Abby Block, CD(DONA), CBC

Doula & Breastfeeding Support ~ Serving Brooklyn & NYC

nyc pregnancy

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.

A cervix in labor

Abby BlockComment

What does it look like? Check out this handy guide to understanding how your cervix will change in the late third trimester and in labor. Maybe you followed your pregnancy by reading about your baby's size being compared to fruit... and now you get to read about your cervix in relation to fruit :)

NYC's Newest Birthing Center at LOMA

Abby BlockComment

Finally, earlier this year, New York City unveiled a new in-hospital birthing center. Until recently, our only in-hospital birthing center was the Birthing Center at Mt. Sinai West (formerly known as St. Luke's Roosevelt). As of this winter, women have another in-hospital birthing center option: The Birthing Center at New York Presbyterian/ Lower Manhattan Hospital. I had the pleasure of attending a birth there as a doula just a few weeks ago, and the facilities are beautiful! (Not to mention the birth, too, of course!!)

Hopefully this trend will continue in NYC. There are so many women looking for low intervention birth settings, with the option to labor in a tub amongst other great options available in the birthing center. NYC residents also have the option to give birth at the Brooklyn Birthing Center, an out-of-hospital freestanding birthing center, and New York City's only independent birthing center.

Read more about the opening of Lower Manhattan's Birthing Center here.

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Postpartum & Breastfeeding Nutrition For the New Mother

Abby BlockComment

Postpartum nutrition! Many women aren't aware that for breastfeeding a newborn (or older baby), that often women need to eat more than they did when when they were pregnant! Of course, quality is important as well, as it's not just about getting enough calories.  The amount a breastfeeding mother should eat also depends on level of exercise, overall caloric needs, and other variables, or course. The best rule of thumb is to eat to your hunger, being mindful of making healthy choices whenever possible. Through recent research, we know that a mother's varied diet will encourage her child to enjoy a wide palette of flavors - all the more encouraging to eat well while breastfeeding! Check out the links below for more info on postpartum eating and nourishing the new mother:

Recovery From Childbirth: Postpartum Foods

Do Breastfeeding Mothers Need Extra Food or Fluids?

Nourishing the New Mom

Maternal Nutrition During Breastfeeding

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

Tongue Tie and the Newborn Baby

Abby BlockComment

Since I have been training to become a Certified Breastfeeding Counselor, I've been thinking about and learning a great deal about breastfeeding - more than I had ever imagined. Something that comes up quire frequently with many new mothers is the challenge of breastfeeding. At a certain point, once you begin to hear of so many stories of difficulty breastfeeding, and depending on how much detail you hear in these stories - you may start to hear of tongue ties, lip ties, and the procedures done in attempt to remedy these situations. Why, if breastfeeding is supposed to be so natural and necessary for the survival of our species, are so many humans struggling with it? There are MANU reasons. One of the many possible reasons might be folic acid vs. folate. Read on in this article to learn more...

Tongue Tie and Breastfeeding, By Dr. Wilson

Breastfeeding & What to Eat

Abby BlockComment

Spice it up!! I don't think these findings are at all surprising, in fact they seem pretty intuitive. But why not have a little research on it?! It's just one more reason to breastfeed.

Here's an excerpt from the article from the NYT, which you can read in full here:

"The variety of flavors that you eat during pregnancy go into your blood and then into the amniotic fluid, which the baby is constantly drinking, in utero, and the flavors that you eat while nursing cross from the blood vessels that supply the mammary glands into the breast milk. So instead of restricting the maternal diet, there’s now good evidence that by eating a wide variety of healthy and tasty foods during these periods, we are actually doing our babies a major favor.

“Breast-fed babies are generally easier to feed later because they’ve had this kind of variety experience of different flavors from their very first stages of life, whereas a formula-fed baby has a uniform experience,” said Lucy Cooke, a psychologist specializing in children’s nutrition, who is a senior research associate at University College London. “The absolute key thing is repeated exposure to a variety of different flavors as soon as you can possibly manage; that is a great thing for food acceptance.” "

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!!
 

US C-Sections Rate: Too High

Abby BlockComment

If you've been or are pregnant in NYC,  probably one of the first things you did was to figure out who your doctor would be and where you would give birth. You may have spent hours googling something like "NYC OB low cesarean rate," or "NYC hospital low c-section rate." And you may or may not have found the answers you were looking for. Consumer Reports just released an article reviewing the current state of cesarean births and rates by hospitals around the country. Many of the hospitals in NYC that my clients have given birth in do not release their statistics. Considering that your biggest Cesarean risk might be the hospital that you give birth in, withholding c-section rates by hospital (and even by practice or doctor) just doesn't seem ethical.

You can read the full article here: http://www.consumerreports.org/doctors-hospitals/your-biggest-c-section-risk-may-be-your-hospital/

Seeding the Microbiome

Abby BlockComment

This is a relatively new phenomena that has come up in the birth world as more and more research on the significance of gut health and our microbiomes has emerged. In birth, this applies in particular to a vaginal vs. Cesarean birth. During a vaginal birth, the baby is colonized, or "seeded" with bacteria from the mother's vagina, which leads to long term health benefits; in a Cesarean birth, the baby does not have the same bacterial colonization opportunity. It is because of this that some women are looking to simulate this process at the time of a Cesarean.

We are just now beginning to understand that many modern day health conditions, such as colon cancer, Autism, and mental health (just to name a few) are likely affected by the balance, or lack of balance, in good and bad bacteria in our bodies. Think of the recent surge in the understanding and promotion of probiotics, our understanding of antibiotics, and the fermented food movement. 

The recent documentary "Microbirth" focuses on bacterial health in birth, as well as some recent articles below. You can also check them out to understand how some women are choosing to take vaginal seeding into their own hands in the event of a Cesarean.

https://www.scienceandsensibility.org/p/bl/et/blogid=2&blogaid=825

http://www.positivebirthmovement.org/pbm-blog/category/gauze-seeding

http://www.mostlymicrobes.com/vaginal-seeding/

 

Essential Oils in Pregnancy, Birth, and for Your Baby

Abby BlockComment

I recently attended a workshop on Essential Oils in Pregnancy and Birth. Big inhale, exhale... there are some great scents that can be used for a variety of ailments, concerns, and comforts. Some are quite powerful! So, what's the right way to use them? Read on for some more info.

https://www.youngliving.com/blog/pregnancy-and-essential-oils-a-guest-post-by-dr-lindsey-elmore/

 

http://doterrablog.com/ask-dr-hill-pregnancy-doses-and-zendocrine-supplements/

 

http://www.theessentialmidwife.com/

 

The Truth About Your Due Date

Abby BlockComment

Get some perspectives on your due date, or "EDD" (estimated due date), as well like to call it. Read what a midwife, a doula, an OB, a labor nurse, an acupuncturist, and a pediatrician have to say about. it And in case you didn't know already, only about 5% of women give birth on their due date. The rest of us tend to naturally go somewhere from week 37 (full term) to week 42. There are exceptions to this, of course - as always, with birth. My best advice on the "due date" situation is to consider it your due month, and when people ask you when you are due, you give them the month, not the date :)

Read the article on due dates from Well Rounded NY here.

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.

 

The Big Baby Card

Abby BlockComment

Below is an excerpt from When A Big Baby Isn't So Big

"The new study, called Listening to Mothers III, was based on Childbirth Connection’s nationally representative survey of some 1,960 new mothers. It found that four out of five of the mothers who were warned they might have large babies gave birth to infants who were not large, and weighed less than 8 pounds 13 ounces.

Yet these mothers were almost twice as likely to have medical interventions such as having doctors medically induce their labor or attempting to self-induce labor, presumably out of concern the baby would continue growing otherwise. They were also nearly twice as likely as other mothers to have a planned cesarean, though the increase fell just short of being statistically meaningful."