The Monthly Doula
A newsletter by Birth a Miracle Services
Volume 1 Issue 12 June 2009
How to have an easier, faster, and safer birth
Mission Statement: My goal is to educate and inform all parents and future parents of their rights and responsibilities of bearing children and of the truth and wonder of birth. My mission is to inspire them to enjoy their pregnancies and to look forward to bringing their children into the world.
Letter from the Editor
In the News
Quote of the Month
Benefits of a Natural Birth
How Giving Birth on All-Fours Could Be Better For You
Enough Room in the Womb by Lenore ZurWelle
Website of the Month
Book of the Month
Online Video of the Month
What is Birth a Miracle Services?
Request for Contributions
Letter From the Editor
The reaction to childbirth activists’ protests includes the accusation that if “normal birth” is better than your standard hospital birth, that women who have epidurals, cesarean sections, or give birth with a male obstetrician, are somehow “less than” those who have normal, natural births, maybe even at home. And while I am sorry to say that there are women so passionate about what they promote that they do not consider the feelings of those who are hesitant about normal birth, that is not at all the purpose of the movement.
Normal birth is about promoting safe, healthy, and empowering birth experiences for the mother, the baby, and the rest of their family. It is about learning how our bodies will function well if they are nourished and taken care of, it is about celebrating the birth of a child, it is about incorporating birth into the rest of ones life. I hope that my newsletters will inspire women to choose options which promote normal birth. This issue includes very “non-standard” ideas that promote safe and more comfortable birth. If you have any questions about what you read here, do feel free to contact me or visit my blog for more information on normal birth at http://www.birthamiracle.wordpress.com
Naomi Kilbreth, CD
Birth a Miracle Services
36 Greenwood Street
West Paris, ME 04289
In the News:
Freebirth: In January 2009, ABC did a special on the growing number of women who choose to give birth at home, even unassisted by a midwife. http://abcnews.go.com/Health/story?id=6424603&page=1
Should the AMA and ACOG get to decide where we give birth? Talk about removing constitutional rights! See the full story here: http://abcnews.go.com/Health/story?id=5340949&page=1
Looking for alternative remedies for healing of childbearing issues? Homeopathy may be the answer you’re looking for: http://www.healthnews.com/blogs/melanie-grimes/natural-health/alternative-medicine/homeopathy-labor-childbirth-3283.html
Quote of the Month:
“Dilation, effacement, and cardinal movements are the mechanics of birth, but the mechanics are only one piece of the story of normal birth. Another piece is the incredible hormonal orchestration of labor and birth. Oxytocin causes uterine contractions; the higher the levels of oxytocin, the stronger and more effective the contractions are. When the pain of strong contractions reaches a certain level, endophins are released and pain moderates. Women go into themselves and respond to contractions in more intuitive ways. When women give birth with high levels of both oxytocin and endorphins, catacholamines are released. These hormones work together to insure that mother greets her baby in an alert, interested, and transformed manner.” ~ Judith A. Lothian, RN, PhD, LCCE, FACCE. From Promoting, Protecting, and Supporting Normal Birth J Perinat Educ. 2002 Summer Copyright 2002 A Lamaze International Publication
Benefits of a Natural Birth
By Naomi Kilbreth
Some feel that “going natural” is a rite of passage in life, and offers empowerment to those women who experience a normal labor and birth. While this is true for many women who experience it, still others claim a similar experience after having a medically managed delivery. So for the purpose of this article I will discuss the physical aspects only of how starting labor on your own can start you on the path to having a normal birth.
In essence, induction of labor is a symptom of a culture that is taught not to trust our bodies. The 2005 Listening to Mothers II study suggested that 41% of women are induced into labor, and still more are given drugs or procedures to “hurry things along”. Some of the most common reasons for inducing labor are actually the most questionable, even according to the American College of Obstetricians and Gynecologists, and highly reputable books like A Guide to Effective Care in Pregnancy and Childbirth. These are five of the most common, yet questionable, reasons for inducing labor:
1. “Baby is getting too big” – The prospect of pushing out a larger than average baby can be enough to scare a woman into accepting an induction, but there are a few reasons why this practice is an unacceptable standard. For one, babies do not have hardened skulls until several weeks after delivery, they are designed to mold and and form to the shape of a woman’s pelvis, no matter the size of either one. Also, the fear that a big baby could make birth dangerous is unfounded because half of shoulder dystocia cases (where the baby’s shoulders get stuck after delivery of the head) occur with average sized babies. Other reasons why “macrosomia” is not a medical indication for induction: fetal size appears to level off after 40 weeks gestation, ultrasound measurements of fetal size are likely to be inaccurate when a baby is larger than average and can be misleading by up to a pound smaller or larger than the actual size, and induced labor is actually contraindicated for large babies.
2. Gestational Diabetes – Women who have high intakes of sugar in their diet often have larger babies. However, new research suggests that there is no such thing as gestational diabetes, rather that a pregnant woman’s metabolism changes, and thus her sugar levels appear higher than normal, even if she is in good health. Obviously, a good diet is beneficial to a good birth, but even if a woman is diagnosed with gestational diabetes, it doesn’t mean that labor induction is medically indicated.
3. Too little or too much amniotic fluid – This one is becoming more common in my experience. A woman goes in for a routine ultrasound late in pregnancy and she is told that her amniotic fluid level is a bit higher or lower than average. She is then scheduled for an induction, since a low or high level could indicate that the placenta is getting “old”. In reality, amniotic fluid is only an indicator of placental troubles if it is at a significantly abnormal level. Dehydration of the mother could in itself cause the fluid level to be a little low. Plus, the test is questionable in it’s accuracy, since it is more a guestimate that anything else.
4. “Failure to progress” in labor – This diagnosis is based on the concept that labor and birth must be quick, but in fact there is no prescribed length of normal labor. If mom and baby are doing well, than there is no reason to rush her to delivery. There are several ways that a woman progresses through labor, not just in cervical dilation, and sometimes a baby just needs a bit more time to turn into the right position for birth.
5. Convenience, for mother or caregiver – Your caregiver may come up with a questionable reason to induce because induction is more convenient, and some women prefer to schedule their baby’s birth date. In 2004, 12,000 babies were born every weekday, compared to 8,000 on days of the weekend. Unless there is a very good medical indication, the risks of induction far outweigh the benefits of inducing for convenience.
Risks of inducing or augmenting labor (Pitocin, prostaglandins, amniotomy, and herbs when used inappropriately):
Early decels in fetal heart rate
Reduced fetal oxygenation
Rise in leucocyte level
Amniotic fluid embolism
Fetal brain damage
Increased instrumental and cesarean deliveries
Interference in bonding and breastfeeding
Failure to progress in labor
Although these risks can be serious, the benefits of using them appropriately may outweigh the risks when used for very good medical reasons. Only 5-10% of pregnancies normally fit this description and include the following indications:
1. Gestation past 42 weeks – The due date should really be a “due month” because a healthy baby can be born between 38 and 42 weeks, and sometimes even outside this time period. As Dr. Michel Odent has said, you don’t pick all your apples on the same day. Approximately 3% of pregnancies, if left alone, would go beyond the 42 week mark, and only about 10% of babies get into trouble after 43 weeks of pregnancies, so although a truly postdate pregnancy is reason to consider induction, other aspects of the mother’s and baby’s health should be considered as well, to make sure that the benefits of induction outweigh the risks.
2. Evidence of placental malfunction – Sometimes a placenta will gradually stop functioning well before the baby is ready to be born. Obviously this is not a good situation for the baby, so it would be better to cut the pregnancy short in this case. Placental malfunction can’t be diagnosed until after the birth, but signs of it occuring include a significantly declining fetal growth rate, and little fetal movement. It is reassuring to know that even at 42 weeks, 95% of placentas are functioning just fine.
3. Too small for gestational age – although some babies are born small because of genetics, this can be a sign of placental malfunction.
4. Preeclampsia – This prenatal health condition indicates stress on the mother’s body, it’s way of saying “I’ve had enough!” If not monitored carefully, and induced if symptoms are reaching dangerous levels, serious consequences could result. However, mild pregnancy-induced hypertension (moderately high blood pressure) is not an indication for induction.
5. Premature rupture of membranes – If the mother’s water breaks before contractions start, it is safe to wait 48 hours before inducing, unless there are signs of infection. One 1996 study said there was no increased rate of infection up to four days following rupture of membranes! If this happens to you, you can reduce your chance of getting a uterine infection by abstaining from sex, showering instead of bathing, keeping vaginal exams to an absolute minimum, and not inserting anything else into your vagina either. Your vagina is a sterile environment until something is inserted, and even sterile gloves inserted can carry bacteria from the vaginal outlet up the vaginal canal.
6. Fetal hypoxia in labor – If the heart rate of the baby starts reacting negatively to contractions, it can be an indicator that he is not getting enough oxygen and the labor is stressing him out. Although electronic fetal monitors have high false positive rates for fetal distress, a clear pattern of hypoxia is a strong indicator for hurrying labor along (if close to birth) or for cesarean section (if birth is not imminent). Fetal hypoxia and distress rarely happen when a woman goes into labor on her own and she is given no drugs whatsoever during labor.
If you do consent to an induction or augmentation, NEVER allow your doctor or midwife to give you Cytotec. This drug is very dangerous because it frequently causes hyper-stimulation of the uterus, which can easily lead to fetal distress and uterine rupture, and has a much higher rate of fetal and maternal death than other induction drugs. This drug is not approved by the FDA or it’s manufacturer for the purpose of labor induction, but sadly it is still used in many hospitals across the United States.
If your doctor or midwife suggests that you be induced or given drugs or herbs to augment labor, ask questions like these to make sure that you are fully informed of the pros and cons to the decision that you make (specific information on labor inducing drugs can be found on the NIH or CDC websites. You can also check my references for more information):
1. Why are you suggesting this? Is it medically indicated?
2. Is the drug FDA approved for inducing labor?
3. How will it help me?
4. What are the risks and consequences associated with it?
5. How often do your patients need an epidural after this drug is used?
6. How often do your patients need an instrumental or cesarean section after this drug is used?
7. What are the alternatives and their pros and cons?
8. What happens if I don’t get induced?
Safer alternatives to drugs and herbs for inducing labor, if it is medically indicated, include nipple and clitoral stimulation, unprotected sex, long walks, gravity, and spicy food.
Now, after scaring you about inductions and bad births, I will tell you what a woman’s body will most likely do if she is left alone and trusted to do what she needs to do.
There are several theories as to what starts labor, and no one knows for sure how to explain this mystery of nature. Most likely this is about what happens. The pregnancy is a time of creating and developing the baby’s organ systems and all the intricacies that allow the baby to survive outside the womb. Near the end of pregnancy, as the baby’s lungs (the last to finish development), or the adrenal glands, send enzymes and chemicals to the mother’s brain through their blood supply. This enzyme and/or chemical signal tells the woman’s body that it is time and she begins to produce prostanglandins that soften and loosen her cervix, and oxytocin (the body’s natural version of Pitocin) to begin effective contractions that will open her cervix.
As the contractions increase in frequency and strength, they force the baby to move downward against the cervix, which triggers the release of more oxytocin, which causes contractions that open the cervix and push the baby down. It becomes a natural cycle of labor, and the majority of women will do this on their own within a safe time period if they are “allowed” the opportunity.
“Creating Your Birth Plan” by Marsden Wagner, M.D., M.S.\
“A Guide to Effective Care in Pregnancy and Childbirth” Second Edition, by Enkin, Keirse, Renfrew, and Neilson
“Pushed” by Jennifer Block
“Born in the USA” by Marsden Wagner, M.D., M.S.
Copyright 2009 Associated Content
How Giving Birth on All-Fours Could Be Better For You
By Naomi Kilbreth
More and more research is being conducted on the benefits of upright birth positions versus the semirecumbant and lithotomy birth positions. Although the latter have been most common in the United States for the past 100 years, success stories from other countries and minorities within our own have led researchers to question the common practice.
What other countries (with lower birth mortality rates than our own) have been finding is that women who give birth upright or in the all-fours position have less pain in labor and birth, have shorter labors and pushing times, less shoulder dystocia (where the baby’s shoulders get stuck in the pelvis), and fewer perineal tears.
In addition to all of the above benefits, current American-based studies also suggest the following benefits to giving birth on hands and knees: fewer maternal and infant injuries and infant deaths related to shoulder dystocia1, less painful and more efficient contractions2, impressive rate of rotating posterior babies to anterior within 10 minutes3, shorter labor4, and the potential to decrease risk of both instrumental and cesarean deliveries5.
The question becomes, why is the all-fours position helpful, and since it is, why are not all women delivering this way? The explanation for why it is helpful probably lies in the increased freedom of movement within the pelvis. A woman’s pelvis is made of three sections, joined together by flexible cartilage, so that it can move easily. When a laboring woman lies on her back, her pelvis is constricted to a certain space. However, the all-fours position allows her pelvis to open 1-2cm, allowing adequate room for even a large baby to pass through6.
As for why this position is not used more frequently, the answer is complicated. Births that take place outside of the hospital generally result in this position being used more freqently, presumably because the mother is encouraged to choose the most comfortable position for her. Within the hospital, there may be several reasons for the lack of use of the all-fours position. These may include: patient risk factors that necessitate intervention, which is easier to use on a patient lying down, assumption that the patient is supposed to be on her back, preference of the hospital staff, or routine interventions (whether necessary or not) that require a lithotomy position.
An all-fours position may not be appropriate for all women. If she is tired, on pain meds, or has certain health conditions, lying on her side may be a better option for her.
Considering the definite benefits, however, all women should consider the all-fours position, among other upright positions, to be useful for them in labor and birth. Speak to your care provider to learn if this is a good option for you, and don’t be afraid to ask for a second opinion if your care provider is unfamiliar with this practice.
1, 6 – “A New (Old) Maneuver for the Management of Shoulder Dystocia” by Meenan, Gaskin, Hunt, and Ball.www.lifepassages.net/ShoulderDystocia.html
2 - www.consumerjusticegroup.com/birthinjury/paininback.html
3 – “Baby Malpositions: Implications for Birth” by KMom. www.plus-size-pregnancy.org/malpositions.htm#Strategies%20To%20Correct%20Malpositions
4, 5 – “A Meta-Analysis of Upright Positions in the Second Stage to Reduce Instrumental Deliveries in Women with Epidural Analgesia” by Roberts, Alger, Cameron, and Torvaldsen. Acta Obstet Gynecol Scan. 2005 Aug; 84(8):794-8.
Copyright 2009 Associated Content
Enough Room in the Womb
Learning About Enough Space
By: Lenore ZurWelle
In this world of “bigger is better” and striving for more space we could learn a lesson from a growing fetus in the womb. At each stage of pregnancy, the growing child has all of their needs met. There is just enough room for growth, there is nourishment to sustain life, all the necessities to thrive. Just enough at each stage in the growth to produce a perfect human being. What happens then, when the child is born and is introduced to a far greater world? A room of his own is just a much bigger space to fill. The big crib is spacious compared to the small place of comfort and safety the newborn came from, so we fill it with blankets and stuffed toys to make the space seem more cozy. As parents, we may even move to a bigger home to accommodate the new addition to the family. But is it space and a big room that a newborn really needs? In fact, do any of us really need more space? Maybe we could take a lesson from the newborn child and realize that we all crave closeness in all aspects of our lives. Our babies have something to teach us, even while they are in the womb. Physical and emotional closeness is what make us thrive, not bigger houses. It has been said that the space we need to be comfortable living in is the “7 inches”, that space between our ears or put another way, the space behind our eyebrows. That, like the womb is a very small space but certainly a place where there is room to grow. It is there that our thoughts, feelings, creativity and emotions grow and flourish. If we cannot be comfortable and thrive in this space then there is not enough space in a home or in the universe to satisfy our needs. This is the lesson our babies teach is as they grow inside our bodies. Just enough room is not only just enough, it is all we need. When anticipating the birth of your new little one, let the progression of their growth be an opportunity for learning. It is not the amount of rooms in the house but the amount of love, comfort and nourishment that comes from the parents and family. It doesn’t take much room to give warm hugs and security to your family. That is a lesson that is given to us from our babies even before they are born. A lesson that holds truth and lasts a lifetime.
Website of the Month:
This article is from 2002 but considering the current assault on normal birth, this article is still relevant. http://www.midwiferytoday.com/articles/disinformation.asp
Book of the Month:
Your Best Birth: Know All Your Options, Discover the Natural Choices, Take Back the Birth Experience by Ricki Lake
Online Video of the Month
What is Birth a Miracle Services?
Birth a Miracle Services is the name of the birth doula and childbirth education service that I started in 2002.
A birth doula is a person who offers informational, physical, emotional, spousal, and advocacy support to women through pregnancy, birth, and the early postpartum period. I also offer traditional childbirth preparation classes, birth art classes, and childbirth counseling.
All of this is available to women within an hour of my home in West Paris, Maine for a sliding scale fee. Single, teen, and low-income moms can receive my birth doula support for free.
For more information visit my blog: http://birthamiracle.wordpress.com/
I am proud to announce the birth of my first book, Inspired Birth: A Fresh Perspective for Christian Maternity Care Providers. It is an inspirational guide for all Christians who attend women in childbirth, with fresh ideas on how to meet the emotional and physical needs of childbearing women while addressing current challenges to American maternity care. This book is still in the editing process and is not currently available for purchase, but if you know any Christians who are doctors, nurses, midwives, or doulas, please let them know that this book is on the way!
Request for Contributions
Next month’s topic is on motherhood and sexuality. If you have anything you would like to contribute, such as how having a baby affected your sexuality, please email your thoughts with the subject line “Monthly Doula” to Kilbrethfamily@yahoo.com . Thank you!
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To view previous issues of The Monthly Doula, click this link: http://birthamiracle.wordpress.com/category/the-monthly-doula/