A baby asked God, "They tell me you are sending me to earth tomorrow, but how am I going to live there being so small and helpless?" God said, "Your angel will be waiting for you and will take care of you."
The child further inquired, "But tell me, here in heaven I don't have to do anything but sing and smile to be happy."
God said, "Your angel will sing for you and will also smile for you. And you will feel your angel's love and be very happy."
Again the small child asked, "And how am I going to be able to understand when people talk to me if I don't know the language?"
God said, "Your angel will tell you the most beautiful and sweet words you will ever hear, and with much patience and care, your angel will teach you how to speak."
"And what am I going to do when I want to talk to you?"
God said, "Your angel will place your hands together and will teach you how to pray."
"Who will protect me?"
God said, "Your angel will defend you even if it means risking its life."
"But I will always be sad because I will not see you anymore."
God said, "Your angel will always talk to you about Me and will teach you the way to come back to Me,
even though I will always be next to you."
At that moment there was much peace in Heaven,but voices from Earth could be heard and the child
hurriedly asked, "God, if I am to leave now, please tell me my angel's name..."
On Wednesday March 21, a group of DASC (Doulas Association of Southern California) doulas are invited to tour the USC County Hospital on Marengo St. in Los Angeles. Our gracious host is legendary lactation guru Kittie Frantz, RN, CPNP-PC, Clinical Instructor in Pediatrics, University of Southern California Keck School of Medicine. The doulas’ goal is to learn more about LAC-USC’s Labor and Delivery department, postpartum practices and to visit the NICU. Doulas are prepared with a lot of questions, and visiting a facility and meeting the staff is going to be a valuable learning experience for us. I can only assume that having fourteen doulas in the same room asking questions is probably a first for the staff at LAC-USC.
In the entry to the historic USC County Hospital which now sits abandoned and lonely on the back of the new facility, the builders carved into stone the following edict: “ERECTED BY THE CITIZENS OF THE COUNTY OF LOS ANGELES TO PROVIDE HOSPITAL CARE FOR THE ACUTELY ILL AND SUFFERING TO WHOM THE DOCTORS OF THE ATTENDING STAFF GIVE THEIR SERVICES WITHOUT CHARGE IN ORDER THAT NO CITIZEN OF THE COUNTY SHALL BE DEPRIVED OF HEALTH OR LIFE FOR THE LACK OF SUCH CARE AND SERVICES.”
In light of the new health care reform and all the talk we have heard about public health care and care for the uninsured, this gave me pause. Is there actually a hospital in town that would care for the uninsured (including yours truly,) and that is not plagued by long lines, huge crowds, untidiness, danger and maybe even a bit of chaos one associates with a free hospital? Here is what I discovered:
A bit of history:
LAC-USC MedicalCenter sits at the “hub” of the Department of Health Services for Los AngelesCounty, which is the most populous county of the state. It is not in a great neighborhood, but the building is impressive and new. I read that the medical center’s history is rich and extends to the pre-antibiotic era, the days of the iron lung. The medical center was born in the ‘30s from the social activism that was spawned by the great depression and, when it was built, it was the largest hospital in the United States (with close to 2000 in-patient beds). Kittie informed us that VBACs (vaginal births after cesarean) were first “invented here,” which is a good sign since there are very few doctors and/or hospitals who will even consider attempting this procedure.
Researching on the web I learn that about thirty years ago this hospital became a Burn Center, a Level I Trauma Center, a Neonatal Critical Care Nursery, a PediatricCriticalCareCenter, and hosted one of the busiest Obstetric Services in the country delivering 1 out of every 4 babies in California. William Mallon, MD - President of the California Chapter of the American College of Emergency Physicians writes that, “When I was an intern [at LAC-USC 1991] we–our team—delivered over 100 infants per 24 hour call.”
Today
Unfortunately LAC-USC has had to reduce its services and the medical center shrunk in 2008 to host only 650 in-patient beds and Obstetrics now averages 2-4 deliveries in a 24-hour period. Of course this last detail brings a smile to my face as it only means that moms have a much greater chance to be cared for personally, find a bed when they reach the hospital in labor and have a comfortable room in postpartum. But I am getting ahead of myself.
When we meet in the in-patient tower we have to go through an airport security-like check point, which might seem strange but it gives one a sense of safety. The lobby is clean and pleasant and not too populated. Everyone gets a wrist band at the information booth up front and all fourteen doulas and Kittie are now ready for the tour. Before we begin, Kittie gives us the run down:
·LAC-USC is a teaching hospital which means that there are doctors and anesthesiologists [or an anesthesiologist] on the premises at all times. For the consumer this translates into the ability to have a VBAC, not having to wait for the attending doctor to arrive at the hospital before you are allowed to push (it has happened to my clients in those hospital who have no residents or midwives on premise) or to manage an emergency by an OBGYN vs. an emergency physician. It also means having anesthesia promptly available when you want it, and having a highly skilled neonatology staff on hand for emergencies with your baby. LAC-USC is one of the best facilities to handle any type of emergency.
·Medical students and residents who are chosen to work here are in the top 3 percentile in their academic performance nationwide.
·There are 10 nurse midwives on staff who work 24/7. These midwives manage and deliver patients but also are part of the teaching staff.
·Services are free to those women who have MediCAL . Delivery for the uninsured or those non-eligible to get MediCAl is only billed at $2,000 and, if you include prenatal care, the total bill will be only $2,500. The fixed rate for the uninsured has one qualification. The baby has to qualify for MediCAL.
·Child Birth Education classes are offered free of charge and baby care classes (4 of them taught by the residents themselves) are also free. My readers know I am not a huge proponent of hospital-taught classes, as most educators who work in a hospital have to tailor their presentation to the ‘hospital policies’ vs. the best ways to obtain a natural drug and intervention free birth. Nevertheless, free is a darn good price and education is better than ignorance.
·All nurses have been trained as lactation experts and even though there are no lactation consultant on staff, Kittie explains that “if all our nurses are lactation experts then moms who have questions at 2 AM don’t need to wait for the LC (lactation consultant) to arrive for her shift in the morning, or wait around for her availability.” And since Kittie is on call as well for all lactation questions I can confidently say that breastfeeding will not only be encouraged but closely followed for maximum success.
We are now jazzed and proceed on the tour. The corridors are clean and Kittie tells us that the administration sought artists to donate their work to embellish the walls and create a calming experience. After all the modern-art-museum-like hallways of Cedars Sinai and UCLA (which also are teaching hospitals that accept MediCAl) are tough acts to follow.
The L & D department is quiet and we are told there are only two women in labor at the moment. The residents are welcoming and we pile up in their room as an avalanche of questions is presented to them. Frankly, I could not share all the questions and answers or I would have to prepare a twenty page-paper, but suffice to say that all questions were answered, that the residents, who mostly manage critical care in this hospital (as all critical MediCAl patients, even those admitted at the emeritus UCLA or Cedars, are sent here,) were interested in what we have to say, but most importantly are open to witnessing a ‘natural childbirth,’ and willing to make some concessions. We discuss Heplock (a small tube connected to a catheter in a vein in the arm for easy access, which many moms prefer for better freedom of movement and less risk of engorgements following the birth) vs. mandatory IV fluids, intermittent monitoring of mom and babe during labor, freedom of movement during labor, and we hear that all is possible within safety. Then Karen Grey, RN, CNM, a lovely and seasoned midwife takes us to see a laboring room. Clean, spacious and well equipped, it’s enough to host us all and once again the avalanche of questions comes pouring out. Karen skillfully and with great patience responds to all. She tells us that if all is well moms can take a shower during labor, (they would use a Doppler to monitor the baby intermittently,) that they have and are open to using a squat bar or allow mom to deliver on all fours if that’s her preference. To our questions about induction and augmentation of labor, she tells us that they use Cervidil and Pitocin, one as a ripening agent during an induction and the other to augment labor, versus Cytotec, which is a very dangerous, yet widely used drug. This is good news. Unfortunately, the hospital policy is to induce at 41 weeks of gestation and not later; which is debatable but not unusual, as most hospitals and private doctors feel the same. Then again, I tell my clients that there are no induction patrols that will come to your house and force you to go to the hospital and be induced. If the baby is ok and there is enough fluid in the placenta, and it is safe to wait a little longer, one can always negotiate the scheduled induction with their provider.
On our way to visit the postpartum wing we meet with Dr. Jamie MacGregor, OB faculty in the University of Southern California Keck School of Medicine, who is also welcoming and speaks with passion about the critical ‘golden hour,’ the first hour immediately following the birth where moms and babes bond and where successful breastfeeding starts. I like to call it the two golden hours as it usually takes the babe up to 45 minutes to even want to breastfeed, but this is a good sign, as unfortunately, few OBGYN will even consider immediate skin to skin, option for the nurses to admit and examine the child in the warmer before they give it back to mom.
The postpartum rooms are nice and comfortable, the nurses are very experienced (we ask how long they have been at this hospital and we hear “I have been here 25 years” “16 years for me,” loyalty to the place of work is a good sign) and as I mentioned before, all are trained in the art of breastfeeding by the guru herself. Then a quick stop to a very empty nursery, only one baby on the premises and Kittie explains that mom and babe room in and very few newborns make it to the nursery. Here we meet a lovely nurse Kelley Dantzler, RN who tells us that there is a huge diabetic population that comes to LAC-USC so babies are often checked for blood sugar and they feel comfortable with blood sugar levels at 50 (which is a bit higher than most hospital which consider 40 or 45 the minimum level before they intervene. Once again in a normal labor and delivery situation with a mother who is not diabetic, knowledge and asking questions can go a long way in having the right care.) We also learn that sugar water is not used in the nursery but that only formula is used in case of an emergency (i.e. low blood sugar.)
Then we enter the NICU, which is huge, and we meet with Dr. Rangasamy Ramanathan, also known as Dr. Ram,who is the head neonatologist in charge of the NICU and also Pediatric faculty for University of Southern California Keck School of Medicine. He graciously stops to answer our questions and give us information on this impressive facility. LAC-USC has one of the highest levels of critical care units in the city, about 10% of babies in the NICU are transported from other facilities. We can see that parents are welcomed as we observe mom and dad caring for and feeding their little one just to the right of us. The middle of the room is crowded with chairs for potential visiting parents. Dr. Ram answers questions about kangaroo care, (Kangaroo care is a technique practiced on newborn, usually preterm, infants wherein the infant is held, skin-to-skin, with an adult) and Dr. Ram tells us that, Kangaroo care for a pre-term infants may be restricted to a few hours per day, but if they are medically stable that time may be extended. He also tells us about a special room that has been set up for parents who, before taking their little one at home, can spend an overnight in the hospital rooming in with their child, in close proximity to the doctors and nurses available 24/7 to answer any question a new parent might have. It is called the transitional room, and I find this an amazing and unique service as I am sure many parents are afraid of their first night away from the hospital, especially if their little one has been in the NICU for long or have special needs.
Towards the end we discovered yet another pleasant surprise. Walking around the floor a lovely lady is available with her portable multimedia, multilingual translator in the guise of a laptop, on a trolley rigged with a camera. In case there is a question or need for instructions for a non-English speaking mom a live interpreter will be reached via computer used as a virtual video-phone. I believe there are nearly 25 language interpreters made available.
We end the visit in the very long corridor that conjoins the two towers of the medical center, as we meet an assistant nurse who stops by to steal a quick hug from Kittie and offers us a big smiling welcome and a little dance.
We leave the hospital after a very informative tour that lasted nearly three hours. I am personally impressed by what I’ve seen. Hoping to actually experience a birth there we all stop at the coffee shop just outside the in-patient tower entrance and enjoy an espresso and some delicious Porto’s pastries as we chat amongst ourselves.
Helpful hints for dealing with LAC-USC Hospital:
1.If you have insurance do NOT use this hospital as your insurance company will pay very little and you will be stuck with a huge bill.
2.Be proactive in your care. I can't emphasize this enough. Know what you want, have a birth plan, find a doula (DASC is now working on a volunteer program for those who cannot afford a doula, visit DASCdoulas.org) and find a student doula who is looking for certification and will offer her services either free or at a very low cost.
3.Know what your rights are, visit the hospital, go to the classes, get names of the midwives and call or visit them in the clinic and ASK questions and tell them your birthing preferences.
4.Aside from Obstetrics the clinics are full and the wait is long. Emergency room is overcrowded, but you do not need to go to the emergency room if you are in labor, and that’s good news.
5.Ask questions and don't stop until you get the answers you want.
6.It is a county facility so, yes, you will see prisoners handcuffed walking with security officers in the hallways, and some homeless too. Bless them and send love, they need it.
7.Don't worry if you cannot pay. They have an "ATP" (ability to pay) program. If you qualify, you will be allowed to pay what you can. If that's only $20 per month, then that's what it is. ASK. They will help you fill out the forms.
8.Make friends with and get to know your nurses. They're the ones who run the day-to-day operations and often are a little more informed than the doctors. Get the nurses on your side.
9.Have someone who can bring you food to eat. The hospital food, I hear, is not great. Art's Coffee Shop across the street on Zonal makes a superior al pastor burrito and the best fish tacos, so I heard from a former patient. There is a coffee shop in the courtyard that serves good sandwiches and Porto’s pastries. There is also a Subway across the street.
10.They do have patient parking, and it is free. However it is very limited. There is street parking and meter parking, but it might take a long time to find one and meter might not be a good idea as things might take more then you expect. You may just have to suck it up and pay the $8 to one of the private lots.
The Coalition for Improving Maternity Services (CIMS) is concerned about the dramatic increase and ongoing overuse of induction of labor. The U.S. induction rate has more than doubled since 1989, rising from one woman in ten to one woman in five in 2001.22 This may, however, grossly undercount the true incidence of labor induction. Nearly half of women in a 2002 survey reported that some effort had been made to start labor artificially.5 The World Health Organization recommends no more than a 10 percent induction rate.31 Despite modern techniques, induction of labor still introduces considerable risk compared with natural onset of labor, and many, if not most, inductions are done for reasons that are not supported by sound medical research.
HAZARDS OF LABOR INDUCTION
First-time mothers have approximately twice the likelihood of cesarean section with induction compared with natural onset of labor. This risk is due to the procedure itself, not any reason that might have led to inducing labor.9 Inducing labor at 41 weeks in a hypothetical population of 100,000 first-time mothers will result in somewhere between 3,700 and 8,200 excess cesareans and cost an extra $29to $39 million.17
women who have had prior vaginal births may increase their chances of cesarean section five-fold if the cervix is not ready for labor, and they are given cervical ripening agents.26 Inducing 100,000hypothetical women with prior births at 41 weeks will result in between 100 and 2,300 excess cesareans and cost an extra $25 to $26 million.17
All induction agents can cause uterine hyper stimulation (contractions too long, too strong, and too close together and higher baseline muscle tension).10 Uterine hyper stimulation can cause fetal distress.10This means that, paradoxically, inducing labor because of concern over the baby’s condition may cause the very problem the induction was intended to forestall while the baby might have tolerated natural labor.
Induction of labor involves the need for other interventions. IV drip, continuous electronic fetal monitoring, usually confinement to bed. that also can have adverse effects.
Rupturing fetal membranes, a routine component of labor induction, can cause fetal distress and increases the likelihood of cesarean section.2,8,11 It may also precipitate umbilical cord prolapse (a life-threatening emergency for the baby in which the umbilical cord slips down into the vagina).7,19 Forty percent of all full term births involving cord prolapse were induced labors, rising to nearly 50% of births involving prolapse at 42 weeks or more.21
Induced labors are usually more painful, which can increase the need for epidural analgesia.3Epidurals introduce a higher probability of a host of adverse effects on the labor, the baby, and the mother.
women with prior cesarean sections have a slightly increased probability of the scar giving way with Pitocin (oxytocin) induction (8 per 1,000 vs 5 per 1,000 with spontaneous labor onset) and greatly increased risk when prostaglandins (24 per 1,000) are used for cervical ripening or induction.20
HAZARDS AND PROBLEMS OF INDUCTION AGENTS Cytotec (Misoprostol)
Cytotec, although widely used as an induction agent, is neither formulated nor intended for use inlabor. Cytotec.s manufacturer, Searle, has repudiated its off-label use as an induction/cervicalripening agent because of Cytotec.s attendant risks.27
The FDA states that Cytotec.s major adverse effects include uterine hyper stimulation, which can become severe and result in profound fetal distress; uterine rupture; amniotic fluid embolism, which has a high maternal and infant mortality rate; severe genital bleeding; shock; fetal death; and maternal death.6 Other adverse effects include retained placenta, cesarean section, and passage of meconium(the baby’s first stool) into the amniotic fluid, which can cause a type of newborn pneumonia if inhaled.6
Cytotec is commonly believed to pose a life-threatening risk only in women with a uterine scar or with high doses. However, cases of maternal and infant death and hemorrhage requiring hysterectomy have been reported in women with no uterine scar, some of whom were given a minimal dose.13,28,30
Cytotec dosage cannot be controlled because the drug is a small pill that must be cut in pieces.
Once given, the drug cannot be rescinded or the dosage reduced in case of adverse effects.
Cytotec does not decrease cesarean rates compared with prostaglandin E2, which is FDA-approvedfor use in labor.16
Cytotec.s only advantages compared with prostaglandin E2 are much reduced cost and fasterlabors.16 Both benefit only hospitals and doctors as short labors are usually intense, tumultuous, anddifficult.
Prostaglandin E2 (Prepidil, Cervidil)
Prostaglandin E2 can cause uterine hyperstimulation and fetal distress.18 Fetal distress can requirecesarean section.
Prostaglandin E2 does not reduce excess cesareans associated with labor induction.18
Unless the drug is formulated in a tampon (Cervidil), the drug cannot be rescinded or the dosagereduced in case of adverse effects.
Oxytocin (Pitocin)
Complications of oxytocin (Pitocin) include uterine hyperstimulation,25 which can lead to fetaldistress; twice the chance of the baby being born in poor condition;15 postpartum hemorrhage;25and greater probability of newborn jaundice.25 Rare, severe, maternal complications include uterinerupture and water intoxication leading to coma and death. Oxytocin may also cause brain damageor death in the baby.25
MEDICAL RESEARCH FAILS TO SUPPORT COMMON INDUCTION RATIONALES
Elective induction of labor, that is, induction for no medical reasons such as convenience, exposes babies and mothers to the hazards of induction with no counterbalancing benefit.
Inducing labor for suspected big baby produces no benefits but increases the likelihood of cesarean section.12,29
No credible evidence supports inducing labor in women with gestational. as opposed to pre-existing. diabetes.
routinely inducing labor for prelabor rupture of membranes does not reduce the incidence of newborn infection with the exception of women testing positive for Group B strep who do not receive IV antibiotics during labor.14
Inducing labor in women with Group B strep has not been shown to improve outcomes when antibiotics are given regardless of membrane status and is not part of the Centers for Disease Control recommended guidelines.4
Studies claiming to support routine induction of labor at 41 weeks of pregnancy have serious flaws.23 No research supports routine induction at any earlier point in pregnancy; no sound research supports routine induction at any point in pregnancy.
Proponents of inducing labor at full-term argue that the stillbirth rate and the rates of other newborn complications increase markedly after that date, but, in fact, these rates show no such increase.1,23 Induction at 41 weeks in a hypothetical population of 100,000 first-time mothers would theoretically prevent 120 fetal deaths that would statistically occur in the ensuing week, but:17
We don’t know how many of those deaths would actually be prevented by routine induction in that they were unpredictable events in healthy mothers carrying healthy, normally formed babies.
That number would be offset by some babies dying as a result of the hazards of induction.
Any decrease in fetal deaths would be outweighed by the infertility, miscarriage, and fetal and newborn losses consequent to the excess cesareans. (See The Risks of Cesarean Delivery for Mother and Baby, a CIMS fact sheet.)
Forty-one weeks is the median length of pregnancy in healthy first-time mothers.24 This means that one-half of such pregnancies will last longer than 41 weeks.
If there is no reason to curtail the natural length of pregnancy, then there is no reason for measures such as stripping or sweeping membranes, which themselves introduce the possibility of risk.
The Coalition for Improving Maternity Services (CIMS), a United Nations recognized NGO, is a collaborative effort of numerous individuals, leading researchers, and more than 50 organizations representing over 90,000 members. Promoting a wellness model of maternity care that will improve birth outcomes and substantially reduce costs, CIMS developed the Mother-Friendly Childbirth Initiative in 1996. A consensus document that has been recognized as an important model for improving the healthcare and well being of children beginning at birth, the Mother-FriendlyChildbirth Initiative has been translated into several languages and is gaining support around the world.
1.Alexander JM, McIntire DD, and Leveno KJ. Forty weeks and beyond: pregnancy outcomes by week of gestation.Obstet Gynecol 2000;96:291-4.
2.Brisson-Carroll G et al. The effect of routine early amniotomy on spontaneous labor: a meta-analysis. Obstet Gynecol1996;87(5 Pt 2):891-6.
3.Cammu H et al. Outcome after elective labor induction in nulliparous women: a matched cohort study. Am J ObstetGynecol 2002;186(2):240-4.
4.Centers for Disease Control and Prevention. Prevention of perinatal Group B streptococcal disease. MMWR2002;51(No. RR-11).
5.Declercq ER, Sakala C, Corry MP. Listening to Mothers: Report of the First National U.S. Survey of Women.s ChildbearingExperiences. New York: Maternity Center Association, Oct 2002.
6.FDA. Cytotec (misoprostol). Access at: http://www.fda.gov/medwatch/SAFETY/2002/safety02.htm#cytote,2002.
7.Fullerton JT and Severino R. In-hospital care for low-risk childbirth: comparison with results from the NationalBirth Center Study. J Nurse Midwifery 1992;37(5):331-340.
8.Garite TJ et al. The influence of elective amniotomy on fetal heart rate patterns and the course of labor in termpatients: a randomized study. Am J Obstet Gynecol 1993;168(6 Pt 1):1827-1832.
9.Goer H. Elective induction of labor.
10.Goer H. The Thinking Woman.s Guide to a Better Birth. New York: Perigee Books, 1999, p 228-9.
11.Goffinet F et al. Early amniotomy increases the frequency of fetal heart rate abnormalities. Br J Obstet Gynaecol1997;104(5):548-53.
12.Gonen O et al. Induction of labor versus expectant management in macrosomia: a randomized study. Obstet Gynecol1997;89(6):913-7.
13.Goodman D. Forced labor. Mother Jones Jan/Feb 2001:17-19.
14.Hannah ME et al. Maternal colonization with group B Streptococcus and prelabor rupture of membranes at term:the role of induction of labor. Am J Obstet Gynecol 1997;177(4):780-5.
15.Herbst A, Wolner-Hanssen P, and Ingemarsson I. Risk factors for acidemia at birth. Obstet Gynecol 1997;90(1):125-30.
16.Hofmeyr GJ and Gulmezoglu AM. Vaginal misoprostol for cervical ripening and labour induction in late pregnancy(Cochrane Review). In: The Cochrane Library, Issue 3, 2000.Oxford: Update Software.
17.Kaufman KE, Bailit JL, and Grobman W. Elective induction: an analysis of economic and health consequences. AmJ Obstet Gynecol 2002;186(4):858-63.
18.Kelly AJ, Kavanagh J, Thomas J. Vaginal prostaglandin (PGE2 and PGF2a) for induction of labour at term(Cochrane Review). In: The Cochrane Library, Issue 2, 2002.Oxford: Update Software.
19.Levy H et al. Umbilical cord prolapse. Obstet Gynecol 1984;64(4):499-502.
20.Lydon-Rochelle M et al. Risk of uterine rupture during labor among women with a prior cesarean delivery. N Engl JMed 2001;345(1): 3-8.
21.MacDorman M et al. Trends and characteristics of induced labour in the United States, 1989-98. Paediatr PerinatEpidemiol 2002;16:263-73.
22.Martin JA et al. Births: final data for 2001. Nat Vital Stat Rep 2002;51(2).
23.Menticoglou SM and Hall PF. Routine induction of labour at 41 weeks gestation: nonsensus consensus. BJOG2002;109:485-91.
24.Mittendorf R et al. The length of uncomplicated human gestation. Obstet Gynecol 1990;75(6):929-32.
25.Mosby. Oxytocin. Mosby.s GenRx Access at: http://www.orgyn.com/resources/genrx/d001945.asp
26.Peck P. Preinduction cervical ripening significantly increases risk of cesarean. Medscape Medical News, 2003.
27.Searle. letter to health care providers. Aug 23, 2000
28.Stein L. Un-informed consent. Metroactive ,2002.
29.Tey A, Eriksen NL, and Blanco JD. A prospective randomized trial of induction versus expectant management innondiabetic pregnancies with fetal macrosomia. Am J Obstet Gynecol 1995;172(1 Pt 2):293.
30.Wing DA and Paul RH. Am J Obstet Gynecol 1996;175(1):158-64.
31.World Health Organization. Appropriate technology for birth. Lancet 1985;2(8452):436-437.
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Most parents say that swaddling helps their babies get to sleep, stay asleep, and get comforted quickly, especially when they are newborns. My problem with this is that th
e focus is on getting the baby to shut up, settle, be quiet in his/her crib, on his own. Dos this reminds you of an old adage, seen but not heard . A baby will fall asleep in mom’s arms just as quickly. A baby will sleep on dad’s chest just as sweetly, without needing to feel like he is back in the womb. We are too quick to try to get our newborn to stop crying, or communicating. Have you ever thought about how crying for a baby is really talking? Babies speak one language we don’t quite understand right away, so we quickly respond by shushing, telling the baby “don’t cry,” and we are told that if we turn on vacuum cleaners or hairdryers we’ll see the baby’s gaze switch and they will quiet down. Yes, indeed that works, but what about allowing the baby to talk? Now I don’t mean we should let a baby cry on his/her own, but have you heard how after a few weeks a mom will hear a baby cry and say, “I know that cry, he is hungry. Or he needs to be changed. “ Mom’s eventually learn their babies language. So let’s change our perception from the baby is crying to the baby is talking, and let’s ask the baby what he/she needs as we offer, food, comfort, cuddle, empathy and love.
This being said one of the reasons why the swaddling methods, as well as the shushing methods, have come to the forefront is because those are tools we should use when our baby cry is making a mom go deeper into postpartum depression, or is making the baby being at risk of being miss-handled by a frustrated parent. So, if you feel like you need a break or you will go mad, PLEASE SWADDLE your baby and turn on the vacuum cleaner. Or better call a postpartum doula and go for a walk. Don’t feel bad if you find yourself frustrated especially from the lack of sleep. We all felt that way, and the quieting techniques have grown from the empathy felt by some experts for new moms. But these techniques have become the norm, the crutch nearly used daily, instead of being the exception, the tool used in only special occasions.
So if you can, and I am only asking to put aside a few months of your life for this: hold your baby, go ahead it is O.K. you are not going to spoil her, in fact you might just teach her that what she says counts and you will listen. “If your only goal were to get your baby to sleep through the night, then leaving him to cry would accomplish that goal. The problem is that the reason the baby stops crying and sleeps is that he becomes so discouraged he gives up trying to signal that he needs help. In effect, he has learned to sleep through the night……… out of despair rather than contentment.” ~ Dr. Martha Heineman Pieper, Author of Smart Love
According to modern technology and medicine, there are several ‘mistakes’ in the divine design we call humans.
Ever since man began worshiping one God giving himself the prerogative of being the chosen one, or calling himself the son of this god, man began also believing in his own superiority to nature. In the early Judeo/Christian beliefs nature and God were not seen as one, but one subordinate to the other.
After the industrial revolution and the evolution theory’s victory over creation, man declared himself all knowing over nature, able to outsmart, out-create and even improve on nature’s design. Some further declared that God really did not exist; nature was a series of coincidences, measurable, calculable and even fixable. In philosophy the theory of materialism holds that the only thing that exists is matter; that all things are composed of material and all phenomena (including consciousness) are the result of material interactions. In other words, matter is the only substance. Science reigned supreme in fact not only there was no god but humans, and especially women, needed help from science to understand and do anything, including having a baby. Then in the 20th century quantum physics began to tell us that the world, or the matter maybe it was not so clear cut, measurable or easily predictable as we thought. In the realm of quantum physics, observing something actually influences the physical processes taking place. So the influence of man might actually be more important than the mechanical or mathematical calculation of an outcome. In fact the deeper scientists got into quantum physics the more they marveled at the design that some emeritus believe can only generate from a supreme intelligence.
But never mind that… medicine, way too practical to bother with new discoveries and financially well set in its ways transformed childbirth and child rearing (birth being one of the highest income revenue for hospitals, and babies being the new and lifelong potential clients) from a natural event to a ‘condition” that needs to be fixed, managed, made efficient, streamlined, made quantifiable, predictable and of course greatly improved.
So it began. More doctors delivered babies at home pushing away the midwives, but that became truly inconvenient. Birth had to be taken away from the homes so that it may be supervised by highly skilled surgeons in the hospitals. Doctors observed, consulted among themselves and declared they could improve on the condition called childbirth. But first they had to make the woman stay still, lay on her back quietly, so they could focus their lights, placed their rolling stools in front of her spread legs, insert their expert fingers into her vagina and calculate, speculate, improve and help the poor thing do what she obviously was not really meant to do on her own - birth her baby.
In the fifties women were told that they would be helped endure the unnatural way of natural birth and were sent to oblivion (with total anesthesia,) so that they successfully could escape the curse of laboring and birthing., never mind the babies came out with an overdose of narcotics running in their blood streams. The nurses would skillfully observe them for day in the nursery away from the unskilled eyes of the mothers.
Now the drugs are milder but the approach similar. In essence today with an epidural we are told “It will not harm the baby and please, let us deliver you from the evil of childbirth, relax and enjoy some television while you are laboring.”
The more the surgeons observed this condition the more they realized that they could take away the annoyance not only of pain but of the unpredictability of the due date. Yes , they declared, we can indeed induce and schedule a birth, to help with women’s busy lives. Oh the heroes. But wait the inconvenience could even be completely eliminated. To further to ease the poor mother's distress at having a baby, surgeons now could cut the baby out of the mother's belly thus this whole event could be scheduled, catered, and designed.
Country or regional comparisons of cesarean birth rates are challenging because of varying types of data available, but overall rates are estimated to vary from 2.9% in Sub-Saharan Africa to 26.3% in Southeast Asia (Stanton & Holtz, 2006). Elective primary cesarean birth rates are among the highest in the world in Latin America, with a reported rate of 80% to 90% in white, insured women who give birth in private hospitals. Differences in rates have been found in Greek public and private hospitals and in South Korea, where a study reported that providers and the health care system contribute to high cesarean birth rates rather than maternal demand. These high rates are significantly higher than the 15% cesarean birth rate recommended by the World Health Organization, and thousands of elective cesarean births are performed each year.
The rates of cesarean births in Brazil are high. In Sao Paulo, Brazil, 59 private hospitals have cesarean birth rates over 80%, and women at 38 weeks' gestation are scheduled for a collective cesarean “surgical day.”
Worldwide the cesarean rate is growing in leaps and bounds, vanity also being called in to convince our women that sectioning a baby is far better than the ancient pagan way of vaginally delivering it. Indeed isn't it better to cut that baby out than to stretch your birth canal…unnaturally darling?
More Mistakes Found
Every decade is marked out by a craze for some form of unnecessary surgery. In the fifties, they whipped out your adenoids (except in the case of Melvyn Bragg, who mistakenly had an extra couple of sets put in), in the Sixties they wanted your tonsils, and foreskin. Even today the battle for circumcision endures. It must have been a grave mistake in the divine’s design to give you those unwanted parts.
Again in the fifties /sixties women were told that formula was far better than mother’s milk, heck even now we hear that formula has vitamins lacking in mother’s milk. The formula adds during times of flu scare, whisper “You feed his brain, we feed his immune system.”
In the 21st centuries we have the means to change our body, face, appearance that was given to us and improve the original design. We now have expressionless men and women who rather have Clostridium botulinum bacterium (botox) injected into their forehead than show how disappointed they are with a simple frown.
When I contemplate the universe, the nature of matter, and the presence of life and this planet, the great mystery is how it was possible at all. Given the range of properties of matter that could have occurred in the Big Bang or whatever happened at the Beginning - the balance between strong and weak nuclear forces, the mass of the electron, the strength of gravity, the speed of light - I am stunned that there was a choice of values for all these and many more properties that could lead to the formation of stars and planets, the existence of the water molecule and the vast world of carbon chemistry. The most fundamental building blocks of this universe are filled with evidence of intelligent design.
Then there is the marvel of DNA, of birth and reproduction, of the mind and its ability to grasp math, music, and art, to be self-aware, to love, to weep, to strive. These are not the fruits of crass natural selection blindly churning away to select the toughest predators.
The issue is not whether you can improve the human body or enhance the process of creation, but rather what happens when you modify the natural course of things - without creating a cascade of deleterious consequences at the physical as well as emotional level for both mom and babe.
Those so-called design flaws may be the result of divine optimization.
Philosophically speaking we can view the intensity of birth as an obligatory rite of passage for the woman to transform herself into mother. It would seem obvious that breastfeeding is the necessary method to be introduced to the world with a sense of trust for all human kind, and that the foreskin’s location and structure indicate that it is the most important sensory tissue of the penis. Its persistence over millions of years suggests that it has played a role in the propagation of the species.
But never mind philosophy, we have now medical evidence. Indeed, studies have shown what we knew all along, but needed studies to believe in it: we now know that a natural childbirth (regardless whether is at the hospital or at home) has the best outcome and the least complication for both mom and babe, we know that biologically the absence of added chemicals into the mother and baby’s body promotes better health and bonding. We know that breastfeeding is the best nutrient for our children, we know that allowing bonding immediately following the birth preserve the babies natural instincts for a successful latch on, allows the mother to produce milk in a timely manner, promotes bonding, among a myriads of other important psychological and developmental improvements. We know that breast milk increases the baby’s immune system and promotes better health. According to Dr Taylor the various parts of the penis, including the foreskin, form a functional whole.
Mankind has tried to do better, with their own supreme intelligence, to conquer the world but their system is not working. The planet is dying, our mothers are dying in hospitals, our men are getting more diseases in this country than in those of uncircumcised men, and fake beauty is killing our women and girls.
It’s time to respect Mother Nature and her ways trusting that Divine design is indeed flawless.
While a family reunion may not sound as exciting as a trip to a theme park or far away land it provides children with an understanding of their heritage. Family reunions are an opportunity to teach the kids about family. Who are our ancestors? Where were they born? Were they involved in the making of history? Who will be attending? How is everyone related? Where will they be traveling from? These are but a few of the questions that are likely to spark the interest of the children.
Of course if you have a new baby, even if I encourage you to talk to him about the upcoming trip, your concerns are others -- if you must take an airplane to get there and are wondering how you are going to manage bringing over all the gadget your baby needs, there are a few solutions. First get your own pediatrician's opinion, bring some help with you, get a nonstop flight, fly during an off-peak time, and be prepared for everything. Best to wait at least six weeks before you fly.
But what about all the gadgets you have been accustom to?
If you can afford it I found this interesting website called Traveling Baby Company here's their pitch and promise: " [TBC]offers you high quality baby products that are clean, safe and comfortable. Our network is dedicated to provide outstanding customer service and making your trip stress free. Experience the ease of traveling with children as trusted brand name items are delivered straight to your door. You will never have to pack extra luggage or carry bulky equipment again. The convenience is amazing!! Relax while you travel and put your mind at ease, we will do the rest."
A client of mine swears by them. As a bi-coastal (LA- NYC) family they used this service to manage the back and forth in the first few months of their baby's life. Eventually they bought enough stuff in their second home to live comfortably in both places. The site is called traveling baby co
If you cannot afford it don't worry you can still make it work.The most important item in your traveling luggage for a baby (or a toddler) is a car seat. All car rental companies rent car seats too, so it might behoove you to get rent a car so that you are independent and you have enough car seats for your kids. But you can also only rent a car seat, make sure whomever pick you up at the airport has it securely installed in their car, do not travel at any time with out one.
The most important items to pack for a new born are:
A good sling A Snuggle Nest(which is a small comfortable traveling bed 0 to 3 months) Enough swaddling blankets A white noise maker I love the Cloud Sleep Sheep because you can take the little noise machine out of the sheep and place it just about anywhere. Babies do love noise.
If you got used to breastfeed with a bopy you really don't need one. Before you leave get a lactation consultant, postpartum doula, or lactation peer from La Leche League to teach you how to feed your baby just using your arms, and free your self from that gadget.
When you travel via airplane make sure you breastfeed your baby on take off and landing and if you have a toddler it is a good idea to encourage him to eat something (a small piece of his favorite fruit for example) during the same time, this will ease ear pressure and make her comfortable.Include a change of clothes for both mom and baby in your carry-on. It is better to be safe than sorry. (Don’t forget extra diapers!)
When you travel with your newborn try to reserve a bulk seat in the middle of the airplane. Many airlines do carry an infant crib you can hook up in front of you. Especially if mom is flying alone, the portable crib is a great place to safely place your baby while you eat, rest, or search for that one pacifier that got away.Ask the flight attendant for help if you are flying solo. They are usually happy to assist you or hold your baby if you need to use the restroom. Utilize a good baby carrier or sling. These keep baby close and safe and your hands free. Schedule your air travel during the sleep hours of your baby, if you can. Also you might consider asking your homeopathic doctor for an emergency remedy kit, check out Dr. Feder's Family Kit
Newborns are much more vulnerable to germs than older children, since their immune systems are still developing. Maintaining exposure at a minimum is important. Avoid having every family member and friend breath on or touch the newborn. Be adamant that only those with clean hands and no colds get close. The power to breastfeed conveniently and safely is best, and it will also help them since they'll get your immune system to help fight anything that may come their way.
Make sure you pack different clothing from warm to cold. Temperature variations from an air-conditioned car to the hot sun at grandmother's house. Or, it can similarly be from the heated car to a house that is a little chilly for the newborn. Be ready for either contingency.
With toddlers remember to bring distraction:
Bring toys that travel well and can be used quietly. For young kids books,and coloring books, it is a good idea to get something he/she has never seen before but don't forget a favorite doll or stuffed animal it will help your child cope with the stress of being in a new environment and and new bed. For older children bring, activity books, and travel versions of their favorite games. Again sometimes a little trip to the .99 cents store can go a long way in getting something new your children can get excited about.
STAY AWAY FROM SUGAR SNACKS, you don't want your kids to bounce off the walls. Remember many airlines these days do not provide meals, so pack some food for your children. here are some yummy ideas:
Ziploc filled with: carrots - cucumbers - grapes - apple slices - corn chips low in salt - multigrain cheerios - peanut butter and bananas sandwiches (cut in small bite size pieces) - string cheese - one avocado (you can bring a spoon and give your toddler half, it also makes great fresh baby food and it is good for 6 months and up.
Don't forget to bring either a sippy cup or a bottle (they must be empty for security reasons) but you can always ask the flight attendant to fill them up with water (no need to feed soda or juice to your kid, all that sugar can get him/her restless.)
Remember to breathe deeply (from your belly rather than your chest) if you start feeling tense. Traveling can be stressful not only for parents but for kids too. Make sure you discuss your travel well ahead of time, talk about rules at the airport, on the train, in the car and on the plane. When I traveled in the car with my kids we often played great games like the alphabet game where you need to find each letter of the alphabet on different signs on the road. In fact on our last trip from LA to San Francisco, we still played the same game and my son is 26 and my daughter is 24, and you know, it made the time go so much faster and it made us laugh all the way there.
Once you arrive at destination make sure the each day contains at least one activity that everyone will enjoy, for example:
A tour of the city can end with a visit to the local zoo. A visit with adult relatives can include games for the kids or a trip to the local park.
If you have a baby make sure you spend time alone in a quiet room with him/her. over-stimulation can cause your baby to be fussier. For small babies a great portable bed is the snuggle nest,; it's small and your baby will enjoy having her own familiar territory.
Don't always make food a reward. Often parents use it to compromise: "We'll go around the city and then we'll get ice cream;" or "We'll visit Aunt Maggie and get cake and pizza." Food should not be a reward nor should be television, remember you are raising a human being and working on the foundation of his/her future habits. Engage your kid ask the adult you visit not to offer sugar treats to your child, but ask them to tell your kids a story about their past, your relationship when you were kids etc.,(all adult love story telling especially about themselves.)
When you tour a city make sure you engage your child's imagination, making things fun can change the experience dramatically. If you are going back home to were you grew up consider driving around and pointing out the school you or your family members attended, the house you grew up in, the park you used to play at. Tell your children what you know about family members. They may be surprised to learn that chubby Aunt Meggie, the one that gives slobbery kisses, once marched against the war in Vietnam.
Make it fun!
Take lot's of pictures and when you get back home involve your kids in creating a scrap book for the trip. Create a healthy travel ritual from the very beginning and your kids will turn into pro globe trotters.
The decision to change doctors or midwives is never easy, particularly during pregnancy. Though sometimes there comes a point when you realize that neither you nor your practitioner are happy and that you need to find someone who can provide you with the care that you need and deserve in pregnancy. There are many reasons why you might decide that you need a different doctor. Some of the reasons that women share include:
• Practitioner doesn’t listen (poor communication) • You don’t like how you are treated • Too many doctors in the practice • Not enough time is spent with you • Different philosophies of birth • Found another practitioner you like better • Disagreements on treatment practices • Issues with office staff or insurance • Very long waits for appointments • Your practitioner leaves practice or no longer does births
The first thing you should try to do is to resolve the issue with your midwife or doctor. Explain the problem and search for a resolution together. This may not always be possible. If you fins yourself in a situation where you have tried and things still aren’t working out, it is time for a change.
1. Interview other practitioners. Go back to your original list of questions and find others to interview. Perhaps you had a second choice when you originally selected this doctor. If you’ve already interviewed them, you might simply select them off the bat. Ask a local doula or midwife for recommendation, they know many of the doctors in town and can stir you towards one that will respect your desires.
2. Make a decision on which one you will chose. Call to see if the practice is accepting new patients and takes your insurance. Sometimes, at the end of pregnancy you may have a harder time switching practices. Usually you can get in if you talk to the office manager or practitioner and explain the situation. Don't give up, I have had clients who switch in their 39th week it can be done.
3. Notify your old practice. Once you’re ready to leave, you will need to notify your old practice. You can do this in writing or via a phone call. Be sure to cancel any previously scheduled appointments well enough in advance to prevent missed appointment fees.
4. Get a copy of your medical records. You will need to request, in writing, a copy of your medical records. You can chose to hand carrying these records or to have them sent directly to your new practitioner. State laws may vary slightly but they cannot refused your records, they can, however, charge you for them. This is usually a slight copying fee and in many states the first copy is free. This can be done in person or have them fax, email or mail you the form they need you to fill out.
5. Start seeing your new practitioner. Be sure to make an appointment with the new practitioner. Depending on how far along your are in your pregnancy, the timing may not be convenient if they are working you in.
You may or may not decide to let your old practice know why you have left their services. If you think that you would feel better or that they would learn from it, you may decide to send them a letter. Many women never hear back from their old practices. Though occasionally they will get a letter or a call. Decide in advance how you will handle that and be prepared for it, in case it happens.
While switching doctors is never easy, so many moms have done it before and are very glad that they did. One mom said that she had considered waiting until her next baby but then asked herself, “Doesn’t this baby deserve the best I can offer?”
We have it ingrained in our heads throughout our entire adult lives-pregnancy is 40 weeks. The "due date" we are given at that first prenatal visit is based upon that 40 weeks, and we look forward to it with great anticipation. When we are still pregnant after that magical date, we call ourselves "overdue" and the days seem to drag on like years. The problem with this belief about the 40 week EDD is that it is not based in fact. It is one of many pregnancy and childbirth myths which has wormed its way into the standard of practice over the years-something that is still believed because "that's the way it's always been done".
The folly of Naegele's Rule
The 40 week due date is based upon Naegele's Rule. This theory was originated by Harmanni Boerhaave, a botanist who in 1744 came up with a method of calculating the EDD based upon evidence in the Bible that human gestation lasts approximately 10 lunar months. The formula was publicized around 1812 by German obstetrician Franz Naegele and since has become the accepted norm for calculating the due date. There is one glaring flaw in Naegele's rule. Strictly speaking, a lunar (or synodic - from new moon to new moon) month is actually 29.53 days, which makes 10 lunar months roughly 295 days, a full 15 days longer than the 280 days gestation we've been lead to believe is average. In fact, if left alone, 50-80% of mothers will gestate beyond 40 weeks.
Variants in cycle length
Aside from the gross miscalculation of the lunar due date, there is another common problem associated with formulating a woman's EDD: most methods of calculating gestational length are based upon a 28 day cycle. Not all women have a 28 day cycle; some are longer, some are shorter, and even those with a 28 day cycle do not always ovulate right on day 14. If a woman has a cycle which is significantly longer than 28 days and the baby is forced out too soon because her due date is calculated according to her LMP (last menstrual period), this can result in a premature baby with potential health problems at birth.
The inaccuracy of ultrasound
First trimester: 7 days
14 - 20 weeks: 10 days
21 - 30 weeks: 14 days
31 - 42 weeks: 21 days
Recent research offers a more accurate method of approximating gestational length. In 1990 Mittendorf et Al. undertook a study to calculate the average length of uncomplicated human pregnancy. They found that for first time mothers (nulliparas) pregnancy lasted an average of 288 days (41 weeks 1 day). For multiparas, mothers who had previously given birth, the average gestational length was 283 days or 40 weeks 3 days. To easily calculate this EDD formula, a nullipara would take the LMP, subtract 3 months, then add 15 days. Multiparas start with LMP, subtract 3 months and add 10 days. The best way to determine an accurate due date, no matter which method you use, is to chart your cycles so that you know what day you ovulate. There are online programs available for this purpose (refer to links in resources section). Complete classes on tracking your cycle are also available through the Couple to Couple League.
ACOG and postdates
One of the most vital pieces of information to know when you are expecting is that ACOG itself (American College of Obstetricians and Gynecologists) does not recommend interfering with a normal pregnancy before 42 completed weeks. This is why knowing your true conception date and EDD is very important; if you come under pressure from a care provider to deliver at a certain point, you can be armed with ACOG's official recommendations as well as your own exact due date. This can help you and your baby avoid much unnecessary trauma throughout the labor and delivery. Remember, babies can't read calendars; they come on their own time and almost always without complication when left alone to be born when they are truly ready.
Sources:
Mittendorf, R. et al., "The length of uncomplicated human gestation," OB/GYN, Vol. 75, No., 6 June, 1990, pp. 907-932.
ACOG Practice Bulletin #55: Clinical Management of Post-term Pregnancy
There are no accidents. When you forget something and need to drive back home to get it, don’t just grab it and go, stop and count to ten, there is a good reason why it happened and you’ll never know it if you simply waste your time in self-deprecating statements.
We run too fast from point A to point B etc, and at times the only way that spirit can communicate with us is by slowing us down one way or another. If you don’t stop regularly during your daily routine, if nothing else to simply be grateful of what you have, you might end up getting sick, so that you have to slow down and then take stock. Your practice is there not for God’s benefit, but yours.
How often do you look down while you walk, your mind lost in thoughts of the future or past occurrences or desires? Repeating to yourself over and over again the same thing, reliving the same action, recalling the same feelings?
When you keep your eyes on the horizon and you really look at what you see, you are forced to do two things: stay in the present moment and rejoice at the simple beauty of a puffy cloud, majestic mountains, or even the entirety of your village. So no longer will you focus on yourself as a separate entity you'll become one with your surroundings. Losing yourself and becoming part of your Universe. What is yours only would not matter as much as what belongs to all. You will feel you are part of this wholeness.
So many of us doulas, nurses, midwives and even doctors need to regularly do some continuing education courses to renew our certifications and or licenses. This is such an important part of what we do. Recently I went to the DONA conference, and even though I admit at times I heard myself saying, "being there, done that," I still came out with some great new insights, new info, and a renewed feeling that what I am doing is exactly what I want to do. You know how important your continuing education is for your clients. Many times I have heard parents come home from the hospital or from family gatherings with old fashion believes that some doctor, nurses, and even doulas and midwives, still have about breastfeeding, caring for a new born, or pregnancy and delivery. After many years in the business, we all gravitate to workshops on subjects we have not seen before, strange and unusual situations, diseases, complications etc. Yet, once in a while doing the tried and true breastfeeding workshop, or even hearing Dr. Karp's lecture on the 5 Ss umpteen times has kept my practice up-to-date.
MYTHS DEBUNKED
Here are some old fashion myths that are still perpetrated by many who have not bothered to know what is new up there:
Myth 1 "You must induce before 41 weeks, or your baby will be too big and it will get stuck and die - A breech baby must be delivered via cesarean due to the high mortality risk -Once a cesarean always a cesarean or you could lose mom and babe"
So many doctors induce as early at 39 weeks using all sort of reasoning, including fetal mortality. There are only a handful of doctors I know in Los Angeles that deliver a breech baby. For the most part a breech is an automatic cesarean, and don’t even get me started with the VBACs since now many hospital will not allow, even if you find a doctor who is willing. Here are the risk factors according to Andrew Kotaska MD, OBGYN, (from his lecture “Normalizing Birth in the 21st Century” Dona Conference 2008.)
The risk of mortality is as follow:
• 1/1000 Stillbirths risk from 41 to 42 weeks of gestation
• 1/1000 Risk of perinetal death with cautious selective vaginal breech delivery
• 1/1000 Composite risk of perinatal death or hypoxic inschemic encephalopathy (HIE - Reduced brain oxygen in the baby’s brain) with VBAC
Think this is too high consider the comparison:
• 1/200 risk of miscarriage from genetic amniocentesis
• 1/1000 yearly risk death in a 40 year-old non-smoking Canadian man (doc is from Canada)
• 1/1000 background stillbirth risk over ten days at term
• 1/1000 risk of trysomy 21 (down syndrome) infant in a 31 Y/O woman
• 1/1000 risk of MVA (moving vehicle accident) driving for 4 years
It would seem that the risks we are willing to take with a routine amniocentesis are way higher then a simple VBAC. Dr Kotaska goes on to say that “The increased neonatal and maternal morbidity and cost in the index and future pregnancy make it unreasonable to perform 1000 C/S to prevent one perinatal death. The obstetrician should recommend against cesarean section to prevent risks similar in magnitude to background risks.” In short, women should be informed of their choices and the pitfalls of cesarean sections, and/or pitocin induction. Those pitfalls should be discussed with as much emphasis as the supposed advantages. Women need to demand that there is a discussion of all reasonable alternatives for all these situations. It is called informed consent, no longer should the doctor just establish that “the baby is too big, we need to induce, section” etc. Autonomy demands that the ultimate decision regarding care rests with the woman.
Marshall Klauss MD, in his lecture “How Doulas Can Reduce Cesareans by Their Care” (Dona International Conference 2008) told us that “With a cesarean section vs. a vaginal delivery, there is a higher illness rate as well as a higher death rate in the mother. (c/sec – 5.85/100,000 vs. vaginal – 2.06/100,000.) He further went on to dispel yet another myth:
Myth 2 “Honey, you’d want an epidural as soon as you get into the hospital. It will not hurt mommy or baby”
Dr. Klauss tells us that “An epidural in the a first time mother can delay the first stage labor by an additional 4 hours, and the second stage by an additional 1 ½ hour for a total of 5 ½ hours. With an epidural, the baby receives medicine almost immediately, and 15% of the time the mother and infant develop a fever of 38 degrees centigrade. On delivery after the baby is born, the staff takes the baby to the NICU for observation and a blood culture. The baby is separated from the mother and father but usually there is no infection. If the epidural is started before 4-5 cm of dilation of the cervix, there is a reasonable chance that the infant might not complete rotation, which leads to a posterior position that often leads to a c/section” Let’s add also that often the epidural leads to pitocin and failed induction is the number one cause for cesareans in the United States.
Myth 3 “You have no milk; the baby is hungry and losing weight. You should give baby formula”
I can’t begin to tell you how many times moms hear this at the hospital, it seems none has told the nurses that as long as the baby looks good and is nursing every 1 to 3 hours and mom's nipples are not getting sore, there is no need to do anything but nurse often. New born can lose up to 10% of their body weight in the first week. Is better to help mom switch breasts every 5 minutes or so and wait another day or two for the milk to come in. A thirsty baby nurses strongly and is in no danger. A baby given water or formula might not nurse so strongly and mom's confidence (and milk supply) will suffer for it. As Dr. Gordon says “Look at the baby not the scale.”
Myth 4“Your baby’s weight gain is not acceptable, go ahead and supplement with formula.”
When hearing this comment, pediatrician Jay Gordon MD, suggests asking yourself the following questions:
Is your baby eager to nurse?
Is your baby peeing and pooping well?
Is your baby's urine either clear or very pale yellow?
Are your baby's eyes bright and alert?
Is your baby's skin a healthy color and texture?
Is your baby moving its arms and legs vigorously?
Are baby's nails growing?
Is your baby meeting developmental milestones?
Is your baby's overall disposition happy and playful?
Yes, your baby sleeps a lot, but when your baby is awake does he have periods of being very alert? If you have answered yes to the above questions, you may want to progress on to two important questions which the "charts" seem to ignore.
How tall is mom?
How tall is dad?
If someone were to ask you what weight a 33 year old man should be, you would laugh. The range of possibilities varies according to height, bone structure, ethnicity and many other factors. Yet babies are expected to fit onto charts distributed throughout the country with no regard to genetics, feeding choice or almost anything else.
Myth 5 “When breastfeeding, don’t eat broccoli, tomatoes, onion, and garlic. It will give your baby colic!!!”
This is one of my favorites, so many ‘expert’ including friends and grandmas and even midwives and doulas speculate on what a mom should and should not eat and how what she eats gives baby colic. Here is what Kittie Frantz, R.N., C.P.N.P.-P.C, one of the lactation luminaries of Los Angeles, and professor at USC says about the subject:
“I find these myths come from the mother community and not the hospital! Who on earth is spreading this incorrect information? Which hospital? Egad! Most agree that a breast feeding mother should eat a VARIETY of good wholesome foods and she will do just fine. In a variety, too much of one food is diluted by the variety. It is that simple. For example: The FDA says to reduce the amount of certain fish to avoid large amounts of mercury for pregnant women, breast fed babies and small children. A variety of food would prevent getting too much of any one fish so that would take care of that issue! A mother should not be told never to eat fish while pregnant or breast feeding.
Manella did research on foods and flavors in mother's milk. She found that what mother eats flavors her amniotic fluid and her breast milk. Is that such a bad thing? The mother who ate onions in pregnancy, has a baby who is used to onion flavor and will enjoy it in her milk. Manella found that the garlic flavor actually makes baby suck better! Vanilla is like catnip to a baby. I am sure the same thing is true in cultures who eat spices and chilies in pregnancy and breast feeding. They do breast feed in Central America and India you know! I was donating my milk to research while I was nursing my son back in the 1960's. I loved horseradish and ate a lot of it. My son was avidly breast feeding so I never gave it a thought that the flavor got through. The lab called to ask me what I was eating as the monkeys were rejecting only my milk. They asked if I would stop the horseradish and I did and the monkeys then began to take my milk. My son, who had tasted the horseradish all through my pregnancy was used to it in my milk and loved it.
Foods like peanuts, tomatoes, cow milk, etc. are known allergens. These foods do not CAUSE allergy in a child of a family with no allergy to peanuts. A child who has inherited an allergy to that food will have an allergic reaction to the food if he ever eats the food. Eating peanuts would only effect babies born of families with known allergies to peanuts. Example: Allergists who saw severe peanut allergy reactions to two year olds getting their first peanut butter & jelly sandwich (pb & j) realized that humans do not have severe reactions to foods the first time they get them. They realized that the peanuts eaten in pregnancy was the first exposure in the amniotic fluid. The peanuts eaten while breast feeding was the second exposure. The pb & j was the third exposure and tipped the severe reaction. This would only have relevance to the family with a history of peanut allergy. Peanuts given to children of families without an allergy to peanuts would not develop the allergy. So why tell all pregnant and breast feeding women to avoid peanuts?
Broccoli, cabbage, beans often aggravate reflux in humans and some feel it causes gas to the eater. Does it do this to the baby from the breast milk? Don't know. If a baby is gassy or bothered by reflux, the mother might try avoiding these foods and see if her baby seems less bothered. If baby gets better, try eating the foods again next week to see if he gets bothered by them a second time. If he does not, then it was only a coincidence that the broccoli bean salad you ate was on the same day he was fussy. If he reacts the second time you ate these foods, stop again and see if he is better and reintroduce it a week later to see if he reacts again. If he does get fussy all three times, then avoid those foods. If he does not react each time, then it was probably just a coincidence. NOT ALL BABIES WILL REACT TO THESE FOODS! Why take all women off of them just because a few babies reacted? Avoid telling all the moms in your breast feeding support group to avoid these foods just because your baby reacted.
Sometimes I think giving mothers too many "breast feeding rules" is done by folks who have controlling tendencies. Are they trying to punish the woman for doing something so wonderful for her baby? Just remember that variety is still the spice of life and everything in moderation! Eat a well balanced diet of foods that are good for you: fruits, vegetables, whole grains, & protein. Eliminate from your diet only what family members are allergic to. If your family has allergies, you are probably in touch with an allergist. Consult your allergist for his/her advice. If you have no family allergies and you feel your baby is reacting to a food you have eaten, experiment. Every baby is different. Every family is different. Enjoy breastfeeding!”
What we know is that probably milk is the one allergen that most commonly brings a negative reaction. In August 2000, the American Academy of Pediatrics issued an official statement about allergenic proteins in a mother's diet appearing in her breast milk and creating problems for her baby. As Kitties says moderation is the name of this game, too often overtired moms simply open the fridge and start with cereal with milk, followed by scoops of cottage cheese, topped off with delivery pizza for dinner (dad’s contribution,) and we wonder why the baby is fussy????
About colic
Babies simply cry, that’s how they express themselves, often there isn’t anything truly wrong with them. They need to be heard, and parents should be taught how to calm them with cuddling techniques not drugs such as Mylicon. Too many babies have been wrongly diagnosed with colic, or the latest craze - acid reflux. Dr. Karp suggests that colic are grossly misdiagnosed. In fact only 10 to 15% of all babies do have colic and usually it comes from milk allergy and a very low percentage from other foods such as caffeine, also contained in chocolate. Dr. Karp jokes, “How can you call it colic if the screaming and fussy stops when the baby is either swaddled, or placed in a sling, or taken on a car ride? How can these actions make pain go away?” Is it really pain or is the baby just in need of something else? Reflux usually only happens in 1/50 crying babies. More women should be told to expect the baby crying and not to immediately go into “something must be wrong” mode.
Myth 6 “It sounds like your baby has a lot of gas, it’s probably colic”
Studies show that actually gas increases in babies’ stomach after the baby cries and not before. Dr. Gordon tells us, “Babies are gassy. That is an immutable fact caused by the need to double or triple one's weight in a year. Try doing that yourself and see if you don’t spend a little time gassy.”
Myth 7 “You just don’t have enough milk to feed your baby”
Here is a list of common early breastfeeding challenges according to Jacqueline Kelleher (in her lecture “When Mommy Really Want to, But It Just Isn’t Working” Dona conference 2008.)
For the baby:
• Attached frenulum
• Prematurity
• Down Syndrome
• Illness
• High Palate
• Cleft palate
Conditions in the mother that can lead to breastfeeding difficulties
• Hormonal problem (bleed out)
• Conical shaped breasts (insufficient tissue)
• Thyroid problems
• Postpartum mood disorder
• Retained placenta fragments
• Large nipples (flat nipples)
• Breast reduction or augmentation
Common early breastfeeding challenges
• IV fluids in labor
• High cesarean rates
• Separation in hours following birth
• Separation during hospital stay
• Lack of emotional support
• Lack of experienced support
• Contradictory information in support
Myth 8“Just One Bottle of Formula Won’t Hurt the Baby”
According to Dr. Gordon one bottle can make the a difference.
• Breastfed and formula-fed infants have different gut flora.
Breastfed babies have a lower gut pH (acidic environment) of approximately 5.1-5.4 throughout the first six weeks that is dominated by bifidobacteria with reduced pathogenic (disease-causing) microbes such as E coli, bacteroides, clostridia, and streptococci. Babies fed formula have a high gut pH of approximately 5.9-7.3 with a variety of putrefactive bacterial species.
In infants fed breast milk and formula supplements the mean pH is approximately 5.7-6.0 during the first four weeks, falling to 5.45 by the sixth week.
When formula supplements are given to breastfed babies during the first seven days of life, the production of a strongly acidic environment is delayed and its full potential may never be reached.
Breastfed infants who receive supplements develop gut flora and behavior like formula-fed infants.
• The neonatal GI tract undergoes rapid growth and maturational change following birth.
* Infants have a functionally immature and immuno-naive gut at birth.
* Tight junctions of the GI mucosa take many weeks to mature and close the gut to whole proteins and pathogens.
* Open junctions and immaturity play a role in the acquisition of NEC, diarrheal disease, and allergy.
* sIgA from colostrum and breast milk coats the gut, passively providing immunity during the time of reduced neonatal gut immune function.
* Mothers’ sIgA is antigen specific. The antibodies are targeted against pathogens in the baby’s immediate surroundings.
* The mother synthesizes antibodies when she ingests, inhales, or otherwise comes in contact with a disease-causing microbe.
These antibodies ignore useful bacteria normally found in the gut and ward off disease without causing inflammation.
Thus, Dr Gordon suggests that, “Infant formula should not be given to a breastfed baby before gut closure occurs.”
Bottom line, unless there is a serious medical reason for low milk production a woman with enough professional support can breastfeed her baby. Unless there is a serious reason for the newborn to have formula supplement, breastmilk is best. By addressing any health issue before the birth and having the help of a professional Lactation Consultant can make a difference in your experience. Knowledge is power. If you know about breastfeeding before you go into the hospital all those nay-sayers about your ability to feed your baby can be, gently and lovingly, put in their place.
Keeping up to date is the only way I know we can serve our clients best. Not only by our recommendation but also by providing facts and figures they can show their provider when given old and no longer substantiated information.
Mothers can stand up for themselves demanding information that is accurate, proven and if needed with sound back up material. I often suggest, when a client has been told she must have a cesarean for elective reasons (such as your baby is too big, or VBACs are dangerous etc.,) that she should do as most people do when they are told they need major surgery – get a second opinion hopefully from a doctor who is mother-friendly. When it comes to feeding your baby, trust that you are the perfect mother and the perfect match for your baby, and unless you have a serious health problem all it takes is patience, loving support and when it gets difficult the resources to get professional help.
There are so many more myths and this is the very first article of a series I am planning to write to keep you up-to-date.
Visit my website at www.joyinbirthing.com to get our free monthly newsletter
I practice clinical hypnotherapy and a method of natural childbirth that uses hypnotic techniques to reduce stress and fear during labor and delivery, alleviating pain and making the birth experience positive and enjoyable. I also teach healthy infant mental, emotional and cognitive health and development.
I focuses on infant mental health and pre-birth bonding, where I use guided meditations and visualizations to help women communicate and empower their babies before birth. These hypno-therapeutic techniques are also used throughout pregnancy for maternal/prenatal stress reduction, self confidence, relaxation, strength and generally increasing positivity.
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