Shelley Scotka

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For the first time, expectant parents can easily find out the cesarean rates for their local hospitals!! The Leap Frog Group http://www.leapfroggroup.org/c-section did a voluntary survey to hospitals nationwide to determine cesarean rates by state. The numbers are so interesting! Overall, the National rate remains about 33%. The Leap Frog Group adopted the rate of 23.9% as an acceptable rate as proposed  by the HealthyPeople.gov 2020 initiative http://www.healthypeople.gov/2020/topics-objectives/topic/maternal-infant-and-child-health/objectives.

Texas as a state (based on the reporting hospitals) is running #29 with a 29.8%. Here are our local hospitals rankings:

St Davids South Austin 39.3%

St Davids North Austin 34.3%

Seton Medical Center 31.5%

Seton Hayes 31.3%

St Davids Medical Center 30.5%

Seton Northwest 28.2%

St Davids Round Rock 27.6%

St Davids Georgetown 23.9%

Seton Williamson 22%

Scott & White Round Rock 16.4%

Cedar Park Regional, Lakeway Regional, and Seton Southwest declined to respond.

Interesting notes: Hospital with the LOWEST c-section rate in Texas is the Doctors Hospital at White Rock Lake in Dallas with an amazing 12.6%!! The Texas hospital with the highest rate is Covenant Medical Center in Lubbock with an embarrassing 52.9%

Having worked with women now for nearly 20 years, I can honestly say, in my very “unscientific” way, that women change when they give birth. Really change.

Every woman who has been there knows what I’m talking about. We feel differently, we think differently, we act differently. My friend/former client Cathy O’Neill, one of the authors of “Babyproofing Your Marriage” calls it the “Mommy Chip”. Well, scientists seems to have finally “found” the Mommy Chip!

This article outlines what we’ve “known” and “seen” for years- a change in how our brain works, likely to be related to the hormones of pregnancy, birth, lactation and postpartum.

Helping moms through the initial changes  physically and emotionally seems even more critical, in getting parenthood off to a good balanced start. Our culture has forgotten the 40 days of “lying in” that is so prevalent in many parts of the world– where a woman does nothing for 40 days postpartum (that’s nearly 6 weeks!) but care for her baby. She is nurtured and fed. Her home, husband, and other children are cared for, so she can rest, nurse, and get to know her new baby. This support allows a woman to “give in” to the Mommy Chip urges, heal physically, and gently adjust to the new change in her family.

Sometimes this help comes from family, friends, and neighbors, but not everyone has those resources. When they don’t (and sometimes even when they do) a postpartum doula can be a lifesaver. Postpartum doulas are specifically trained to assist the family during this transitional time, helping the mother with breastfeeding, her baby, and her household. A doula will help build a woman’s confidence so that eventually she feels more and more capable to handle things on her own. A doula may make recommendations, offer suggestions, or provide resources to a new family to smooth the transition. She may teach skills, such as babywearing. She may educate, on baby care and breastfeeding, baby safety in the home, or self care. She may validate a mother’s feelings, or choices in parenting. She may nurture the Mommy Chip.

Studies indicate as many as one in six women suffer from some kind of postpartum mood disorder (PPMD) such as depression or anxiety. Could we greatly reduce these numbers, and the severity of some cases if we provided better care to mothers during this critical time?

The American College of Obstetricians and Gynecologists in their most recent bulletin Read the Article Here reviewed the statistics for primary cesareans over the years, and has concluded that… hold onto your hats folks… that we are doing too many! We need to be taking action to reduce the primary cesarean rate, which will of course reduce the repeat cesarean rate, bringing the numbers down significantly. One main topic in the article is about being patient. In previous years, we’ve “called it a section” after too many hours (often 2) with no progress. The new recommendation is to BE MORE PATIENT and wait before making those decisions. When we do, we see more vaginal deliveries without compromising the health of the baby. Who knew!?

The other BIG NEWS– at the very end of the article, it states:  “Published data indicate that one of the most effective tools to improve labor and delivery outcomes is the continuous presence of support personnel, such as a doula. A Cochrane meta-analysis of 12 trials and more than 15,000 women demonstrated that the presence of continuous one-on-one support during labor and delivery was associated with improved patient satisfaction and a statistically significant reduction in the rate of cesarean delivery (111). Given that there are no associated measurable harms, this resource is probably underutilized.”

Probably underutilized? Probably.

I am thrilled to say I have partnered with OBGYN North to offer in house childbirth classes for their patients. These classes, which have been customized to fit with the philosophy and style of their practice, will be perfect for first time as well as experienced parents. They will be suitable for those delivering at the hospital OR birth center!

Prepared Childbirth: A 4 week series for first time parents, which will help you understand what is labor, practice a variety of ways to cope with labor pain including breathing, relaxation, positions, massage, visualizations and more. Also included is a discussion of medical interventions- why, when, and how to decide.  What if you decide on an epidural? What is a cesarean becomes needed? We’ll cover it all, even a short and fun discussion about what to expect during the postpartum period.

Preparing to VBAC: A one time 2.5 hour workshop designed for those who are wanting to have a Vaginal Birth After Cesarean. This workshop reviews the most up to date literature on the safety and outcomes of VBAC, as well as helps women and their partners understand what they can do physically and emotionally to create the best odds for success.

Labor Skills: A one time 2.5 hour workshop for those who just want to work on labor skills for birth. Ideal for 2nd or 3rd time parents who want a “refresher” or for those who need to expand their “skill set” for labor. Lots of hands on with breathing, relaxation, positions, touch and massage, acupressure, and how to deal with challenges in labor.

For more info and find out how to register:

http://obgynnorth.blogspot.com/2014/01/in-house-childbirth-classes-exclusively.html

Of course you probably know by now that I am a strong advocate for normal physiologic birth. However, even the most “crunchy” of us agree that there are times when a cesarean birth is absolutely the right choice. For those families who need a cesarean, they too deserve to birth surrounded by compassion, joy and gentleness. Yes, it’s major surgery. But still the birth of a baby, of a family. Particularly when planned ahead of time, in a non-emergent situation, a more family centered approach is working in other parts of the country, and can work here too. You just might have to ask for it! If you know you need a Cesarean in advance, consider taking my Planned Cesarean Birth Class.

What is Family Centered Cesarean Birth? How is it different from the routine Cesareans we have been doing?

Routine Cesareans typically go down like this: Mom goes into the OR to get prepped for surgery. Her one support person enters when it’s time for the surgery to begin. The doctor delivers the baby within about 5 minutes and the baby immediately goes to a warmer with a nurse for assessment and suctioning. Usually after a few minutes, if the baby is doing well, they swaddle the baby and allow the support person to bring the baby to mom for a quick meeting. They might be able to enjoy a whole 5-10 minutes together before a helpful nurse says “Ok Dad, let’s take that baby over to nursery”. The chosen support person and baby are escorted to nursery where Baby gets a more thorough assessment, basic meds (eye ointment and vitamin K shot) and sometimes a bath. Meanwhile, mom has been left “alone” in the OR so the medical staff can complete the repair portion of the surgery, which typically takes 30 minutes. During this time it’s not unusual for an anesthesiologist give the mother “something to help her relax” which makes her sleepy and she typically “checks out” during this period. She’s taken to the Recovery Room where she’s monitored closely following the surgery. When she is alert and ready for baby, they will re-unite mom with her support person and baby. (Typically 1-1.5 hrs after the birth, but there can be delays)  If there is time, she may be able to hold and/or breastfeed her baby in Recovery before being moved again to Postpartum.

Family Centered Cesarean Birth takes a slightly different approach. Recognizing it’s still a surgical procedure, but instead of just thinking about the efficiency of the hospital and staff, there is focus on the EXPERIENCE of the family. It starts the same, with the chosen support person at the mother’s head as the surgery begins. The mother may listen to music or her partners voice to keep her calm and relaxed. The doctor may allow the surgical screen to be lowered at the time of birth so both mother and her partner can see the baby emerge. They may have even allowed another support person (doula or midwife) to be present to offer emotional support and to explain what is happening during the procedure, and/or to take pictures. The baby is dried off and suctioned if necessary but quickly taken to the mother where she can hold her baby skin to skin across her chest. Her arms are as free as possible so she can touch and hold her baby. The baby stays on the mother, covered in warm blankets as the repair takes place, allowing the family to get to know each other. Instead of using medications to aid the mother in discomforts of the surgery, the partner, doula or midwife may encourage the mother to use deep breathing/visualization or other natural methods to cope. That person may also offer touch and massage, even aromatherapy to distract from some of the unpleasant smells and sensations related to the surgery. The family stays together throughout the entire surgery and goes into the Recovery Room together, where baby is typically ready to breastfeed, since there has been no separation.

What are the results of Family Centered Cesarean Birth (FCCB)? Families that have a much greater satisfaction with their birth experience, and memories and pictures of the first few moments they met their baby. Babies benefit from the immediate skin to skin have higher APGARS at 5 minutes, and transition better in general. Their respiration is normal, they stay warmer, and their glucose levels are stabilized. (Particularly helpful in gestationally diabetic mothers) Babies breastfeed much better and more easily when there has been no separation.

How can you get a FCCB in Austin? For a small number of practices in town, this is their new “norm”. For the rest, you’ll have to ask. Bring it up with your provider ahead of time– especially if you are higher risk for a cesarean birth. It does require some minor changes in where staff is (Baby Nurse stays in the OR instead of heading back to Nursery) but is well worth the work. Want to see how it’s done? Check this out: Family Centered Cesarean Video

Families who are doula shopping, now can get more information about doulas as well as have a chance to meet local Austin birth and postpartum doulas! Every 4th Sunday 5-6pm in Austin is “Keep Austin Doula’d” Day– We will show a short film about doulas, then go through FAQ’s and answer questions from the group. Then there will be a casual “mix and mingle” opportunity for couples who want to chat and meet individual doulas.  Most sessions will be held at St Davids Medical Center (32nd street location) in the Plaza Room 405. Only the October location will be different, in pairing with the larger and better “Doula Share” event that same day.

Sept 22  St Davids Medical Center 5-6pm

Oct 27 Any Baby Can (7th street Austin) 3-6pm Doula Share, 5-6pm Meet the Doula

Nov 24 St Davids Medical Center 5-6pm

Dec 22 St Davids Medical Center

Doula Share is a FREE event where doulas share information with new and expectant families. Please join us on Sunday April 28th from 2-5pm to learn about breastfeeding, babywearing, infant massage, comfort measures for labor, infant CPR, optimal fetal positioning for easier birth! Expectant parents can also meet with local doulas and get information on other resources for parents!

Thank you Any Baby Can for allowing us to use your space (1121 E. 7th Street in Austin) RSVP to ctdarocks@yahoo.com to register for prizes!

Doula Share Flyer 2013

There has been a lot of attention on what most are calling “Delayed Cord Cutting”… I am hearing it more in my childbirth classes as well as on blogs and from my birth clients. The evidence is building… what we “thought” we were doing right now for about 100 years (clamping and cutting the cord immediately after the baby is born) may actually be doing babies HARM.

Briefly, the evidence is suggesting that by allowing the cord to continue to pulse (for approximately 90 seconds or so after the birth), the baby receives an additional 1/3 of their blood volume. Key ingredients in this additional blood include iron, and red and white blood cells. What do we see as an outcome of “delayed” cord cutting? Babies at 3-4 months don’t have the same problems with iron deficiency that we see in babies who had their cords cut immediately. Red blood cells carry iron, and white blood cells fight infection. Those all seem like critical things to a newborn’s health.

In addition, that “extra” 90 seconds or so continues to provide oxygen to your new baby, just like it has for the last 9 months of pregnancy. Many babies need a little time to transition from womb to  world- and that includes “figuring out how to breathe”. Many babies would not be oxygen deprived if we simply allowed the cord to keep doing it’s job.

So what’s the argument FOR immediate cord cutting? I am still hearing OB’s locally tell parents “it’s not safe”, “the baby will get too much blood”, or even “I can do that but I’ll have to hold the baby even with the placenta” (ie I cannot put the baby onto you Skin To Skin, another topic). Unfortunately, non of these common responses are evidence based. Parents have a right and responsibility to seek out accurate information and to communicate with their care providers about what they want for their newborns– and to find care providers who will support their wishes.

So shall we call it “Delayed”… or shall we call it “Optimal”? You decide.

http://thedoulaguide.blogspot.com/2012/12/cutting-cord-at-right-time-its-not.html

http://cord-clamping.com/links/

http://www.tedxbrussels.eu/2012/speakers/alan_greene.php

On Friday, Oct. 5, 2012, an amazing gathering of birth related professionals joined to celebrate those who provide outstanding care to families during the perinatal period. I felt honored to be a part of such an incredible group of passionate, dedicated men and women who have centered their lives around helping women prenatally, during birth, and postpartum. Congratulations to all who were nominated, all finalists, and of course all winners. Want to see who won? www.austinbirthawards.org