“Heck no, I won’t go”

“Heck no, I won’t go”

After experiencing giving birth in both a hospital and a birth center setting, Tieska Jumbo sums up her thoughts about another hospital birth in five words: “Heck No, I Won’t Go!”

In an article for Jacksonville Moms Blog, Jumbo explains why she sought out midwives and a birth center for her second pregnancy.

“I’ve heard women say that giving birth is an amazingly beautiful experience and that they continue having babies because they forget the toil that is pregnancy and labor. After being traumatized by the hospital birth of our first son and going back to work after six weeks, those sentiments did not compute for me. So, when we found out we were pregnant again, I was determined not to give birth in another hospital, nor to return to work so soon. After thoroughly researching my options, I settled on a local birthing center.”

Jumbo listed the personalized approach to care, small staff, and the patience and flexibility demonstrated by her midwives as reasons she would choose birth center care over a hospital birth again. She also found the setting at the birth center to be more conducive to labor.

“Mostly, I enjoyed the privacy of the setting and the ability to create the atmosphere we desired. Our room was big and naturally lit with a with a full-sized bed, artwork on the walls, a chest of drawers, two chairs, a garden tub, and a thermostat. With my music on, I sat on my birthing ball and made figure eights while praying aloud. Before getting us lunch, my husband joined in and we created our peace. Although (midwife) Ashleigh entered periodically to check my vitals, she was very quiet, polite, and sensitive to the mood we’d created. In the hospital, it was virtually impossible to find peace with the noisy machines, different strangers constantly coming in and out, the awful lighting, being limited to eating ice chips and being held hostage by the bed.”

Notably, Jumbo’s first birth in the hospital had included an epidural, but she found her unmedicated birth in the birth center to be less painful.

“Without an epidural or any kind of medical intervention, my water birth was by far easier and less painful than my hospital birth with an epidural. Instead of being discharged feeling traumatized, I left feeling empowered, healthy and strong and like we’d made the best decision for our family.”

Have you experienced birth in both a hospital and a birth center? How did they compare?

Dr. Sarah Buckley:  Epidurals – Risks and Benefits

Dr. Sarah Buckley: Epidurals – Risks and Benefits

In Babymoon’s 5-week Lamaze series, we discuss at length the six “Healthy Birth Practices” that have been linked to better outcomes for moms and babies. One of these healthy birth practices is to avoid unnecessary interventions.

But how does one determine when an intervention is necessary or unnecessary? We recommend using your BRAIN – examining the Benefits, Risks, and Alternatives to an intervention, and then asking yourself what your Intuition says and what happens if we do Nothing (right Now).

In the first of series of her blogs on her web site, Sarah Buckley begins to examine the benefits and risks of an epidural and shares some of the research surrounding this common intervention. Buckley, a physician who also authored Gentle Birth, Gentle Mothering: A Doctor’s Guide to Natural Childbirth and Gentle Early Parenting Choices, says:

“Obviously, the main benefit of an epidural is the very effective pain relief that most women experience. Because of this effective analgesia, epidurals also reduce stress, and stress hormones, in labour. This can be beneficial when women are experiencing very high levels of stress and pain, which can slow labour progress.”

To understand some of the risks or side effects of an epidural, we first must understand oxytocin. As we discuss in our Lamaze series, the hormone oxytocin – also known as the “love hormone” – is a key player in the process of labor and birth.

Childbirth Connection explains:

“Receptor cells that allow your body to respond to oxytocin increase gradually in pregnancy and then increase a lot during labor. Oxytocin stimulates powerful contractions that help to thin and open (dilate) the cervix, move the baby down and out of the birth canal, push out the placenta, and limit bleeding at the site of the placenta.”

Buckley explains that within the oxytocin “positive feedback cycle” (as illustrated in the diagram), uterine sensations lead to oxytocin release which contributes to stronger contractions, more sensations, and more oxytocin. The cycle continues and helps baby to be born quickly and easily. Oxytocin also activates reward and pleasure centers in the brain.

When epidural analgesia is introduced into the equation during labor, there are no longer sensations to trigger oxytocin release, and therefore levels will decline.

Buckely will explore the consequences of a lack of oxytocin in Part 2 of her series, coming soon.

Read all of Part 1

8 bizarre pregnancy dreams and what they really mean

8 bizarre pregnancy dreams and what they really mean

Have you wondered what those crazy pregnancy dreams mean? I had several vivid dreams during my pregnancy with my second son (sorry, Robert!) and would have loved to use this article to decipher what I was sorting out in dreamland.

Approaches for Ob-gyns and Maternity Care Providers to Limit Intervention During Labor and Birth in Low-Risk Pregnancies

Approaches for Ob-gyns and Maternity Care Providers to Limit Intervention During Labor and Birth in Low-Risk Pregnancies

ACOG released new guidance advising providers to consider “low tech, high touch” approach to care for low-risk women.  The Midwifery Model of Care as delivered in the birth center setting has studied this approach, and our data also supports the low-intervention approach as providing a SAFER model of care, avoiding the risk of unnecessary intervention.  It is wonderful to see ACOG endorsing this evidence-based model, and also acknowledging that emotional support is an important factor in providing safe standard of maternal care.  Bravo, ACOG!

From their press release:

“Practitioners always put the best interests of moms and babies at the forefront of all their medical decision-making, but in many cases those interests will be served with only limited intervention or use of technology,” said Committee Opinion author, Jeffrey L. Ecker, M.D., chief of the Obstetrics & Gynecology department at Massachusetts General Hospital. “These new recommendations offer providers an opportunity to reexamine the necessity of obstetric practices that may have uncertain benefit among low-risk women. When appropriate, providers are encouraged to consider using low-intervention approaches that have been associated with healthy outcomes and may increase a woman’s satisfaction with her birth experience.”

What constitutes “low-risk” will vary depending on a laboring woman’s condition and medical circumstances but generally involves a clinical scenario in which a woman presents at term in spontaneous labor and has had an uncomplicated course of prenatal care. For such women in the early stages of labor with reassuring maternal and fetal status, patients and providers may consider delayed hospital admission until approximately five to six centimeters dilated. Also, for women who are progressing normally and do not require internal fetal monitoring, it may not be necessary to rupture the amniotic sac. In the case where a woman at term experiences premature rupture of membranes, patients and providers may consider planning a short period of expectant management before undertaking labor induction if there are no maternal or fetal reasons to expedite delivery.

The recommendations also suggest that women benefit from continuous emotional support and the use of non-pharmacologic methods to manage pain. Support offered by trained labor coaches such as doulas has been associated with improved birth outcomes, including shortened labor and fewer operative deliveries. In addition to considering use of medications or epidural anesthesia to manage pain in labor, practitioners are encouraged to offer women coping techniques, such as massage, water immersion in the first stage of labor, or relaxation techniques. Recognizing that the complete absence and elimination of pain is not what all women value, use of a coping scale rather than pain scale is recommended to evaluate the multifactorial experience of labor.

The Committee Opinion, “Approaches to Limit Intervention During Labor and Birth,” #687, will be available in the February 2017 issue of Obstetrics and Gynecology.

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