat on a stool and discussed the reasons for doing an INT. She mentioned that she once had a mom who needed a cesarean and did not have an IV and they almost had to use lidocaine on her belly to do the cut for the cesarean. THERE IS NO WAY that would have occurred. The vein in the bend of the arm is almost always accessible and can be done in an emergency. And this mom would have been put under general anesthesia before doing such a procedure.

Then the nurse decided to chime in. She said that if the mom who had desired to get in the tub wanted to stay in the tub as she once had agreed upon (Not funny how the nurse had to agree to allow this mom to get in the tub), she instead of staying in the tub for 50 minutes and out for 10 for a monitoring strip ( she said the one telemetry unit was in use and did not  work well with the jets on in the tub) she would instead have to get out every 20 minutes for a 10 minute strip. She said without the INT she would be worried about the wellbeing of the baby. And she reminded us that it was about her license.

I knew this mom had just been told two LIES to try to manipulate her. Coercion has no place at a birth. Then the kicker- her doctor is going off call after saying she felt the mom could stay in the tub for the full 50 minutes of every hour. And the new doctor coming on is not happy that the mom does not have an INT. This is a doctor in a completely different practice- one she has never even had an opportunity to meet. Did you know that your practice may be one of the practices that shares call with another whole group or two or three of doctors? This doctor said they would not have accepted a patient who was not willing to allow an INT.  So of course he wants her to get it. So now the nurse is still making the 20 minute rule stand.

The dad was fabulous! He said, “So wait. because my wife is declining the INT you are going to punish her?” I had to bow my head to hide the huge smile that spread across my face. This is not my battle to fight for them. I can remind them of what they desired and support them but my words should not enter into this negotiation. So this dad stepping up with such raw honesty was fabulous.

The mom and dad talked about having some time away from the manipulators and decided to get the INT. The freedom of being in the tub for longer lengths of time was more important in the end. What is sad about this story is this should never have happened. Having an INT IV access is not essential to a birth. If the mom had been dehydrated or wanted medication she could have gotten it early on. This was not this situation.

Sometimes you make a decision to use a provider or birth location you will find more choppy waters to negotiate than others. This couple was well prepared. They had had several discussions about what they desired in their birth. Their provider never said that they HAD TO HAVE an INT. She only asked them to keep considering it. The dad said he felt the doctor had been a push over or conflict avoider. I feel that she was a bait and switcher. She never told them what she knew she would inevitably make them do. The nurse who had lied and been manipulative all of a sudden found the telemetry unit and started to be kind after the INT was placed.  She even told the mom she was lucky she was the one placing the INT since she never put it in the moms hand so she has more mobility and she used lidocaine so it was less painful. Gee- you mean the other nurses if she waited would not honor those same desires? Thanks!

I respect this couple for standing their ground- although I do think all of that adrenaline and lack of ability to relax and go to her laborland space interfered with her labor. I do think that when they repetitively asked her why she was declining and she repeated herself over and over, she was not being respected or heard. I do think that having to fight in your labor is counterproductive. I think they were worn down a bit but I feel in the end they chose their battles. But why do we have battles in labor to begin with?

When will informed decisions by a woman in labor be respected? Several times the word dead baby was used in the conversations about this procedure. When you use such phrases as sick or dead baby, it makes women fold. That was not true in this case because this couple recognized the lie. I hate that this couple had to even have any of these conversations taint their beautiful birth.

This couple negotiated the choppy waters of this hospital. They knew there would be some battles when they learned that this hospital had protocols that were not evidenced based and were more interventive. I am unsure if they knew that several practices shared call with their practice.  Negotiating beforehand does no good at all in this case.  Making a concession to get the INT for more freedom in the tub was one I would have made as well if I had been in this same situation. Having her husband as her protector and extra emphasis to her voice was priceless.

Understand the choices you make may mean you need to learn how to negotiate choppy waters in labor to get closer to the birth you desire. Ask your questions long before you get into the last months of your pregnancy.

I published this article in November 2008, but felt it needed to be republished.

Babies born by cesarean section before labor are more likely to have breathing problems and to need special care in the early days of life, compared to babies born after labor. Sometimes the obstetrician thinks the baby is older than he or she actually is, perhaps even ignoring the mother’s opinion of when she conceived. Other cases seem to reflect the normal human variation which leads some babies to mature sooner than others, just as they roll over, sit and walk at different times. None of the tests are 100% accurate in dating a pregnancy or in assuring fetal maturity. However, even when the baby is definitely mature, a certain number of born before labor suffer from lung disease, particularly complications from excess fluid in the lungs.

cesarean

A recent article in Scientific American documents why labor benefits,including their lung functioning. (“The ‘Stress’ of Being Born,” Hugo Lagercrantz and Theodore A. Slotkin, Scientific American, April 1986, pp.100-107). Hormones called catecholamines are released in the baby in response to the stress of experiencing contractions, being pushed through the birth canal, and the intermittent oxygen deprivation which occurs in normal labor. Twenty years of research indicates that these hormones not only protect the baby from a lack of oxygen, but also prepare him or her to adapt to life outside the womb. Adults also produce catecholamines in response to physical or emotional stress. The heart rate increases, while blood is redirected away from many organs and sent to the heart, brain, arms, and legs, all needed for the so-called “flight or flight” response. This is the reason for a mother’s fear and anxiety can lead to prolonged labor and fetal distress. (See C/SEC Newsletter, Vol.12(2), 1986). With the immature nervous system of the fetus, however, catecholamines work somewhat differently. Blood is kept in the brain and heart rather than the limbs, and the heart rate shows rather than rises. This allows the brain to survive without damage at much lower oxygen levels, similar to the way people can survive for hours in very cold temperatures under ice or buried in snow. The discovery of this different response to stress in the fetus means two things: 1) Babies are well protected from reduced oxygen in labor; and 2) When the fetal heart rate slows in labor, rather than meaning the baby is in danger, it may mean the baby is being protected from damage. This process explains why over 50% of babies delivered by emergency cesarean after monitor tracings indicate fetal distress are in fact not short of oxygen at birth. The authors recommend that only when fetal scalp blood sampling shows the baby is truly short of oxygen should he or she be delivered quickly. Catecholamines appear to help the baby adapt to life outside the womb in several ways. First, a surge of catecholamines in labor facilitates breathing by causing fluid to be absorbed from the lungs and surfactant to be released. (Surfactant allows the lungs to remain open once they are expanded with the first breaths.) Lung compliance, the ability of the lung to stretch and fill with air, is partially dependant on lung liquid absorption. In research at the Karolinska Institute in Sweden, lung compliance was correlated with catecholamine levels at birth.

Two hours after birth, vaginally delivered babies had significantly better lung compliance compared to cesarean babies. This helps explain why even mature babies born by elective cesarean are more likely to have breathing problems. A second benefit of catecholamine surge at birth is to speed up the baby’s metabolism, so energy stores in the liver and fat cells are made available until the baby begins to nurse. Cesarean stored fuel, and were more likely to have low blood-sugar levels. The burning of stored fuel also helps the newborn maintain body temperature. A third effect of catecholamines is to alter blood flow so more blood is sent to the vital organs. Blood flow in vaginally delivered babies was lower in the legs and higher through the lungs during the first two hours of life. This effect is particularly important for babies experiencing breathing difficulties right after birth. In general, the higher the catecholamine surge, the better the baby can withstand oxygen deprivation. Babies who were moderately deprived of oxygen during birth had good Apgar scores if they had high catecholamine levels and lower Apgar scores if they had low catecholamine levels. This was published initially in November 2008, but I felt this information was worthy of republishing- Another effect of high catecholamine concentrations is to produce a state of alert arousal. It is possible that the catecholamine surge leads to the extended quite alert state which usually occurs in a healthy baby in the first hour of life, and which may contribute to the beginning of parent-infant bonding right after birth. The Karolinjska Institute studies also found that babies born by elective cesarean without labor had markedly lower catecholamine levels compared to those born vaginally, while those born by cesarean after labor had begun had only slightly lower levels. The message seems clear: A mother who wants a VBAC is not putting her own experience ahead of her baby’s well-being. Babies benefit from a vaginal birth whenever possible. When it is not possible, they benefit from experiencing labor before a cesarean birth. The authors conclude, “Taken together, the weight of the evidence indicates that the elevation of ‘stress’ hormones in the normally delivered newborn reflects not only a response to acute stress but also an attempt by the body to enhance the chances for survival at birth. Such findings suggest that infants delivered by elective cesarean section before the mother begins labor may be at some disadvantage.”

How Labor Benefits Babies: Adaptational Effects of a Catecholamine Surge

  • Improves Breathing
  • Increases lung surfactant
  • Increases lung-liquid absorption
  • Improves lung compliance
  • Dilates bronchioles
  • Protects Heart and Brain
  • Increases blood flow to vital organs
  • Mobilizes Fuel
  • Breaks down normal fat into fatty acids
  • Breaks down glycogen (in liver) to glucose
  • Stimulates new production of glucose by liver
  • Activates heart-producing brown fat in response to cold
  • Facilitates Bonding
  • Dilates pupils
  • Appears to increase alertness

(From “The ‘Stress’ of Being Born,” by H. Lagercrantz and T.A. Slotkin, Scientific American, Apr.’86, p.106.)

So why are doctors usually unwilling to have a planned cesarean occur only after a mom goes into labor when it is not due to things like placenta previa where going into labor would prove too dangerous? I have heard doctors state that when it is planned they are not awakened in the middle of the night and would be more alert. I have heard it is difficult to get the surgery staff together last minute. Well, if I needed surgery in the middle of the night I would hope the doctor would be alert and the staff assembled quickly. I am sure that it is easier to do it in a planned surgery but if that is not the best for the baby, then don’t do it!

Most of us guess at our due dates. It is based on last menstrual periods with the speculation that you will ovulate mid month. Unless you have perfect ovulation cycles and your baby gestates perfectly on schedule- or you have IUI or IVF , you really may not know exactly when you are due. The earliest ultrasound is usually the best one to determine the age of the baby based on developement. What is considered term pregnancy? ACOG defined this in 2013, http://www.acog.org/

Definition of Term Pregnancy

ABSTRACT: In the past, the period from 3 weeks before until 2 weeks after the estimated date of delivery was considered “term,” with the expectation that neonatal outcomes from deliveries in this interval were uniform and good. Increasingly, however, research has shown that neonatal outcomes, especially respiratory morbidity, vary depending on the timing of delivery within this 5-week gestational age range. To address this lack of uniformity, a work group was convened in late 2012, which recommended that the label “term” be replaced with the designations early term (37 0/7 weeks of gestation through 38 6/7 weeks of gestation), full term (39 0/7 weeks of gestation through 40 6/7 weeks of gestation)late term (41 0/7 weeks of gestation through 41 6/7 weeks of gestation), and postterm (42 0/7 weeks of gestation and beyond) to more accurately describe deliveries occurring at or beyond 37 0/7 weeks of gestation. The American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine endorse and encourage the uniform use of the work group’s recommended new gestational age designations by all clinicians, researchers, and public health officials to facilitate data reporting, delivery of quality health care, and clinical research.

In fact, approximately 7% of babies are not delivered by 42 weeks, and when that happens, it is referred to as a “post-term pregnancy. ”

42-weeks-pregnant-the-end-of-pregnancy-e1357175738877

ACOG even has a pamphlet with information titled  What to Expect After Your Due Date.

It is stated that  the risks of waiting to have your baby once you are postdates are:  dysmaturity syndrome- decreased alertness, low birth weight, and increased respiratory distress, the placenta gets older and may not work as well, the fluid gets less and can cause the umbilical cord to become pinched, the chance of the baby becoming too big is increased and the risk of meconium aspiration is increased. They say it may also lead to an increase of a cesarean birth.  They suggest checking on the baby’s well being by using two tests, a biophysical and a non stress test.

There is an excellent blog Birth Without Fear that addresses this as well- http://birthwithoutfearblog.com/2011/08/22/what-acog-has-to-say-about-due-dates/

The Cochran Database is considered a location of studies and summaries that are evidenced based. http://summaries.cochrane.org/

Induction of labour in women with normal pregnancies at or beyond term (more…)

This was a question posed on a birth professional group I am a member of online. I wanted to share the top ten things that birth professionals- midwives, doulas and educators had to share.

(One person said it was hard to pick just one since there were many issues.)

one thing

  1. staff was shared- the lack of education on their part and the lack of desire to support laboring women.
  2. many said it was the lack of education on behalf of the woman- about her choices, her options and even the birth process itself, leading to a lack of informed consent. And women not knowing what they do not know until it is too late- and women not taking responsibility to make sure they know.
  3. induction was sited by many, the lack of trust women had in the birth process and allowing someone else to intervene in the process.
  4. profits and lies was mentioned- lies between women talking to women, lies between medical professionals to women, lies between parents to children.
  5. laziness, passiveness and apathy- it is easier to just show up- get the epidural or the planned cesarean than it is to learn what you need to learn to actually labor to birth- looking for a reward without putting in the work.
  6. power over instead of power within- women giving up their power.
  7. fear- fear of the unknown, fear of failure, fear of not being accepted, fear of being treated badly if you do not obey.
  8. fear mongering by pharmaceutical and medical professionals- and preying on this ignorance of the consumer.
  9. lack of support- being more focused on machines to tell us how a woman is doing rather than looking at and supporting the woman.
  10. the medicalizing of birth and women no longer being taught to trust birth and own their birth and their decisions.

I do realize that all women do not want a non interventive natural birth. but as a birth professional I will say that often we say many women do not know what they do not know. Now this is not every woman- but I will say it is the majority of women today. They may read a few books- many of them instilling more fear with a splash of comedy but no real truths revealed. They may watch some youtube videos and maybe even get one from netflix but they do not really seek out information about their particular community from those who will reveal the truth. Birth has become a business. Women are looking for quick appointments with no waits. They want a fancy office decorated beautifully. They want a local hospital to be a close drive that is beautifully decorated with the newest of all the gadgets. They want to be directed by their doctor and told what to do so they do not have to take much if any responsibility for the outcome of their births. They want a nursery with the highest level of NICU for the just in case, not realizing that many of the interventions is what causes their babies to be in the NICU. They want someone to help them perfect breastfeeding with one quick visit since they did not take the time to take a prenatal class. They want a comfortable bed for their partner and great food for them both while being taken care of in both labor and postpartum. The idea and benefits of getting home quickly are not something they would fathom.

What we do know- for a healthy mom- the fewer interventions the better outcomes for both her and her baby. The shorter the stay, the better outcomes with breastfeeding and less intervention for the baby. Healthy mom and healthy baby relies on less intervention not more.

do not disturb

Birth will not change until women change birth. Doctors and hospitals cater to the consumer. If you demand a different experience, they will begin to listen and offer you options you desire. Birth will not change until women take back their birth responsibility. Preparation is up to the woman. You can not expect an outcome without putting in the effort to make that ideal birth happen.

Change is happening. Inductions were at such an increase that cesarean rates rose so high insurance companies started to look into the situation. Why was birth costing so much more? Women were getting more drugs, having more surgical birth and babies were spending more time in the NICUs across the country. When the cesarean rate is upwards to 40% something is really wrong. When women begin to believe that an induction at 37 weeks gives them a full term baby to only find that baby born prematurely and needing NICU support for weeks, something is really wrong. When women elect to have major surgery after their first birth ending in a surgical birth, not realizing the risk to their bodies and their baby’s because of the fear put in them to have a VBAC, something is wrong, especially since the rate of rupture increased only due to doctors fiddling with a woman’s body after having done so the first time leading to that cesarean.

If you want to change your birth experience from the “normal” birth today, you have got to take responsibility in doing so. Take a childbirth and breastfeeding class that is taught by an independent educator- not where you pay the hospital or your doctor.  There is control over what those educators can teach. Get your team together- your partner needs some classes too! Hire a doula- not just a friend but someone who is trained to help you have a better chance for a better outcome. Eat a nutritious diet, growing a baby with a healthy diet and get exercise. Learn about optimal fetal positioning and help your baby line up for an easier birth. Choose your care provider wisely. Does he or she listen to you in a respectful way? Do they guide you to explore options that are right for you? Do they encourage you to investigate choices that are available?  Choose your location for birth carefully. Every hospital is not right for every woman. Find out what the stats are at that hospital. It is great if your doctor has a low epidural rate if you want a natural birth, but if the staff only sees medicated births, how supportive will they be or even know how to be for you?

I recently have a mom who was beginning to take homeopathic tinctures to get her labor going. I asked her why she was considering this induction. She was taken aback by my question. She had no idea she was about to begin an induction. This is not to say she should not have been doing so. Nor do I believe that in most cultures there are things done and items consumed to help get a mom going if she is at the end of her pregnancy. But it made me aware that sometimes we do not know what an induction means.caulophylumcomplex

When you do a web search of induction of labor you will find things like this:

Induction of labor

Web definitions:(obstetrics) inducing the childbirth process artificially by administering oxytocin or by puncturing the amniotic sac.

ACOG states:

Cervical ripening is the first component to labor induction. If the cervix is not sufficiently dilated, then drugs or mechanical cervical dilators should be used to ripen the cervix before labor is induced. Once the cervix is dilated, labor can be induced with oxytocin, membrane stripping, rupture of the amniotic membrane, or nipple stimulation. Misoprostol, a medication for peptic ulcers, is a commonly used off-label drug that both ripens the cervix and induces labor. The ACOG guidelines indicate that inducing labor with misoprostol should be avoided in women who have had even one prior cesarean delivery due to the possibility of uterine rupture (which can be catastrophic).

We understand the risk of medical inductions. The domino effect can often cause a surgical birth to be the outcome when it is rushed and not done gently. But I want you to consider things outside of the medical induction as induction. I believe anything outside of your normal activity or what would be normal for most, is an induction method. And I would then suffice that anything that is not common or natural for your normal activity is a means of inducing.

So, having sex- great sex- can give you prostaglandins (semen) and oxytocin or nipple stimulation (orgasm) – therefore it is not an artificial or unnatural method of induction. Going for a nice walk is normal. Having good oils in your regular diet would also perhaps help to ripen your cervix and would fall in that normal realm. But taking castor oil is probably not something your body is used to having on a regular basis. Taking evening primrose oil is probably not in your regular diet either- although it is not an induction method but can ripen your cervix. Eating papaya, pineapple and eggplant is normal foods- and they are found to be natural cervical ripeners.
Taking a homeopathic like sites like www.gentlebirth.org state:
Cohosh (in my experience) can make lots of uncomfortable toning contractions and false labor sometimes with the risk of raising the blood pressure. Because of this, I suggest another option which is taken orally. Nutritional Formulas make Matrigin. A similar medicine is made by Weleda with a different name-Dolisos Caulophyllum Complex. It is a 5 remedy homeopathic concoction that has reduced the length of labor in a double blind study in France (The Dolisos Study). Women started taking it at the beginning of the ninth month.I have used it for preventing postmaturity and ripening the cervix in a few women who would seem to benefit from that. The remedies in the combination are Arnica, Caulophyllum, Cimicifuga, Pulsatilla and Gelsemium. Perhaps clients seem to fit to the personality/fears/symptoms of a certain remedy, in which case it is better to give a single remedy if a remedy is even warranted. Cimicifuga fears she will die in childbirth, for example. I have turned to caulophyllum in a putzy labor.

But although some folks may take items like arnica for bruising or injuries, it is doubtful that most of you would the other homeopathics on a regular basis. If it is not something you have taken before, remember you could be hyper sensitive to this.

So realize although something may be homeopathic or natural in a sense, it may still be a means of induction. It is not just about breaking the bag of water, putting Pitocin in a woman or giving a medical method of cervical ripening for it to be the only method of inducing a labor. And any method of induction may not be without risks.

This reminded me of weaning a breastfed baby. Many do not realize that putting a pacifier in the baby’s mouth or offering a bottle of breast milk or formula is weaning. You do not need to offer solid foods for it to be weaning.

Make an informed decision.  Do your research. Understand the benefits. Know the risks. Take your birth decisions back and make the right ones for you and for your baby.

Well… I guess they could, but it is really rare. Sometimes women come to us as doulas and begin to detail their dream birth. They tell you how they want it to unfold. And then we ask them what they are doing to make that happen. They often pause and then say, well we are hiring a doula!

magical

Hmmm… doulas are great. I can say that because after all I am one! I think we offer wonderful services to support moms and families. BUT, we are not GOD. We can not make your birth magical an unfold just as you dream. Recently I talked to a young doula who had already begun to burn herself out. She had felt disappointed that she had not had more of an impact on the few births she had attended. But as we began to chat, I realized she was beginning to take responsibility for the woman’s birth rather than helping the mom to take responsibility for her birth. Doulas can certainly help the outcome of births be improved but she is only one part of the equation. At times we may be told what we did was magical- but we do not perform magic per se!

When my oldest daughter had three beautiful births that were neither long or complicated, many of her friends told her how lucky she was. They did not realize she was well read, taken fabulous childbirth preparation classes, taken prenatal yoga, ate healthy, exercised and had really prepared her mind and body for her birth. Hmmm… her birth may have been magical because of all of those things.

And I have been with women who did everything within their power to prepare for their births and still ended up with a difficult or complicated birth experience. Why does that happen? It really is unfair! Those are the births where as a doula we really do wish we had a magic wand! But we have to remember there are two people in labor during a birth… the mom and the baby. Sometimes there are things we can not prepare for and have no knowledge about until the aftermath that the baby knows, but we don’t.

But remember when you hire a doula, you need to also do many other things to prepare to make that magical birth more likely. And let me remind the doulas who read this blog, it is the mom’s birth- not yours- you can be responsible to support her, encourage her, share the things you have learned in your training and experience within your scope of practice and love her- not give her a magical birth. We must give the responsibility for the birth back to the mom and baby… and the unknown who is all knowing!

I have known Brenda Parrish for a couple of decades. We met online and did not meet in real life until a year or so ago at a breastfeeding rally. She had just recently moved from south Georgia to the metro area. She is a fabulous home birth certified professional midwife. I in fact am awaiting a birth with her to happen soon. Here is her protocol for women to kill the GBS bacteria that sometimes lives within us- in fact some say 40% of women have it at any given time. It is not dangerous unless you are giving birth when it is present. If the baby picks it up once your water breaks, it can be fatal to the newborn. Ironically the only baby I have ever been the doula for who went to the NICU with GBS+ status was a mom who had tested negative! But here is her wonderful protocol that has proven to be very effective in her home birth moms!

brenda

 

Sometimes being forced to think “out of the box” leads to accidental discoveries that end up being quite important.  Such has always been the case of midwives who are open to alternative remedies, especially when the medical alternatives tend to have unwanted side effects.

GBS (group beta strep) is the most common cause of sepsis and meningitis in newborns and can cause newborn pneumonia.  Many people carry GBS in their bodies but do not become ill.  Because it can be present and not cause problems, many women are colonized and do not know it.  A baby can become colonized if the mothers is colonized in the rectum or vagina at birth.  This normally happens during labor or birth.  The standard of care is for mothers who test positive to GBS to receive intravenous antibiotics every 4 hours during labor to help prevent the baby from becoming sick.

Many CPMs (Certified Professional Midwives) do not have access to the recommended intravenous antibiotics to treat GBS.  So we have always looked for alternative ways to reduce the colonization in expectant mothers who have tested positive.  For many years, I have encouraged women to insert a peeled clove of garlic vaginally at bedtime-either one week on and one week off or every other evening  until delivery. (a cheesecloth packet holding the clove is an easy way to get it out.) We followup with the use of Hibiclens disinfectant solution to rinse the outmost vaginal canal and perineum during labor.  While this has actually served me well for many years, I’m sure it is not the most pleasant experience for the mothers.

Several years ago, a study was presented at a MANA (Midwives Alliance of North America) Conference detailing the use of a specific probiotic to actually keep GBS bacteria in check or significantly reduce the colonization, thus increasing the number of mothers who would test negative.  The product was FemDophilus and it contained a strain of good bacteria called L. Rhamnosus.  This made such good sense to me.  If we could help moms to simply naturally control GBS colonization without the use of antibiotics, it was a win-win situation, because even though the antibiotic normally works pretty well, it is not without side effects for both mother and baby.  If we could do something that had only GOOD side effects, how much better would that be?

I looked around for this product and didn’t find it right away but after reading a few labels, I realized Jarrow made yet another formula called “Jarro-Dophilus EPS” which was readily available locally and also had a significant amount of the desired L. Rhamnosus.  So, a little over two years ago I began to strongly recommend that all the clients in my care take this probiotic formula daily as a preventative to GBS.

jarrow

In that period of time, until recently, I had not had a SINGLE mother test positive.  Recently I had one mother who was positive with her first pregnancy test positive again.  I have not questioned her yet as to how closely she followed the protocol.  Another mom was in her fourth pregnancy and had never tested positive before so she did not take the probiotic on a regular basis.  The third was an expectant mom who transferred to my care one week before we ran the GBS lab and had earlier tested positive in a urine culture so she is very highly colonized and one week was not a sufficient amount of time to make much difference to her digestive tract.  So, that’s a pretty good track record.

My protocol is this:

New client in the first trimester-no previous GBS history and no UTIs–just take one of the EPS formula probiotic a day.

New client in the first trimester-previous positive GBS or a positive urine culture–take three probiotics a day for a week, then 2 a day for a week, then one for the balance of pregnancy.

Late transfer-3 probiotic a day for a week, 2 a day for a week, then 1 a day for the balance of pregnancy.

Once I question the mom who tested positive recently that had a previous positive GBS in her other pregnancy, I may tweak that protocol in the future to stay on three a day for a longer period of time.

But so far, this probiotic is having very good success. Nice side effect is several moms have mentioned that is also seems to be helping them with regularity.

 

Brenda Parrish, CPM, CLC is a homebirth midwife who currently lives in Marietta and serves metro-Atlanta area mothers in their quest for a natural birth.  Originally from south Georgia, she served women there for many years before relocating her practice.  Her first primary “catch” was the late in life “surprise” baby born to her former preceptor, 18 years ago.  Many babies later, she is still enjoying her midwifery career.  She is a mother to three grown children and “Nana” to seven delightful grandchildren.  She loves music and singing (used to work in a recording studio and in a traveling music group), photography and scrapbooking, crafts, sewing and good food.

Traditional  Birth Services, LLC

http://traditionalbirthservices.com

Charlotte Sanchez another home birth midwife has offered her suggestion for probiotic use. I thought I would share this as well- She recommends this probiotic due to the higher level of good bacteria. You can see this one is for vaginal health specifically and has 50 billion organisms per capsules.

ultimate flora

 

formula gift

I went to a blessingway last night. The pregnant mother being honored mentioned that although she has every intention to breastfeed, she thought it odd that she received two large containers of powered infant formula in the mail. I asked if she had registered at BabiesRUs and of course she had. What she did not realize is they sell her name to the formula companies to get free samples!

Today on facebook a fellow doula and friend of mine posted this picture. A gift the mom received at the hospital. These hospitals get free formula for their hospital by giving away free gifts to each mom who has had a baby. The bottle feeding moms get a huge supply while the breastfeeding moms get a smaller sampler.

It is no wonder that in the metro area of Atlanta we still don’t have a Mother- Baby Friendly hospital.  Our local hospitals may have IBCLCs on staff- others only have limited access to these trained women, but they also hand out nipple shields, pacifiers and formula with great regularity.  There are ten steps to becoming classified as Mother Baby Friendly.

The Ten Steps to Successful Breastfeeding are:

  1. Have a written breastfeeding policy that is routinely communicated to all health care staff.
  2. Train all health care staff in the skills necessary to implement this policy.
  3. Inform all pregnant women about the benefits and management of breastfeeding.
  4. Help mothers initiate breastfeeding within one hour of birth.
  5. Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants.
  6. Give infants no food or drink other than breast-milk, unless medically indicated.
  7. Practice rooming in – allow mothers and infants to remain together 24 hours a day.
  8. Encourage breastfeeding on demand.
  9. Give no pacifiers or artificial nipples to breastfeeding infants.
  10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or birth center.

How do you think offering pacifiers, throwing nipple shields at moms who have latch issues and handing out free formula fits into this initiative?

I hear women say, “I had an emergency cesarean.”  I have attended well over 500 births and I have to say there have only been three that were real emergencies. If you have time to discuss things with your care provider. Time to get your partner dressed for the birth, and time to have them pack up the room, time to make a phone call, etc… then it is not an emergency situation. Emergency cesareans happen quickly. The room fills up with staff- your bed is unhooked from the wall- they are shouting orders as they wheel you down to the OR… if your care provider is not there they will snag any doctor available… that is an emergency cesarean. If you don’t have an epidural then you are put under general anesthesia and your partner is not invited into the OR suite at all. So, unless that happened, note that you had an unplanned cesarean. And according to the statistics those will more likely occur between 8am and 5pm, next likely between 5pm and 11pm and rarely between 11pm and 7am… why? Because there is less “management” of your labor and your care provider is sleeping or may not even been at the hospital. Then you have to ask yourself was my unplanned cesarean really necessary at all?

After all as in Monty Python’s The Meaning of Life, you are probably not qualified to know how to birth!

meaning-of-life_frame

Recently a doctor wrote an article Top Ten Signs Your Doctor Is Planning To Perform An Unnecessary Cesarean Section On You to forewarn parents of the signs that your doctor really does not like to wait for natural birth to occur. His honesty is profound. I consider this a must read!

I recently had a birth at a satellite hospital in North Forsyth. It was my first birth here. I had hoped it would be a great facility that supported natural birth since some of the doulas with my company have had good births here. The mom had vacillated about moving to a different facility but due to insurance reasons, made the decision to stay the course. She took a childbirth class with friends of mine and felt really prepared.  We had discussed being prepared to have to stand firm in some areas if she wanted the birth she desired.

She started out with on again off again type contractions that had started Sunday and continued into Monday. She had had an exam in the office on Friday. (Vaginal exam 3- she had had two prior to this appointment) Often times labor gets a kick start by having an exam. But sometimes the exam causes a start that is not quite ready to get going and thus leads to an on again off again irritated uterus. The mom had knowledge of the risks.

I was in touch with them on and off.  I met them at the hospital early on Tuesday morning. She was concerned that she was not yet in active labor. And then we met our nurse, Tammy. She came in and announced we were lucky since she was not only a nurse but a previous midwife. She then told my client that if she was wondering if she was in active labor, she most certainly was not. BOMB!

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