Labor
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.!
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.
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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.)
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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.
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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.
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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.
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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
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What Healthcare Reform Means for Mamas on Bedrest
March 25th, 2010I have been somewhat glued to the television these past few days as I have watched the Health Care Reform bill voted on in the House of Representatives and then signed into law by President Obama. There is a lot of controversy surrounding the new law, but the bottom line is that there are some health care revisions on the horizon and Mamas on Bedrest stand to benefit.
When a woman receives a high risk diagnosis, medical interventions are not far behind (or I should say More medical interventions). There are the endless ultrasounds, Non-Stress tests, blood tests and office visits-and that’s just before the birth. If a woman goes into preterm labor, she may have a cesarean section to “avoid potential complications”. If she delivers a premature infant, the costs can skyrocket. If the baby spends a long time in the neonatal intensive care unit (NICU), even with the best of insurance policies, the family’s portion of the medical costs can reach well into the thousands and in some cases a million dollar. Who has that kind of money? The question that we all have to ask is, “Even if a woman has a “high risk pregnancy” how much of the current interventions and technologies are really necessary?”
Childbirth Connection, a national not-for-profit maternity advocacy organization, is dedicated to making evidence based improvements to maternity care. Their mission is to improve the quality of maternity care through research, education, advocacy and policy. Childbirth Connection promotes safe, effective and evidence-based maternity care and is a voice for the needs and interests of childbearing families. This description may seem pat but let’s take a look at what Childbirth Connection is doing for maternity practices in general, Mamas on Bedrest in particular, and see how they are advocating for all women in the Health care Reform Debate.
For the past 2 1/2 years, the leaders and advocates of Childbirth Connection have been studying maternity practices in the United States and what they found is nothing short of shocking. Citing statistics from Agency for Healthcare Research and Quality and the National Vital Statistics Reports (both reports are dated 2009),
“Childbirth and birth-related conditions are the most common reasons for hospital care, accounting for one-fourth of hospital discharges in 2007. In that year, cesarean delivery was the most common operative procedure in the country, comprising 31.8% of births. Meanwhile, the incidence of vaginal birth after cesarean (VBAC) has declined to 9.7% (from 35.3% in 1997)”
According to “The National Hospital Bill: The most expensive conditions by payer (2006)” the Agency for Healthcare Research and Quality states that in 2006, charges for “mother’s pregnancy and delivery” and “newborn infants” were $86 billion — far exceeding charges for any other hospital condition. At this rate who can afford to have one child let alone more than one? And keep in mind, these statistics are for the so called “normal” births. Heaven forbid there are complications and intensive care admissions as is often the case for Mamas on Bedrest. What then?
But hang on, the most alarming statistics (at least in my opinion) were presented by Childbirth Connection. In the course of their research, Childbirth Connection noted that rates of preterm birth have increased to 12.7%, and rates of low birth weight infants rose to 8.2% in the past two decades.
So let me get this straight. Americans pay more for health care than any other industrialized nation. We are the only industrialized nation that charges its citizens for health care. It’s true that we have some of the most advanced technologies available and some of the most cutting edge research is taking place in American research centers. But the sad truth is that all of the money spent and all of the technology has not translated into improved outcomes. In fact, The Unites States has some of the worst maternal and infant mortality rates not only in the industrialized world, but in the world as a whole. And, if a US citizen is uninsured or unable to pay for treatment, they have virtually no access to medical care. So what are we gaining with all of our technological advances?
Since 2008 Childbirth Connection has been researching and analyzing the health care delivery system as it pertains to maternal and infant care. In 2008, organizational leaders authored “Evidence-based Maternity Care: What It Is and What It Can Achieve,” a Milbank report that takes stock of the US maternity care system and identifies a wealth of opportunities for improving quality, outcomes, and value. It is truly a comprehensive assessment of what is wrong and what is right with maternal and infant health care delivery. As a result of this study, Childbirth Connection and health care policy experts and advocates have come together to form Transforming Maternity Care. This project has been in effect for the past 2 1/2 years and it is a candid assessment of what needs to happen in order to improve maternity services.
MedScape’s Katharine Hikel, MD caught up with Childbirth Connection’s Carol Sakala, Phd, MSPH, The Director of Programs for Childbirth Connection and a co-editor of the publication, to assess what The Blueprint for Transformation* has uncovered via its research and what strategies it proposes in an effort to redirect the current course of maternity care in the United States.
Discoveries and Inefficiencies
- Maternity Care (which includes moms and newborns) accounts for 25% of all patients discharged from the hospital.
- There exist considerable overuse of interventions that may pose risk and expense without benefit, underuse of beneficial practices and broad practice variation that largely cannot be explained by needs and preferences of childbearing women and their newborns.
- Not enough Evidence-Based, reliable data exists to justify many of the current procedures and protocols.
- Two major interventions that are overused are labor induction and cesarean section and many times have no clear indication for use.
- Epidural anesthesia is widely overused and is known to slow labor and create need for other interventions
- The Milbank Report also presents data on overuse of continuous electronic fetal monitoring, artificial rupture of membranes, and episiotomy.
Proposed Changes- Most of these underused techniques are proven effective by Evidence-Based research in relieving labor and delivery discomfort, promoting maternal and fetal wellness and curtailing hospital labor and delivery costs.
- smoking cessation interventions for pregnant women;
- External version to turn babies to a vertex position at term;
- Continuous support during labor (such as from a doula);
- Use of hydrotherapy to promote comfort and labor progress;
- Non-supine positions for giving birth;
- Early skin-to-skin mother-baby contact;
- Interventions to increase initiation and duration of breastfeeding;
- psychosocial and psychological interventions to relieve postpartum depression.
Sakala also addresses the fact that obstetricians and other health care providers involved in providing maternity care have recognized the vast variations in practice styles. Childbirth Connection has approached these various groups and has received widespread support of its initiatives. In order to clearly identify the shortfalls and a path towards repair, Childbirth Connection’s committees have developed two written reports:
The first report, “2020 Vision for a High-Quality, High-Value Maternity Care System,” from the project’s Vision Team, clarifies where we need to head.
“Blueprint for Action: Steps Toward a High-Quality, High-Value Maternity Care System,” from the project Steering Committee, summarizes priority recommendations for getting there. It is available for review and download as well as in bound, published form.
With so many initiatives ready to be implemented, it’s hard to imagine that there is still a lot of work left to be done. But as with any recommendation for change, the path to progress is often slow. Sakala is heartened because the Vision team and Steering committee at Childbirth Connection have identified clear cut areas of deficit and proposed clear cut pathways to change. Now it is time to work with all of the various providers, agencies and organizations to implement these changes and to truly deliver health care reform in Maternity Care.
Mamas on Bedrest, be a part of this change! Voice your opinions and concerns regarding childbirth and high risk pregnancy and childbirth in particular. Childbirth Connection is really working hard for all moms, but we can’t let the focus be only on “uncomplicated” pregnancies. We are the ones with much to lose and everything to gain. Submit your comments and I will submit them to those that I know at Childbirth Connection and to other influential advocates.
Sign up for the Mamas on Bedrest newsletter (Upper right hand corner of this page!!) so that you can keep up with the advocacy efforts and learn what progress has been made on your behalf. Whenever there is news on the high risk maternity front, you’ll be first to hear it! (after me of course) ~DTL
* If you are interested in having the full Transforming Maternity Care Vision and Blueprint, you can order the Women’s Health Issues Journal, Volume 20 Number 15, January/February 2010 from Elsevier Publications.
