The Nuances of Dilation....

On my local mommy message board, there is much talk about dilation and effacement. Around here, doctors start checking you at 36 weeks. Why? Who knows. The information is not beneficial to anyone from what I can see. It seems to only serve to make the mom anxious.

There are women who actually believe that they have "undilated"....meaning they were told they were a certain number of cm's, and then at the next visit told they were less. So just for my own peace of mind, I explain the art of checking dilation from my perspective.

When I first began checking dilation, one of my mentor midwives showed me how to get a good feel for the cervix, then withdraw your fingers and actually check on a tape measure to see how many centimeters it was. Now this is still tricky as you must visualize in your head how far apart your fingers are since you can't see them. And you can't withdraw your two fingers and keep them apart as that would be uncomfortable for the mother. So you can get my drift here that this is NOT an exact science.

Now, when a cervix is almost closed, or one fingertip....that is usually 1cm. But as you get into 2-7cm....it is very tricky. And everyone is a little different. Sometimes a practitioner will stretch the cervix a bit and be generous with their cm's, whereas my midwife wants to know the dilation without any stretching. So if you are checked by two people, one who interprets with a stretch and one who doesn't, you may get two very different results. Also, since perception plays such a big role, this can cause discrepancy between two different cervical exams. My vision in my head of how far apart my fingers are may be innacurate by a cm or so. This is why I always call a cervix about 1cm less that what I think it really is. I would rather underestimat than over...then have a devastated mom if someone else checks and she has appeared to "go backwards."

There is usually no question at 8, 9, and 10cm as these are not hard to assess. But no one ever thinks to ask their nurse how long they have been checking cervixes. You may have the newest nurse on the L&D floor and she may not have really gotten adept at cervical checks yet. She has to feel as insecure as I did those first few times. And out of those first few times, I was off a bit according to my midwife.

It is an art....not a science. And just when I think I have mastered it after a year of working in the birth biz, I will check a cervix that makes me go, "huh?" becuase it is so puzzling.

So the fact is, if your doctor or nurse says you're 8, 9 or 10cm..do the happy dance and get ready to push out a baby. If its somewhere between 2 and 7...take it with a grain of salt, keep breathing and know that the baby will come. And those routine checks at the dr's office.....a simple no thank you will keep you from letting those numbers transform in your brain to crazy thoughts such as, "This baby is never going to come!" or "I'm 3cm, I will go into labor tonight!" only to go another week.

Will informed consent become extinct???

Recently I attended a birth where the doctor told my client that studies have proven that women and babies have better outcomes when we "manage" labor. He cited "the Ireland Study" which at the time I had never heard of. There was a good reason for that. It was done before I was born. I am 38. That's been a while. I can't think of many studies that were done that many years ago that still hold water today.

Here is what we do know. Our cesarean rate as a nation is at an all time high - curently 31.8% as of 2007. This was a 48% rise from 1996. In 1970, the national cesarean rate was 6%. See date from fellow blogger:


With stats like that, how dare a doctor reference an outdated study to try to convince my client that she needs pitocin so that she will have her baby faster. Those statistics are a frightening look at what managing labor can do.

Most women never question what their doctor suggests. Many women go their entire lives thinking that they would have never gone into labor if they hadn't been induced because they were induced with all of their children at 41 weeks. One thing that statistically we do know....no one stays pregnant forever. Many women believe that it's a good thing that they had that cesarean for failure to progress because when the baby was born, he/she had a cord wrapped around their neck (maybe even twice). Cords are gently unwrapped from around baby's necks(during homebirths)the majority of the time, I would say. It is not an uncommon occurence.

Women are believing a lie that they are powerless in their birth process. They are being taught by providers that listening to their instincts is reckless and instead, they should completely trust the information from their doctor. Little do they know that it is the insurance companies that have more control over a doctors decisions and protocols. Dr's are threatened on a daily basis with unseen increase in their malpractice insurance if they don't follow the game plan. As long as no harm is done right?? Well, no visible harm. Sometimes, the harm of a interventive labor is to the woman's psychological well being. But hey, most lawsuits for that aren't successful, so it's as good of a risk as any. The doctor's malpractice insurance remains affordable.....and women everwhere don't understand why they feel they lost control of their whole experience? Informing and empowering????? I think not.

Enlightenment continues......

My current reading for my midwifery study unit is Easing Labor Pain by Adrienne Leiberman. I must say, the first few chapters were dry as a bone. Granted, I do have an older edition and some of the information is dated, but still dry nonetheless. However, as you get past the 4th or 5th chapter, I found the book to be very informative. Here are some excerpts I found important:

In Chapter 6, titled "You are what you eat", I found wonderful nutritional advice. For instance, Adelle Davis, a respected nutritionist, recommends calcium supplementation at the beginning of labor. The premise is that calcium eases muscle cramps....thereby making uterine contractions less painful, but not less effective. This is not studied and documented, but I find it to be logical. And besides, what can it hurt to take a little extra calcium when your contractions get going. So have a tall glass of whole milk and take a nice cal-mag supplement at the get go and see what happens!

In chapter 17, "Hospital Routines: Is the pain worth the gain?", Lieberman writes,
"Each form of intervention carries with it certain risks, which are worth accepting in high risk situations where the benefits may outweigh the drawbacks. However, in low-risk situations, advantages of intervention frequently do not exist. Then these interventions only add risk and discomfort wihtout providing any compensatory benefits."

I wish I could help every woman embrace this concept. All of the things that you are subjected to at the hospital - for the good of you and your baby - have not been proven to make your outcome better. Unless your risk level during pregnancy warrants constant monitoring, routine IV fluids or other things, they really aren't necessary. And my next point explains why this is.

Quote from the same chapter: "By 1985, indeed two thirds of this country's obstetricians had been sued for malpractice at least once. This medicolegal climate makes an obstetrician much more likely to intervene in the birth process. As one obstetrician said, 'I've never heard of a doctor being sued for doing a cesarean, but lots of doctors have been sued for not doing one.'"

This is the crux of the matter. Many of the things that women believe are just part of a safe and healthy pregnancy are simply tools to put on paper to thwart a lawsuit. We don't want to believe that. Birth is beautiful....babies are cute....doctors who deliver them are pro woman and baby, right? Doctors must practice defensively in a country that allows them to be put out of a career over one lawsuit. How do they know that you aren't the one who will end their career? It's better to strap you with the fetal monitor and make you uncomfortable enough to scream for the epidural rather than not have it on and take that 2% chance that something will happen to your baby unknowingly.

Women must educate themselves on the true facts and figures regarding all of these interventions. Know what really makes you safe. The safest thing for you and your baby during labor(as long as you have no major medical complications) is to be up and walking around - moving. Do this at home. The longer you are at the hospital, the more likely you are to become uncomfortable enough to need the epidural. As soon as you get that first intervention and become immobile, then the baby runs the risk of struggling to adapt. If that happens, you will find yourself in the operating room.

Easing Labor Pain is worth the read for the mom who wants to be informed. THe book is not anti-hospital or anti-doctor. It is not going to tell you that you should just have a homebirth(but I might...LOL). It is very conservative, yet factual. There is also some wonderful information on methods of relaxation and labor coping strategies.

Want an empowering hopspital birth? Know your stuff. Find a provider you can trust. Hire a doula. Trust in your body. Keep moving. Push in a position that feels natural. Make your wishes clear. Make sure anyone present at your birth is completely onboard with your philosophies. Don't run through the doors after your first contraction. And finally.....remember that your body and your baby know the drill. Just relax and respond.

Morning Sickness.....a new perspective.

I got this from a fellow midwife in training. I cannot attest to its effectiveness, but from what I remember about morning sickness, anything is worth a try.

Morning Sickness

You can beat this. The cause and cure for morning sickness has been shrouded in mystery for a long time. But it is really not that difficult to understand, neither is it that difficult to conquer. Most medical texts say the cause is either hormonal or unknown. The standard answer of eating several small meals per day, or coating the gastrointestinal tract with crackers or fruit, is usually not effective. Even worse is the recommendation to take vitamin B6. This usually exacerbates the morning sickness, not abates it. Also, I think most of you understand this already, but I think I should mention it anyway: you do not have feel nauseous only in the morning to have morning sickness. The nauseous feeling can come at anytime of the day or night.

A powerful ally with a sidekick
When a woman becomes pregnant certain hormones are produced in large amounts. One of these hormones is the hCG hormone (Human chorionic gonadotropin) . This hormone is primarily responsible for maintaining the pregnancy. The measurement of this hormone is the most common diagnostic tool to confirm conception. Non-pregnant women will not have significant levels of hCG, in fact oftentimes it cannot be detected at all. The hCG hormone will keep a woman from spontaneously aborting (miscarrying) the newly conceived child. However, these high levels of hCG precipitate a response from the liver. The liver is stimulated to produce larger amounts of a digestive enzyme called bile. The hCG hormone is our powerful ally, working to maintain the pregnancy. The bile, whose release is stimulated by the hCG hormone, is the sidekick that causes the morning sickness. The encouraging news is that the more nauseous you feel, the less likely you will miscarry.

Why bile makes us feel nauseous
Bile is a digestive enzyme designed to break down the fatty acids that we eat. When we have no fatty acids in our duodenum (the first part of the small intestine and what most people commonly call the stomach), there is nothing to digest but YOU! This causes us to feel nauseous. We will feel queasiness in the center of our upper abdomen, right under the sternum (the small bony extension where the front rib cage joins together) and above the belly button (umbilical cord site). But eating fats is not the answer Oh ho! You must be thinking now that if you put fatty acids into your digestive tract that this will solve the problem. It seems to make sense that if the bile is meant to digest fatty acids, all we need to do is give the bile the fatty acids it wants to digest. Then the bile will not bother our intestinal lining making us feel nauseous. But, when we eat foods with fats in them, it actually causes a further release of bile. Now we have the original bile making us feel queasy PLUS a new onslaught of this same nauseous-causing substance. Then there is more to the bile story. Bile is also the carrier of expended hormones. Because the liver is responsible for filtering fat soluble substances from the bloodstream, hormones (which are fat soluble) are collected by the liver. The liver has the job of expelling from the body these expended hormones. The only exit out of the body that the liver has available to it is the bile. Bile will leave the liver, travel to the gall bladder, continue its journey to the duodenum, thread its way through the rest of the small intestine and then the large intestine. Finally it will be expelled out of the body through a bowel movement.

Well, that is the design of our Creator, but when we eat the way of the Western world, this plan can be thwarted. Before I explain that, I need to impress upon you this fact: the more hormones that are filtered out of the bloodstream by the liver, the more bile the liver will release for the purpose of disposing these hormones. When more bile is released, the probability of nausea increases drastically. How the Western diet affects bile In the West, we generally eat very high fat diets. The more fat we eat, the more we stimulate the liver to release bile in order to break down these fats. However, bile itself is a fat, and not all of the bile fats will exit the body. In fact, a large amount of the bile will be reabsorbed and recycled to the liver. The problem with the bile recycling is that these bile fats carry much debris. This debris has been filtered out of the bloodstream and put in the bile fat carriers to be escorted out of the body. But if the bile recycles, so does the debris that is carried in the bile fat. This means that there is more debris to be discarded in the next release of bile. The repeated recycling of the same bile creates a very nasty debris-laden bile that will make us feel even more nauseated. Bile’s good buddy I mentioned above how the Western high fat diet contributes to an elevated bile roduction. But even more significant is the lack of soluble fiber in the Western diet. If we Westerners would eat soluble fiber in ample amounts, we could eat all the fat we wanted and never suffer adverse effects.

Soluble fiber is found in legumes (there are other sources but they are so minimally endowed with soluble fiber that it is not worth mentioning them for the cure of morning sickness). Legumes are pinto beans, kidney beans, garbanzo beans (also known as chick peas), black-eyed peas, lentils, black beans, red beans, navy beans, white beans, great northern beans, crowder peas (also known as field peas), yellow-eyed beans, and the list goes on. They are also termed soup beans. Most Westerners will admit that it is not often that we eat beans, if ever. These beans are dense with soluble fiber. Soluble fiber and bile (or any fatty acid) have a great affinity toward one another. In fact, they will bind so tightly together that they cannot be parted. As no fiber (soluble or insoluble) can cross the intestinal barrier, all the bile that has been bound together with the soluble fiber will exit
the body through a bowel movement. That means the bile will not recycle. That means the bile will not grow nasty with accumulating debris. That means you will feel less nauseous.

Less nauseous? Could I feel no nausea?
Yes, it is possible for you to feel no nausea from the blessing of increased hCG levels. I say blessing because the increased hCG means that you will most likely have a full term pregnancy. Eliminating the nausea does not decrease the production of the hCG hormone, but it just negates the hCG side effect of nausea.

The answer
I think you already know. The answer is to eat legumes. Now you must know to what extent you must eat legumes. If you are feeling nauseous, you must immediately consume your beans. You will need to eat at least 1/4 cup of cooked legumes. If you can eat more, it is even better. You will see relief in under 20 minutes. The nausea will go away. However, the nausea will be back in a period of time. That period of time is dependent upon the liver’s stimulation to produce more bile. If the hCG hormone is at high levels, it won’ be long (1-4 hours) before you are feeling that queasy feeling again. Then what? You eat your beans again. And so you go. You eat beans every time you have that nauseous feeling. If that means you are spending the majority of your time at the table with a bowl of beans in front of you, so be it! It will only be for a short period of time. As the bile is carried out of your body, the successive releases of bile become less potent with debris. After the consumption of legumes, each release of bile is less nauseating. Eventually (within a few days) you will not have to hang your head over a pile of beans all day. In fact, you will be able to consume beans just once or twice in the day to prevent the morning sickness from reoccurring.

Are there any side effects to eating legumes?
None, except the possibility of flatulence (commonly known as gas). However, if the gas is not causing you physical discomfort, continue on the legumes. The gas eventually will go away as the digestive system begins to produce the enzymes necessary to break down the beans. If you have gas to the extent that it causes you pain (not social pain, but physical pain), decrease your intake of beans at one setting. Instead of eating the 1/4 cup plus, eat a few teaspoons. Then gradually increase your intake until you can eat ample amount of the legumes. I would like to point out though that the majority of women who are experiencing morning sickness will not have much trouble with gas with the addition of legumes to their diet. There is so much bile present, the beans never really have a chance to become gas-producing.

Do not be fooled by simplicity
The answer to morning sickness, as you can see, is not that difficult. I urge you to try the solution. Do not fall into the trap of thinking that this is too simple of an answer. I am always amazed at how difficult we make things. Truly, we, as a medical community, have the tendency to turn mole-hills into mountains. Ladies, eat your beans! You will be surprised and grateful at how your pregnancy will become wonderful.

Pregnant woman = Doormat?????

Sometimes the birth climate in the US saddens me. You know, there was a day and time when doctors told women that reading was bad for their health. They said that all the sitting and strain on the eyes was taxing on their bodies. In reality, it was an effort to stop women from becoming informed.

But this is 2009 and we have come a long way, baby.....or have we? The sign above would suggest we have not. This is an actual sign that appears in the Aspen Women's center in Provo, Utah.

It has been shown in many studies that doulas improve outcomes for mothers, not harm them. Yes, I am aware that there are a few doulas out there who argue with doctors, contradict them in front of their patients and come across as arrogant in the birth room. There are heavy handed people in every profession. But the majority of doulas are there for the mother.

The Bradley Method of childbirth is simply a matter of choice. For some couples, Bradley classes have made them able to face labor without fear and anxiety. Bradley is getting picked on, in my opinion. THere aren't too many childbirth education "brands" in the US currently that would agree that our current state of obstetrical care is stellar.

This is about rights. On the side of the doc, kudos for at least being honest and posting publicly in your office that you have no intention of allowing women to choose the care options that they feel are best for them personally. No one can say they weren't warned. But in googling this office, for every woman who rallied against this policy, there was another who raved about their care at this office. I also found out that one doctor in the practice proudly uses forceps in all of his vaginal deliveries claiming it makes birth easier for the mother. I think even most of his fellow OB's would disagree with that. See this link for the facts: http://www.efn.org/~djz/birth/betterbirth/7bottom.html#fore

Regrettably, here in Charlotte, I have come across this attitude among individual doctors and entire practices. The difference is that they tell their patients something very different. They vow their support and encouragement to the mother who seeks a natural birth experience.....until she goes past 40 weeks, or her fluid levels are slightly low, or her measurements are 1-2cm beyond her dates or the most popular by far....the ultrasound shows a BIG baby. See information about true reasons for induction and intervention here: http://www.lamaze.org/ChildbirthEducators/ResourcesforEducators/CarePracticePapers/LaborBeginsOnItsOwn/tabid/487/Default.aspx

If you are a woman seeking a natural birth experience, the responsibility has to be yours to educate yourself about your rights as well as the facts regarding medical protocols. I have seen too many women who had very strong resolve compromise when faced with scare tactics and inaccurate information. And steer clear of doctors who seem at all uncomfortable with your having a doula or tells you what childbirth education curriculum you should/should not use. This is an individual decision. And by all means....run from any doctor who refuses to accept a birth plan. YOU are the consumer. YOU pay the bill. The decision is YOURS.

So much for the textbook......

Labor is different for every woman, but occasionally, someone really breaks the mold. With permission, I share the story of my client, S.

S is a strong, energetic young woman having her first baby. She and her husband quickly became dear to my heart. Upon her labor beginning, like a good girl, she went for a beautiful walk in the park with her hubby, and called me when the contractions became a little closer. I told her that by listening to her, I did think she was in early labor and that she would be having her baby soon(meaning in the next couple of days). This went on all day. I went to an early morning birth, then had to take my toddler to the doctor, and decided to run over and check on her. She was frustrated. The contractions had been going on all day with no apparent change.

By the time I arrived, there were no clues that she was in active labor. Many times, contractions will slow down or even stop when I show up...then they pick up again. She would casually mention that she was having a contraction between our topics of conversation. With a loving smirk, I told her husband to call me when she stopped talking so much, that we would know then that it was time to get really serious. I also gave her some homeopathics just to see if it would help. After about an hour....I left thinking it would be a while.

I got home and took a much needed hot bath. The baby born that day had pulled me out of bed at 5am. I had also been at a birth the day before that...LOL. I was hoping for a few hours of sleep. But S's husband called me back before my hair was even dry. He said she had not stopped talking....rather...she had begun yelling and cursing and had droppped to her hands and knees on the floor. I told him to ask her what she felt like we needed to do....mamma instincts know. She said we should go to the hospital and out the door I went to meet them there.

Upon arriving, she was still chatty. She did stop talking for a contraction, but I did not see the seriousness and the concentration that I normally see in active labor. Usually, toward delivery, mom will stop talking even in between contractions....other than to say, "water" or "bathroom" or "hurts here." She and hubby didn't even bring the bags in out of the car because they had convinced themselves on the way to the hospital that this might not even be real labor. LOL Imagine all of our surprise when the nurse announced that she was 9cm.

There are always exceptions to the rule and she was one. But, it proves that mamma instincts will always tell you the right thing to do. It was time to go - even though she wasn't exhibiting the textbook signs. And by the way, she never did get quiet and contemplative. She never stopped cracking jokes and smiling. She made it look easy. And she made me stop looking so hard for absolutes.......

ACOG gets a big surprise.....

This is what happens when women speak up for their rights to the birth they want. I love it!


Issued: August 31, 2009

Viral Internet Campaign Exposes Bogus Research on the "Problem" of Increased Demand for Midwife Care

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Thousands of Activists Nationwide Force Physician Group to Scrub Its Website

FOR IMMEDIATE RELEASE

WASHINGTON, D.C. (August 31, 2009) – In under 18 hours, a viral internet campaign targeted at the American College of Obstetricians and Gynecologists (ACOG) forced the group to take down a public plea asking its members to submit anecdotal, anonymous data about patients who planned out-of-hospital deliveries. According to the request, which was originally linked from ACOG's home page, the professional trade association for OB/GYNs is "concerned" about the "problem" of growing numbers of women seeking out-of-hospital maternity care.

"Just follow the money," said Steff Hedenkamp of The Big Push for Midwives Campaign. "ACOG does not want to continue losing patients to Certified Professional Midwives and out-of-hospital birth, so they're telling members to send in more of the same old tall tales that far too many OBs love to scare women with. Well, we have news for ACOG8
0it's not working."

The campaign to expose the physician group's plans began on Facebook and Twitter and rapidly drew thousands of women to ACOG's website, where they submitted their own data about their healthy deliveries in private homes and in freestanding birth centers throughout the country. In response, ACOG moved quickly to scrub its website and placed its request for unsourced data from members behind a password-protected firewall.

"This was almost as fun as last year's campaign pressuring the American Medical Association to back off from its ridiculous claim that Ricki Lake is responsible for the increase in out-of-hospital deliveries," said Sabrina McIntyre, mother of two. "The AMA and ACOG seem to forget that women are capable of making rational, informed decisions about our maternity care providers and birth settings. We don't appreciate fear-mongering tactics meant to try and scare us away from using safe and cost-effective, community-based alternatives to our current maternity care system."

Analysts familiar with ACOG expect the group to use the anecdotal data collected from members to support its ongoing state and federal lobbying campaigns aimed at denying women access to out-of-hospital maternity care and Certified Professional Midwives, who are specially trained to provide it. "ACOG admits in its own documents that they've been forced to use 'hardball tactics' against women who are advocating for choices in maternity care," said Hedenkamp. "Frankly, this latest stunt of theirs to troll for 'fresh' folklore reek
s of desperation. "

The Big Push for Midwives Campaign represents thousands of grassroots advocates in the United States who support expanding access to Certified Professional Midwives and out-of-hospital maternity care. The mission of The Big Push includes educating national policymakers about the reduced costs and improved outcomes associated with out-of-hospital birth and advocating for including the services of Certified Professional Midwives in health care reform. Media inquiries: Katherine Prown (414) 550-8025, katie@thebigpushfor midwives. org

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