Archive for the ‘Shelley’s Blog’ Category

While the debate will always continue about the safety of homebirth vs hospital birth, a recent meta analysis of 14 studies which included 500,000 women concluded that in LOW RISK women, home birth did not pose a higher risk for either moms or babies than LOW RISK women in a hospital setting. The Authors concluded:

Planned home birth is a reasonable option that should be available to childbearing women as part of the maternity care system, and to achieve optimal outcomes, home birth practitioners should be integrated into the maternity care system.

We still have a long way to go in the United States in offering options to childbearing women– but hopefully this is a step in the right direction! Read more here: https://www.lamaze.org/Connecting-the-Dots/Post/research-review-systematic-review-finds-no-increase-in-adverse-outcomes-with-planned-home-birth-1

A recent ACOG article made the following recommendations, which have been part of the Lamaze Healthy Birth Practices for some time now! For low risk women in labor, it is recommended that women wait until active labor before being admitted, have freedom to move around and change positions to maintain comfort and enhance labor progression, to utilize non-pharmaceutical pain management techniques such as massage and/or water immersion, to do intermittent fetal monitoring, follow your body’s urges to push (not forced long breath holding) and – for those desiring it- 1:1 physical and emotional support from a doula! There are a few more details in the article as well- but the big message is- if you are low risk, limiting routine interventions is best for both mother and baby outcomes- things like routine IV’s, continuous electronic fetal monitoring, and amniotomy have NOT been shown to improve outcomes.

Ultimately – talk to your provider about what is best for you and your baby. Open up communication with him/her about your desires or wishes. Find out what is “routine” for their practice or the hospital where you’ll be delivering. (Birth centers and homebirth midwives generally follow the low intervention protocol- unless a medical situation warrants interventions) Stay involved in your care and make decisions if those “routines” apply well to your scenario. Don’t be afraid to speak up for what you want!

Here is the BRAIN acronym I use in my classes when we talk about medical interventions in birth:

B- Benefits- tell me how this could help me, my baby, or my labor

R- Risks- tell me about the potential risks/side effects or trade offs for this procedure/treatment

A-Alternatives- what else should I consider (including non-medical alternatives)

I-Intuition- how do you feel about this intervention?

N-Not now- if not an emergency, take some time to think about it, discuss your options with your support team, or just wait and see what happens!

 

 

Here is a link to an interview https://soundcloud.com/ptbelowthewaist/doula with me hosted by Jessica Chastka who is a Physical Therapist who specializes in pelvic floor issues. She works for Sullivan Physical Therapy in North Austin. https://www.sullivanphysicaltherapy.com/

In our interview, we take a look at what doulas do, both in their role as birth and postpartum professionals, and debunk some myths about doulas. We talk about finding a doula, what to expect, what questions to ask, how much doulas cost, and what exactly doulas do/don’t do in their roles.

And–what does a pelvic floor PT do? Well, I should let Jessica talk to you about that since she’s the expert… but what do I refer my clients/students to PT for? Lots of things. Here are the most common:

Urinary incontinence  (leaking pee) during/after pregnancy (this is common but does NOT have to be something you live with!)

Diastasis Recti (separation of the abdominal muscles) after pregnancy

SPD pain during pregnancy (loosening of the pubic bones in pregnancy)

I also refer to pelvic floor PT to my clients who have had previous pregnancies where babies were malpositioned. (breech, OP or acynclitic) which often results in a cesarean birth. In particular, if they are planning a VBAC, I’ll recommend they seek PT to make sure their bodies are balanced for the upcoming labor/birth. PT’s can work on the soft tissue (muscles/ligaments, etc) to help the uterus and pelvic floor function normally which is critical for normal placement of the baby and facilitates an easier vaginal birth!

Thanks Jessica for hosting the interview!

 

Lots of families come into my childbirth classes asking how they can reduce their risk of having a cesarean birth. We talk about what the research has clearly indicated, which includes:

-Get good prenatal care, eat well, exercise, go into labor as healthy as possible

-Stay at home during early labor

-Avoid medical interventions, especially induction and continuous fetal monitoring, unless medically indicated.

-If a mom wants an epidural, wait until labor is well established (5cm or more)

-Wait until the baby is low enough before pushing

-Hire a birth doula

One thing that has not come up in the articles or research though is something that needs to happen way before all these things… and that’s CHOOSE A PROVIDER WHO HAS A LOW CESAREAN RATE. My students are often surprised to hear that while our cesarean rates at our local hospital here in Austin typically fall into the “average” range matching the national averages, the rates actually vary greatly from physician to physician. A recent article in the Science and Sensibility blog outlines some research which shows clearly that provider attitudes vary greatly, and that does indeed influence their recommendations when it comes to making decisions about performing a cesarean. https://www.scienceandsensibility.org/blog/providers-support-vaginal-birth?source=1&utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+science-sensibility+%28Science+%26+Sensibility%29

What can you do? Ask your provider about their cesarean rate for low risk, first time moms who have a head down baby at full term. (This is known as the NTSV rate) Find out how this rate compares to the “target” rate of 24%… Ask him/her the reasons they usually do cesareans, and their general attitude about cesareans. You’ll get a feel for things, and if they seem to not be in alignment with your beliefs, you may be better off finding another provider.

From a medical/physical perspective, the postpartum period lasts 6 weeks. From a social/psychological perspective, it’s the first year of motherhood.

In our culture, families tend to get a lot of “attention” the first week or two after a baby is born. Visitors, helpers, meals, etc. Then everyone gets back into their normal routine and mom is left with a baby all on her own, especially after her partner returns to work.  She may feel overwhelmed, isolated (it’s hard to get out when a baby is nursing every 2 hours) have a ton of questions about what’s normal. Her relationship with her partner has changed. Perhaps these days alone with a baby are not what she expected. She’s probably tired- maybe exhausted.  Maybe breastfeeding is going well- maybe not. She can barely fit in time for a meal, let alone a shower or nap. How will she figure out laundry, meals, grocery shopping or cleaning? How can she figure out this baby? How can she keep her sanity?

Postpartum/new mom support group to the rescue! This is the place for new mamas and babies to meet, have honest discussions about what new mothering is like, normalize the emotions during this period, setting up expectations for both moms and partners. This is the place for a good cry. Loving support and encouragement. Discussions about changing relationships, frustrations with family expectations, discovering your “new” self as a new mom.

I encourage new moms to come as early as they can manage it- ideally by week 3 or 4.  I hear often that moms don’t come because “they didn’t get a shower”, or “the baby might cry”, or “I haven’t mastered public breastfeeding yet”, or “I’ll come when things get easier”. This group is for moms well before all that works out! You are welcome in your pajamas or yoga pants, with or without a shower, with a fussy baby. Don’t worry about public breastfeeding- we’re all mamas. This is the space for non-judgemental support, information, and encouragement. You might even make some wonderful friends.

There are several groups in the Austin area. My resources page has local listings. Many are free! Find a group and come on out! If you are on the north side of town, come and see me, every Wednesday at noon at Thrive Chiropractic. https://www.facebook.com/newmamahappyhour/

NEW: I’ll be offering a comprehensive “Birth in a Day” class through Austin-Born doula collective with my colleague Amanda Wyszkowski! We are super excited to partner our collective 30+ years in the birth field to offer FUN and informative classes to first time parents in Austin. Our 1-day comprehensive class will leave you with all the info and tools you need to confidently bring your baby into the world, without having to give up weeks of your time learning the ropes. Austin-Born Childbirth Education

 

OBGYN North Patients only- Please call the office to register!

Prepared Childbirth (first time parents): Feb and March classes are already full

April 9, 16, 23, 30th 6:30-9pm

April 3, 10, 17, 24 6:30-9pm

April 30, May 7, 14, 21 6:30-9pm

May 1, 8, 15, 22 6:30-9pm

June 4, 11, 18, 25 6:30-9pm

May 29, June 5, June 7, June 12 6:30-9pm

VBAC class (ideal in 2nd trimester):

Sunday 3/25 12:30-3pm

Sunday 5/20 12:30-3pm

Labor Skills (refresher for 2nd/3rd timers):

Sunday 2/25 3:30-6pm

Sunday 3/18 3:30-6pm

Sunday 4/29 3:30-6pm

Sunday 6/24 3:30-6pm

 

OBGYN North (their patients only- call the office to register) Classes are on a first come, first served basis and have limited space, so it’s recommended that you sign up early!

Prepared CB June 5, 12, 19, 26 6:30-9pm

Prepared CB June 6, 13, 20, 27 6:30-9pm

VBAC Class June 4, 12:30-3pm

Labor Skills June 25, 3:30-6pm

Prepared CB July 10, 17, 24, 31 6:30-9pm

Prepared CB July 11, 18, 25, Aug 1 6:30-9pm

VBAC July 23 12:30-3pm

Prepared CB Aug 7, 14, 21, 28 6:30-9pm

Prepared CB Aug 8, 15, 22, 29 6:30-9pm

Labor Skills Aug 27 3:30-6pm

OBGYN North/Natural Beginning Patients: Classes may be added as the need arises. Please call front desk to register/check on availability or be put on a waiting list for a new class! 

Prepared Childbirth series  evenings 6:30-9pm

Tuesdays March 7, 14, 21, 28 (full)

Mondays April 3, 10, 17, 24 (full)

Tuesdays May 2, 9, 16, 23

Mondays June 5, 12, 19, 26

 

Prepared VBAC:

Sunday Mar 26, 12:30-6pm (full)

Sunday June 4, 12:30-6pm

 

Labor Skills Class:

Sunday Feb 26 12:30-6pm (full)

Sunday Feb 26 3:30-6pm (full)

Sunday April 30 3:30-6pm

Sunday June 25 3:30-6pm

 

St Davids North Austin Medical CenterPlease call Parent Ed 512-544-4226 to check on availability and register:

Reality Childbirth Classes:

Sat March 3 and Sun March 4 10am-4pm each day

Sat April 8 and Sun April 9 10am-4pm each day

Sat May 6 and Sat May 13 10am-4pm each day

Sat June 3 and Sat June 10 10am-4pm each day

VBAC class, PlannedCesarean Class, and Advanced Coping Skills classes are also offered regularly. Call for schedule.

Any Baby Can – Wednesday evenings 6:30-9pm. Call 512-454-3743 or register online www.anybabycan.org

March 1, 8, 22, 29 (no class spring break)

May 3, 10, 17, 24

Are you an expectant mama or a mama with a new baby? Do you have questions about birth, babies, breastfeeding, motherhood? Want to share your story, learn from others? Is motherhood exactly what you expected? Or not? Do you just need some adult interaction with other mamas? No matter your reason, we are here.

New Mama Happy Hour is a FREE support group hosted by birth and postpartum doulas just for you. We meet every Wednesday from noon to 1:15pm at Thrive Chiropractic, located at 15501 Ranch Road 620 N. ste 1200 Austin 78717. (just west of Mesa Rosa restaurant) Come as you are- no makeup, yoga pants and all. Bring a snack for yourself- or not. Older sibs are welcome but we do not provide childcare. Just a space to chat, laugh, listen, and offer non-judgemental support for those of you taking this journey from pregnancy into motherhood.

Juicy topics include sleep (or lack thereof), normal newborn behavior and development, going back to work/childcare, emotions, changes in our family/relationships, older sibling adjustment and more! If you have questions, contact me. 512-468-8526

 

How does a doula really make a difference?
Results from different studies have all suggested that having a doula reduces the overall cesarean rate by 50%, Pitocin use by 40% and requests for epidurals by 60%. The use of a doula also showed a major reduction in the length of labor due to fewer stress hormones being produced in the laboring woman’s body.

The Doula Book © 2002; Klaus, Marshall, Klaus and Kennell.