Here is a link to a new study on the safety of home birth- slightly safer with fewer interventions than hospital birth. (Maybe fewer interventions make birth safer... just a thought)
http://www.cmaj.ca/cgi/rapidpdf/cmaj.081869
Friday, September 4, 2009
Wednesday, August 12, 2009
Due Dates- What do they mean?
Overdue
I am overdue! AHHHHH! Though I hate to admit it it makes me crazy and I just want to have this baby. So, today I am just going to write really to reassure myself that this is normal and ok and generally safe.
How We Calculate Due Dates
The general assumption now is that a woman should have a baby by 40 weeks gestation. This is based on a decades old assumption that is not necessarily based in fact but rather tradition. The method of calculating due dates most commonly used is known ans Naegele's Rule and you can read more about it here.
http://en.wikipedia.org/wiki/Naegele's_rule
If you read the description you will find that A) there are some imperfections in it that make it more of a rough estimate than an exact calculator and B) recent studies have shown that the average gestation is closer to 41 weeks and one day for first time mothers rather than 40 weeks.
What is the big deal about going overdue?
Officially you are not actually overdue until you go past 42 weeks! Yes- read that again- you are not overdue until you go past 42 weeks. Yet currently you will have a hard time finding a care provider that will "let" (I hate that term) you go past 40 weeks. So now, instead of 40 weeks being considered an average, give or a take a few weeks, you pretty much are expected to deliver by 40 weeks or induction is on the horizon.
The blog below has some great info on pitocin inductions and their risks and dosages.
http://nursingbirth.wordpress.com/2009/07/09/pitocin-protocol-for-labor-inductionaugmentation-decoded/
What is going on here? Truthfully there are some risks to going overdue, they are however statistically small for most women. In fact, one article I found stated that:
"Routine labor induction at 41 weeks likely increases labor complications and operative delivery without significantly improving neonatal outcomes."
(ObstetGynecol 2000; 96: 291-4)
There is some evidence however that going overdue does increase the chance of neonatal death. "At 44 weeks the death rate of these infants escalates to at least four times that of term infants, although it is still less than 1%" (Ob Gyn News, July 15-31, 1996).
So- once we get past 42 weeks there is a slightly increased chance of neonatal death but the risk is still low. We also can be pretty sure that the interventions used to start labor earlier also have risks and can be dangerous to both mother and baby.
Induction, Convenience, and Liability in Postdates
Right now we are seeing outrageous induction rates. They very from hospital to hospital and region to region, but, they are dangerously high and in my opinion, inductions are damaging women and their babies across the country right now.
They are not however causing hospitals to lose money. In fact, the opposite is probably true. Induced babies are more likely to have problems and need a stay in the NICU, and their mothers are more likely to "need" a costly c-section and the added hospital stay.
The other benefit to the induction prior to 42 weeks is that it can be planned. Ask a midwife when women go into labor- the answer will probably be- usually at night. Women often go into labor when their parasympathetic nervous system is activated and they are relaxed, like they are at night when asleep.
Now take a trip to your local L&D unit at a nearby hospital. You fill find (often, though it varies a lot) that hospitals are very empty at night and very busy on weekday mornings. Inductions can happen when you want them too. They are predictable. They can be scheduled. They can fit into your golf game, vacation, work schedule, sleep schedule, etc. Don't just blame the ob though, they can fit into your husbands travel schedule, or your kids school schedule. You can't predict how they will turn out, but you can pick the day.
Will We Ever Get Back to Just Allowing Birth to Happen?
I love to talk to women about birth, especially of different ages. I find that even 15 years ago doctors didn't really start to worry until you went past 42 weeks. Talk to your mothers and Aunts and friends. These women routinely went past 40 weeks and it was just not worried about that much. This is almost unheard of now as induction is so common and a naturally starting labor is quickly disappearing in our hospitals.
I hope that the pendulum of induction will swing the other way as we realize how dangerous the routine induction is and how much it is damaging not just babies (do we really know what pitocin does to their rapidly developing brains?) but to the psyche of women everywhere (does the thought that your body doesn't work properly and will never go into labor upset you?).
The convenience for the care provider and scheduling guru at your local hospital, not to mention you, seem so tempting that I worry that we will be slow to get back to the idea that labor can and will and SHOULD occur on its own when the baby is ready.
What Should You do if You Go Overdue?
How about what I will try to do now that I am going overdue?! First, I am trying to be patient with my body and my baby. If you believe that birth is normal and safe and that babies come when they are ready (note the they, not you) than it is worth the wait to give your baby the best start possible. I will try to keep myself healthy and happy and feed my body right so that the baby can get any last minute things it needs before it can be born. I will try to learn some mothering skills from this little wait (like patience!). I will be grateful that my babies come a little late rather than dangerously early. I will be grateful for their health and their own personalities that choose when they are ready. I will do some natural things that prepare my body for birth, like walking, without trying to "induce myself". (I have always found the term 'natural induction' to be somewhat silly).
I will be grateful for all the women I know who believe in birth and allow it to happen naturally and support me even when I am feeling a little crazy!
Thanks for reading! Would love to hear back from you too!
I am overdue! AHHHHH! Though I hate to admit it it makes me crazy and I just want to have this baby. So, today I am just going to write really to reassure myself that this is normal and ok and generally safe.
How We Calculate Due Dates
The general assumption now is that a woman should have a baby by 40 weeks gestation. This is based on a decades old assumption that is not necessarily based in fact but rather tradition. The method of calculating due dates most commonly used is known ans Naegele's Rule and you can read more about it here.
http://en.wikipedia.org/wiki/Naegele's_rule
If you read the description you will find that A) there are some imperfections in it that make it more of a rough estimate than an exact calculator and B) recent studies have shown that the average gestation is closer to 41 weeks and one day for first time mothers rather than 40 weeks.
What is the big deal about going overdue?
Officially you are not actually overdue until you go past 42 weeks! Yes- read that again- you are not overdue until you go past 42 weeks. Yet currently you will have a hard time finding a care provider that will "let" (I hate that term) you go past 40 weeks. So now, instead of 40 weeks being considered an average, give or a take a few weeks, you pretty much are expected to deliver by 40 weeks or induction is on the horizon.
The blog below has some great info on pitocin inductions and their risks and dosages.
http://nursingbirth.wordpress.com/2009/07/09/pitocin-protocol-for-labor-inductionaugmentation-decoded/
What is going on here? Truthfully there are some risks to going overdue, they are however statistically small for most women. In fact, one article I found stated that:
"Routine labor induction at 41 weeks likely increases labor complications and operative delivery without significantly improving neonatal outcomes."
(ObstetGynecol 2000; 96: 291-4)
There is some evidence however that going overdue does increase the chance of neonatal death. "At 44 weeks the death rate of these infants escalates to at least four times that of term infants, although it is still less than 1%" (Ob Gyn News, July 15-31, 1996).
So- once we get past 42 weeks there is a slightly increased chance of neonatal death but the risk is still low. We also can be pretty sure that the interventions used to start labor earlier also have risks and can be dangerous to both mother and baby.
Induction, Convenience, and Liability in Postdates
Right now we are seeing outrageous induction rates. They very from hospital to hospital and region to region, but, they are dangerously high and in my opinion, inductions are damaging women and their babies across the country right now.
They are not however causing hospitals to lose money. In fact, the opposite is probably true. Induced babies are more likely to have problems and need a stay in the NICU, and their mothers are more likely to "need" a costly c-section and the added hospital stay.
The other benefit to the induction prior to 42 weeks is that it can be planned. Ask a midwife when women go into labor- the answer will probably be- usually at night. Women often go into labor when their parasympathetic nervous system is activated and they are relaxed, like they are at night when asleep.
Now take a trip to your local L&D unit at a nearby hospital. You fill find (often, though it varies a lot) that hospitals are very empty at night and very busy on weekday mornings. Inductions can happen when you want them too. They are predictable. They can be scheduled. They can fit into your golf game, vacation, work schedule, sleep schedule, etc. Don't just blame the ob though, they can fit into your husbands travel schedule, or your kids school schedule. You can't predict how they will turn out, but you can pick the day.
Will We Ever Get Back to Just Allowing Birth to Happen?
I love to talk to women about birth, especially of different ages. I find that even 15 years ago doctors didn't really start to worry until you went past 42 weeks. Talk to your mothers and Aunts and friends. These women routinely went past 40 weeks and it was just not worried about that much. This is almost unheard of now as induction is so common and a naturally starting labor is quickly disappearing in our hospitals.
I hope that the pendulum of induction will swing the other way as we realize how dangerous the routine induction is and how much it is damaging not just babies (do we really know what pitocin does to their rapidly developing brains?) but to the psyche of women everywhere (does the thought that your body doesn't work properly and will never go into labor upset you?).
The convenience for the care provider and scheduling guru at your local hospital, not to mention you, seem so tempting that I worry that we will be slow to get back to the idea that labor can and will and SHOULD occur on its own when the baby is ready.
What Should You do if You Go Overdue?
How about what I will try to do now that I am going overdue?! First, I am trying to be patient with my body and my baby. If you believe that birth is normal and safe and that babies come when they are ready (note the they, not you) than it is worth the wait to give your baby the best start possible. I will try to keep myself healthy and happy and feed my body right so that the baby can get any last minute things it needs before it can be born. I will try to learn some mothering skills from this little wait (like patience!). I will be grateful that my babies come a little late rather than dangerously early. I will be grateful for their health and their own personalities that choose when they are ready. I will do some natural things that prepare my body for birth, like walking, without trying to "induce myself". (I have always found the term 'natural induction' to be somewhat silly).
I will be grateful for all the women I know who believe in birth and allow it to happen naturally and support me even when I am feeling a little crazy!
Thanks for reading! Would love to hear back from you too!
Monday, July 13, 2009
Started Selling Slings- Again
Just a shout out that I have started selling slings again. For some reason this seems to work well for me despite my aspirations for something greater! The link to my Etsy shop is now on the upper right hand corner of my blog.
Also- if you are just a sling mama and need some info on using your sling, check out the links. There are some great free links online so you don't have to buy a DVD to learn to use your sling.
I am getting going and trying to come up with ideas of other stuff I can make and sell- so I would love to hear some of your feedback and ideas. Let me know. I have had a request for a full coverage nursing cover, and am considering hot packs for labor. Any other ideas or tools that you doulas need but have a hard time finding.
Thanks!
Sarah
Also- if you are just a sling mama and need some info on using your sling, check out the links. There are some great free links online so you don't have to buy a DVD to learn to use your sling.
I am getting going and trying to come up with ideas of other stuff I can make and sell- so I would love to hear some of your feedback and ideas. Let me know. I have had a request for a full coverage nursing cover, and am considering hot packs for labor. Any other ideas or tools that you doulas need but have a hard time finding.
Thanks!
Sarah
Tuesday, July 7, 2009
Birth Centers Lose Medicaid Funding in Texas
Please go to the website listed to sign a petition to once again fund Birth Centers in Texas.
www.birthcenters.org
Recently legislation has been passed ending the funding of Medicaid to Birth Centers in Texas. This is such a tragedy for many reasons.
1. This was certainly not motivated by a desire for fiscally responsible government. Birth Center births are far less expensive and also have much lower C-section rates.
2. Medicaid funding gives low income women the option for out of hospital births. Most midwives already do not accept Medicaid for home birth because the pay is so little.
3. Cutting off this funding could potentially put some Birth Centers out of business. Those that accept Medicaid are limited already because Medicaid does not pay as well as insurance.
4. It will force more women to either birth in Texas hospitals (which frankly are shameful in their treatment of women and their disgusting interventions).
5. It will hurt babies and women as those hospital births have higher C-section rates, NICU stays, interventions, and drugs.
I am grateful that when I lived in Texas I had the option of a wonderful Birth Center birth at Inanna Birth Center in Denton. I could not afford a home birth and was not willing to birth in the nearby Texas hospitals. The ones closest to me had C-section rates of 50%, induction rates around 95% and epidural rates close to 100%. Successful breastfeeding was rare, and women were still delivering in stirrups, with episitiomeys, continuous fetal monitoring, and IV were standard.
Please sign the petition to find Birth Centers again in Texas.
www.birthcenters.org
Recently legislation has been passed ending the funding of Medicaid to Birth Centers in Texas. This is such a tragedy for many reasons.
1. This was certainly not motivated by a desire for fiscally responsible government. Birth Center births are far less expensive and also have much lower C-section rates.
2. Medicaid funding gives low income women the option for out of hospital births. Most midwives already do not accept Medicaid for home birth because the pay is so little.
3. Cutting off this funding could potentially put some Birth Centers out of business. Those that accept Medicaid are limited already because Medicaid does not pay as well as insurance.
4. It will force more women to either birth in Texas hospitals (which frankly are shameful in their treatment of women and their disgusting interventions).
5. It will hurt babies and women as those hospital births have higher C-section rates, NICU stays, interventions, and drugs.
I am grateful that when I lived in Texas I had the option of a wonderful Birth Center birth at Inanna Birth Center in Denton. I could not afford a home birth and was not willing to birth in the nearby Texas hospitals. The ones closest to me had C-section rates of 50%, induction rates around 95% and epidural rates close to 100%. Successful breastfeeding was rare, and women were still delivering in stirrups, with episitiomeys, continuous fetal monitoring, and IV were standard.
Please sign the petition to find Birth Centers again in Texas.
Friday, July 3, 2009
Banned From Baby Showers: Beta-Endorphins and Their Affects on Pain Perception in Labor
Just wanted to put a link to a friends blog. Amazing what the body does in labor. Natural birth is not as painful as we are often led to believe, and can in fact be painless and wonderful.
Banned From Baby Showers: Beta-Endorphins and Their Affects on Pain Perception in Labor
Banned From Baby Showers: Beta-Endorphins and Their Affects on Pain Perception in Labor
C-section's Contribute to Later Health Problems
The Invisible Scar's Left by C-sections
I thought this was an interesting article that pointed out some of the risks of C-section that are just being discovered. The next post is a link to the same article so you can go directly to it.
How sad that once again an obstetric procedure has become commonplace without proof that it is safe. (In fact there is ample evidence that C-sections are less safe and death is more likely for the mother.) Just as x-rays during pregnancy were once thought to be 'safe' and were not stopped until LATER proven to be cancer causing, so, c-sections are used in abundance while years later we are seeing the negative results.
Certainly, all mothers must be careful to avoid any kind of obstetric intervention from pharmaceuticals to excessive ultrasound to induction procedures. Just because something has yet to been proven unsafe does not mean it is safe. The problems associated with exposing our babies to these interventions are often not visible until later on in life, especially if they are more subtle or can yet be proven and examined by science.
The C-section rate in this country is around 30% and rising. We must learn to trust in birth and our bodies again. Just knowing that we are capable of birth and believing that it is natural and safe changes the way we look at it and changes the way we will experience it. If you know that birth is beautiful and safe, a care provider that suggests otherwise will be someone you avoid. The idea of a scheduled C-section based on flimsy medical reasoning will seem abhorrent to you when you know that you can birth your baby.
Money talks. If you are not comfortable with your care provider, or if you know they do not respect you and your choices, tell them by choosing somebody else. We can create change but we must ask for it. It will not happen if we keep giving our money and our time to those who who feel a vaginal by-pass is superior and safer.
That May Increase Odds For Developing Diseases in Later Life
ScienceDaily (June 29, 2009) — Swedish researchers have discovered that babies born by Caesarean section experience changes to the DNA pool in their white blood cells, which could be connected to altered stress levels during this method of delivery, according to the July issue of Acta Paediatrica.
It is thought that these genetic changes, which differ from normal vaginal deliveries, could explain why people delivered by C-section are more susceptible to immunological diseases such as diabetes and asthma in later life, when those genetic changes combine with environmental triggers.
Blood was sampled from the umbilical cords of 37 newborn infants just after delivery and then three to five days after the birth. It was analysed to see the degree of DNA-methylation in the white blood cells - a vital part of the immune system.
This showed that the 16 babies born by C-section exhibited higher DNA-methylation rates immediately after delivery than the 21 born by vaginal delivery. Three to five days after birth, DNA-methylation levels had dropped in infants delivered by C-section so that there were no longer significant differences between the two groups.
"Delivery by C-section has been associated with increased allergy, diabetes and leukaemia risks" says Professor Mikael Norman, who specialises in paediatrics at the Karolinska Institutet in Stockholm, Sweden. "Although the underlying cause is unknown, our theory is that altered birth conditions could cause a genetic imprint in the immune cells that could play a role later in life.
"That is why we were keen to look at DNA-methylation, which is an important biological mechanism in which the DNA is chemically modified to activate or shut down genes in response to changes in the external environment. As the diseases that tend to be more common in people delivered by C-section are connected with the immune system, we decided to focus our research on early DNA changes to the white blood cells."
The authors point out that the reason why DNA-methylation is higher after C-section deliveries is still unclear and further research is needed.
"Animal studies have shown that negative stress around birth affects methylation of the genes and therefore it is reasonable to believe that the differences in DNA-methylation that we found in human infants are linked to differences in birth stress.
"We know that the stress of being born is fundamentally different after planned C-section compared to normal vaginal delivery. When babies are delivered by C-section, they are unprepared for the birth and can become more stressed after delivery than before. This is different to a normal vaginal delivery, where the stress gradually builds up before the actual birth, helping the baby to start breathing and quickly adapt to the new environment outside the womb."
The authors point out that the surgical procedure itself may play a role in DNA-methylation and that factors other than the delivery method need to be explored in more detail.
"In our study, neonatal DNA-methylation did not correlate to the age of the mother, length of labour, birth weight and neonatal CPR levels - proteins that provide a key marker for inflammation" says Professor Norman. "However, although there was no relation between DNA-methylation and these factors, larger studies are needed to clarify these issues."
Professor Norman states that the Karolinska study clearly shows that gene-environment interaction through DNA-methylation is more dynamic around birth than previously known.
"The full significance of higher DNA-methylation levels after C-section is not yet understood, but it may have important clinical implications" he says.
"C-section delivery is rapidly increasing worldwide and is currently the most common surgical procedure among women of child-bearing age. Until recently, the long-term consequences of this mode of delivery had not been studied. However, reports that link C-section deliveries with increased risk for different diseases in later life are now emerging. Our results provide the first pieces of evidence that early `epigenetic' programming of the immune system may have a role to play."
The authors feel that their discovery could make a significant contribution to the ongoing debate about the health issues around C-section deliveries.
"Although we do not know yet how specific gene expression is affected after C-section deliveries, or to what extent these genetic differences related to the mode of delivery are long-lasting, we believe that our findings open up a new area of important clinical research" concludes lead author Titus Schlinzig, a research fellow at the Karolinska Institutet.
I thought this was an interesting article that pointed out some of the risks of C-section that are just being discovered. The next post is a link to the same article so you can go directly to it.
How sad that once again an obstetric procedure has become commonplace without proof that it is safe. (In fact there is ample evidence that C-sections are less safe and death is more likely for the mother.) Just as x-rays during pregnancy were once thought to be 'safe' and were not stopped until LATER proven to be cancer causing, so, c-sections are used in abundance while years later we are seeing the negative results.
Certainly, all mothers must be careful to avoid any kind of obstetric intervention from pharmaceuticals to excessive ultrasound to induction procedures. Just because something has yet to been proven unsafe does not mean it is safe. The problems associated with exposing our babies to these interventions are often not visible until later on in life, especially if they are more subtle or can yet be proven and examined by science.
The C-section rate in this country is around 30% and rising. We must learn to trust in birth and our bodies again. Just knowing that we are capable of birth and believing that it is natural and safe changes the way we look at it and changes the way we will experience it. If you know that birth is beautiful and safe, a care provider that suggests otherwise will be someone you avoid. The idea of a scheduled C-section based on flimsy medical reasoning will seem abhorrent to you when you know that you can birth your baby.
Money talks. If you are not comfortable with your care provider, or if you know they do not respect you and your choices, tell them by choosing somebody else. We can create change but we must ask for it. It will not happen if we keep giving our money and our time to those who who feel a vaginal by-pass is superior and safer.
That May Increase Odds For Developing Diseases in Later Life
ScienceDaily (June 29, 2009) — Swedish researchers have discovered that babies born by Caesarean section experience changes to the DNA pool in their white blood cells, which could be connected to altered stress levels during this method of delivery, according to the July issue of Acta Paediatrica.
It is thought that these genetic changes, which differ from normal vaginal deliveries, could explain why people delivered by C-section are more susceptible to immunological diseases such as diabetes and asthma in later life, when those genetic changes combine with environmental triggers.
Blood was sampled from the umbilical cords of 37 newborn infants just after delivery and then three to five days after the birth. It was analysed to see the degree of DNA-methylation in the white blood cells - a vital part of the immune system.
This showed that the 16 babies born by C-section exhibited higher DNA-methylation rates immediately after delivery than the 21 born by vaginal delivery. Three to five days after birth, DNA-methylation levels had dropped in infants delivered by C-section so that there were no longer significant differences between the two groups.
"Delivery by C-section has been associated with increased allergy, diabetes and leukaemia risks" says Professor Mikael Norman, who specialises in paediatrics at the Karolinska Institutet in Stockholm, Sweden. "Although the underlying cause is unknown, our theory is that altered birth conditions could cause a genetic imprint in the immune cells that could play a role later in life.
"That is why we were keen to look at DNA-methylation, which is an important biological mechanism in which the DNA is chemically modified to activate or shut down genes in response to changes in the external environment. As the diseases that tend to be more common in people delivered by C-section are connected with the immune system, we decided to focus our research on early DNA changes to the white blood cells."
The authors point out that the reason why DNA-methylation is higher after C-section deliveries is still unclear and further research is needed.
"Animal studies have shown that negative stress around birth affects methylation of the genes and therefore it is reasonable to believe that the differences in DNA-methylation that we found in human infants are linked to differences in birth stress.
"We know that the stress of being born is fundamentally different after planned C-section compared to normal vaginal delivery. When babies are delivered by C-section, they are unprepared for the birth and can become more stressed after delivery than before. This is different to a normal vaginal delivery, where the stress gradually builds up before the actual birth, helping the baby to start breathing and quickly adapt to the new environment outside the womb."
The authors point out that the surgical procedure itself may play a role in DNA-methylation and that factors other than the delivery method need to be explored in more detail.
"In our study, neonatal DNA-methylation did not correlate to the age of the mother, length of labour, birth weight and neonatal CPR levels - proteins that provide a key marker for inflammation" says Professor Norman. "However, although there was no relation between DNA-methylation and these factors, larger studies are needed to clarify these issues."
Professor Norman states that the Karolinska study clearly shows that gene-environment interaction through DNA-methylation is more dynamic around birth than previously known.
"The full significance of higher DNA-methylation levels after C-section is not yet understood, but it may have important clinical implications" he says.
"C-section delivery is rapidly increasing worldwide and is currently the most common surgical procedure among women of child-bearing age. Until recently, the long-term consequences of this mode of delivery had not been studied. However, reports that link C-section deliveries with increased risk for different diseases in later life are now emerging. Our results provide the first pieces of evidence that early `epigenetic' programming of the immune system may have a role to play."
The authors feel that their discovery could make a significant contribution to the ongoing debate about the health issues around C-section deliveries.
"Although we do not know yet how specific gene expression is affected after C-section deliveries, or to what extent these genetic differences related to the mode of delivery are long-lasting, we believe that our findings open up a new area of important clinical research" concludes lead author Titus Schlinzig, a research fellow at the Karolinska Institutet.
Subscribe to:
Posts (Atom)