Choosing a care provider that is on the same page as you and your birthing wishes is one of the first steps in preparing for the birth you want. The questions you ask when interviewing a provider can offer some insight into their beliefs surrounding birth and the care that they provide but it's important to look deeper than simple questions about statistics. Here are some ideas to get you started.
1. Look out for always and never. If the response you get to a question about episiotomies is "I never cut episiotomies," that should be a big red flag. Not only could that not possibly be true, but that could also put babies at risk. By no means should interventions be routine but if they are never used than that brings up concerns regarding well-being also. If your provider says "Yes, my patients always move around in labor," then that sounds quite promising. But, again, how can that be true when many providers in our area have epidural rates that hover around the national average of about 76%? Bottom line: if you're getting answers that are so black and white, either ask more questions or interview someone else. 2. Ask "What" questions. This is a great follow-up to the "always/never" response. "What would be a situation where you may do an episiotomy?" "What would be a situation where a woman is not encouraged to move around?" "In what position do you encourage women to push their babies out?" "What" questions will get you a lot more info than simple yes and no questions. 3. Explore the philosophies of others in the practice. Follow-up your previous questions with inquiries as to how the other providers in the practice tend to feel. Ask your provider what they love about the practice that they're in and, if applicable, what drew them to working at the hospital or birth center that they are in. How likely is it that they will be at your birth versus another provider in their practice? 4. Watch their body language. Is your potential provider quick to pack up your chart and look at the door? Are they checking their watch or did they leave their previous engagements at the door, providing you with full attention? Do they respond to your questions before you're even finished asking? Or do they take a moment to absorb what you've said and offer a thoughtful response? Pay attention to the details and the way you feel about your meeting, aside from simply the responses to your queries. 5. Ask if they have any questions for you. Providers should always have questions for you. They should, in an ideal world, also want to make sure that what they have to offer matches up with what you desire for your birth.
2 Comments
Social media is an incredible tool for anyone building or maintaining a business, particularly a business that is as community based as that of the birth professional. The ease with which one can connect to other birth workers in outlets such as Facebook and Instagram, share resources and research, and seek guidance and support is unprecedented. And the ability to stay in touch with clients while enabling them to be part of a larger sense of community - both on and off-line - does wonders for surrounding new families with other like-minded individuals in an unpressured environment. As with any form of social connection - be it conversations at the playground, playdates with other parents in the community, or get-togethers among birth professionals - there is an unspoken code of ethics that guide the conduct of behavior, commentary, and sharing within the realm of the outlet.
Interestingly, Facebook is full of articles decrying the judgment parents cast upon one another both in online commentary and in real-life situations. The social media outlet allows for actions and comments that one may never actually do or say in real life. The internet abounds with humorous satire on this topic, such as this recent article on HexJam. Although some may be a bit far-fetched, the idea is that social media subconsciously allows a bit of leeway when it comes to appropriate or acceptable behavior. But where is the boundary when it comes to professional conduct on social media, particularly in a career field where intimacy, confidentiality, and privacy are at the heart of the work? Most well-respected doula training and certification organizations, such as Childbirth International, DONA, Lamaze, and CAPPA to name a few, have strict codes of conduct and ethics that their members are expected to uphold. Whether a birth worker chooses to certify with an organization or not, upholding an ethical code of conduct allows a client to feel confident and secure in the working relationship with her doula. CAPPA even goes so far as to have a specific section on social media conduct in the outline of their birth worker policies. According to the policy statements of the above listed organizations, as well as a general code of conduct that transcends most professions, providing client information that is not relevant to the care that they receive or that provides personal information to anyone other than the back-up doula without the client's consent is unethical. Perhaps the most important ethical code, particularly as we discuss social media, is the maintenance of confidentiality - discussing only the amount of information necessary to provide appropriate care. Birth work is exhilarating, emotional, and energy-investing work that often thrives when shared among a strong community of individuals sharing the same passion and love for the work. However, as birth workers strive to build community that reaches beyond in-person meetings and geographical boundaries, the sharing of what should be confidential client information is often easily done, perhaps even without specific intention. The excitement of heading off to a birth or being called by a client who has managed to stay home well into labor as she had originally planned is what birth workers live for. And when this happens, it's a completely normal response to want to share this excitement with those who can recognize and embrace it. Quite often, this translates into a quick status update, perhaps even with a last minute request for guidance, "Headed to a birth! Any pointers for a mom with a doc at Lankenau?" Without even realizing it, the client's right to confidentiality is breeched without necessity. Whether the client has seen this post or not, someone has. And whether that person is another birth worker, a nurse at that hospital, or the person that referred the client to the doula, information about that client's birth has been exposed without the person's consent. This is a breech of appropriate ethical conduct and weakens the sense of security and trust between the client and non-clinical provider. So what can a birth worker do? Build real relationships. Develop a close-knit network of two or three birth professionals that can be counted on to provide sound advice, guidance, and a listening ear. Call or text these people when something needs to be discussed or a burst of excitement needs to be recognized. And let the client know ahead of time that there are a few people who may gain a bit of insight into the client's information in the attempt to provide appropriate and optimal care. Rather than sending out a general post to a support group page when in need of back-up, use these people or other colleagues whose professionals standards are known to be concrete, if unable to tend to a client's needs. Write it out. Keep a well-documented litany of one's thoughts, feelings, and the insights gained through experience. A journal devoted just to the birth work journey can go a long way in developing one's own philosophies of professionalism and doula support. Obtain consent. If it is really pertinent that the question or concern be brought to a larger audience, such as an online doula support group, obtain the okay from the client prior to asking the question. Leave out any potentially identifying information unless it is specifically pertinent to the question at hand. Have a confidentiality clause and stick to it. Every doula contract should include a clause of confidentiality. This is the perfect place to write a statement or two on what this means to the professional, including with whom information may be shared without further consent (for example, a back-up doula). When birth workers break codes of conduct that are integral to the entire career field - regardless of certifying organization or type of training - a disservice is done to the entire community and the credibility of the profession is lost. Doulas offer a type of service that is incredibly unique and rewarding for both the professional and the client. A working relationship built in trust during such vulnerable and transcendental experiences such as pregnancy, childbirth, and parenting deserves the utmost respect, integrity, and value and the doula has a crucial role in upholding those ideals. A few years back, smoothies were in. My Facebook feed was filled with exciting ideas for creating awesome and often very different smoothie combinations. What happened? Now my feed is filled with far more intense and hotly debatable topics and smoothies have fallen to the wayside. But less we forget how wonderful and nourishing and versatile they are! With the reemergence of beautifully warm spring weather, brightly colored blossoms, and vibrant green grass and trees, I’m ready to bring back the beauty of the green smoothie (and maybe a few other colors too)! Let’s start with the basics. What is needed to really get down and dirty with a superfood smoothie?
Now for the details - some suggestions for whipping up some awesomely refreshing and nourishing drinkable meals that please kids, adults, and pregnant mommas alike! Greens: Remember to vary these! Different greens provide different nutrients. Spinach is a great base - it’s mild flavor and solid nutrient content makes it a favorite for adding a bright green color and a strong base of micronutrients to your smoothie. It’s full of vitamin A, vitamin C, vitamin K, and manganese. It’s often touted for it’s high iron content but the iron in spinach is not all that absorbable due to it’s high oxalic acid content, which binds with the iron, decreasing it’s absorption. Steam your spinach first and add some vitamin C-rich fruit to your smoothie to increase it’s iron absorption ability. Don’t leave it out - just add another green to enhance the nutrients. Kale is a great source of vitamin K, vitamin A, vitamin C, manganese, copper, vitamin B6, calcium, iron, and more. Kale has three stand-out qualities - it’s antioxidant nutrients, it’s anti-inflammatory nutrients, and it’s anti-cancer nutrients. With kale and collard greens, as with most of the denser dark leafy greens, cooking it well actually helps the body take advantage of it’s nutrients, including the fiber-related components that bind with bile acid in the digestive tract best when steamed, which will then allow these acids to be excreted and aid in lowering cholesterol. You can even add a squeeze of lemon to your kale to enhance it’s phytonutrient concentration (phytonutrients are plant chemicals that protect the plant from fungi, bugs, germs, and other threats and which may help prevent disease and optimize health in humans). Collard greens shine in their anti-cancer properties as well as in their content of vitamin K, vitamin A, manganese, vitamin C, fiber, calcium, choline, vitamin B2, vitamin B6, iron, copper, vitamin E, magnesium, and more. But let’s not stop there! Arugula will add a peppery bite to your smoothie as well as phytonutrients and antioxidants. It’s high folate content, richness in B-complex vitamins, and high levels of vitamin A, vitamin C, vitamin K, as well as adequate content of copper and iron, make it a powerhouse addition to a smoothie. Dandelion will boost your smoothie’s vitamin A, vitamin K, vitamin C, vitamin E, calcium, and iron. Swiss chard is full of antioxidants, anti-inflammatory phytonutrients, vitamin K, vitamin A, vitamin C, magnesium, copper, manganese, potassium, vitamin E, iron, fiber, choline, calcium, and more. Keep exploring new options for your greens - watercress, chines cabbage, beet greens, chicory, green leaf lettuce, romaine, starting out with small amounts as some of the real nutrient dense greens can be quite flavorful (such as the strong spice of mustard greens and turnip greens). Frozen Fruit: Bananas are a favorite of mine for adding some sweetness and a bit of creaminess to a smoothie. I buy a big bunch at a time and freeze those that are starting to turn. Throwing a frozen banana into the blender keeps the smoothie cold and also adds a variety of nutrients - vitamin B6, manganese, vitamin C, potassium (which has the ability to lower blood pressure), fiber, biotin (a B vitamin that metabolizes carbohydrates as well as strengthens hair and nails), and copper. If your bananas aren’t frozen or get eaten long before they’ve made it into the freezer, a handful of frozen berries, pomegranate seeds (high in vitamin C, vitamin K, thiamin, B6, folate, and pantothenic acid), pineapple (rich in vitamin C, manganese, copper, vitamin B6, and vitamin B1), or mango (a good source of vitamin C, vitamin A, B vitamins, and copper) works great too. Superfoods: What makes avocados, berries, red peppers, parsley, pumpkin, orange, lime, grapefruit, kiwi, honey, dark chocolate, broccoli, beans, and sweet potatoes superfoods? There is no legal definition but generally superfoods are considered to be vibrant nutritionally dense foods that are also low in calories. Superfoods boost your body's cancer fighting ability, lower cholesterol, combat heart disease, protect DNA, reduce stress, increase quality of sleep, stabilize blood sugar (www.naturalnews.com). Add these in to your smoothie on a consistent basis and start reaping their amazing benefits. Add-Ins: These are my favorite - just a little something to boost up nutritional value. A tablespoon or two of ground flax (full of healthy fats), chia seeds (a great source of calcium and protein and healthy fats), wheat germ (a powerhouse of B vitamins), hemp seeds (high in healthy fats and easily digestible), or spirulina (a blue-green algae loaded with easily absorbed iron) can turn an average smoothie into an incredibly healthy and satisfying meal. Protein: This is simple - a spoonful of a nut, seed, or legume butter (almond, cashew, peanut, hazelnut, tahini), a quarter cup of an easily digestible bean (white beans work great), or a small handful of nuts or seeds (sunflower, sesame, almonds, brazil nuts) pack a protein punch and round out the mineral content as well. Liquid: This could be anything! Water, herbal teas or infusions (some of my favorite include Blossoming Bellies Pregnancy Tea blend, nettles, oatstraw, hibiscus, and peppermint), a splash of coconut milk (full of healthy fats) mixed with water, coconut water (rich in electrolytes), and even kombucha can change the flavor and texture of your smoothie when you're in need of something different. Try some new things too! Cucumber, apples, carrots, beets, jicama - get creative with these refreshing and earthy flavors! Smoothies are all about experimentation, nutrient density, filling and easily digestible meals, and making healthy snacks portable and palatable. Try out these great combinations below or conjure up your own! Classic Green a handful of spinach two leafs (and stem if your blender can handle it) of kale frozen banana ground flax seed peanut butter water Purple Passion a handful of spinach two leafs of dandelion frozen banana frozen berries chia seeds raw cashews oat straw tea Beach Baby a handful of spinach frozen mango frozen pineapple frozen banana hemp seeds coconut milk coconut water Vitamin Cheat Sheet: Vitamin A: vision, immune system, cell and hair growth B vitamins: cardiovascular health, mood-related hormones, immune system Choline: liver health, brain power Vitamin C: immune system, skin health, wound healing Vitamin D: absorption of calcium, iron, magnesium, phosphate, zinc, mood balance Calcium: bones and teeth Iron: oxygen carrying capacity of hemoglobin Magnesium: heart health, blood pressure, nerve and muscle function, immune system Manganese: bone, skin, blood sugar, Phosphorous: bones and teeth Copper: blood vessels, nerves, immune system, bones, aids iron in formation of red blood cells Fiber: blood sugar regulation, lower cholesterol, lower blood pressure Zinc: immune system, cell division and growth, muscle contractions, wound healing carbohydrate breakdown Sources:
Boutenko, Victoria. Green For Life. Raw Family Publishing, 2005. Print. Healthy Eating. SF Gate, n.d. Web. 5 May 2015. Health Impact News. Health Impact News, 2015. Web. 6 May 2015. Medline Plus. U.S. National Library of Medicine, 2013. Web. 6 May 2015. Mercola.com. Dr. Joseph Mercola, n.d. Web. 6 May 2015. Julius, Sonny. Natural News. Natural News Network, 11 January 2008. Web. 6 May 2015. Olson, Cathe. The Vegetarian Mother's Cookbook. Nipomo, CA: GOCO Publishing, 2005. Print. Park, Alice. Time. n.p., 6 June 2014. Web. 5 May 2015. Self Nutrition Data. Conde Nast, 2014. Web. 3 May 2015. The World's Healthiest Foods. George Mateljan Foundation, n.d. Web. 5 May 2015.
I am so excited to have Ally write this beautiful and poignant piece. Ally is a dear friend of mine, my former back-up doula, and a truly amazing woman, mother, and birth activist, advocate, and worker. Her energy is endless and her inspiration knows no bounds. - Britt I don't know how to make a family tree.
I want to make one for our family. I envision a bunch of names and dates and relationships blending into a gorgeous picture. I want to design a Tree of Life that branches all about with births and marriages and even deaths, and I want to bask in its history and meaning. I can't figure out how to do it, because this 'tree' stuff is far more complicated than I realized. This month, my husband left to attend the funeral of his father in the U.K. Sadly, his father and grandfather died within 17 days of each other: my mother-in-law lost both her husband and father, and the family was gathering to grieve, and to remember. While he prepared to to depart, we were preparing also to celebrate the 7th birthday of our youngest daughter. The family things going on, all of the communications and details and whatnot, led to quite a few discussions with our daughters about their relatives...and emphasized how prevalent the roots of birth are in our lives. Birth is about women. Their bodies. Their pregnancies. Their children. It is the complete adoration I have for my three daughters, and for the baby I never met. It is the ache I feel as I continue to recover, physically and emotionally, from a recent hysterectomy. It's feeling an emptiness from where my womb sheltered my babies, it's letting go of more munchkins under our roof, and it's feeling the weight of apron strings thinning and separating as my girls grow and blossom. Each week, friends announce the arrival of their babes, and they share their escapades with their toddlers. These friends are assorted ages, varied in personality and background, 'first-time' and 'repeat' moms. The little ones & their adventures are the wisps of my own children, who used to curl into my arms, crawl about my floors, and climb on my furniture and steps. Bed-bouncing monkey songs and sweet finger games are replaced in my mind's albums by the voices of my growing daughters belting out chart music and sophisticated dance moves. And as birthdays pass and calendars get tucked away, I accept that I am getting older too. Birth is transitioning, as described by a friend who is fostering two young brothers. She and her partner are trying to find their footing and groove as sudden-mamas, and they have opened their arms, home, minds, routines, and hearts to these little guys, for as long as they are allowed to share their lives together. Birth is uncovering a capacity for parenting, beyond biology and circumstance. Birth is watching from afar as my one sister and her wife try repeatedly to conceive. They try, despite the hurt, the expense, the red tape and the indignities. It is watching up-close as another sister survives four miscarriages, with no understanding of why they happened, nor any certainty about how to proceed if she wants her son (my nephew, whom she had as a teen) to have a sibling. In the meantime, birth is watching these couples hope, shower fondness upon their nieces, nephews, and classroom students. Birth is carrying the genetics of my own biological mother, who was fourteen when she had me. I was adopted by her older married sister, my Mom, at my birth. My Mom and Dad had been waiting for several years to have a child, and were overcome with sorrow that they could not. My Mom was one of six children, who grew up up in a multi-generational household. My Dad was one of five children, who grew up in orphanages after being placed there for most of their lives. My parents desperately wanted children, and to have their own family. The sculpture of a stork in my bedroom as a child became a symbol of their yearnings and then of their happiness. Later, when I attended college for Social Work, and then attended trainings to be a doula, the stork represented my belief in the power and significance of birth and families. I couldn't imagine doing anything other than surrounding myself with women, children, and the zany paces and pieces of their lives. Birth is graduating university and finding the love of my life while being a camp counselor...and finding out that this life partner of mine had an upbringing that included boarding schools and traveling to other countries - while mine took place in the same neighborhood where we live now. Birth is roaming through the world of birthwork, and transferring my skills from there to the world of the elderly, as I become the primary caregiver for my parents, who are struggling with illness and age. I see glimpses of their past selves and hear notes of our shared history as their moods and states ebb and flow. I drift between roles and responsibilities - of offspring and adult, of 'family member here' and of 'woman with her family there'. A friend described the dynamic with my parents as this: 'It's like mothering all over again, or mothering coming full circle'. Because birth is about parents. Parenthood. Parenting. Nouns and verbs, people and actions. Children and childhoods, stories with characters and themes, beginnings and endings, cliff-hangers and continuations. While listening to my husband mourn over the phone with his mother, I think about the layers that emerge when we contemplate the lives of those before us; the lives of those who gave us life; the lives of those who live with us now; and the lives of those who will live beyond us, too. Perhaps the pieces of blank paper and scattered art supplies don't make sense because my image doesn't make sense. The individuals and the couples. The bodies, the blood, the pregnancies, the adoptions. The learning, the vocations, the decisions. The celebrations and ceremonies. The suicides, the losses, and the deaths. So many faces, so many voices, so many legacies, so many memories. A tree isn't the image I need. An orchard is. Where there is not one tree, but many, with seeds and nourishment from many sources. Where a tree has blossoms and fruits, and where the seasons emanate with the temperatures of emotions. Where a tree has a swing hung for fun, a trellis dug for support, and a bench built for peace. Where a tree has patches of bark peeled away and the markings of etched scars. Perhaps here I can dwell in the stillness of sunrays and shade, and honor the heart-breaks and heart-swells. Perhaps you will join me here, and perhaps we will burrow in the branches of your tree and see what story we discover together. With all the different types of birthing classes available these days and the many methods that some offer, what is really at the heart of working through labor? What are the key elements for those women who are able to enter into what us birth professionals like to call "the labor haze"? How do these women find this space and move through it? Here are ten crucial insights into finding your labor haze.
1. Choose Wisely. The people with whom you surround yourself in labor can make all the difference in how easily you get into that primal zone. When the care provider you've chosen is someone you trust, someone who is aligned with your priorities and philosophies surrounding your birth, and is someone who is willing to work with you in obtaining a positive birth experience, you can let go of the need to control the outcome and allow yourself to let go into the moment. 2. Love Yourself. Take pride in your body that has grown and nourished your baby for the past ten months. Speak confidently about the strength in your legs that keep you moving, the curves in your hips that hold reserves for nursing, and the blooming of your belly as it houses your baby. Affirm to yourself that each stretch in your skin is the mark of the journey of growth and be proud to find yourself in a body that is capable, strong, and empowered. 3. Know Support. Explore what you anticipate needing in labor and how your birth support can best provide you with that. Have support present for partners, who are often expected to be experts in labor although their experience may be little to none. The best birth support are those who truly believe in the normal process of labor, the body's intuition, and the woman's ability to give birth. Put things in place so that you are able to labor as smoothly as possible, so that your partner has the support they need to best be there for you, and so that everyone surrounding you is listening, is believing, and is guiding. 4. Be Restful. In mind and in body, seek moments of solace, moments where your mind can just be. Take time in pregnancy to center your mind on the path ahead, to experience the quiet, and to connect with your baby. Seek out these moments and enjoy them. In labor, find yourself in these moments between every contraction. Every contraction throughout almost all of labor, is followed by a longer rest. You will spend more time in the rest between contractions than you will in contractions during labor. Use this rest to re-center, to breathe, to enjoy. 5. Let Go (of your expectations). Do not judge your labor - your sensations, your time, your needs - by the stories you've heard or the images you've seen. Although there are great universal elements to labor and much support can be found in feeling like another woman in a long line of women who have birthed their babies through the centuries, your labor is its own. The circumstances, the sensations, the movements are all part of your process and do not need to meet anyone else's standards. 6. Stay Present. Let go of the need to analyze your labor and guess at how long it will be. Think of each contraction as one less in front of you, one step closer to your baby. But don't focus on the time you have left in labor or the time that you've already spent. No one - not your doctor, not your doula, not your midwife - can tell you how much or how little is left in your labor. 7. Let Go (of your inhibitions). Allow yourself to be open to laboring naked, bottom in the air, moaning through your contractions. The more comfortable you are with your body's natural state, the easier it will be for those primal hormones to flow freely and allow you great rest in between contractions and immense power during contractions. 8. Face Fear. Work out your fear with a plan and with truth. Ask yourself, is this really happening or am I imagining this? If this fear is true, how can I handle this? What will the path be if this does come true? And then put it all behind you and allow the process to unfold as it will. 9. Move Freely. If it feels good, then it's a sign you should be doing it (in labor at least). We are ruled in labor by our most primal hormones, hormones we share with all laboring mammals. Change position, move your body, and you will find what is working and you will let go of what is not. Hike a leg up into a lunge, pace back and forth with your partner, pop a squat on the toilet. The more you move, the more space you change, the more you wiggle your baby into position. You can't expect a key to move straight into the lock, why would you expect a baby to do the same? 10. Accept Discomfort. You are moving a human being through your body and out into the world! In the words of Jillian Michaels, "Be comfortable with being uncomfortable." The sensation of labor is unlike anything else and labor does not benefit from fight or flight the way an injury does. Low adrenal, high oxytocin, and high endorphins make for a manageable sensation more intense and more invigorating than any other. The stronger the contractions, the greater their work. Allow yourself comfort with the reality of the process and you will begin to find the beauty in the quiet moments, in the power of your body opening for your baby, and in the complexity and simplicity of the journey. When we hear the word "doula", it often brings up images of a woman holding pressure on a laboring woman's back while she gazes into the eyes of her partner during a contraction, or the offering of a cold cloth on a laboring woman's face while she breaks in between pushes, or soft words of encouragement as a laboring woman reaches a point where she feels as if she can't go farther. What is not often envisioned, is a doula sitting patiently in the waiting room, offering encouragement and reassurance to a woman's extended family, or a doula rubbing a woman's legs and feet while in recovery even though she still can't feel the sensation, or even a cold cloth being offered to fend off the itchiness that comes with narcotic medication post-surgery. A strong doula, however, has the ability and the wisdom to arise to whatever the situation requires and to continue to offer physical, informational, and emotional support whether a birth is vaginal or cesarean.
Many couples I have come across have questioned the use of a doula when birth by cesarean is known ahead of time. (I've also come across many couples that have said they would want a doula far more if they were having a cesarean!) The continuous presence of a loving, supportive, non-judging, and informed woman during physical challenges such as labor or a cesarean can provide a sense of calm and release for the new parents. She can offer words of wisdom, encourage small gestures on the part of partners of which they may not have otherwise thought, and offer the simple reassurance of touch (that is not through gloves or assessment). Herbs are a part of the wisdom of midwifery care that has been used for many many years during the childbearing year. I recently came across this wonderful blog post with some really helpful and guiding information about herbal use during pregnancy and breastfeeding.
There have been many fantastic posts written in the past few years detailing the errors in judging a pregnancy by it's due date and I won't try to recreate these here. (Although I cite a great one at the bottom of this post "The Lie of the Estimated Due Date" - definitely take a look!). There are also some simply excellent articles written about the problems with induction for going post dates (like this one from Midwifery Today). Check them out.
What instead I'd like to offer are some simple words of reassurance and, possibly, wisdom to those creeping up on or past their "due dates." First, remember, "due dates" are just averages! Only about 4% of women actually birth on their due date (Simkin) and it is estimated that about 50 to 80% of mothers will go past 40 weeks of pregnancy (Safranski). That said, I am no stranger to the anxiety that settles in as the days continue to go by and the baby continues to stay put and the care providers continue to pressure. So here are my words of wisdom! They come as a doula but also as a momma of two boys who really liked life in the womb, so much so that they chose to spend a good solid 42 plus weeks in there. Think of the due date as a day of celebration! A day of "Yay! We have made it, baby and I, forty weeks into pregnancy!" Momma's body and Little One's placenta have grown a healthy and happy baby that is getting more and more equipped for life outside the womb with every moment that passes. Think of the due date as the due month, rather than one day - such a small moment in the scheme of a full term pregnancy can feel very daunting. When it is generalized to the due month (which is actually far more accurate as about two thirds of women birth within ten days of their due date (Simkin) and up to 19% of women actually reach 42 weeks of pregnancy (Davis), it feels like a space in time where the baby can prepare, where the body can make changes, and where labor can unfold. The due month allows time for the process to take place. A process requires time and space and effort - all of which is far too much to ask of just one day. Think of the due month as your time to take mental note of your head space. Tie up loose ends, set aside moments for reflection and appreciation. And spend every moment savoring the time and energy that your body and baby are so willing to give to the pregnancy. The "due date" is no more than one day, nestled in around the end of pregnancy. By reframing a woman's outlook, she can enjoy the last moments of pregnancy and stay calm and centered, allowing the process of labor and birth to unfold in a supported and peaceful space. Davis, Elizabeth. Heart and Hands. Berkeley: Celestial Arts, 2004. Print. Misha Safranski. "The Lie of the Estimated Due Date (EDD): Why Your Due Date is Not What You Think." Peaceful Parenting. Peaceful Parenting, 9 Sept. 2009. Web. 17 Oct. 2014. Simkin, Penny. Prengancy Childbirth and the Newborn: The Complete Guide." New York: Meadowbrook Press, 2001. Print. Now that we've taken a look at the evidence supporting delayed cord clamping, let's have a chat about incorporating it into the birth wishes and having a discussion with the care provider, if need be. Despite the World Health Organization's strong recommendation for delayed cord clamping at all births ("Delayed Clamping"), many care providers in the greater Philadelphia appear to continue to be quick with the snipping. As we often discuss in birth classes, policies and practices quite frequently get handed down to students without much question about their basis (Gaskin). Unfortunately, many policies are also enforced despite a lack evidence supporting their use (Trochim). Still other practices remain in place because of the desire to keep things moving along in a process that often requires a lot of "just waiting." The lack of delayed cord clamping can fall into all of these categories.
As their is greater awareness about the importance of stem cells, we've begun questioning the practice of immediate cord clamping even more. Is it more important for babies to have these stem cells at birth or more important to save them for a potential sibling down the road? This has brought up other questions related to the benefits of the baby receiving much of his own blood back into his body at the moments following birth. The benefits have been discussed in the prior post so let's assume now that a couple is trying to exert their legal right to evidence-based care in relation to delayed clamping ("The Rights"). It's always helpful to approach a provider about their common practices, whether it be cord clamping, episiotomies, manual rotation of the baby's shoulders at birth, etc. before labor. Despite this being another legal right for a laboring woman, most interventions are not discussed with a couple before birth, unless an out-of-hospital birth class is being taken. Yet, even then, as educators, we are often limited by time and scope in discussing every possible intervention in depth. Anyway, I digress. Back to the point, a conversation during pregnancy can do wonders in terms of helping a couple to assess if they've chosen the right provider for them, if they feel they have a trusting relationship with their doctor or midwife, and what their provider's common practices really are. However, as Sheila Kitzinger states, "...you may have to develop new social skills to create a satisfactory dialogue with those who care for you." (The Complete Book of Pregnancy and Childbirth). Understanding that the answer not only lies in response but in the body language, the willingness to discuss, and the answer to the question "Why?" Stating your request clearly and concisely (Kitzinger), while fully clothed and seated in an upright position, is key to an open dialogue. If your request is met with reluctance or hesitation, you can simply restate your wishes. It's also never a bad idea to ask a provider for the research they are using to back their practice. I have, unfortunately, had several clients who did just that and were told by their provider that they did not have the research. Waiting until labor to voice requests can put a woman in a very vulnerable position, making it more difficult for her to voice her needs clearly and assertively. After a discussion with your provider, it's always a great idea to ask about the way that other providers in the practice carry out the same routine. This will help in knowing what to be prepared for in the moment, should a different provider be present during the labor, and also helpful in getting an overall feel for the practice. If your provider has okay'd a request that you've made, it may be helpful to ask them to make note of that in your chart or to have them initial it on a list of your birth priorities. In the moment, while mom is pushing her baby out or, in the case of a cesarean, while the baby is emerging, partners can take an active role in continuing to advocate for what had been requested. Reminding a provider that delayed clamping is a priority for you can help ensure that things are done the way you'd prefer. A doula or other birth support person can also remind the partner at this point to advocate for the birth wishes. With clients, I've been in situations where they've requested delayed clamping only to have the doctor or midwife wait 30 seconds before clamping the cord. (On the flip side,I've also been in situations where the provider has asked the client if they were ready for the cord to be clamped before doing anything, which I've found to be very respectful.) One thing that I've found helpful in ensuring that the cord is allowed to finish pulsating is when client's have requested that the cord not be clamped or cut until the placenta is birthed. This provides a bit more insurance that the baby will receive as much blood back into his body as possible. In a hospital, if there is a concern about the baby's well-being, the baby will be taken to the warmer for the pediatrician or neonatologist to evaluate. In a home birth, the vast majority of the time, the baby is able to be assessed while still on mom, allowing the cord to provide a back-up of blood and nutrients to the baby. Unfortunately, in the hospital scenario, cord clamping does happen immediately so that the baby can be checked out. However, in your average healthy birth, the baby is able to be fully assessed while on mom, cord intact. A move is slowly made towards a family-centered cesarean yet the hospitals in our area still have a ways to go. Unfortunately, at this point, I don't know of any obstetrician who will allow for delayed cord clamping outside of 15 to 30 seconds, during a cesarean section. The client is the catalyst for change and it's important that we all remember this. The more informed, the more actively participating, and the more knowledgeable a client is, the more opportunity they have to ask questions and request evidence-based care. As much of a fan of the written birth wishes as I am, nothing can replace a face-to-face conversation between a client and their provider. Having a birth in which you are as in control of the process of decision making as possible, quite often makes for a very positive experience. Your birth, your baby, your body. Sources "The Rights of Childbearing Women." Childbirth Connection. Childbirth Connection. 2006. Web. 14. Oct. 2014. "Delayed Clamping of the Umbilical Cord to Reduce Infant Anaemia." WHO. n.p. 2014. Web. 5 Oct. 2014. Gaskin, Ina May. Birth Matters: A Midwife's Manifesto. New York: Seven Stories Press, 2011. Print. Kitzinger, Sheila. The Complete Book of Pregnancy and Childbirth. London: Dorling Kindersley Limited, 2003. Print. Trochim, William, Ph.D., Cathleen Kane, M.P.A., Mark J. Graham, Ph.D., and Harold A. Pincus, M.D. "Evaluating Translational Research: A Process Marker Model." CTS Journal 4.3 (2011): 153-162. Web. 14 Oct. 2014 |
AuthorAs the Philadelphia birth world blooms bigger and brighter, I think it's time I start putting some of the insightful questions I've received and information I've research into a public journal. I hope you'll find this inspiring, empowering, and totally enjoyable. Archives
February 2021
Categories |