Time for Gratitude - Medical Technology

Ok, so in my work as a doula and as I work on my childbirth educator certification, I'm really all about natural, intervention-free, normal, physiological birth. Obviously (or, I hope it's obvious), as a doula, I'm not going to tell any of my clients what they should and should not do...that's not my job. I mean, if a mama wants an epidural and she knows that she wants one, I'm not going to tell her that she shouldn't have one for "this reason or another". But, I am going to make sure she understands what an epidural does and ensure that she's making an informed decision, and not just doing it because her friend said she'll love it.

I believe that women's bodies were designed by God to give birth.The majority of women can have a normal physiological birth without medical intervention.

And then there are those mamas who are exceptions to the rule and have a true medical reason that they need some intervention.

These mamas are the ones I'm going to talk about a little bit today.

I'm going to tell you a story about a mama who wanted a completely normal, natural, physiological birth. It was their first baby, and she and her husband prepared for it, they studied up on it, they took a natural birthing class, they talked to their doula often, they had a great midwife as their provider, and they were ready. As ready as any couple could be.

And then she was diagnosed with pre-eclampsia.

She did all the right things to minimize her risk...she upped her protein intake, she rested well, she ate healthy, did her best to keep her stress down, etc, etc.

Her blood pressure still spiked and she needed to be admitted for induction before she was ready. It was a difficult time, but once she came to terms with the fact that she was going to need to be induced, she was ready. She armed herself with as much information as possible, she relied on her midwife and doula for informative support, and her husband was right there by her side as they began the magnesium sulfate and induction.

She did a great job laboring through her contractions, and never once asked for any pain medication or epidural. As her labor progressed and things got more difficult, however, her cervix didn't dilate. She was having strong contractions, she was doing a great job of relaxing through them and working with her labor instead of against it. She had even more challenges because *she couldn't move* during labor. Everytime she moved - got up to go to the bathroom or anything - her blood pressure spiked. High. There were only three positions she could be in comfortably that they could also get the baby's heart rate (making sure baby is ok while on magnesium sulfate and pitocin is very important).

She was at the same dilation for eight hours. Since her contractions were so strong (pitocin contractions) and she wasn't able to move much, she wasn't able to try to get her baby in a different position, and frankly, she was getting tired! She had such a wonderful midwife...so many providers would have whisked her off to a cesarean since she would have been considered "failure to progress". She was blessed to have a provider that wasn't in a hurry.

After her eight hours of very little progress, no dilation, and utter exhaustion, her midwife suggested something that she rarely, if ever, does. She suggested that she try an epidural. Hopefully it would help her pelvis relax just enough that her baby could move in just the way she needed to and mama would begin dilating. Her midwife also very gently told her that if her baby didn't move and she begin to progress, she would likely need a cesarean. She was in no hurry, though, as long as baby was stable.

So, mama got the epidural (she was even quite relieved to get it at that point!), and got comfortable so she could get some rest...as did her husband and doula.

And to her and her husband's relief she began dilating - hooray! It only took her a few hours to finish dilating and for baby to move down enough to begin pushing. At this point she felt her contractions, knew exactly when to push, followed her body's cues, and vaginally birthed her beautiful baby.

This is an example of when medical intervention is truly indicated, and I'm SO grateful that we have things like pitocin, continuous fetal heart monitoring, epidurals, and cesareans! I am not grateful for the amount of unnecessary usage of these medical technologies....just that they exist so they can be used as needed for women like the one I told about here.

~Evie

Etc Expo for Her Tickets!

Have you ever been to the Etc Expo for Her?

Well, being held here in Sioux Falls this coming Friday and Saturday, it's a great place to find local information on *everything* for "Her"!

Elegant Mommy will be there, and we want you to come see us, so we are giving away 2 tickets to 9 lucky winners!

Winners will be announced on Thursday morning, and will need to pick up their tickets at our store before the expo.

Enter below:

a Rafflecopter giveaway

Birth Practices on Breastfeeding – Part 2

So last week I shared with you some of what Linda Smith shared at the SD Breastfeeding Summit. It was a summary of how epidurals and other meds during labor and delivery can and do affect breastfeeding.

As I said in my last post, ANY medical intervention during birth can have an effect on breastfeeding and the breastfeeding relationship/ability of your baby.

Since approximately one in three mamas have a surgical birth (cesarean) in the United States today, it is extremely important for us to talk about the consequences of this statistic for those 33%. There are essentially three different kinds of cesarean: Elective (scheduled) without labor, Cesarean with labor, and Emergency.

An elective cesarean without labor has shown in several studies to increase infant respiratory problems and also decrease breastfeeding success (studies listed below). This makes complete sense to me. For one thing, if there isn’t any labor initiated by the baby, then baby obviously isn’t ready (baby is the one that releases the hormone that begins labor)! If baby isn’t ready, then there is a higher risk of respiratory problems – after all, the lungs are the last major organ to develop. If there are respiratory problems – you know – if the baby can’t breathe, then baby will clearly have a difficult time eating at the breast. That all seems like a no-brainer. Also, I have read several articles recently that talk about the hormones released in labor and how they are so important for baby (and mama). Without labor, baby and mama don’t get them. Even a little labor is better than none. So, bottom line: Elective cesareans without labor are risky to baby (and mama), particularly in the breastfeeding relationship.

Studies also show that any cesarean (even with a trial of labor) can have negative effects on breastfeeding.

Again, if you think about this, it really makes a lot of sense. First of all, according to the World Health Organization, we (the U.S.) are over double the acceptable level of cesareans based on their standards. They figure that 10-15% of all births should reasonably be surgical based on medical necessity. Anything over that is considered unnecessary.  

So, if you are one that needs a surgical birth, how can you minimize the risk of impeding breastfeeding?

Let’s think for a minute what happens during a normal cesarean surgery in this country (Please note I am not referring to medically emergent surgical births here. There are things that happen when a true emergency is happening that I’m not going to go into. This is a normal, non-emergent cesarean that I’m talking about). In the simplest of terms, during a surgical birth, mom is going to have an epidural or spinal block (remember what I said about epidurals last week?), a screen is going to be put up to ensure a sterile incision site, mom’s arms are going to be strapped down, doc will make incision through all layers of mom’s abdomen through her uterus, he will pull baby out of the uterus, clamp/cut the cord, baby will be lifted high enough for mom to see, then will be taken over to the warmer to get vitals, footprints, weight, APGARs, etc, etc, then baby will be swaddled tight with a hat on his head, dad may get to hold him for a bit, then after a kiss from mom and some snapshots he will be taken away to the nursery until mom has been sewn back up and is out of recovery. Obviously, there will be some variation of all of this depending on provider and facility, but you get the idea.

So to minimize the risk of jeopardizing breastfeeding, there are things that we need to be asking for and yes, demanding, from our care providers. Surgical births don’t need to be traumatic experiences where mom doesn’t even get to touch baby other than maybe a kiss until after recovery. One thing that we heard about a lot at the SD Regional Breastfeeding Summit was the importance of skin-to-skin contact with mama and baby. I’ll talk more about that later this month, but for now, just believe me that immediate skin-to-skin is of utmost importance. Dr Raylene Phillips actually showed a demonstration of what they are doing at her hospital in California for all cesarean surgeries, and it seems to me that it’s a really important, easy, and cost-free step that we can ask our hospitals and providers to begin taking.

It’s pretty simple, but basically instead of whisking baby away after he is born, therefore having a time of very stressful (for mama and baby) separation, they simply put a diaper on baby (to keep environment as clean and sterile as possible) and put him on mom’s chest while closing her up. Dad is right there and makes sure baby stays on mom’s chest, and baby is happy, can initialize breastfeeding on his own, gets all the warmth, love, oxytocin, and mama-bonding time that he needs. She said that this simple step has eliminated all kinds of things: Anesthesiologists are loving it because it makes their job keeping mom comfortable and stable SO much easier! Babies are obviously loving it, because they get their mommies and can just follow their instincts and go straight to the breast without the trauma of separation. Dads feel important, because they can actually do something instead of just watching the ones they love shivering and stressed because they don’t have their baby near them. Seriously – everyone wins!

So let’s start the conversation. If you are pregnant, talk with your provider about this! If you end up needing a surgical birth, you will be SO glad you did! If we all start talking to our providers and encouraging our friends to do the same, we can help make changes that affect everyone involved positively!

~Evie

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• Tita, A. T. N., Landon, M. B., Spong, C. Y., Lai, Y., Leveno, K. J., Varner, M. W., et al. (2009). Timing of Elective Repeat Cesarean Delivery at Term and Neonatal Outcomes. N Engl J Med, 360(2), 111-120.
• Kamath, B. D., Todd, J.K., Glanzner, J. E., Lezotte, D., & Lynch, A. M. (2009). Neonatal outcomes after elective cesarean delivery. Obstet Gynecol, 113(6), 1231-1238.
• Wiklund, I., Edman, G., & Andolf, E. (2007). Cesarean section on maternal request: reasons for the request, self-estimated health, expectations, experience of birth and signs of depression among first-time mothers. Acta Obstet Gynecol Scand, 86(4), 451-456.
• Dewey, K. G., Nommsen-Rivers, L. A., Heinig, M. J., & Cohen, R. J. (2003). Risk factors for suboptimal infant breastfeeding behavior, delayed onset of lactation, and excess neonatal weight loss. Pediatrics, 112(3 Pt 1), 607-619.

Birth Practices on Breastfeeding...Part 1

For the rest of this month I’m going to be talking about some issues surrounding birth. Since I’m freshly back from the SD Regional Breastfeeding Summit, I really want to give you some highlights of one of LindaSmith’s presentations on how birth affects breastfeeding.

I wrote briefly about this awhile back where I posted an excerpt from the Womanly Art of Breastfeeding. I had long suspected this was the case, and in recent months have found and received information and research verifying that yes, birth in fact *does* have an impact on the breastfeeding relationship. It actually can have a very big impact. So, I was very excited when I learned that this was going to be one of Linda’s topics. (insert happy dance for doula, blogger, and studying childbirth educator-to-be)

Ok, so what about today’s birth practices can have such a big impact and why?

Well, it’s going to be difficult to put all the information Linda gave us on this topic in one little blog post, so I’m actually going to do a mini-series on it, but let me give you the bottom line: ANY intervention can have an effect on breastfeeding and the breastfeeding relationship/ability of your baby.

Linda gave us the following practices that compromise infant status and/or feeding ability:

•          ALL labor drugs - *including* epidurals
•          Cesarean surgery
•          Induction of labor
•          Instruments (vacuums, forceps)
•          Suctioning, intubation
•          Separation from mother for ANY reason
•          Maternal IV hydration

Today I’m going to talk about labor drugs that are commonly used.

I don’t know how many times I’ve heard - from all sorts of different people…from other women to  medical providers to random strangers on the Internet that epidurals are safe – that they don’t reach the baby anyway, so really all that’s happening is mom is more comfortable as she labors (well, sometimes she is – that’s the goal anyway).

I’m going to repeat Linda here: All drugs reach the baby within seconds. Period.

First of all, several types of analgesia given to the mother during labor may interfere with the newborn’s spontaneous breast-seeking and breastfeeding behaviors and increase the newborn’s temperature and crying (1) and disturbs newborn behavior in general. There can be *measurable* effects for at least 30 days after birth! (Sepkoski) Can you believe that? No wonder some babies sleep so much!

Epidurals are actually a combination of narcotic (i.e. fentanyl or morphine) and anesthesia (i.e. bupivacaine or lidocaine) that is administered via a small catheter into a woman’s epidural space in her spine. Each hospital and anesthesiologist will differ on the dosages and combinations of medication, so you may want to talk with your provider about theirs. One reason to ask about dosages, is that there are significant negative effects from high dosages of fentanyl. In fact, in the study that Linda cited, the conclusion was that among women who breast-fed previously, those who were randomly assigned to receive high-dose labor epidural fentanyl were more likely to have stopped breast-feeding 6 weeks postpartum than women who were randomly assigned to receive less fentanyl or no fentanyl. (2) And as we know, not breastfeeding is a risk to baby's health!

There are other reasons that epidurals and drugs in labor affect breastfeeding…since all of these drugs go directly into baby’s blood, baby is actually altered and can have a more difficult time feeding, latching on, etc. Drugs can undermine a mother’s confidence, block or reduce endorphins that are released in labor (endorphins are natural pain relievers), and can also suppress onset of lactation because the baby isn’t feeding effectively enough.(3)

So, if you don’t get anything else from today’s post, please just be really educated about risks vs benefits of things like epidurals and other drugs that are often given in labor and delivery. Drugs can have a significant effect on not only your birth, but your breastfeeding relationship with your baby and success, so please weigh your options carefully before proceeding.

In the next post, I’m going to go through even more birth practices that Linda talked about that have shown to have an effect on breastfeeding.

~Evie

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1. Ransjo-Arvidson, A., Matthiesen, A., Lilja, G., Nissen, E., Widstrom, A., & Uvnas-Moberg, K. (2001). Maternal analgesia during labor disturbs newborn behavior. Birth, 28, 5-12.
2. BeilinY et al. Effect of labor epidural analgesia with and without fentanyl on infant breastfeeding: A prospective, randomized, double-blind study. Anesthesiology 2005, 103(6), 1211-1217
3. Smith, L., Impact of Birthing Practices on Breastfeeding 2012, Drugs for Pain Management Clinical Implications, 12.

Call to Action to Support Breastfeeding

We had the distinct pleasure to be a supporting sponsor of the SD Regional Breastfeeding Summit yesterday in Brookings, which was hosted by the newly re-formed SD Breastfeeding Coalition, and I personally want to say what an amazing day it was. We had the honor of getting to hear from Dr Raylene Phillips as well as Linda Smith and I know I learned a ton. So, in the next months I will be sharing some of the information they shared with us.

One of the things we talked about was the Surgeon General's 2011 Call to Action to Support Breastfeeding. Because of this Call to Action, there has been a nationwide movement to increase breastfeeding awareness, support, and to help mommies breastfeed for longer.

The following is from the Call to Action's fact sheet found at www.SurgeonGeneral.gov. Take a minute and read through it....you won't be sorry :)

What are the health benefits of breastfeeding?

• Breastfeeding protects babies from infections and illnesses that include diarrhea, ear infections and pneumonia.
• Breastfed babies are less likely to develop asthma.
• Children who are breastfed for six months are less likely to become obese.
• Breastfeeding also reduces the risk of sudden infant death syndrome (SIDS).
• Mothers who breastfeed have a decreased risk of breast and ovarian cancers.

What are the economic benefits of breastfeeding?

• Families who follow optimal breastfeeding practices can save between $1,200–$1,500 in expenditures on infant formula in the first year alone.
• A study published last year in the journal Pediatrics estimated that if 90% of U.S. families followed guidelines to breastfeed exclusively for six months, the U.S. would annually save $13 billion from reduced medical and other costs.
• For both employers and employees, better infant health means fewer health insurance claims, less employee time off to care for sick children, and higher productivity.
• Mutual of Omaha found that health care costs for newborns are three times lower for babies whose mothers participate in the company’s employee maternity and lactation program.

What obstacles do mothers encounter when they attempt to breastfeed?

• Lack of experience or understanding among family members of how best to support mothers and babies.
• Not enough opportunities to communicate with other breastfeeding mothers.
• Lack of up-to-date instruction and information from health care professionals.
• Hospital practices that make it hard to get started with successful breastfeeding.
• Lack of accommodation to breastfeed or express milk at the workplace.

What can employers do?

• Start and maintain high-quality lactation support programs for employees.
• Provide clean places for mothers to breastfeed.
• Work toward establishing paid maternity leave for employed mothers.

What can community leaders do?

• Strengthen programs that provide mother-to-mother support and peer counseling.
• Use community organizations to promote and support breastfeeding.

What can families and friends of mothers do?

• Give mothers the support and encouragement they need to breastfeed.
• Take advantage of programs to educate fathers and grandmothers about breastfeeding.

So, what can you do?

• You can come to events and classes at Educated Mommy to learn about and help support mamas in their breastfeeding journey. As a bonus, while you are supporting others, you will get the support that you need!
• Join Milk Monologues on Wednesdays at 1:00 p.m., Going Back to Work on the 2nd Saturday of each month at 9:00 a.m., and of course, join us for La Leche League this Thursday at 6:30 p.m.