7 VBAC TRUTHS

Let’s be real; there can be a lot of myths, misconceptions and out-right misinformation about the risks of Vaginal Birth After Ceasarean (VBAC). Educating yourself and finding a care provider who informs their practice with the latest research and references is key to planning the safest birth for you and your baby. Here are some things to keep in mind as you ponder and plan.

1. Your uterus is strong and it will heal well

Good research continues to show that the risk of uterine rupture for a VBAC is very low and is comparable to other risks faced by birthing mothers without a history of ceasarean. Avoiding induction or augmentation is an easy way to reduce your risk of having a uterine rupture.

2. VBACs are healthy for babies

Vaginal birth is the biologically appropriate way for babies to be born and as the norm for our species, carries with it many elements that are important for a lifetime of health. Exposure to mom’s natural bacteria gets baby’s immune system started the right way, and all that good squeezing during the birth means fewer trips to the NICU or worries about breathing issues both at birth and beyond.

3. VBACs are healthy for moms

There is no question that a vaginal birth is safer than major abdominal surgery. Some studies have shown that mothers face at least twice the risk of death if they have a ceasarean due to complications from the surgery like blood clots, infection and embolism. And forget those myths about ‘protecting’ your vagina with a ceasarean: a study of nuns showed incontinence and prolapse occuring similarly to their child-bearing counterparts of the same age.

4. A VBAC is a good choice even if you’ve had more than one ceasarean

Dr. Mark Landon et al found in a large and well-designed study that VBAmC (m = multiple) mothers were not substantially at higher risk than VBAC moms, and that vaginal birth should be a reasonable option presented to them should they desire a trial of labour. (http://www.scfmresidency.com/SCFM_Curriculum/Journal_Club/10-19-06_Journal_Club/Uterine_Rupture_Article.pdf)

5. VBAC labours come in all shapes and sizes

Patient care providers recognize that sometimes the real reason a mother had a ceasarean previously was because she wasn’t supported through a labour that might have been a bit different than average. Having patience, avoiding induction or augmentation, and having a birth team equipped with a variety of ways to keep mom focused and supported through her unique labour can make all the difference for a successful VBAC.

6. VBAC moms come in all shapes and sizes

Many moms have been told they are ‘too small’ to have a baby vaginally or that they are ‘too overweight’ to do the same. However, we know from experience (and supported by research) that if you have a supportive care provider, all sizes of women can be great candidates for a VBAC. For an inspiring video of women who were all told they were too small to give birth but then subsequently birthed a bigger baby via VBAC, go to www.ican-online.org/questioncpd

7. VBAC is your choice, not your doctor’s

You are the one that ultimately gets to decide what your birth will be. VBAC is not a special procedure nor should it be treated as such. A doctor may have concerns about a VBAC versus a ceasarean, but they are not the ones that will bear the risk of either choice for the rest of their lives. A good care provider will offer solid research and resources to a mother making a decision, and then remind her that in the end, it is her decision to make.

Krista Cornish Scott is the Education Director with the International Cesarean Awareness Network (ICAN).

Magic of Labour and Birth

WHAT YOU NEED TO KNOW

Having a baby is the true "change of life." Women who go through labour and birth fully supported often emerge from the experience changed forever. One of my patients who had her two children at home told me: "My births were absolute peak experiences of ecstasy and spiritual fulfillment. Nothing I’ve ever experienced before or since has come anywhere close. As a result of my experiences, I now trust my body implicitly."

SPIRITUAL AND HOLISTIC OPTIONS

In order to experience the transformational power of birth, women need to know the following: 

1. Labour proceeds on its own schedule. The delicate timing that is a result of the delicate interaction between a baby and her mother needs to be respected. (Risky labour inductions for "convenience" and all the complications associated with them [e.g., increased risk of pre maturity, C-section, and maternal death] are now on the rise all over the country.) 
2. Childbirth is designed by nature to be a peak experience that is joyous, ecstatic, and loving. The body of the laboring woman is flooded with natural morphine-like substances called endorphins as well as oxytocin, the bonding hormone.
3. Birth is sexual. This makes sense—after all, the baby is moving down the vaginal canal and stimulating the G-spot and all the nerves connected with sexual feeling. As midwife Ina May Gaskin says, "The energy that got the baby in is what gets the baby out. Many women experience the most intense orgasm of their lives when they birth in environments in which they are loved, adored, and fully supported." 
4. How you do it is what you get. Because of the heightened emotional and neurological receptivity of both mother and baby, the birth experience deeply imprints both mother and baby and impacts their relationship for a lifetime. 
5. Natural birth is safe. Studies have repeatedly shown that in healthy mothers with no risk factors, home birth is as safe as hospital birth. Perhaps safer. 
6. There are many choices for how to have your baby. In fact, there are more childbirth choices now than ever before—everything from high-tech hospital birth to water birth at home.

Article courtesy of Christiane Northrup.

LEARN MORE | RECOMMENDED READING OR RESOURCES

• Ina May Gaskin is one of the best-known pioneers of midwifery. Learn more about her work at www.inamay.com.
• Coalition for Improving Maternity Service (CIMS) is a collaborative effort of numerous individuals and more than 50 organizations representing over 90,000 members. CIMS aims to promote a wellness model of maternity care. 
• Doulas of North America (DONA) is an international association of more than 4,000 doulas nationwide who are trained to provide the highest quality emotional, physical, and educational support to women and their families during childbirth and postpartum.
• Childbirth.org, founded by doula Robin Elise Weiss, is a source of comprehensive information on pregnancy and childbirth.
• Birthworks believes in empowering women by developing their self-confidence, trust, and faith in their ability to give birth.
• Mother-Daughter Wisdom, by Christiane Northrup, M.D., Chapter 4, "Pregnancy: Trusting the Process of Life" and Chapter 5, "Labor and Birth: Accessing Your Feminine Power"
• The Wisdom of Menopause, by Christiane Northrup, M.D., Chapter 12, "Pregnancy and Birthing"
• Birth As We Know It, a movie by Elena Tonetti-Vladimirova shows the beauty of natural birth in water 
• Journey into Motherhood: Inspiring Stories of Natural Birth, by Sheri Menelli

Birth: Perfection in Action

Article courtesy of Christiane Northrup.

I’ve often said that if you want to know where a woman’s true power lies, look to those primal experiences we’ve been taught to fear—not coincidentally the very same experiences the culture has taught us to distance ourselves from as much as possible, often by medicalizing them so that we are barely conscious of them anymore. Labour and birth rank right up there as experiences that put women in touch with their feminine power, along with the menstrual cycle and menopause. But imagine what would happen if our culture believed that we required medical help to have our monthly periods. 

What if all women went to medical centers for menstrual "anesthetics," to help them avoid feeling the passage of menstrual blood, or for a procedure to extract menstrual blood quickly and painlessly, so they wouldn’t have to go through this monthly "nuisance." If, when reading this, you notice that the idea of menstrual extraction appeals to you, you will probably also be drawn to birth interventions. This is simply a sign that you’ve been talked out of some of your feminine power.

At no other time than in the act of giving birth does your body serve so directly as a channel for the life force—if you do not interfere with that life force. And at no other time can you see Nature’s wisdom so palpably in action—if you are willing to allow Nature to do what Nature does best.

The process of birth is one of Nature’s highest achievements. Nature in all her wisdom has designed it so that the experience teaches a woman about her inner resources and how to access them. If participated in consciously and fully, labour will also cement the relationship between mother and child, and, if the mother’s mate is present, among all three of them.

The teaching is embodied in the rhythms of labour, which entrain the body and brain of the mother with strength, flexibility, and resilience. You experience contractions, which force you to find the resources to deal with the discomfort and to go deep within. And then you have a period of rest and relaxation, during which you can change positions, get more support, drink some water, and prepare yourself for the next contraction. You learn to go with a situation you cannot control, which may involve pressure and pain. And you learn to trust that the process will give you the time and strength you need to ready yourself for the next wave of contractions.

The bonding occurs thanks to the extraordinary biochemistry of labour, which primes the body and brain of both mother and child with high levels of two potent neurotransmitters, oxytocin (which causes uterine contractions as well as intense feelings of love) and beta-endorphins (the body’s natural opiates, which cause euphoria and numbing of pain). Together these hormones create a biological imprint in the bonding circuits.

All of these processes occur naturally, and most women do not need any of the numerous interventions, mechanical and drug-mediated, that make childbirth in this country resemble a medical emergency rather than a normal physiological event. But pregnant women tend to go along with this overmedicalized approach unthinkingly, assuming that their doctors know best. If, however, you understood that birth interventions such as IVs, electronic fetal monitoring, episiotomy, epidural anesthesia, labour induction, vacuum extractor and forceps deliveries, and cesarean sections might have adverse consequences for yourself and/or your baby, would you still participate in them under circumstances when they’re not medically necessary—which in most cases they aren’t? Birth interventions that bypass the normal processes of labour and birth are the equivalent of clamping the umbilical cord before the baby has had a chance to adjust to breathing on her own—another medical procedure that is all too common in the rushed environment of today’s delivery rooms.

No one speaks more clearly about the perfection of the design of the female body for giving birth naturally than Ina May Gaskin, a professional midwife who is the founder and guiding spirit of the Farm Midwifery Center and who has been delivering babies for over thirty years. From their birthing center in a rural community in Tennessee, Gaskin and the other midwives at the Farm have overseen the prenatal care and attended the births of more than 2,200 babies, most of them born in their parents’ homes or at the Farm. They have a safety record for mother and child that would be the envy of any medical center anywhere, despite (or probably because of!) the fact that fewer than 2 percent of their births were cesareans, fewer than 1 percent were assisted by forceps or vacuum extractors, and none of their births were drug assisted, except in cases of medical emergencies.

"Remember," Ina May says, "your body is not a lemon. You are not a machine. The Creator is not a careless mechanic."

(a lemon in American terms means that something is not working).

LEARN MORE | RECOMMENDED READING OR RESOURCES

• Ina May Gaskin is one of the best-known pioneers of midwifery. Learn more about her work at www.inamay.com.
• Mother-Daughter Wisdom, by Christiane Northrup, M.D., Chapter 4, "Pregnancy: Trusting the Process of Life" and Chapter 5, "Labor and Birth: Accessing Your Feminine Power"
• The Wisdom of Menopause, by Christiane Northrup, M.D., Chapter 12, "Pregnancy and Birthing"
• Ina May’s Guide to Childbirth, by renowned midwife Ina May Gaskin

Article courtesy of http://www.drnorthrup.com/womenshealth/healthcenter/topic_details.php?topic_id=136

What does a midwife do?

The Art of the Midwife

Care with a modern midwife is truly an art form - combining the guiding, healing hands of one's most trusted advisor and nurturer with today's knowledge, science and medicine. This fusion is what sets midwives apart from most doctors.

A midwife's care is based on the idea that the woman is the central decision maker in matters regarding her birth and her child. Midwives respond to mothers as a caring and collaborative partner, highly trained to work with each unique situation individually. Her goal is the health and well being of mother and baby. She has the resources, wisdom, and professional training to safely guide the journey of pregnancy.

A qualified midwife will provide comprehensive prenatal care, guides labour and birth, and cares for newborns. However, her unique value is revealed as she connects with a woman and her family to offer a deeper level of care. During pre and postnatal visits that are three to ten times longer than standard doctor visits, the midwife listens to what is needed at each step of the process. She can then offer appropriate information, physical, emotional or clinical support, and options.

The safety and benefits of midwife care have been proven again and again in countries across the world. World Health Organization statistics show that births attended by midwives have lower infection rates, lower C-section rates, fewer complications, and healthier outcomes - thus, lower overall medical costs - than physician-attended hospital births. In addition, there is no difference in infant mortality between midwife-attended and physician-attended births for low-risk women. Countries such as the Netherlands, Sweden, and New Zealand, which have the best birth outcome statistics in the world, use midwives as their main maternity care providers.

Article courtesy of this link.

Waiting for Baby

WHAT YOU NEED TO KNOW
The body is doing a lot of inner work to grow a baby. One of the healthiest things to see is a woman pregnant with her first child who takes the time to enjoy the process. Usually it is women in their late thirties or early forties who have seen success in the outer world who are now willing to abdicate the "benefits" of the corporate world and reassess their lives through the lens of parenting.

SPIRITUAL AND HOLISTIC OPTION
The tenor of pregnancy contributes to a child’s constitution for the rest of his or her life. It is a crucial time in a child’s development. And because the baby is part of a woman's own body, positive inner communication between the two can translate into a woman’s deeper trust in herself that continues after birth.


COMMUNICATE WITH YOUR UNBORN CHILD
Once pregnant, you can regularly communicate with your baby. Visualize your child in a pink bubble (or another color of choice—I suggest pink because it is associated with love) and send the message that she is safe and loved. This is an especially useful exercise during times of stress or when you are scared or anxious. You can also read to your baby and talk to her regularly. Hearing begins to develop in the first trimester! And remember, pregnancy is a two-way street. If you tune in carefully, you may sense that your daughter is also communicating with you.
Teresa Robertson is a midwife and a birth intuitive who helps women enhance the health of their babies in utero and their own ability to carry a child to full-term. She does this by teaching pregnant women to tune into and connect with their unborn child. Since meeting her at the Omega Institute in Rhinebeck, New York in the’80s, I’ve referred many pregnant women to Teresa. I found her approach both empowering and effective—it’s the essence of what I call "yin" power, the power of waiting, of being open and receptive. Teresa helps encourage the fundamental nature of femininity, and that’s exactly what it takes to both conceive and carry a healthy baby—or any other creation.

GOOD VIBRATIONS 
Make listening to music, dancing, and singing a regular part of your pregnancy. It helps tune both of your bodies. Layne Redmond, an accomplished drummer and author of When the Drummers Were Women, points out that the original beat our bodies were exposed to was our mother’s heartbeat. And that’s why the beating of drums still stirs us right to the bone.

Music has been shown to reduce anxiety, heart rate, and respiratory rate. It also decreases stress hormone levels, boosts natural opiates, relaxes laboring women, and has beneficial effects on the physiology and behavior of the newborn, including contributing positively to weight gain in both normal-weight and premature babies.¹

DON'T WISH AWAY YOUR PREGNANCY
When she was diagnosed with breast cancer, comedian and writer Erma Bombeck wrote down some of the things she wished she had done while she still had the time. One of those was savoring her pregnancies. She wrote, "Instead of wishing away nine months of pregnancy, I’d have cherished every moment and realized that the wonderment growing inside me was the only chance in life to assist God in a miracle."²

USE THE POWER OF THE MIND-BODY CONNECTION
Take advantage of your emotional porousness. Use birth affirmations regularly during your entire pregnancy to help you program your body and mind for optimal birth. In her book Ina May’s Guide to Childbirth, midwife Ina May Gaskin points out the amazing power of the mind to influence the body during labor. She told one pregnant woman that during her labor her vagina, vulva, and cervix would become huge openings to allow her baby to pass through easily. When she gave birth, that is exactly what happened! Put affirmations all around your environment—your refrigerator, bathroom mirror, Palm Pilot, journal, and phone—to remind you of your birthing power. Say them out loud or in your head regularly. Write them down repeatedly. Let the power of your emotions and thoughts do its magic with your body.


CREATE AN OUTER PLACENTA
Pregnancy, labour, and birth are physically demanding events that require a large outpouring of life energy. Every woman who is going through the changes of pregnancy needs to replenish that energy, not just through proper nutrition but through the love and support of those around her—the nourishing environment I call the outer placenta. Just as the developing baby cocreates her own placenta in partnership with her mother, so too must the mother "implant" herself into her community to cocreate this outer placenta. The urge to reimplant yourself into your own mother is particularly strong at this time. Obviously a supportive mate is a major plus in a woman’s ability to care for herself optimally. A carefully chosen, committed health-care team can also make a big difference. In general, the more effective and diverse your community of support, the better.

Article courtesy of the following site.

LEARN MORE | RECOMMENDED READING OR RESOURCES

• Ina May Gaskin is one of the best-known pioneers of midwifery. Learn more about her work at www.inamay.com.

• To learn more about Teresa Robertston’s work, visit her atwww.BirthIntuitive.com.

Birth Stories

Do you have a Birth Story or two you'd like to share? 

Have you had a baby at Genesis Clinic recently? What was your baby's birth like? Did you have an easy or difficult time in labour? We all love to hear other people's birth experiences and also to share about our own experiences, no matter what the outcome of your birth, whether you had natural or you had a VBAC (Vaginal Birth After C-section), or you tried for natural but ended up with a C-section.

Story telling is an important part of moving into parenthood. You have probably told the story of your labour and the birth of your baby over and over many times to your friends, family and neighbours, maybe even to complete strangers on the bus or when you were at work!

Each woman's story is unique and each labour and birth is unique for every woman. So whether you have one child or ten, no two labours will be the same - at least it would be very rare if they were. Have you had 2 labours that were identical? If so please do tell us about them.

So take some time and write your story. When you're happy with it email it here for others to read. By sharing your experience you can help other people to learn by things you have gone through.

Whatever your childbirth journey is, we'd all love to hear it! 

Do You Have A Birth Story To Share?

Share it with us and we will post it on the Genesis Clinic website under our 'Birth Stories' section.

Please email all birth stories to birth@genesisclinic.co.za

Coping with labour naturally

• Choose a care provider and birth place that will allow you freedom in labour and plenty of support.
• Practice relaxation during pregnancy.
• Use affirmations and visualization during pregnancy.
• Choose labour companions who will support and encourage you - consider a Doula.
• Read inspiring birth stories during pregnancy.
• Labour at home as long as possible.
• Make your location as comfortable as possible.
• Keep your space warm and dark.
• Bring comforts of home to the birth center.
• Go about your daily routine during early labour - sleep if it's night.
• Eat and drink as you need to.
• Move. Walk inside or outside, use a birth ball, slow dance - movement helps.
• Surrender to the power of labour and the power of your body, embrace it.
• Play music that you love, that helps you move deeper into labour, or that soothes you.
• Stand and bear down on low support, or pull on a soft rope support if it helps.
• Be grateful that you'l be meeting your baby soon. Be grateful for your attendants.
• Vocalize -use deep, open moans. Relax your jaw. This relaxes your bottom.
• Know that you can do this.
• Visualize your body opening and your baby moving down.
• Keep peeing. This gets you moving and some women like labouring on the toilet.
• Try aromatherapy. Massage with essential oils in a carrier oil can be wonderful.
• Have an attendant use counter-pressure for strong back labor.
• Use a hot sock, rice sock, or aromatherapy stuffed animal to apply moist heat.
• Use cool washcloths or a frozen hot sock, rice sock, or aromatherapy animal for cold.
• Get in the shower.
• Get into warm water.
• Have an attendant give you a massage on your legs, or anywhere that feels good.
• Don't try to escape the pain - embrace it, go with it. Explore it, be curious about it, if it helps.
• Feel the love of those around you.
• Talk to your baby.
• Look in the eyes of your support team.
• Do what your body tells you to do. Breathe.
• Trust yourself.

The benefits of using water in labour.

Extract from “Water Birth” by Janet BalaskasHow water can help you in labour“The water looked very inviting and I was delighted with it when I got in. I had a fire burning and the room was candle lit, with soft music and lavender oil in a burner.”

The change in how a woman feels and behaves soon after entering a birth pool in a quiet darkened room can be remarkable. It seems to alter her state of consciousness and her concentration – sometimes dramatically – so that she very soon relaxes and sinks more deeply into herself and is able to let herself surrender to the involuntary rhythms of her labour. It’s as if she becomes sleepy, even dreaming.

In the ‘Birth and the Family Journal (Vol 8)’ Michel Odent writes: ‘The reason why kneeling or immersion in water during labour is so helpful is mysterious. What is clear is that water is often the way to reduce inhibitions… we observe that during such immersion in warm water, semidarkness is the best way to reach a high level of relaxation. Water may be a good way to reduce adrenergic secretion. Immersion in warm water with semidarkness may also be a way to reach alpha brain wave rhythms.

Water may be a symbol of mother, of comfort, regression to childlike needs and behaviour. Whatever way we want to talk about the effect of water during labour, one thing is sure.

The contractions become more efficient and less painful at the same time, so that sometimes the labour is very quick. Many women do not want to leave the pool because it is so comfortable. As a result sometimes the baby comes while the mother is in the pool.’

The benefits of water immersion, or hydrotherapy, in labour have been studied and assessed by many experienced midwives, researchers and doctors all over the world.

It is clear from common findings that including a pool of warm water in the birthing room adds a whole new dimension to the experience of childbirth. A recent study of 1,300 water births found that the use of a birth pool is rated very highly by women, whether having their first or subsequent baby and their enthusiasm is shared by midwives.

This echoes the findings of thousands of women and their midwives all over the world. There are some women who have had several water labours or births and have had such satisfactory experiences that they cannot imagine giving birth in any other way.

But just as every labour is unique, no two women will use a birthing pool in quite the same way. Moreover, a minority of women who try the pool do not find it helpful.

Many women however, are very keen to get into the pool at the earliest possible moment (although we will see later that it is not wise to get in too early) and some are so comfortable that they want to stay in the water for the whole of the remaining labour and birth.

Others find the pool helpful for pain relief during labour, but feel the need to be on dry land for the birth itself. A further group may labour and give birth on land but use the pool for relaxation after the birth.

In a long slow labour, episodes in the pool can be useful for resting. The message is that water can be of benefit in a variety of ways.

“My labour was very short and intense. Near the end I wanted to get my head down to slow the pain down When I went into the pool I found that I couldn't get my head down lower than my hips as I had been doing out of the water, so I felt the contractions more strongly than ever. I got out because I missed the presence of my husband to cling to and overall felt very isolated in the pool.”


Privacy and non-intervention

One of the benefits of labouring in a pool is the sense of privacy that most women who use it experience. Enclosed in her private space, protected by the gentle barrier of the water, a woman can feel secure from unwanted contact and more in control of her body. She is free to turn her attention inwards and focus on the rhythms of her labour and what she needs to do to ride the powerful sensation of the contractions.

Although it is essential that regular fetal monitoring is carried out periodically while the mother remains in the pool, in practice there are fewer internal examinations and other procedures than in most labours on land.

And, significantly, this ‘hands-off’ approach seems to have no adverse effect on mother or baby as was noted in a study of 2,000 women in a hospital in Switzerland where water birth is offered as an option to every woman.

“I was glad not to need any stronger pain relief (I had an epidural for the birth of my first baby) and to give birth naturally feeling in total control in the pool and in my own home. I liked the fact that being in the pool meant that the midwives keep a hands-off approach and leave it up to you with no internal examinations and no breaking of the waters. It was so different from my first experience.”

Midwives who attend water births often have to develop different ways of assessing progress in labour. Instead of routine vaginal examinations to check dilation, the midwife relies on more subtle indicators, such as the woman’s breathing, vocalisations and movements.

In fact, many midwives feel that attending labours and births in water has added an extra dimension to their midwifery skills, including an extra sensitivity to changes in the mother without the need for manual confirmation.


Pain relief through water

“The pool helped the labour to progress rapidly… I was very eager to get in the water and found it a huge relief when I entered… the pool was very useful in coping with the pain, helping to focus me so I could concentrate on making the pain useful and positive.”

One of the main reasons that women choose to use water during their labour is for the relief of pain. There is no doubt among midwives experienced in its use, that immersion in water can provide dramatic relief of discomfort for a high proportion of women.

Various studies have confirmed this finding. For example a clinical audit of water births carried out in five birthing units in England, ‘supported the proposition that water birth is effective as a method of pain relief.’

In hospital birthing units that have a long-standing commitment to the provision of pool facilities and support from birth attendants who feel at ease with using water in this way, there has been a dramatic reduction in the use of analgesic drugs such as pethidine (meperidine in the US).

The study cited above found that only 3 per cent of women who used water in labour used pethidine as well, compared to 60 per cent of women who laboured on land. A reduction in the use of such narcotic drugs is welcomed by all concerned, as its is now widely recognised that they can have a depressive effect on both mother and baby’s central nervous system, especially in repeated or large doses

A systematic review of three randomised control trials exploring immersion in water in labour only (not birth) found that there was a significant decrease in the use of medical pain relief in the women who used a birth pool in labour – indicating that for some women the use of a birth pool provides an effective alternative route to epidural anaesthesia.

Epidurals have become very sophisticated and generally provide effective relief from pain and can be used very positively in some circumstances. You need to be aware that using a birth pool will not eradicate the pain in the same way as an epidural – but works indirectly by helping significantly through the benefits listed below, to make it easier for you to tolerate and manage the pain yourself.


Summary of benefits of labouring or giving birth in water

Increases privacy
Provides significant pain relief
Reduces the need for drugs and interventions
Encourages a woman’s sense of control in labour
Facilitates mobility and enables the woman to adopt optimal positions for an active birth
Speeds up labour
Promotes relaxation and conserves energy
Helps to reduce tears
Is rated highly by mothers and midwives
Encourages an easier birth for the mother and a gentler welcome for the baby

Midwives: Starting a Trend & Saving the Birth Industry

06.22.12 My wish list to revolutionize the way we have babies here in the US, making it safer, more affordable and more available to all women

A recent article in the New York Times claims midwives have become increasingly popular healthcare providers because they’re a status symbol.  Apparently, upper middle class women are no longer too posh to push.  Instead, they’re posh enough to take over the childbirth market with demands for personalized, family centered and wellness oriented prenatal, labor and delivery care.  Hallelujah!  If midwifery care has become the hottest trend, I say there’s hope for the American birth industry yet.

Here’s a newsflash though.  Americans aren’t out in front on this trend.  Midwives rule the market in lots of countries including those where maternal health outcomes are the best in the world (and way ahead of the US), like Norway, Holland,  Ireland and Australia.  In other parts of the world where obstetricians are scarce (including developing countries like rural Africa, India and South America) and there are very few midwives, it’s the midwives who are saving women’s lives.

Not just certified nurse midwives either, but also certified practical midwives and trained birth attendants (AKA lay midwives).  They’re providing prenatal care and family health care, delivering babies and following up with postpartum and family planning care.  In countries like Uganda, for instance, there are obstetricians, but not very many and most women can’t get to where they practice and they don’t provide most of the routine, normal, healthy-mother services.  They focus on emergencies and complications.  Midwives are more readily available, though there aren’t enough by any means.

The Times article quotes Christy Turlington Burns, model, film maker, CARE advocate, entrepreneur and founder of Every Mother Counts, (a non-profit advocacy and awareness organization working to improve global maternal health conditions). Turlington Burns says, “I knew I wanted a natural childbirth.  When I met my midwife, her whole approach felt closer to home.”

That’s what a lot of women are looking for, partly in response to the backlash created by ever-increasing C-section rates and not-so-hot American maternal health statistics.  They aren’t necessarily looking for home births (and neither was Turlington Burns. She delivered in a birth center located within a hospital), however, or even all-natural births. Instead, they’re looking for alternatives to the cookie-cutter, baby factory, high-intervention model of care that’s been prevalent for much of the last couple decades.

Rather than being viewed through the lens that many obstetricians use that evaluates women as potentially risky,midwives tend to see women as probably normal.  Pregnancy and birth aren’t usually rife with complications.  Most of the time, for most women they’re, well, normal. That’s what midwives do.  They take care of normal women.  Can you use a midwife if you want an epidural?  Sure.  Certified Nurse Midwives that work in hospitals have easy-access to epidurals and if you need one, you can get one and still continue as a midwife patient.

In many parts of the world (including areas with the very best maternal outcomes) labor and delivery units are staffed with certified professional Midwife (CPMs), not certified nurse midwives (CNMs).  Here in the US, there’s a strong preference and bias towards CNMs.

What’s the difference?  Certified professional midwives go through an intensive training program usually via a university program and take a test that certifies their education and skills meet all the same requirements as certified nurse midwives. The difference is, their course of study doesn’t include nursing school.  Instead, they become the specialists in out-of-hospital birth settings like birth centers and home births. In a few states here in the US, CPMs also do hospital births).

There are some advantages to having a nursing background as CNMs do, but it isn’t always a mandatory element when it comes to choosing an excellent midwife.  In fact, in many nurse midwifery programs, the nursing piece is covered by only a one-year boot camp nursing education that prepares them to function in a hospital setting. CNMs are generally considered the experts at providing hospital births though many also deliver in birth centers and at home.  The biggest advantage of having that CNM versus CPM title is that CNMs are generally more accepted and respected by obstetricians and hospital administrators and they can practice legally in all 50 states.

Last year, I fundraised for an organization called Shanti Uganda, which was opening a birth center staffed by midwives in a rural area of Uganda.  They’ve been providing high-quality care for over a year now and just celebrated the birth of their first twins last month.  In addition to providing patient care, they also provide ongoing education to Ugandan women and children and healthcare providers who want to work with pregnant women.  In fact, this fall they’re doing a ten-day intensive doula training workshop that’s open to anyone with a passion for pregnant women.  If you or someone you know wants in on this, click the link and go for it.  It could be the adventure of the lifetime and the beginning of a great career.

So back to that New York Times article - if what it takes to put normal childbirth in high demand is for it to become a status symbol, well then, so be it.  Here are a couple other items on my wish list that I think could revolutionize the way we have babies here in the US, making it safer, more affordable and more available to all women, not just status-seekers:

·      Open more birth centers focused on normal childbirth located in or near hospitals.

·      Respect that midwives are really, really good at what they do and that includes CPMs, CNMs and     even some non-certified midwives.  They deserve the support and respect of the OB community.

·      Provide more pain relief options to American women, including Nitrous oxide (AKA laughing gas which is available to women all over the world except here in the US), so we have more to choose from than just going all natural or going for an epidural.

·      Add a safety net for women and midwives who want to try home birth by making it easier, friendlier and less adversarial to transfer to a hospital if an emergency arises.

·      Make it easier for all women to get good quality prenatal care whether they live here in the US or somewhere else in the world.

 

Jeanne Faulkner, R.N., lives in Portland, Ore., with her husband and five children. Got a question for Jeanne? Email it to labornurse@fitpregnancy.com and it may be answered in a future blog post.

This Fit Pregnancy blog is intended for educational purposes only. It is not intended to replace medical advice from your physician. Before initiating any exercise program, diet or treatment provided by Fit Pregnancy, you should seek medical advice from your primary caregiver.

Yoga Mama

Kristy Nel and Claire Stephenson, both Prenatal Yoga teachers, have many years of experience in teaching Yoga and currently offer Prenatal Yoga classes at Genesis Clinic on Thursday evenings from 17h00 to 18h30.

They have this to say about the benefits of Yoga for pregnant women.

“Recommended by most doctors and midwives, prenatal yoga offers a multitude of benefits to both mother and baby throughout pregnancy, 

during birth and beyond: 

• Joint exercises - perfect for poor circulation, swelling/water retention and excellent to improve mobility. Also enhances squatting and other birthing positions.

• Gentle Stretching - maintains supple and toned muscles, stabilizes blood pressure levels and alleviates heartburn and lower back ache.

• Breathing - balances the autonomic nervous system which regulates the major systems of the body and controls hormonal secretions. Deep breathing increases the intake of oxygen to both mother and baby. 'Birthing breaths' aid in the preparation for a calm birthing.

• Yoga Nidra - during this relaxation technique and one gains the equivalent of 4 hours deep sleep. Yoga Nidra also promotes inner communication with your child and assists in releasing any impressions associated with the fear of birthing.

• In addition, by developing a deeper awareness of your body, a powerful connection between a mother and her child is established.”

Yoga Mama will be at the Genesis Clinic Open Day 

on the 1st of September.

www.prenatalyoga.co.za

Woman's Day

Have you ever wondered why we cel­eb­rate Woman's Day on the 9^th August in South Africa? It has noth­ing to do with hon­our­ing women just because we need another "Mother's Day", this day com­mem­or­ates the 9 August 1956 when women par­ti­cip­at­ing in a national march peti­tioned against pass laws ... (For any­one who does not know the his­tory — "pass laws" were legis­la­tion that required African per­sons to carry a doc­u­ment on them to ‘prove’ that they were allowed to enter a ‘white area’ dur­ing the Apartheid regime).

On this day in 1956, over 20 000 women of all races and ages from every corner of South Africa marched together towards the Union Buildings in Pretoria. These brave women were march­ing in protest against the pass laws that pro­posed even fur­ther restric­tions on the move­ments of women.

We celebrate these pioneers of feminism as women all over the world are still struggling for their right to equality and choices that they are restricted from making, in all aspects of their lives.

In the ‘birth world’, we have the feminist pioneers of birth – Ina May Gaskin, Gloria Lemay, Michel Odent, to name but a few. In the same sense, these birth pioneers advocate for pregnant and birthing women; in that they should not have restrictions imposed on them regarding their choice of labour and birth, obviously with the safety of the mother and child in mind.  Whilst we value the ways that obstetrical science has made birth safer for women with high-risk pregnancies, low-risk pregnancies and births show that the midwifery model of care is as safe as hospital birth with a gynaecologist, often with fewer interventions and post-birth complications.

From a feminist perspective, it’s all about taking the power back. Women are powerful and smart and amazing enough to make these choices for themselves. We can rely on the help and expertise of doctors, midwives, and doulas to walk with us through our journeys in birth — but it’s essential that we’re put at the forefront of the decision making process. The power of birth is systematically being taken away from us by a culture that believes that our bodies and minds are fundamentally flawed to the point where birth is no longer a natural process, but rather a medical one —and that absolutely makes birth a feminist issue. Our babies and we deserve so much better.

We believe that Genesis Clinic embraces this philosophy, in that a woman has the right to have the birth she chooses, with the expertise care of the midwife and back-up of the gynaecologist. 

Have a wonderful Woman’s Day!

Did you know that it is World Breastfeeding Week - 1-7 August ?

Genesis Clinic supports breastfeeding for various reasons:

Why Breastfeed?

IF I NURSE FOR A DAY...

Breastfeeding your baby for even a day is the best baby gift you can give. Breastfeeding is almost always the best choice for your baby. If it doesn't seem like the best choice for you right now, these guidelines may help.

IF YOU NURSE YOUR BABY FOR JUST A FEW DAYS

He/she will have received your colostrum, or early milk. By providing antibodies and the food his brand-new body expects, nursing gives your baby his first - and easiest - "immunization" and helps get his digestive system going smoothly. Breastfeeding is how your baby expects to start, and helps your own body recover from the birth. Why not use your time in the hospital to prepare your baby for life through the gift of nursing?

IF YOU NURSE YOUR BABY FOR FOUR TO SIX WEEKS

You will have eased him through the most critical part of his infancy. Newborns who are not breastfed are much more likely to get sick or be hospitalized, and have many more digestive problems than breastfed babies. After 4 to 6 weeks, you'll probably have worked through any early nursing concerns, too. Make a serious goal of nursing for a month, call La Leche League or a Lactation Consultant if you have any questions, and you'll be in a better position to decide whether continued breastfeeding is for you.

IF YOU NURSE YOUR BABY FOR 3 OR 4 MONTHS

Her digestive system will have matured a great deal, and she will be much better able to tolerate the foreign substances in commercial formulas. If there is a family history of allergies, though, you will greatly reduce her risk by waiting a few more months before adding anything at all to her diet of breastmilk. And giving nothing but your milk for the first four months gives strong protection against ear infections for a whole year.

IF YOU NURSE YOUR BABY FOR 6 MONTHS

She will be much less likely to suffer an allergic reaction to formula or other foods. At this point, her body is probably ready to tackle some other foods, whether or not you wean. Nursing for at least 6 months helps ensure better health throughout your baby's first year of life, and reduces your own risk of breast cancer. Nursing for 6 months or more may greatly reduce your little one's risk of ear infections and childhood cancers. And exclusive, frequent breastfeeding during the first 6 months, if your periods have not returned, provides 98% effective contraception.

IF YOU NURSE YOUR BABY FOR 9 MONTHS

You will have seen him through the fastest and most important brain and body development of his life on the food that was designed for him - your milk. You may even notice that he is more alert and more active than babies who did not have the benefit of their mother's milk. Weaning may be fairly easy at this age... but then, so is nursing! If you want to avoid weaning this early, be sure you've been available to nurse for comfort as well as just for food.

IF YOU NURSE YOUR BABY FOR A YEAR

You can avoid the expense and bother of formula. Her one-year-old body can probably handle most of the table foods your family enjoys. Many of the health benefits this year of nursing has given your child will last her whole life. She will have a stronger immune system, for instance, and will be much less likely to need orthodontia or speech therapy. The American Academy of Pediatrics recommends nursing for at least a year, to help ensure normal nutrition and health for your baby.

IF YOU NURSE YOUR BABY FOR 18 MONTHS

You will have continued to provide your baby's normal nutrition and protection against illness at a time when illness is common in other babies. Your baby is probably well started on table foods, too. He has had time to form a solid bond with you - a healthy starting point for his growing independence. And he is old enough that you and he can work together on the weaning process, at a pace that he can handle. A former U.S. Surgeon General said, "it is the lucky baby... that nurses to age two."

IF YOUR CHILD WEANS WHEN SHE IS READY

You can feel confident that you have met your baby's physical and emotional needs in a very normal, healthy way. In cultures where there is no pressure to wean, children tend to nurse for at least two years. The World Health Organization and UNICEF strongly encourage breastfeeding through toddlerhood: "Breastmilk is an important source of energy and protein, and helps to protect against disease during the child's second year of life."* Our biology seems geared to a weaning age of between 2 1/2 and 7 years**, and it just makes sense to build our children's bones from the milk that was designed to build them. Your milk provides antibodies and other protective substances as long as you continue nursing, and families of nursing toddlers often find that their medical bills are lower than their neighbors' for years to come. Mothers who have nursed longterm have a still lower risk of developing breast cancer. Children who were nursed longterm tend to be very secure, and are less likely to suck their thumbs or carry a blanket. Nursing can help ease both of you through the tears, tantrums, and tumbles that come with early childhood, and helps ensure that any illnesses are milder and easier to deal with. It's an all-purpose mothering tool you won't want to be without! Don't worry that your child will nurse forever. All children stop eventually, no matter what you do, and there are more nursing toddlers around than you might guess.

WHETHER YOU NURSE FOR A DAY OR FOR SEVERAL YEARS

The decision to nurse your child is one you need never regret. And whenever weaning takes place, remember that it is a big step for both of you. If you choose to wean before your child is ready, be sure to do it gradually, and with love.

*Facts for Life: A Communication Challenge, published by UNICEF, WHO, and UNESCO, 1989**K Dettwyler. A Time to Wean. Breastfeeding Abstracts vol 14 no 1 1994 ©1997 Diane Wiessinger, MS, IBCLC 136 Ellis Hollow Creek Road Ithaca, NY 14850