Archive | April, 2016

(Birth) Location, Location, Location

17 Apr

Continuing our “11 Ways to Prepare for Your Best Birth”, this week takes us to #2 on the top 10 actions toward your optimal birth:

Consider the birthplace best for your family

There are three main options (listed in order of current popularity):

  • Hospital
  • Birthing Center (in-hospital or freestanding)
  • Home

One major question to ponder is:
Where do I feel safe, secure, and private in general, and where do I think I will feel safe, secure, and private in labor so that my labor progresses in a healthy way?

Hospital

Currently, the vast majority of pregnant parents choose to give birth in a hospital setting. This is the best place for most high-risk expectant parents, and is also a location that helps many parents (particularly first-time ones) feel more comfortable in the unlikely but possible “what if”/emergency scenario.

Here are some considerations:

  • Hospitals are for sick patients, with the exception of the labor & delivery unit. This fact, in addition to the way our U.S. culture makes birth feel like an (untrue) emergency and sick condition, can cause it to not necessarily be an ideal place for a low-risk, health mom to labor.
  • Hospitals have a non-evidence-based, arbitrary “clock” on which labor progress must be made so that a general sense of impatience can all too often lead to unnecessary interventions.
  • From a physiological, and specifically hormonal, perspective, our bodies labor more readily and well when we are in our safe & secure place of privacy.

Birthing Center

A birthing center is usually a space in which to labor that is more spacious, more home-like in its decor, furniture, and lighting, and might have a large laboring tub. There are two kinds of birthing centers:

  • In-hospital – parents have the benefit of a more home-like environment with the security of knowing medical help is immediately nearby if needed
  • Free-standing – this is one step further removed from a hospital; birthing centers work in conjunction with a backup hospital should the need for transfer arise.

In NYC and at the time of writing, there are two in-hospital birthing centers (The Birthing Center at Mt. Sinai RooseveltNewYork-Presbyterian/Lower Manhattan Birthing Center), and one free-standing (Brooklyn Birthing Center).

Most of the time, care providers who have birthing center privileges are more natural-friendly, and can be either midwife or OB. Most commonly, only midwives work at free-standing birthing centers vs midwives and OBs work have privileges at in-hospital ones.

If you think you might want to use epidural for pain relief, it’s important to know that this won’t be offered in local birthing centers. If the decision is made for epidural or most other medications/interventions in the middle of labor, a transfer would be required. Some birthing centers here in NYC are starting to offer nitrous oxide (“laughing gas”) for pain relief, however. In fact, a recent client of mine was the first to use it at NYC’s newest birthing center and found it to be a very helpful tool for pain management.

Home

Giving birth is an increasingly popular option. The home tends to be the place we feel safest and where we feel the greatest sense of privacy in the normal course of life. One major selling point for a lot of families who choose this as their birth venue is not having to leave the comfort of home, particularly as the transfer in a car to a hospital/birthing center is, for many women, one of the most challenging times in labor. Another advantage is being farther removed from routine pressures of potentially unnecessary interventions. For those who both are low-risk and have their hearts set on giving birth naturally, giving birth at home increases the chances of this being possible.

Questions to ask here: if there is a non-pregnant partner involved, would they be supportive of this choice? How nearby is the closest hospital in the (unlikely) event of necessary transfer? In NYC, we have hospitals all over the place, so if you live here, rest assured you are almost undoubtedly close enough to one. Do you have home birth midwives available in your area? NYC has many wonderful ones, see here for listings. Here are some beautiful home birth stories with two of my clients’ favorite midwives.

At this point, you’re just deciding on general venue category; better not to pick a specific hospital or birthing center (ie if one of these is your choice). In most cases it is more important once you’ve decided on the general birth setting to look for the best care provider for you and let that guide the decision of specific birthing center or hospital. Please note I say this mostly for those who live in larger cities (such as my NYC clients, where there are many hospitals and 3 birthing centers), realizing that there are not always as many options in smaller towns.

New Yorkers, check out Choices in Childbirth for their workshop offerings as they often offer ones that help you decide on birth venue type.

In closing, I leave you with this thought:
Birth is one of the most sacred journeys you will ever experience. Choose the birth venue that gives you the greatest sense of peace and optimism for this beautiful, monumental event in the life and growth of your family.

For further research:

Planning Your Birth Environment (Choices in Childbirth)
Why Not Home? (documentary)
The Business of Being Born (documentary)
NY Homebirth Midwives
Home birth stories from Midwifery Care NYC

Advertisements

11 Ways to Prepare for Your Best Birth

10 Apr

Here in the beginnings of my blog, I thought it would make sense to “get back to basics” and help expectant parents think through some important things at the front end of the pregnancy.

I’m going to start a series of articles breaking down the following list that I drew up for a “Meet the Birth Pros” event for expectant parents in my community. We’ll call it “11 Ways to Prepare for Your Best Birth” and is compiled from not only my own experience and knowledge but also pulling from NYC’s own Choices in Childbirth and Lamaze’s Healthy Birth Practices. 
  1. Take some time to envision your ideal labor (below)
  2. Consider the birthplace best for your situation – hospital, birth center, or home
  3. Create your “dream birth team”
  4. Prepare your Body: Focus on Nutrition, Exercise & Bodywork
  5. Prepare your Mind: Get a realistic view of birth and understand it as a natural, healthy process
  6. Prepare your Mind & Body: Take a comprehensive childbirth education class that includes newborn care and breastfeeding
  7. Listen to & trust your body – it will guide you
  8. Allow labor to begin on its own & avoid interventions that are not medically necessary
  9. Avoid giving birth on your back, and follow your body’s urges to push
  10. Keep mother and baby together, and with lots of skin-to-skin – it’s best for mother, baby, and breastfeeding
  11. Postpartum: Arm yourself with support and resources (postpartum doula, lactation consultant, moms’ groups, etc.)

Today we’ll cover:

1) Take some time to envision your ideal labor

It is very helpful and important toward a positive birth experience to consider what your “dream” birth would be if you were able to call all the shots. Some ways you could do this are:
  • Discuss with your beloved (my favorite word to use in class for spouse or partner), a friend, or family member
  • Create a “vision” board or collage, including images, quotes, words that resonate for you for birth
  • Sketch, paint, or sculpt
  • Write a song
Some questions to help guide this exploration:
  • Where am I?
  • What would my environment be like? Lighting? Aesthetics? Smells? Consider all your senses.
  • Would I have music playing?
  • Who is in the room with me? Be specific; think about how you feel when each of them enters the room.
  • What do those around me do or say, if anything?
  • What would I be doing?
  • What would I want to eat and drink?
  • How long would it last?
  • How do I feel?
  • What would I be thinking?
  • At the time of baby’s birth, what would I want to do in those moments?
Keep in mind that there is no one “right” birth vision – just as every woman is unique and brings her own life experiences to her birth, every woman will envision and prefer something different.
 
Also, as part of this exploration, you may also want to explore how you are feeling emotionally, psychologically, and spiritually presently—prenatally. How do you feel, what are you thinking, what is your mental state as you approach the day in which you will meet your baby? Do you feel confident, relaxed? Or do you feel apprehensive, scared? None of the above and other things? We will do a deeper exploration of this in a subsequent post on #4 – trusting birth as a healthy, natural, normal process.
 
Please know that I am not suggesting that your birth will look anything like what you envision. There are many pieces to the organic, 2-body puzzle of a process of birth that remove a great deal of control, so that it would be naïve to guarantee such a thing.  However, taking the time to consider these specifics can be a compelling exploration toward making intentional, critical choices for a better birth.
 
For further study:

Birthing from Within (on artistic envisioning)
Choices in Childbirth
Lamaze’s Healthy Birth Practices

 

9 ways to avoid unnecessary Cesarean birth

4 Apr

In observation of April’s Cesarean Awareness Month, I would like to make a few comments and direct readers to several resources on cesarean section/surgical birth.

First, it’s important to acknowledge a few things on this topic:

  • Cesarean birth is major abdominal surgery, so it is not something to be taken lightly. There are more risks for both mother and baby in this mode of birth, and healing usually takes significantly longer and is more complicated for the postpartum parent.
  • It’s a good thing that cesarean birth is possible when it’s the best birth for a baby, but the vast majority of the time this is not the case.
  • Obstetricians’ primary training is in surgery. We tend to trust and lean towards our expertise. Also, many doctors never see a natural vaginal birth during their time in medical school/residency.
  • In 2014, the American College of Obstetricians & Gynecologists (ACOG) issued a major report on how to safely reduce the dangerously high cesarean rate in the U.S. They are 18 important and evidence-based recommendations. However, studies show that hospitals take an astounding ~17 years to incorporate new recommendations, so we are a long way from making visible progress in this area.
  • In a cesarean birth, the baby misses critical seeding of the microbiome, which is a major contributing factor in the overall health of the immune system of the baby. There is research being done on helping seed baby with mom’s vaginal microflora in cesarean birth, but U.S. hospitals are far from making it standard procedure.
  • In light of these things, expectant parents need to be their own advocates to reduce their chances of an unnecessary surgical birth.
  • For women who have had a cesarean in a previous birth: assuming healing goes well, it’s thought to be very safe (even optimal) to give birth vaginally in a subsequent pregnancy if she would like. This is called a VBAC. It’s important here, too, to find a supportive care provider for this specific scenario.

Lamaze_CesaraenInfographic

Reduce your chances of an unnecessary cesarean:

  • Choose a care provider who 1) has a low C-section rate and 2) is supportive of your goals. For low-risk, healthy women, it’s best to avoid working with an OB who specializes in high-risk since those patients more often require cesarean.
  • Consider hiring a midwife as your care provider, because this takes you one step farther away from a cesarean. Midwives work both in hospitals and home. They are experts in natural, uncomplicated birth and always work in conjunction with an OB in the unlikely event a cesarean is necessary.
  • Secure continuous labor support (doula or family in addition to partner).
  • Stay home as long as possible.
  • Use gravity-friendly positions in labor, balancing activity to help progress with rest for stamina.
  • Drink and eat; you need fuel for this marathon of indeterminate length! (Check out this late 2015 press release from anesthesiologists telling hospitals they should stop withholding food from the laboring woman.)
  • Use all your labor coping tools — these are learned most optimally in a birth class environment.
  • Request intermittent fetal monitoring if that is not your care provider’s default.
  • Wait for your labor to gain momentum (cervical dilation of 5cm+) before considering epidural or any medications, if possible.

In preparing for the unlikely but possible scenario of a necessary cesarean, discuss incorporating gentle cesarean techniques (aka “woman-centered” or “family-centered”) with your care provider in order to help it feel like the positive birth that is truly is. Information on this topic here and here.

Read more:

International Cesarean Awareness Network (ICAN)
What You Need to Know about Cesarean (Childbirth Connection)
Video: What’s the Deal with Cesareans? (Lamaze)
Statement on Cesarean Section (Coalition for Improving Maternity Services/CIMS) 
Video: Women-Centred Cesarean Technique (YouTube)

ACOG’s Report on the Safe Reduction of First Cesareans
How to Have a Natural & Gentle Cesarean (Wellness Mama)
“Using a Mother’s Microbes to Protect Cesarean Babies” (NY Times)
Microbirth (documentary)
Lamaze International: VBAC — Yes, It’s an Option!
VBAC Facts

%d bloggers like this: