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Reasons to Induce: Poor, Controversial, and Solid September 10, 2009

Filed under: Pregnancy — Rachel @ 9:09 pm
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What’s a good reason to induce and what’s really NOT?  Today I’ll be sharing thoughts from Jennifer Bock’s excellent exposé, Pushed: The Painful Truth about Childbirth and Modern Maternity Care, as well as opinions offered by Ricki Lake and Abby Epstein via an article “Choosing to Wait” in Fit Pregnancy magazine, Sept 2009.  Ricki Lake and Abby Epstein produced the film The Business of Being Born and have since published a new book Your Best Birth

Gary Hankins, MD, chair of the obstetric practice committee of the American College of Obstetricians and Gynecologists (ACOG) says he never induces for convenience.  “And induction absent a solid indication absolutely increases all risk to mom and baby” (Block, pg. 8).  So maybe you agree.  You don’t want to induce.  Considering that the induction rate is growing by leaps and bounds, waiting for spontaneous birth may not be as easy as you’d assume.  Educating yourself about what constitutes a “solid indication” for induction may help you choose a good caregiver or at least bolster your resolve if your doctor pressures you at some point to an unnecessary induction. 

Pressures?  Do doctors really pressure women into induction?  Author Jennifer Block shares the stories of several women who were induced, all for different reasons.  Interestingly, all three women report being encouraged to induce earlier on in their pregnancies. Here’s what one woman experienced:

“It started at 39 weeks,” says Hilton.  “She said, ‘When do you want to be induced?’ I said, ‘I don’t.’ She said, ‘Well, I’ll give you one more week and that’s it.'”  At her 40-week appointment, Hilton says her OB asked, “So are you ready to have a baby?” and offered to schedule her the following day (Block, pg. 16).

Unfortunately, this kind of attitude is all to common with doctors, for whom an induction scheduled during regular business hours or before a upcomming vacation is so much more convenient.  Doctors are people too, with families to see and personal business to do.  It is easy to see how they would be tempted to put the needs of their families before the best interests of their patients when our culture becomes accepting of questionable medicine.

Poor Reasons to Induce:  Included in this category are indications commonly given for induction that are discredited by medical studies discussed in both Pushed and The Business of Being Born.  There is not sufficient medical justification for inducing based on any of these reasons.

  1. The ultrasound technician moves your due date– an ultrasound can accurately determine a due date early on in pregnancy.  Late in pregnancy, an ultrasound technician can only estimate your due date, and can be off by plus or minus 3-4 weeks (Fit Pregnancy, pg. 54).
  2. An ultrasound shows your baby is “measuring” big– although you’d think this would be an exact science, ultrasounds only estimate baby’s weight and can be off by pounds in either direction!  This justification is not supported by the American College of Obstetricians and Gynecologists (ACOG).  And, what’s more “statistically, fetal size appears to level off after 40 weeks gestation” (Block, pg. 9).   
  3. An ultrasound show your amniotic fluid is low – again the ultrasound is only an estimate of your amniotic fluid level.  “Amniotic fluid shifts constantly, with more being produced all the time (Block, pg. 11).  Your doctor should be recommending you drink plenty of fluids and rest, not scheduling an induction (Fit Pregnancy, pg. 54).
  4. Your doctor is leaving town – as much as it helps to have the right caregiver, it doesn’t make sense to increase your chances of c-section by 2-3 times to ensure your doctor will be available (Fit Pregnancy, pg. 54). 
  5. You’re 40 weeks pregnant – you are not “overdue” until 42 weeks.  A baby is considered normal, “full-term” if it is born between 38 and 42 weeks (Block, pg. 11).  “In other words, if we were to distribute a large sample of pregnancies along a graph, we’d see a bell curve.  Forty weeks would be the height of the curve, and an equal number of women would give birth before and after… Thus a due date would be expressed more accurately as a ‘due month'” (Block, pg. 11). 

Controversial Reasons to Induce:  Included in this category are indications commonly given for induction that are rejected by some doctors and most midwives, but not entirely without reasonable medical support.

  1. You’re 41 or 41.5 weeks pregnant – One large study shows that slightly more stillbirths occur after 41 weeks.  Researches disagree as to the reason why this is so (Block, pg. 11).  If time in the womb is not to blame, than inducing every pregnancy at 41 weeks is foolish for the vast majority of women (pg. 12).  A wise doctor will consider other factors such (fetal nonstress test) and childbirth history, as well as suggesting natural means of encouraging labor, rather than making a beeline for the drugs.
  2. Your bag of waters is broken– Most women go into spontaneous labor within 24 hours of the bag of waters breaking (pg. 13).  But, sometimes labor might not begin for a few days.  During that time, there is concern for infection since the seal has been broken, so to speak.  How does infection make its way up there?  Through vaginal exams.  A study of 5000 women (the largest to date) “found no increase in neonatal infection in (women) that were watched for up to 4 days after rupture.  The vagina is a nearly airtight passageway, so loss of the plug and rupture alone don’t significantly increase the risk of infection…” (pg. 12).  As a matter of course, hospitals insist a baby must be delivered within 24 hours of the waters breaking, which means induction within 6 hours in most cases (Fit Pregnancy, pg. 55).  Midwives disagree with this approach, instead opting to use natural means of induction at this point, while avoiding vaginal examines.
  3. Baby is smaller than normal – while the authors of Your Best Birth state this is a solid reason for inducing, it seems an odd generalization to me (pg. 55).  If you’re still 39 or 40 weeks, maybe you baby needs more time to grow?  Also, remember that ultrasounds only estimate weight and can be off by over a pound in either direction.  Jennifer Block does not address this issue, and neither have I read about it elsewhere. 

Solid Reasons to Induce:  Included in this category are indications commonly given for induction that are supported by good reasearch.

  1. You’re 42 weeks pregnant:  the placenta may start to deteriorate after this point, failing to support baby properly with oxygen and nutrients (Fit Pregnancy, pg. 55).
  2. Baby is moving less:  your observations and further testing show baby is moving much less than normal (pg. 55).  Keep in mind that babies do move less as they reach term because they have less room!  But, if baby stops moving at all, you should seek care immediately. 
  3. Baby’s heart rate is irregular:  clear irregularities indicate distress and should be treated seriously (pg. 55).
  4. You have signs of Preeclampsia:  spiking blood pressure and protein in the urine indicate preeclampsia (pg. 55).
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You CAN Stop Stretch Marks September 8, 2009

Filed under: Pregnancy — Rachel @ 7:52 pm
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Yesterday my mother saw my stomach as I was changing and exclaimed, “You didn’t get stretch marks!?!”  Most women get stretchmarks during pregnancy, but a lucky few do not.  Research shows that genetics has a lot to do with it.  And yet, my mother and sister both got a fair amount of stretch marks, but I did not – at least not on my belly – even after two pregnancies.  How’s that?

First off, I realize that getting stretch marks is not the end of the world.  It’s true that a woman has more pressing concerns during pregnancy than preserving her smooth skin.  She’s got a lot to do between having a healthy baby, preparing for birth and shopping for must-have bedding and gear.  And yet, all of us do have some concern over the fate of our looks, do we not?   And if we can preserve our youth without threatening our health or baby’s, why not? 

I believe that most women can prevent or greatly reduce stretch marks with frequent and early use of conditioning oil.  Before my first pregnancy, I worked with pregnant women in a local maternity boutique.  It was there that I first became aware of all the many creams, oils and solutions designed to prevent or fade stretch marks.  I learned that oils are better than creams, as far as efficacy, since they are more readily absorbed into the skin.  I learned that those who shopped for fading creams usually wished they had used a preventative product during their pregnancy.  I decided I would invest in a bottle of preventative oil as soon as I found out I was pregnant.  If that bottle could preserve my skin for years to come, it was worth the investment.

So,  I did.  I applied a pregnancy oil early on in my pregnancy, at least once and sometimes twice a day (twice a day is recommended!).  It was a pleasant after-shower regime that kept me in touch with the daily changes caused by the life growing inside.  After my first baby was born and my body recovered, I noticed that my belly was stretch mark-free.  But… I had stretch marks at both hips and very slight ones at the breasts.  Oops!  Yes, the pregnant belly is not the only spot that grows.  So, here’s my take-home for you – apply that oil wherever you’re seeing growth, considering hips, thighs, buttocks, and breasts

With baby #2, I used Motherlove Organic Belly Oil as faithfully as before, but this time I slathered my hips and bust too.   I came through that pregnancy with no new stretch marks and lots of confidence in a good quality pregnancy oil!  By the way, I gained the recommended amount of weight (about 25 lbs) with both pregnancies.

You may have heard that some women have good results with plain cocoa butter.  I’m sure that’s true, but I’d recommend that you choose an oil actually designed for pregnancy.  Oils have been shown to penetrate the skin better than creams.  Since oils are naturally produced by the skin, it’s not surprising that the skin finds it easiest to recognize and utilize nutrients carried in oil.  Pregnancy oils are complex, super-nourishing blends that prepare your skin to stretch and bounce back without becoming damaged.  When choosing an oil, check the ingredient list for questionable chemicals and preservatives.  Choose something safe and natural, since you’ll be using it consistently during your baby’s most vulnerable months. 

You CAN stop stretch marks:

  • Buy a safe, natural pregnancy oil as soon as you find out you’re pregnant
  • Apply it at least once, hopefully twice a day, especially after a shower
  • Massage the oil into your belly, hips and bust – or wherever you’re experiencing growth
 

Would you Like to Induce Labor? September 1, 2009

Filed under: Pregnancy — Rachel @ 8:07 pm
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Would you like to choose your baby’s birthday?  Would you prefer to get baby out ASAP, rather than wait that last week or two?  If you’re considering inducing, you’re not the only one. 

Last night I began reading Jennifer Block’s Pushed: The Painful Truth about Childbirth and Modern Maternity Care.  It is well-written and clear, with compelling stories about real births too.  Block cites the information she shares in detail in her book, so you can look up any studies or reports of interest.   The first chapter,”Arranged Birth” examines the subject of induction in detail, with interesting perspectives from nurses and doctors too.   

According to the CDC, the induction rate was under 10% in 2004 (Block, p. 5).  Contrast that with 40% induced into labor and 70% receiving Pitocin during labor to speed up progression in 2006, according to a study of 5500 low-risk, first-time mothers (p. 5-6).   Pitocin is a hormone-mimicking drug that stimulates contractions and is commonly used to induce labor. 

Why are doctors recommending inductions and women agreeing in such drastically increasing numbers?  There are any number of official reasons that a woman may be given when an induction is ordered.  We’ll look at these in more detail next week.  But, before we get bogged down in medical debate, take a step back and ask yourself this:  Do you think our ability to give birth, to progress in labor has drastically changed in the last 6 years?  Or, could it be, that it’s just more convenient for mothers and doctors to induce?  In America, isn’t convenience king?  We want to do the best for ourselves, for our babies, but when something is touted as pretty safe, easier, more convenient for everyone, will mom say “no”?  Judging by the popularity of fast food, obviously not. 

It is convenient, but is it safe?  Is it wise?  Here’s an excerpt from Pushed, beginning with a quote from Kathleen Rice Simpson, PHD:

“‘I firmly believe that mothers are not informed enough to know that this is not a good idea, and that any woman who has the right information would not want to have her baby induced.’ Inducing tends to create longer, more difficult, more painful labors in general, and it ups a woman’s chance of a C-section by two to three times.” (p. 14)

But who is this Simpson?  She’ s only a professor of nursing at St. Louis University School of Nursing, a labor and delivery nurse of 30 years, author of dozens of journal articles, conductor of several studies, author of safety manuals for the American Society of Healthcare Risk Management, the American Hospital Association, the Association of Women’s Health, Obstetric, and Neonatal Nurses, etc.  She claims that liberal use of Pitocin to start and speed up labor often violates safety standards and is under-reported.  “Mismanagement of Pitocin, she says, is the leading cause of liability suits and damage awards” (p. 14).

So if Pitocin is the most common mistake doctors make, why do we feel so at ease to induce labor for convenience?  If this is beginning to bother you, you’re not alone.  That’s why Jennifer Block subtitled her book “The Painful Truth about Childbirth and Modern Maternity Care.”  A mama ought to be informed.  More on induction next week!

 

Must-Reads for Pregnancy & Birth August 27, 2009

Filed under: Pregnancy — Rachel @ 3:57 pm
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As soon as you began thinking about getting pregnant (or realized you already were!) your mind was filled with a million questions.  There’s a lot to learn about pregnancy and birth.  Here’s a book list to get you started:

Healthy Pregnancy

  • The Mother of all Pregnancy Books: The Ultimate Guide to Conception, Birth & Everything In Between by Ann Douglas.  A great introduction and resource for first pregnancies.  Lots of information on common problems of pregnancy.
  • Mothering Magazine’s Having a Baby, Naturally by Peggy O’Mara.  “We’ll inform, you choose”  Having a Baby, Naturally reflects this spirit with straightforward, uncensored information about pregnancy and childbirth, addressing common concerns and questions in a compassionate, nonjudgmental style.
  • Eating for Pregnancy: The Essential Nutrition Guide and Cookbook by Catherine Jones and Rose Ann Hudson.  A practical book from a perinatal nutritionist on proper eating and weight gain goals, with a large collection of recipes.  It’s a cookbook in its own right.  Also addressing the requirements of diabetic, vegetarian and vegan diets during pregnancy.

Safe Childbirth

  • Ina May’s Guide to Childbirth by Ina May Gaskin.  A classic, full of positive birth stories to prepare you mentally and physically for natural childbirth.
  • The Doula Guide to Birth: Secrets Every Pregnant Woman Should Know by Ananda Lowe & Rachel Zimmerman.  Insights from experienced doulas and real moms for birth and the welcoming a newborn.
  • The Thinking Woman’s Guide to a Better Birth by Henci Goer.  A truly empowering resource covering the many procedures and tests available during pregnancy and birth.  Offering data and advice so you can make informed decisions regarding your care. 
  • The Doula Advantage by Rachel Gurevich.  Why and how to hire a doula, with interviews from more than 235 women and birth professionals.  So much good information, and real life tools to help women choose the best doula for their birth.
  • Pushed:  The Painful Truth about Childbirth and Modern Maternity Care by Jennifer Block.  “The United States has the most intense and widespread medical management of birth” in the world, and yet “ranks near the bottom among industrialized countries in maternal and infant mortality.”  This provocative, highly readable expose raises questions of great consequence for anyone planning to have a baby in U.S.

Fun, Encouraging Reads

  • Baby Catcher: Chronicles of a Modern Midwife by Peggy Vincent.  This fun, lighthearted book is chock-full with Peggy’s experiences delivering babies in Berkeley, California, including 40 birth stores from a wide-range of diverse, interesting women.  It’s the perfect prelude to your own labor, sure to leave you with realistic expectations for your own birth and some inspiration too.
  • The Girlfriend’s Guide to Prengnacy by Vicki Iovine.  Although I don’t share the perspective of the author, this book is so hilarious that I had to include it here.  The author’s sassy writing style will have you laughing at your pregnancy woes. 
  • Pregnancy Stories: Real Women Share the Joys, Fears, Thrills, and Anxieties of Pregnancy from Conception to Birth by Cecilia Cancellaro.  A collection of honest short-stories written by real mothers about the ups and downs of pregnancy and birth.  Support for the journey.
 

Preparing a Birth Pool for your Homebirth July 30, 2009

Filed under: Pregnancy — Rachel @ 8:32 pm
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http://www.waterbirth.org/mc/page.do?sitePageId=38425&orgId=wi

If you’ll be giving birth at home, consider using a birthing pool.  Whether or not you decide to deliver in the water, you may enjoy laboring in a warm birth pool.  At one reader’s request, I did some research for choosing and preparing your birth pool.

Your midwife may offer pool rental services.  This is an eco-friendly choice, since professional grade pools can be reused to avoid waste.  Be sure to ask questions so you understand what type of pool you’ll be using.  Will it be big enough for one or two persons?  Maybe you’ll want your partner to support you while you labor.  Are the sides comfortable to lean against and high enough for your liking? 

Also, what about toxicity?  Most birth pools are made of vinyl, a phthalate-filled plastic that emits toxic fumes.  Unfortunately, vinyl seems to be the only reasonable option for an inflatable pool, but there are ways to limit the toxicity.  A new pool should be inflated and aired outside for 3-7 days (the longer the better), which will help toxic VOC’s to release.  Your midwife probably provides a reusable pool with single-use liners.  Ask if she can air out the liner for you, or leave it with you so that you can air it out.  If your midwife’s reusable pool doesn’t include a liner, find out what cleaners she uses to disinfect the pool.  Harsh cleaners must be rinsed excessively, so your baby isn’t born into a chemical soup.  If at all possible, choose to rent a pool with a single-use liner, so cleaners aren’t necessary. 

You may also choose to purchase your own birth pool.  Don’t worry about getting one with a heater built-in.  Vinyl easily retains heat, so this isn’t a problem for most births.  One of the most popular birth pools is actually a kiddie pool!  The Aquariumfishy pool has a padded floor and high sides that make it perfect for birthing.  Moms report excellent results with this pool, which is sturdy and strong enough to lean against.  Its affordable price ($30-40) makes it single-use without the need of a liner.  But, buying and throwing out a toxic vinyl pool every time you give birth is not so eco-friendly. 

I’ve only come across one birth pool made with phthalate-free vinyl – Birth Pool in a Box Eco.  At $190, this birth pool is not cheap, but it’s certainly well-made.  I can find nothing but good reviews!  It has a seat, handles for stabilization, adjustable height and disposable liners.  You’ll still want to air out this pool, but you’ll rest a little easier knowing that the plastic is more eco-friendly and non-toxic than other options.  Buy an extra liner for use when you do a test run.  And, when you’re done, you can store it carefully for your next homebirth or sell/give it to someone else who can use it!  The plastic can be damaged by extreme heat or cold, so store at room temperature. 

After purchasing or renting your pool, you’ve got some more work to do.  You’ll want to test drive the pool.  This sounds silly until you realize how many things can go wrong!  You need a tarp to place underneath to protect your floors and discourage slipping.  Next, you’ll need a pump for inflating the pool.  Depending on your pump, it can take 30 minutes+ to inflate.  If it takes long, consider keeping your pool inflated those last 2 weeks to cut down your setup time. 

To fill your pool, you’ll need an aquarium hose or RV hose that runs to your sink.  The shorter the hose the better, so as to keep that water warm.  Add to that an adapter so that your hose can be fitted to a sink in your house.  No, you don’t want to use a garden hose instead.  There are hygenic problems with that approach!  When you fill the pool, you’ll ideally use cold water for the first bit and then go to hot.  This is so that the plastic is not damaged by exposure to scalding hot water.  Lastly, you’ll need a method for emptying and deflating the pool.  The bucket approach works, but will take a looooong time.  With a newborn at hand, this is not a good time for tedious tasks. 

So many steps!  That’s why you need to do a trail run.  The trial will give you confidence that your pool is airtight and watertight, plus it’ll ensure that you have all the right parts on hand for the big day.  Be sure to time how long setup takes, so you know during labor what to expect.  You can shop for all the various waterbirth supplies to inflate/deflate and fill/empty your birth pool at Your Waterbirth.

Enjoy your birth!

 

Why & How to Find a Midwife or Doula July 21, 2009

Filed under: Pregnancy — Rachel @ 2:17 pm
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When you’re pregnant (if not before) you’ve got to investigate all of your options.  Is your OB-GYN making you feel comfortable and capable?  Finding time to answer all of your questions?  Helping you prepare emotionally and intellectually for childbirth?  If you’re not happy with your current caregiver, it’s not too late to make big changes (provided you’re not already 36 weeks!). 

A midwife’s model of care is totally different than an OB-GYN.  While an OB is trained to be well-versed in medical ways to address problems during childbirth, a midwife is trained to appreciate the process of childbirth as a natural, powerful and sacred event.  And, she brings natural tools for addressing problems and pain of which an OB is often completely unaware.  An OB views birth as something to be controlled or “made-safe”.  A midwife views birth as something to gently assist (both physically and emotionally)  and respect – it’s already safe in most cases. 

Of course, these are just generalizations – there are many exceptions to the rule.  The first midwife I interviewed was discouraging and controlling!  But, the other two I hired were wise, respectful and reassuring.  I encourage you to consider the care of a midwife and/or that of a doula, who can make a tremendous difference in how you’ll feel about your birth experience.  Each birth is a unique, miraculous experience that only occurs once.  It’s yours to be enjoyed – yes, really!

Here are some great links for beginning your search:

http://www.midwife.org/
http://cfmidwifery.org/index.aspx
http://www.dona.org/mothers/index.php

 

Enter to Win a Hot Mama BornFit Ensemble! July 6, 2009

Filed under: Giveaways,Pregnancy — Rachel @ 2:51 pm
Tags: ,

Everyone knows a pregnant woman should stay active… but what do you wear to cover your bump while running, biking, or playing volleyball?  There’s no reason why your pregnancy should consign you to second-rate clothing that leaves you sweaty and uncomfortable.  BornFit is a new activewear line designed by two active mamas who grew up among the stunning Rocky Mountains of Colorado.  Here are some words at the heart of their vision:

“We believe that all of us are BornFit. The beauty of being “Fit” is that it comes in all different sizes, shapes, interests and even passions. It’s that feeling inside your heart…that vibrancy for life – when you’re about to embark on a new adventure and it makes you feel alive, scared or even anxious.”

BornFit’s maternity clothing is designed in high-tech wicking fabrics with comfortable waistbands and plenty of stretch so they can be worn throughout pregnancy and well beyond baby ‘s arrival.  What’s more, the line features smart details like mesh panels to keep you cool, zipper pockets for your keys, and reflectors to keep you safe on the road.  It’s been a hit with moms in our store, and we know you’ll love it too!  Ready to get moving?  Enter below!

Enter to win!  One lucky reader will win the Hot Mama BornFit Ensemble: the best-selling Challenger Shorts and a Lindsey Tee in your choice of color.  Enter now through July 31st by adding your comment to this blog post.  In your comment share how you stay active during your pregnancy or where you would love to sport your BornFit clothes.  We’ll choose one random winner! 

Shipping included.  Winner will be notified by email, at which point a shipping address and preferred sizes/color will be requested.

EXTRA ENTRIES!

You can do any of these things for an extra entry. Make sure to leave a separate comment on this blog post for EACH thing you do.

1- For TWO extra entries, blog about this giveaway and link it back to my blog. 

2- Follow me (euphoriatweets) on twitter AND tweet about this giveaway. Please leave me the link in your comment to your tweet. Just following me does not count-you MUST tweet about this giveaway. You can copy and paste: Win a Hot Mama BornFit Ensemble for pregnancy @Euphoria for the Green Mama http://tinyurl.com/m4zoyp