Supporting Women Without Epidurals

Presentation at the Virtua Voorhees Hospital

by Cathy Daub,  PT

I recently gave two presentations on “Supporting Women Without Epidurals” at Virtua Voorhees, the local hospital in Marlton, NJ. The hospital has approximately 5,500 births per year and  a 43% cesarean rate.  New Jersey and Florida have the highest cesarean rates in the country.  My audience consisted of doctors, midwives, doulas, labor and delivery nurses, and the nursing supervisor.  One doctor stayed for both presentations.  At the end she stood up and said to everyone, “I think it is time for Virtua and BirthWorks to have a relationship with each other.” 

They were very interested in hearing what it means to have an emotional preparation for birth as well as an academic preparation.  Human values, pelvic bodywork, grieving and healing, and primal health are not part of their current childbirth preparation curriculum. They do not see underwater births because they have no birthing pools.  So many women give birth with epidurals there, that they are not as familiar with the fetal ejection reflex and behaviors of hormones. 

The need to present such a topic as this indicates that with such a high epidural rate, many nurses and caregivers are not witnessing women giving birth normally and naturally anymore.  They only see birth as a medical event that is treated with medical procedures and obstetrical drugs.  They do not see women moving around, working with their bodies, and having euphoric endorphin expressions that come with feeling the experience of birth.   

I presented three surveys on the topic.  The first was an informal BirthWorks survey with 55 responses that addressed the following questions:

1. Where do you feel safe giving birth?
2. I want to be engaged in my birth and am choosing not to have an epidural.  Some tools and strategies for my birth are?
3. If you have previously given birth without an epidural, what kind of things made your pain better (less)?
4. What can birth professionals and hospital staff do for women who choose not to have an epidural?
5. Do birth professionals and hospital staff need training not currently being provided?  If yes, what type?

The second was a small Facebook survey with 16 responses, and the third was the Listening to Mothers II survey¹ with over 1500 responses.  The surveys presented all pointed to the same conclusions as the Listening to Mothers II survey

•         Our maternity care system is profoundly failing to provide care that many mothers told us they want and that is in the best interest of themselves and their babies.

•         Safe and effective maternity practices are available but not being used by enough pregnant women. The goal is to increase childbirth preparation for all childbearing women and their families so more can achieve safe vaginal birth. 

•         Health professionals need to become educated in normal birth and improve their care and skills to help more women achieve safe vaginal birth.

•         Research must seek ways to translate current knowledge about safe and effective maternity care practices, so they are easily understandable, and can be put into practice by not only childbearing women and their families, but also health professionals. 

Few women used highly rated nonmedical methods of pain relief such as:

1. Fetal monitoring with handheld devices rather than electronic fetal monitoring,
2. Drinking or eating during labor,
3. Freedom of movement during labor,
4. Pushing and giving birth in non-supine positions, and
5. Supportive rather than directive bearing down. 

The Listening to Mother’s II survey concluded:

• Nurses should be very concerned that care practices known to support normal birth are apparently unavailable to the majority of healthy childbearing women in the United States.
• The challenge is to take seriously and respond to the disregard for care practices that support normal birth apparent in the experiences of women reported in Listening to Mothers II.

These conclusions point to three concerns:

1. We need more childbirth educators.
2. We are not reaching enough pregnant women and their families with good quality consumer oriented childbirth education.
3. Birthing women need to learn about non-pharmacological ways of coping with labor that are proven to be effective and safe.
4. Childbirth education is beginning too late in pregnancy; it needs to begin in the first trimester or even before women become pregnant.
5. Essential topics such as pelvic bodywork and human values are missing  from most traditional childbirth education classes.

Consider becoming a childbirth educator today.  Contact BirthWorks International to begin a career helping women and their families to have more positive birthing experiences.

Reference:

1.  Declercq, E.R., C. Sakala, M.P. Corry, and S. Applebaum.  2006.  Listening to Mothers II: Report of the Second National survey of Women’s childbearing Experiences.  New York: childbirth Connection. Available at http://www.childbirthconnection.org/listeningtomothers

Birth Panel

by Anna Holder CCE(BWI)

Truth, like surgery, may hurt, but it cures.
- Han Suyin

The fourth annual Hudson Valley Birth Options panel took an especially hard look at the truth this year. As in previous years a number of childbirth educators, doulas, midwives and mothers form a panel for local families to explore their birth options. Families from a wide range of backgrounds and birth experiences attend in hopes of connecting with providers and to better understand the choices in pregnancy and birth.

It is interesting to note that the hospital with the highest cesarean section rate (58%) once again failed to send a representatives and that two Ob/gyns who were slated to appear did not. This year’s panel experience was different in that many of the women in the audience were moved to tears. A brunette raised her hand and began to speak

. “ This question is for any of you, I am just wondering if I have any options; I am 8 weeks pregnant and I have had multiple c-sections and it was so horrible that I didn’t want to have any more children and now i find myself pregnant and I just….”

She began to sob and was unable to continue. Luckily she was in a room full of support and love and thus was quickly surrounded by hugs and tissues. The most interesting development was from one of the older homebirth midwives in the area.

“ You have to leave the state. I can’t tell you what your birth will be like but if you want an honest chance at a vaginal birth, then you have to leave the state.”

            Even sadder is that the entire room full of women knew she was right. What kind of society are we living in where it is easier to schedule a major surgery with its inherent risks, than it is to have a natural, physiological birth?  What kind of society are we living in where mothers fear having more children because of trauma from previous births? What kind of society are we living in where a woman is told that her only option for a VBAC is to leave her home, children and familiar surroundings to go to another state? Someone brought up the familiar OB saying,” I don’t get sued for doing the C-section”

If the upper limit of the World Health Organization (WHO)  recommended rate is 15% then we can conclude that the other 23% in New York State and 17% nationally are more likely than not unnecessary.  Doctors are failing to practice by their governing bodies (ACOG) guidelines, which state that women should be given a trial of labor even after multiple cesarean sections.

The evening further explored:

• Suing for non urgent or emergent primary cesareans
• The limited availability of skilled providers to attend breech vaginal births and the failure to recognize breech as another variation of normal
• The fact that even positive birth stories can be detrimental by “setting the bar too high “ and influencing a mothers idea of a “good birth”

 It is clear that the climate of birth is changing, at least in New York State.

In a time when we are facing an ever-increasing C-section rate, there is a small but not discountable group of women rallying against it saying “We are taking back birth,” but  we need to remember is that we never gave it away in the first place!

The Power of a Birth Circle

By Molly S. Wales CCE(BWI)

Our small town of Athens, Ohio is home to a consumer birth group called The Birth Circle.  Over the ten years since it began, The Birth Circle has grown from a handful of mothers who got together to share their birth stories, to a powerful community organization that has made a substantial difference in the lives of birthing families, and in our local birthing climate as a whole.  We share information, offer support, and build friendships. We do not endorse or judge.  And as the director of this group, I have the great honor of witnessing how, every single time we gather together, whether to talk about potty training or pain management in labor, or to share a meal, or to grieve a childbearing loss, we lift each other up, and give each other courage, simply by being present.

Let me give you two examples of this from recent meetings.  A few months back, a new couple joined us for a discussion about gentle discipline.  They quickly shook my hand, took a seat, didn’t engage with anyone around them, and in general gave an impression of being very shy and conservative.  She was pregnant for the first time, and new to Athens, and I hoped that this meeting would open some doors for them, in terms of building community and answering questions about birth and parenting.  About halfway through the meeting, a mom seated on the floor across from them pulled her breast up and out of her shirt, and began to nurse her baby.  The dad looked at his wife with wide eyes, clearly a little shocked at how she displayed her breast.  Within seconds, the mother’s toddler came over, and she tandem nursed them for a while, the baby laying in her lap while the toddler kneeled and wiggled.  The new parents tried not to stare, but their discomfort was obvious.  I thought to myself, “We’ve lost them.”  When the meeting adjourned they rushed out, and I didn’t expect to see them again.  But to my great surprise and delight, at our next meeting a month later, there they were.  And at the next meeting, and the next.  They never spoke up, but they came to every meeting, and along the way their demeanor relaxed a little.  I don’t know what sort of birth they had, nor the sex of their baby, nor if they’re even still in town.  But I think of them often, and how their decision to return showed openness and courage, and I think of that mom, too, who tandem nursed so nonchalantly in public, and never knew how she’d so beautifully exposed this couple to a new idea.

Another example.  Every April we dedicate our meeting to sharing birth stories.  This last time was heavy with home births, with hospital birth stories (both natural and with interventions) interspersed in between.  After the meeting I got a call at home from a mom who was 38-weeks pregnant, who had decided, after that meeting, to change her care provider.  She was tired of “impersonal, rough OB care.”  She wanted to know about midwifery options.  I encouraged her to interview local midwives, and a few days later she called back to let me know she’d taken the plunge.  She had chosen a home birth team, had collected her records from her OB office, and was ready to come pick up a birth pool (we loan them out for free).  When she showed up with her husband, she was glowing.  They smiled ear to ear.  It seemed such a bold to move, to change caregivers so late in her pregnancy, and I commended her for her bravery.  “I would never have thought I could do it,” she said, “if I hadn’t heard those birth stories.”  What exactly was said that empowered her, I don’t know.  But that’s not really important.  She heard something that helped her take a critical look at how she was being treated, that helped her see and feel her own personal truth, and that emboldened her to make a decision that her  extended family perceived to be reckless, yet which was absolutely right for her and her baby.  Those are the times that I think, “Wow, we are changing the world.”

And that is the power of a birth circle.  The power of women and their families getting together to talk.  Not to compare, but to share.  We lift each other up.  We are challenged.  We teach and learn.  And with every tiny bit of support that is exchanged, intentional or not, we become more fulfilled people, and better parents for our babies.

Molly S. Wales is the director of operations of The Birth Circle in Athens, Ohio. 

www.athensbirthcircle.com

Value of a Doula

by Tiffany Hare

When people ask me what I do, I always respond by saying, “I’m a doula and a childbirth educator.” And then I wait. I wait for the look of uncertainty to fill the face of the person who asked me the question, or for them to say, “What’s a doula?” The word is still a very unfamiliar one in some parts of the country, and even though I live in a large suburban area outside of Philadelphia, many of the people I come into contact with outside of the birth-world have never heard of a doula.

And that makes me a bit sad.

I think back to a time when women were surrounded by other women during their labors and their  births; a time when by the time a woman had reached childbearing age, she would have seen birth happen so many times that she was well-prepared for it herself.

But we don’t live in that time. We live in a time in which birth is unknown and frightening to many women. It is during this time that we need doulas.

We need doulas to help us get the information that we need so that we are empowered to make the right decisions for ourselves and for our babies. Doulas can help us make decisions by providing us with information and guidance. Doulas help us through our labors and our births by offering constant companionship .

The value of having a birth doula cannot be underestimated. As anyone who has given birth can tell you, giving birth is one of the most life-alerting events that one can experience. Birth is an intimate event. It is an event that does not come with a do-over button. And while we can never predict an outcome, especially in an event as unpredictable as birth, we can take steps in order to achieve the birth experience that we dream of.  Doulas are one step you can take in order to get the birth that you hope for.

Since the beginning of human history, birth took place in the home, with family present, and with a midwife who was experienced in normal birth. Girls and women witnessed birth and experienced it long before they gave birth to their own children. Today, in a culture in which birth typically takes place outside of the home, most women have no experience with childbirth until they give birth themselves. It is a new and foreign experience for most of us.

On average, the length of time a woman who giving birth for the first time spends in labor is about eighteen hours. During most of that time, she and her partner are left to blaze this unexplored trail on their own. It can sometimes be a scary experience that is full of unknowns.

However, studies have shown that having a doula present at your birth can greatly increase your chance of having a birth outcome that you feel good about. Doulas can help to increase positive birth outcomes and decrease the use of medications such as Pitocin and epidural anesthesia. Doulas can decrease the total length of labor by about 25% and decrease the incidence of cesarean delivery by about 50%. Overall, doulas can help you avoid unnecessary interventions and they can help you get off to a better start with your baby and increase your chances of having a successful breastfeeding relationship.

A doula is present during the entire labor and her knowledge and experience can help the mother find confidence and security throughout her birthing experience. When a woman feels safe, confident and secure, oxytocin (“the love hormone”) flows freely and facilitates the progression of her labor. Feeling safe reduces the presence of adrenaline, the hormone responsible for fight or flight syndrome, which can slow or stall a labor. When a woman is supported by a doula, she feels that she has better control of her birthing experience, can make decisions with confidence, and is free to trust what her body is telling her. 

Birth is an event that is not forgotten. The experience stays with us throughout our lives. In birth, as in life, there are no guarantees, but having a doula present at your birth can help get one step closer to realizing the birth that you hope for. 

BirthWorks 5K Fun Run!

BirthWorks International will be hosting its first fundraiser, the BirthWorks International 5K Fun Run at Freedom Park in Medford, NJ.   The walk will be preceded by a free yoga class and registration.  After the walk, the rest of the day will include fun activities for the family, a mini pelvic bodywork class, vendors and much more!

The run will take place at Freedom Park in Medford, NJ on September 8, 2012.  The park is located at 86 Union St. in Medford, New Jersey.   The event will occur between 9am and 3pm.  There will be a free yoga session at 9am, taught by Tricia Heiser of the Yoga Sanctuary of Medford followed by the 5K Fun Run/Walk at 10am.  Cathy Daub, the president and founder of BirthWorks International, will teach a free pelvic bodywork class for expecting mothers at 12pm.  Furthermore, the event will hold various children’s races and activities.  Prizes will be rewarded to all winners.

BirthWorks International embodies the philosophy of developing a woman’s self-confidence, trust and faith in her innate ability to give birth.  BirthWorks seeks working relationships with other childbirth related organizations, striving together to help birthing families make more informed and safe choices for birth.  It is our mission to train childbirth educators and doulas that in turn provide evidence-based, current information to birthing families through a unique experiential approach that is based on human values.  All proceeds from this event will fund programs that help educate and empower women and families around the world about safe birth practices and natural birth options.

            

    Being an international organization, we are aware that many of our friends and colleagues are unable to attend this event on September 8^th; however that should not discourage anyone from helping us raise the funds necessary to provide these programs and research to birthing families and enhance their knowledge and experience during this special and important time in their lives.  Please join us as a virtual walker.  By registering online at www.active.com/running/medford-nj/birthworks-international-5K-run-walk-2012, you can support BirthWorks and its philosophy by asking for sponsorship and donations from family, friends or co-workers.  Thank you and good luck!  

Silence In Labor

by Mali Schwartz  

Why is it so important to create a quiet, peaceful atmosphere during labor?   And how can women take charge of creating a peaceful environment no matter where they choose to give birth? 

The Leboyer Method, established by Dr. Frederic Leboyer in the 1970s was proven to minimize the trauma and stress experienced by a baby at birth.  This method of delivery advocated giving birth in a quiet room that had low or dim lighting.   Not pulling on the baby’s head; placing the baby on the mother’s stomach; not cutting the baby's umbilical cord until it has stopped pulsating, and placing your baby in a warm bath shortly after birth were other ways to ensure a less stressful birth. 

This method has had some influence in delivery rooms where noise levels are minimized to make the atmosphere more peaceful for mothers.  According to an article found on the website (pregnancy-info.net), “many midwives and doctors are willing to incorporate some, if not all, of the facets of the Leboyer method into the birth experience.”

Dr. Michel Odent, another birth pioneer who has conducted extensive research on how womb ecology can impact human development, has proven how important the quieting of the neocortex is during birth.  BirthWorks International provides a link on their website where anyone can access Odent’s primal health research.

According to Odent, the neo-cortex is the center for what we commonly consider our intellect.  It is the part that allows us to be logical and also creates our sense of inhibition, giving us our civility and our modesty.  When we are being stimulated intellectually or feel we are being watched, the neocortex is active.  This is not conducive to laboring women, who like mammals need no distractions while in labor.  They naturally focus inward and shut out the outside world.  Dark, warm, quiet surroundings are critical for her to maintain this space of consciousness safely and have the best possible labor and birth experience/outcome.

Engaging the birthing woman in discussion is not a good idea.  Other triggers that should be avoided are watching television, bright lights, feeling cold, and feeling observed.  Even music with certain beats, tempos and lyrics may cause– without the woman’s total awareness– a stimulation of the neocortex.   Although a woman might not even be aware when her neocortex is being stimulated, it’s vital that this part of the brain be at rest so that primitive brain structures can more easily release the necessary hormones such as endorphins, serotonin, acetylcholine, and vasopressin which help relieve stress and pain.

Have you ever heard someone say “I feel like I was on another planet,” while she was giving birth?  This means that the activity of her neocortex was reduced.  This reduction of the activity of the neocortex is an essential aspect of birth physiology.   Even the slightest attention can keep her from the true meditative nothingness of the primal consciousness her birthing body seeks.

What can we do to reach this state of meditative nothingness?   A book “Frequency: The Power of Personal Vibration,” helps us to understand how to intentionally work with energy to transform our lives.   Author Penny Peirce makes a leap that science has not yet made – namely that the energy frequencies of matter have matching consciousness frequencies.  In describing the four categories of brain waves from fastest to slowest -  beta, alpha, theta and delta, it is interesting to note that the fastest brain waves correspond with lower frequency waves, while the slowest brain waves correlate with higher frequency - expanded awareness. 

According to Peirce we can influence our personal vibrations, although our personal vibrations are also affected by vibrations in the world, other people’s vibrations, and our environment.   Peirce believes that we all have the power to determine how we want to feel and when we choose to attune to the frequency of our soul, a new perception based on our souls expansive, loving wisdom opens to us.

The Leboyer method, Dr. Michel Odent’s neo-cortex research and author Penny Peirce understanding of personal vibrations can empower us with the knowledge of how important silence is during labor.  With knowledge comes wisdom – the wisdom to create a peaceful, loving atmosphere in which to welcome a new life into this world.

Women Face the Risk of Pelvic Organ Prolapse after Childbirth

Elizabeth Carrollton writes about defective medical devices and dangerous drugs for Drugwatch.com.

 One of the main reasons pelvic organ prolapse (POP) occurs is due to childbirth. The stress of birth can, in some cases, shift the organs in the pelvis from their normal positions. The most common organs affected during childbirth are the bladder and the uterus itself. When this occurs, the symptoms can be mild or severe, depending on the type and extent of the prolapse.

 The most common symptom is a feeling of fullness or pressure in the lower abdomen. Frequent urination and incontinence are common with a prolapsed bladder. As the prolapse worsens, the feeling of pressure can change to pain, and the condition can be very uncomfortable and debilitating.

 There are several treatments for pelvic organ prolapse, and recently, the use of an implant called transvaginal mesh has become very common. During this procedure, a light mesh material is inserted through the vagina to help secure the prolapsed organs. While in theory this seems like a great solution for pelvic organ prolapse, in reality there have been numerous complications associated with this procedure.

 These complications have been reported with increasing frequency to the Food and Drug Administration (FDA). Between the years of 2008 and 2010, more than 2,800 complaints about the transvaginal mesh procedure were logged. The FDA has made these complaints public in order to help patients realize the risk they are facing if they elect to go ahead with this procedure.

 The most common side effect following transvaginal mesh surgery is the erosion of the mesh into other organs. This erosion can cause bleeding and other side effects. Another common complication is the actual wearing through of the vaginal walls, as the mesh presses against them. This is a very serious complication that can result in internal bleeding and serious infections. Because of such severe complications, mesh users have started to file a transvaginal mesh lawsuit against the mesh manufacturers.

 Other side effects noted by the FDA include pain and neuromuscular problems following the procedure. Unfortunately, many doctors are not aware of the complications that their patients are facing with this procedure. It appears that few are properly trained in the insertion of the transvaginal mesh, and this in part explains the high rate of complications associated with the procedure.

 The FDA is continuing to monitor the problems associated with transvaginal mesh surgery. The agency has ordered dozens of mesh manufacturers to conduct safety studies on their products.

 If your doctor has recommended transvaginal mesh, it is vital to understand the potential risks you may face. While all surgical procedures carry risks, the number of complaints associated with mesh are cause for real concern.

 Ask your doctor if there are alternatives to this procedure. For minor cases, simple muscle exercises can be used to help shift the prolapsed organs back into place and strengthen the vaginal walls. Serious cases can be fixed with a surgical procedure that does not include the insertion of the mesh.

 If you feel that you are not receiving enough treatment options, don’t be afraid to ask for a second opinion from another surgeon or specialist. You deserve to know the true complications associated with transvaginal mesh, and you deserve to have a surgeon who has been properly trained in the procedure before going ahead with surgery.