Today I met with a repeat client for her prenatal meeting- she is due in a few weeks. We were talking about how three years ago I suggested she consider a different hospital than the one she was planning on birthing at. I don’t always recommend a change- but this mom was describing the birth she desired and I knew that the hospital she was choosing would be hard pressed to give her what she desired.

I am often known to say going to some hospitals and asking for a non interventive, naturally supported birth is like going to KFC Chicken and asking for sushi. Now you can occasionally find a store manager who if you go every day and ask for sushi- goes out and gets you sushi knowing that you are coming today to ask again. So, you can have a great birth most everywhere but it may be not the norm and therefore you may have to work harder to get what you want.

This young woman chose to stay at her hospital last time- even though one midwife in the group she did not like- and you guessed it- that is who attended her in labor. After a few hours with no increase in dilation, there were threats of a cesarean being needed and this mom chose to have some interventions she originally had not wanted… then the cascade began- but she ended up with a vaginal birth…her ultimate desire… and of course a beautiful, healthy baby. (more…)


…got an email today from a client saying she would not need the doula she hired after all. Seems her baby is breech and so her doctor has told her she needs to have a cesarean birth. Hmmm… her doctor made this decision when she is only 36 weeks pregnant. I do not know if he talked to her about her options… the various ways to get the baby to turn… the medical ways to get the baby to turn…the option of a vaginal birth with a skilled physician… I do not know if he told her about these things… All I know is as of tonight, she has somehow been convinced that a surgical birth- one which would more than likely determine all of her future births, was her only option… I find this sad. Gentle Birth Archives.

Sad because she put her trust in her doctor to guide her. His or her guidance should be information that then allows her patient to make a decision based on that information. I sent her information tonight in that email in case he or she did not. It makes me sad that she is four weeks from her due date- and actually six weeks from when the baby could come without being officially “late,” and her care provider has already determined that it is hopeless for her to consider a vaginal birth! And sad that the truth may be hard for her since she does not know me or trust me- and her medical care provider is the “good” guy here that she may trust more than the full truth. (more…)


When making a decision, we need to ask the right questions so that we can see our options clearly. This is a little acronym to remind you to use your brain when making decisions. It is useful in labor, but can be used for making all kinds of decisions along life’s journey!
Benefits– what are the benefits of doing this?
Risks– what are the risks involved in doing this?
Alternatives– what are the alternatives to doing this? Are there other options?
Instinct or intuition– what is my intuition telling me to do?
Now what will happen?– what will change if I do this?


Using your brain will help you to gather the information needed to make good decisions!

So, you have taken childbirth classes, read a ton of books and now you think you are ready for the birth of your baby. Well, let me share some things you need to know before you give birth. I share these things because recently I have encounted clients who have realized some difficulties that could have been avoided if a few more questions had been asked before the birth of their babies.

About your care provider: 

Do they understand your birth desires? Sometimes there is no planned time to share what your desires for your birth are with your doctor or midwife. If it is not a scheduled appointment, then ask for a longer appointment time so that you can discuss your desires. Sometimes this is done really late in the pregnancy and it becomes apparent that they may not agree with your desires. But early in pregnancy you may not have formulated your desires yet. So, changing providers, although an option, is not one many people want to do. But don’t be afraid to share your desires and your plans expecting them to honor your wishes even if it is not what they would normally do. This is a consumer driven industry and you do have a say in your birth process. The law says they must give you informed consent. Ask questions, you have to live with the repercussions of the decisions. (more…)
How are due dates calculated?

 

In the 1850’s, a Dr. Naegele determined the average length of human gestation was 266 days from conception, or 280 days (40 weeks) from last menstrual period. He assumed that the average woman had cycles that lasted 28 days and that she ovulated on Day 14 of her cycle. He used his data to come up with a mathematical calculation for due dates: 

((1st day of your last menstrural period -LMP + 7 days) – 3 months) = Due Date. EX: ((January 1, 1996 + 7 days) – 3 months) = October 8, 1996

This is still the standard method used to calculate due date, despite the fact that it doesn’t take into account: that many women are uncertain of the date of their last menstrual period and not all women ovulate on day 14. Other factors which affect term are: mother’s age, ethnicity, prenatal care, prenatal nutrition, number of prior pregnancies.

Another Calculation (more…)
The increase in cesareans today is linked to the increase in inductions. but there is certainly a seduction to induction today. The reason for inductions being so prevalent today is multifaceted. There are reasons to medically induce a labor. The signs of preeclampsia is one reason. There are some conditions that make the pregnancy threatening to the mom’s health as well as the baby’s. But many inductions are not medically indicated. 

When a mom has had a fast birth the first time, sometimes there is concern about a precipitous labor with the second. I have accompanied moms in just such an induction. Many times the induction is easy, but it can also cause the labor to be more painful and longer than it would have normally been if not interfered with by the induction.

 

Sometimes childcare arrangements for the couple with one or more children, makes an induction seductive. Knowing the exact day the birth will occur helps some couples decide to have an induction. The element of the baby not being ready, or the body not responding to the induction in a favorable way is always a risk. (more…)

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.

 

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. (more…)

Do you need a birth plan? I think it is important to think about and discuss with those who plan to support you in birth, about your birth ideals. But, I think it is not only misleading but unreasonable to even begin to think that a woman can really plan her birth. I believe that we need to think in terms of planning our births in a different way.

Take the online birth plans that are out there on the internet today… considering the ideas that they make will help you to begin to consider your options. How should you consider their usage? The ideas suggested are great if you use it for facilitating communication between you and your birth team prior to labor beginning. But expecting the nursing staff to read a three or four page document prior to supporting you in labor is not something that I believe is reasonable. The ideas you may have for your birth should have been discussed a long time prior to you arriving at the location for your birth. Your doctor or midwife can write orders for you based on your ideals after this conversation occurs. Their written orders have much more clout than a document you bring to the hospital.

Since so many practices have multiple doctors or midwives within the practice, having a birth plan that is approved by one provider does not insure that the next provider will agree. Many women think that if their primary provider signs the document it insures them of their wishes being taken seriously. I hate to say, this does not. (more…)

I want to be well now! I want to be done hurting- done being sedentary… done… And then this made me think about women who are pregnant. Seems women anticipate- prepare- read- go to class- talk about- and wait for the contractions to begin. But then we they do they either focus too much attention to the early ones that are not really worth demanding their attention yet, or they get anxious about them not starting and agree to an induction. But it is all a process. And when you try to hurry it up, there are consequences. And we need to understand that being patient and waiting for things to happen as they are supposed to is a virtue.

When we try to rush things, force things, whine about the time it takes, we are fighting the process. I have seen the rushed processes in labor and birth- they are not pretty. They are full of interventions, surgical births and regrets on the part of the parents. So, I am going to try to remember the words I preach as a doula… trust the process. I will wait patiently- trusting that my body is healing just the way it should- at just the right speed.

This process of cancer and the aftermath has taught me so much as a doula and childbirth educator. I just hope I can impress upon my students the need to trust their bodies and the process along the way.

imagesToday I received a call from an intelligent woman who has run a marathon before. She read an article I wrote- visited my website and decided she may like to have a doula. I was super excited to hear from her. But then as we talked I was sad about some of the information her doctor had given her. Since she has somehow bought that she has a low tolerance for pain- which I doubt if she is a long distance runner- and would need an epidural. But she was open to considering she may not. I asked her how she would know what she may need in labor since she had never been in labor before. But her doctor had told her that the hospital childbirth class was really geared to women who wanted a natural birth- which I also doubt since most hospital educators are required to teach a certain curriculum that the anesthesia and obs approve. But since she was considering using an epidural, her doctor told her that the class would be useless to attend.

So, now instead of having a full range of options available to make an informed decision- she has been limited to the books she has read.

I was delighted she had found a good one- Pregnancy, Birth and the Newborn by Simkin. But it made me sad when she commented that she wanted to choose what was best for her and her baby… and somehow had come to believe that may be an epidural. I discussed that she needed to understand the risks of all of the decisions she would make in labor.

She is considering a private class with me. I do not have a problem with the choice of an epidural, but when it is the only option you have- you have little options. I believe in full informed consent. Women trust their doctors to guide them- in the best interest of the baby and them… when did “learn all you can about all of your options” not become the best way to guide someone in an area that is unknown like birth? When did it not become about helping a woman empower herself?

I hope she attends my private class- I will at least know then that she is making informed decisions that are the right ones for her- instead of the ones the doctor chooses for her.