Labor and Delivery
The Mind/Body Connection: What it Means For Mamas on Bedrest
June 24th, 2010Yesterday was my oldest sister’s birthday. She turned 52. She may not be too happy to know that I have blasted her age
to the masses, yet her birthday is truly an extraordinary event. My sister was a preemie. She was born at 6 1/2 months (they didn’t really do weeks back then according to my mother) and weighed a mere 3 lbs. She subsequently dropped down to 1 pound and everyone in the neonatal unit was sure that she wasn’t going to make it. But my parents, the wide-eyed teens that they were, never for one moment doubted that she would make it and yesterday’s birthday is a testament to that fact. My mom says that “I just never even thought about her dying.” I believe it’s that spirit that kept my sister alive. My mom also says that every time she visited my sister in the NICU, my sister would move and squirm. The doctors believed that this movement helped her to deep breathe and contributed to her survival.
We don’t talk much about my sister’s birth but it is still a clear memory for my mother. I realized this 8 years ago when I had my daughter at 36 weeks and 6 days and she was admitted to the NICU. My mother came down to support me and as we entered the NICU she stopped just inside and was momentarily frozen. I didn’t think much about it then but I now realize that my mother, in that moment, was reliving her own experience of entering the NICU to visit my sister. 44 years later, the NICU still had the power to halt (albeit momentarily) my mother.
Back in 1958 when my mother had my sister I am sure that no one discussed the mind/body connection and what it could mean for premature infants and their parents. But researchers now know that there is a very strong connection between the mind and the body-not only within an individual but also between people, especially between premature infants and their parents.
Last night I had the great fortune to attend a parent discussion group hosted by Hand to Hold, a non-profit organization dedicated to supporting parents of premature infants and children utilizing a mentoring model. New preemie parents are paired with “veteran” preemie parents so that the vets can help the new parents navigated the complicated hospital system, cope with the myriad of peaks and valleys that constitute caring for a fragile child and to be a support and a caring, comforting ear. Dr. Jennifer Gunter, OB/GYN, Physiatrist, pain medicine specialist and author of The Preemie Primer spoke about the mind/body connection and how it can have a huge impact on premature infants as well as their parents. She talked at great length about her own experience carrying triplets, losing one at 22 weeks and subsequently delivering the two remaining boys at 26 weeks. “Everyday I would say to myself and to the babies, Not today, not until 26 weeks.” She actually gave birth to her boys at exactly 26 weeks. Dr. Gunter also offered several good, simple techniques for parents 
to use when they are feeling overwhelmed.
- Take a deep breath that expands the belly not just the chest
- Go for a walk, outside if possible. Walking eases tension, forces you to take deep breaths and the fresh air and sunshine will help lighten your mood
- Use positive affirmations. Positive affirmations change the brain’s chemistry and actually affect how the body reacts. Dr. Gunter keep telling herself and her boys “not until 26 weeks” and helped delay her delivery. My mom kept talking to my infant sister and held it in her own mind that her baby would come home and she did.
- Yoga. Yoga is a great stress reliever and helps with breathing and calming the mind
- Dr. Gunter recommends that parents of preemies be screened for post partum depression 2 weeks after the birth of their child. This is also a good idea for parents who had a traumatic birth.
Mamas on Bedrest are at risk for delivery complications and premature delivery. This knowledge can be very troubling causing mamas to worry and fret. This is no good for you or your baby. As Dr. Gunter said, the emotional state of the mother does influence the baby. Worry releases brain chemicals that can have negative effects on both mama and baby’s health. Likewise, a positive attitude along with positive affirmations will release brain chemicals that have a calming and health enhancing effect on mama and her infant. I encourage you to begin cultivating a positive attitude towards your pregnancy, labor and delivery. Speaking positively about your child’s health-not only to yourself, but to your child. Studies have shown that babies in utero and out respond to their parent’s voices and to their environment. Keep the environment as calming, soothing and positive as possible. Read to your baby, sing to your baby, play music or just talk lovingly to your baby. This will release calming, positive brain chemicals into your blood stream that will subsequently make the in utero environment calmer and more health enhancing as well.
You’re doing very Important work, Mamas on Bedrest! Here’s to you and to healthy, full term pregnancies, safe and uncomplicated labors and deliveries and to healthy, happy babies.!
The Smart Mother’s Guide to a Better Pregnancy: Book Review
June 22nd, 2010
I have had the opportunity to read The Smart Mother’s Guide to a Better Pregnancy and I have to say that this is a really handy little book for expectant mothers. The book is broken down into four parts
1) Selecting the Right Healthcare Provider
2) Routine Prenatal Care and Potential Problems
3) High-Risk Problems During Pregnancy
4) Thirty-Six Weeks and Beyond
Each section really gives great practical information about how to navigate our crazy US health care system and in turn, to minimize potential misunderstandings or worse-life threatening complications to mother and baby.
Linda Burke-Galloway, MD, is the author and she really knows her stuff. She has specialized in high risk pregnancy for much of her career and has a particular interest in public health and safety. This passion is evident as you read through the book. She repeatedly provides vignettes pertaining to prenatal care and often provides real life stories of “what went wrong” to substantiate her recommendations. Several of her insights can only come from someone who has been there. This is especially true in “Selecting the Right Healthcare Provider”. Dr. Burke-Galloway gives step by step instructions on how to research a provider, including checking their credentials as well as investigating whether or not they have any legal judgments against them-past or present. She addresses the danger of selecting a provider from an insurance directory list without performing these crucial checks and she gives vital advice on how to deal with a provider who has decided not to obtain medical malpractice insurance as well as those with numerous satellite offices. An unknowing woman could easily fall prey to pitfalls of these practices, but with this book, they are educated, 
prepared and quite possibly protected.
My favorite section is, of course, the section on “High Risk Problems During Pregnancy.” Dr. Burke-Galloway gives very good explanations of chronic hypertension and pre-eclampsia. I have to disagree with her about incompetent cervix, however. She states that this is a fairly uncommon problem. Now perhaps it’s because most of the women that I work with are on bed rest or its this age of assisted reproductive technologies, but I see a lot of women with incompetent cervices. Now I don’t have over 20 years of experience like Dr. Burke-Galloway has, but in my observation and with the women with whom I am dealing, incompetent cervix is not “infrequent”.
One of the best parts of the book is the list of references at the end. Dr. Burke-Galloway gives an extensive list of resources for women to be able to do the research and to ask the questions that she suggests.
I was a little disappointed that Dr. Burke-Galloway did not address VBAC at all. There was no mention of giving a woman a trial of labor after a c-section or what to do if you wanted to try for VBAC. While Dr. Burke-Galloway may not be a VBAC advocate herself, I do think that this topic-so prominent in today’s health care debate and in discussions on how to reduce maternal mortality-at least deserved a mention. I was also disappointed that she did not mention methods of labor relaxation such as showering, using a birth ball or other tools, massage or other means of relaxation. It seemed like she was only advocating a “mechanized” labor and delivery-in hospital, in bed, fetal monitor attached. This tone will likely turn off a lot of women.
I was also surprised that Dr. Burke-Galloway did not speak more about post partum depression. She gave some important facts and statistics, but didn’t really delve into the etiology of post partum depression. I really think that it would have been helpful if she had talked about a patient of hers that had had post partum depression, how she diagnosed it and how she treated it.
Which brings me to my final comment about this book. I am a physician assistant by training so much of this book was a good review for me. Yes, I did learn some new things while reading it but much of it was review. As I read the book, I felt a real distance from the author. This is not a “warm read”. Now granted, these aren’t “warm and fuzzy” topics about which Dr. Burke-Galloway is speaking. Yet, for a book that is directed at mothers-and I am assuming laywomen-this book was too formal. For example, Dr. Burke-Galloway uses the term “Labor Assistant” in the section on labor and delivery. Why not use “doula”? I realize that there are more than one type of labor coach. It could be a spouse or family member. But in my experience, when women think of a labor coach or assistant, they are referring to a doula.
In some ways the book reminded me of a Grand Rounds presentation (a presentation where one health care professional is speaking to a group of other health care professionals). Much of this book made sense to me because I have previous education and experience from which to draw. My concern is that many women who may read this book may miss a few of the points that Dr. Burke-Galloway is trying to make because they won’t have the frame of reference in which to place the topic. For example, in one section, She talks about having “spirited discussion” over a case with another provider. Why not say “We argued”? In fact, if she could have shared some of the argument, I think it would have given meat to what she was trying to say. Much of her stories are bare bones facts and it would be nice to have more “flesh” to be able to draw a fuller mental picture. In one section she talks about a colleague who was delivering. Why not give her a name (even a pseudonym) and refer to her by name instead of as “my colleague”? She talks about feeling relieved after such a difficult delivery, but it would have had more impact if she had given just a few more details, let us know how concerned she was, the specific perils she faced and how she managed them and then talked about the relief she felt after.
These last comments are purely stylistic and in no way take away from this book. I am simply suggesting that if Dr. Burke-Galloway writes subsequent editions (which she says she wants to do in the forward and afterward) that she make the text more conversational. It is a good book and I think that it will help a lot of women-especially a woman who may be relocating to another area and needs to find a new provider or a woman who become s pregnant unexpectedly and is really unprepared for what she needs to do to take care of herself and her baby. However, I think that for a number of women, the cool tone and the lack of attention to more holistic methods will be a turn off.
Doulas are for Women Who Have Planned Cesareans
May 24th, 2010Every now and then I come across something that is so powerful that I have to share it. So it was with this blog post.
“Doulas are for Women Who Have Planned Cesareans“ is a wonderfully thought out and beautifully written blog post by Kristen Oganowski of Birthing Beautiful Ideas. (www.birthingbeautifulideas.com). Kristen is a mama to two little guys as well as a wife to a pretty cool big guy (her words not mine!) and a future lactation educator who’s working on a PhD in philosophy. She’s also a birth and breastfeeding advocate, a lover of good food and wine, an obsessive fan of various books and television shows. Kristen blogs about childbirth, her work as a doula, breastfeeding, being a mom and how crazy life can be when one has all these elements to juggle.
After I read this post, I immediately contacted Kristen to ask if I may share it with you, the many mamas on bed rest and those who love and support them. Too often high risk pregnant women (aka Mamas on Bedrest) feel powerless and without options. Kristen’s post is yet another reminder that no matter how tough it gets, it’s still your birth, your body and your baby. So Thank you, Kristen, for this fabulous reminder and for hopefully empowering many mamas on bed rest to seek out the births that they want and the support necessary to get them.
The Original Blog Post
It can sometimes be a mental hurdle for people to get past the idea that doulas aren’t only for women who choose a “natural” or drug-free birth.
It can be even more of a mental hurdle for people to get past the idea that doula support is only for women who are planning vaginal births!
But in reality, doula support can be quite valuable for women and families who are planning a cesarean section for the upcoming birth of their child (or children). Here’s how.
*
A doula can help you to create a cesarean birth plan.
Yes, you can create a birth plan or birth preference list for a planned cesarean section!
And a doula can help you to determine what preferences you would like to include on your list. What’s more, she might even inform you of some options that you didn’t even know that you had!
For instance, would you like to specify that your urinary catheter to be inserted after the spinal epidural is placed?
Would you like someone to explain the surgery to you as it happens?
Would you like to have music playing during the c-section?
If your baby is healthy, would you like to be able to hold him or her while you are being moved to the recovery room (with assistance, if needed)?
Do you have any postpartum preferences, such as those related to breastfeeding or vaccines?
These items and more can all be included in a cesarean section birth plan or preference list.
(If you’d like to read more about cesarean birth plans, Morgan at Adventures in Diapering and Beyond created this example of a C-section Birth Plan for her readers. She has had four c-sections herself and has some great experiential wisdom to offer here.)
*
A doula can take the time to discuss your feelings about the c-section and offer any tips or advice on recovery well before the big day arrives.
Especially if this is your first cesarean section, you might have some fears or concerns about your upcoming surgery. Well before your baby is born, a doula can help you practice relaxation techniques (such as breathing exercises or visualization) that you can use during the epidural or spinal placement, throughout the surgery, and during your recovery period.
Where appropriate, a doula can even help you to devise ways to alleviate your fears or concerns in your birth preferences list. For instance, some women who become nauseous at the very thought of surgery might request that no one describe the cesarean section as it happens–or at least that any conversation between the medical staff be as least graphic as possible.
A doula can also help you to plan ahead to ensure that you to have your best recovery possible. Whether it’s demonstrating the breastfeeding positions (such as the football hold) that seem to be most comfortable to women recovering from a c-section, or recommending that you bring a breastfeeding pillow (such as a Boppy or My Brest Friend) to wrap around your abdomen even when you’re not nursing, or suggesting that you ask friends to offer to perform light housekeeping in lieu of bringing baby gifts, a doula might be able to offer you just the sorts of tips and advice that will make your initial recovery from major abdominal surgery as smooth as possible.
*
A doula can support your husband, partner, or other support person while you are being prepped for surgery.
In many cases, a dad and/or a doula is not permitted to accompany a woman into the operating room during the initial preparation for surgery (including the spinal or epidural placement).
And in many cases, dads or partners are extremely nervous during this waiting period!
A doula can help a woman’s support person to remain calm while s/he is waiting for the “okay” to enter the operating room. She can help to describe what will likely occur during the surgery, she can remind him or her of any “responsibilities” that s/he might have (such as taking pictures after the baby is born), or she can even just offer the general emotional support and encouragement that the dad or partner might need at that very moment.
If your anesthesiologist and OB/GYN allow it, your doula can remain by your side during the surgery.
In some cases, care providers will allow a second support person (such as a doula) to accompany a couple during a cesarean section.
This can be particularly helpful after the baby is born. Oftentimes, the baby must be monitored in an area of the operating room that is relatively far away from the mother. Sometimes, this monitoring is even performed in a separate nursery. With a doula by your side, your husband or partner can go to be near the baby without having to worry about leaving you alone.
In addition, it can be particularly helpful for a woman to have a doula by her side while her uterus is being repaired. To the surprise of many women, this is the longest part of a c-section, ranging anywhere from twenty minutes to a couple of hours, often depending on how many previous cesareans a woman has undergone. Having continuous emotional support from a doula at this time can be exceedingly important for some women.
If you would like your doula present during your cesarean section, especially if you plan for your husband or partner to accompany you as well, please make sure to discuss this option with your care provider and with the hospital staff. Often, the policies on this issue vary from doctor to doctor.
*
Your doula can offer physical and emotional support in the recovery room.
The initial recovery period can be quite stressful for a new mom. Her spinal or epidural is wearing off, she may feel groggy from that or other pain medication she is now receiving, and she has very limited mobility. And did I mention that she also has a new baby?!
A doula can help both a mom and her partner to have as peaceful a recovery as possible. She can guide a mom through various physical comfort measures (such as guided breathing or visualization) if the mom is experiencing a lot of pain. She can help with positioning, both for breastfeeding and for simply holding the baby. She can take pictures, she can wipe away tears, and she can even set up an appointment to join you at the hospital later that day or the next to help you as you regain your mobility and begin the sometimes arduous task of walking.
And when desired, she can recommend local or national groups (such as ICAN) that can offer you peer-to-peer support in your physical and emotional recovery.
*
So while doula support during a planned cesarean might look much different from doula support during a planned vaginal birth, it is still the same in spirit. In other words, a doula can still offer physical, emotional, and informational support to you before, during, and after your cesarean birth.
And you might even be surprised find how much this support enhances your experience and eases your recovery!
- Doulas are for (Women who Have) Birth Partners
- Doulas are for Women who Want Epidurals
- Doulas are for Women Who Don’t Think They Can Afford One
If you liked this blog post, sign up to receive our blog regularly via RSS feed. If you want to be first to know about information and support pertaining to high risk pregnant women, sign up to receive our newsletter.
