This little girl was welcomed into the world absolutely surrounded by loving family - grandmothers, aunts, grandpa, dad, and a fantastic care team. I most remember from this birth the laughter and smiles as the mom heroically pushed her beautiful baby out - amidst much cheering! This image is the new baby clutching tightly to her grandmother's finger just before she received her first bath from grandmom, while mom and dad watched and rested.
Story Behind the Photo | Denton Birth Photography
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Birth Support After Trauma | Tips for Doulas
Originally posted May 2011:
Update: I'm reading When Survivors Give Birth: Understanding and Healing the Effects of Early Sexual Abuse on Childbearing Women
When a woman has experienced trauma in her past it's important for all of her care team (OB, midwife, doula, partner) to be aware of and sensitive to this issue. Trauma can include a history with domestic or sexual abuse, assaults, prior traumatic births, a miscarriage or loss of an infant, etc. These are issues that ideally a woman will be comfortable telling her care team about but she may NOT be comfortable sharing (and probably not something she'll want to share with the variety of medical staff members that may come into her room and/or want to examine her.) Those aware of her previous traumas (doula, partner) will need to respect her privacy while also advocating for her - if she is not comfortable with vaginal exams from anyone besides her primary care provider, this needs to be shared with the L&D nurses or on call doctors, for example. If she's not able to express that need, her partner and/or doula need to make sure her wishes are respected. (If there are extenuating/emergency circumstances that necessitate things like immediate exams then the partner/doula need to turn their attention to helping her cope with the unexpected.) Continue reading
Inspiration
It’s not how much we give but how much love we put into giving.
— Mother Theresa
Consumer Report on Birth!
Here's their report on the ten things to avoid and the ten things to get during your birth. I love it! Especially this part:
"Get labor support. Women who receive continuous support are in labor for shorter periods and are less likely to need intervention. The most effective support comes from someone who is not a member of the hospital staff and is not in your social network—a doula, or trained birth assistant, for example—according to a systematic review of 21 studies involving more than 15,000 women in a range of circumstances and settings. Ask your provider for a referral, and see if your insurance company will cover doula care."
WHAT TO REJECT:
1. Cesareans for low risk births.
2. Repeat cesareans (explore VBAC option)
3. Elective early delivery (medicaid will not pay for inductions before 39 weeks without medical cause.)
4. Induction without medical reason (dramatically increases your risk of cesarean.)
5. Ultrasounds after 24 weeks without medical reason.
6. Continuos electronic fetal monitoring.
7. Early epidurals.
8. Breaking your water.
9. Episiotomies.
10. Sending baby to the nursery.
WHAT TO SEEK OUT:
1. Confirm your due date early (to avoid early inductions/unnecessary interventions at the end of pregnancy.)
2. Make a birth plan - and a back up for alternate scenarios.
3. Use a midwife.
4. If you are at risk considering 17-P shots (for former preemie moms.)
5. Consider an external version to turn breech babies (but first try chiropractic care and Spinning Babies!! That addition is from me.)
6. Stay at home in early labor.
7. Be patient - labor takes time!
8. Hire a doula.
9. Listen to your body, and seek out comfort techniques.
10. Skin-to-skin with your newborn as much as possible (not just immediately after birth.)
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Cesarean Rates for Texas
As you can see here in the metroplex the hospitals with the highest cesarean rates are:
Presby Plano - 49.3%
Las Colinas 45.3%
Medical City Dallas 44.6%
Presby Dallas 43.8%
Presby Allen 42%
Baylor Grapevine 41.8%
Baylor Frisco 39.1%
Sadly I am not surprised at any of those, as they are known for being quick to induced, get moms on pitocin if they are "taking too long" and only one of those has a doctor on staff known for being VBAC supportive (the last one.)
The cesarean rates for the three hospitals I hear most often listed as being natural birth friendly in the metroplex:
Harris Methodist in Fort Worth - 36%
Presby Denton 33.9%
Baylor University Medical Center - not listed, oddly enough! I see University Medical Centers and that may be them, in which case the rate is 21.3%.
Interesting enough Harris and Baylor both have incredibly high risk cases with perinatologists on staff and large level III NICUs (Harris works with Cook Children's for their NICU care.) And yet even as they are fantastic with those high risk cases, both hospitals also have midwives on staff and allow waterbirths for those moms wanting low intervention births. Denton also has a level III NICU but it's much smaller, and they allow a tub for labor but not birth.
For those situations in which a cesarean is necessary then of course you want to be at a care facility with a really wonderful surgeon and excellent anesthesiologist. But if you are anticipating a vaginal birth then look closely at all of your options. A hospital with a cesarean rate near 50% is beyond concerning - it's frightening.
Bloggers for Birth Kits
Bloggers for Birth Kits is a charity program creating birth kits for women in rural Papua New Guinea, where the rate of maternal death is 1 in 7.
Puts things into perspective, doesn't it?
You can donate online here (charges are in Australian dollars, don't worry - your credit card will convert it for you!)
What other charities have you supported to support mother-child health? Last year we donated to Every Mother Counts - another great one!
Story Behind the Photo | Denton Birth Photography
This is an image I captured at the very first birth I attended, and I was so glad I had brought my camera with me! I remember getting a phone call asking, "Would you be our doula?" and laughing - I'm not a doula, I said! I could probably fake it if you need me. 🙂 I'm so glad that I did, as it was the beginning of such an amazing journey. I'm grateful to this sweet couple for letting me learn alongside them as they welcomed their first child into the world.
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VBACs, ICAN, and Special Scars
Unfortunately there is still a lot of misinformation being shared these days about the risks of repeat cesareans vs. VBACs (vaginal birth after cesarean.) According to the ACOG guidelines (American College of Obstetrics & Gynecology):
Attempting a vaginal birth after cesarean (VBAC) is a safe and appropriate choice for most women who have had a prior cesarean delivery, including for some women who have had two previous cesareans, according to guidelines released today by The American College of Obstetricians and Gynecologists.
ICAN is the International Cesarean Awareness Network, an invaluable resource for moms learning more about cesarean recovery & support and VBACs. If you are local here is the link for ICAN of North Texas.
The Special Scars group provides resources and support for moms with any type of special incision - vertical, T, +, J, etc. And want some inspiration??
Here's Abbey's VBA3C with fused sacrum story. She's a local doula and involved with our local ICAN group - she's incredible!
Here's Katie's amazing VBA3C with inverted T incision story. Katie works with the Special Scars group and has wonderful stories on her website - she's a doula & student midwife and someone I've been honored to learn from as a new doula.
In August the Tarrant County Birth Network will be hosting a repeat of our ICAN meeting for doulas on how to better serve moms through cesareans, recovery, VBACs, and those with special scars. I'll post more details once we confirm dates and locations - and yes, I'll be on the panel of speakers, presuming I'm not at a birth. 🙂
However a mom chooses to birth, it's so important that she is given accurate information to make her decision. You have options! As a doula I am happy to support moms in a variety of birth situations, but I also want to make sure every mom knows about the choices available to her.
(Image is the first of my three VBAC babies!)
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Birth Gallery | Denton Birth Photography
This family kindly gave me permission to share the gallery from their birth - you can view it here.
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Hospital Protocols
A client shared with me her notes after a hospital tour. This is a facility with a strong reputation for both natural birth AND high risk situations, which I learned first hand as I birthed my 23 week preemie there! I was thrilled to read about their policies:
· Get hooked up to contraction monitors for the first 20 minutes after check in to confirm labor, then monitors removed. After that, only intermittent monitoring with a doppler.
· IVs are not standard. Heplocks are, but you can refuse.
· Consumption of clear liquids are fine, including jello, broth, popsicles, etc. And if you have been laboring a long time, they bring you peanut butter, granola, or cheese and crackers if your doc is OK with it.
· They made several references to value of freedom of movement and how they want moms to walk throughout labor. They have rocking chairs in all the rooms and provide birthing balls for all moms if requested. I’ve heard they have birthing bars, but there was no reference to any.
· They encourage laboring in the tub in each bathroom and allow you to bring in a rented tub for the birth itself. Their in-room tubs aren't quite big enough to birth in, but they have rooms configured for bringing in a birthing tub.
· All babies are placed onto mom's chest prior to any measuring, checking, etc and stay there through delivery of placenta, at a minimum.
· All assessments are done in the room and all are done with the baby on mom's chest except for about 5 minutes to weigh, measure, check respiration and reflexes. Someone asked about bili lights for jaundice; they bring those into the rooms rather than taking the baby away.
· They made lots and lots of references to skin-to-skin and discouraging any visitors for the first two hours until after mom and baby have breastfed and had time to bond. They also made several references about why skin-to-skin was better than warmers.
· Babies are not bathed until sometime between 7 and 10 hours after birth and then it is done by dad in the postpartum room.
· They expect baby to breastfeed within the first hour and will send in a lactation consultant if you haven't been able to.
· They showed us a nursery, but said not to expect any babies to actually be in it because they expect and plan for both mom and dad to room in until the baby goes home. They provide a 7-foot-long bed for dad in the postpartum rooms and a rocking chair.
· Labor rooms have iPod docking stations, really dim lights, and a very nice overall feel.
· Epidurals were referenced, but the vibe was clearly that they expected you not to have one.
I share this to let you know that hospitals can implement mother-baby friendly procedures - as consumers we need to start expecting this level of care!
* Depending on mother's personal situation & choices this list may be altered - if you choose an epidural then an IV is mandatory, etc.