Abby Block, CD(DONA), CBC

Doula & Breastfeeding Support ~ Serving Brooklyn & NYC

birth tips

The Cesarean Rate Epidemic

Abby BlockComment

This article looks at the current rates, state, and climate of Cesarean Births in the U.S. It provides statistics and rates, reasons for Cesareans, as well as the associated risks. 

Cesarean delivery may be a safe alternative to vaginal delivery but its use in 1 of 3 women giving birth in the US seems to high.
— contemporaryobgyn.modernmedicine.com

An excerpt discussing the rising rates and unusual number of Cesarean rates below:

"One possible reason for the rise in the cesarean delivery rate may be that there has simply been a rise in the need for cesarean. The most common indication for a primary cesarean is cephalo-pelvic disproportion, or arrest of progress in labor. It is unlikely that maternal pelvis size has changed over the past 3 decades, but it is possible that birth weight has increased. In fact, evidence suggests that rates of macrosomia have increased over the past 2 decades.8 Other issues that contribute to increasing rates of cesarean delivery, possibly through the mechanism of birth weight, are maternal obesity and gestational weight gain.9,10 Without question, the proportion of obese women has increased over the past decade and higher weight classes are associated with even higher rates of cesarean.11,12 In addition, increased gestational weight gain has been associated with cesarean delivery and is commonly above standard guidelines.13

Another reason for increasing cesarean rates may be a rise in elective cesarean delivery, also known as cesarean delivery by maternal request (CDMR). Because there was no ICD-9 code for CDMR, it is unclear what proportion of cesareans are due to it. One recent study, however, estimated the proportion as high as 4% in the United States.14 Interestingly, CDMR is more common in other countries, such as Brazil, Taiwan, and Chile. A study in Chile comparing women receiving private care (cesarean rate >40%) to women receiving public care (cesarean rate <20%) found that 8% of those receiving private care and 11% of those receiving public care stated a preference for cesarean delivery, with the vast majority preferring to deliver vaginally.15 Thus, even in this setting, it is unclear that maternal preferences are driving the increase in cesarean delivery rate."

Full article can be read here: http://contemporaryobgyn.modernmedicine.com/contemporary-obgyn/news/cesarean-epidemic-are-we-too-quick-cut?cfcache=true

 

Why delay cord clamping?

Abby BlockComment

Science and Sensibility, the research blog from Lamaze, has an excellently evidence based article on the practice of delayed cord clamping. The article is structured by listing objections, which is a great way to go about learning the benefits, as well as to be prepared to answer to someone's concerns about this practice. Delayed cord clamping is becoming so much better understood and common place. Many Ob and midwife practices in Brooklyn and NYC do this as a matter of protocol. 

Read the full article here

 

 

VBACs are more likely successful if you call the midwife

Abby BlockComment

A new study shows that VBACs (Vaginal Birth After Cesarean) are more likely to be successful if a midwife provides the care instead of an obstetrician. 

You can read a portion of the abstract of the study here, and an excerpt is below:

Background

Research is yet to identify effective and safe interventions to increase the vaginal birth after cesarean (VBAC) rate. This research aimed to compare intended and actual VBAC rates before and after implementation of midwife-led antenatal care for women with one previous cesarean birth and no other risk factors in a large, tertiary maternity hospital in England.

 

Conclusions

Implementation of midwife-led antenatal care for women with one previous cesarean offers a safe and effective alternative to traditional obstetrician-led antenatal care, and is associated with increased rates of intended and actual VBAC.

What A Doula Does

Abby BlockComment

I adore this blog post written by my dear doula colleague, Yiska Obadia. You can read an excerpt below, and the full article here.

"Doulas are there to serve their clients. You want to birth naturally? I will support you. You want an epidural? I will support you. You want an epidural and to avoid a c-section? I will do my best to help you achieve that. Doulas serve our clients in helping them to achieve the birth THEY want as well as supporting them wholeheartedly with the birth they get."

A secret to a quick and easy childbirth?

Abby BlockComment

There is certainly not one quick and easy solution that's going to work for everyone. I also don't even believe that this is THE way to go, but I have seen scenarios in which women do completely ignore the fact that hey are in labor, whether intentionally or not, and give birth quite smoothly and swiftly. But this is not to discount the women who need to focus and actively think in one way or another. There is no one right way to birth. But I think this article raises some interesting points worth thinking about.

Read the article here:

http://www.dailymail.co.uk/health/article-3147111/The-secret-quick-painless-childbirth-Just-don-t-think-ban-partner-room-leading-doctor-claims.html

http://www.dailymail.co.uk/health/article-3147111/The-secret-quick-painless-childbirth-Just-don-t-think-ban-partner-room-leading-doctor-claims.html

New Evidence: Give Women More Time in Labor.

Abby BlockComment

This one is so simple, so straight forward. Give women a bit more time to labor and we can reduce the cesarean rate. This is of course assuming that everything points to the mother and the baby being in good health. As long as everyone is doing find, and the mother is game, let's create the space and be encouraging and supporting to women who want to labor just a bit longer and potentially avoid a c-section. This recent study showed that giving mothers just one more hour of time can cut the Cesarean rate in half. That's big. Here's the article you can read to learn more:

http://www.huffingtonpost.com/entry/new-evidence-that-we-just-need-to-give-women-more-time-to-labor_us_56ec4f66e4b084c672203418

Flipping A Breech Baby

Abby BlockComment

It happens! Babies are breeched and babies flip to the head down position. Occasionally they stay in the breech position. Ideally, baby flips! If your baby is in the breech position and you need to get them to flip, these are my recommended resources:

Spinning Babies: Breech Babies - very informational and detailed - recommend reading it all the way through

Prenatal Chiropractic Visits - ask me for a recommendation, based on where you are

Acupuncture - ask me for a recommendation, based on where you are

Good luck!!
 

How to Avoid an Episiotomy in Birth

Abby BlockComment

I have not yet met a woman who does not want to avoid an episiotomy in birth!! Read on below to get some tips on how to avoid this unwanted procedure, published by Choices in Childbirth.

ASK THE MIDWIFE: HOW CAN I AVOID AN EPISIOTOMY DURING BIRTH?
FEBRUARY 16, 2016

ChildbirthMidwiferyNutritionPregnancySexuality

“How can I avoid an episiotomy during birth?”

Today an episiotomy is no longer a routine procedure – thank goodness – but is performed for cause. Some reasons include a tight perineum which prevents the baby’s head from distending the perineum, prior scarring of the perineum, female circumcision, and/or the baby’s heart beat is low and delivery needs to be expedited. We can decrease the problems with the perineum but not some of the other causes.

The other question is how to prevent natural tears of the vagina and the perineum. It is important for women to know that there is a group of muscles in the vagina that support the vagina, bladder and rectum. These muscles need to be strengthened and toned prenatally to increase their elasticity to allow for relaxation of the vagina and perineum during birth. These same muscles need continued exercise for the remainder of our lives. Thank Dr. Kegel for giving us the Kegel exercise!!

Proper overall fitness is important so consider walking and squats for toning. Proper nutrition is also key. Make sure that you get adequate protein and other nutrients for your tissues to respond well to the stretching of birth.

Keeping the vagina healthy and reporting any signs of an infection to your provider promptly to maintain good vaginal tissue integrity is hugely important. Perineal massage is advocated by many to be helpful in preparing the vagina and the vaginal muscles for birth. This needs to be initiated at 34 weeks and done for approximately 5 minutes 3-4 times per week.

When it comes time to push, your position is important, as is the use of warm compresses on the perineum. The lateral position or squatting for birth is protective of the perineum.

Finally, a slow, controlled delivery of your baby’s head will definitely help to decrease tears. This is difficult when you have a very strong urge to push. I recommend practicing techniques learned in childbirth classes such as focused relaxation.

 

Susan Papera, CNM,MSN received her undergraduate degree from Cornell University and her Master’s degree and Midwifery from Columbia University. She joined the staff at NYC Health + Hospitals/North Central Bronx as a staff midwife shortly after the Obstetrical services were open in 1978 and she has been helping to care for the women and families in the Norwood section of the Bronx ever since. Presently, she is Director of Midwifery Services. Working with such a richly diverse group of women is extremely rewarding and also an on going learning process as she says. Ms Papera is particularly proud of the fact that she is an NCB “Grandmother”- babies she has helped into the world are returning and she has had the privilege of helping their babies into the world.

Midwife Thinking: Birth From the Baby's Perspective

Abby BlockComment

Such a fascinating article! Excerpt below, and definitely head over here to read the article from Midwife Thinking in its entirety, as well as watch the videos.

Here are the bullet points from the article on treating a newborn with respect:

"A humane approach to welcoming a baby to the world

Whilst in some cases it is not possible, I believe that we should aim for all babies to have the opportunity to:

  • Make their own way through their mother’s body and into the world (ie. no unnecessary pulling).
  • For their first touch to be from the hands of a person who loves them (mother, father, family member, friend).
  • To be held immediately by their mother skin-to-skin.
  • To be sustained by their placenta until the placenta stops functioning (ie. leaving the cord intact).
  • To be left in peace to find their mother’s nipple and latch on.
  • To be treated gently and with dignity and respect during any ‘checks’ that their mother chooses to have done."

Spinning Babies!

Abby BlockComment

Ever since I became a doula, I've been fascinated with the concept of fetal positioning. With my background in dance and yoga, and my interest in alignment, optimal fetal positioning is right up my alley when it comes to birth! A baby that is positioned well can make for a smoother birth. How does a baby get positioned well? Some of it relates to the mother's physical structure, and some of it is related to lifestyle. The good news is that during pregnancy, there are daily and weekly exercises that women can practice to encourage balance. What if you are about to give birth and haven't practiced any of these exercises? You can rest assured that most babies do turn in labor, if they haven't rotated into the optimum position already. And some babies just make their entrance in whatever position they want to be in, regardless of how "optimal" it may be. 

Interested in learning more about Spinning Babies? This is something I cover with my clients during their prenatal sessions. In addition, you can also watch the parent class, available on DVD or as a download. Visit the site here to purchase: http://spinningbabies.com/shop/

 

 

New Birth Plan Template

Abby BlockComment

Many of my birth doula clients - whether they are planning a natural birth in a hospital or birthing center, or birth with medication, or a home birth - want to create a birth plan. One hospital in NYC (NYU) provides a fairly succinct birth plan template, which is great, however I don't know many other hospitals that do provide a template. You can find some templates online, some simple and some that are pages and pages long (which I don't recommend). The image above is of a new one that I came across and thought I'd share - link below. Enjoy!

https://thebestseasonofmylife.wordpress.com/2015/08/20/a-downloadable-visual-birth-plan/

 

Placenta: Essential Resuscitation Equipment

Abby BlockComment

When people hear "placenta" these days, they may tend towards thinking about placenta encapsulation. What about the placenta's role and potential as the baby is born? This is fascinating article on the placenta, delayed cord clamping, and newborn resuscitation. It's a little bit birth-nerdy, but if you are interested in cord clamping and your newborn's transition to breathing on her/his own, please have a read!

Read the full article here from Midwife Thinking.

 

The Forgotten Art of Untucking The Tail

Abby BlockComment

Very interesting as it relates to birthing a human...

“Modern birthing science has placed a large burden on secreted hormones (like relaxin) to prepare the body for needed mobility.” Katy Bowman says. Yes, hormonal relaxin is useful in letting the body open up for the birth, but it’s not enough, unless we have strong muscles that can fully contract, but also fully release. But then, strong isolated muscles are not enough either. In order to have smooth births we need to have a whole-body endurance. A great way to develop endurance is to walk as much as you can. “The woman who wants to go about a birthing process naturally can follow the lead other “natural” processes women have been doing for millennia — walking 5–6 total miles per day, and squatting to bathroom multiple times daily” — she adds.

Read the full article here.