Tips from a midwife « BirthWays

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Tips from a Midwife:
Preparing for Pregnancy

February 29, 2012

By Michelle Edgar, LM, on behalf of East Bay Home Birth Midwifery

Making the decision to start a family or add a new member to your brood is exciting. There is a lot you can do before you conceive to prepare yourself and your family for a healthy pregnancy, beautiful birth, and empowering experience.

Pregnancy, birth, and parenting an infant are intense times in our lives. Changes in identity, relationships, physical ability, and income are a few examples of what many parents navigate during this time. Before becoming pregnant is an ideal time to connect with other parents and, if you are partnered, talk with your partner about how you see yourselves working together through this amazing time. Also, talk about your preferences when it comes to testing done in pregnancy, birthplace, maternity care provider, and immunizations for your child. Become informed consumers – learn about all the options available to you. There are so many wonderful resources in the bay area for prospective parents (explore the rest of the Birthways website for some ideas).

Optimize your health now. There may be dietary or lifestyle changes you want to make before becoming pregnant such as: reducing daily stress, beginning an exercise program, or getting to an ideal body weight. Orange Our diets and exposure to environmental toxins can have a great impact on our overall health and, in particular, on our fertility and our ability to nourish a healthy pregnancy and recover from birth. Work with your maternity care provider, naturopathic doctor, or nutritionist if you need to make some changes. In addition, studies show that taking folic acid supplements prior to becoming pregnant, as well as during your pregnancy, reduces the risk of neural tube defects in babies. So start taking a high quality food-based prenatal vitamin now.

You may also want to consider now what maternity care provider you will use for the pregnancy and birth. It is not too soon to change doctors or interview midwives to find the best fit, even before you become pregnant. If you already have a doctor or midwife, let them know of your pregnancy plans. There may be health screening you would find useful if done before pregnancy, such as: a Pap smear, communicable disease antibody testing, metabolic screening, and genetic counseling. It can be useful to chart your menstrual cycles so that you’ll be clear about when conception occurs and therefore end up with a reliable due date for the baby. This can help you avoid an unnecessary induction of labor at the end of pregnancy.

If you do not already have health insurance that covers maternity services, you should think about getting coverage before becoming pregnant, as many insurance companies consider pregnancy a pre-existing condition and may not cover care related to a current pregnancy. Depending on your income, you could qualify for MediCal or AIM (Access for Infants and Mothers) once you are pregnant. If there is an open enrollment coming up at work, you may want to consider your options and make a change between HMO and PPO. If you are considering a home birth, talk to midwives about the best insurance options.

There are so many considerations and good preparation can save you time and help you to avoid stress. You’ll be able to more fully engage in all the magic that comes with the experience of bringing a child into our world.

We wish you all the best on this amazing journey.

–The Midwives of East Bay Homebirth Midwifery

www.eastbayhomebirth.com

None of the information in this column is intended to be used for medical diagnosis or treatment. Talk with your healthcare provider about any questions you may have regarding a medical condition.

Tips from a Midwife:
Preparing for the Birth of your Baby

June 15, 2011

The bun is finally in the oven, and now there are so many decisions to make! Whether you are expecting your first baby or you’ve done this once or twice before, most parents spend quite a bit of time preparing for their baby’s birth. Among other considerations, parents decide where to have the baby, who will be the medical care provider, what classes to take, and who will be members of their birth support team. The focus of this article is the question of finding childbirth education that is right for you.

In our practice, we strongly encourage all first-time parents to take a childbirth preparation class. We also recommend veteran parents consider taking a refresher class in order to re-familiarize themselves with techniques that worked in their previous births and to spend focused time connecting with their current pregnancy and upcoming birth. If you’ve reached your second trimester, it’s a great time to start looking for your class.

In the Bay Area, we are fortunate to have access to a wide variety of great options in childbirth education. There are classes available at the hospitals, through centers like BirthWays, and with experienced independent educators. There are series that meet once a week for several weeks as well as weekend intensives. Some classes take an eclectic approach, offering you the opportunity to learn and practice a variety of techniques to help in labor. Other classes focus on a specific technique such as: hypnobirthing, the Bradley method, or mindfulness-based meditation. Still others are specific to folks planning homebirths, single mothers by choice, queer families, and second-time (or more) parents.

Ask your care provider for referrals, check out the BirthWays website, search Berkeley Parents Network, and ask your friends what they did. Consider what approach resonates most with you and speak directly with the instructors to get a better feel for what the class will be like. Some parents even take more than one class. For example, they may sign up for the class given at their hospital so they can learn about hospital procedures and protocols and also take a hypnobirthing series in order to gain practical skills for experiencing an unmedicated birth.

Practice the techniques you learn in class so they will be familiar to you when you want to make use of them in labor. Finally, try to remember that no matter how much you prepare for the birth of your baby, there is no way to truly plan a birth. Trust your body to know how to give birth, surround yourself with unconditional, loving support, and surrender to whatever the mystery of your baby’s birth brings you.

We wish you many blessings on this amazing journey.

–The midwives of East Bay Homebirth Midwifery

www.eastbayhomebirth.com

None of the information in this column is intended to be used for medical diagnosis or treatment. Talk with your healthcare provider about any questions you may have regarding a medical condition.

Informed Choice:
What does it mean for pregnancy and childbirth?

March 15, 2011

By Anna Hurty, CD, CCBE, PES

I once had a couple in my childbirth class at Stanford. When discussing pros and cons of various types of technology, “Mark” said that he was planning to do whatever his doctor said, and, if anything didn’t work out the way they wanted it to, he would file a lawsuit. The class seemed shocked and his wife was embarrassed. I suspected that he didn’t want to know, was scared to know, or didn’t understand the value of knowing, the options that were available. He was choosing to leave all the responsibility to the care provider, while accepting none in return. I’m actually thankful that he made that comment, as it opened up a helpful conversation and spacious discussion about personal responsibility and opportunity, reflective study and informed choice. As the years have passed, I realize that there are many more “Marks” than I would have expected. So, the question is: Who “wants to know?” If you are one who does, I hope that today will be the beginning of your journey towards readiness. I hope that you find time to reflect, study and prepare to make your birth the very best it can be.

During the months of pregnancy and as we prepare for our labor and delivery, we are bombarded with information, advice and opinions. It seems that everyone, from the media, our caregivers, to our friends and families, has something to say about what is best for us and for our babies. In addition to what can seem like a deluge of opinions and birth stories that may influence us one way or another, we face decisions about testing, type of provider, place of delivery, pain management, interventions to speed or “enhance” the birth process, and how to care for our newborn. As a doula and childbirth educator, I often emphasize the importance of “informed choice” when women and their families consider their options and make decisions and plans during pregnancy and for childbirth. But what does this term mean, and why does it matter? And how can we find the information we need to make the decisions that feel right for our own unique experience – for ourselves and our babies?

An informed choice is a carefully considered decision, based on accurate information, an understanding of the various options available, the risks and benefits of each option and their possible results. Making an informed choice implies thorough education and clarification of issues to allow us to confidently decide what to do – or not do – in our own best interest and in the interest of our unborn children. In California, patients are protected under CACI No. 532, an informed consent law that states that patients have the right to a full explanation of any procedure, medication, drug, test or other treatment that is being considered as part of their care. Our care providers therefore have a responsibility to provide clear information, but the responsibility does not rest with them alone. As we prepare for the birth of our babies, we too have a responsibility to learn about our options and consider our choices.

Becoming informed enough to make a choice or confidently “consent” or “refuse” takes time. It requires time to research on our own, time with our medical caregivers who can shed light on benefits and risks, time to tease out and understand research and statistics, as well as time to consider the physical, spiritual and philosophical values and goals that we hold dear. While it initially may seem daunting and stressful to fully explore and understand our options, the decisions we make are extremely important, as they may be birth- or life-altering in unforeseen ways. For example, there may be certain physical or psychological consequences to having or not having had a specific test, procedure or intervention. Being educated about our options allows us to take responsibility for our health and for the health of our babies.

So how can we prepare ourselves to confidently make such decisions? Our decision-making must be preceded by investigation and understanding of alternatives. This process is most useful when undertaken before we are in the throes of labor. That is, before we are in the somewhat delicate and necessarily vulnerable state when our bodies and minds are functioning in a primal physical and emotional state, rather than an analytical and intellectual one.

I believe that one of the most proactive ways to feel confident about our decision-making is by nurturing a solid, trusting relationship with our medical caregiver (midwife or obstetrician). Our caregivers should be open to our questions and concerns and be willing to explain their reasons for, and thoughts about, any tests, procedures or interventions they recommend – or do not recommend. They should offer this information in language that is clearly understood so that we may make our decisions voluntarily and without a sense of pressure. If we feel that our caregiver appreciates and respects our need to know, our values, goals and determination to be a full participant in decision-making during our pregnancy and birth, then we are off to a healthy start. If, on the other hand, our questions are met with condescension, or we feel “brushed off” and are left out of decision-making, our ability to trust may be threatened. With mutual trust and respect, there is a much greater chance that conflict of any sort can be avoided and confidence enhanced.

When considering a specific option, we can use the acronym BRAND to help us get the information we need to make the decision that feels best.

B – What are the Benefits of this test, procedure, intervention?
R – What are the Risks of this test, procedure, intervention?
A – What are the Alternatives to this test, procedure, intervention?
N – What if I do Nothing?
D – Based on the information gathered, we make a Decision.

We can gather this information by asking questions of our caregivers; talking to a doula, a childbirth educator, other mothers; reading up-to-date books and seeking other sources of reliable information. While the Internet is an incredible resource with a wealth of information, we must be aware that not all information is cross-checked for accuracy or based on actual research. There is a risk of being misinformed or getting caught up on a site that is more a forum for emotion than evidence. One exceptional online resource is the Cochrane Collaboration (cochrane.org), a research organization which reviews studies and provides summaries of current evidence-based health care practices. Seeking recommendations from the key resources mentioned above can lead to sources of high-quality information.

An in-depth understanding of pregnancy and childbirth options, which allows for knowledgeable informed consent (or refusal), should benefit all involved:

- Benefits to the provider include more positive patient evaluations, possibly a greater number of referrals, possibly improved communication with patients, and the satisfaction that comes with a happy client.
- Benefits to the mother include greater trust in birth and in herself, enhanced communication with her provider and support team (which decreases fear), as well as a greater sense of empowerment and self-esteem.
- Benefits to the baby include the mother’s enhanced sense of connection and confidence, which, I believe, will enhance her awareness and capabilities as a new mother.

It is often said that if we don’t know our options, we don’t have any. When we commit to being active and informed participants in making decisions during our pregnancy and in preparation for the birth of our babies, we increase the chance for a positive and satisfying birth experience. We expand the range of options available to us and ensure that we are engaged in and involved with the process that will bring our babies into the world. This deep dedication to the birth process provides a powerful beginning to what may be the most magical time in our lives.

Anna Hurty is a Certified Doula (CD), Certified Childbirth Educator (CCBE) and Placenta Encapsulation Specialist (PES) living in Oakland. www.birthgarden.com

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Choosing Your Birthing Place

By Beah Haber, CNM, Eastbay Homebirth Midwifery

When considering where to give birth, women can choose to have their babies at home, at a freestanding birth center or at a hospital. Ultimately, the question that will lead each woman to the right place for her is, “Where do I feel safe?” Different things help different people to feel safe. For some, feeling safe may mean being supported emotionally so that they can be vulnerable. For others, it may be about where their babies can get the most effective and quickest medical care. Most likely it is a combination of the two.

For those who prefer to give birth at home, it is reassuring to know that statistics from the United States, and other developed countries, show that, for low-risk mothers, homebirth attended by quali?ed midwives can be as safe as birth at a hospital or birth center. This kind of personalized, continuous care and the absence of routine interventions can lead to increased satisfaction and empowerment for birthing mothers and their families. The midwife in attendance witnesses the process of birth as a rite of passage, while being attentive to possible complications and trained to provide appropriate interventions. The ability to transfer to a nearby hospital ensures quick access to medical interventions, if needed.

Freestanding birth centers attended by qualified midwives provide a second option for those considering an out-of-hospital birth. Birth centers offer a ‘homier’ setting than hospitals and present a safe and comfortable option for low-risk women. Some people believe that giving birth at a birth center is safer than giving birth at home as they expect that more equipment would be available in case of an emergency. In fact, the equipment at a birth center is the same equipment that a midwife brings with her to a homebirth. Other women may just prefer to go “somewhere,” other than their homes, to give birth. Therefore, for those who live too far from a hospital that provides maternity services, or whose homes do not feel comfortable or appropriate for a homebirth, a birth center may be the best choice.

Some mothers may choose to deliver their baby in a hospital due to a medical condition that develops during pregnancy. Other mothers will simply feel safer or more comfortable in a hospital setting. For those who do choose a hospital, and hope to have an unmedicated birth without routine interventions, it will first be important to choose a medical practitioner who shares the same philosophy of birth. It is important to keep in mind, however, that very few doctors or hospital-based midwives can guarantee that they will be available to attend the births of all of their clients. Thus, it will also be very helpful to work with an experienced doula and give thorough consideration to a birth plan. This thoughtful planning and preparation can help women ensure they have the information and support they need for a positive and satisfying birth experience.

If you are having a hard time choosing among these options you may want to talk with your doula, your childbirth instructor or other moms. Many midwives and doctors are also happy to talk with families to help them decide what is right for them.

Regardless of your choice, there is no wrong place to go. Each offers a different opportunity as well as a different challenge. Remember that only you and your family can choose what feels right for you.

Beah is a certified nurse midwife serving homebirth clients in the East Bay. She is committed to supporting all women and their families in choosing the birth place that feels best to them based on their individual hopes, needs and expectations.

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Tips from a Midwife:
Are there natural ways to induce labor?

July 1, 2010

By East Bay Homebirth Midwifery

There are many things that influence when labor begins. Hormonal changes, fetal development, stress, lifestyle, and even your own sense of readiness all contribute to determining when your baby will make its way into the world.

To improve your likelihood of going into labor “on time,” is important that you begin with the right due date. This is something you want to establish with the help of your provider during your first prenatal visit. Familiarize yourself with how your due date can be affected by both the date of the first day of your last period and the length of your menstrual cycle, and be aware that your provider may be using a calculation method that does not take these factors into account. You may find it useful to do your own calculation in advance, and to bring your calculation to your first visit.

Ultrasounds can never date a pregnancy exactly, and depending on when they are done, have a greater or lesser margin of error. Therefore, an estimated due date based on your last menstruation could be much more accurate than an ultrasound estimate. Avoid agreeing to a due date that seems wrong to you with the idea of clarifying it later on, as providers may base their recommendation to induce labor on the due date that was assigned at the beginning of your care.

Whether your body will respond to nudges towards labor and birth will depend primarily on the readiness of your cervix. Before labor begins, the cervix goes through a process of “ripening” or softening. A soft, buttery cervix can open more easily than a relatively firm cervix that has yet to ripen. This ripening process is influenced by prostaglandins, a hormone naturally produced by women’s bodies in late pregnancy. Exposing your cervix to semen, which is prostaglandin-laden, as often as possible during the last four weeks before your due date can make a big difference in readiness for labor.[i] Make sure that you remain in a supine position (lying on your back) to allow the semen to stay in contact with your cervix. (Please note that any kind of penetration should be avoided after your bag of water breaks to avoid increasing risk of infection.)

Your provider can get a sense of where your body is in the process of getting ready for labor by judging cervical effacement, dilation, and softening, as well as the location of your baby’s head. If, at 36 weeks of pregnancy, your provider finds that your cervix has not started to get ready yet you may want to use evening primrose oil, another rich source of prostaglandins, to help ripen it. Take two capsules daily by mouth, and at bedtime insert two capsules vaginally after first piercing them with a pin. You can also begin to take one of the late pregnancy (pre-labor) herbal tinctures that are available online, following the instructions on the bottle.

The use of acupuncture in late pregnancy is very valuable in preparing the body for labor. Find a practitioner who has experience with induction points, and expect that it will take about three treatments around your estimated due date to have an effect.

Sweeping or stripping of the membranes can be used to encourage labor. One of the risks of this procedure is spontaneous rupture of the membranes (breaking the bag of water, thereby creating a pathway for infection).[ii] This procedure must be done by your provider and it is important that it’s only done after careful evaluation of its benefits versus risks.

There is controversy about the use of castor oil to induce labor. In our practice we have used castor oil for over 20 years with great results if the cervix is ripe. Some practitioners claim that they have seen an increase in meconium (baby’s first stool) in the amniotic fluid when using castor oil, but that has not been our experience.

We have also had great outcomes with the use of a homeopathic spray solution called Birth Ease available in some herbal stores.

These are tools in our baskets. We often use a combination of several of them to induce a labor successfully. Make sure that you consult with your provider before deciding on your plan of action.

–Blessings from the midwives of East Bay Homebirth Midwifery

www.eastbayhomebirth.com

The information in this column is not intended to be used for medical diagnosis or treatment. Talk with your healthcare provider about any questions you may have regarding a medical condition.

[i] A study found that 6% of women who had sex an average of four times after 36 weeks were still pregnant beyond 41 weeks as compared to 29% of women who did not have sex during this time. See “Effect of Coitus at Term on Length of Gestation, Induction of Labor, and Mode of Delivery,” Obstetrics & Gynecology, July 2006.

[ii] According to one study, membrane sweeping increased the likelihood of prelabor rupture of membranes (breaking water) for women who were dilated 1cm or more at the time of the membrane sweep, but did not decrease the likelihood of induction or the average age of babies at birth. See “The Effect of Membrane Sweeping on Prelabor Rupture of Membranes: A Randomized Controlled Trial,” Obstetrics & Gynecology, June 2008.

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