The Safety of Homebirth Reviewed
Posted by doularama | Filed under News, Recommendations
Following is an abstract of a study that demonstrates the safety of midwife-attended homebirths from The Canadian Medical Association Journal. This is extremely important! People quote and misquote the findings of a very flawed study to say that homebirth is not safe and they are just wrong. Dr. Marsden Wagner, in his book Born in the USA, does a wonderful job of educating his readers on this. Too bad we’re not all his readers!
Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician.
Patricia A. Janssen PhD, Lee Saxell MA, Lesley A. Page PhD, Michael C. Klein MD, Robert M. Liston MD, Shoo K. Lee MBBS PhD
ABSTRACT
Background: Studies of planned home births attended by registered midwives have been limited by incomplete data, nonrepresentative sampling, inadequate statistical power and the inability to exclude unplanned home births. We compared the outcomes of planned home births attended by midwives with those of planned hospital births attended by midwives or physicians.
Methods: We included all planned home births attended by registered midwives from Jan. 1, 2000, to Dec. 31, 2004, in British Columbia, Canada (n = 2889), and all planned hospital births meeting the eligibility requirements for home birth that were attended by the same cohort of midwives (n = 4752). We also included a matched sample of physician-attended planned hospital births (n = 5331). The primary outcome measure was perinatal mortality; secondary outcomes were obstetric interventions and adverse maternal and neonatal outcomes.
Results: The rate of perinatal death per 1000 births was 0.35 (95% confidence interval [CI] 0.00–1.03) in the group of planned home births; the rate in the group of planned hospital births was 0.57 (95% CI 0.00–1.43) among women attended by a midwife and 0.64 (95% CI 0.00–1.56) among those attended by a physician. Wo men in the planned home-birth group were significantly less likely than those who planned a midwife-attended hospital birth to have obstetric interventions (e.g., electronic fetal monitoring, relative risk [RR] 0.32, 95% CI 0.29–0.36; assisted vaginal delivery, RR 0.41, 95% 0.33–0.52) or adverse maternal outcomes (e.g., third- or fourth-degree perineal tear, RR 0.41, 95% CI 0.28–0.59; postpartum hemorrhage, RR 0.62, 95% CI 0.49–0.77). The findings were similar in the comparison with physician-assisted hospital births. Newborns in the home-birth group were less likely than those in the midwife-attended hospital-birth group to require resuscitation at birth (RR 0.23, 95% CI 0.14–0.37) or oxygen therapy beyond 24 hours (RR 0.37, 95% CI 0.24–0.59). The findings were similar in the comparison with newborns in the physician-assisted hospital births; in addition, newborns in the home-birth group were less likely to have meconium aspiration (RR 0.45, 95% CI 0.21–0.93) and more likely to Abstract be admitted to hospital or readmitted if born in hospital (RR 1.39, 95% CI 1.09–1.85).
Interpretation: Planned home birth attended by a registered midwife was associated with very low and comparable rates of perinatal death and reduced rates of obstetric interventions and other adverse perinatal outcomes compared with planned hospital birth attended by a midwife or physician.
Tags: Born in the USA, Canadian Medical Association, Homebirth, Marsden Wagner
Unnecessary Pain in Childbirth
Posted by doularama | Filed under Recommendations
Following is some concise information from the site Birthing Naturally. I give this to my students and to prospective clients before I am even hired.
Sources of Unnecessary Pain in Childbirth
Tension If you are skeptical of this, try it while you labor. During one contraction, do whatever you want, tensing your muscles. Then, during the next contraction actively relax your muscles. You will feel a difference.
Paying Attention Too Soon Many women become obsessed with timing contractions from the very first contraction. For some, there is a fear that if you do not pay attention, you may miss something. Some of the signs of progress in labor can be subtle, but you will not miss the major signs. When contractions begin, ignore them and go about your day for as long as you can. When the contractions demand more attention, give them only as much as they demand. Contractions will demand your full attention by the time you are in good active labor, which will require a lot of energy. Don’t waste your energy by paying attention too early.
Lack of Sleep A tired body is less able to deal with the stress of labor, causing everything to “feel” more even though your body is not doing more work. Be sure to get plenty of rest in the days leading up to your labor. When contractions begin, don’t be afraid to take a nap. I promise you will NOT sleep through the birth of your baby. If you have the luxury of a slow starting labor, use the early mild contractions to get some sleep.
Thirst If you do not take sips of water or juice between your contractions, you stand a good chance of becoming dehydrated. When your body is dehydrated, your muscle output is decreased by 30%. That means that your uterus will contract just as hard, but it will do 30% less work. Dehydration also heightens feelings of exhaustion and can elevate your temperature. If your temperature goes up, your medical team, intent on ensuring your baby is healthy, will assume this “fever” is caused by an infection and you may begin to receive antibiotics via injection or IV (which is a pain in and of itself).
Hunger Your body uses food as its energy source. If you are not eating during labor, you are depriving your body of energy it needs to labor. Many hospitals now allow you to eat during labor. If your birthplace does not allow eating, understand that most women lose their desire to eat during active labor, so simply stay home until your desire to eat is gone.
Needing to Urinate There will be a lot of activity going on in your pelvic region. During active labor you may not be able to distinguish the need to urinate from the other pressures you feel. Your uterus will put pressure on your bladder as contracts, so the best way to prevent pain from an over-full bladder is to urinate frequently (at least every two hours).
Performance Anxiety Also known as going to the hospital too soon. Some women believe that if they can just get to the hospital, everything will happen faster. That is not true. In fact, the move to the hospital can actually be stressful enough to temporarily slow down or stop your contractions. Waiting until you are in good active labor can help prevent this. Being in the hospital too early makes the labor seem slower than if you had stayed at home and busied yourself with your life. Having nurses and doctors checking on you can make the “seeming slow” labor seem even slower, causing the mom to feel that she has to perform better, labor must get moving. This anxiety can be enough to send some women into the fear/tension/pain cycle.
Lying on your Back When you are on your back, the contracting uterus has to move “up” against gravity, which is much more work than simply moving forward. Also, you can constrict the blood flow to the heart, causing you to be light-headed. Staying off you back can help in preventing labor pain.
Reducing Infant Mortality
Posted by doularama | Filed under News, Recommendations
DONA International is the Associate Producer for the important film, Reducing Infant Mortality, Improving the Health of Babies. DONA International Founder, Phyllis Klaus, is featured as an expert along with many other wise and caring professionals, including Sarah Buckley and Marsden Wagner.
The film can be seen and downloaded for FREE! It is available on the web site at www.reducinginfantmortality.com.
Penny Simkin on Doulas for Birth Care
Posted by doularama | Filed under News, Recommendations
Tags: doulas, Midwifery Today, Penny Simkin
What is a Rebozo?
Posted by doularama | Filed under News, Recommendations
I’ve never used a rebozo at a birth because, up until a few weeks ago, I wasn’t trained and didn’t really know what to do with one. Several months ago, I wondered if one of those five-dollar “pashmina” shawls that are being peddled by any one of the hundreds of street and small store salesmen in my fine city would do as a rebozo until I figured out what to do with a real one and bought it. I threw one in my doula bag, mostly in case someone was cold during a birth, but also in case I got up the courage to use it. I never took it out, as births are usually warmer than cold and my rebozo experimentation never poked it’s head at those times. Recently, when placing an order through the DONA Boutique, I saw that they are selling rebozos for only $10. That is a bargain! To my surprise they had one in black. My doula motif is mostly black and white (and oh, how it isn’t), so that’s the one I had to have. I laughed when my package arrived and I saw that my rebozo looked like it had been purchased by the Nigerian guy on Broadway and 74th Street, same package and all. It doesn’t matter that it cost me twice as much. At least I know that the shawl I already have in my bag will indeed suffice as a rebozo. I’m sure DONA can put the profits to good use too.
The rebozo is a traditional Mexican garment, like a long shawl or Spanish mantilla. In addition to its use as a shawl, it is multifunctional, being used during pregnancy, labor and as a baby or toddler carrier. During pregnancy, it is used to counteract back pain, during labor to help the mother into various positions, for relaxation and to adjust the position of the baby.
When used by a doula, the rebozo is like an extension of the arms, allowing one to help support the woman’s weight and helping to ensure that she is in a good position. During the pushing stage of labor, it can be used like a tug-of-war rope to help the mother focus her pushing and widen the pelvic outlet. The rebozo can be used by a midwife to assist in repositioning a posterior or breech baby.
The most basic technique one can practice with a rebozo is used to relax the soft tissues of the abdomen and the broad uterine ligaments. It is called jiggling or sifting and is pretty much what these names imply. This method can also be used during pregnancy to help the baby get into the optimal position for birth.
For photos and videos on these techniques and more, visit Spinning Babies and Birthing Essentials.
For books and other related materials, check out The Rebozo Way Project.
For more uses, view Midwifery Today’s Transcription of the Rebozo Workshop Given by Dona Irene Sotelo and Naoli Vianver.
So, go out and get a cheap pashmina shawl. Dress it up, dress it down and carry your groceries home from the farmer’s market in it. Then, when you’re pregnant, it will help you relax and get your baby into the right position for birth. When the time comes, it will be right there to help you in labor and even support you in pushing your baby out. How great that you can then use it to carry that baby. On second thought, maybe you don’t want to get such a cheap one.
Tags: childbirth, DONA, doula, labor, Pashmina, pregnancy, Rebozo, Rebozos, Using a Rebozo
Baby Glutton The Breastfeeding Doll
Posted by doularama | Filed under News, Recommendations
I’ve just spent a few minutes (because I couldn’t stand any more) watching videos of people saying things like it’s unnatural for six-year-old girls to breastfeed dolls. I don’t see how much more natural it is for them to bottle-feed dolls. Both of my children, and one is a boy, used to breastfeed their dolls. It was completely natural to them because they didn’t even know what a bottle was. I don’t buy dolls, but it’s nice to know that there will be an alternative to pacifiers and bottles on the shelves. Maybe in time for the holidays? Scandalous! I don’t think the shirt is necessary and they should work on the English translation, but it will be nice to have options. That’s a common doula sentiment. Regarding the question posed in the last line below, how sad that we live in a society in which this might be considered a gimmick to shock, and many may actually be shocked.
From today’s New York Times online- Motherlode
The Doll That Breast-Feeds by Lisa Belkin
The doll aisle of your local toy store will have a new offering soon — a baby doll that breastfeeds. Called Bebe Gloton (in Spain, where it is manufactured and sold, that translates to Baby Glutton) it is expected to be marketed in the U.S. next year.
There are already dolls that allow children to care for their babies the way Mommy and Daddy do — diapering them when they pee, giving them a bottle when they are hungry, wiping them when they burp.
But this latest is like nothing else out there. The toy comes with the doll and also a brightly colored halter-top with two strategically placed flowers where nipples would be. There is a sensor in the doll and the flower such that bringing the mouth of the doll into position causes the baby to make suckling motions and sounds.
Videos of the doll in use have gone viral in recent days, with parents and experts discussing among themselves whether this is a natural and appropriate way to teach children about something natural and appropriate, or whether it is a step too far.
Some are even arguing with themselves. Dr. Ronald Cohen, medical director for the Mother’s Milk Bank in San Jose as well as director of the intermediate intensive care nursery at Lucile Packard Children’s Hospital at Stanford University, told ABC News, “My take is that anything which reminds young girls that their bodies are something other, and more, than sex objects, is a very good thing.” In the next sentence he added: “On the other hand, encouraging young girls to want to have babies at a very young age may not be so great.”
In response, the director of sales and marketing for Berjuan, which manufactures the doll, told abcnews.com: “Breast-feeding is completely natural; it is not something that we have invented ourselves, it is something that is done all around the world. There are studies that discuss the benefits of breastfeeding, and there are associations around the world that are … supporting this.”
True. But there are many other things that are natural for adults that children don’t necessarily need to be mimicking at five, no?
Will you be buying the doll for you child? Is this a way to bring them closer to Mom while she’s nursing, or just another gimmick designed to shock — and sell?
Tags: Baby Glutton, Bebe Gloton, Breastfeeding, Breastfeeding Doll, Motherlode
Breastfeeding Remedies from Susun Weed
Posted by doularama | Filed under Recommendations
Tags: Breastfeeding, Herbs, Home Remedies, Susun Weed
