Tzipp-ity-dou-la

Hospital vs. Homebirth–Which is Safer? July 26, 2012

Filed under: Uncategorized — Tzippitydoula @ 11:38 am

When a Routine Epidural Turns Deadly

I have so many thoughts on this article that I’m dying to write a “reply” article. If only I can find the time…

This is such a scary thing to think about–and it DOES happen. More often than I think most people realize. (Just ask my dad who contracted TWO infections whilst in the hospital last year for an in patient surgery! Something that a year later is still affecting him.

So, hospitals are not nearly as “safe” as we often think them to be. That said, does telling one of the most shocking stories about hospitals really help to better prove the safety of home birth? Does telling a horror story about homebirth better promote the safety hospital births?

Me thinks not. Because the truth is, people need to be making these individual decisions for themselves, and THAT is what birth professionals should be promoting. Making educated decisions is the safest route to a healthy, happy birth for you and your baby. Birth comes with a long list of blessings and a long list of possible risks anyway you cut it. “Natural” doesn’t necessarily mean “safe” anymore than “hospital” means “pain-free”. And it makes me sad often the those key words are confused as being synonymous with each other.

I cannot recommend anything better than to do not only the research for yourself, but also to consider your individual needs regarding birth before coming to a decision. Where to birth your baby is the first important decision you make for you baby! It deserves a lot of thought and care.

If you need help deciding on these matters, don’t hesitate to call or email a doula near you–that is exactly what we are here for! In fact, talk with a few so you can get the benefit of several combined years of experience and education on your side. It’s never too late nor too early to start planning for your optimal birth experience.

 

Popular Childbirth Procedures, scrutinized. May 20, 2012

Filed under: Uncategorized — Tzippitydoula @ 7:37 pm

I had a chance to read a fantastic article today, “Top Ten Pregnancy Procedures to Reject“. It was a rather long, and extensive article to say the least–but it left me both nodding and wanting a little more clarity. I thought I would share a few of my own ideas here as well.

Although some women turn to home births as an alternative, our experts say that isn’t a good idea in this situation. “The risk of uterine rupture is low,” Main says, “but if it happens, it can be catastrophic.”

I’m not entirely sure who the “experts” they reference are, but I did feel this to be a slightly misleading and incomplete statement as there are actually MANY factors in deciding which is the right care provider for a VBAC. Examples of such factors would be–but are not limited too–the length of time between last cesarean and the following pregnancy, how many cesareans you have had,  and if you’ve ever had a successful VBAC before.

… if you had a C-section, find out whether your obstetrician and hospital are willing to try a VBAC. Let them know that you understand that you your baby will be monitored continuously during labor, and ask what the hospital would do if an emergency C-section became necessary

I would instead recommend not just finding out *if* your hospital is willing to try a VBAC, but to go out a find a hospital and care provider which best align to your birthing goals. Much as it would be silly for someone to expect to buy a mini van from a coupe dealer, it is not wise to expect a hospital with a high cesarean rate and low VBAC rate to assist you in your VBAC. Being a responsible parent starts with finding the best care provider for your particular situation.

Late preterm babies “may look like full term babies,” she says, “but they are different in important ways.

I don’t think any parent would feel that the risk of your baby ending up in NICU because of no better reason than impatience for labour to start is worth the risk of early induction. I would also think the parents of NICU babies would appreciate their own sick or premature children being given the best treatment they can–and that’s simply not possible when the nurses are bogged down with babies that would otherwise have had no problems. Common sense is that NOBODY *wants* their baby in NICU just avoid another week or two of pregnancy discomforts. Let’s leave the NICU for the babies who truly need it.

It turns out that carrying an infant to term has health benefits for both moms and babies. Research shows that babies born at 39 weeks or later have lower rates of breathing problems and are less likely to need neonatal intensive care. Full-term babies may also be less likely to be affected by cerebral palsy or jaundice, have fewer feeding problems, and have a higher rate of survival in their first year. Some research even suggests that full-term infants benefit from cognitive and learning advantages that continue through adolescence.

Perhaps because late preterm infants have more problems, mothers are more likely to suffer from postpartum depression. In addition, the procedures required to intentionally deliver a baby early—either an induced labor or a C-section—also carry a higher risk of complications than a full-term vaginal delivery. ‘There is just much more chance of things going wrong if you interrupt the normal course of pregnancy,’ Spong says.

What amuses me about these types of things is that it always seems to come back to nature. Do we really need scientific studies to tell us that we should allow our babies to grow inside of us as long as they need to? A few days or a week in the womb might not seem like a lot to us here on the outside, but it can be to a newborn. Likewise, with all of the changes a women goes through right before labour, it truly is no wonder that such matters as risk of post partum hemorrhage increase when a mother is forcefully induced into labour before her body begins the process on it’s own. I truly disheartens me by how little is explained to new parents by hospital staff regarding the decisions to induce early. It is simply not a decision to make lightly and with out thoroughly planning for possible undesirable outcomes.

Unless there is a specific condition your provider is tracking, you don’t need an ultrasound after 24 weeks. Although some practitioners use ultrasounds after this point to estimate fetal size or due date, it’s not a good idea because the margin of error increases significantly as the pregnancy progresses. And the procedure doesn’t provide any additional information leading to better outcomes for either mother or baby, according to a 2009 review of eight trials involving 27,024 women. In fact, the practice was linked to a slightly higher C-section rate.”

This one actually disturbs me a lot and I’m glad it was brought up. In my experience as a doula I can’t tell you how often a client has been induced because of an ultrasound saying the baby was “too big”. In my personal experience, I have yet to see one of these clients have a baby bigger than 8 lbs. I have, unfortunately, seen babies pulled from the womb far too early and suffer from the common side effects–difficulty with breath, latching and bonding. The danger to moms, of course, is also in that these inductions often sadly end in non-emergency related surgical births which comes with their own set of risks. Sadly, despite this 2009 review, this seems to be happening more and more in hospital managed births.

“Continuous monitoring, during which you’re hooked up to monitor to record your baby’s heartbeat throughout labor, restricts your movement and increases the chance of a cesarean and delivery with forceps.”

There is a very interesting fact that many childbirthing women don’t knows– electronic fetal monitoring was never meant to be standard practice for healthy births, but it was created to help prevent cases of CP (Cerebral Palsy–thought to stem from lack of adequate oxygen at birth). It was later not only proven to be unsuccessful in preventing CP, but then adopted to help avoid lawsuits in the event of an undesirable outcome once medical providers realized that the tape reading–no matter how accurate a picture if gave of what was going on inside the uterus–was the best evidence that could be used to prevent legal problems on their end.*

Not only has EFM evolved into “normal hospital procedure”, it has actually decreased the level of one-on-one care to nurses. As it would seem, since nurses can track your fetal heartbeat from the main station, there is less need to come and speak with patients directly. The results of this aren’t just less medical attention for the baby, but also less emotional attention for the mom. Often moms start to feel more like a number than a patient, and nurses lose valuable experience in basic childbirthing techniques for pain management, speeding lulling labours along, and last but not least–bedside manner. Even considering the amount of losses the EMF may have prevented, it’s hard not to wonder just how many complications it is responsible for causing.

In other words, despite the common misunderstanding that EFM (electronic fetal monitoring) is primarily for the benefit of the mother and baby, it is firstly there for the obstetrician. Giving mothers this clearer understand should help make decisions about fetal monitoring a little easier. Unless in the case of a real need for continuous monitoring, one can always request intermittent monitoring by their obstetrician. Most baby-friendly hospitals are willing to work with moms to find a compromise that makes both patient and hospital feel comfortable.

Doctors sometimes rupture the amniotic membranes or “break the waters,” supposedly to strengthen contractions and shorten labor. But the practice doesn’t have that affect and may increase the risk of C-sections, according to a 2009 review of 15 trials involving 5,583 women. In addition, artificially rupturing amniotic membranes can cause rare but serious complications, including problems with the umbilical cord or the baby’s heart rate.

In truth, AROM (artificial rupture of membranes) often *does* help strengthen contractions which *can* shorten labours… but it also comes with many possible risks. Though it sounds “natural” to break someone’s waters, it is actually an intervention in the labouring process. It is important to make sure you are aware of the possible risks before deciding this is the right step for you.

“Get labor support. Women who receive continuous support are in labor for shorter periods and are less likely to need intervention. The most effective support comes from someone who is not a member of the hospital staff and is not in your social network—a doula, or trained birth assistant, for example—according to a systematic review of 21 studies involving more than 15,000 women in a range of circumstances and settings. Ask your provider for a referral, and see if your insurance company will cover doula care.”

Of course I agree wholeheartedly with this! Though I would say, not everyone needs nor wants a professional doula. Birthing support can come in a variety of forms and needn’t be limited to one person. Some prefer a whole support team, whilst others prefer the privacy and meditative feel of only having one or two trusted people help them through their births.  Birthing support teams can be built from a combination of trust friends, family members, spouses, doulas, midwives and nurses. Deciding what type of birth you would like to have should come first, followed by finding the right place for your birth, and next in line is to find the complimentary team to assist you in your goals. Once all of these are in order you can begin to hash out the details to help you attain the healthiest and safest birth for you and your little one.

 

*http://www.gehealthcare.com/usen/education/clinical_best_practices/docs/Reprint_Intrapartum_Fetal_Monitoring_David%20MillerMD_Contemporary_OBGYN.pdf

 

The line between doula and activist. March 9, 2012

Filed under: Uncategorized — Tzippitydoula @ 4:10 pm

As a doula, I find that clients often seek an answer to difficult decisions they must make by asking what I would do if I were them. Though it is very tempting to take that chance to give my personal preferences, it rarely helps to empower the couple and even worse–can undermine their self-confidence as parents.

It is important to never abuse the authority a doula has with her clients, by forcing our own preferences on to our clients, no matter how deeply we feel about them. Instead is it best to help them find out what it is THEY really want to do. Some ways of accomplishing this are by helping them access their own intuition and feelings. As it is not at all unusual for a client to feel like they are not “knowledgeable” or “educated” enough to be allowed to have an opinion on a medical matter, it is important for doulas (and other health care providers) to help them find the information they do need to make important decisions. It doesn’t take a medical degree to make one worthy of asking important questions and being a part of their own health care decisions. It just takes some education, research and learning which questions to ask.

When trying to find out how a client is truly feeling avoid asking questions that instigate predicable answers such as, “what are you thinking about?”, which usually met with a “nothing”. Instead, trying re-phrasing words in a way that give the parent(s) permission to access their own feelings, such as, “so tell me what’s going your through your mind right now.” This is a great way to get the ball rolling and help them figure out what they want, and even to help them formulate what questions they should be asking their health care providers. What a client needs most from a doula during the difficult times is to know that you believe in them and their ability to work through their problems or trials successfully. And also, sometimes a warm hug or a back rub when necessary.

It’s important as a health care professional to always keep a firm distinction between what YOU want to do for your clients, and what they actually need from you. Though we should always be highly educated in the physical and biological aspect of birth, the most important thing to we bring to the table is our ability to show mom (and even dad) how to trust their own instincts as parents.

And always remember that there IS a proper place to showcase your opinions and beliefs; become an activist on your own time or support others who are! The world needs movers and shakers! They are the ones who pave way so that future moms and dads will be allowed the right to be a part of their own medical decisions.

 

That was so last night. December 14, 2011

Filed under: Uncategorized — Tzippitydoula @ 2:17 pm

So did anyone happen to hear the news that Matisyahu shaved his beard!?!

(That was a joke.)

 

names December 6, 2011

Filed under: Uncategorized — Tzippitydoula @ 1:41 pm

My regular Starbucks is now asking your name so they can call you when the order is ready:

–What is your name?
//Tzipporah
–Deborah?
//No, Tzipporah
–Deborah?
//No, Tzipporah
–Teeborah
//Tzziiipppooorrraaahh
–oh, okay, Zivorah?
//yeah let’s just go with that one

They never did call me, but when I went up there I read on the side of my cup “Qoborah

It’s just a recipe for disaster with how many ethnic and religious groups live in this area.

Last month I got a letter addressed to “Mr. Tzipjiberick.” Awesomeness! They even messed up my gender on that one.

(I just realized that my first and last names combined have 17 letters. heh. Never noticed that.)

 

Awesome phone call with my mother November 21, 2011

Filed under: Uncategorized — Tzippitydoula @ 8:41 pm

Mom: Where are you?

Me: Going to the grocery store.

Mom: In this weather!? Be careful! You shouldn’t be driving when it’s raining. It’s dangerous!

Me: Well, where are you?

Mom: At the grocery store.

Me: Mom!!!!!

Mom: Well… I worry.

 

Conversation with the husband… November 7, 2011

Filed under: Uncategorized — Tzippitydoula @ 10:14 pm

…on the way home from DC after passing by a Taco Bell:

Shmuel: Apparently, Taco Bell now sells extra, extra-large chalupas.

Me: Huh. Wasn’t the large big enough?

I guess it just wasn’t.

Well what about the extra-large? Did that not work either?

I guess they were like “Look, this still just isn’t large enough.”

So the guy was like, “Yeah, Ya know what? Go get me a pizza crust and let’s fry that sucker up.”

(ok maybe that was funnier in the car.)

 

 
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