good luck w/ your entries (this is my entry)
i can see that it would be a more difficult journey than it would for a hetero couple. so far i've found out that more than half of the homosexual population wants kids. and they have multiple routes to that goal. adoption, artificial insemination, surrogacy, etc.
but if they want a child who is biologically tied to at least one half of the couple, well how many of those procedures would be covered by insurance? how costly are they?
i learned that most children sucessful artificial insemination produces male offspring. some people really do have a preference for one sex or another so thats something to consider.
i'll be posting something on the topic soon, maybe this month if i get a chance to do enough research.
additionally the recent live streeamed birth http://www.facebook.com/l.php?u=http%253A%252F%252Fwww.theunnecesarean.com%252Fblog%252F2009%252F11%252F6%252Flynsee-is-in-labor-broadcasting-birth-live-right-now.html&h=f67aa58d7a5a5128bff33de74c36c390&ref=mf has me thinking about the nature of birth advocacy. the discussion has fallen from one end of the spectrum with complete disrespect for hospital birth to a sort of resigned "well at least it wasn't a cesarean" to total acceptance of that mamas experience epidural, hospital and all.
so i'm re-evaluating my role as a self appointed "advocate for normal birth". i mean what does that mean? canada defined "normal birth" almost a year ago http://www.sogc.org/guidelines/documents/gui221PS0812.pdf and i know other countries have done so as well. but what is "normal birth" in america and how best to advocate for it?
more to come on that topic as well as i mull it over.
I'm doing my part by going to the town hall meeting and making sure my congressperson knows I support removing the inclusion of domestic violence from pre-existing condition clauses in insurance contracts (pregnancy can also be considered a pre-existing condition btw)
the section of the healthcare reform bill thats relevant is
SEC. 2706. PROHIBITING DISCRIMINATION AGAINST INDIVIDUAL PARTICIPANTS AND BENEFICIARIES BASED ON HEALTH STATUS.
'(a) IN GENERAL.--A group health plan and a health insurance issuer offering group or individual health insurance coverage may not establish rules for eligibility (including continued eligibility) of any individual to enroll under the terms of the plan or coverage based on any of the following health status-related factors in relation to the individual or a dependent of the individual:
(1) Health status.
(2) Medical condition (including both physical and mental illnesses).
(3) Claims experience.
(4) Receipt of health care.
(5) Medical history.
(6) Genetic information.
(7) Evidence of insurability (including conditions arising out of acts of domestic violence).
(9) Any other health status-related factor determined appropriate by the Secretary.
and here is some background info
so the today show did a recent scare segment re homebirth (originally titled 'the perils of midwifery' but later changed to 'the perils of homebirth' and naturally the birthing blogosphere has been abuzz
of course the topic of home birth has been a contentious one for quite some time as these earlier links attest.
some of the debate focuses on the rights to even have a homebirth, some on the safety of homebirth
the australian healthcare system has been duking it out over homebirth for a while . heres some of the latest from over there http://www.thepunch.com.au/articles/homebirth-wars-confusing-a-right-with-whats-right/
despite the evidence regarding the safety of homebirth http://www.bmj.com/cgi/content/full/330/7505/1416 the american college of obstetrics and gynocology has been on a campaign to remove the choice of homebirth... they put out a press release in february 2008 in which they re-iterated their stance http://www.acog.org/from_home/publications/press_releases/nr02-06-08-2.cfm and now they are using the media to skew public perception as to the dangers of homebirth and the competancies of midwives.
Lamaze Healthy Birth Practices
The six Lamaze Healthy Birth Practices below are supported by
research studies that examine the benefits and risks of maternity care
practices. Therefore, they represent "evidence-based care," which is the gold
standard for maternity care worldwide. Evidence-based care means "using the best
research about the effects of specific procedures, drugs, tests, and treatments,
to help guide decision-making." Please note: The English versions
were revised in 2009.
Let Labor Begin on Its Own
Walk, Move Around, and Change Positions Throughout Labor
Bring a Loved One, Friend, or Doula for Continuous Support
Avoid Interventions That Are Not Medically Necessary
Avoid Giving Birth on the Back and Follow the Body’s Urges to Push
Keep Mother and Baby Together – It’s Best for Mother, Baby, and
Ten Steps of the Mother-Friendly Childbirth InitiativeFor
Mother-Friendly Hospitals, Birth Centers,* and Home Birth Services
CIMS designation as “mother-friendly,” a hospital, birth center, or home birth
service must carry out the above philosophical principles by fulfilling the Ten
Steps of Mother-Friendly Care.
A mother-friendly hospital, birth center, or home birth service:
Offers all birthing mothers:
Unrestricted access to the birth companions of her choice, including
fathers, partners, children, family members, and friends;
Unrestricted access to continuous emotional and physical support from a
skilled woman—for example, a doula,* or labor-support professional;
Access to professional midwifery care.
Provides accurate descriptive and statistical information to the public
about its practices and procedures for birth care, including measures of
interventions and outcomes.
Provides culturally competent care—that is, care that is sensitive and
responsive to the specific beliefs, values, and customs of the mother’s
ethnicity and religion.
Provides the birthing woman with the freedom to walk, move about, and
assume the positions of her choice during labor and birth (unless restriction is
specifically required to correct a complication), and discourages the use of the
lithotomy (flat on back with legs elevated) position.
Has clearly defined policies and procedures for:
collaborating and consulting throughout the perinatal period with other
maternity services, including
communicating with the original caregiver when transfer from one birth site
to another is necessary;
linking the mother and baby to appropriate community resources, including
prenatal and post-discharge follow-up and breastfeeding support.
Does not routinely employ practices and procedures that are unsupported by
scientific evidence, including but not limited to the following:
IVs (intravenous drip);
withholding nourishment or water;
early rupture of membranes*;
electronic fetal monitoring; other
interventions are limited as follows:
Has an induction* rate of 10% or less;†
Has an episiotomy* rate of 20% or less, with a goal of 5% or less;
Has a total cesarean rate of 10% or less in community hospitals, and 15% or
less in tertiary care (high-risk) hospitals;
Has a VBAC (vaginal birth after cesarean) rate of 60% or more with a goal
of 75% or more.
Educates staff in non-drug methods of pain relief, and does not promote the
use of analgesic or anesthetic drugs not specifically required to correct a
Encourages all mothers and families, including those with sick or premature
newborns or infants with congenital problems, to touch, hold, breastfeed, and
care for their babies to the extent compatible with their conditions.
Discourages non-religious circumcision of the newborn.
Strives to achieve the WHO-UNICEF “Ten Steps of the Baby-Friendly Hospital
Initiative” to promote successful breastfeeding:Have a written breastfeeding policy that is routinely communicated to
health care staff;
Train all health care staff in skills necessary to
implement this policy;
Inform all pregnant women about the benefits and
Help mothers initiate breastfeeding
within a half-hour of birth;
Show mothers how to breastfeed and how to
maintain lactation even if they
should be separated from their infants;
Give newborn infants no food or drink other than breast milk unless
Practice rooming in: allow mothers and infants
to remain together 24 hours
Encourage breastfeeding on
Give no artificial teat or pacifiers (also called dummies or
Foster the establishment of
breastfeeding support groups and refer mothers
to them on discharge from
hospitals or clinics
† This criterion is presently under review.
this topic has been on my mind lately. and this video from msnbc http://www.msnbc.msn.com/id/21134540/vp/32795933#32795933 brought it to the forefront for a blog post. i actually haven't watched the video b/c i don't have speakers on my computer right now but i did post a reply on the discussion (the question was basically what are your thought on the risks of homebirth) heres my reply
"Its always a risk/benefit analysis. There are risks and benefits to either scenerio and its a matter of choosing which risks are acceptable and which benefits are most important to you.
there are benfits to homebirth that show up in the research: fewer interventions, more skin-to-lskin, more rapid initiation of breastfeeding, greater satisfaction with the birth experience, one-to-one care for mom, etc
there are also risks. an emergent situation can arise that requires urgent action. sometimes a transfer to hospital care can be accomplished in time and sometimes time is of such essence that a transfer can't be accomplished in time. sometimes a woman will find labor to be more painful or more exhausting than anticipated and she wil want to tranfer for a non-emergent complication.
there are several kinds of midwives and the kind of training they have will vary but most midwives have training in ergency situations. most midwives can perform at least basic rescucitation on mom and or baby. many midwives carry oxygen, pitocin, suture equipment and other equipment to deal with emergencies. that would definately be a question to ask a midwife: "what kind of training do you have to manage an emergency?" "what are your transfer protocols?" etc
there are times when the benefits of a hospital birth will outweigh the benefits of a homebirth. if a woman goes into pre-term labor at say 32 weeks, or has pre-eclamsia, or an unmanaged health condition then a hospital birth may be the wisest choice. but there are very real rsks to hospital birth. some of these risks are the same risks anyone faces walking into a hospital : hospital aquired infection, medication errors, miscommunications between care providers during shift changes. some risks are specific to labor and delivery. the epidural delivers very good pain relief but it can also cause fever and a decrease in blood pressure. pitocin can jump start contractions but those contractions can be very intense and can even hyperstimulate the uterus leading to an emergency section. even some basic hospital procedures such as denying food and drink carry risks. you wouldn't run a marathon w/o adequate nourishment why expect to have a baby w/o eating and drinking?
the way transfers are managed is one area where improvement is sorely needed. a study was done recently that showed that there is so much fear on both sides that it is affecting the care women recieve when a transfer is needed. i think some kind of no-fault transfer policy needs to be implemented at a national level so obs can use their training when it is needed w/o fear of a lawsuit, so midwives can transfer women who need hospital services w/o fear of lawsuit....so everyone can share information freely and no one lets fear get in the way of care.
and as to the actual question, i've had 2 hospital births and one birth in a freestanding birth center. if i have another it will be a planned homebirth."
And this topic homebirth versus hospital gets to the heart of the matter. Your choices in childbirth boil down really to 2 things: your choice of healthcare provider and your choice of birthing place.
Many many women plan to just use whoever they've been using for well woman gyno care. You probably know and like your hcp. But this post from jen at vbac facts demonstrates how liking your hcp is not enough. http://vbacfacts.com/2009/08/26/an-ob-you-like-or-who-makes-you-comfortable-isnt-enough/
you pretty much have 3 choices in birth care: An OB, a family practice dr, or a midwife. any one of the 3 can be a good choice if they have a birth philosophy that works for you but in general obs will be the most interventive of the 3 and midwives the least interventive.
midwives work within the midwifery model of care. http://cfmidwifery.org/mmoc/define.aspx
The Midwives Model of Care
The Midwives Model of Care is based on the fact that pregnancy and birth are normal life processes.
The Midwives Model of Care includes:
- Monitoring the physical, psychological, and social well-being of the mother throughout the childbearing cycle
- Providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support
- Minimizing technological interventions
- Identifying and referring women who require obstetrical attention
The application of this woman-centered model of care has been proven to reduce the incidence of birth injury, trauma, and cesarean section.
Copyright (c) 1996-2008, Midwifery Task Force, Inc., All Rights Reserved
An OB on the other hand is a sugeon trained in the technocratic model of care. this is a long read but explains the technocratic model in great detail http://www.davis-floyd.com/USERIMAGES/File/TECHNOCRATIC%20MODEL%20OF%20BIRTH.pdf
basically in the technocratic model the birthing mother is seen as a machine destined to malfunction at some point.
Afamily practice dr who still attends births is hard to find but if found is oftn somewhere in between midwife and ob in mindset.
regardless of the letters behing your hcp's name you have got to be sure your birth philosophy meshes with theirs. Because if she usually cuts an episiotomy she'll probably cut one on you too. If he only "allows" a 12 hour labor before he starts a pit drip to "move it along" thats probably the care you'll get too.
And then you also have to be sure that the place you choose to give birth is willing and able to be supportive of your birth philosophy also. What are their usual procedures? If everybody who goes to hospital A has to do some time on the fetal monitor you probably will too unless your dr or midwife has okay'd you not doing it in advance. if they don't "allow" most of their mothers to labor in the tub they probably won't "let" you either.
a good place to start is with this list from the coalition for improving maternity services
Having a Baby?
Ten Questions to Ask
©2000 Coalition for Improving Maternity Services (CIMS).
1. Ask, “Who can be with me during labor and birth?”
Mother-friendly birth centers, hospitals, and home birth services will let a birthing mother decide whom she wants to have with her during the birth. This includes fathers, partners, children, other family members, or friends.
They will also let a birthing mother have with her a person who has special training in helping women cope with labor and birth. This person is called a doula or labor support person. She never leaves the birthing mother alone. She encourages her, comforts her, and helps her understand what’s happening to her.
They will have midwives as part of their staff so that a birthing mother can have a midwife with her if she wants to.
2. Ask, “What happens during a normal labor and birth in your setting?”
If they give mother-friendly care, they will tell you how they handle every part of the birthing process. For example, how often do they give the mother a drug to speed up the birth? Or do they let labor and birth usually happen on its own timing?
They will also tell you how often they do certain procedures. For example, they will have a record of the percentage of C-sections (Cesarean births) they do every year. If the number is too high, you’ll want to consider having your baby in another place or with another doctor or midwife.
Here are some numbers we recommend you ask about.
They should not use oxytocin (a drug) to start labor for more than 1 in 10 women (10%).
They should not do an episiotomy (ee-pee-zee-AH-tummy) on more than 1 in 5 women (20%). They should be trying to bring that number down. (An episiotomy is a cut in the opening to the vagina to make it larger for birth. It is not necessary most of the time.)
They should not do C-sections on more than 1 in 10 women (10%) if it’s a community hospital. The rate should be 15% or less in hospitals which care for many high-risk mothers and babies.
A C-section is a major operation in which a doctor cuts through the mother’s stomach into her womb and removes the baby through the opening. Mothers who have had a C-section can often have future babies normally. Look for a birth place in which 6 out of 10 women (60%) or more of the mothers who have had C-sections go on to have their other babies through the birth canal.
3. Ask, “How do you allow for differences in culture and beliefs?”
Mother-friendly birth centers, hospitals, and home birth services are sensitive to the mother’s culture. They know that mothers and families have differing beliefs, values, and customs.
For example, you may have a custom that only women may be with you during labor and birth. Or perhaps your beliefs include a religious ritual to be done after birth. There are many other examples that may be very important to you. If the place and the people are mother-friendly, they will support you in doing what you want to do. Before labor starts tell your doctor or midwife special things you want.
4. Ask, “Can I walk and move around during labor?
What position do you suggest for birth?”
In mother-friendly settings, you can walk around and move about as you choose during labor. You can choose the positions that are most comfortable and work best for you during labor and birth. (There may be a medical reason for you to be in a certain position.) Mother-friendly settings almost never put a woman flat on her back with her legs up in stirrups for the birth.
5. Ask, “How do you make sure everything goes smoothly when my nurse, doctor, midwife, or agency need to work with each other?”
Ask, “Can my doctor or midwife come with me if I have to be moved to another place during labor? Can you help me find people or agencies in my community who can help me before and after the baby is born?”
Mother-friendly places and people will have a specific plan for keeping in touch with the other people who are caring for you. They will talk to others who give you birth care. They will help you find people or agencies in your community to help you. For example, they may put you in touch with someone who can help you with breastfeeding.
6. Ask, “What things do you normally do to a woman
Experts say some methods of care during labor and birth are better and healthier for mothers and babies. Medical research shows us which methods of care are better and healthier. Mother-friendly settings only use methods that have been proven to be best by scientific evidence.
Sometimes birth centers, hospitals, and home birth services use methods that are not proven to be best for the mother or the baby. For example, research has shown it’s usually not helpful to break the bag of waters.
Here is a list of things we recommend you ask about. They do not help and may hurt healthy mothers and babies. They are not proven to be best for the mother or baby and are not mother-friendly.
They should not keep track of the baby’s heart rate all the time with a machine (called an electronic fetal monitor). Instead it is best to have your nurse or midwife listen to the baby's heart from time to time.
They should not break your bag of waters early in labor.
They should not use an IV (a needle put into your vein to give you fluids).
They should not tell you that you can't eat or drink during labor.
They should not shave you.
They should not give you an enema.
A birth center, hospital, or home birth service that does these things for most of the mothers is not mother-friendly. Remember, these should not be used without a special medical reason.
7. Ask, “How do you help mothers stay as comfortable as they can be? Besides drugs, how do you help mothers relieve the pain of labor?”
The people who care for you should know how to help you cope with labor. They should know about ways of dealing with your pain that don’t use drugs. They should suggest such things as changing your position, relaxing in a warm bath, having a massage and using music. These are called comfort measures.
Comfort measures help you handle your labor more easily and help you feel more in control. The people who care for you will not try to persuade you to use a drug for pain unless you need it to take care of a special medical problem. All drugs affect the baby.
8. Ask, “What if my baby is born early or has special problems?”
Mother-friendly places and people will encourage mothers and families to touch, hold, breastfeed, and care for their babies as much as they can. They will encourage this even if your baby is born early or has a medical problem at birth. (However, there may be a special medical reason you shouldn't hold and care for your baby.)
9. Ask, “Do you circumcise baby boys?”
Medical research does not show a need to circumcise baby boys. It is painful and risky. Mother-friendly birth places discourage circumcision unless it is for religious reasons.
10. Ask, “How do you help mothers who want to breastfeed?”
The World Health Organization made this list of ways birth services support breastfeeding.
They tell all pregnant mothers why and how to breastfeed.
They help you start breastfeeding within
1 hour after your baby is born.
They show you how to breastfeed. And they show you how to keep your milk coming in even if you have to be away from your baby for work or other reasons.
Newborns should have only breast milk. (However, there may be a medical reason they cannot have it right away.)
They encourage you and the baby to stay together all day and all night. This is called “rooming-in.”
They encourage you to feed your baby whenever he or she wants to nurse, rather than at certain times.
They should not give pacifiers (“dummies” or “soothers”) to breastfed babies.
They encourage you to join a group of mothers who breastfeed. They tell you how to contact a group near you.
They have a written policy on breastfeeding. All the employees know about and use the ideas in the policy.
They teach employees the skills they need to carry out these steps.
Would you like to give this information (and more)
to your doctor, midwife, or nurse?
This information taken from The Mother-Friendly Childbirth Initiative written for health care providers. You can get a copy of the Initiative for your doctor, midwife, or nurse by mail, e-mail, or on the Internet.
To Get a Copy by Mail
Coalition for Improving Maternity Services (CIMS)
1500 Sunday Drive Suite 102
Raleigh, NC 27607
Tel 1: 888-282-CIMS
Tel 2: 919-863-9482
Permission granted to freely reproduce in whole or in part along with complete attribution.
To Get Copies on the Internet
please vivist their site. they have lots of useful info on there.
i feel like this is a long post so i'll stop for now but i think i'll continue on with this topic tuesday....
looks like the sue happy culture isn't a us only thing http://www.newsday.co.tt/news/0,106690.html midwives in spain are failing to renew their liscences due to a rise in negligency suits
heres a blog i came across today http://www.thehealthcareblog.com/ not specific to pregnancy/birth/postpartum but relevant nonetheless seems to give a good overview of the healthcare reform debate nd current healthcare policy and procedure
new drug, tafoxiparin for the prevention of prolonged labor during childbirth is in clinical trials http://www.reuters.com/article/pressRelease/idUS120679+04-Sep-2009+PRN20090904
sounds like its intended to be given prophylactically?
wish i could go to this birth film festival in orlando http://centralfloridagreenguide.com/2009/09/04/baby-international-film-festival-coming-oct-2nd-and-3rd/
this post http://womensphere.wordpress.com/2009/09/04/photos-of-childbirth-have-been-branded-pornography-in-zambia/ about a newspaper editor in zambia facing charges of pornagraphy for mailing a picture of a woman delivering a stillborn baby to a government oficial shows how deeply healthcare crisises affect birthing women all over the world. and how important it is to shed light on that. looks like the blog womensphere will be of interest in the future as well http://womensphere.wordpress.com/
and here are several links to articles about homebirth midwives in australia. you may be aware that homebirth advocates have had a rough time over there lately
well looks like the little may wake up in a minute so i guess thats it for now. hopefully will get back to it later to post more.
eventually i would like to write some thoughtful original informative insightful post but ......
first up The Breastfeeding Promotion Act introduced by Representative Carolyn B. Maloney (NY) and Senator Jeff Merkley (OR) in the senate on June 11
heres a link to the actual text http://bit.ly/Hi944 or http://maloney.house.gov/documents/women/breastfeeding/061009%20Breastfeeding%20Promotion%20Act.pdf
(sorry to make you cut and paste but links are wonky for some reason)
The Breastfeeding Promotion Act (H.R. 2819, S. 1244) includes five provisions:
- Amends the Civil Rights Act of 1964 to protect breastfeeding women from being fired or discriminated against in the workplace.
- Provides tax incentives for businesses that establish private lactation areas in the workplace, or provide breastfeeding equipment or consultation services to their employees.
- Provides for a performance standard to ensure breast pumps are safe and effective.
- Allows breastfeeding equipment and consultation services to be tax deductible for families (amends Internal Revenue Code definition of "medical care").
- Protects the privacy of breastfeeding mothers by ensuring they have break time and a private place to pump (applies to employers with 50 or more employees, see text of legislation for details)
Heres a site that will look up your congresspeople. http://www.visi.com/juan/congress/ and heres a pre written letter to send with an auto everything if thats easier for you http://org2.democracyinaction.org/o/5162/t/6359/campaign.jsp?campaign_KEY=1697
Let them know how important this is!
#2 on my list is a new blog i found http://bfwlibrarymidwifery.wordpress.com/
haven't read it in detail yet but seems to focus on protocols for clinicians.....literature reviews, studies etc oh and its british.....
and here is a good post about the different types of midwives practicing in florida http://centralfloridagreenguide.com/2009/08/04/florida-midwifery/
ok well i'm posting for now but i'll prolly (maybe) edit to add more later
have i mentioned i changed my weekly plan a bit? i'm doing topics in childbirth education on tuesdays and thursdays now....
on to todays topic "breastfeeding, galactagogues and reglan warning"
many many new mamas think they have a low milk supply. in fact according to this study
"The perception that their infant was not satisfied by breast milk alone was cited consistently as 1 of the top 3 reasons in the mothers' decision to stop regardless of weaning age (43.5%–55.6%)"(most have a fine supply btw)
Now the best wy to asess milk supply is by observing weight gain and counting wet and poopy dipes.
the world health organization has new weight gain charts based on breastfeeding you can refer to. heres the one for girls http://www.who.int/nutrition/media_page/cht_wfa_girls_z_0_5.pdf and heres the one for boys http://www.who.int/nutrition/media_page/cht_wfa_boys_z_0_5.pdf
and heres a quick diaper counting link from kellymom http://www.kellymom.com/bf/supply/enough-milk.html (basically you want to see 6 or more wet dipes a day and at least 1 poopy dipe, though younger infants, less than a month old often have several little poops each day rather than 1 big one)
if your baby isn't gaining and isn't wetting and pooping it could be a supply issue. ( it could also be transfer issue - you could be making milk and s/he isn't taking it in ) in either case please see a healthcare provider to be sure baby is ok and see a lactation counselor or a lactation consultant to check for breastfeeding issues such as a bad latch.
if you determine a low supply is the culprit there are lots of ways to increase your supply but the simplest is just to nurse.
- if you can arrange to spend a day or several in bed skin to skin with your babe that will often do the trick.
- be sure to offer both sides before you call it quits on any one nursing session.
- even if you have a sleepy baby be sure you wake him or her up every 2-3 hours to nurse
if increasing the time you spend nursing your little one doesn't increase supply you can add a pumping session or several into your routine.
and there are foods, herbs and medications that can increase supply if necessary. heres another link from kellymom http://www.kellymom.com/herbal/milksupply/herbal_galactagogue.html that gives a good list of various galactagogues and the dosages and side effects
and that leads me to the warning portion of this post: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm149533.htm
Reglan or metoclopramide is a drug used to treat reflux and other gastric conditions but it also increases milk supply. it is not fda approved for use as a galactagogue but is often used as one.
from the fda release linked above:
"Current product labeling warns of the risk of tardive dyskinesia
with chronic metoclopramide treatment. The development of this condition is
directly related to the length of time a patient is taking metoclopramide and
the number of doses taken. Those at greatest risk include the elderly,
especially older women, and people who have been on the drug for a long
Tardive dyskinesia is characterized by involuntary, repetitive
movements of the extremities, or lip smacking, grimacing, tongue protrusion,
rapid eye movements or blinking, puckering and pursing of the lips, or impaired
movement of the fingers. These symptoms are rarely reversible and there is no
known treatment. However, in some patients, symptoms may lessen or resolve after
metoclopramide treatment is stopped."
i guess there are two componets to the postpartum period: mother care and baby care.
and i guess postpartum actually begins when? after baby is born? before the cord is cut? after? lets just start with the 3rd stage of labor, delivery of the placenta
gloria leamy recently posted an excelent article about the "30 minute third stage" http://www.glorialemay.com/blog/?p=161
heres a different take on third stage mqnagement from the aafp http://www.aafp.org/afp/20060315/1025.html
basically the delivery of the placenta is managed either physiologically or actively. in a physiologic third stage the birth attendant does nothing other than watch for some time. loria suggests 30 minutes. the aafp states that there is a ower incidnce of postpartum hemmorhage in an actively managed third stage though. active management includes "uterotonic medication", early cord clamping and cutting, and controlled cord traction.
this from the article from the aafp:
"A Cochrane systematic review6 identified five randomized controlled
trials (RCTs) comparing active and expectant management that included more than
6,400 women. Compared with expectant management, active management was
associated with: a shorter third stage (mean difference, -9.77 minutes); a
reduced risk of postpartum hemorrhage (number needed to treat [NNT] = 12) and
severe postpartum hemorrhage (NNT = 57); a reduced risk of anemia (NNT = 27); a
decreased need for blood transfusion (NNT = 65); and a decreased need for
additional uterotonic medications (NNT = 7).6 Active management also was
associated with an increased risk of maternal nausea (number needed to harm
[NNH] = 15), vomiting (NNH = 19), and elevated blood pressure (NNH = 99), likely
caused by the use of an intramuscular ergot alkaloid as the uterotonic
medication in four of the five studies in the systematic review. There were no
advantages or disadvantages for the baby with either approach."
BTW: let me explain nnt and nnh. actually heres a wiki on it http://en.wikipedia.org/wiki/Number_needed_to_treat
dr. sara j. buckley weighs in in favor of a physiologic third stage here http://www.birthresourcenetwork.org/the-news/68-leave-well-alone-a-natural-approach-to-the-third-stage-of-labor dr. buckley takes the reduction in blood transfer from the cord to the baby into account in her article."While the aim of active management is to reduce the risk of haemorrhage for the
mother, 'its widespread acceptance was not preceded by studies evaluating the
effects of depriving neonates [newborn babies] of a significant volume of
It is estimated that early clamping deprives the baby of 54 to 160
ml of blood,11 which represents up to half of a baby's total blood volume at
and here is a very detailed look at the third stage from childbirth connection
this is actually taken from the book A Guide to Effective Care in Pregnancy and Childbirth (Oxford University Press, 2000)
In all that i just read it seems to boil down to what the mother wants. the risk of post partum hemmorhage is about 4%. some women would want to do everything to eliminate even that risk whereas others would prefer to have that time of undisturbed bonding as a new family.
in my own case i would have strongly prefered a physiologic third stage. but i can see that active management is an evidence based option as well. it does reduce risk....i just don't feel that the risk is high enought to warrant all the fiddling.
of course there is a third option...... http://en.wikipedia.org/wiki/Lotus_birth
Saturday, August 8, 2009 at 8:14pm
so for the last few weeks of pregnancy my mom called every morning to make sure i was ok. which sounds nice but was actually annoying. she was worried i was going to go into labor and wait too late to call her and end up having the baby in the car.
little did she know.
i was getting impatient and started nipple stimulation tuesday. finally on tuesday night around say 7 i started to have some contractions that felt a little more intese than the braxton hicks i'd been having for months. they settled into a pattern of about 10 minutes apart and continued even evenn after a meal, a shower...soo around 9 or 10 we called mama.oddly enough cvs called right around then also to see how i was doing. i had been just about to call and tell them we were headed out. by the time she got there and we loaded everthing in the car it was around 11 when we headed out to savannah.
kurt had booked us a room at the courtyard at marriot on abercorn. we got their about 1 and had a late supper. krystals. deciided to just go on to bed, contractions petered out so i figured i just as well rest.
woke up early wednesday and had some snack-y things for breakfast. had some contractions. was waiting for them to get to be 5 minutes apart. ended up taking kellen to the pool but didn't stay in long cuz it started to storm. had contractions all day but never got to 5 minutes aoart, 1 minute long. had been continueing to stimulate the nipples and also walked the halls some. but eneded up going to bed again w/ no baby after a very long walk.
woke up thursday with not much to show for my walk except a sore back. was sick of clock watching and contracting timing and nipple stimulating. we decided to stay over even though it didn't seem like a whole lot was happening or at least not very quickly. but priceline wouldn't let us renew the same room a second time so we had to change hotel rooms. moved to the hyatt on river st.was focused on enjoying the extended vacation so we went out and had a nice seafood supper. blackened salmon for me, shrimp for the kids and raw oysters for the hubby. then a fabulous ice cream for desert.had some good contractions during supper but ignored them as much as possible.
later on in the evniong had more good contractions.started timing again around 12:30 am friday morning. definately stronger but not really a consistent pattern...averaged about 5 minutes apart and 1 minute long. took a hot bath to see if they would continue. they did. went back to timimng....was definately having to work with the contractions at this point. kurt was at the restaraunt/pub a couple of doors down so decided to call him because now they were like 2-3 minutes apart and getting more and more intense and averaging about a minute. called him and he was on his way out the door anyway. as soon as he got back we called the midwife. she said come on to the birth center.
i was so escited it was finally time to have this baby! i had honestly been pissed off earlier in the day for what i thought was a wasted trip to savannah. had been dissapointed with waiting and tired of being all keyed up for no reason. it was a big relief for something to finally be happening that was unmistakablely labor.
though i had read about prodromal labor and knew thats what was happening, the intellectual knowledge had not fuly prepared me for he emotional reality. it was so unexpected....even though i know every pregnancy, every labor and every birth is different my 1st 2 were such textbook cases. they were both born a day before their due date. both labors progressed in a typical manner.
of course i was induced with olivia so who knows how that would have gone had her labor and birth been undisturbed?
the kids were asleep and i knew my mama was tired so kurt and i took a taxi to the birth center. we got there right at 2:45 and withing seconds my midwife, jill, was there. she let us in and did an exam and i was 5 centimeters. she also put me on the fetal monitor for a little while, prolly about 20 minutes.
i hate enduring contractions flat on my back on a monitor. well i wasn't flat on my back she adjusted the exam table so i was itting up somewhat but just to be so imobilized was aweful. freedom of movement makes contractions so much easier to bear. but i tried my best to relax and breath through them.
another couple arrrived a little while after we did. which was kind of neat. and also gave us more time undisturbed.once she took me off the monitor (with perfect readings) we went on back to the birthing room. i wanted to get in the tub right away but she wanted me to wait until the nurse got there. she was afraid i would get in the tub and get relaxed and deliver before the nurse got there.
but i squatted and rocked my hips and leaned on various things and dealt just fine.every contraction made me feel like i needed to pee so i spent alot of time sitting on the potty too. it just felt good to squat like that but to still be supported. and kurt was ready to help however i needed him to but i wasn't feeling very verbal so i ended doing for myself somewhat. he was good for support to lean on and all though. and get my water and manage the fan and all the small things.
finally jill said i could get in the shower. it felt so good to blast hot water on my belly and especially my hips. i was feeling lots of pressure in my pelvis. i knew it would soon be time to push.once the nurse, amanda got there and they got the other couple settled in, i asked about getting in the tub and jill said she would have to break my waters to make sure wasn't any mec (meconium....1st baby poo) in the water 1st.
they don't let you do a water birth if there is b/c it can indicate fetal distress and if its aspirated it can cause a nasty infection too so they don't want any delay in case they need to suction or do any other resucitative actions. personally i think with light mec a waterbirth would be fine especially with good readings on the monitor but if they have protocols they have to follow, well thats ok. i would've prefered to have kept the bag intact but that close to delivery (and i knew i was close because i was getting that pusshy feeling with some of the contractions at this point) i was ok with it, especially if i wasn't getting in the tub w/o them doing it.so there was mec in the water. very light lime green mec.
i'm glad i hadn't had my heart set on a water birth. my main dissapointment was just knowing i wouln't have hot water as pain relief.i tried the birth stool for a little while. but ended up on the bed in a hands and knees position. it hurt really bad in my hips. a pain i had been anticipating because it had been such a suprise to me with kellen's birth.
they told me that it would feel better to push...they said to push past the pain. and that was kind of true.i could tell when she made her way into the birth canal. i felt very full down there. and i knew that within a few pushes we'd meet our baby! it didn't take but a few pushes and she was crowning. that was a very intense feeling. more painful than it was with kellen but ok. i had to really summon courage to keep pushing though. its funny how even knowing as much as i do, i still had that fearful feeling. of course there wasn't a whole lot to do but to push her on out.
kurt made me a little mad b/c he took my glasses off so he could wipe my face with a cold wash cloth. but it felt good once he did it and later i forgot they weren't on my face anyway.
jill suggested i stack a bunch of pillows in front of me to lean on. it gave me a more upright position. only a few pushes (and lots of encouragement!!!!) and she was out. that was at 5:01 am.they suctioned her just a bit. mostly snottyness i think not mec. then handed her to me and helped me lay down with her. she latched right on and nursed well.
and then the placental drama started.
i'd originally plannned to wait until the placenta was born to cut the cord but they needed to take some cord blood to see if i need to get rhogam b/c i'm rh negtive. i had it at about 32 weeks so it shouldn't be an issue but just in case we do have another one sometime i want to be sure.so we waited until the cord stopped pulsing and then i cut the cord. kind of neat. the ob cut olivias. kurt cut kellen's and now i've cut one.
w/in just afew minutes jill was ready for the placenta to come out. i really don't know why it was so urgent. especially since i had mentioned reading gloria lemays blog post on the 30 minute thrid stage and jill said she had shared it on her fb page.she kept saying that if it was right there at the cervix there wasn't any reason to wait.
she tugged on the cord very gently and waited a bit. encouraged me to try pushing. gave me some "placenta release tincture", finally ended up injecting some pit into the cord. (mind you i was nursing and they took B'Elanna away for some of this) (baby nursing is supirior to pit imho) she ended up basically going in and removing the placenta manully.
it was all completely unnecessary i think. not evidence based practice at all. i don't know, maybe there was some urgency she didn't fully communicate the reason for? she did say that it almost looked like there was a velatinous (sp?) insertion in the cord...a term i've heard but still don't really know exactly what it means. (i'll look it up and post a link.) anyways its not something i knew to mean urgency in placenta delivery.
i will say the placenta was the funniest looking placenta i've ever seen. she looked at it and had the other midwife double check and seemed like it did come out intact. haven't had any hemmorhage so i guess its ok.what makes me mad is that i had specifically asked about third stage management at a prenatal apt and was told (by the other midwife) that they practiced "watchful waiting"
after we had a chance to nurse a bit jill helped me get a quick shower and to pee.i had already peed in the bed all over the chux pads.at that point i said "i must not have torn much b/c it really didn't hurt to pee" ( you mamas know exactly what i'm talking about)she said she hadn't seen a tear and would look and see. barely a skidmark and it was on my episiotomy scar so if the tissue hadn't already been weakened i prolly wouln't have torn.
we stayed and nepped for a few hours. mama and the kids came around 12:30 and we all left around 2. we went straight to mcdonalds and then hheaded back to dublin. so nice to come straight home.i guess thats it. any questions.... feel free to ask!
v = variable decels = c = cord compression = bad
e = early decels = h = head compression = normal
a = acels = o = ok if w/in 120- 160
l = late decels = p = placental deterioration = bad
So variable decels are when the heart rate goes UP above baseline during a contraction then down then Up again above baseline and then returns to normal. If you look on a strip it will look like "shoulders"
Early decels are when the heart rate goes down DURING a contraction. This is totally normal.
Late decels are when the heart rate goes down AFTER a contraction.
quoted from mdc thread linked in title
rixa delivers as always....
i'll add my 2 cents in my "official" follow up friday post, but you've done an awesome job of getting the whole story....
in fact heres an article from sara buckley (who i heard speak at the ican conference and she was so awesome....gave so much info my hand was sore from taking notes) this is about the risks involved in choosong epidural pain relief.
http://www.sarahjbuckley.com/articles/epidural-risks.htm i'll just quote the last paragraph here but ireally encourage you to read the full article
Epidurals have possible benefits but also significant risks for the laboring mother and her baby. These risks are well documented in the medical literature, but may not be disclosed to the laboring woman. Women who wish to avoid the use of epidurals are advised to choose carers and models of care that promote, support, and understand the principles and practice of natural and undisturbed birth."
the best book i've read about pain in l&d is grantley dick-read's "Childbirth w/o fear" http://www.amazon.com/Childbirth-Without-Fear-Original-Approach/dp/0061092487/ref=sr_1_2?ie=UTF8&s=books&qid=1247773081&sr=1-2 in it dick-read describes the Fear-Tension-Pain cycle that leads to pain.
Basically women these days having not seen normal birth (or often any actual birth...only the highly dramatized tv variety) tend to fear what they don't know. Fear leads to tension which leads to pain.
The solution is to learn about normal birth.
One of the important things to realize is that not every birth is painful. About 20% of births are actually painless. A film i highly reccomend is "Orgasmic Birth". http://www.orgasmicbirth.com/ I saw it last summer and it is so, I just can't even describe it.... inspiring, educational, just a fantastic film!
For births that do include pain, it's usually managable. My last birth never felt worse than bad menstrual cramps. Actually what surprised me most about that birth was the leg cramps I got while pushing :lol I didn't even feel the "ring of fire" during crowning. (although i did have a very intense sensation at my clitoris....not orgasmic, but not painful either just intense)
Highly effective non-medical techniques are available for pain managment during l&d. Heres a sampling:
Freedom of Movement: laboring and pushing and delivering in the position that is most comfortable for you will significantly reduce your pain sensations.
Freedom of movement is one of the 6 Lamaze Care Practices that supports Normal Birth http://www.lamaze.org/ChildbirthEducators/ResourcesforEducators/CarePracticePapers/FreedomofMovement/tabid/484/Default.aspx
Now for freedom of movement to be the most helpful you should familiarize yourself with common labor and delivery positions.
heres a slideshow from the mayo clinic with some ides http://www.mayoclinic.com/health/labor/PR00141
and heres some others from about.com http://pregnancy.about.com/od/laborbasics/ss/laborpositions.htm
Other pain management options include
You don't have to have a full water birth to take advantage of the pain relieving properties of water. Most hospital rooms have at least a shower if not a full tub. If a tub is available you can relax in the tub and if a shower is your only option you can let the spray hit your belly or your back and get some relief that way. This is an option you'll have to work out in advance with your dr or midwife but well worth it.
A word of caution: I have read that laboring in water can slow your labor so this is an option you may want to hold off on until you feel you need it. Of course if things seem slow you can always get out too.
I think the Bradley Method and the Hypnobirthing Methods offer a great deal of insight into the use of relaxation during labor and delivery.
i have this book at home and it has some good relaxation exercises http://www.amazon.com/Natural-Childbirth-Bradley-Way-Revised/dp/0452276594/ref=sr_1_1?ie=UTF8&s=books&qid=1247801922&sr=1-1
and if you can take a bradley class they'll do lots of practicing too http://www.bradleybirth.com/
hypnobirthing involves relaxation via a self induced state of hypnosis http://www.hypnobirthing.com/ i don't have any personal experience w/ it but lots of mamas swear by it
and of course there are plenty of stand-alone methods of relaxation.
this blog post from women giving birth naturally covers a few of the most popular
and heres a different site that gives more tips on different techniques http://www.womenshealthmatters.ca/centres/pregnancy/childbirth/relaxation.html
things like deep breathing (you don't have to learn anything complicated just in through the nose out through the mouth), progressive muscle relaxation where you tense then release muscle groups starting either at the toes, the fingers or sometimes the head/neck shoulders, visualization techniques, etc can all be useful helps to achieving a relaxed state.
okay well the kiddo wants the computer now so i guess i'll have to add more next thursday.....
some follow-up from salon http://www.salon.com/mwt/broadsheet/feature/2009/07/14/epidural_epidemic/index.html
and from london based delia lloyd http://www.politicsdaily.com/2009/07/16/no-pain-no-gain-the-value-of-epidurals-during-childbirth/
I posted rixa's reply seperately in the previous post. and she did an awesome job of collecting all the chatter. all i really have to say is trhat all the hoopla about him being a MAN is getting in the way of what he has to say. its sexist at the very least....i mean do we also question so strongly the pronouncements of other males dealing in birth such as the mostly male writers of obstetrical texts?
a study about bottle-feeding
the study basically says that women who choose to bottle feed are ignored by the medical profession and not given appropriate safety info. i ahve to say i agree with this. i bottlefed my daughter from about six weeks and did not get any safety info wrt formula feeding.
when i got my lactation counselor certification they suggested giving formula feeding classes as well as breastfeedig classes. it wasn't until i took that class that i learned formula isn't sterile for instance. and how many moms are told to add water to the bottle before powder to ensure accurate measurements? i wasn't. lucky for my daughter i knew that.
i thnik pediatricians would do well to pay attention to this study and to pay attention to their patients and parents as individuals....
dick morris makes claims that govn't is telling women to quit having cesareans
actually according to healthy people 2010 we do have a goal to reduce primary section rates from %18 in 1998 to %15 in 2010 and the repeat section rate from %72 to %63
however the site states
"(The targets presented here apply to the population as a whole and are not intended to be used as practice outcome objectives for individual physicians or institutions, as the medical needs of the patients in each practice will vary.) In addition to monitoring rates of cesarean births, the outcomes of these deliveries (for both the mother and the infant) should be watched closely to assure that changes in the mode of delivery do not put women or their infants at risk."
so section rate reduction is not being pushed in terms of a money saving strategy....thats really all i can find about obamas take on section rates....and of course these goals were crafted before obama took office anyway
anybody with more info? please comment....
and heres gloria lemays take on a letter posted on the american college of nurse midwives site http://www.glorialemay.com/blog/?p=147
i still don't know what i think about the situation. i'm an aspiring midwife. i'm currently thinking of going the cnm route rather than cpm because taht would allow me to bring the midwifery model of care to more women. if things were to change legally in this state to allow for legal recognition of cpms then i might go that route....
i do think the letter was unecessarily divisive, and i have not seen any research to support the conclusion that cpms are not qualified providers, BUT i do like the idea of a standardized education for cpms.
i don't see why apprenticeship couldn't be incorporated into that.
okay well this was kind of a lazy post but ithink its all i got for now....
this one is a mom comparing her epidural birth w/ her natural birth. guess which birth she prefered?
and that is ina may gaskin talking about birth.
i'm working backwards so the first few rounds are mostly going to be a few months back but hopefully it will become more current as i weed through.
1st up, an awesome resource http://www.nationalpartnership.org/site/PageServer the national partnership for women and families. they put out a daily report on women's health that you can sign up for here http://www.nationalpartnership.org/site/PageServer?pagename=daily2_fullreport (this link takes you to the days report, scroll all the way down to the bottom to subscribe)
and on to this article http://www.physorg.com/news157818920.html which is about the lack of consideration given to women's health in judical decisions the article is based on this study http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1345824# heres a quote from the abstract:
" judges regularly -- and often inaccurately -- cite the theoretical availability of alternative reproductive health services as proof that women's health will not suffer even if a law curtailing reproductive rights is upheld. I label this the "availability tool." Second, when alternatives are not available, decisions may blame women for the lack of availability. I call this the "culpability tool." Application of the availability and culpability tools in reproductive health cases can result in a truncated analysis of how laws impact women's reproductive health. "
heres an article about egg donation and possible risks to donors http://www.time.com/time/health/article/0,8599,1888459-1,00.html heres a quick quote:
"Right now egg donors are treated like vendors, not as patients. Patients need to be followed up," says internist Jennifer Schneider, who has been advocating for the government to track egg donors since 2007, a few years after her daughter, a three-time egg donor, died of colon cancer at age 31. "After the first few days of being discharged from the IVF clinic and seeing that there were no immediate consequences, they are never contacted again."
here is an awesome blog entry about the cyclical nature of womanhood and the disservice we do ourself in not respecting our rites of passage http://redtenttempletn.blogspot.com/2009/04/women-and-depression.html
just found a new blog to keep up with. this one written by a cnm in training http://nursemidwifeintraining.blogspot.com/ go check it out ya'll
a new study shows that women feel ignorant and uninformed re pregnancy and childbirth: http://ec.europa.eu/research/headlines/news/article_09_04_03_en.html
attributes this to hospital birth and geographic mobility
ok so i guess thats it for this mondays edition....
Two-fer Tuesdays: when iwill post two awesome birth related videos
Wild Wednesdays: for whatever tangent i'm on lately
Topical Thursdays: devoted to topics in childbirth education to be covered on a rotating basis
Follow-up Fridays: when i'll catch up on reading my favorite birthy blogs and give my take on what everybody else is talking about
At Your Cervix: What you may (or may not) know about labor and birth
i just started reading "the savvy woman patient" published by the society for women's health research and found out i was ignorant as to the two different kinds of risk: relative and absolute.
"relative risk is the amount of increase or decrease in whatever the study was designedto evaluate-breast cancer,heart disease,etc-over an entire population. So, for instance if a news report says that a certain medication doubles the risk of heart attack, it simply means that twice as many people taking the drug will have a heart attack as those not taking the drug.
absolute risk however, is the average persons risk of experiencing that side effect. so, for instance if you personally have a 5% risk of having a heart attack in your lifetime, then taking the drug increases your individual risk by another 5% resulting in a relative risk of 10%. in other words 10% is 5% doubled"
so if you're already at low risk of this or that and you double that low risk its still low risk.
just something to think about.
here are a few links on the topic as well
i use the term "health care provider" often becasue not all healthcare providers are in fact physicians. my midwives are not physicians, my chiropractors are not physicians, heck my dentist is not a physician....
of course not all physicians are true HEALTH care providers.... 5 minute visit that ends with an rx? is that really health care?
i'll give them that hey do spend a lot of years in school and do have a lot of specialized knowledge....but so do other health care providers. and many of the other healthcare providers i use spend more time with me as a patient, give more counseling, and focus more on actual health.....
some quick links
will have to think my own thought s on it though....
but have bben stewing on somethings posted on facebook....re you tube and birth videos.the nyt ran an article recently about the trend of posting birth videos and then kneelingwoman ( http://closetotheroot.blogspot.com/ ) posted some thoughts as to thefact that so many of us in the natural childbirth community claim birth as a sacred and private act and the contradictions inherent in posting a "private" act on the internet.
heavy stuff to be thnking about. i doubt i would post a birth video on you tube myself...the hubster is too private for me to be able to do that. i know its my body but yk its his baby too....
but there are some beautifule videos posted. here are some of my favorites:
well i thought i had more favorited than i did but go searching.....
other thoughts, i have started the first of the childbirth education series....plan to work on it some more this weekend, and i'll also check my email and post whatever turns up in the inbox that's interesting
oh and one more thought...the pharmacists yesterday made the mistake of saying that for most women who have sexual problems its psychological...i called bullshit on that but now i need to do some research to back myself up. will share when i find it...
the gist of it revolves around response to a study that came out recently that seems to indicate that childbirth education "doesn't work"
since i'm working on the first in what will become a continuing online cbe series i thought this would make a good kick-off
and heres an opinion from australia regarding intervention in birth http://www.smh.com.au/opinion/caesarean-scar-mongers-should-zip-it-20090220-8dkm.html?page=-1 the article has a strong anti-midwife tone to it as seen in this quote " ... a review of maternity health services ordered by the Health Minister, Nicola Roxon, and due to report in the next few weeks, is expected to place more pressure on women to reject the so-called "medicalisation" of childbirth. The review is expected to pave the way for a midwife takeover.
A discussion paper released last year raised the prospect of expanded Medicare access for midwives, independent of doctors, which will increase the numbers of more risky home births. ..." they go on to state that research shows the medcalization of birth to be improving outcomes.
however i think that was before the tragedy with janet fraser. (just checked and yes it was)
the australian press really went into hyperdrive after that as seen in this article which has lots of links.... http://www.news.com.au/dailytelegraph/story/0,22049,25294178-5001021,00.html
ooh and heres a blog post that links to the report mentioned in the original article above http://viv.id.au/blog/20090221.3841/maternity-services-review-medicare-payments-to-obs-up-from-77m-to-211m-since-2004/ heres the report link if you want to skip the blog post (although the post is pretty much a cheat sheet on the report ) http://www.health.gov.au/internet/main/publishing.nsf/Content/64A5ED5A5432C985CA25756000172578/$File/Improving%20Maternity%20Services%20in%20Australia%20-%20The%20Report%20of%20the%20Maternity%20Services%20Review.pdf
ireland is also reviewing their maternity services. apparently their system utilizes stand alone maternity hospitals http://www.rte.ie/news/2009/0220/health.html
and heres a study that indicates breastfeeding reduces risk of a relapse more that resuming medication for moms with ms http://www.theglobeandmail.com/life/health/article9936.ece " ... "It turns out that the women who are going right back on medications [and not breastfeeding] are doing the worst. They are at the highest risk of relapse," said lead researcher Annette Langer-Gould. ..." and heres an article that goes into a little bit more detail http://www.medpagetoday.com/MeetingCoverage/AAN/13030 and heres another article that references an older study that reached a different conclusion http://www.aan.com/elibrary/neurologytoday/?event=home.showArticle&id=ovid.com:/bib/ovftdb/00132985-200903190-00013
and heres an article from florida re midwifery business http://www.wctv.tv/news/headlines/40031382.html
heres an interesting article about nurse practitioners.... http://www.azcentral.com/news/articles/2009/02/21/20090221nursepractitioners0220.html
and an article about the societal impact of shorter maternity leaves http://www.sundayherald.com/life/people/display.var.2490823.0.0.php it contrasts a speedy return to regaular activity with the more traditional practice of babymooning
well the littlest little is up from a nap now so i guess i will close for now
this was just too awesome....thing is they've known about these risks for awhile, i've been doing quite a bit of reading re cesarean section lately and some of the books are fairly outdated but they still mention all these risks
today is the 10th anniversary of the introduction of national midwifery service in ireland http://www.herald.ie/breaking-news/national-news/10th-anniversary-of-national-midwifery-services-launch-1749483.html
something from south africa on the importance of female assistants for pre-natal care and at birth http://www.plusnews.org/Report.aspx?ReportId=84516
heres a whole article about the retirement of a childbirth educator http://www.midiowanews.com/site/tab3.cfm?newsid=20319959&BRD=2700&PAG=461&dept_id=554434&rfi=6 how awesome that she was valued that much to be written up.!
and its so interesting when everybody posts on the same topic:
here are 3 blogs posting on delayed cord clamping
these just after i stumbled onto this http://blogginboutbirthandmore.blogspot.com/2009/05/we-are-only-mammals-who-do-it-this-way.html
i had decided to wait until the placenta is born to cut the cord for my upcoming birth already but it was neat to read ... and informative to read some of the arguments against delayd cord clamping (which you'll find primarily in the comments )
and ugh! http://www.chicagotribune.com/news/local/chi-autism-doctor-rosimay22,0,5086891.story ""Eighty percent of complications in childbirth are psychological," he said. "Babies can be killed by a mother's attitude."
and heres something new to research "nunchal cord" heres a quick link to a blog post about it http://jeremyscorner-grifter.blogspot.com/2009/02/cord-around-neck-is-not-emergency.html but there are quite a few dissenting comments so...
well suppers ready so...
"Help the PushNation rise up to tell Congress about how access to out-of-hospital maternity care and Certified Professional Midwives (CPMs), who are specially trained to provide it, are a top priority in national health care reform! Help alert Congress to the Capitol Hill Issue Briefing on Thursday, May 21, focused on how out-of-hospital maternity care reduces costs and improves outcomes. "
TO GET STARTED: Download the specific-to-your-state information below.
DON'T SEE YOUR STATE?: Use this link http://zip4.usps.com/zip4/welcome.jsp to determine your ZIP+four code, and then this link http://www.house.gov/zip/ZIP2Rep.htmlto type in your ZIP+four code to determine your U.S. Representative. ... Also, this link http://www.senate.gov/general/contact_information/senators_cfm.cfm can help identify your U.S. Senators. Then you can use any of the other states documents below to help guide you from there.
TO SHARE: Send a link to this page http://www.thebigpushformidwives.org/index.cfm?fuseaction=enews.signup to all your Facebook friends and Twitter followers, as well as others in your personal and professional networks, with an urgent note on why this is so important to you, and why they should help too, today.
TO SHARE EVEN MORE: 1) Download the flier http://www.thebigpushformidwives.org/attachments/pages/DC+Birth+Briefing+5-21-09_FLIER.pdf and include in your emails to others, and 2) Share key information about the briefing on your blogs and organizational websites, and to your e-lists.
TO JOIN THE CAUSE: 1) Make sure you've signed up for PushAlerts on this page http://www.thebigpushformidwives.org/index.cfm?fuseaction=enews.signup 2) Make sure you've joined us on Facebook http://apps.facebook.com/causes/139482?m=8c3a5226&recruiter_id=21060214, and 3) Check out the state-level advococy orgs http://www.thebigpushformidwives.org/index.cfm/fuseaction/home.stateStatus/index.htm hard at work in your state. ... You may even consider joining one of them too
AND HERES MORE DETAILED INFO from the arizona specific flyer but just insert your state info from the above links
this just gives some suggested talking points and other tips
http://www.bloomberg.com/apps/news?pid=20601103&sid=aqXXW3MCHV5Q&refer=us "The intravenous therapy, ATryn, is purified from the milk of goats whose parents were injected with a human protein that helps prevent blood clots, GTC said today in a statement. The drug will be used for surgery patients or expectant mothers who have a rare genetic disorder that keeps them from making enough of the protein, called antithrombin. " and heres a slightly more in depth article from the nyt http://www.nytimes.com/2009/02/07/business/07goatdrug.html?ref=business
a short piece in praise of epidurals http://www.thedailysound.com/020609coasting i had one with my first and didn't like it. nobody told me i'd be cathetered for one thing and that HURT. but i felt i'd be remiss if i didn't throw that in here
heres a quick link to the hypnobabies blog http://hypnobabies.wordpress.com/ not a method i am very familiar with but something i know folks are interested in. the first post i saw about the compatability of hypnobabies and christianity was interesting though http://hypnobabies.wordpress.com/2009/05/17/christians-using-hypnobabies/ i've occaisionally read articles that hypnosis is unchristian and this post did a good job of refuting that while pointing out that the monagan method used in hypnobirthing is a lot more "woo" here are a few comparisons btw the 2
seems like most of the people felt that hypnobabies was more comprehensive
heres some legislation thats pending in south carolina http://www.thestate.com/local/story/675868.html "Rep. Greg Delleney of Chester, the General Assembly’s most outspoken abortion foe, gained initial approval Thursday to require doctors to save any fetus that survives an abortion. The bill, which unanimously passed a House subcommittee Delleney chairs, is aimed at rewriting state law to recognize the “personhood” of the unborn.
If the bill becomes law, a person would be redefined as anyone at any stage of development who is breathing, has a heartbeat, a pulsation of the umbilical cord or definite movement of voluntary muscles after birth, whether that be by labor, Cesarean section or abortion.
Delleney says it has wider implications than just for abortion clinics."
guesss its time to close, gotta figure out supper