Guest Post Ashlea- Mother Friendly Care

From Kellie: Ashlea is Birth Boot Camp instructor I recently met and she is very knowledgeable about all things birth! She spoke a little about the Mother Friendly initiative and I knew this was something really important for us all to be aware of-  and for our (your) daughters and grand-daughters. For me, the basic premise of this movement is to reinstate the norm to be the natural process of birth and to use science when necessary- not let it completely take over (which it seems to be doing). I would like to see a day when all birth experiences/requests are accepted and welcomed in hospitals. I would like to eliminate pressure to conform to a certain type of care, and where Midwifes were just as accepted as OBGYNS..and covered by insurance.  Rant over? Not hardly, but this is a Guest post, lol, so I really should get to Mrs. Ashlea's post......

Mother-Friendly Care

When I was pregnant in 2013, I never considered researching a midwife or OB/GYN to find out if they were mother friendly. I assumed, insert play on words here, if they are caring for a pregnant woman, they must all be mother friendly.  Not the case at all!  It’s quite telling of an era when you actually have to seek out care-providers who are classified as “mother-friendly”.  Even more shocking, this has to be grounded in evidence based practices; they actually researched what benefited mothers throughout pregnancy and birth.  Naïve, pregnant me thought these were “duh!” moments, but this is not at all the case.  When you stop to reflect on where birth in our country has come from, it is totally amazing that the Coalition for Improving Maternity Services was founded. 

(photo reference: www.truthaboutnursing.org

In the 1900s, approximately 90% of all births took place in the home.  Hospitals were not widely assessable, and mothers were attended by both midwives and doctors.  But from 1910 and 1920, the midwifery model of care was tossed to the side as the medical model of care became prevalent.  Instead of focusing on the physical, psychological, and social well-being of a mother, the medical model is geared toward pathology (identifying what’s wrong) and diagnosing from patient symptoms. Childbirth was no longer considered a normal time in a woman’s life.  Dr. Joseph B. DeLee wrote and published an article in the American Association for Study and Prevention of Infant Mortality (1914-1915) where he (and others) discuss opposition to any movement to perpetuate the careers of midwives.  They are considered a “drag on (obstetric) progress as a science and art” are “not necessary at the present time” and “is a relic of barbarism”. As this field of obstetrics grew and the home birth midwife discredited, fear of childbirth and the pain associated with it helped encouraged women to birth in the hospital.  Today, 99% of U.S. women birth in the hospital (the majority with an obstetrician). 

Simultaneously, “twilight sleep” was introduced, and through a combination of morphine (pain medicine) and scopolamine (amnesiac), a laboring woman would have no memories of giving birth.  Considering this happens about the same time women are fighting for suffrage, it was widely welcomed among upper-class women. These unconscious women were strapped to beds, given a cut in their vagina (episiotomy), and their babies pulled out with forceps.  Today, only few women are unconscious for their births, but many of these practices carry over:

• ·         Laboring  flat on your back
• ·         Interventions to “speed” labor
• ·         Treating mother as the passenger in her birth rather than the driver 

As fewer births took place at home, women weren’t able to see what a natural birth is like from aunts, sisters, and friends.  Soon, women would labor without having ever seen a birth and this created the fear of the unknown. They would most likely not know that the body releases endorphins when a woman labors without drugs.  Naturally released oxytocin crosses the blood-brain barrier and causes the uterus to contract and the endorphins allow you to cope with these contractions.

Fast forward to the modern birth climate:

• ·         The U.S. cesarean rate is 36%.
• ·         The U.S. epidural rate is 76%. 
• ·         The U.S. maternal mortality rate is four times greater for African-American women than for Euro-American women.
• ·         The U.S. spends more money per capita on maternity and newborn care than any other country and falls far behind most industrialized countries in perinatal morbidity and mortality.

Holy cow! Well, as a result, the Coalition for Improving Maternity Services (CIMS) has set out to make a difference. Individuals and national organizations, who are concerned for the care and well-being of mothers, promote a wellness model of care to improve these outcomes (and save money).  I love that CIMS is a group of people working towards the same awesome goal: quality care for mamas and their babies.

There are 10 Steps of the Mother Friendly Childbirth Initiative for a hospital, birth center, or home-birth midwife to fulfill before receiving the CIMS distinction:

A mother-friendly hospital, birth center, or home birth service:

1. 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.
2. Provides accurate descriptive and statistical information to the public about its practices and procedures for birth care, including measures of interventions and outcomes.
3. 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.
4. 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.
5. 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.
6. Does not routinely employ practices and procedures that are unsupported by scientific evidence, including but not limited to the following:
• shaving;
• enemas;
• 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.
6. 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 complication.
7. 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.
8. Discourages non-religious circumcision of the newborn.
9. Strives to achieve the WHO-UNICEF “Ten Steps of the Baby-Friendly Hospital Initiative” to promote successful breastfeeding:

1.      Have a written breastfeeding policy that is routinely communicated to all health care staff;

2.      Train all health care staff in skills necessary to implement this policy;

3.      Inform all pregnant women about the benefits and management of breastfeeding;

4.      Help mothers initiate breastfeeding within a half-hour of birth;

5.      Show mothers how to breastfeed and how to maintain lactation even if they should be separated from their infants;

6.      Give newborn infants no food or drink other than breast milk unless medically indicated;

7.      Practice rooming in: allow mothers and infants to remain together 24 hours a day;

8.      Encourage breastfeeding on demand;

9.      Give no artificial teat or pacifiers (also called dummies or soothers) to breastfeeding infants;

10.  Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from hospitals or clinics

† This criterion is presently under review.

What can you do to ensure your location/provider is “mother friendly”? In my opinion, take a Birth Boot Camp class. Childbirth education is well worth your time and money.  We cover red flags of care providers and talk about how to be confident when choosing a birth location.  Ask some important questions regarding “standard” procedures: episiotomies, group B strep, pushing positions, and so many more. 

Your baby’s birth day will only happen once.  Carefully and thoughtfully consider your desires.  A mother friendly care provider will respect you, your wishes, and honor the sacredness of your special day.  ~Ashlea

Visit Ashlea's website
http://anindulgentbirth.com/

Going with your gut!

And today I think I'm a motivational speaker.....

Call it whatever you want.....Mothers Intuition, Mothers Instinct.....going with your gut! Learning to do this has served me well.  My husband is a big believer in going with your gut too, the statement "well, what does your gut tell you?" pops up frequently when either of us has a dilemma.

Over the course of pregnancy and becoming a parent you get a TON of unsolicited advice from friends, family, strangers, and even know-it-all-bloggers, lol...whew I could name a few of them! Some of the advice is great and really helps, sometimes you are unsure, and some just sounds ridiculous...this is where I will give you advice to smile and GO WITH YOUR GUT!  Do it with as much confidence as you can as well, there are no take-backs so you might as well not second guess yourself, right? No one knows your body in pregnancy like YOU do, and just the same no one knows your baby like YOU.

Let me tell ya a little story...After we brought our brand new baby boy home, we soon realized this kid would not sleep or nap in his bassinet...ever. While I didn't mind holding my new baby as much as possible sometimes you need to eat, relieve yourself...have free hands for a moment! I didnt know what to do....every time I put him on his back in the bassinet asleep he would wake up screaming.  The first night was the worst! I had an arms reach co-sleeper right next to the bed I thought would be the ideal sleeping arrangement for us....nope, only screaming...I didnt know what to do so I listened to my gut and we spent the first few weeks sleeping like this (see photo)

He slept on my chest on his stomach...most of the time we were skin to skin, which turns out its called "Kangaroo Care"  which is kind of a dumb name if you ask me, but it has many benefits. It was also very convenient for breast feeding.
After a few weeks or maybe months (pregnancy brain) he slept in the bassinet...on his stomach...thats the ONLY way he would sleep, but he had really good neck control so I just had to have faith that he would be okay.  People were concerned about him sleeping on his stomach because "its so dangerous!" My reply would be "ok, well tell HIM that!"

This would be the first of many times I didnt know what the hell I was doing and I just had to use my Mothers Intuition and trust myself.

Its important to listen to your instincts during the labor and birth as well, some things feel right and some just dont and you are the captain of your ship so YOU make the calls....labor positions, possibly feeling rushed by someone...whatever the case may be...If there ever was a time to have a take charge attitude its the birth of your children...

My friend Angie and I were talking about the birth of her daughter and she was sick of being rushed by the Doctor to just do a C-section and her shining moment was when she literally told him to "F-off!" and had that baby 2 pushes later! She is a nurse herself so that probably gave her more confidence to say that to a Doctor than a normal person.  The point is the same though, listen to your instincts!

I know this sounds repetitive, but its true that no one cares about you and your baby more than YOU! I will cut you if you mess with my child! lol. The consequences of your decisions during pregnancy & birth will only affect you & your baby.....Not the Doctor, or Nurse, or whomever... They carry on as usual with their workday and lives.... Just like during my birth when the Doctor suggested a vacuum extraction, and dangled that carrot stick in front of my face, lol...yes, it made the birth faster for all of us, but she was certainly not the one whose body spent months in recovery and healing...it was MY choice and I had to live with the consequences....grrr, and boy did I.

How can you get the confidence to listen to your instincts & know your stuff??....Lets say it together....

EDUCATE YOURSELF!

(does a mic drop and hops of soapbox)


Disclaimer: 
Do I think I'm smarter than a Doctor, no, but I think a good Doctor LISTENS to the momma.....
Do I think I know everything, no....but I'm always learning and it gives me more confidence.

Guest Post Allison- Natural ...Inductions?

From Kellie:  Allison's birth stories have so much useful info in them, if you are a first time preggers doing a hospital birth I would read this a few times! 

Natural ...Inductions?

When I got pregnant with my son I'd never really heard about natural childbirth, let alone thought about it. I was perusing a local mommy forum one day during my first trimester and stumbled across a member's birth story. She had a successful home birth with a midwife using the Bradley Method. I was mesmerized - I never knew childbirth could be like that. It sounded so different from what I'd seen in the movies or docudramas on TLC. I was struck by how in control she was of her labor and delivery.

After some research I located a local Bradley instructor and dragged my husband to a weekend well baby/well mamma seminar. I LOVED what I heard and was immediately sold that the Bradley Method was for me. I signed us up for classes the next week.

Hubby was skeptical at first. We have doctors on both sides of the family so we're definitely not anti-hospital or anti-doctor. However, I really liked the idea of having options to manage my labor other than medication. I ruptured a disc in my back several years earlier and had surgery. I knew this could potentially impact the effectiveness of an epidural and I wasn't about to go into labor totally unprepared.

By the end of the 12 weeks we were really glad we'd gone to the classes - we both felt prepared and knew the kind of birth experience we wanted to try for. I wouldn't say my OBGYN was pro-Bradley Method or pro-natural childbirth, but he was supportive of what I wanted and signed off on my birth plan.

Our son was due on March 8th, but was too comfortable inside his mommy to cooperate.  When we went in for our checkup on the 10th, I was 75% effaced and 2 cm dilated.  The doctor felt I would probably go into labor spontaneously over the next few days, but we did schedule an induction for the 16th just in case. I was thankful he was letting me go a week past my due date.

Well after much walking, nipple stimulation, thumb sucking (not kidding - it's supposed to start contractions) and other attempts at getting labor underway, the morning of the 16th came.  We were pretty discouraged that we were going to have to be induced, but were hopeful that we could follow at least some of our birth plan. We called the hospital at 5:30 am and were told to arrive at 7 am. They started the Pitocin around 7:30 and I was having mild contractions about 30 minutes later. Our Dr. said he would give us until noon to see how we were doing, but that he might need to break my water if things didn't progress.

From 8 to 10:30 or so the contractions were regular and very manageable.  I was sitting on my birthing ball and we were watching the Today Show.  DH had to come rub my back a few times, but I could easily relax through most of the contractions by myself.

At 10:30 the nurse bumped up my pitocin dosage and things started to change fast. I could no longer handle contractions on the ball - and I moved to the bed.  By 10:45 the contractions were much stronger and very close together.  There were maybe 3 to 4 minutes at most between contractions and many of them were very strong.  Hubby did great coaching me to relax, but sometimes the sensations were very overwhelming.

At 12:30 they came to check me and I was fully effaced and 5 cm dilated.  Since I was progressing so well my Dr. was ok with me continuing to labor with my bag of waters intact.

This was the point that things really got down to business.

I spent the next hour or so either on the bed or on the toilet. It was surprisingly comfortable to labor there - a tip from the Bradley classes. Another good tip - we broke the rules and brought in snacks. DH did great getting me water, a few slices of apple and peanut butter crackers when I was hungry. He also helped by counting down each contraction and put on Enya to help me relax.  I was very focused and was starting to vocalize through some of the contractions.  When the stronger ones hit I did start to wonder if I could make it through the rest of the labor.  The hardest part was that I had so little break between contractions - around 2 minutes at most.

At 2:15 I was checked again and was 7 cm dilated.  We decided I just couldn't relax laying down any more and moved a chair to the side of the bed.  I would sit up during the breaks and lean forward on the bed during the contractions.  At 3:30 I was checked again - I had progressed to 8 cm and my bag of waters broke while they were measuring me.

At this point it was impossible not  to bear down during the peak of each contraction. We lowered the bed and I got down on my knees on a pillow beside the bed and leaned over on the mattress.  I had less than a minute between each contraction and several of them double peaked.  I just remember being very tired and wondering if I was going to be able to finish the labor. This last hour flew by and when I was checked at 4:15 I was 9 cm dilated and they called our doctor.

I want to stop here and say that a few times during my labor I felt like I was "doing it wrong" because I wasn't laying down and relaxing the way I had been taught. However, I was listening to my body's cues. Laboring on the toilet actually felt good, so I recreated that posture with a chair on the side of the bed. After my water broke and my body started bearing down during contractions I HAD to be on my hands and knees - I honestly can't imagine laboring in any other position. When they asked me to lay on my back for them to check my progress, it was definitely the most painful time of the entire labor. I also felt helpless - like my labor was happening TO me. When I was up on my hands and knees I felt like I was laboring WITH my body. I felt much more in control and able to deal with the sensations.

The Dr. arrived at 4:30 and gave me several local anesthetic shots to numb my bottom.  I started pushing at 4:35 and pushed through 10 contractions over the next 20 minutes. Each contraction I averaged about 4 pushes. Pushing did not hurt - it felt good! But I didn't like pushing on my back, it just felt awkward. The baby's heart beat started falling into the 90s and I had some scar tissue that was stopping his head from completely descending.  After asking my permission, the doctor cut a small episiotomy and my son was delivered 2 pushes later at 4:59 pm.

They handed him to me immediately and the first thing I thought was wow - what a big baby!  They took his apgar measurements and he was a 9.  While the Dr. was delivering the placenta and sewing up the episiotomy they took him to the warmer to start cleaning him.  His color went gray pretty quickly and they were concerned about his oxygen levels. The neonatalogist came in and said he had really low blood sugar and needed to be given some pedialite quickly to keep him from being stressed out.  We weren't excited about this, but agreed that his coloring was really bad and we should do what was suggested.

DH went with the neonatologist to the nursery where our son was given pedialite through a small tube.  His coloring improved within seconds and his blood sugar got a lot better. Hubby came back about an hour later with the news that he was 21.5 inches and 9 pounds 1 oz!  I couldn't believe I had just delivered such a big baby without pain medicine!

DH went back to the nursery to help with the bath and then baby boy was brought to our room at 8pm.  We started breastfeeding immediately and he was a champ - he had a really strong suck and went 15 minutes on each breast.

Overall I was happy with the birth. I hated that they took my baby away so soon - it felt like it took forever for me to get him back. I liked my nurse, but I got the impression that I was one of her first "natural" births. She didn't interfere with my labor, but I didn't feel like she was totally part of my team.

Thankfully when my daughter was born I got the labor and delivery I had "almost" been hoping for.

Luckily I have pretty easy pregnancies. However, my second was rougher than my first. With my daughter I had morning sickness from the week I conceived - NO LIE - until almost 20 weeks. It was also the lovely all day sickness and didn't stop after lunch the way my first pregnancy had. I also got varicose veins in a very "sensitive" area - yes this apparently happens and it does hurt just as badly as you would think. Thank God for compression garments.

Other than that, it was smooth sailing. My Dr. was a little worried that I would have another 9 pounder so he ordered an ultrasound to get an estimate of her size around 37 weeks.The ultrasound estimated that she weighed between 7.5 and 8 pounds. However, I knew that late term ultrasounds are VERY inaccurate.

Fearing a 10 pound baby, my Dr wanted to induce me a week early, but I held him off until two days before her due date. I so wanted to go into labor on my own, and was disappointed that once again I was going in for a scheduled induction.  And yes we did ALL the same antics trying to induce labor this time that we did the first time.

I started off my induction similar to last time - I was about 70% effaced and 3 cm dilated. I do think that it helped that my body was "ready" to go into labor. Both times I was already very effaced and had started to dilate.

We didn't record our daughters birth the way we did our sons - the curse of the second born. :) But overall this labor closely mirrored the first, just on a faster timeline. The one difference was I had an INCREDIBLE nurse! She actually asked to be assigned to me when she heard I was going to have a natural birth. She had helped lots of Mamma's have a medication free labor and delivery and had such a great demeanor. I totally felt like she was on my team the entire day - she was a huge help.

Pitocin drip started around 9am - I was able to lay in bed and read and watch TV through contractions until about 11. Things started to get a little more serious around lunch time and when my Dr. came in and checked me, I was already a 6. The stimulation seemed to speed up the intensity of the contractions and remembering how I felt better laboring on the side of the bed with my son, I had DH pull up a chair and I tried to recreate my first labor experience.

This is when my nurse really was a life saver. Instead of coming in and re-positioning the fetal monitor every five minutes (that happened in my first labor) she would come in every 30 minutes or so, get a quick check and leave. During one of these checks she saw me laboring on the side of bed and made an awesome suggestion. She had me get on the bed on my hands and knees. She raised the head of the bed into an upright position (like it would be if you were sitting up in bed). During a contraction I could rest my arms and head on the raised part of the bed and sit back on my heels during the break. It was a similar position to what I had created on the side of the bed, but SO MUCH MORE COMFORTABLE! If you can call labor comfortable. ;) She also never checked me - just said to let me know when I started feeling pressure.

I started feeling pressure around 1:30 - she came and checked and I was complete! They called the Dr. and the room was a flurry of activity. I suddenly felt like I REALLY had to go the bathroom. The nurse said she would take me, but warned "You better NOT have that baby in the bathroom!" Made it to the bathroom, but couldn't go - I was really starting to feel like I had to push. She helped me back into my all fours position facing the head of the bed. This was absolutely the most comfortable position I could be in - I also appreciated that I didn't have to look at the 8 other people in the room with me. Yes I had 8 people other than myself in the room - husband, nurse, delivery tech, pediatric nurse, two nurse trainees, one paramedic trainee and finally the doctor.

The Dr. confirmed I was complete and then asked me if I could turn over on my back. I REALLY didn't want to, but probably would have anyway. Then my nurse stood up for me! She said "I think she's doing just fine where she is." BLESS THAT WOMAN!

I couldn't see my doctor's face, but I got the impression that he shrugged his shoulders and then said "Here we go!" He broke my water - it was still intact and I can tell you that it is SO MUCH BETTER TO LABOR WITH YOUR BAG OF WATERS INTACT. I know many of us don't have that choice, but labor was much less intense compared to when my water broke at around 7 cms during my first labor.

Two pushes and I gave birth to my daughter at 2:02 p.m. She was only 8 pounds, 3 oz - so much for the 10 pound baby. I flipped onto my back and they put her right on my chest. And this time I got to hold her for almost an hour before they bathed her in the room with me while I got to watch. :)


While we were both getting cleaned up (and I was getting stitched up - I did have a small tear) I heard from all 8 people how impressed they were that I had a natural delivery in a very "surprising" position. None of the trainees that had been watching had ever seen a natural birth and certainly never one where the mom delivered backward.


I'm disappointed that I never got to spontaneously go into labor, but I'm so thankful that I had the labors and deliveries I did. I'm not sure more children are in our future (I'll be 35 this year), but if I ever have another you better believe I'll be delivering on my hands and knees! ~Allison