The Birth plan

CESAREAN COURAGE

I Love this post from another blog!


As a doula, I keep up with "birth stuff". I read blogs, research and discussions on birth. There is a lot of talk about the medicalization of childbirth, about VBAC and VBAC bans, and women's choices and lack of choices and OBs fear-mongering and the negative effect of interventions and early inductions. We talk about the benefits of home birth and midwifery care, doulas, Hypnobabies, water birth, unassisted birth, hands off birth, free birth, active birth, gentle birth, natural birth....but what we really talk a lot about is fear and the cesarean "epidemic".

We, in the birth community talk a lot about fear because childbirth in our culture is saturated in fear. And there is no doubt in my mind that it is because of this culture of fear that we have such a high cesarean rate. And in all our talk of unnecessary cesareans, and of fear, I don't hear a lot of talk about courage. Because no matter what the culture is, it takes courage to give birth. A lot of courage. The courage to give birth is in every woman, whether she knows it before hand or not, and even if she thinks it isn't there, she finds it inside of herself.

And all those mothers having cesareans? They have courage. Courage that needs to be recognized.

In our analysis of cesarean births and their increasing numbers, we get caught up in the focus of why the cesarean was or was not necessary, if this or that intervention caused it, if only that had been done or not done then perhaps the birth could have been vaginal. We get angry, we get sad, we work to change things. This is all good and very important, because too many women are subjected to unnecessary cesareans.

But can we please stop, for one moment and recognize, that no matter how educated or uneducated, coerced or informed the choice that woman on the operating table made or didn't make, whether that cesarean was elective or emergency, necessary or unnecessary - it takes a lot of courage to get there. Our birth culture may be saturated in fear-based decisions, but behind every cesarean and "unnecesarean" is a woman of courage. In that moment, it doesn't matter how that woman got to the operating table. It doesn't matter if the surgery is necessary or unnecessary, what matters is that it takes extraordinary courage to say:

"Cut me open.

I love my baby so much, that I will do anything to get my baby out of my body alive.

Lay me out, cut me open

because I love my baby so much."

That is courage. That is bravery and sacrifice and mothering in its purest form. That is the willingness to lay down your body and risk your life that your child might be born, that your child might live.

Cesarean mothers are BRAVE.

In the midst of our efforts as doulas and mothers and midwives and counselors and friends, in the work we do to educate and empower and change things...we need to take a moment to recognize the courage it takes to lay down and allow yourself to be cut open to have your baby.

http://avital.blogspot.com/2011/01/cesarean-courage.html

The Dangers of Early Cord Clamping and Cutting

Immediate clamping of the umbilical cord at birth has been associated with short- and long-term problems in newborns. Early clamping (within one minute after birth) can reduce the amount of umbilical cord blood transferred to the baby by more than 50 percent. Research shows that delaying clamping produces higher hematocrit and hemoglobin levels (more red blood cells, less anemia), healthier blood pressure, and improved heart rate and breathing in newborns. Polycythemia and hyperbilirubinemia are risks associated with delaying cord clamping, but studies find these risks extremely low.
Detrimental effects of early cord clamping
Nurse midwife Judith Mercer has investigated cord clamping in several studies and authored a 2001 literature review that points to some long-term harmful effects associated with early cord clamping. These include infant anemia, childhood mental disorders, and hypoxic ischemic brain damage.
Benefits of delaying for preterm infants
A 1993 study measured the effects of umbilical cord clamping on preterm infants. The investigators found that holding the newborn at about eight inches below the vaginal opening for 30 seconds before clamping the cord (sometimes referred to as “milking” the cord) improved bilirubin levels, decreased red cell transfusion requirements, and lowered the infant’s dependence on supplemental oxygen.
Lasting benefits of delaying for full-term infants
A 2007 study examined the timing of umbilical cord clamping in full-term babies. The conclusion was that delaying clamping for at least two minutes after birth improved the babies’ hemacrit and iron status (stored iron), and that these benefits extended two to six months into infancy. Similar results were found in a large 2004 study on 476 newborns.
La Leche League’s The Womanly Art of Breastfeeding cites this 2004 literature review. The authors conclude that delayed cord-clamping increases hemoglobin concentration in babies at 2 to 3 months, reduces the risk of anemia (especially in babies with anemic mothers), and does not increase the risk of complications.
Benefits of delaying for breastfed babies
In a 2006 study published in The Lancet, delaying cord clamping by two minutes resulted in increased iron stores in the babies at six months by 27 to 47 milligrams. And this effect was significantly greater in breastfed babies not receiving iron-fortified milk or formula, in babies whose mothers had low ferritin (a protein that stores iron), and in babies who weighed between 5.5 pounds and 6.5 pounds at birth.
A natural stem cell transplant
In a 2010 review article titled “Mankind’s first natural stem cell transplant,” researchers point out that a few types of important stem cells are transferred through the cord blood and argue that this greatly increases the benefits of delaying cord clamping.
Most research on the timing of cord clamping emphasizes the benefits of delaying. Only a few studies focus on the dangers of immediate clamping. From the studies cited in this article, one could conclude that the detrimental effects of early cord clamping are the loss of the benefits associated with delayed clamping, and these effects are significant and lasting.
Discuss this procedure with your birth attendant (obstetrician, midwife, or doula) and include your preference in your birth plan. As Ina May Gaskin, CPM, writes in her Guide to Childbirth, if you prefer to delay cord clamping, “the evidence is on your side.”

Amy Mitchell is a freelance writer in Jacksonville, Florida.

Additional References:
American Academy of Pediatrics, Evidence-Based Review of Science for Cord Clamping, http://www.aap.org/nrp/pdf/030B.pdf
World Health Organization, Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes (Reproductive Health Library Commentary), http://apps.who.int/rhl/pregnancy_childbirth/childbirth/3rd_stage/cd004074_abalose_com/en/index.html

The Top Five Benefits of Baby Massage

ntroduction:

Baby massage is becoming a growing trend, not only because it is a unique way to bond with your baby, but because it offers so many benefits to your child. Here are the top five benefits that massage offers babies.

Massage For Blood Flow:

Your baby was born with an underdeveloped circulatory system, as all babies are. Massage stimulates blood flow to your baby's extremities. It takes your baby's body a while to get acclimated to the world outside the womb, and by giving your baby regular massages, you can help strengthen their circulatory system. This helps your baby's blood flow.

Massage For Immune System:

As a result of the stimulation to your baby's body, and the increased blood flow to each part of their body, your baby's immune system may be improved. This means your baby's resistance to common illnesses will be built up, reducing their chances of infections.

Relaxation For Tense Muscles:

Just like when you exercise, your muscles can become tense. Your baby is also working their muscles, all day long, by learning how to hold up their head, discovering fingers on their hands, and toes on their feet. No matter what action you or your baby does, there is always some type of muscle contraction needed for that action. Massage is a great way to relieve the tension in muscles.

Massage As a Stress Reliever:

Baby's learn at a much faster rate than adults. When you try to learn something new, you become stressed. Your baby is learning many things all at once, and you can bet their stress level is often very high. The body's natural reaction when stress occurs is to release a hormone called cortisol. By giving your baby regular massages, you can reduce the base amount of cortisol in your little one's blood, so they will feel less stressed between massages. Your baby's body will also release a hormone called endorphins, just as any adults body would. Endorphins are released during exercise, which is why you feel better when you get up and move. Your baby is not able to get up and exercise. The good news is that these good hormones are also released when you are relaxing. By giving your baby a massage, you can help his/her body release more endorphins, thereby giving them that warm, tingly feeling of calm. With an increased level of endorphins, and decreased level of cortisol, your baby will have a sense of well-being during, and between, massage.

Massage As a Pain Reliever:

Because of the release of the endorphins, your baby can also be relieved of pains caused by trapped wind, constipation, teething, and sinus congestion, because endorphins also serve as your body's natural pain reliever.

http://www.listmyfive.com/a50fc222/The-Top-Five-Benefits-of-Baby-Massage

Are You Hiring a Lactation Consultant?

"When I get annoyed or feel under pressure, I cave in just to get people to leave me alone. That's why we are looking for a doula and a lactation consultant: people to help us with labor, delivery and breastfeeding." Expectant mom

Excellent point and a deep understanding of who she is under pressure. Let's face it, having a baby is living life under pressure even in the best of circumstances. What are you going to do when the pressure comes in its various forms? Do you know the breastfeeding stumbling blocks?

• Let me take the baby to the nursery so you can sleep
• Let's give the baby some formula so you can rest
• You're not making enough milk for your big baby- he needs a bottle
• Your baby is feeding too frequently; you're not making enough milk
• Your baby needs more calories than breastmilk (I'll talk about this in my next post)
• Colostrum is not enough for your baby- he's hungry
• You're being selfish: I want to feed the baby, too
• You can't possibly feed your baby every 1.5-2 hours- you'll be exhausted
• Let the baby cry; you're feeding her too often
• You're spoiling her by feeding her every time she makes a sound
• Your baby is too old to breastfeed
• Your baby needs more milk now that he is older

What other myths and bad information did you hear when trying to persevere with breastfeeding?

Could it be that the people saying these things are totally clueless about how breastfeeding works?

Become the breastfeeding advocate in your area. Speak the truth. Find pregnant women for whom you can dispel these myths. Empower women to nurture their babies with human milk. The truth you speak and the truth they embrace will bring freedom to both of you.

Thank you Debbie Page

http://www.thenewbornbaby.com/breastmilk_kills_cancer_cells/bid/15476/Are-You-Hiring-a-Lactation-Consultant

breastfeeding laws by state

http://www.ncsl.org/IssuesResearch/Health/BreastfeedingLaws/tabid/14389/Default.aspx?sms_ss=facebook&at_xt=4d2e470d25ec4e0c%2C0

l Pregnant Women Should Watch for Signs of Pre-eclampsia

If there’s one rule about the type of pregnant woman who develops pre-eclampsia, it’s that there are no rules. “It’s pretty much an equal opportunity disease,” says Kathleen Mahoney, APN, prenatal clinical nurse specialist at Robert Wood Johnson University Hospital in New Brunswick, N.J.

Also called pregnancy induced hypertension, pre-eclampsia occurs in about 2% to 7% of healthy women, but both incidence and severity are greater in women with risk factors, such as multifetal gestation, chronic hypertension, previous pre-eclampsia, diabetes, obesity and thrombophilia, according to the medical textbook “Obstetrics: Normal and Problem Pregnancies,” published in 2007.

But risk factors alone don’t dictate who will develop the life-threatening condition, which is sometimes responsible for maternal deaths, says Jane Salzone-Johnson, RN-C, BSN, nurse manager of labor and delivery and high-risk antepartum at St. Barnabas Medical Center in Livingston, N.J.

“Recently an Asian woman, who didn’t have any risk factors except that she was having twins, was brought in by ambulance [while] seizing,” Salzone-Johnson says. “We delivered her babies, and she did very well. But here’s someone who didn’t fit the category — she had good prenatal care and was followed regularly — and she came into the hospital seizing.”

The condition affects the vascular system by increasing blood pressure, which can decrease or block blood flow to the placenta-fetal unit. To date, the only known way to resolve the condition is delivery.

Since there is no known cause, there is no way to prevent the condition. “We treat everyone when they’re in prenatal care as if it’s something they’re going to get — we take blood pressure at every visit, weigh people at every visit to check if they’re starting to accumulate fluid,” Mahoney says. “Prenatal care is the foundation for detection, education and entry into treatment.”

Serious Risks

If left untreated, pre-eclampsia can cause stroke, stillbirth and maternal death. The disease’s outward symptoms, which usually appear in the third trimester, include swelling in the face, hands and feet, blurred vision and epi-gastric pain. As soon as medical professionals notice an indicator, such as a blood pressure increase from 110 over 70 to 130 over 85, extra weight gain or decreased urine output, a woman’s blood and urine are tested and she’s placed on a maternal fetal monitor, Salzone-Johnson says.

“If the blood work comes back normal, the doctor is likely to tell her to go home and be on limited activity and come back in a week,” she says.

In more severe cases, a diagnosis leads to immediate delivery. “No matter what week gestation; she could be 24 weeks and could be delivered,” Salzone-Johnson says. “In pre-eclampsia, the placenta is not nourishing the baby, so the baby is not going to get any larger or get any more nourishment from the placenta.”

Regardless of how quickly delivery occurs, patients receive magnesium sulfate, which lessens the chance of the condition worsening to eclampsia and the mother suffering from convulsions. Antihypertensive medications are given to lower severely high blood pressure. If the gestational age is 24 to 34 weeks, corticosteroids are administered to accelerate fetal lung maturity.

“If you have pre-eclampsia, we’ll do everything to prevent eclampsia,” Mahoney says. “All of the medication and even the decision to deliver is based on the desire not to have the women seize. If you have an eclamptic seizure, you’ll have the same movements as a tonic-clonic seizure. You could lose consciousness, and because you have this massive kind of muscle activity, you could have decreased oxygen to the baby.”

Additionally, the seizures could lead to maternal cerebral hemorrhage and fetal death or brain injury from oxygen deprivation, says Maria DeMarinis Smilios, MS, ACNS-BC, assistant director of nursing for maternal child services at Flushing Hospital Medical Center in Queens, N.Y.

Rest and Recovery

Despite the potential severity of the outcomes, the majority of cases end well, nurses say.

Mothers on magnesium sulfate can have vaginal births and recover quickly from the effects of the magnesium sulfate, which include lethargy, hot flashes and overall malaise, they add.

“Mothers are still at risk for developing seizures 24 to 72 hours after birth, so we keep mothers in the post-anesthesia care unit and on magnesium sulfate for 24 hours after birth until they are stabilized,” Smilios says. “We keep the lights dim, a quiet environment and minimize the visitors to keep her from being overly stimulated.”

At Flushing, mothers are wheeled to the nursery to see and, if possible, touch their babies. Most facilities encourage mothers to pump their breasts or breast-feed as the benefits of breast-feeding outweigh the effects of the magnesium sulfate, Smilios says.

Over the six-week postpartum period, the mother will eliminate the excess fluid and her blood pressure will normalize, Salzone-Johnson says.

From the moment it’s detected to the time of delivery, nurses should advise mothers that with proper treatment, it is possible to have a healthy baby, Smilios says.

“As long as it’s identified early, it’s treatable,” Smilios says. “It’s not something that will harm the mother dramatically or the fetus dramatically, and the outcomes are very successful.”

More than anything nurses can do to minimize the impact of the disease is remain educated, Mahoney says.

“You really need to keep track of the literature because there are patients who come to you and they can’t walk and they can’t talk and they aren’t engaged in their care, so you have to be able to give them the tools to help them be fully engaged,” Mahoney says. “And the more you know, the more they will know and the better off they’re going to be.”

http://news.nurse.com/article/20101227/NATIONAL01/312270001/-1/frontpage