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Category Archives: Home Birth

Research Checklist Ideas for Pregnancy, Labor, Birth and the Postpartum Period

Looking for ideas on things to know about pregnancy, labor, birth and the postpartum period but don’t really know where to start? Here is a great research checklist to give you a starting point for the things you should research for your pregnancy, labor, birth and postpartum care. Just click on the link below:

Research Checklist

 

Research Checklist

Posted in After Birth, Home Birth, Hospital Birth, Labor, Pregnancy.

My reflections on reading Born in the USA by Mardsen Wagner

Reading Born in the USA by Mardsen Wagner was very overwhelming and I was surprised by most of his points including the fact that the American Congress of Obstetricians and Gynecologists (ACOG) is not regulated or given responsibility to set the standards it does, the fact that off-label and against-label drug use by doctors is tolerated, why the US does not have regulations or required standards on recording and investigating maternal mortality, and the fact that doctors are surprised and complain about the “litigation crisis” while continuing to put into practice the things that result in litigation.

I have heard of ACOG several times before reading Born in the USA. It has been mentioned in other books and articles I have read as well as brought up in conversations when talking about home birth and specifically water birth. I was under the impression that ACOG was a very important organization that had the responsibility of setting standards for care providers. Much to my surprise, thanks to this book, I know the truth about ACOG. While they are a very important group (to doctors) no government agency has given them the responsibility and right to see such standards and have care providers be reprimanded if they practice against these standards and statements. How did they get so much power? I know there are several care providers out there that don’t agree with the way ACOG does things but they fear speaking out because they do have so much power and fear it would have negative effects on their careers. We need more people like Wagner to speak out with confidence against ACOG in order to overcome this organization that claims to care about the health of our country.

The tolerance of off-label and against-label drug use by doctors such as using Cytotec to induce labor, absolutely blows my mind! How is this even legal? Wagner mentions several studies that have been done that suggest Cytotec is not safe to use for labor induction and it says right on the bottle that this drug should NOT be used on pregnant women. Doctors have been using this drug for years against label and there have been so many cases with negative outcomes, and yet they continue with this practice. We need to make this illegal! I work in real estate doing appraisals for bank loans and for realtors when a house goes up for sale. I was discussing with my boyfriend the other day how ridiculously regulated the real estate market is compared to our health care system, specifically our maternal health care system. There are so many rules, standards, and regulations on how to put together an appraisal on a house and to make sure your appraisal is not misleading and contains 100% accurate information, but yet our doctors and nurses have a very relaxed system and very little accountability.  It’s insane to me that more effort is put into making sure a house sale is legit and fair but yet obstetricians don’t have to or are not being reprimanded for not ensuring women are making informed choices about their health and are giving them drugs without their knowledge that are known to be dangerous and cause adverse effects.

The frustration about the use of Cytotec and the fact that doctors are giving women drugs without informed consent, including Pitocin among others, brings me to my awe that doctors are surprised with this “litigation crisis” and the raises in cost for malpractice insurance. Litigation isn’t just from the use of drugs but from all of the interventions that women feel they have no control over whether it be the doctors and nursing staff don’t tell the woman what they are doing or they impose an intervention on them against their will or without true informed consent. To this day, these care providers are still allowing and suing these practices. They blame their patients for having such high malpractice insurance and need to use some intervention to avoid litigation but it’s those very interventions that the care providers are getting sued for using. If care providers took the time to create a trusting relationship with their patients (clients) and truly gave them informed consent, their patients would not be taking them to court, or at least much less often. They need to allow for better communication and explain all of the benefits and risks of every option, and when there is a negative outcome, they need to be accountable to it and keep open communication with the families about what the possible cause was instead of making it so hard for them to figure out what happened.

When a poor outcome does arise and a mother dies, which sometimes you just can’t avoid, what are the chances that it would accurately reported or recorded at all? According to Ina May Gaskin, the CDC has admitted that maternal deaths are severely underreported. I do not understand why making sure maternal deaths are investigate and accurately reported is not a priority. We have one of the worst maternal mortality rates in the industrialized world and there seems to be no real effort in changing that, at least not from the medical model of care standpoint. They just keep focusing on how the latest technology should prevent negative outcomes but continue to be blind to the fact that using those technologies and continuing to intervene in one of the most natural processes of life, is actually what is causing those outcomes and insane mortality rates. We know that these rates can be much better by just looking at other countries and researching their systems. It makes me so sad that women and families are not respected enough to be worthy of investigation if they die during the childbearing cycle but yet the justice system can spend weeks, months, or even years on other death related events such as murders or even accidental deaths while on the job. Without these deserving investigations on maternal mortality, that should be a no brainer, the maternal health care system will be extremely difficult to improve because we won’t have the data to show where exactly needs improving and how we can make change. Putting in place regulations on reporting and investigation maternal death should be at the top of our health care system’s priority list.

It is ever so clear the need for change in our maternal health care system. Midwives are definitely a necessity in bring about the right change but without concern and dedication from other care providers such as OB/GYNs, the change will be very difficult. We won’t give up though. The need for midwives is growing and the number of midwives is growing. The health care system will be forced to work with us and they will eventually come to realize the need for change. Midwives can and do change the world!

Posted in General, Home Birth, Hospital Birth.

Safety of Home Birth and Midwives Model of Care

Home birth, is it safe? This is the million dollar question. The topic of home birth has been quite popular in the recent years and more specifically about whether home birth is safe for mothers and their babies. Less than 1% of mothers are choosing to deliver at home in the United States (Cheyney et al., 2014). It wasn’t too long ago that the majority of births took place at home, until the 1940s when it fell to 44%. (MacDorman, Mathews & Declercq, 2012). Birth became medicalized and it was the norm to give birth in a hospital. Between 2004 and 2009, however, the rate of home birth increased by 29% (MacDorman et al., 2012), and is most likely still on the rise. This significant increase has created more attention to the safety issue of midwifery care and home birth. The Midwives Model of Care, trademarked by Citizens for Midwifery, provides a great backbone when discussing how and why home birth is safe when attended by a qualified midwife because it is based on the certitude that pregnancy and birth is one of the most natural processes of life.

Midwives believe it is very important to monitor women’s physical, psychological, and social well-being during the childbearing cycle, and are very thorough in doing so. This is the first tenet of the Midwives Model of Care. Midwives pay close attention to a woman as a whole and know that several factors contribute to their overall health and wellness. During prenatal care as well as postpartum care, midwives spend anywhere from a half hour to an hour and a half discussing things that contribute to the health of their clients, from diet and exercise, to mental contributors such as stress and fears, and so much more. These long visits allow midwives to really know the health of their clients and discuss their options for better health if needed. Because their prenatal care is so thorough, this allows midwives to constantly be screening to make sure their clients are low-risk and good candidates for home birth, and they respond appropriately when things may fall out of normal range. Not only do they monitor the well-being of mother and baby during the prenatal period, they continue to monitor during labor, birth and the postpartum period. According to the North American Registry of Midwives (NARM) Certified Professional Midwives (CPMs) must be certified in CPR and neonatal resuscitation, have extensive training in natural pregnancy and birth, are educated on monitoring and decision making using Evidence-Based practices and insuring informed consent from their clients, and must take continuing education credits to recertify every 3 years (NARM, 2014). CPMs are qualified to insure that women are safe to deliver at home.

The second tenet of the Midwives Model of Care describes how midwives provide individualized care to every woman. This is so important in discussing the safety of home birth. Every woman is different and what one woman may need to have a safe delivery at home may not necessarily by something another woman needs. CPMs providing care determine baseline and normal health ranges for each client and when things fall out of normal range for that specific client, options are discussed between midwife and client and the client decides what option is best suited for their safety and their needs. “The focus stays on the birthing woman, it is her unique needs and rhythms that will be paramount in the unfolding of her birth” (Davis-Floyd, 2001, p. 14). Home birth midwives also provide continuous support throughout labor and delivery. Studies show that continuous support during childbirth result in better outcomes for mother with less medical interventions and more satisfaction for her birth experience (Hodnett, Gates, Hofmeyr, Sakala & Weston, 2013). Another very important aspect of home birth with qualified midwives is the quality of postpartum care and support. Evidence suggests that during the postpartum period, several stressors can arise that increase the risk of physical and mental illness (Fahey & Shenassa, 2013). Because of this increased risk during the postpartum period, midwives find it very important to provide extensive support and include in their services several visits between birth and at least 6 weeks postpartum to avoid and catch any issues that may arise. The support provided by midwives during the postpartum period contributes to women’s psychological well-being (Lavender & Walkinshaw, 1998).

Minimalizing medical and technological interventions is the third tenet of the Midwives Model of Care and is a main factor in insuring the safety of home birth when attended by a qualified midwife. Obstetric interventions have the potential to increase adverse effects, so low intervention rates are very important implications of good, quality care (A de Jonge et al., 2009). According to a study done by Kenneth Johnson and Betty-Anne Daviss on all home births in 2000 with Certified Professional Midwives in the United States and Canada, intended home births resulted in lower rates of intervention including electronic fetal monitoring, cesarean section, episiotomy, and vacuum extraction, when compared to low risk hospital births (2005). In a study done by Cheyney et al. on 16,924 planned home births in the United States between 2004 and 2009, the majority of women and newborns experienced very low rates of intervention with exemplary outcomes (2014). There were very low rates of oxytocin augmentation, epidural analgesia, operative vaginal birth, and cesarean section when compared to hospital births (Cheyney et al., 2014). The risks of all maternal adverse outcomes including perineal tears, postpartum hemorrhage, and infection were significantly lower in women who planned to have a home birth attended by a registered midwife in Canada compared to a physician attended hospital birth (Janssen et al., 2009). Not only is home birth safe for mothers, but it also supports favorable outcomes for newborns as well. Newborns of planned home birth resulted in low or similar risk of fetal and neonatal morbidity compared with hospital births (Janssen et al., 2009).

When a situation does fall outside of normal range for a specific client, qualified midwives are trained to recognize this and will refer women who require obstetrical intervention when needed, whether it be during prenatal care, labor, birth, or the postpartum period. This is the fourth tenet of the Midwives Model of Care. The availability of the hospital and its technologies is very important when it is needed, but most of the time, birth is a normal physiological process that works perfectly on its own. When a situation presents itself with red flags that something is just not right, midwives will discuss the options with their clients and they will choose what they want to do based on all of the information needed to make an informed decision. Sometimes going to the hospital is necessary, and because midwives are trained and experienced in the normalcy of birth, they know when that time comes. Of 16,924 women who planned a home birth, only 10.9% transferred to the hospital intrapartum with the most common reason being failure to progress (Cheyney et al., 2014). Only 1.7% of women who gave birth at home transferred postpartum and the most common reason were related to hemorrhage and/or retained placenta and laceration repair (Cheyney et al., 2014). Only 149 of the 15,134 newborns born at home transferred to the hospital most commonly for respiratory distress and/or low APGAR scores and congenital anomalies (Cheyney et al., 2014). CPMs are trained to deal with all of these outcomes and they carry with them to every birth the necessary equipment to do so, making home birth safe for women and babies even when adverse outcomes may arise. In the study by Johnson and Daviss done on all women who intended to have home births with Certified Profession Midwives in the United States and Canada, only 3.4% of the home births were considered urgent transfers by the midwife (2005).

In a sample of 160 women who completed an online survey about their home birth, the most common response for why they wanted a home birth was because they felt it was the safest place for them to give birth (Boucher, Bennett, McFarlin & Freeze, 2009). Several studies are out there that suggest the safety of home birth. Home birth with a qualified midwife can be very beneficial for women and babies because of the expertise and the quality of care that midwives provide. Home birth is becoming more popular because women are getting more educated about birth and evidence-based practices. Ultimately, the choice is up to the women where they want to give birth and whom they want their care provider to be. Home birth with a midwife is definitely a safe option.

 

 

References

Boucher, D., Bennett, C., McFarlin, B., & Freeze, R. (2009). Staying Home to Give Birth: Why Women in the United States Choose Home Birth. The Journal of Midwifery & Women’s Health, 54(2), 119–126. doi:10.1016/j.jmwh.2008.09.006

Cheyney, M., Bovbjerg, M., Everson, C., Gordon, W., Hannibal, D., & Vedam, S. (2014). Outcomes of Care for 16,924 Planned Home Births in the United States: The Midwives Alliance of North America Statistics Project, 2004 to 2009. Journal of Midwifery & Women’s Health, 59(1), 17–27. doi:10.1111/jmwh.12172

Davis-Floyd, R. (2001). The Technocratic, Humanistic, and Holistic Paradigms of Childbirth. International Journal of Gynecology and Obstetrics, 75(1), S5–S23.

De Jonge, A., van der Goes, B. Y., Ravelli, A. C. J., Amelink-Verburg, M. P., Mol, B. W., Nijhuis, J. G., … Buitendijk, S. E. (2009). Perinatal mortality and morbidity in a nationwide cohort of 529 688 low-risk planned home and hospital births. BJOG: An International Journal of Obstetrics & Gynaecology, 116(9), 1177–1184. doi:10.1111/j.1471-0528.2009.02175.x

Ed, H., Gates, S., Gj, H., & Sakala, C. (2013). Continuous support for women during childbirth (Review). The Cochrane Library, (7).

Fahey, J. O., & Shenassa, E. (2013). Understanding and Meeting the Needs of Women in the Postpartum Period: The Perinatal Maternal Health Promotion Model. Journal of Midwifery & Women’s Health, 58(6), 613–621. doi:10.1111/jmwh.12139

Janssen, P. a, Saxell, L., Page, L. a, Klein, M. C., Liston, R. M., & Lee, S. K. (2009). Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician. CMAJ : Canadian Medical Association Journal = Journal de l’Association Medicale Canadienne, 181(6-7), 377–83. doi:10.1503/cmaj.081869

Johnson, K. C., & Daviss, B. (2005). Outcomes of planned home births with certified professional midwives: large prospective study in North America. BMJ (Clinical Research Ed.), 330(7505), 1416. doi:10.1136/bmj.330.7505.1416

Lavender, T., Walkinshaw, S. A., (1998). Can Midwives Reduce Postpartum Psychological Morbidity? A Randomized Trial. Birth, 25(4), 215–219. doi:10.1046/j.1523-536X.1998.00215.x

 

MacDorman, M. F., Mathews, T. J., Declercq, E. Home Birth in the United States, 1990-2009. NCHS Data Brief, 84. Hyattsville, MD: National Center for Health Statistics. 2012.

North American Registry of Midwives. (2014).

Posted in Home Birth.

What is a Doula?

doula baby

 

 

Definition: a woman who is trained to assist another woman during childbirth and who may provide support to the family after the baby is born.

The word “doula” comes from the Greek meaning “a woman who serves”.

Studies show that in doula attended births:

*Labors are shorter

*Babies are healthier

*There are fewer complications

*Breastfeeding is more successful

*Spontaneous vaginal birth is more likely

*Less likely to need or ask for pain medications

*Less likely to have a Cesarean Section, vacuum or forceps-assisted birth

 

There are 2 different types of Doulas: Birth Doula and Postpartum Doula

Birth Doulas – Offer education and assist women in planning and carrying out their birth plans and expectations. They stay with the women throughout labor and offer emotional support, help with physical discomforts, creats an open line of communications between the women, her partner, and her care provider.

Postpartum Doulas – Offer education and support on things related to after birth such as breastfeeding, physical and emotional recovery, newborn care, bonding, light housekeeping and meal preparation. Research shows that families transition much easier with a good support team including a doula.

 

DOULA DO’S AND DONT’S

Do’s:

*Prepare and educate women and families for birth

*Help create a birth plan that includes expectations, wants and needs, and things you are uncomfortable with

*They help create a safe space allowing comfort, open communications between families and care providers, and emotional support

*They are advocates for mothers and partners during labor and childbirth

 

Dont’s:

*They are NOT medical professionals and therefore do NOT offer or perform any medical services such as exams, fetal heart monitoring, medical diagnosis, deliver babies, etc.

*They do NOT judge you or decisions you make

 

How much does a Doula cost?

Fees can be anywhere from $400-$1000 depending on the individual doula and the services she provides.

 

 

RESOURCES

http://www.dona.org/mothers/

http://americanpregnancy.org/planningandpreparing/postpartumdoula.html

http://www.mindbodygreen.com/0-11595/what-is-a-doula-and-why-you-should-have-one-during-after-birth.html

http://ssbdoula.weebly.com/birth-services.html

http://evidencebasedbirth.com/the-evidence-for-doulas/

 

 

Posted in After Birth, Home Birth, Hospital Birth, Labor, VBAC, Water Birth. Tagged with , , , , , , , , , , .

When to Call Your Midwife When You Think “Its Time”

When to call your midwife is definitely an important question to have answered before your labor starts.

Midwife Monitoring Baby

I’m going to give you a few pointers based on what I have learned so far as a Student Midwife, but ALWAYS ask your Midwife any questions that you have, that is why you hired them.

 

Despite what the movies show, labor rarely just starts by your water breaking. You usually, not always but usually, start having very small contractions that get more intense over a couple days time. If you can walk through, talk through, and sleep through your contractions, you definitely have time and can hold off on calling your Midwife. Most Midwives tell you that if you can sleep through your contractions DO IT, because you are going to work harder than you have ever had to work before. If possible, don’t tell anyone when you think you are starting to have contractions because people tend to create too much excitement which may lead to causing things to slow down and maybe stop completely. The best atmosphere to be in during any stage of labor is a calm, peaceful, and stress free environment. I would say, make the first call to your Midwife when your contractions are strong, lasting about 1 minute, and are about 5 minutes apart, for more than an hour. At this point you most likely have a lot of time before your Midwife needs to show up but, its nice to give a heads up so they can plan their day accordingly. Your Midwife will want to listen to you over the phone going through a contraction, they can usually tell how intense they are by the way you cope with the contraction and will be able to decide whether or not you will need them soon.

If your water breaks, you most DEFINITELY need to call your Midwife! They will want to know about how much fluid there was, the color and smell of the fluid, and whether or not you can still feel the movement of your baby. What a lot of women don’t know is that it is very easy to mistake your water breaking for a little gush of urine. Your baby is sitting right on your bladder so any little movement from them at this point can squeeze out a little urine, no problem. The easiest way to check if it is urine or if it was a rupture of your membranes: Lay down for several minutes, if you get up and there is no gush of fluid it was most likely just a little urine leak, if there is another gush of fluid its very likely your membranes have ruptured and you need to call your Midwife.

*Again unlike the scenes they show on the movies and TV, rupture of membranes does NOT mean that you are in active labor. You could still have hours to go after your water breaks, so your Midwife does not necessarily need to come right away. If everything is going well, you feel good, you can still feel baby moving, your Midwife says everything is good and normal based on the information you give, then you can just relax as much as possible and rest up for when things get much more intense.

Call your Midwife again when you are almost to the point where you cannot talk through your contractions and they feel almost unbearable. That’s a good sign things are progressing. Again, your Midwife will be able to make a good decision on the next steps to take based on how you sound over the phone.

 

You should ALWAYS call if any of these occur:

*You have a fever

*The familiar movement of your baby has changed

*You have any vaginal bleeding

*A contraction comes but does not go away

*You have back pain

*You experience very soft bowel movements or diarrhea

*You feel or see anything coming out of your vagina

 

Always keep in mind, you were made to give birth! Trust your body and listen to it!

 

Disclaimer: The opinions expressed on my blog are based on my own thoughts, knowledge, and experiences. Please keep in mind that I am not a Doctor, Midwife, or other health professional so please consult the appropriate professional before making any changes to your health or other applicable areas. You should always do what is right for your body.

 

Posted in Home Birth, Labor.

Wise Words on Home Birth vs Hospital Birth from an OB/GYN Herself!

Here is a great article from OB/GYN Aviva Romm, who was once a Midwife and incorporates the midwifery model of care into her practice today. She makes some very interesting points and explains why she chose to have her four children at home and why she would still choose home births today. I have posted a few quotes from her article but please, go read the whole article! 

 http://avivaromm.com/choosing-home-birth

 

 

There are very real health reasons for women to consider birthing at home.  These include mom’s safety, baby’s safety, and the economic sustainability of our health care system.”

“Now, having been through obstetrics training I can honestly say that I’d feel even more concerned about having my baby in the hospital – unless absolutely medically necessary.”

“There are not only immediate risks to the mother; we know that babies born by cesarean section miss out on the benefits of exposure to the vaginal flora that they’d otherwise come in contact with if born vaginally – and this lack of exposure can predispose a baby to disrupted gut flora and significant consequent health problems. Additionally, babies born by cesarean get a dose of antibiotics before birth via mom’s system, adding to the double hit on gut flora!”

“Obstetric Evidence Is Reliable Only 30% of the Time”

I wasn’t brave at all – I was simply terrified of having my babies in the hospital!”

“I was just having a baby, not an emergency appendectomy! I didn’t want all of these potentially dangerous interventions for something that was almost always natural and safe. It sort of reminds me of those commercials for a medication for something benign like a foot fungus. You know, you’ve got a little athlete’s foot so treat it with something that can cause “heart problems, coma, and death.” It’s just overkill for something that’s usually just not that big a deal in a healthy person.”

“As a midwife I’d observed the loss of autonomy that too often occurred when a woman set foot in the hospital – the transformation that occurred with the ritual of shedding her “real person” clothes in favor of the hospital johnnie, and with it the shift of going from being an independent, capable woman into “a patient” – which culturally equates with being dependent, helpless, and sick – qualities that are a far cry from feeling empowered and strong”

Posted in Home Birth, Hospital Birth. Tagged with , , , , , , , , , , .

The Midwives Alliance of North America Statistics Project , 2004 to 2009 Results on Care of Planned Home Births

From the abstract of the Outcomes of Care for 16,924 Planned Home Births in the United States: The Midwives Alliance of North America Statistics Project, 2004 to 2009 article:

“Among 16,924 women who planned home births at the onset of labor, 89.1% gave birth at home. The majority of intrapartum transfers were for failure to progress, and only 4.5% of the total sample required oxytocin augmentation and/or epidural analgesia. The rates of spontaneous vaginal birth, assisted vaginal birth, and cesarean were 93.6%, 1.2%, and 5.2%, respectively. Of the 1054 women who attempted a vaginal birth after cesarean, 87% were successful. Low Apgar scores (< 7) occurred in 1.5% of newborns. Postpartum maternal (1.5%) and neonatal (0.9%) transfers were infrequent. The majority (86%) of newborns were exclusively breastfeeding at 6 weeks of age. Excluding lethal anomalies, the intrapartum, early neonatal, and late neonatal mortality rates were 1.30, 0.41, and 0.35 per 1000, respectively.”

Here is a link to the full article.

Here is a link to the Development and Validation of a National Data Registry for Midwife-Led Births: The Midwives Alliance of North America Statistics Project 2.0 Dataset article

 

Posted in Home Birth. Tagged with , , , , , , , , , , , , , .